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

Between 1989 and 1996, 35 patients with prostate cancer without metastasis received intraoperative radiotherapy combined with external beam radiation. 10 of 16 stage B patients and all of 19 stage C patients received additional endocrine therapy for the initial treatment. The radiation therapy included 25-30 Gy of intraoperative radiotherapy for prostate and 30 Gy of external beam radiotherapy for small pelvic region. One patient of stage C was dead for cancer and 4 patient were dead for other causes during 15-99 (mean: 41.6) months follow up period. The overall actuarial survival at 5 years by Kaplan-Meier method were 92.3% for stage B and 87.2% for stage C. Although cystitis, proctitis and anal bleeding were observed as the adverse effects of radiotherapy, both acute and chronic symptoms were not critical. In conclusion, intraoperative radiotherapy combined with external beam radiotherapy was revealed as an effective treatment for prostate cancer without metastasis.
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PMID:[Intraoperative radiotherapy combined with external beam radiation for prostate cancer without metastasis]. 975 May 30

Pelvic radiation is a common therapy for the treatment of prostate cancer. A complication of this therapy, radiation proctitis, may be limited to the direct posttreatment period or it may appear as serious complications that occur months to years after therapy has been completed. Mucosal damage, present with both acute and chronic radiation proctitis, produces a variety of symptoms including mucoid diarrhea, pain upon defecation, serious rectal bleeding, stenosis, and fistula formation. The treatment of radiation proctitis is symptom related, and the goals of therapy include the prevention or correction of mucosal changes and eradication of rectal bleeding. This article will review the pathophysiology of radiation proctitis and its treatment.
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PMID:A review of radiation proctitis in the treatment of prostate cancer. 1081 51

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

Clinically symptomatic late injury to the rectal wall occurs in about one third of patients with prostate cancer treated with external beam irradiation. Reducing the physical dose to the anterior rectal wall without a similar reduction in the posterior peripheral zone is difficult because of the proximity of these structures. Based on our previous observations that intrarectal application of amifostine resulted in very high concentrations of amifostine and its active metabolite WR-1065 in the rectal wall of Copenhagen rats, the authors initiated a phase I clinical trial in 1998. Twenty-nine patients with localized prostate cancer were accrued. Eligibility criteria included histologically confirmed adenocarcinoma, a Karnofsky performance status of > or =70, and no pelvic lymphadenopathy or distant metastases. The total dose to the prostate was 70.2 Gy (20 patients) and 73.8 Gy (9 patients). Therapy was delivered using a 4-field axial technique and 3-dimensional conformal planning. Amifostine was administered intrarectally as an aqueous solution 30 minutes before irradiation on the first 15 days of therapy. Amifostine dose was escalated, in cohorts, from 500 mg to 2,500 mg. Toxicity was evaluated using the Radiation Therapy Oncology Group late morbidity scale. All patients completed therapy with no amifostine-related toxicity at any dose level. The application was feasible and well tolerated. With a median follow-up time of 21 months, 9 patients (33%) had rectal bleeding (8 grade 1, 1 grade 2). Four patients (14%) had symptoms suggestive of radiation injury, which proved to be secondary to nonrelated processes. These included preexisting nonspecific proctitis (1 patient), diverticular disease of the sigmoid colon, rectal polyp (1 patient), and ulcerative colitis (1 patient). Symptoms developed significantly more often in patients receiving 500 to 1,000 mg than in patients receiving 1,500 to 2,500 mg amifostine (7 of 14 [50%] versus 2 of 13 [15%]; P =.0325, 1-sided chi(2) test). Intrarectal application of amifostine is feasible and well tolerated. A complete lack of systemic toxicity obviates the need for close monitoring of patients during and after administration. Rectal symptomatology after external beam radiotherapy to the pelvis cannot be assumed to reflect late radiation damage, because it often is a manifestation of an unrelated pathologic process. The preliminary efficacy data are encouraging and suggest that intrarectal administration of amifostine may reduce radiation damage. Further clinical studies are warranted.
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PMID:Intrarectal application of amifostine for the prevention of radiation-induced rectal injury. 1191 90

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

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

To evaluate retrospectively the efficacy of adjuvant radiation therapy (ART) in patients with T1-T2 prostate cancer (CaP) in whom extracapsular cancer (pT3) was detected after radical prostatectomy (RP), together with biochemical failure characterized by a recurrent level of serum prostate-specific antigen (PSA)>0.1 ng/mL. Twenty-two patients with T1-T2 CaP treated by RP who subsequently were found to have pT3 CaP with (13) or without (9) positive surgical margins and/or seminal vesicle invasion, exhibited biochemical failure characterized by a recurrent level of serum PSA, 2-40 (mean: 25) months after RP and were treated with ART (65 Gy). Bone and CT scans were negative in every patient, 15 of whom were submitted to TRUS biopsy (Bx) of the anastomosis (resection site), which was positive in 8. Patients were followed up for between 6 and 60 (mean: 32.5) months. Transient side effects (urgency, proctitis, diarrhea) were experienced by 9 patients after ART. A decrease in serum PSA was observed in 19 patients; however, only 14 of these achieved an undetectable level (<0.1 ng/mL) on one or more occasions after completion of ART (in 12 cases this was after 3 months). Of the 14 patients, 8 achieved a persistently unmeasurable PSA level at a mean follow-up of 20.4 (range: 9-48) months. There was no difference between patients in whom an undetectable level of serum PSA was attained and those in whom it was not, with regard to specimen pathology, PSA doubling time, timing of ART, and the result of Bx. Patients who achieved an undetectable PSA had a lower mean PSA at the time of ART (1.1 vs 2.9 ng/mL, P<0.05) and a lower preoperative mean PSA. Although ART for biochemical failure after RP may lead to undetectable PSA levels in a significant proportion of patients for a significant period of time, a longer follow-up shows that such unmeasurable levels persist in only 36.4% of such patients.
Prostate Cancer Prostatic Dis 1998 Dec
PMID:Adjuvant radiation therapy for recurrent PSA after radical prostatectomy in T1-T2 prostate cancer. 1249 74

