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

In 712 patients, mapping of the prostate by six systematic ultrasound-guided core biopsies was performed without major side effects using the "biopyt gun". The histologic findings provided data on patients with normal and those with abnormal prostates on digital rectal examination (DRE). Only 3 of 72 (4%) nonurologic patients with normal prostate-specific antigen (PSA; less than 4 ng/ml) had prostate cancer. In patients with firm prostates on DRE and normal PSA, 13 out of 101 (13%) had prostate cancer. In patients in whom PSA was greater than or equal to 4 ng/ml, 92 of 158 (58%) had prostate cancer. In patients with clinical stage B or C and PSA less than 4 ng/ml, 20/56 (36%) had prostate cancer, compared to 155 of 187 (83%) patients with PSA greater than or equal to 4 ng/ml. Transrectal ultrasound (TRUS) seemed not to be useful in screening for prostate cancer, due to its low specificity of 54%, although in patients with clinical stage B or C TRUS identified 157/175 (90%) patients with prostate cancer. For staging prostate cancer we compared in 103 men with pelvic lymph node dissection the value of digital rectal examination, computerized tomography (CT), magnetic resonance imaging (MRI), PAS, TRUS, and random systematic biopsy for identification of lymph-node-positive patients before radical prostatectomy. CT had a sensitivity of only 7% and a specificity of 96% in detecting lymph nodes, whereas MRI had a sensitivity of 50% and a specificity of 100%.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Diagnosis of localized prostate cancer: screening and preoperative staging]. 172 21

Between 1976 and 1989, 115 patients at UCLA had radical retropubic prostatectomy for clinically localized prostate cancer with positive surgical margins, penetration of tumor into or through the capsule, or positive seminal vesicles. Twenty-four of those received adjuvant radiotherapy after having recovered from surgery. Complications of adjuvant treatment were uncommon and included urethral strictures in 3 patients and transient leg edema in 1. No patient in this group has had proved clinical disease progression though 6 have isolated detectable serum prostate-specific antigen (PSA) values. Clinical disease-free survival at five and seven years was 92 percent. If detectable PSA is also considered as evidence of tumor recurrence, the corresponding disease-free survival rates were 75 percent at five years and 54 percent at seven years. The 91 patients who received no postoperative radiotherapy had a clinical disease-free survival of 67 percent at five years and 56 percent at seven years. Disease-free survival drops to 43 percent and 24 percent, respectively, if detectable follow-up PSA is considered an indicator of disease progression. The comparisons of the survivorship curves in this retrospective study for the two treatment groups are statistically significant both for disease-free survival (p = 0.041), and disease-free survival with undetectable PSA (p = 0.043). Adjuvant radiotherapy has a beneficial effect after radical prostatectomy in patients with local tumor extension.
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PMID:Adjuvant radiotherapy in patients post-radical prostatectomy with tumor extending through capsule or positive seminal vesicles. 172 97

Twenty-two patients seen between 1975 and 1988 were analyzed who had surgical attempts to cure locally advanced prostate cancer by exenterative procedures or salvage surgery for radiation recurrent disease. Twelve patients (Group I) underwent either a salvage cystoprostatectomy or perineal prostatectomy for radiorecurrent disease, including three patients with a Kock continent urinary diversion done in combination with the salvage operation. Five of the 12 (41.7%) recurrent disease confined to the surgical specimen and 11 of 12 (91.7%) are alive at a mean follow-up of 49 months, including four patients (25%) with a completely negative serum prostate-specific antigen (PSA) value (less than 0.2 ng/dl). All perineal prostatectomy patients are continent, and two of the three Kock pouch patients are continent. Ten of the 22 patients (Group II) had a cystoprostatectomy or exenteration for locally advanced disease that the surgeon did not think was amenable to standard radical prostatectomy. Only one of these ten patients had negative surgical margins, capsule, and seminal vesicles. Nine are alive (although only one patient has no evidence of disease) at a mean follow-up of 59 months. Morbidity was substantial with a 50% major complication rate including four patients requiring reoperation because of bleeding, abscess, bowel obstruction, or colostomy closure. Salvage procedures for radiorecurrent disease can be done safely, even with the inclusion of a continent diversion, and may be curative or provide survival benefit to carefully selected patients. Cystoprostatectomy or exenteration for locally advanced disease does not appear to be a curative endeavor for most patients and may be accompanied by significant morbidity.
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PMID:The role of radical surgery in the management of radiation recurrent and large volume prostate cancer. 187 80

Little is known about the efficacy of flutamide monotherapy in previously untreated patients with prostatic carcinoma. In this study, 40 patients with advanced disease were treated with 250 mg flutamide, three times daily. The mean follow-up was 7 months. After 3 months, 35 patients were evaluable for efficacy; 17 showed a partial response and 18 showed no change. Tumor response after 6 months was evaluated in 22 patients; 10 had a partial response, nine had stable disease, and three had progression. The level of prostate-specific antigen was reduced markedly following 6 months' treatment with flutamide. Levels of testosterone increased slightly but significantly, and were still elevated not significant after a follow-up period of 1 year. Follicle-stimulating hormone did not change markedly, whereas luteinizing hormone rose significantly. Eighteen patients experienced mild gynecomastia and eight suffered diarrhea. In two patients, flutamide was discontinued for 2 weeks due to serious diarrhea. One patient was withdrawn after 6 weeks because of cholestatic hepatitis. Sexual potency was evaluated in 15 patients, 10 of whom remained sexually active during treatment. Flutamide monotherapy was concluded to be relatively safe and effective in patients with advanced prostatic cancer.
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PMID:Flutamide monotherapy as primary treatment in advanced prostatic carcinoma. 194 17

