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Query: UMLS:C0178874 (tumor progression)
 40,807 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Carcinoma of the prostate is the most commonly diagnosed cancer in men. The natural history and the biological aggressiveness are primarily determined by tumor volume. At the time of diagnosis, only one third of all tumors are pathologically confined to the prostate and eligible for curative therapy. Early detection by the general practitioner with prostate-specific antigen and digital rectal examination should be the primary goal. Currently, diagnosis is best established by transrectal ultrasound-guided biopsies. For the treatment of localized prostate cancer, men who undergo radical retropubic prostatectomy have been shown to have superior long-term results when compared to those who have received radiation therapy. With an improved understanding of the prostatic anatomy and nerve-sparing surgical techniques, morbidity from impotence and incontinence are minimal. In advanced carcinoma, 70 to 80% of men initially respond well to androgen withdrawal. Unfortunately, androgen-independent cells will continue to multiply, leading to tumor progression and death. Until effective chemotherapeutic agents are developed, we can only achieve palliation in advanced disease.
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PMID:[Prostate carcinoma--a current review]. 137 72

The biochemical markers alkaline phosphatase (Alk P), prostatic acid phosphatase (PAP) and prostate-specific antigen (PSA) were measured 3-monthly in 61 patients with disseminated prostatic cancer who were treated with LHRH analogues. The decrease in Alk P and PSA during the first 6 months of treatment was significantly related to a better survival. In this follow-up study, only PSA was useful for monitoring prostatic cancer during hormonal treatment. Before it was visible on a bone scan, PSA gave an indication of tumor progression. PSA might permit omission of routine bone scanning. Consensus must be obtained about the cost-saving use of biochemical markers in the treatment of disseminated prostatic cancer. With the number of treatment options increasing, objective measures are of utmost importance. Biochemical markers can be used for prognosis and monitoring of the treatment of patients with disseminated prostatic cancer.
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PMID:Value of biochemical markers in the management of disseminated prostatic cancer. 137 92

Prostatic acid phosphatase (PAP), prostate-specific antigen (PSA), and beta-microseminoprotein are organ-specific markers. Also Leu-7 may be regarded as an organ-specific marker. The main utilization of PAP and PSA immunostaining is to establish the prostatic origin of a carcinoma. Changes of PAP and PSA immunoreactivity may be correlated with histologic grade of prostatic carcinoma. Keratin expression assessment is useful to identify prostatic basal cells or epithelial secretory cells. Neuroendocrine marker reactivity in prostatic carcinoma seems to be related with increasing histologic grade and tumor progression.
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PMID:Tissue markers in the diagnosis and prognosis of prostatic carcinoma. 138 34

Serum testosterone and prostate-specific antigen (PSA) levels were measured in 3 patients with Stage D2 prostate cancer before and after discontinuation of the long-acting LHRH agonist, goserelin acetate (Zoladex). The patients had received goserelin acetate for ten, sixteen, and thirty months prior to discontinuing the drug because of progressive metastatic disease. In all 3 patients, PSA and testosterone levels increased after goserelin acetate was discontinued. In 2 patients the testosterone level reached normal levels. A bilateral orchiectomy was performed one hundred sixty, one hundred, and seven days, respectively, after the drug was discontinued. In all 3 cases PSA and testosterone levels were reduced following castration, although PSA levels again began to increase within two weeks of orchiectomy in 2 of the 3 patients. These findings suggest that suppression of testosterone by LHRH agonists is not permanent and if tumor progression occurs, maintaining hormone suppression may still be beneficial.
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PMID:Response to orchiectomy following Zoladex therapy for metastatic prostate carcinoma. 170 66

