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

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

The authors present their experience in the technique of laparoscopic radical prostatectomy. After 841 operations done from January 1998 to april 2001. They use a trans peritoneal approach with 5 ports of 5 and 10 mm. The prostatectomy is done antegrady and the urethrovesical anastomosis is rebuilt with interrupted 3/0 resorbable sutures. Operating time is 2 hours and 40 minutes (1 h 30 to 6 h 30) Conversion rate is 0.9%, average bleeding is 330 cc and transfusion rate is 2.8%. Bladder catheter is removed between days 3 to 6. hospital stay is 5.8 days. Post-op pain is minimal (2% of antalgics at day 2). There was no death, no embolism, 0.2% of phlebitis, 1.1% of rectal injury. Anstomotic strictures occur in 0.3% of cases. 89.2% of patients are continent after 1 year and 75% of patients under 70 years old who underwent a bilateral nerve sparing procedure were potent at 6 months. Positive margins were observed in 5% of pT2a, 22.5% of pT2b, 22.7% in pT3a and 30% in PT3b. After 2 years 92.5% of patients pT2a and b have a PSA < 0.1 ng/ml. No port seeding or peritoneal invasion by cancer was observed. Laparoscopic radical prostatectomy is a safe surgical procedure which limits the risk of transfusion, of anastomotic stricture, which reduces post op pain and allows a good continence. Potency recovery is promising.
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PMID:[Localized prostatic cancer: treatment with laparoscopic radical prostatectomy: study with 841 cases]. 1214 36

Urologists are frequently faced with the dilemma of treating a patient with a high index of suspicion of prostate cancer (PCa), but an initial set of negative biopsies. In this review, we evaluated the current knowledge on repeat prostate biopsies, focusing on when to perform them and in which patients, how many samples to take, where to direct the biopsies and what morbidity should be expected. We focussed on the available literature and the multicenter European Prostate Cancer Detection (EPCD) study. The EPCD study included 1051 men with a total PSA from 4 to 10 ng/ml who underwent a transrectal ultrasound (TRUS) guided sextant biopsy and a repeat biopsy in case of a negative initial biopsy. Most studies support that increasing the number of biopsy cores as compared to the sextant technique and improving prostate peripheral zone (PZ) sampling result in a significant improvement in the detection of prostate cancer without increase in morbidity or effects on quality of life. Re-biopsy can be performed 6 weeks later with no significant difference in pain or morbidity. At least 10% of patients with negative sextant prostatic biopsy results in the EPCD study were diagnosed with PCa on repeat biopsy, percent free PSA and PSA density of the transition zone being the most accurate predictors. Despite differences in location (more apico-dorsal) and multifocality, pathological and biochemical features of cancers detected on initial and repeat biopsy were similar, suggesting similar biological behavior and thus advocating for a repeat prostate biopsy in case of a negative finding on initial biopsy. Indications and ideal number of biopsy cores to take when repeating biopsies in patients who already underwent extensive biopsy protocols on the first biopsy remains to be determined.
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PMID:Repeat prostate biopsy: who, how and when?. a review. 1216 May 78

Understanding the role of chemotherapy for prostate cancer has advanced along two axes, better definition of endpoints, and biologic understanding of disease targets. Use of PSA as a surrogate endpoint makes possible the more rational design of phase III trials which will include survival and disease free intervals as an endpoint. Pain control has emerged as an important treatment endpoint through which more cost-effective care can be envisioned. Discovery of growth factor interactions with prostate cancer cells and the elucidation of apoptotic pathways have provided numerous new targets for biologic and chemotherapy of advanced disease.
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PMID:Refractory disease, new horizons and patient-physician relationships. 1249 52

The safety of sextant prostate biopsy has already been documented since the end of the 90's. As a higher efficacy of biopsy has been proved when increasing the number of samples taken, we have tried to assess the safety and tolerability of prostatic 8-core biopsy. From January to December 2001, 204 patients, aged between 50 and 88 (average 70) with a PSA between 0.74 and 196 ng/ml (10 +/- 9.25), underwent in 8-core prostate biopsy. After biopsy, the patients were given an oral antibacterial for 3 days. After taking the samples, patients were interviewed about the tolerability of the biopsy, and especially about the following: I. A feeling of irritation (77 patients, 37.7%); 2. A slight pain (72 patients, 35.29%); 3. A moderate pain (32 patients, 15.68%); 4. Intense pain (23 patients 11.27%). After 20 days all patients came back and were interviewed again about possible complications (biopsy was Ca positive in 86 cases, 42.15%). 153 patients (75%) reported a slight hematuria for an average period of 5 days; 88 patients (43.13%) showed slight anal-rectal hematic discharges, mainly after defecation efforts. It was never necessary to hospitalize any patients because of complications. 71 patients (34.8%) reported a perineal pain which disappeared after 24-48 hours. 175 patients reported having had an ejaculation after biopsy and 158 (90.2%) of them showed hematospermia. 4 patients (2%) had a short period temperature and only 2 (0.98%) were hospitalized for hyperpyrexia with symptoms of genitourinary sepsis. It has been proved that TR prostate biopsy is almost exclusively followed by minor complications, major ones being an exception. A biopsy with more than six samples (8-10-12) shows a higher number of minor complications (hematospermia and hematuria). The fact that a higher number of samples proves this method to be significantly more suitable, pays off all the problems. Also, such a casistics makes us think that prostatic 8-core biopsy is generally well tolerated (73% of patients reported either irritation or slight pain) and fairly safe, as complications are mainly minor ones. We must therefore underline the suitability, good tolerability and safety of the TR prostatic 8-core biopsy.
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PMID:[Acceptability and safety of transrectal prostatic 8-core biopsy]. 1250 61

