Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This study was performed to assess the relationship between the level and extent of prostatic capsular invasion (PCI) by cancer and the clinical and pathological features and prognosis of early-stage prostate cancer. We conducted a retrospective analysis of the clinical (age, stage, grade, prostate specific antigen [PSA] level) and pathological (tumor volume, stage, grade, surgical margins) features of 688 patients treated with radical prostatectomy to determine the pathological features and probability of recurrence associated with various levels of PCI. Radical prostatectomy specimens were serially sectioned and examined by whole-mount technique. Progression-free probabilities (PFP) after radical prostatectomy were determined by Kaplan-Meier and Cox proportional hazards regression analysis. Progression was defined as a rising serum PSA < or = 0.4 ng/mL or clinical evidence of recurrent cancer. Increasing clinical stage, Gleason grade in the biopsy specimen, and pretreatment serum PSA levels were each associated with increasing levels of PCI (P < .001). In the radical prostatectomy specimen, increasing levels of PCI were significantly associated with increasing tumor volume (P < .001), Gleason grade (P < .0001), seminal vesicle involvement (SVI, P < .001) and lymph node metastases (+LN, P < .001). None of 138 patients without capsular invasion had SVI or lymph node metastases (+LN), and all remained free of progression, even though some had large volume (up to 6.26 cm3) or poorly differentiated (Gleason sum up to 8) cancers. Invasion into the capsule (n = 271) was occasionally associated with SVI (6%) or +LN (3%) and a significantly (log-rank test) lower PFP of 87% at 5 years. Focal and extensive extraprostatic extension (EPE) were associated with progressively increased risk of SVI and +LN and lower PFP (73% and 42%, respectively). In a multivariate analysis, the level of PCI was an independent prognostic factor (P < .001). There is a strong association between the level of invasion of cancer into or through the prostatic capsule and the volume, grade, pathological stage, and rate of recurrence after radical prostatectomy. Prostate cancer does not appear to metastasize in the absence of invasion into the capsule regardless of the volume or grade of the intracapsular tumor. Subclassification of patients according to the levels of PCI provides valuable prognostic information.
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PMID:Clinical and pathological significance of the level and extent of capsular invasion in clinical stage T1-2 prostate cancer. 971 29

Analysis of the results of treatment of localised prostate cancer with radiation and surgery has identified patients who are at high risk of developing metastatic dissemination. High histologic grade, serum prostate specific antigen above 20 ng/ml, extension beyond the capsule of the prostate, and involvement of lymph nodes are highly predictive of metastatic risk. Antiandrogen therapy has high rates of activity in the treatment of overt metastatic disease prompting its assessment as an adjuvant treatment added to radiation therapy. There are now major prospective randomized trials which have been completed. The current evidence indicates that a large survival benefit ensues when antiandrogen therapy is added to radiation for appropriately selected patients. This adjuvant approach is likely to become the standard of care. Strategies for further enhancement of adjuvant therapy are discussed.
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PMID:The current status of adjuvant hormonal therapy combined with radiation therapy for localised prostate cancer. 978 May 60

A 57-year-old man was admitted with the chief complaint of macrohematuria. Digital rectal examination showed a slightly enlarged, irregular prostate with stony consistency. Serum levels of prostate specific antigen (PSA), neuron-specific enolase (NSE) and progastrin-releasing peptide (ProGRP) were elevated. Transurethral resection (TUR)-biopsy of the prostate revealed small cell carcinoma with poorly differentiated adenocarcinoma. Various radiological examinations revealed metastases to pelvic lymph nodes and liver. He was treated with chemoendocrine therapy consisting of cisplatin, etoposide, flutamide and luleinizing hormone-releasing hormone (LH-RH) agonist. The primary tumor and metastatic lesion decreased and serum PSA, NSE and ProGRP levels were decreased to normal ranges after 5 cycles of chemotherapy. After the 5-cycle chemotherapy, TUR-biopsy proved viable tumor cells. During the additional chemotherapy, tumor markers increased and 4 months later liver metastasis progressed. He died 13 months after diagnosis of small cell carcinoma of the prostate.
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PMID:[Small cell carcinoma of the prostate: a case report]. 978 1

Although prostatic carcinomas rarely present as intrathoracic metastases, they may occasionally exhibit clinical and radiographic findings suggestive of a primary pulmonary carcinoid, particularly when they have a cribriform pattern. This report describes three patients who presented with lung and mediastinal neoplasms initially diagnosed as primary carcinoid tumors. These tumors were later proven to be metastatic prostate carcinoma by the use of immunohistochemical studies, including stains for chromogranin, carcinoembryogenic antigen and prostate specific antigen. These findings emphasize the importance of considering metastatic prostate adenocarcinoma in the differential diagnosis of carcinoid or neuroendocrine carcinoma with a cribriform pattern.
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PMID:Metastatic carcinoma of the prostate mimicking primary carcinoid tumor of the lung and mediastinum. 984 33