Response of prostatic cancer bone metastases to therapy (androgen withdrawal and Estracyt) was studied in 43 patients by applying scintiscanning and radioimmunodetective measurement of serum osteocalcin (OC) values. The prostate-specific antigen (PSA) and prostatic acid phosphatase (PAP) concentrations, as sensitive probes for the overall tumor spread, were used in parallel in a monitoring procedure. A significant rise in OC levels to values elevated from a pretreatment normal level has been found in patients with a partial osseous tumor remission, and this may be easily distinguished from normal and/or subnormal OC level in bony tumor progression (P less than 0.01) and during stabilization in metastatic spread (P less than 0.01). On these bases, differences between disease progression and the "no change" response category could not be statistically recognized (P greater than 0.05). A sharp increase in circulating OC level has been recorded 1 months after the beginning of the treatment leading to bone remodeling processes and precedes improvements in scintiscan appearance. Blood OC concentration seems also to be of utility 1) in distinguishing scintigraphic flare phenomenon from a slight bone scan progression and 2) when related to scans with regions of both disease improvement and worsening. Furthermore, serum OC concentration can frequently be measured through a noninvasive procedure, thus serving as a significant addition to bone scintigraphy.
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PMID:Correlation between bone scans and serum levels of osteocalcin, prostate-specific antigen, and prostatic acid phosphatase in monitoring patients with disseminated cancer of the prostate. 247 38

Previous immunohistochemical studies with prostate-specific acid phosphatase and prostate-specific antigen documented the diagnostic value of these antigens in the identification of metastatic prostatic adenocarcinomas and in the differentiation of primary prostatic adenocarcinomas from poorly differentiated transitional cell carcinomas. Although attempts have been made to correlate immunostaining with degree of tumor differentiation, no study has directly assessed the relation of either prostate-specific acid phosphatase or prostate-specific antigen immunoreactivity of tumors with their biologic behavior. Nineteen patients with predominantly intermediate Gleason grade untreated stage A2 carcinomas of the prostate were studied by the unlabeled antibody immunoperoxidase technique for prostate-specific acid phosphatase and prostate-specific antigen in an attempt to identify those in whom the disease would progress without further therapeutic intervention. Of the 12 carcinomas with areas of either weak or negative prostate-specific acid phosphatase staining, nine progressed. Two of the seven carcinomas that did not have these foci of poor immunostaining also progressed. Although there was a trend for foci of poor immunoreactivity to predict tumor progression, the correlation was not significant. All seven patients who had tumor foci with weak or negative prostate-specific antigen immunostaining experienced progression of the disease. Of the 12 patients with only moderate or intense staining, the tumors did not progress in eight. This correlation between foci of poor immunoreactivity and progression of disease was statistically significant. When the study was repeated by varying the technique without awareness of previous grading results, the same predictive results were obtained. When results of prostate-specific antigen immunostaining were compared with those achieved with prostate-specific acid phosphatase, the superiority of the prostate-specific antigen antisera for labeling prostatic tissue was evident. This study suggests that prostatic cancers consist of subpopulations of cells with differing immunoreactive properties and that the presence of cells that lack sufficient differentiation to express normally present immunologically recognizable antigens is an indication of potentially more aggressive neoplasms.
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PMID:Immunohistochemical localization of prostate-specific acid phosphatase and prostate-specific antigen in stage A2 adenocarcinoma of the prostate: prognostic implications. 638 Dec 84

Heterogeneity in human androgen receptor (hAR) expression in prostate cancer is considered to be implicated in tumor progression. hAR expression was therefore studied immunohistochemically in localized and locally progressive, hormone refractory (HR) prostate cancer. Because altered functional activity of the hAR may be due to changes in the structural integrity of the hAR gene, exons 2 to 8 of the hAR gene were assessed for mutations by single-strand conformation polymorphism (SSCP) analysis and exon 1 was analyzed for the size of the CAG repeat. The hormone binding capacity, a prerequisite for ligand-regulated receptor function, was determined by a ligand binding assay. Coexpression of the hAR and prostate-specific antigen (PSA) was studied by a sequential double immunoenzymatic staining to verify whether PSA expression is a parameter of hAR function. Almost all human prostatic carcinomas revealed heterogeneous hAR expression, regardless of tumor differentiation and progression. Putative predominance of hAR-negative tumor areas in HR prostate cancer was not observed. No hAR gene mutations or major changes in the CAG repeat were found in the 18 HR carcinomas or in the 9 control samples. Moreover, all selected hAR-expressing cancers were able to bind the synthetic androgen methyltrienolone (R1881). Immunoenzymatic double staining revealed even PSA expression in hAR-negative tumor areas. PSA immunohistochemistry in human prostatic carcinomas therefore is of no use in determining hAR functional activity. Thus, most prostatic carcinomas, even when progressed to a state of hormone insensitivity, contain a structurally intact hAR gene, heterogeneously expressed with retained androgen binding capacity.
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PMID:Androgen receptor status in localized and locally progressive hormone refractory human prostate cancer. 751 91

