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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The aim of this study was to investigate the effect of goserelin-acetat (Zoladex) on testosterone suppression, to compare achieved suppression with clinical effects in patients with prostate cancer with bone metastases and consequent painful syndrome, to study the behavior of adiol during treatment and to assess life quality with emphases on the physical and psychological domain in relation to clinical and biological treatment effects. Fifteen patients were treated by Zoladex in one dose every 28 days, and followed-up for 12 months. All patients had several metastatic localizations in the bones, initial high prostate specific antigen (PSA), and high acid (AP) and alkaline phosphatase (ALP). PSA, testosterone, adiol (delta-5-androstenediol), luteinizing hormone (LH), foliculostimulating hormone (FSH), ALP and AP were also measured before every cycle. For evaluation of the life quality Rotterdam Symptom Checklist was used. Clinical progression was not registered during follow-up, with drop of PSA, ALP and AP. Testosterone and adiol displayed mainly inverse trends during treatment. The complete testosterone suppression was never achieved. It seems that Zoladex has quite different influence on LH and FSH, as levels of those hormones have shown opposite trend. Some of the observed hormonal effects could be attributed to stimulation of the monoamine system. Suppression of LH level provoked by administration of LHRH agonists increases level of dopamine in hypothalamus which inhibits releasing of its hormones. By inhibition of corticotropic releasing factor and ACTH, and by its influence on adrenal gland, we could explain drop of adiol levels in the first months of administration of LHRH agonists. Testosterone increase and adiol drop in the first months, and adiol increase following testosterone level drop in the fourth to eight month, may be explained by negative feed back mechanism between different androgens which could be stimulated or provoked by LHRH therapy. The question of effects which are results of LHRH agonists modulation of the monoamine system and consequent activation of other central mechanisms of hormonal regulation is still open. Patients' quality of life under therapy was improved for about 30% in psychological and functional domains. There were no significant changes on physical subscale, during treatment. It seems that the obtained positive psychological treatment effect is not only a consequence of pain decrease, but it could be the result of the change in the level of monoamines in CNS under Zoladex.
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PMID:Androgen level variations, clinical response to LHRH agonists and changes in the quality of life subscales in metastatic prostate cancer--speculations about possible role of the monoamine system. 947 91

It is well known that prostate cancer metastasizes bone with osteoblastic change and that osteolytic change is rare. We report a case of prostate cancer that had bone metastases which were all osteolytic. A 62-year-old man was referred to our department because of abnormal prostatic acid phosphatase and pain in his right upper arm. Digital examination revealed an enlarged and hard prostate. A computed tomographic scan revealed multiple osteolytic changes and a bone scintigraphy was positive at these sites. Histopathology of both prostate and humerus showed poorly differentiated adenocarcinoma. He received castration and antiandrogen as hormonal therapy, but the patient's prostate specific antigen did not normalize. Therefore this case was suspected to be hormone-refractory prostate cancer.
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PMID:[A case of prostate cancer associated with osteolytic bone metastases]. 1041 Mar 24

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

Current therapy for advanced prostate cancer is hampered by the propensity of the disease to progress from an androgen-dependent state to an androgen-independent state. Current treatment for advanced disease is palliative. Therefore, the therapeutic goal for prostate cancer treatment today is to arrest the disease at an early state when it is still localized to the gland. The standard treatment for clinically localized disease is radical prostatectomy or radiation therapy by way of external beam irradiation or local radioactive seed implants (brachytherapy). In advanced disease, the use of radiation therapy is limited to palliation of pain secondary to bone metastases and for spinal cord compression. Tracking residual disease and predicting outcome is limited to following the level of prostate specific antigen (PSA) production, evaluating for bone or solid organ metastasis, and analyzing their preoperative clinical stage, PSA and Gleason's score. Apoptosis as a molecular process of genetically regulated cell death has a critical endpoint that coincides with the goal of successful treatment of human malignancies. Since in cancer treatment the therapeutic goal is to trigger tumor-selective cell death, activation of the apoptotic pathway in prostatic tumor cells offers attractive and potentially effective therapeutic targets. As our understanding of the vital role of apoptosis in the development and growth of the prostate gland has expanded, numerous genes that encode apoptotic regulators have been identified that are severely impaired in prostate tumors. Human prostate cancer cells undergo apoptosis in response to androgen ablation, chemotherapeutic agents and ionizing irradiation. The expression of apoptotic modulators within individual prostate tumors appears to correlate with the cancer cell's sensitivity to traditional therapeutic modalities, including radiotherapy. No strict correlation between radiation-induced apoptosis and longevity of prostate cancer patients has emerged, possibly because the ability to achieve an initial remission alone does not adequately predict long-term outcome and patient survival. In this review we summarize the current understanding of the effects of radiation therapy on prostatic tumor cells within the context of the therapeutic significance of radiation-induced apoptosis in the effective elimination of androgen independent prostate cancer cells. As we enter a new millenium, identification of distinct molecular markers predictive of therapeutic response of prostatic tumors to radiation therapy may afford alternative prognostic indicators in optimizing our treatment protocols for advanced disease.
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PMID:Radiation-induced apoptosis: predictive and therapeutic significance in radiotherapy of prostate cancer (review). 1085 29