PSA for children continues to be an integral part of the practice of emergency medicine. The advancement of knowledge for all health care professionals must continue so that pain and anxiety in children may be minimized during their visits to EDs.
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PMID:Procedural sedation and analgesia for children in the emergency department. 1263 Jul 35

A phase II trial of vinorelbine and low dose prednisone in hormone-refractory metastatic prostate cancer was conducted in order to investigate its safety, efficacy and impact on quality of life. Vinorelbine was administered at the dose of 25 mg/m(2) i.v. weekly for 12 weeks and then biweekly, along with 10 mg of daily oral prednisone until time of progression. Fourteen patients, median age of 74 years, were treated. The treatment was generally well tolerated with leukopenia and anemia as the major side effects. One patient achieved partial remission and eleven remained with stable disease. One of the eleven patients with stable disease had a dramatic PSA response from 1000 to 236 ng/ml; seven of these progressed after week twelve when vinorelbine was given biweekly. PSA response occurred in 5 of 14 patients. The median time to progression was 28 weeks and the median survival was 17 months. Nine out of the 14 accrued patients were evaluable for quality of life assessment. Five of them improved, three remained unchanged and two had a slight worsening. Four patients had improvement in pain control and fatigue. Our preliminary data suggest that the combination of vinorelbine/prednisone has modest activity in metastatic prostate cancer with a very favorable toxicity profile and is very well tolerated in this group of elderly patients.
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PMID:Phase II study of vinorelbine with low dose prednisone in the treatment of hormone-refractory metastatic prostate cancer. 1279 40

While there are numerous uncertainties surrounding prostate cancer's detection and treatment, more research focusing on the psychological needs of prostate patients is required. This study investigated the support and psychological care needs of men with prostate cancer. Patients were approached during urological oncology clinics and asked to complete the: Support Care Needs Survey (SCNS), Support Care Preferences Questionnaire, EORTC QLQ-C30 (Version 3) Measure plus Prostate Module, and the Hospital Anxiety and Depression Scale (HADS). Of the 249 patients meeting study entry criteria, there was an 89% response rate resulting in a cohort of 210 patients. The data showed that significant unmet need exists across a number of domains in the areas of psychological and health system/information. The more commonly reported needs were 'fears about cancer spreading (44%),' 'concerns about the worries of those close to you (43%),' and 'changes in sexual feelings (41%).' Half of all patients reported some need in the domain of sexuality, especially men younger than 65 years. Needs were being well met in the domain of patient care and support. A significant number of patients reported having used or desiring support services, such as information about their illness, brochures about services and benefits for patients with cancer (55%), a series of talks by staff members about aspects of prostate cancer (44%), and one-on-one counselling (48%). Quality of life (QoL) was most negatively impacted in those who: were < or =65 years old, had been diagnosed within one year, or had metastatic disease. Men < or =65 had decreased social functioning, greater pain, increased sleep disturbance, and were more likely to be uncomfortable about being sexually intimate. Patients recently diagnosed had increased fatigue, more frequent urination, greater disturbance of sleep, and were more likely to have hot flushes. Those with advanced disease scored lower on 12 out of 15 QoL categories. PSA level had no effect on QoL or anxiety/depression scores. Men with advanced disease had greater levels of depression and those < or =65 years old were more likely to be anxious. Although most men with prostate cancer seem to function quite well, a substantial minority report areas of unmet need that may be targets for improving care.
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PMID:Prostate cancer patients' support and psychological care needs: Survey from a non-surgical oncology clinic. 1468 51

Prostate cancer is currently the most-frequency malignancy in men, and the second cause of death from cancer in the Western world. Once the disease has metastasized, palliative treatment is the rule. First-sine therapy consists in surgical or chemical castration, associated or not with anti-androgens. This treatment approach is active in 80% cases but failures occur within 12-18 months. When the disease becomes refractory to hormone therapy, few alternatives are available. The combination of mitoxantrone-steroids improves clinical symptoms, namely by reducing pain, but does not improve patient survival. Both docetaxel and estramustine act through microtubules and synergistic interactions have been shown between these two compounds. Recently, several studies have demonstrated the efficacy of a combination of estramustine and taxanes, and in particular docetaxel. Phase II trials using docetaxel monotherapy have demonstrated responses rates concerning PSA of 45 to 58% and objective response of 33% and 40%. Combination with estramustine increases the biochemical response rate from 45% and 74%. A randomized phase II trial revealed the superiority of this combination compared to mitoxantrone in terms of response rate and clinical benefit. The results of phase III trials are still not available, in particular as concerns survival, but the combination docetaxel-estramustine appears very promising, even though the ideal therapeutic protocol is still under evaluation.
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PMID:[Docetaxel and prostate cancer]. 1504 57

A 76-year-old man with prostate cancer T3N0M0 and increasing PSA was treated with goserelin three times in a half year. As soon as the first treatment, he described subjective muscle weakness. After the third treatment, he developed complex motoric symptoms and atypical central pain with a likely association to goserelin. His left arm had signs of spastic movement; pain deteriorated after relaxation. The right hand showed muscle cramps under passive movements of the left arm that were not typical for rigor. He felt aching and partial burning pain in his whole body. There were few allodynic areas, mainly in the left arm. Several treatment approaches failed and the patient died some weeks after the first contact with our pain clinic due to pneumonia.
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PMID:Central pain and complex motoric symptoms after gosarelin therapy of prostate cancer. 1557 20


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