The anatomical radical retropubic prostatectomy currently may be performed with low morbidity and mortality. The nerve-sparing aspect of the anatomical radical retropubic prostatectomy has allowed preservation of potency in the majority of men with localized prostate cancer. Overall potency rates of up to 71% may be achieved without compromising the complete eradication of cancer. Prostate cancer control with nerve-sparing surgery is similar to that reported for the standard radical retropubic prostatectomy. Inaccurate clinical staging of prostate cancer and the inability to determine tumor involvement of the neurovascular bundle have made it difficult to decide with certainty preoperatively which patients should undergo preservation versus wide excision of the neurovascular bundle. Some of the controversies that may determine utility of nerve-sparing radical prostatectomy include the impact of prostate cancer capsular penetration and positive surgical margins on tumor progression and patient survival. The selection of the ideal patient who has clinically localized prostate cancer for nerve-sparing radical prostatectomy has been improved by using as guidelines such preoperative factors as serum prostate-specific antigen tumor grade and the presence of perineural invasion on biopsy, and by using tumor location and volume to help predict true pathological stage. Other preoperative studies including transrectal ultrasound, computed tomography, and magnetic resonance imaging are generally not helpful.
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PMID:Current results and patient selection for nerve-sparing radical retropubic prostatectomy. 852 Nov 34

To date androgen receptor (AR) expression and structure in human prostatic cancer have been studied in primary tumor specimens and in cell lines. Investigation of alterations in the androgen-signalling transduction cascade in prostatic carcinoma metastases is important to improve our understanding of tumor progression towards androgen insensitivity. In the present study we have collected data comparing AR expression in both the primary tumors and the respective pelvic lymph node metastases. Formalin-fixed and paraffin-embedded tissues derived from the primary tumors and positive lymph nodes of 12 patients undergoing radical prostatectomy were immunostained for the AR and prostate-specific antigen (PSA). AR expression was evaluated with the polyclonal antibody PG-21, which is directed against amino acid 1-21 in the N-terminal region of the AR. All primary tumors stained for the AR. In 8 of the 12 lymph nodes examined more than 50% of the tumor cells were AR positive and displayed a uniform staining pattern; in one lymph node metastasis remarkable heterogeneity in AR expression was observed. In two cases less than 10% of the tumor cells stained for the AR. In one case the lymph node metastasis was immunohistochemically negative for the AR, whereas the primary tumor obtained from the same patient displayed intense staining for the AR. PSA was expressed in all metastases and primary tumors. Our data demonstrate that loss of the AR in lymph node metastases from prostatic carcinoma is a rare event.
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PMID:Androgen receptor status of lymph node metastases from prostate cancer. 860 94

So far, no curative treatment is available for hormone-refractory prostate carcinoma. Therapy is thus focused on alleviating symptomatic tumor progression with the aim of improving quality of life. Therefore, anthracyclin-derived mitoxantrone was administered to 25 patients with hormone-refractory prostate carcinoma and symptomatic progressive disease. After a median treatment of 13 weeks, a median of 4 cycles and a follow-up of 14 months, 48% of the patients (12/25) reported improvement in tumor-related pain; in 60% (15/25) there was improvement of the self-assessment symptom score and 32% of the patients (8/25) gained weight. Additionally, partial tumor response with regression of lymph-node metastases occurred in 3/25 patients (12%). In 10/25 patients the serum level of prostate-specific antigen (PSA) decreased as well as the alkaline phosphatase (AP) in 7/25 patients. Side effects subsequent to chemotherapy were leucopenia WHO grade III in 25% of the patients and thrombocytopenia WHO grade III in 3/25 and grade V (treatment-related death) in 1/25 patients. Non-hematological toxicity occurred in 2 patients (cardiotoxicity n = 1, nephrotoxicity n = 1, WHO grade II each).
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PMID:[Therapy of hormone refractory prostate carcinoma with mitoxantrone. A clinical phase II study]. 865 Aug 48


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