Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0376358 (prostate cancer)
 59,338 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We compared the outcomes, advantages, and disadvantages of retropubic and perineal approaches to radical prostatectomy for prostate cancer. From 1990 to 2000, 37 patients (average age: 66.6 years) who underwent radical retropubic prostatectomy (RRP) and 30 patients (average age: 70.1 years) who underwent radical perineal prostatectomy (RPP) were identified from the database of our department. Outcome measures included operative duration, estimated blood loss, blood transfusions, positive margins, complications, and incontinence rates. There were no differences between the RRP and RPP groups in complications, incontinence rates, or positive margins. The mean operative duration was 228 min in the RRP group and 198 mm in the RPP group (p < 0.05). The mean estimated blood loss was 1,060 ml in the RRP group and 717 ml in the RPP group (p < 0.01). The mean volume of blood transfusions was 620 ml in 17 patients in the RPP group and 700 ml in one patient in the RPP group (p < 0.001). In conclusion, the clinical results of RRP and RPP groups were similar; the advantages of the perineal approach were shorter operative duration, smaller estimated blood loss and less blood transfusion.
 ...
PMID:Clinical comparative evaluation of radical retropubic and perineal prostatectomy approaches for prostate cancer. 1262 74

The diagnosis of prostate cancer brings with it a number of emotional issues for the patient. These may include: fear of cancer; confronting one's own mortality; quality of life issues such as incontinence and impotence; and the question "why me?" In addition, there is burden of coping with the emotional responses from friends and loved ones which, arising from their concern, can range from fear to seeking to take charge. Added to this is the need to make choices regarding treatment and obtaining information about these. This article is based on a contribution to a symposium on prostate cancer at the Fifth International Conference on Psycho-Oncology and describes a personal experience of confronting these issues. The concept of communities of practice is used to interpret the learning experiences undertaken by the cancer patient.
 ...
PMID:Reacting to the diagnosis of prostate cancer: patient learning in a community of practice. 1264 93

OBJECTIVES: To determine the questions that treating Ontario urologists think should be addressed with patients who have curable prostate cancer before treatment decisions are made. METHODS: All Ontario (Canada) urologists (179) were given a scenario describing a case of curable prostate cancer and asked to judge the importance, using one of four categories (essential/important/no opinion/avoid), of addressing each of 78 questions. RESULTS: Ninety-seven (54%) of urologists completed the survey. The questions identified most frequently as "essential" to address were: treatment-related incontinence rates (76%), cure rates (74%), treatment-related impotence rates (73%), right of refusal (71%), and mortality from watchful waiting (63%). The questions identified most frequently to "avoid" related to searching for the first medical centre (29%) and the number of prostate cancer patients cured by the physicians (16%). There was little agreement among the urologists on the importance of addressing most of the remaining questions (Average agreement 40.7%). CONCLUSIONS: Most urologists assign great importance to addressing questions related to major treatment morbidity and success rates. Beyond these few major categories, there is widespread disparity among urologists about what information the patient should know. This "information gap" presents an identifiable dilemma in our adherence to the ethical principles underpinning informed consent in patients with potentially curable prostate cancer.
 ...
PMID:What the prostate cancer patient should know: variations in urologists' opinions. 1273 8

To decrease side effects observed after high-intensity focused ultrasound (HIFU) treatment for localized prostate cancer and to re-establish normal micturition in a patient population that often presents with concomitant prostate enlargement, the impact of a combined transurethral resection of the prostate (TURP) and HIFU has been evaluated. TURP and HIFU treatments were performed under the same spinal anesthesia. For the HIFU treatments, the Ablatherm device (EDAP SA, Lyon, France) was used. Selection criteria for HIFU treatment were localized prostate cancer, no previous treatment for prostate cancer, and prostate-specific antigen (PSA) pound 15 ng/mL at diagnosis. All patients meeting these criteria were considered for treatment and analysis. PSA nadir and stability, histology, International Prostate Specific Score (IPSS) and IPSS-quality of life, and morbidity were assessed during follow-up; 271 patients were selected: 96 in the HIFU group and 175 in the TURP plus HIFU group. A statistically significant impact was observed on catheter time (40.0 days versus 7.0 in median), incontinence (15.4% versus 6.9%), urinary infection (47.9% versus 11.4%), and the evolution of the post-treatment IPSS (8.91 versus 3.37 in average) in favor of the TURP plus HIFU group. No significant changes were observed regarding efficacy during short-term follow-up when considering a 25% retreatment rate in the HIFU group versus a 4% retreatment rate in the TURP plus HIFU group. The combination of a TURP and HIFU treatment reduces the treatment-related morbidity significantly. The patient management after a combined TURP and HIFU treatment is comparable with the management after a single TURP.
 ...
PMID:The status of high-intensity focused ultrasound in the treatment of localized prostate cancer and the impact of a combined resection. 1275 90