The purpose of this article was to provide an overview of the morbidity and mortality of prostate cancer, QOL issues and the economic impact of the disease. We searched Medline (from 1990 onwards) for all studies dealing with prostate cancer epidemiology, treatment, screening and staging, and critically reviewed the most relevant articles, focusing on pharmacoeconomic issues. Prostate cancer is the most common cancer in men. In the US, new estimated cases of prostate cancer represented 14.8% of all new cancer cases for 2000, with estimated deaths from prostate cancer comprising 5.8% of all deaths from cancer. Current options for prostate cancer management include radical prostatectomy, cryosurgery, radiotherapy, hormone therapy and watchful waiting. Many of the long-term effects of treatment, such as urinary incontinence, impotence and radiation-induced proctitis, have a large impact on patients' quality of life and, in some patients, may offset the clinical benefits. Regulatory bodies and managed care organisations are assigning increasing importance to the evaluation of QOL benefits as an independent clinical endpoint and a measure of patient satisfaction. Several screening programmes for early detection of prostate cancer, mostly based on prostate-specific antigen (PSA) measurement or digital rectal examination, have been proposed, but their routine implementation in all asymptomatic elderly men has been questioned. There is still no definite proof that patient outcomes are improved by extensive PSA screening. Furthermore, the total cost of a screening programme is difficult to define since it extends well beyond the initial test. Several instruments are used for QOL assessment in prostate cancer, some of which have been specifically developed for, or adapted to, patients with this disease, such as the Functional Assessment Cancer Therapy (FACT) tool, Prostate Cancer Treatment Outcome Questionnaire (PCTO-Q) and Prostate Cancer Specific Quality of Life Instrument (PROSQOLI). More than 50% of treatment costs for prostate cancer are accrued during the patient's last year of life, and total initial care costs decrease with increasing age. In the US, initial average inpatient costs were estimated at $US 2253, in 1995, for men aged > or =80 years, compared with $US 4540 for men aged 35-64 years. In recent years, treatments based on combined modalities (i.e. radiotherapy/prostatectomy plus hormonal therapies) have emerged. Although cost-effectiveness analyses of various treatment options have been attempted, the strength of their conclusions appears to be limited by the lack of homogeneous literature data on the effects of such interventions on survival and morbidity.
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PMID:Quality of life and economic considerations in the management of prostate cancer. 1275 12

Radiation oncology has undergone rapid technical development during the last few years. The further development of treatment planning systems and treatment machines had a major impact on the improvement of radiation therapy results in prostate cancer. This paper presents different treatment modalities and results. Currently available are three-dimensional conformal radiation, intensity modulated radiation therapy (IMRT), high dose rate brachytherapy, and low dose rate brachytherapy (seed implantation). All modalities offer the possibility for dose escalation, which is essential for curative treatment. Dose escalation using these techniques makes it possible to reduce the dose for the surrounding organs at risk. Three-dimensional conformal radiation therapy can be delivered with doses up to 78 Gy. The biochemical control rate is up to 90% depending on the risk factors T stage, initial PSA, and Gleason score. The incidence of late side effects is <10%. IMRT is a newer modality for percutaneous radiotherapy. By individual dose modification in the treatment fields, doses >80 Gy can be delivered in small treatment volumes. Treatment has to be highly precise to avoid dose peaks in the organs at risk, i.e., rectum and bladder. The preliminary data for remission and toxicity rates are promising, but it is too early for final conclusions. For cases with high-risk factors such as PSA >10 ng/ml, Gleason score >6, and stage T3, percutaneous radiation can be combined with neoadjuvant or adjuvant hormonal treatment. Randomized trials showed an improvement of the results in favor of combined treatment. HDR brachytherapy in combination with external radiation is a good option for dose escalation in patients with locally advanced tumors and/or other high-risk factors. The biochemical control rates are between 60 and 84%, late effects occur in less than 10%. Seed implantation (LDR brachytherapy) as sole treatment is indicated for prognostically favorable situations (PSA <10 ng/ml, Gleason score < or =6, and T1c or T2a tumors). The biochemical control rates are between 80 and 90%. Toxicity consists of urine retention and proctitis, occurring in 10-20% of the patients.
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PMID:[Curative radiotherapy of localized prostate cancer. Treatment methods and results]. 1450 54

Hydrogen peroxide is a widely available disinfectant that has been reported to cause colitis. We report a case of a 67-year-old man who presented with an acute proctitis caused by a self-inflicted 3% hydrogen peroxide enema. The patient's intention was to cure himself of a recently diagnosed prostate cancer, because the waiting list for oncological consultation was deemed too long. The pathogenesis of hydrogen peroxide mucosal injury and a review of the literature is discussed.
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PMID:Waiting-list induced proctitis: the hydrogen peroxide enema. 1467 22


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