HIGH MORTALITY: Despite progress in early diagnosis, mainly due to prostate specific antigen (PSA) assay, metastasic cancer of the prostate remains an important health problem; more than 40,000 men died from prostate cancer in 1996 in the USA. More than 50 years after the hormone sensitivity of prostate cancer, antiandrogen therapy remains the cornerstone of treatment protocols. Although this is only a palliative therapy, it does delay disease progression for several years before the tumor inevitably escapes from hormone control. STAGE D1 DISEASE: In patients with microscopic nodal metastases (stage D1) it is classical to propose early or delayed hormone therapy which gives a 5-year survival rate in the 77-85% range. Certain teams also associate radical treatment (radical prostatectomy or pelvic prostate radiotherapy) with the hormone therapy, basically with the aim of better local control despite the lack of proven gain in survival rate. STAGE D2 DISEASE: Medical or surgical castration is the gold standard when the disease reaches stage D2. Specific treatments for urinary, neurological or bone complications may also be associated. Median survival is approximately 3 years. ASYMPTOMATIC PATIENTS: There remains a certain controversy about the best time to initiate treatment. Some advocate treatment immediately upon diagnosis while others propose delaying treatment until the onset of symptoms. There is a trend towards early treatment, but the beneficial effect in terms of survival and quality of life has not been proven. STAGE D3 DISEASE: When the tumor escapes hormone control (stage D3) mean survival is less than one year. Castration should be maintained and antiandrogens, which may have been given initially in combination with castration to achieve total androgen blockade, should be withdrawn (antiandrogen withdrawal syndrome) before assessing the need for second intention hormonal or other treatment. Such second intention regimens usually have a temporary and symptomatic effect. Their indication depends on side effects which may have a deleterious effect on quality of life. Symptomatic treatment plays a predominant role at this stage, combining analgesics, external or metabolic radiotherapy for bone pain, transurethral excision and/or urinary tract derivations for neurological or urological complications, and psychological care which requires the combined efforts of the radiotherapist, oncologist, urologist, and general practitioner.
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PMID:[Treatment of metastatic prostate cancer: certainty and doubts]. 987 24

Serum sialic acid (N-acetylneuraminic acid) was evaluated as a tumour marker for prostate cancer and compared with serum prostate specific antigen (PSA). The records of 35 patients suffering from prostate cancer (9 with bone metastases) were analysed and compared with those of 21 healthy individuals. Total serum sialic acid was significantly elevated among the cancer patients. Levels in patients with distant metastases were significantly higher than in those with locally restricted disease and normal individuals, whereas no such difference was seen between the latter 2 groups. A direct association between serum sialic acid and tumour T category and grade could not be established. The difference between the cancer and the control groups was reflected more significantly by PSA. As sialic acid lacks tumour specificity, it is not helpful in screening for prostate cancer, yet might contribute towards the early detection of tumour progression and metastases during both therapy and follow-up.
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PMID:Plasma sialic acid in patients with prostate cancer. 1007 49

Prostate cancer is the most common cancer amongst males in developed countries. Surgical removal of the prostate effectively cures the primary disease but the metastatic disease is refractory to most forms of chemotherapy. There is a clinical need to develop novel treatment strategies that exploit the mode of action of both conventional and alternative drugs/medicinal plants. We have been investigating the anti-proliferative and anti-tumor effects of an herbal preparation termed PC-SPES (patent pending, US serial number 08/697, 920) which is a refined powder of eight different medicinal plants. PC-SPES administered as a food supplement caused a dramatic decrease in prostate specific antigen levels in some prostate cancer patients with advanced disease. These preliminary clinical findings laid the foundation for a program to examine the in vitro and in vivo effects of PC-SPES, and identify the active component in this mixture so that a standardized treatment regimen can be formulated. In this communication, we report the anti-tumor effects of PC-SPES incorporated in the diet utilizing a well studied Dunning R3327 rat prostate cancer model. Dietary PC-SPES at levels of 0.05% and 0.025% did not exhibit any toxicity and no significant difference in food intake was noted at the end of six weeks. Dose dependent inhibitory effect of dietary PC-SPES was observed on both tumor incidence (P=0. 01) and rate of tumor growth when tumors were induced in syngeneic Copenhagen rats by intradermal injections of MAT-LyLu cells that are known to metastasize in the lung and lymph nodes. The number of pulmonary metastases in animals on PC-SPES that showed no primary tumor growth had no metastatic lesions in the lung, however, in animals that did not respond to PC-SPES, the number of pulmonary metastases was not significantly different from the non-treated controls. The significant anti-tumor effects of PC-SPES on MAT-LyLu induced tumorigenesis and metastasis in Copenhagen rats, in general refractory to most conventional therapy, suggests a therapeutic benefit of this herbal food supplement and may be a useful adjuvant to conventional therapeutic modalities.
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PMID:Anti-tumor effects of PC-SPES, an herbal formulation in prostate cancer. 1008 19

