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

Urinary incontinence following radical retropubic prostatectomy is a serious medical and psychological complication with a major negative impact on quality of life in patients with localized prostate cancer. The overall incidence of this complication is higher than 2% regardless whether the surgery has been done by the retropubic or perineal approach. The correct diagnosis of incontinence is based on urodynamic investigations. Two main causes of incontinence are detrusor hyperactivity and sphincteric insufficiency. The best prevention for postoperative incontinence of urine is meticulous surgery. Treatment options of incontinence are pharmacological or surgical (injections of collagen, autologous fat or implantation of artificial urinary sphincters).
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PMID:[Urinary continence after radical retropubic prostatectomy]. 1074 39

New diagnoses of prostate cancer more than tripled between 1990 and 1996, largely because of improved methods of detection and heightened public awareness. Radical prostatectomy is often undertaken in men with prostate cancer who are expected to live at least 10 more years and have tumors confined to the prostate gland. Because of high 10-year survival rates, the demand for radical prostatectomy has increased steadily during the past decade and continues to climb as men pursue a cure and attempt to maximize survival. Survival benefits aside, however, radical prostatectomy carries a significant risk of urinary incontinence, which can dramatically impair quality of life. Despite medicine's steadfast pursuit of continence-preserving approaches to radical prostatectomy, nurses are currently challenged to provide care for a growing cohort of patients with postprostatectomy incontinence. This article reviews the clinical presentation and pathophysiology of postprostatectomy incontinence, including assessment and treatment options.
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PMID:Managing urinary incontinence following radical prostatectomy. 1081 46

Urinary incontinence is a common adverse effect associated with treatment for early stage prostate cancer. The influence of this factor on treatment selection decisions by patients and their partners has been explored only minimally in the literature. Data regarding the actual incidence of incontinence associated with prostate cancer treatment are confusing because of the lack of standardized definitions of incontinence. Radical prostatectomy is associated with higher rates of urinary adverse effects than is radiation therapy. Brachytherapy appears to be associated with a low risk of incontinence, whereas cryosurgery is associated with significant urinary adverse effects. Including incontinence, urethral sloughing, and bladder neck obstruction. The influence of these adverse effects on decision making regarding prostate cancer treatment selection is difficult to ascertain. Research indicates that both men and their partners appear to have difficulty processing information presented to them regarding the probability of urinary adverse effects and the degree to which these adverse effects may have an impact on their daily lives.
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PMID:Urinary incontinence as a factor in prostate cancer treatment selection. 1081 47

Beam radiation with three-dimensional conformal planning appears to decrease morbidity of prostate cancer therapy. The 3-field, arc technique (3-FAT) technique was designed by computer modeling to improve radiation dose to the target and minimize dispersion to nearby organs. Toxicity was studied in patients with prostate cancer. We performed a retrospective study of 168 consecutive men with prostate cancer after 3-FAT radiotherapy with a median follow-up of 24 months. All patients, treated from 1996 through 1999 at the University of Colorado had a pathological diagnosis of cancer before irradiation. Therapy was designed with a urethrogram and planning computed tomography scan. The 3-FAT was employed using noncoplanar, rotational beams, and nonuniform blocking of portals. Patients were treated to a minimal tumor dose of 74 Gy in 37 fractions. Adverse effects were investigated. Definitive radiotherapy was given to 80% of the group, and 58% received total androgen blockade. 3-FAT produced favorable dose distributions for the rectum, bladder, femoral heads, and base of the penis. Patients routinely report minimal dysuria and frequency during treatment. There were minimal urinary complaints after irradiation and no proctitis, diarrhea, incontinence, or change in potency as a result of radiotherapy. The 3-FAT represents a technical improvement in the treatment of prostate cancer by minimizing radiation delivered to adjacent critical structures. There were minimal side effects to the rectum, bladder, and penis base despite high doses to the prostate and seminal vesicles. The large percentage of patients with preliminary prostate-specific antigen values below 1.0 portends efficacy.
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PMID:Minimal toxicity with 3-FAT radiotherapy of prostate cancer. 1087 53

The extension of life expectancy is one of the most dramatic achievements of the 20th century. Th elderly population, over 65 years, is the fastest growing age group. The implication of this population growth will need considerable medical and socioeconomic attention during the beginning of this century. A large proportion of elderly people are afflicted by several prevalent urological diseases such as prostate cancer, benign prostatic hypertrophy, incontinence, erectile dysfunction and androgen deficiency. The urologist is in a privileged position to play a key role in several medical aspects of the aging male. It is the responsibility of the urological community to address the challenge of the aging male in the beginning of this new millennium.
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PMID:The aging male: a challenge for urologists. 1091 72

