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

In an effort to help physicians offer their patients unbiased advice on the best alternatives for treatment of localized prostate cancer, we present a retrospective comparison of the effectiveness of brachytherapy and radical retropubic prostatectomy in 1305 men with stage T1 and T2 adenocarcinoma of the prostate. Data from 1305 patients treated in our community-based private practice urology group from 1993 to 2002 were reviewed, and patients were classified by initial prostate-specific antigen (PSA) level and risk grouping. Risk grouping was defined by preoperative PSA levels and Gleason scores. We used time to PSA-indicated recurrence as the measure of efficacy. Brachytherapy and radical prostatectomy provided similar responses to treatment (no significant differences given the sample size, length of follow-up, and numerical differences observed) for localized prostate cancers. A prospective study is presently underway to evaluate the respective outcome of these procedures (including incidence of incontinence and impotence), and assess their impact on patient quality of life. The results presented here fail to show any superiority of prostatectomy over brachytherapy with palladium-103 (TheraSeed; Theregenics Corp., Buford, GA) with respect to time until relapse indicated by PSA level increase (> 0.2 ng/mL for prostatectomy and >1.5 ng/mL and rising for brachytherapy). In fact, any differences between treatments favor brachytherapy, particularly for intermediate- and high-risk groups. We conclude that both brachytherapy and prostatectomy should be offered, equally and without bias, to men with stage T1 or T2 organ-confined prostate cancer.
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PMID:Brachytherapy versus radical prostatectomy in patients with clinically localized prostate cancer. 1208 97

The important progress achieved in the treatment of prostate cancer comes by exacting significant costs [11, 16-18, 20, 23, 25]. Currently, there is incomplete evidence that the radical interventions at hand significantly reduce the human costs of the disease. Surgery and radiotherapy induce substantial risks of incontinence and impotence. The PSA test has probably decreased the stage at which prostate cancer is diagnosed [15]. Nonetheless, the PSA is a means of earlier detection; it does not elucidate quantitatively distinct modes of treatment. The PSA test is not a means of prostate cancer prevention. The continuing incidence, morbidity, and mortality imposed by this disease strongly indicate that preventive strategies for its control are necessary. Chemoprevention with selenium and other agents offers a promising approach that is undergoing intensive investigation. Randomized trials underway at the authors' center are building on the important clinical trial results reported by Dr. Larry C. Clark. These studies will evaluate the activity of selenium at several points along a continuum ranging from cancerous prostatic tissue in men with diagnosed cancer to premalignant tissue in men with high-grade PIN to healthy tissue in high-risk men with negative biopsy to long-term effects on cancerous tissue in men with frank cancer. These trials will also offer an opportunity for preliminary evaluation of the mechanisms by which selenium treatment could result in the slower development or progression of prostate cancer.
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PMID:Prostate cancer and selenium. 1210 57

This investigation was designed to identify potential directions for future modification of the percutaneous prostate cryoablation procedure. An analysis of prostate cancer location and volume in radical prostatectomy specimens was performed to evaluate the potential clinical consequences of these proposed modifications. A list of recommendations for improvements in the prostate cryoablation procedure was compiled from informal discussions held with participants in 9 training courses and conferences on prostate cryoablation over 18 months. Subsequently, a population of 112 consecutive, sagittally sectioned whole-mount radical prostatectomy samples was evaluated for prostate cancer volume, number of individual foci, and location to examine the disease-specific outcomes of these proposed modifications. The most common areas for potential alterations in the current cryoablation technique include modifications that would further simplify the procedure, continue to reduce real and perceived toxicity, and augment efficacy. Importantly, modifications designed to reduce treatment side effects could conflict with efforts designed to improve eradication of prostate cancer. Pathologic analysis revealed multifocal cancer in 79.5% of the samples, with 66% of cases exhibiting cancer within 5 mm of the urethra. The median volume of the index cancer was 1.6 cm3, whereas the median volume of the smaller ancillary lesions was 0.3 cm3. Prostate parenchymal-sparing alterations, proposed to reduce incontinence and erectile dysfunction by targeting the index cancer, would likely eradicate clinically significant cancer in 79% of men. The recent enthusiasm for prostate cryoablation as a reasonable minimally invasive treatment option for men with clinically localized cancer is likely to result in modifications of the established surgical technique. Knowledge of the anatomic location and cancer volume within the prostate gland is an important adjunct to planning such alterations. It is possible that parenchymal-sparing modifications to total gland prostate cryoablation can eradicate clinically significant cancer in most men, with a reduction in toxicity and cost.
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PMID:Prostate cryoablation: a scientific rationale for future modifications. 1220 44

