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

Transrectal ultrasound provides a safe method for repeated assessments of the prostate gland in the follow-up of prostatic cancer. Changes in the echo pattern of the gland may be observed following treatment, but these may be difficult to interpret. The capsule may be restored; the tumor may appear smaller, and in some cases, ultrasound identification of the tumor may become impossible. The total gland volume decreases with chemotherapy and hormonal manipulation (subcapsular orchidectomy or drug-induced). The volume generally decreases after radiotherapy but may show a transient increase if there is some associated radiation proctitis. The rate of decrease of total prostatic volume has not been established as a reliable indicator of the subsequent prognosis. Future studies should assess whether sequential measurements of the tumor volume rather than the total prostatic volume may be a more useful guide to prognosis.
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PMID:Transrectal ultrasound in monitoring response to treatment of prostate disease. 268 2

Radiation therapy for malignant gynecologic disease and prostatic cancer has resulted in increased survival and cure rates. This modality has unfortunately produced debilitating radiation proctitis. Recently, five patients were seen with continuous rectal bleeding secondary to radiation disease of the rectum. Four of these patients were women who were being treated for cervical carcinoma and one was a man with prostatic cancer. These patients were refractory to steroid retention enemas, iron therapy, and benproperine enema therapy. Treatment was accomplished using the argon laser with a 300-micron fiber passed via flexible fiberoptic sigmoidoscope. The most proximal areas were treated first. One and a half watts at 0.5 pulses was used. Up to 50 pulses were delivered per therapy session. The fiber was placed in contact with the lesion and circumferentially for 0.5 cm surrounding each suspected area. Bleeding stopped in the four women after two sessions and in the man after four sessions.
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PMID:Argon laser treatment of radiation proctitis. 273 Mar 31

Prostatic volume was determined by transrectal ultrasonography before and after castration in 13 patients, and after radiotherapy in 24. Measurements were done after 1, 2 and 3 months, and subsequently at 3-month intervals. Significant volume reductions occurred in the castration and radiation groups within 3 months. The decrease in prostatic volume was significantly more pronounced in the castration group during the entire study (p less than or equal to 0.01). Patients with enlargement of the prostate predominantly owing to benign prostatic hypertrophy also had a decrease in volume. No increase in prostatic volume after initial reduction was encountered for up to 9 months. In several cases progression of metastases occurred with no increase in the volume of the primary tumor. Followup may be too short to encounter local recurrence after radiotherapy or hormone-independent growth after castration. Proctitis after radiotherapy created artifacts that probably led to inaccurate measurements with ultrasonography. The technique provides a new, accurate parameter for followup of conservatively treated prostatic cancer patients. The clinical importance of the technique still remains to be determined.
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PMID:Transrectal ultrasonography in the followup of prostatic carcinoma patients. 714 95

Patients with adenocarcinoma of the prostate with positive surgical margins and/or seminal vesicle invasion after radical prostatectomy (RP) have a high risk of local recurrence or distant spread of disease. Several investigators reported increased local control rates following adjuvant radiotherapy (RT). However, it is unclear whether this procedure, with or without hormonal therapy (HT), improves the outcome. From 1975 to 1987, 56 patients with adenocarcinoma of the prostate underwent adjuvant RT following RP (pathological stage C1, n = 19; stage C2, n = 17; stage D1, n = 20). In 27 of 56 patients an additional immediate orchiectomy was performed. 48 patients received 4000-5000 cGy to the pelvic lymphatics, including the prostatic fossa, followed by a boost to the prostatic fossa to complete 6400-7000 cGy, whereas 8 patients were treated to the prostatic fossa only. With a median follow-up of 89 months, the overall survival rate of patients with stages C1, C2 and D1 did not differ significantly (10-year overall survival rate 84, 74 and 71, respectively). The local control rate for 5- and 10-years was 96 and 90%, respectively. A significant advantage in overall survival (5- and 10-year rate: 92 versus 93% and 92 versus 63%; P < 0.05, respectively) and clinical disease-free survival (5- and 10-year rate: 92 versus 72% and 92 versus 49%; P < 0.05, respectively) was seen in 27 patients with orchiectomy compared with 29 patients without HT. A total of 15 patients (26%) developed at least one form of late toxicity, in most cases a mild proctitis, cystitis, or penile or leg oedema. However, 6 patients (11%) had severe grade 3 or 4 side-effects that necessitated a cystectomy in 2 cases as well as a colostomy in 2 cases. In all patients with grade 3 or 4 side-effects, 70 Gy as a tumour-encompassing isodose were applied. Adjuvant RT, following RP in stage C and D1 prostate cancer with positive surgical margins and/or seminal vesicle invasion increases local control. Whether immediate HT influences the outcome, as seen in this study, should be proven in prospective clinical trials.
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PMID:Adjuvant radiotherapy following radical prostatectomy--results of 56 patients. 753 75