Treatment of incontinence and bladder complaints in the male should be directed to the cause whenever possible. Frequently, however, only symptomatic therapy is possible. Urge incontinence or overactive bladder due to obstruction should primarily be treated by eliminating the obstruction. Medical and surgical treatment methods are available for benign prostatic hyperplasia, bladder neck hypertrophy and prostatic cancer. In contrast, bladder neck sclerosis and uretheral strictures can only be treated surgically. Anticholinergics are primarily indicated if urge symptoms/incontinence persist after obstruction has been relieved or if urge incontinence occurs without obstruction. Seldom, in special cases injection of Botulinustoxin A or augmentation of the bladder may be indicated. Another possible cause of urge symptoms is urinary tract infection. This should be adequately treated according to resistance studies and the cause of the infection determined. In cases of overflow incontinence the infravesicle obstruction must be sought and treated. If limited detrusor contractability is the cause of overflow incontinence and the bladder cannot be emptied through pressmicturition, parasympathicometics may be of help. By insufficient effect, the procedure of intermittent self-catheterization must be taught. If this is not possible, the last resort is placement of a transuretheral or percutaneous catheter for continuous drainage. Stress incontinence is a rare complication in men, usually following prostatic surgery. It can be treated conservatively with pelvic floor training and alpha-adrenergic receptor agonists and if necessary surgically with submucosal collagen or silicon injections in the sphincter area or implantation of a sphincter prosthesis. Supravesicular urinary diversion is occasionally necessary after conservative and less invasive surgical measures have been exhausted and symptomatic suffering persists. Neurogenic disturbances in bladder capacity and/or emptying can be treated conservatively, medically, surgically or a combination of these depending upon the site of the lesion and the resulting urodynamic patterns.
 ...
PMID:[Conservative and surgical therapy of urinary incontinence and bladder complaints in the man]. 1280 98

Prostatic cancer (PC) is a frequent finding in aged men. In fact, 3% of males have the chance to die of PC. Radical prostatectomy by the retropubic approach with pelvic lymphadenectomy was made in 97 males. The treatment was performed in the urological department of the MSMSU urological chair from 1995 to 2001. 69 patients followed up for 3-64 months after the operation were eligible for analysis of the outcomes. The patients had the following PC stages: T1--11 patients, T2--44 patients, T3--14 patients. Prostate-specific antibodies ranged within 2.9-67.8 ng/ml (the mean level 16.7 ng/ml). The results of the treatment were satisfactory in 65 (94.2%) of 69 patients. The operation did not take more than 2.5 hours, mean blood loss was under 870 ml. Adequate urination after the catheter was removed resumed in 41 (59.4%) of 69 patients. Active urinary incontinence was observed within one year after the operation in 25 (36.2%) patients, total incontinence--in 3 (4.3%) patients. 51% patients retained the erectile function after nerve-sparing operation. Most of the patients had an unevenful postoperative period. During the follow-up 3 patients died of acute myocardial infarction (n = 1), intestinal cancer (n = 1) and distant PC metastases (n = 1). A postoperative fall in the PSA level under 0.3 ng/ml occurred in 49 (71%) patients, under 2 ng/ml in 7 patients (10%). In 19% of patients with pT2-3 the PCA rose over 2.0 ng/ml. Radical prostatectomy is indicated for patients with local prostatic cancer (stage T1 or T2) and probable survival from 10 to 15 years and longer. A nerve-sparing, sphincter-sparing and ablastic variant of this operation is widely used world-wide and is a method of choice for therapy of patients with retropubic prostatic cancer.
 ...
PMID:[Radical prostatectomy: surgical techniques and preliminary results]. 1281 17