The technique and recent experience incorporating cryosurgery into our community practice for primary treatment of localized prostate cancer is described. Between December 2000 and December 2001, a total of 93 patients underwent targeted cryoablation for localized prostate cancer. Of the 93 patients, 18 had failed radiotherapy, and cryotherapy was used as salvage therapy. The remaining 75 patients underwent targeted cryoablation of the prostate as primary therapy. A single urologist using an argon-based cryoablation system performed the procedure. Cryoprobes and thermosensors were placed under transrectal ultrasound guidance via a transperineal route. A double freeze-thaw cycle was used with anterior-to- posterior probe operation. Strategically placed thermosensors were used to monitor and control the freezing, and a warming catheter was used to protect the urethra. We achieved a nadir prostate-specific antigen level of < or =0.4 ng/mL in 84% of the entire population we studied (63 of 75 patients). Postsurgery complications were minimal. Incontinence developed in 4 patients, as did postsuprapubic catheter removal urinary retention. Erectile dysfunction developed in 28 of 34 patients who were potent preoperatively, with 6 of the 34 patients regaining potency after surgery. No rectourethral fistula formation occurred. Urethral sloughing was observed in 5 patients, 1 of whom developed a scrotal abscess during treatment of the sloughing. The use of cryoablation of the prostate for the treatment of localized adenocarcinoma of the prostate is feasible and can easily be transferred from the pioneering centers to the community hospitals without sacrificing safety or efficacy.
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PMID:Cryosurgery as primary treatment for localized prostate cancer: a community hospital experience. 1220 46

The diagnosis of early-stage prostate cancer cases creates dilemmas for many men diagnosed with the disease each year. Treatment interventions are all associated with significant treatment morbidity, including impotence and incontinence. The basic concept behind patient preferences, or utilities, is to ask patients to make judgments about the value of particular health outcomes. Several preference-based instruments are available, including the visual analog rating scale, the time trade-off utility assessment, and the standard gamble. These assessments result in scores or weights assigned to different health states. From the perspective of the patient with prostate cancer, the treatment that produces optimal outcomes will depend on the relative importance of several domains, which may include pain, urinary functioning, sexual functioning, and general physical health. Patients with similar diagnoses and overlapping clinical characteristics may have markedly different preferences for treatment outcomes.
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PMID:A review of measurement of patient preferences for treatment outcomes after prostate cancer. 1223 Oct 54

We evaluated whether, and if so to what extent, radiotherapy applied on a series of patients with prostate cancer influenced the patient's bowel habits and anorectal function. Ten consecutive patients participated in the study. The median age of the patients was 74 years (range, 61-71) and the average follow-up period was 22 (range, 15-28) months. Four patients were irradiated using external beam radiotherapy (2 Gy/day for a total of 70 Gy); 6 patients were irradiated with a combination of external beam radiotherapy (50 Gy, 2 Gy/day) and high dose rate brachytherapy (two 10-Gy fractions). Upon interview, patients disclosed characteristic functional disturbances such as urgency with occasional accidents, faecal soiling and spotting of underwear. Involuntary release of gas was another embarrassing problem. One or more of these problems were present in half of the patients. Endoscopy disclosed signs of mild proctitis. Sphincter pressure, rectal capacity and the volume threshold for appreciation of defecation urge were all significantly lower in patients than in 10 age-matched controls. In conclusion, disturbances of anorectal function with imperfection of incontinence still occur so some extent despite improved precision, and reduced margins offered by the modern conformal radiation therapy of prostate cancer. Anal sphincter function, the reservoir capacity of the rectum and its sensory function are adversely affected and radiation proctitis with rectal fibrosis and damage of the extrinsic innervations of the anal sphincters appear to be the principal causative factors. Although conformal radiotherapy together with better positioning may be two substantial improvements of modern radiotherapy, further improvements are needed.
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PMID:Anorectal function after modern conformal radiation therapy for prostate cancer: a pilot study. 1240 55

Interstitial laser coagulation (ILC) treatment is a recent technique in the treatment of BPH that is evolving rapidly. The results of a prospective randomised study vs transurethral resection of the prostate (TURP) is presented as well as results of patients treated with a temperature sensing laser system. The first study included 44 patients treated in a prospective randomised study (randomisation ILC vs TURP=2:1) comparing changes in objective and subjective parameters. In the second part of the study the outcome of the treatment of 34 patients with BPH using ILC performed with a temperature-sensing laser system are presented. The clinical outcome at 12, 26, 52 and 104 weeks was evaluated with symptom scores, quality of life measures, changes in voided volume, post void residual, and peak flow rate. In addition changes in prostate volume and urodynamic parameters at half a year follow-up are presented. In this randomised study patients improved markedly at any time during follow-up. In the ILC group there was a significant and persisting subjective improvement whereas the improvements in the TURP group were even more significant. The changes in voiding parameters, including changes in pressure-flow parameters, are superior in the TURP group compared to the changes in the ILC group. The retreatment rate for the ILC group is 21% compared to 7% in the TURP group, no patient with incontinence was documented in either group, while only one patients in the TURP group developed a urethral stricture. In the second part of the study, the clinical improvements following laser therapy using the temperature sensing treatment mode were more pronounced in voiding parameters when compared to those of the randomised laser group. Lower energy interstitial laser treatment of the prostate results in a significant improvement of all clinical parameters that are inferior to improvement following transurethral resection of the prostate. When using a temperature sensing system, the objective results of laser treatment improved and seem to be more durable.
Prostate Cancer Prostatic Dis 1999 May
PMID:Interstitial laser coagulation in the treatment of benign prostatic hyperplasia using a diode laser system: results of an evolving technology. 1249 24

