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

To define the patient-reported complications after cryoablation therapy for prostate cancer and to compare these results to previously published patient-reported complications for radical prostatectomy and external beam irradiation. A questionnaire similar to previously published patient-reported complication studies was sent to the first 290 patients treated by cryoablation therapy at our Institution. The questionnaire was returned by 267 patients. Forty-four patients were excluded from analysis because of prior irradiation, transurethral prostatectomy, or cryoablation, resulting in a study group of 223 patients. Of the 208 patients with good urinary control preoperatively, 9 (4.3%) patients used incontinence pads after cryoablation. Seven of the 8 patients who used one pad daily reported leakage of only a few drops. Impotency, defined as an inability to obtain erections adequate for vaginal penetration, occurred in 85% of men who were potent preoperatively. Urethrorectal fistula occurred in 1 patient (0.4%). Bladder outlet obstruction caused by stricture of sloughed necrotic prostatic tissue required dilation or transurethral resection in 10% of patients. Scrotal swelling, penile tingling, and pelvic pain occurred in 18, 15, and 12% of patients, respectively; typically, these resolved spontaneously within 3 months. Patient-reported complications for cryoblation compared favorably to those reported for radical prostatectomy and external beam irradiation. Patient satisfaction was high; 96% of patients reported that they would choose cryosurgery as a treatment option again.
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PMID:Patient-reported complications after cryoablation therapy for prostate cancer. 1122 Oct 61

Radical prostatectomy can be successfully performed by transperitoneal laparoscopy by a urologic team experienced in laparoscopy and radical prostatectomy. Operative and postoperative morbidity rates are low. Postoperative pain is minimal, allowing reduction of the length of hospital stay. The oncologic results seem satisfactory based on short-term follow-up. The improvement of the quality of intraoperative vision related to magnification of the image allows a more precise procedure. This subjective improvement of the quality of dissection should reduce the usual functional sequelae of conventional radical prostatectomy, such as incontinence and impotence. This finding needs to be confirmed by a larger series of patients with longer follow-up. Laparoscopic radical prostatectomy is now performed routinely and is proposed as a first-line surgical treatment for localized prostatic cancer at the authors' center.
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PMID:Laparoscopic radical prostatectomy: assessment after 240 procedures. 1127 64

OBJECTIVES: This is a retrospective review evaluating the incidence of incontinence post transurethral resection of prostate (TURP) in patients who have had previous external beam radiation (XRT) for prostate cancer (PCA). MATERIALS AND METHODS: 1,230 patients underwent XRT for PCA between January 1985 and April 1996. From this group, 16 patients mean age of 67.8 years (range 48-84) at the time of XRT had a subsequent TURP for obstructive symptoms a median of 3.25 years later (range 3 months to 10.2 years). Patients have been followed post TURP for a median of 5.0 months (range 1 to 81 months). RESULTS: Nineteen percent (3) patients developed incontinence post TURP. An additional patient remained in retention and continued to suffer overflow incontinence. Incontinence was associated with a shorter time interval between XRT and TURP (13 months versus 55.3 months) and with a greater amount of prostatic resection (19 grams versus 11.4 grams) when compared to the continent group, but did not meet statistical significance. CONCLUSION: A high risk of incontinence post TURP in previously radiated patients was demonstrated. The association with a shorter time interval between procedures and the larger resection suggests that a conservative approach is warranted. Studies with the use of preop and post TURP urodynamics would be useful in further defining risk factors in this population.
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PMID:Post transurethral resection of prostate incontinence in previously radiated prostate cancer patients. 1129 15

The aim of this study was to assess whether the quality of the surgical act could be an important prognostic factor for patients undergoing radical prostatectomy. This study also aims to investigate whether the surgical quality can be assessed by any means. Questionnaires were collected from 23 different institutes including 232 radical prostatectomies (RPr) performed for T1T2 prostate cancer. Blood loss, duration of surgery, margin status, postoperative prostate specific antigen (PSA) and urinary incontinence were analysed and correlated with the yearly number of RPr performed. The mean values obtained for each parameter were very different in the various centres. The outcome in terms of tumour control and incontinence could not be related to a higher or lower number of RPr performed. Quality control of RPr is feasible on the basis of an analysis of a few parameters, such as surgical margins, postoperative PSA and incontinence, that might recognise urologists that perform better or poorer than a proposed average.
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PMID:Quality control of radical prostatectomy: a feasibility study. 1131 77

At the time of diagnosis, prostate cancer is organ confined in 70% of the cases. A quarter of these patients undergo local therapy (surgery/radiation); 75% risk disease progression by "watchful waiting" or systemic side effects through hormonal ablation. Local high-intensity focused ultrasound (HIFU), as minimal invasive tissue coagulation (85 degrees C), ablates prostatic tissue with high precision. Since April 1996, 184 patients have undergone 232 sessions of transrectal HIFU therapy (average 90 min) under spinal anesthesia at 2.25/3.0 MHz, 50 W, and a penetration depth of 25 mm. The follow-up serum prostate specific antigen (PSA) concentration, sextant biopsies, International Prostate Symptom Score (IPSS), quality of life measures (QoL), and complaint registration provide the foundation for this clinical evaluation. Follow-up sextant biopsies (an average of 1.9) showed 80% of the patients to be cancer free. In men with residual cancer, the tumor mass was reduced more than 90%. The PSA nadir in 97% was <4 ng/mL, including 61% with values <0.5 ng/mL. After primary HIFU, no severe side effects (fistula, second or third grade incontinence, rectal mucosal burns) occurred. All patients had a suprapubic tube (average 29 days), and 33% needed a transurethral debris resection averaging 7 g. They were discharged within 23 hours. According to the short-term follow-up transrectal HIFU enables minimal invasive local prostate tissue ablation with high rates of negative biopsies, low PSA nadir, and low complication rate.
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PMID:Results and side effects of high-intensity focused ultrasound in localized prostate cancer. 1139 58