Laparoscopic pelvic lymph node dissection with real-time interactive transrectal ultrasound guided transperineal radioactive seed implantation is a new method of treatment for localized carcinoma of the prostate. A total of 58 patients with clinically confined prostate cancer and negative seminal vesicle biopsies underwent staging laparoscopic pelvic lymph node dissection immediately followed by prostate implantation: 50 had 125iodine and 8 had 103palladium implants. Mean operating time was 226 minutes (range 120 to 475), mean blood loss was 57 cc (range 5 to 400) and average hospital stay was 2.2 days (range 0.5 to 8). At a mean followup of 12 months (range 6 to 24), complications included proctitis in 1.7% of the cases, dysuria in 24%, nocturia in 21% and outlet obstruction in 17%. Erectile function remained unchanged. Prostate volume decreased to 58.9% of the pretreatment value by 12 months and to 44.3% by 24 months. Mean prostate specific antigen level was 18.4 +/- 26.3 ng./ml. before treatment, 3.4 +/- 3.9 ng./ml. at 6 months, 2.3 +/- 2.3 ng./ml. at 12 months and 4.9 +/- 6.0 ng./ml. at 24 months (1.2 +/- 1.0 ng./ml. for patients with no evidence of disease). Of the patients 15.8% had local failure at 18 to 24 months as determined by positive transrectal ultrasound guided biopsy. Five of 58 patients (8.6%) had persistently elevated prostate specific antigen levels, only 1 of whom had a positive biopsy. Laparoscopic pelvic lymph node dissection with transrectal ultrasound guided implantation is a safe and promising mode of therapy for patients with localized prostate cancer.
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PMID:Laparoscopic pelvic lymph node dissection combined with real-time interactive transrectal ultrasound guided transperineal radioactive seed implantation of the prostate. 753 69

Thirty-seven patients with clinically localized prostate cancer of all grades were treated by suprapubic digitally guided implantation of 125I seeds. The median age at the time of diagnosis was 68 years. The mean follow-up period was 62 +/- 19 months. At last follow-up 18 patients were clinically free of disease; 11 deaths occurred: 9 from prostate cancer and 2 from another disease. Complications occurred in 24 patients most commonly urgency and proctitis, attributable to the treatment. Four patients had severe late rectal complications, and 2 patients died of sepsis secondary to rectal fistulae. Digitally directed retropubic implantation of 125I appears inferior to other treatments of clinically confined prostate cancer both regarding outcome as well as complication rate.
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PMID:Iodine-125 brachytherapy for clinically localized prostate cancer: a 5-year follow-up of outcome and complications. 780 6

Staging pelvic lymphadenectomy (PLND) was performed in 210 prostatic cancer patients (mean age 67 years, clinical stage T0-T3 M0). A radical retropubic prostatectomy was subsequently performed in 54 men, ten of whom also received postoperative radiotherapy due to positive surgical margins. Ninety-eight patients were treated with external beam radiation alone (70 Gy in 35 fractions) and the remaining 58 received endocrine therapy. The complications of PLND alone (156 patients), consisted of wound infection in eight patients, hematoma or lymphocele in seven, venous thrombosis in three, and cardiac infarction in one patient. Early side-effects of radiotherapy included mild to moderate proctitis and/or cystitis in 57 patients. One year after completion of therapy, 48 of the irradiated men had proctitis, but only six had severe symptoms. Four patients developed radiation cystitis and two urethral stricture. Following prostatectomy (54 patients), two patients died in pulmonary embolism and another one developed a deep venous thrombosis. Hematoma occurred in five patients. Of the 42 surviving patients who did not receive postoperative radiotherapy, eight developed anastomotic strictures and four had severe stress incontinence. Only five were fully potent one year after surgery. Eight of the ten patients receiving radiotherapy after prostatectomy developed side-effects from the intestine and/or the urinary bladder. Two of them became totally incontinent. One developed a severe hemorrhagic cystitis necessitating urinary diversion. All ten were impotent after treatment.
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PMID:Morbidity of pelvic lymphadenectomy, radical retropubic prostatectomy and external radiotherapy in patients with localised prostatic cancer. 781 68