The purpose of this study was to determine the incidence of patient-self reported post prostatectomy incontinence, impotence, bladder neck contracture or stricture, better, same or worse quality of life and willingness for same treatment again in a large group of radical prostatectomy (RP) patients and to determine if these morbidities are predictable with demographic, surgical or prostate cancer (PC) factors. Methods: A patient self-reporting questionnaire was completed and returned by 374 out of 458 eligible (81.7%) RP patients from one center, 267 (72.2%) have been operated since 1990 and all of whom were a minimum six month postoperative (75%>1 y). Questionnaire results were independently analyzed by a third party and correlated to demographic, operative, and tumor factors in an ongoing comprehensive PC database. Results: The patient self-reported incidence of post prostatectomy incontinence (any degree), impotence, and bladder neck contracture or stricture was 72.2, 87.4, and 25.9%, respectively. The reported rate of incontinence requiring protection was 39.0% and only 2.4% had persistent bladder neck contracture/stricture. Pathologic stage (continuous variable) was the only factor to significantly predict incontinence and no factor could predict impotence or bladder neck contracture/stricture in univariate analysis. No factor was predictive of morbidity by multivariate analysis. Despite incontinence and impotence significantly affecting QOL self-reporting (P=0.001, 0.001, respectively) and willingness to undergo RP again (P=0.001, 0.067, respectively), the majority of patients would choose surgery again. Conclusions: Although radical prostatectomy morbidity is common and affects patient-reported overall QOL, most patients would choose the same treatment again. Demographic, preoperative, operative, and tumor factors did not reliably predict patient-reported morbidity in this series.
Prostate Cancer Prostatic Dis 1998 Sep
PMID:Preoperative and operative factors to predict incontinence, impotence and stricture after radical prostatectomy. 1249 83

Lower urinary tract symptoms (LUTS) are common in middle-aged and elderly men and are frequently caused by an enlarged prostate. Increasing severity of LUTS may negatively affect patients' health-related quality of life (QoL) to varying degrees. Sexual function is an important aspect of QoL and studies show that sexual dissatisfaction increases with increased severity of LUTS. The ICS-BPH International Study of 1271 men aged 45 y and over who reported to one of 12 clinics examined the relationship between urodynamic parameters, LUTS, sexual dysfunction and QoL. Results showed that nearly 90% of men found that the effect of LUTS on their sex lives was a problem and 45% reported that their sex lives were spoilt by LUTS. Storage symptoms, in particular incontinence, had a greater association with sexual dysfunction than voiding symptoms. Similar results were reported in the ICS-BPH UK Community Study, which involved 423 men aged 40 y and over. In contrast, a French Community Study of 2011 men aged 50-80 y reported that symptoms of hesitancy, straining, reduced stream and wet underclothes were most strongly associated with sexual dysfunction. Sexuality is clearly of concern to men with LUTS and should be included in discussions on treatment decisions.Prostate Cancer and Prostatic Diseases (2001) 4, S2-S6
Prostate Cancer Prostatic Dis 2001
PMID:The Relationship between LUTS and sexual function. 1249 52

The degree of enthusiasm for prostate cancer screening seems high given the limited evidence of benefit and the well-documented harms of treatment that include impotence and incontinence. The purpose of this review is to understand the reasons for enthusiasm and positive reinforcement perceived in clinical decisions about whether to screen, whether to choose aggressive therapy for cancer, and in how to view adverse effects following therapy. We discuss a case of a man who must decide whether to undergo prostate-specific antigen screening and treatment to illustrate the kinds of reinforcement that may occur for each decision.Strong positive reinforcement for each decision would make screening and aggressive therapy appear to be successful and the correct decision even if prostate cancer screening and therapy were not beneficial. A physician is positively reinforced for recommending screening, regardless of the test result, because a negative result makes a patient grateful for reassurance and a positive result makes a patient grateful for early detection. A patient who is impotent and incontinent after a decision for curative treatment may attribute his survival to surgery and be grateful for having his cancer cured. Individual experience provides almost no negative feedback that early detection and aggressive treatment may not work. Although reinforcement operates similarly in other medical decisions, the example of prostate cancer provides insight into the strength of the forces at work because the personal harms, which are relatively common and dramatic, are readily discounted or explained away. Even if prostate cancer screening is eventually demonstrated to provide benefit for asymptomatic persons, it is important to appreciate the strength of forces that may act independently of benefit and reinforce decision makers' choices to be aggressive about screening and treatment. Interventions should be considered to temper possible overenthusiasm for screening and treatment.
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PMID:Why is prostate cancer screening so common when the evidence is so uncertain? A system without negative feedback. 1279 64


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