At the time of diagnosis, prostate cancer is organ confined in 70% of the cases. Of these patients, 25% undergo local therapy (surgery/radiation), and 75% risk disease progression by "watchful waiting" or systemic side effects through hormonal ablation. Local high-intensity focused ultrasound (HIFU) for minimal invasive tissue coagulation (85 degrees C) ablates prostatic tissue with high precision. Follow-up sextant biopsies (1.9) showed 80% of the patients to be cancer free. In those cases with residual cancer, the tumor mass was reduced by more than 90%. The PSA nadir in 97% was < 4 ng/ml, including 61% < 0.5 ng/ml. After primary HIFU, no severe side effects occurred (no fistula, no grade II/III incontinence, no rectal mucosa burn). As auxiliary treatments, all patients received a suprapubic tube (29 days), and 33% needed a transurethral debris resection (TUR 7 g). The patients were released from the hospital within 24 h after treatment. According to the short-term follow-up, transrectal HIFU enables minimal invasive local prostate tissue ablation with high rates of negative biopsies, low PSA nadir, and low complication rate.
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PMID:[Therapy of local prostatic carcinoma with high intensity focussed ultrasound (HIFU). Outcome and side-effects]. 1140 27

Although technically challenging, salvage prostatectomy for radiorecurrent prostate cancer is an effective option in carefully selected patients and offers the best chance for cure and long-term survival. Alternatively, cystoprostatectomy may be indicated in some patients who have a small capacity fibrotic bladder or intractable voiding symptoms related to radiation cystitis. Good long-term results can be expected in this patient group; however, exenterative surgery in patients with locally advanced disease is associated with comparably inferior results and should not be advocated. If cystectomy is necessary, orthotopic urinary diversion can be performed safely in young motivated patients who wish to maintain a better quality of life with associated morbidity. Although the higher rate of incontinence and impotence after salvage procedures may detract from the quality of life, the impact of these long-term complications on the patient's overall well-being is less than previously believed, and most patients are satisfied with their treatment outcome and adjust well to the circumstances, accepting some increased degree of morbidity. This observation emphasizes the value of careful preoperative counseling and the discussion of treatment options and outcomes, which also should incorporate quality of life issues.
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PMID:Salvage radical prostatectomy. 1159 Aug 13

Laparoscopic radical prostatectomy is an extremely challenging procedure for even experienced laparoscopic surgeons, and it is not practical to expect most urologists to learn the technique. Nevertheless, it is a feasible procedure and has short-term results comparable with conventional radical prostatectomy. For LRP to be an acceptable and reasonable alternative, the oncologic results must be equivalent to the results of RRP, and significant advantages is morbidity (hospital stay, pain, incontinence, impotence) must be attained; otherwise, the steep learning curve and the additional expense of the procedure make it difficult to justify as an alternative therapeutic modality. Beside a reduction in the transfusion rate, no other significant advantages of LRP over radical prostatectomy have been demonstrated definitively to date. As a result, the role of LRP in the management of prostate cancer remains investigational, and patients should be informed appropriately. The oncologic results and low morbidity of nerve-sparing RRP set a high standard for a laparoscopic technique to equal.
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PMID:Laparoscopic radical prostatectomy: is it feasible and reasonable? 1159 Aug 20

Prostate cancer is together with the carcinoma of the lung the most common cancer in the western world. Better screening methods especially the introduction of PSA (prostate specific antigen) in the beginning of the 90's has increased the early detection rate. In the United States only 30% of prostate tumors were in their early stages before the introduction of PSA-screening as compared to 60% nowadays. The early detection also increased the rate of younger men amongst these patients. Patient demands have increased with respect to incontinence and impotence especially amongst those young patients. Radical prostatectomy still is the gold standard for therapy of localized prostate cancer. Better operating techniques have decreased the side effect rate of this operations but many patients still do not undergo this operation because they fear these side effects. Originating from the USA the low dose rate brachytherapy (LDR) using permanent seeds had a renaissance in recent years. In 1999 alone more than 40,000 patients were successfully operated using this technique. 10 year data published in 1998 showed similar results as compared to a multitude of radical prostatectomy studies and superior results to most of the published external beam studies with significantly less side effects. In Germany and western Europe more and more centers start with LDR-brachytherapy. In contrary to the U.S. where brachytherapy is mostly performed as an outpatient procedure, nearly all European centers do only inpatient brachytherapy. Only very few centers perform outpatient procedures; the first results are very encouraging showing few complications and a very high standard of quality of the treatment.
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PMID:[Low dose brachytherapy with seeds--an interdisciplinary therapy alternative to radical prostatectomy]. 1159 8

Prostate brachytherapy has become a popular treatment option for localized prostate cancer with over 44,000 procedures performed in 2000. Eighty-seven percent to 93% of patients who have a serum prostate-specific antigen less than 10 ng/mL, Gleason score of 6 or less, and low risk (disease stage < or = T2a) can be expected to have an 8 to 10 year disease-free rate. The radiation dose delivered by the implants should exceed 140 Gy in men implanted with I-125 monotherapy. Patients with intermediate- and high-risk prostate cancer would benefit from the addition of either hormonal therapy and/or external beam irradiation to the implantation of seeds. Postimplant incontinence and proctitis can be minimized by controlling high radiation doses to the urethra and rectum. Potency is preserved in 70% of men with good preimplantation erectile function. Advances in technology, such as intraoperative dosimetry, will continue to make brachytherapy an attractive treatment option for men with localized prostate cancer.
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PMID:Permanent seed implantation for localized adenocarcinoma of the prostate. 1208 89


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