A total of 71 men with clinical T1b-T2c carcinoma of the prostate underwent ultrasound-guided interactive seed implantation of the prostate. Sixty received 125I and II 103Pd implants. A laparoscopic lymph node dissection was performed in 58 patients. The patients have been followed a mean of 2 years (1-4.2 years). With use of a prostate specific antigen (PSA) value of 1 ng/ml, patients (n = 8) who presented with an initial PSA of < or = 4.0 ng/ml were all free from failure. This compared with those who presented with an initial PSA of 4.1-10, 10.1-20, and > or = 20 ng/ml, in whom the freedom from failure rates were 52, 32, and 22%, respectively. Patients (n = 49) who presented with an initial PSA of less than or equal to 15 ng/ml had a median PSA of 0.88 ng/ml at last follow-up compared with 2.25 ng/ml for those with an initial PSA of > 15 ng/ml. Prostate biopsies performed 18-24 months after implantation were negative in 82%. The median PSA for those with a negative biopsy was 0.7 ng/ml vs. 4.9 ng/ml for those with a positive biopsy. There were no long-term persistent urinary complaints. Grade 2 radiation proctitis occurred in three (4.2%). No cases of severe radiation proctitis or cystitis occurred. Urinary retention occurred in four patients (5.6%), one of whom required a transurethral resection of the prostate. No patients developed urinary incontinence. Potency was preserved in 94%. We conclude that the real-time ultrasound-guided transperineal seed implantation technique is an effective and safe method of treating prostate cancer. Longer follow-up is needed to substantiate these early encouraging results.
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PMID:Brachytherapy for prostate cancer: real-time three-dimensional interactive seed implantation. 911 74

One of the most difficult tasks for the practicing urologist is to counsel the patient in a decision for the optimal treatment for his localized prostate cancer. After providing the patient with contemporary and unbiased information and data, it is important to find the preferred treatment based on his age, the medical realities and, last but not least, the patient's personal preference. Radical prostatectomy, radiotherapy and observation are standard treatment options. TRUS-guided brachytherapy and cryosurgery are considered investigational treatment options since follow-up is inadequate to provide sufficiently precise outcome estimates. The literature does not provide clear-cut evidence for the superiority of any one treatment. The patient most likely to benefit from radical prostatectomy would have a relatively long life expectancy, no significant surgical risk factors and a preference to undergo surgery. The major advantage of radical prostatectomy is its potential for total removal of the cancer and cure in properly selected patients. Potential harm includes urinary incontinence and impotence. The patient most likely to benefit from radiation therapy would have a relatively long life expectancy, no significant risk factors for radiation toxicity and a preference for radiotherapy. The advantages of radiotherapy are that it has a potential for cure and it is well tolerated in the majority of men when the modern techniques are used. Potential harm includes radiation cystitis, proctitis and impotence, persisting severe complications are only seen in 1% of patients. The patient most likely to benefit from surveillance are those with a shorter life expectancy and/or a low grade tumour. Benefits are lack of treatment related morbidity with only marginal compromise of disease-specific survival at 5-10 years follow-up.
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PMID:Surgery or radiation: is there really a choice for early prostate cancer. 954 15

Between 1986 and 1995 a hundred and seventy-four patients with prostate cancer staged for T1b-T3c N0 M0 were treated with a combined tele- and HDR brachytherapy regimen. The distribution of stage and grading was as follows: T1b two patients, T2a-2c 113 patients T3a-3c 59 patients, and G1 27 patients, G2 87 patients, G3 60 patients respectively. The total dose administered for the subclinical disease (small pervis) was 50 Gy by teletherapy and 30 Gy via two fractions of 15 Gy HDR brachytherapy integrated in the percutaneous regime. Total treatment time 6 weeks. After a median follow-up of 50 months (8-103) the stage related systemic and local progression amounts for stage T3 15.25% and for stage T1-2 20.43%, respectively. The distribution of systemic and local progression related to histological grading is: for Grade G3 23.3% and for Grade G1-2 6.14%. Ten patients died tumor related and 18 others of intercurrent diseases. The overall survival amounts 84%, the cancer specific survival 94% and the disease free survival 88% respectively. The late radiation morbidity scored by the RTOG/EORTC score in relation to proctitis was: 12 Patients Grade I, 10 patients Grade II, and 5 cases (one of five with abdominal anus) Grade III, respectively. In terms of radiogenic cystitis 13 patients developed Grade I side effects, 5 Grade II, and 3 Grade III, respectively. One osteoporotic patient developed a radionecrosis of both bones.
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PMID:[Interstitial high dosage irradiation of prostate carcinoma]. 970 11


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