Radical retropubic prostatectomy is currently the most widely used surgical treatment for localized prostate cancer. This once cumbersome procedure has developed technically over the last 20 years, reducing dramatically the associated complications and morbidity, e.g. blood loss, incontinence and impotence. Currently the operation is safe and is the best choice for eradicating localized disease, with little loss in quality of life. However, differences in reported outcomes indicate that there is still a need for standardization and continued efforts for surgical excellence. This review focuses on the crucial steps of the procedure, in two parts: the first covers apical dissection and the second the steps related to vesico-urethral anastomosis and the nerve-sparing procedure. This evaluation of the technical modifications aims to offer a choice, to vary the procedure according to the individual situation and thus improve the results. Current trends in surgical technique are also presented.
 ...
PMID:Technical advances in radical retropubic prostatectomy techniques for avoiding complications. Part I: apical dissection. 1282 68

The quality of life of patients after radical prostatectomy is mainly influenced by erectile dysfunction (ED) and incontinence. New criteria for treatment and patient selection give us the opportunity to restore sexual function in more patients. When ED is present, we should not wait for 24 months for natural restitution. PDE-5-inhibitors, intracavernosal self injection therapy and the vacuum constriction device are effective and conform to both patient and economic preference.Therefore, every urologists should be able to offer his patients an individual and successful approach to the therapy of ED after prostate cancer.
 ...
PMID:[Prostate carcinoma and erectile dysfunction. Which therapy when?]. 1456 84

Radical prostatectomy is one of the standard treatment of localised prostate cancer. It is considered that cure is obtain if PSA value is undetectable (< 0,1 ng/mL) for at least 5 to 7 years post surgery. 8 to 9 men out of 10 are currently cured by prostatectomy if the cancer is detected at organ confined stage, with PSA < 10 ng/mL. Major technical progress related to patient setting, surgical approach, instrumentation, periprostatic fascial exposure and surgical strategy clearly decreased perioperative morbidity and late effects (erectile dysfunction and incontinence). Laparoscopic approach was described mainly by French teams since 1997 and represents a validated alternative to the gold standard suprapubic open approach.
 ...
PMID:[Surgery of prostate cancer]. 1501 78

This pilot study evaluates a shared decision-making approach to individual decision making in localized prostate cancer care. The approach is based on a decision analytic model that incorporates patient utilities, ie, patient preferences among possible health states that might occur with prostate cancer treatments. Data on comorbidities, histologic grade of the biopsy, and age were obtained for 13 patients with newly diagnosed localized prostate cancer who received care in a Veterans Administration medical center. Using a standard gamble technique, interviewers obtained patient utilities for 5 distinct health states related to prostate cancer treatment. Utilities and patient clinical and pathologic characteristics were incorporated into the decision analytic model, and the derived quality-adjusted life expectancies were shared with the treating urologist before the first patient-physician discussion about treatment options. The results of the pilot study raised 2 major concerns. First, 4 patients had utility scores of 1.0 for all of the possible health states, and 7 patients had inconsistent utilities in which they rated both impotence and incontinence as a better health state than having just one of these problems. Second, the model recommended radiation therapy to individuals with a broad range of clinical characteristics, pathologic findings, and utility scores. Many of the patients who were recommended radiation therapy by the model received discordant recommendations from the treating urologist. Future refinements of both the utility assessment exercise and decision analytic model may be needed before the feasibility of the model in the clinical setting can be determined.
Clin Prostate Cancer 2002 Sep
PMID:Pilot study of a utilities-based treatment decision intervention for prostate cancer patients. 1504 1


<< Previous 1 2 3 4 5 6 7 8 9 10