The purpose of this study was to determine the utility of prostate specific antigen (PSA) level and Gleason score in the prediction of disease stage in men with newly diagnosed prostate cancer. 102 consecutive men, newly diagnosed with prostate cancer and candidates for radical therapy, underwent contrast enhanced pelvic CT and skeletal scintigraphy. Staging examinations used the TNM classification and were reported prospectively with the radiologist blinded to the patient's Gleason score and level of PSA. Lymph node metastasis was confirmed by CT guided biopsy, lymphadenectomy or response to therapy in some cases of massive disease. There were significant differences between the mean PSA values of 18 men with and 84 men without skeletal metastases (p = 0.01) and between men with locally confined and non-confined disease (p = 0.02). There was no difference between PSA values of 13 men with and 89 men without lymph node metastasis (p = 0.9). Only one man with CT evidence of nodal metastasis (N + ve) had a PSA value below 20 ng ml-1. Two men with Gleason scores below 6 were N + ve and both had PSA values over 20 ng ml-1. One man with skeletal metastasis had a PSA value below 20 ng ml-1 but had bone pain. For this study group if only those men with PSA values over 20 ng ml-1 had been examined, sensitivity for lymphatic and skeletal metastasis would have been 92%. Using this threshold about one-third would have been spared imaging investigation. In conclusion, pelvic CT and skeletal scintigraphy are unlikely to show metastatic disease in a man newly diagnosed with prostate cancer who has no suggestive clinical features, a PSA level below 20 ng ml-1 and a Gleason score below 6.
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PMID:Prostate specific antigen level and Gleason score in predicting the stage of newly diagnosed prostate cancer. 1043 6

Four patients, men aged 81, 65, 69 and 52 years, presented with painless lymphomas, pain in the lower back and legs, venous thrombosis in an arm, and headache, vomiting and other neurological complaints, respectively. They were found to have carcinoma of the prostate with metastases. After antiandrogen therapy the symptoms resolved; 2 men died after 2 years and 2 are still alive, 2 and 5 years later. In men with unexplained complaints, it is advisable to perform a thorough physical examination, including digital rectal examination and a prostate specific antigen determination.
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PMID:[Uncommon initial symptoms of metastasized carcinoma of the prostate]. 1056 May 55

Prostate cancer survivors frequently seek natural remedies for elevated or rising PSA concentrations to forestall the necessity for more definitive modalities. PC-SPES is one of the most widely used of the complementary medicines. It consists of eight Chinese herbs, and although it contains no estrogen, it does exhibit some estrogenic effects. For this reason, UsToo was anxious to determine just how successful the product is and whether any side effects are present. A four-page survey form was designed and pretested on a dozen patients. After refinement, the form was sent to 200 PC-SPES users, mostly UsToo members, with anonymity assured. In only five cases did respondents not identify themselves. After 102 responses had been received, a compilation form was designed to simplify computer database entry of the survey results. This produced a spreadsheet of all 102 respondents' categorized answers. Final analysis followed, with emphasis on prostate specific antigen (PSA) concentrations before and after PC-SPES use, quality of life (QoL), side effects, dosage, and relation to concurrent treatment modalities. Graphs were then constructed on each respondent for study of slope data and PSA changes. Twenty respondents provided insufficient data for analysis; the remaining 82 surveys gave us a good picture of PC-SPES usage and results, as well as information on commingling of other modalities with PC-SPES. Beneficial effects were reported by 77% of the respondents, with 23% reporting more limited or marginal results. Side effects reported were breast tenderness and lowered libido, with three respondents also reporting leg edema. There were no reported cases of circulatory problems or thrombosis. Declines in PSA were reported of as much as 70 ng/mL that were sustained for as long as the respondents have been using PC-SPES, approaching 2 years in some cases. No clinically significant adverse effects were observed. For some men, PC-SPES provides an alternative to hormonal therapy; has a palliative effect when used by patients with advanced, metastatic disease; and overall has a reported 77% effectiveness, with 87% effectiveness when recommended dosages are adhered to.
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PMID:Survey of UsToo Members and Other Prostate Cancer Patients to Evaluate the Efficacy and Safety of PC-SPES. 1085 41


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