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Query: UMLS:C0376358 (prostate cancer)
 59,338 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We reviewed 67 cases of total prostatectomy for localized stage B carcinoma of the prostate. There were no operative deaths. Significant morbidity was limited to the well known complications of impotence and incontinence. The over-all survival rates were 92 per cent for 5 years (42 of 46 cases), 79 per cent for 10 years (19 of 24) and 62 per cent for 15 years (8 of 13). Total prostatectomy continues to be the preferred method of therapy for this stage of prostatic cancer.
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PMID:Total prostatectomy for stage B carcinoma of the prostate. 83 95

A review of 159 patients treated by radical retropubic prostatovesiculectomy from 1951 through 1970 has reinforced our belief that this is a satisfactory method of treatment for prostatic cancer confined to the prostate. A 10-year survival of 55 per cent and a 15-year survival of 45 per cent compare well to the results reported for perineal prostatectomy. The postoperative mortality rate was 2.5 per cent and total incontinence was 12.5 per cent after radical retropubic prostatectomy. Completely normal voiding occurred in 108 of the 159 patients. Stress incontinence but no need for an incontinence device occurred in 31 patients. Improved methods for preoperative staging of the disease give promise for even higher cure rates in the future.
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PMID:Radical retropubic prostatectomy for cancer: a 20-year experience. 83 96

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

Radical prostatectomy is a useful procedure for the treatment of prostate cancer limited to the gland; however, failure may occur as a result of the immediate or delayed complications of surgery, or to disease recurrence related to incomplete tumour excision. Seventy-nine radical prostatectomies were performed between April 1985 and August 1991 in patients with prostate cancer (primarily stage B1) who averaged 63 years of age. Immediate post-operative complications included vesicocutaneous fistulae, cystic lymphangiomas, abdominal wall abscesses, extraperitoneal haematoma, acute cholecystitis, and enterocutaneous fistula. Massive pulmonary embolism accounted for 2 deaths. Of the 77 surviving patients followed up for an average of 34 months, 79.2% (61) were continent, 15.6% had stress-related incontinence or severe incontinence and 5.2% were lost to follow-up. Sexual potency was preserved in 13 of the 33 patients (39%) who were pre-operatively potent. A favourable outcome as defined by no recurrence was seen in 69 patients (87.3%). Four patients (5.1%) are living with recurring prostatic cancer and 1 patient has died of the disease 46 months after surgery.
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PMID:Postsurgical management of the patient undergoing radical prostatectomy. 146 77

Radical prostatectomy with curative intent was performed in 13 patients with prostate cancer after local failure of radiotherapy. Of these patients, 2 underwent cystoprostatectomy for bladder neck involvement by the prostatic tumor. Local recurrence had been diagnosed twenty-one to one hundred sixty-eight months (mean 65.4 months) after completion of radiotherapy (6,000-7,000 cGy; mean 6,136 cGy). Three patients had radioactive implants. Rising prostate-specific antigen (PSA) was part of the indication for surgery in 5 patients. Complications included minor rectal injury (1 patient) and total incontinence (2/13 patients). Two patients had positive surgical margins and 6/13 patients had involvement of seminal vesicles, 2 of whom also had positive lymph nodes. The authors conclude that salvage prostatectomy is feasible after radiation failure. Transrectal ultrasound and careful monitoring of PSA after irradiation treatment may improve patient selection and minimize the risk of complications and incomplete excision.
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PMID:Salvage radical prostatectomy after failure of curative radiotherapy for adenocarcinoma of prostate. 152 39

Genitourinary problems, including neurogenic dysfunction, impotence, prostatism, urinary tract infections, and prostate cancer, are common in the elderly, and most of the symptoms can be alleviated through pharmacological management. Patients with neurogenic dysfunction who present with symptoms such as incontinence and urinary retention can be appropriately managed with bladder and sphincter relaxants or stimulants. Anticholinergic agents in the form of oxybutynin, flavoxate, and propantheline are effective bladder relaxants, and phenoxybenzamine, prazosin, and terazosin are commonly used as sphincter relaxants. Bethanechol chloride is the agent most commonly used to stimulate bladder contraction, but physicians should be careful when prescribing it for elderly patients with cardiovascular problems. Organic and psychogenic causes of impotence usually overlap, and oral agents have limited use in the treatment process. The use of yohimbine has increased recently, but its value and rate of success remains questionable. Testosterone is being used widely to treat impotence, but it is only helpful to patients with hypogonadism and should be used with discretion in the elderly, who have a high incidence of prostate cancer. Vasoactive intracavernous pharmacotherapy, on the other hand, is a recently discovered alternative to testosterone with promising results. Although the treatment of choice for benign prostatic hypertrophy is surgery, there have been important pharmacological advances in treating this disorder. alpha-Adrenergic antagonists and anti-androgenic agents have been found to relieve the symptoms of prostatic enlargement. The use of chemotherapeutic and antibiotic agents to treat and suppress acute and chronic urinary tract infections is reviewed; these are second only to pulmonary infections as the most frequent cause of febrile episodes in patients over the age of 65. Lower urinary tract infections can be treated with almost any antibacterial agent. Upper urinary tract infections require full genitourinary evaluation and appropriate antibiotics should be used according to the urine culture sensitivity studies. With the advent of new hormonal agents, more choices are now available for the management of prostate cancer, which is the second most common malignancy in men. Diethylstilbestrol (stilboestrol), an oral estrogen, remains a commonly used agent to achieve castrate levels of androgens in advanced prostatic carcinoma. Agonist analogues, such as goserelin and leuprorelin, of gonadotrophin-releasing hormone (GnRH) [luteinising hormone-releasing hormone (LHRH); or gonadorelin] achieve the same results as diethylstilbestrol but without the cardiovascular side effects. Antiandrogens are also being used in combination with GnRH agonists to produce complete androgen blockage, with mixed results.
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PMID:Current concepts in the treatment of genitourinary tract disorders in the older individual. 172 98