A clinical trial was conducted in a study group of 70 males diagnosed with symptomatic benign prostatic hypertrophy (BPH) (synonym of benign prostatic hyperplasia). They were administered Prostane, a herbal formulation, at a dose of two tablets a day for 1 year and monitored every 4 months during the study period. Analysis of the results showed an improvement in the symptom score of the American Urological Association symptom index rating. There was total relief in pain and haematuria in all the patients (100%); dribbling of urine decreased in 67%, dysuria in 50%, urgency in 60% and hesitancy in 40%. Blood urea levels were within the normal range in 70% of the patients and in the range 31-40 mg/dL in the remaining patients of the study group. Serum prostate specific antigen levels returned to normal in 56% of patients and were in the range 4.1-5.0 ng/mL in 25% of patients. There was a decrease in prostate specific antigen values which were >6 ng/mL in 9 patients at the commencement of the trial. Uroflowmetry studies showed that the peak flow increased from 12.6 to 30.7 s (p<0.001) and the void volume from 60.72 to 660 mL (p<0.001), the latent period reduced from 12.78 s to 2.61 s; the flow time from 57.01 s to 20.17 s and the residual volume from 620 mL to 20 mL (p<0.001). From these results, it is evident that Prostane was effective in alleviating symptoms, reducing prostate specific antigen values and normalizing uroflow dynamics in patients with benign prostatic hypertrophy.
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PMID:A study of prostane in the treatment of benign prostatic hyperplasia. 1150 33

Apart from digital rectal examination, the determination of prostate specific antigen is essential for the early detection of cancer of the prostate. The combination of these two examinations significantly improves screening efficacy. With the aid of a well-tested algorithm, the family doctor can establish the need for a urological investigation, and thus help to ensure early, curative treatment. Preventive measures can be rendered more effective by providing individual advice on such matters as lifestyle (risk factors, diet). It now appears that dietary measures are capable of slowing the increase in PSA following definitive treatment. Schematic disease-specific aftercare is usually the domain of the urologist. The general practitioner, however, is confronted by such problems as logistical considerations, documentation, palliative management (e.g. treatment of pain) and the problems associated with concomitant symptoms, the relevance of which needs to be assessed. Overall, however, the main concern of the general practitioner is with aspects of rehabilitation.
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PMID:[Early detection and follow-up of prostatic carcinoma. Responsibilities of the general practitioner]. 1184 79

Prostate cancer had a development predominantly at peripheral gland and stay for a long time asymptomatic without clinical symptoms. When the cancer is symptomatic, it is often translate an advanced stage. The symptoms of prostate cancer are not specifics: urinary troubles, compression of iliac vessels or bone metastases pain. The digital rectal examination highlight an induration nodule, irregular and painless. The probability to have a cancer increase with the rate of the prostate specific antigen (PSA). Some others situations can increase the rate of PSA: benign prostatic hyperplasia, prostatitis, bladder catheterisation, urinary retention, endoscopic examination. The ratio of free-PSA/total-PSA (fPSA/tPSA) permits a best discrimination between benign prostatic hyperplasia and prostate cancer The more fPSA/tPSA ratio is low, the more the risk of prostate cancer is high. Prostate cancer is suspected with the digital rectal examination and the rate of PSA but the diagnosis is made by histological examination (the tissue samples are took by transrectal ultrasound-guided biopsies). The staging of disease must be realised according to the risk of metastasis appreciated by clinical stage, rate of PSA and Gleason score.
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PMID:[Prostate specific antigen and diagnosis of prostate cancer]. 1501 76

