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

With prostate cancer being diagnosed and treated in more than 300,000 men each year, the pool of long-term survivors is dramatically increasing. Because these patients are usually elderly, they are often receiving follow-up care for unrelated problems in a primary care setting. This offers the physician an excellent opportunity to assist in management of any long-term complications of therapy and in monitoring for cancer recurrence. In addition to performing follow-up evaluations, the physician can provide counseling about a number of testing and treatment issues, including the variability of prostate-specific antigen levels, the appropriateness of a watchful waiting approach to some cancers, and the management of treatment-induced incontinence and impotence, which often have a deleterious effect on quality of life but may be amenable to therapy and psychosocial support.
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PMID:Follow-up after therapy for prostate cancer. Treating the problems and caring for the man. 879 50

Much controversy surrounds the appropriateness of screening for prostate cancer. The individual benefit from screening is unproven. Screening may result in many men being unnecessarily treated for prostate cancer with the associated risks of developing treatment related side effects, including impotence and incontinence. Men requesting screening need to be informed of these issues before they decide whether to proceed. This article reviews the current position in relation to screening, critically appraising current thinking in order to clarify the issues.
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PMID:Prostate cancer screening: what general practitioners and patients need to know. 885 14

Obstructive voiding symptoms are frequent complaints in men with prostate cancer. Some men with prostate cancer require transurethral resection of the prostate (TURP) for relief of these symptoms. Two central questions have been raised regarding whether TURP may have adverse effects on morbidity and mortality in patients with prostate cancer. The first question deals with potential tumor cell dissemination at the time of TURP, resulting increased progression and mortality rates. A review of the literature suggests the risk of tumor dissemination during a TURP is small or negligible. However, patients with prostate cancer and obstructive symptoms appear to have a greater likelihood of high-stage disease at presentation. When the pathological stage is known, progression and mortality outcomes are similar in TURP and non-TURP treated patients with prostate cancer. The second question deals with the potential that TURP increases treatment-related morbidity of radiation therapy or radical prostatectomy. When TURP is required before radiation therapy, the literature suggests that delaying radiation 6 to 8 weeks from the time of the TURP will minimize incontinence and bladder neck contracture to acceptable levels. The literature also indicates that radical prostatectomy may be performed with no increased morbidity following a TURP.
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PMID:Does transurethral resection of the prostate compromise the radical treatment of prostate cancer? 886 80

Cryosurgical ablation of the prostate currently is under investigation as a potential treatment for localized prostate cancer. Results to date indicate that the majority of patients have negative biopsies and a marked reduction in prostate-specific antigen levels following cryotherapy. This treatment, however, is associated with significant side effects, notably bladder outflow obstruction, impotence, and incontinence, and its long-term durability is still unknown.
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PMID:Should cryosurgery be considered a therapeutic option in localized prostate cancer? 894 16

Patients with radioresistant clinically localized prostate cancer may be treated by various means. Although androgen ablation is relatively noninvasive, it cannot be considered a curative option. We believe that a subset of patients with locally recurrent prostate cancer without subclinical metastatic disease exists and would benefit from maximally aggressive local therapy. Salvage surgery may offer long-term cancer control, particularly when the tumor is organ-confined, but is a technically challenging operation with a high incidence of postoperative incontinence. Cryoablation of the prostate for postirradiation recurrence may offer a less invasive alternative to radical surgery, but its long-term efficacy remains to be fully determined. Each therapeutic option has its characteristic attendant morbidity and the choice of therapy for local recurrence should be made with informed consent after frank discussion between physician and patient. We propose the treatment algorithm shown in Figure 1 for the management of patients with suspected recurrence after radiation therapy with the caveat that individual therapeutic strategies must be patterned around individual patient needs.
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PMID:Treatment options for localized recurrence of prostate cancer following radiation therapy. 894 20

We studied 81 patients who underwent radical prostatectomy for prostate cancer. Ten, 57 and 14 patients were clinically diagnosed with stage T1, T2 and T3, respectively. Pelvic lymph node dissection was performed prior to prostatectomy in all cases. The neurovascular bundle was preserved in 21 patients. Compared with pathological stage, the accuracy rate of clinical staging in T1, T2 and T3 was 40, 46 and 64% respectively. Approximately half of the patients clinically diagnosed with stage T2 were pT3. The positive rate of lymph node in pT2 and pT3 was 3.3 and 37% respectively, showing a marked difference between these two pathological stages. The 3-year non-recurrence rates were 89% in patients with pT2 and 79% in pT3. In the well differentiated carcinoma group, no patients had recurrence for up to 3 years. All of the patients with infiltration (INF) gamma showed recurrence within 3 years. Fifty-five patients had no problem on urination post-operatively, while the other 23 patients had a mild or moderate incontinence and the remaining 3 patients had a small urine stream. Regarding erectile potency, 4 out of 18 evaluable patients were potent.
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PMID:[Radical prostatectomy for localized prostate cancer]. 895 80