Multiple treatment options are available for the radiation therapy of prostate cancer including whole pelvic radiotherapy (WPRT), prostate-only radiotherapy (PORT), three-dimensional conformal radiotherapy (3DCRT), intensity modulated radiotherapy (IMRT), as well as proton or neutron beam based therapies and brachytherapy. Numerous technical variations hamper objective assessment of these different treatment modalities. These variations are extensive and often subtle (dose to the prostate, the dose per fraction, number and size of fields, the photon energy, patient positioning, prostatic motion, the use of immobilization devices, 2D or 3D planning for treatment, and others) may cause interpretive uncertainty. Despite this confusion, there is some consensus. Prostate-specific antigen (PSA) nadirs, as well as pretreatment PSA levels, significantly alter outcome. Low-risk patients do well no matter which treatment they receive, although the question of dose-escalation therapy to improve results remains unanswered. High-risk patients do poorly regardless of treatment, although the addition of androgen ablation and dose-escalation therapy may improve results. Quality of life (QOL) studies continue to show a problem for radical prostatectomy (RP) patients secondary to impotence and incontinence and a problem for radiotherapy patients due to gastrointestinal (GI) disturbances. Patients can have access to any specific study through technologies such as the Internet. Although this information can be useful, the subtleties of each different article are usually beyond the understanding of most patients. This report examines some of the new radiotherapy modalities as well as corrects some misconceptions regarding radiotherapy results and morbidity. In addition, we discuss some studies comparing surgery and radiotherapy and attempt to objectively compare different radiation therapy strategies for localized prostate cancer.
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PMID:Deciding on radiation therapy for prostate cancer: the physician's perspective. 1097 94

The International Consultation on Urological Diseases (ICUD), under the cosponsorship of the World Health Organization (WHO), the International Society of Urology (SIU), and the International Union Against Cancer (UICC), is active in the organization of global consultations on urological diseases. The major urological associations from the five continents (the American Urological Association (AUA), the Urological Association of Asia (UAA), the Confederation Americana Urologia (CAU), and the European Association of Urology (EAU)), together with societies with expertise in specific programs such as the International Continence Society, the International Society for Impotence Research, the International Prostate Health Council, the American Cancer Society, the International Union Against Cancer, and the European Organization for Research and Treatment of Cancer, came together in the late 1980s on the basis of their proven record in organizing successful international meetings on urological cancer to initiate the concept of the ICUD. At the suggestion of the WHO, a First International Consultation on Benign Prostatic Hypertrophy (BPH) was organized in 1991, not only to provide recommendations to medical practitioners but also to define and plan future research on the subject. The formula, based on global multiprofessional collaboration and expertise, exceeded expectations, and other consultations were to follow, e.g., on prostate cancer, incontinence, erectile dysfunctions, and nosocomial infections. In 1994 it became necessary to establish a legal nongovernmental organization to foster the goals of the ICUD, essentially for the creation of awareness, knowledge, and recommendations on the diagnosis and treatment of urological diseases.
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PMID:International Consultation on Urological Diseases: a decade of progress. 1102 19

The geriatric population presents a unique challenge to the health care provider. The incidence of common lower urinary tract disorders, such as benign prostatic hypertrophy (BPH), prostate cancer and incontinence increase dramatically with aging. In their more severe forms, these disorders may predispose to hydronephrosis and ultimately to renal deterioration. This review of lower urinary tract and ureterovesical junction (UVJ) physiology and pathophysiology, will focus on: (1) anatomic UVJ obstruction from prostate cancer, or severe bladder hypertrophy, (2) functional obstruction from compression or stretching of the UVJ during bladder distention from urinary retention, and (3) bladder decompensation in the female. We will present a diagnostic and treatment algorithm and discuss future trends in the geriatric population. Clearly, the geriatric health care provider always must consider the lower urinary tract when confronted with acute renal deterioration, because prompt diagnosis and treatment of significant, lower-urinary-tract disease can maximize recovery of renal function.
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PMID:Hydronephrosis and renal deterioration in the elderly due to abnormalities of the lower urinary tract and ureterovesical junction. 1105 85

Radical prostatectomy is an effective treatment for patients with clinically localized prostate cancer and is associated with a very low level of mortality. However, many men with untreated clinically localized prostate cancer do not die from the disease and, following radical prostatectomy, some patients will suffer from a loss of potency and/or incontinence. A major challenge faced by the clinician is to identify the individual patient who will benefit from radical prostatectomy. In this review, we discuss the natural history of clinically localized prostate cancer and the factors likely to affect the treatment decision for an individual patient. Recent studies by other investigators and ourselves have revealed that the T1/T2 tumour is heterogeneous with respect to pathological stage and outcome, and that the quantity of Gleason grade 4/5 tumour is a significant prognostic factor predicting lymph node progression and capsular penetration. Classification and Regression Trees (CART) analysis including such preoperative parameters can be used to predict the probability of an individual patient having a pT2 tumour and, therefore, whether he could have a nerve-sparing radical prostatectomy - a procedure which offers better outcomes in terms of potency and continence.
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PMID:Radical prostatectomy: options and issues. 1111 94

A radical prostatectomy for localized prostate cancer is indicated after evaluation of the disease (initial PSA, clinical stage, biopsy mapping, results of radiologic explorations with an endorectal MRI) and the patient (age, morbidity, life expectancy and wishes of potency conservation). The surgical approaches, retropubic or laparoscopic, depend on the surgeon's experience. Radical prostatectomy provides good disease-free survival for organ-confined disease close to the natural life expectancy. Post-radical prostatectomy morbidity is essentially represented by orthostatic incontinence (up to 6.8%), stress incontinence (up to 27%) and impotence (30 to 95%), depending on the published series and patient age.
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PMID:[Methods and results of radical prostatectomy for localized cancer of the prostate]. 1119 47


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