The treatment of urinary incontinence due to unstable bladder remains difficult. In the case of failure of medical or physiotherapeutic treatments, clam enterocystoplasty represents a major and important therapeutic possibility. The operation consists of frontal section of the bladder to form a bivalve followed by interposition, between the two valves, of a detubed ileal graft in order to increase the functional vesical capacity and to interrupt the transmission of detrusor contraction waves from one valve to the other. 10 patients (7 men and 3 women) suffering from urinary incontinence due to neurogenic unstable bladder (4 cases: 3 meningoceles, 1 operated cauda equina neuroma) or to another cause (6 cases, including one sequela of radiotherapy for prostatic cancer and 5 cases of apparently primary urinary incontinence) underwent enterocystoplasty combined, in the case of neurogenic incontinence (2 cases simultaneously and 2 cases previously), with the insertion of an AMS 800 sphincter. No major complication was observed. 9 patients are continent and 1 had to be reoperated to undergo an augmentation enterocystoplasty (failure of the initial operation due to radiation changes of the bladder), 3 retain a post-voiding residual of about 200 ml but not requiring self catheterisation due to the absence of any repercussions on the upper urinary tract. Lastly, urodynamic studies demonstrated a spectacular increase in compliance and functional capacity of the bladder together with a reduction of the amplitude of intravesical pressure peaks.
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PMID:["Clam" enteroplasty in the treatment of unstable or low compliance bladders]. 184 20

From March 1983 to December 1989 we have performed radical prostatectomy on 429 patients with prostate cancer. With 117 of the cases we performed the sparing nerve procedure. Follow-up was 6-72 months. Early postoperative complications concerned 36 patients (8.4%). We have not had any total incontinence. After a 6-month postoperative period we had a rate of 13.8 +/- 3% of stress incontinence with a confidence level of 95%. This percentage changed to 6.2 +/- 3% after a 12-month period. 33% of the patients after 6 months and 68.5% after 1 year reported full potency with similar pre- and postoperative quality of sexual intercourse. To manage localized prostate cancer it is important to know that with radical prostatectomy we can obtain an excellent quality of life with low morbidity even if the best management of localized prostate cancer is not resolved.
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PMID:Radical retropubic prostatectomy: complications and quality of life (429 cases, 1983-1989). 185 24

The experience of 272 patients with prostate cancer treated between 1976 and 1987 by external irradiation was reviewed to assess causal factors for post-irradiation incontinence and to determine measures to reduce the risk of this complication. No patient had incontinence before definitive irradiation or radical prostatectomy. Post-irradiation incontinence was observed in 19 of 272 patients (7%), including 14 with mild, 2 with moderate and 3 with severe disease. Incontinence after definitive irradiation was not significantly related to tumor stage or tumor control: 8 of 192 patients (4%) had local control and 2 of 33 (6%) had local failure. Incontinence was related to a urological operation performed in 1 of 105 patients (1%) who underwent needle biopsy and 7 of 130 (5.5%) who underwent transurethral prostatectomy before irradiation. Incontinence was more frequent, 2 of 6 patients (33%), and more severe in patients who underwent transurethral prostatectomy after irradiation. Of 31 patients 9 (29%) were incontinent after radical prostatectomy. No additional patient had incontinence after postoperative irradiation. However, 3 patients had a temporary increase in the severity of incontinence. The risk of post-irradiation incontinence may be decreased by more selective use of transurethral prostatectomy. Of 136 patients 26 (20%) underwent transurethral prostatectomy for tissue diagnosis. A needle biopsy would be the procedure of choice. A total of 29 patients with urinary outlet obstruction was treated without transurethral prostatectomy before irradiation. Ten patients with relatively mild urinary outlet obstruction were treated by irradiation alone, while 19 with more severe urinary outlet obstruction had endocrine therapy before irradiation and none of the 29 patients (0%) had post-irradiation incontinence.
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PMID:Prostate cancer: post-irradiation incontinence. 211 97

Retrograde prostatic urethroplasty with balloon catheter was first described by Castaneda et al. in 1987. This procedure is performed using local anesthesia with modified angioplasty balloon catheter. We applied this technique in 5 cases, including benign prostatic hypertrophy in 4 and prostatic cancer with urethral stricture in 1. Improvement in clinical symptoms was seen in 4 patients. Uroflowmetry was performed in 3 patients and flow was improved. Urinary retention recurred a few days after the procedure in one other patient. This was though to be related to the predominant hypertrophy of the middle prostatic lobe. A strong urge to void is commonly present at the time of balloon dilatation. Transient hematuria is seen after the procedure. To prevent the risk of postprocedural incontinence, it is very important to avoid dilating the external sphincter. Further investigation is necessary for the evaluation of long-term results, but this procedure can be performed in poor risk patients since it is less invasive. Hence, retrograde prostatic urethroplasty with balloon catheter is thought to be useful treatment for urethral stricture in poor risk patients.
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PMID:[Retrograde prostatic urethroplasty with balloon catheter]. 248 Jul 50


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