During the past 15 years radical retropubic prostatectomy (RRP) has become the treatment of choice for localized prostate cancer. Before the 1980s the procedure was characterized by a significant number of intraoperative, postoperative and long-term complications. Since then the operation has evolved continuously, using the results from anatomical studies, and has resulted in a marked reduction in the morbidity and mortality associated with this procedure. The modern, anatomical approach to RRP emphasizes the principles of direct visualization and identification of the anatomical structures in the pelvis. Management of the dorsal vein complex and techniques for apical resection of the prostate, combined with improved understanding of the pelvic floor anatomy, have contributed to a reduced frequency of postoperative incontinence. The identification and localization of the "erectile nerves' (autonomic branches of the pelvic plexus to the corpora cavernosa) in the neurovascular bundles outside the prostatic capsule and Denonvilliers' fascia enables nerve-sparing surgery. In selected cases, sparing of the neurovascular bundles is possible to preserve sexual function without compromising cancer control as the principal goal of RRP.
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PMID:Avoiding complications of radical retropubic prostatectomy. 910 Dec 9

Post-prostatectomy incontinence in patients with cancer of the prostate is often the result of sphincteric injury. However, recent studies have emphasized the role of detrusor instability and decreased bladder compliance in the etiology of post-prostatectomy incontinence. To further clarify the primary cause of incontinence, we reviewed the urodynamic studies of 39 patients referred for evaluation of incontinence after prostatectomy (35 radical, 4 TURP and radiation) for prostate cancer. Multichannel videourodynamic studies were performed to characterize bladder function, and sphincteric incontinence was assessed by Valsalva leak point pressure (VLPP). Flexible cystourethroscopy was used to evaluate the vesicourethral anastomosis. A pad scoring system was used to measure symptom severity. Sphincteric damage was found to be the sole cause of urinary incontinence in 23 patients (59%) and a major contributor in 14 others (36%). Twenty-seven patients (69%) had VLPP less than 103 cmH2O (mean = 55) with a urethral urodynamic catheter in place. An additional 10 (26%) had VLPP less than 150 cmH2O (mean = 63) upon removal of the catheter. VLPP is an indication of the severity of sphincteric damage. The importance of removing the urodynamic catheter during measurement of the VLPP is emphasized. Urethral fibrosis was confirmed by cystourethroscopy in 26 (67%) patients. Bladder dysfunction characterized by detrusor instability and/or decreased bladder compliance was seen in 15 patients (39%). In contrast to previous studies, our results indicate that sphincteric damage, and not bladder dysfunction, accounts for the vast majority of post-prostatectomy incontinence in patients with prostate cancer. However, it is essential to identify and treat bladder dysfunction in order to optimize the outcome of treatment for sphincteric incontinence.
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PMID:Sphincteric incontinence: the primary cause of post-prostatectomy incontinence in patients with prostate cancer. 913 37

Prostate cancer is the most commonly diagnosed cancer in men. The radical prostatectomy is the treatment of choice for localized cancer; however, this surgery carries with it the potential complication of urinary incontinence postoperatively. The increasing number of radical prostatectomies each year will thus lead to a growing number of patients suffering from postprostatectomy urinary incontinence. According to the medical literature, the treatment of postprostatectomy incontinence is almost always limited to pharmacological or surgical therapy. Because of the failure of the standard treatment options, many men are left to live with their incontinence. The guidelines for the treatment of urinary incontinence recommend the use of behavioral methods as first-line treatment for stress and urge incontinence. The potential treatment of postprostatectomy incontinence with the use of behavioral methods has a promising future for the advanced practice nurse and for the men who are affected.
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PMID:Treatment of postprostatectomy urinary incontinence with behavioral methods. 927 54

Quality of life is one of several endpoints commonly studied in prostate cancer treatment. It refers to how well an individual is functioning in life and his total sense of well being. There is increasing recognition that cancer therapy impacts significantly on the patient's ability to pursue relational, occupational and social interests. Fifty-one patients with clinically localized prostate cancer who had undergone transperineal permanent prostate implantation were evaluated. All patients were clinically staged as T1c or T2a and received an implant alone with Iodine 125 or Palladium 103 as definitive treatment. Six months after implant, data was collected using the European Organization for Research and Treatment of Cancer (EORTC) genitourinary group questionnaire and supplemental questions. Urinary symptoms such as nocturia, hesitancy, frequency, and dysuria were the most pronounced in the first few months after the implant and then decreased in most of patients; 40% noticed that they urinated more frequently and 17% had mild dysuria. All patients denied hematuria and none reported incontinence. Few patients reported any psychological distress or disruption in social or family life; none reported disruption in economic status or viability. All fifty-one patients said that they would have an implant again as definitive treatment. Seventy-nine percent reported an excellent quality of life post-implant. While survival is clearly a central goal of treatment for prostate cancer, the nature of this malignancy compels clinical attention to the quality of the patient's life after treatment. Sexual quality and function are maintained in the majority of patients and there is minimal interruption of their social and economic function.
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PMID:Quality of life after permanent prostate implant. 935 94


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