In this review the authors consider the commercially available herbal product PC-SPES. This is a combination of eight different herbs marketed for its effects of reducing prostate specific antigen (PSA) levels, improving pain, and enhancing the quality of life of those with hormone refractory prostate cancer. The evidence for these claims does not appear to be as conclusive as reported by the manufactures of this product. There also appears to be a significant risk of deep vein thrombosis (DVT) in those treated with PC-SPES. There have been 116 clinical and laboratory based studies of PC-SPES published to date, but there have been no randomised controlled trials conducted. Many of these studies contain very few patients, thus making the drawing of conclusions difficult. Despite this lack of information, there still remains a large patient group taking this supplement, therefore caution should be advised in the usage of PC-SPES in the treatment of hormone refractory prostate cancer.
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PMID:PC-SPES: a herbal therapy for the treatment of hormone refractory prostate cancer. 1519 24

Patients with metastatic hormone-refractory prostate cancer have a progressive disease with a median survival of approximately 11 months, and currently no treatment offers a survival advantage. The standard drug treatment is a corticosteroid and chemotherapy with mitoxantrone. In a comparison of docetaxel every 3 weeks and prednisone, versus mitoxantrone and prednisone, with a follow-up of approximately 21 months, there were less deaths in the docetaxel group than in the mitoxantrone group (166 of 335 patients and 201 of 337 patients, respectively). Docetaxel also prolonged the duration of survival compared with mitoxantrone (18.9 and 16.5 months, respectively). When given with prednisone, docetaxel was also shown to reduce pain and serum prostate specific antigen levels and improve quality of life compared with mitoxantrone/prednisone. In another trial in hormone-resistant prostate cancer patients, which compared docetaxel and estramustine with mitoxantrone and prednisone during a median follow-up of 32 months, there were fewer deaths with docetaxel/estramustine than with mitoxantrone/prednisone, which were 217 of 338 and 235 of 336 patients, respectively. Median survival was also longer in the docetaxel and estramustine group than in the mitoxantrone/prednisone group (17.5 and 15.6 months, respectively). In conclusion, two combinations (docetaxel/prednisone and docetaxel/estramustine) have been shown to be superior to mitoxantrone/prednisone in hormone-refractory prostate cancer and both should be considered for use. With the present information, there is little to distinguish between these combinations.
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PMID:Which drug combination for hormone-refractory prostate cancer? 1593 92

Prognosis in prostate cancer is determined, in greater part, by the presence of metastases. Bone metastases can occur in any part of the skeleton even, for example, at the base of the skull. We present a case of a 78 year old male who, in December 2001, presented with paralysis of the third cranial nerve. The NMR and CAT scans were normal and circulating levels of PSA were elevated. He was referred to the Urology Service where the treatment guidelines included complete androgen block. Subsequently, he developed retro-orbital pain, divergent strabismus and palpebral ptosis. CAT and NMR indicated a soft tissue mass at the sphenoid level. Treatment was Gamma Knife Radio-surgery. Since August 2004, in conjunction with the latest rise in PSA, the patients general status deteriorated considerably and he was referred to the Oncology Service. There was an increase in the paralysis of the third, fourth and sixth cranial nerve (complete left ophthalmoplegia) and left-central facial paralysis. Metastases from prostate cancer can be disseminated via the lymphatic or the blood system. Currently, there are more metastases from large-size tumours. Metastases are critical in prostate cancer because of their adverse effect on the patients survival. Measurements of circulating levels of prostate specific antigen and prostate acid phosphatase are very useful in the clinical diagnosis of the primary tumour, or its metastases.
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PMID:[Ophthalmoplegia in a patient with prostate cancer and bone metastases]. 1623 78


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