Improved diagnostic information is obtained when prostate volume is correlated with results of prostate-specific antigen assays for early detection of prostate cancer. Three commonly used prostate volume measurement techniques were analyzed: planimetry, prolate ellipse volume calculation (HWL), and an ellipsoid volume measurement technique. For in vitro volume measurement, the declining order of accuracy was planimetry, HWL, and ellipsoid techniques. At the 95% confidence level, inverse prediction produced full-range values for a 40-cm3 model of 5.7, 16.0, 28.8, and 32.8 cm3 for planimetry, HWL, and the two ellipsoid techniques, respectively. Despite its superior accuracy, planimetry is not available on most ultrasound units, increases estimated clinical scanning time, requires additional equipment, and is difficult for a sole operator to perform. Although less accurate than planimetry, HWL is a rapid volume measurement technique that appears to be more accurate than ellipsoid software packages; its universal availability makes it practical for routine clinical use.
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PMID:Determination of prostate volume with transrectal US for cancer screening. Part II. Accuracy of in vitro and in vivo techniques. 158 7

Prostate cancer is the most common malignancy in men and the second leading cause of cancer deaths. Although the mortality rate for prostate cancer has remained unchanged for 50 years, new advances have changed classic concepts in the diagnosis and management of patients with this disease. Our understanding of the anatomy and natural history of patients with prostate cancer has been enhanced. The ability to diagnose early stage prostate tumors has been improved by the introduction of prostate-specific antigen and transrectal ultrasound. Clinical staging of patients with prostate cancer has been refined, which has decreased adverse effects of inappropriate treatment. Modifications in the technique of radical prostatectomy have minimized the morbidity associated with this procedure, making it a more attractive therapeutic option. DNA ploidy analysis holds promise as a predictor of response to hormonal therapy. New agents are available to reduce adverse effects of hormonal therapy. In addition, traditional ideas about the timing of hormonal therapy and the use of total androgen blockade are being challenged. These changes may presage an improved quality of life and improve survival for patients with prostate cancer.
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PMID:Prostate cancer. 201 19

Prostate cancer is the most common cancer among American men and is the third leading cause of cancer death in the United States. Over the past few years, significant advances (e.g. improved prostatic ultrasonography and the discovery of serum prostate-specific antigen) have made it possible to detect prostate cancer at an early stage. In addition, refinements in the treatment both of localized disease (by nerve-sparing radical prostatectomy) and of advanced disease (by novel forms of hormonal therapy) have improved the outlook and quality of life for men with prostate cancer.
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PMID:The diagnosis and treatment of prostate cancer. 203 96

Serum concentrations of prostatic acid phosphatase, prostate-specific antigen, neopterin, osteocalcin, tissue polypeptide antigen, and CA-50 were measured before onset of treatment in 86 patients suffering from prostatic carcinoma. In an attempt to identify patients with a poor prognosis, the data were related to patient survival after 3 years. When the standard reference values, which are based on studies on healthy subjects, were used in the study on the deceased, the diagnostic sensitivity was acceptable, whereas the diagnostic specificity was low. A better relation to prognosis was obtained if higher discrimination values were employed. The increased specificity could be obtained with little loss of sensitivity. It is suggested that the discrimination value should be chosen after careful consideration of the expected performance of the test in differentiating between defined groups of patients. To indicate short-term prognosis in prostatic cancer, a higher than normally recommended discrimination value for the marker should be selected.
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PMID:Tumor markers in human prostatic carcinoma. An optimation of reference values. 218 Jul 21

A statistical analysis of prognostic factors in 175 patients with hormonally treated disseminated prostatic cancer was done. The prognostic significance of performance status (PS), hemoglobin (Hb), alkaline phosphatase (Alk P), and testosterone was assessed with a univariate analysis. The authors did not find significant prognostic value in age, tumor size or grade, prostatic acid phosphatase, and prostate-specific antigen in these patients. In a multivariate logistic model (Cox regression), PS, Hb, and Alk P were found useful for dividing patients into prognostic groups. The prognosis for high-risk patients on standard hormonal treatment was very poor. The authors concluded that research on prognostic factors is useful and permits a division of patients into risk groups that makes choice of treatment more accurate. The use of new treatment combinations as a start treatment is appropriate for high-risk patients with disseminated prostatic cancer.
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PMID:Analysis of prognostic factors in disseminated prostatic cancer. An update. Dutch Southeastern Urological Cooperative Group. 218 88

Laboratory research continues to develop new methods supporting clinicians in the management of prostatic cancer. Routine measurements of serum prostate-specific antigen (PSA) levels improve diagnosis, provide insight into tumor burden, and sharpen prognostication. New organ-specific antigenic targets are identified for monoclonal antibody-directed diagnostic and radiotherapeutic reagents. Such new immunospecific conjugates are already under evaluation in clinical trials. Cell culture techniques carry the promise of noninvasive early detection and prognostic evaluation of prostatic malignancy in preclinical stages. Molecular mechanisms responsible for androgen regulation of proliferation and malignancy of prostatic cancer are becoming open for scientific inquiry.
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PMID:Prospective new developments in laboratory research and clinical trials in prostatic cancer. 220 19


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