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

The treatment of locally advanced prostatic cancer is controversial, as there are several possible treatment options. The aims of temporary androgen deprivation prior to radical prostatectomy are to achieve downgrading and downstaging of the tumor, an increase in local control, a decrease in morbidity and operative sequelae, a decrease in the time to progression, and an improvement in survival. A retrospective study has been carried out on 100 patients who underwent radical prostatectomy between 1988 and 1992. Forty patients received androgen deprivation therapy followed by prostatectomy, while the remaining 60 acted as controls, undergoing prostatectomy alone. Treated patients had a 40-50% reduction in prostate volume after 3 months, facilitating dissection of the prostate, reducing intraoperative blood loss, and reducing operation time. Of these 40 treated patients, one third showed clinical downstaging; one patient staged initially as T2/B was downstaged to PT0. The proportion of patients with positive surgical margins was 32% in the group treated preoperatively, compared with 57% in untreated patients. Treated patients also recovered full continence more rapidly after the operation than patients who underwent prostatectomy alone. After androgen blockade, serum PSA levels returned to normal (< 4 ng/ml) in 37 of the 40 patients. Of these patients, 22 had undetectable serum PSA levels (< 0.25 ng/ml), showing a definite reduction in tumor activity. PSA levels after 3 months of neoadjuvant hormonal treatment might play a useful predictive role in selecting patients before radical prostatectomy, since 86% with undetectable PSA had tumors confined to the gland (T2/B2), while patients who still had PSA > 4 ng/ml all had stage T3-T4 tumors. Although downstaging was confirmed pathologically in only 13% of patients, this is of significance when the total number of patients with locally advanced prostate cancer is considered and, therefore, may have implications for survival in the future. Prospective randomized studies should provide conclusive information on the potential benefit of this approach.
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PMID:Neoadjuvant androgen blockade prior to prostatectomy: a retrospective study and critical review. 751 32

Diseases of the prostate are of high socioeconomic importance owing to their high incidence and prevalence rates. Benign prostatic hyperplasia (BPH) can be detected in 80% of males over the age of 80. Clinical symptoms do not correlate with organ enlargement. Only 10% of patients with BPH need surgical treatment. The decision for surgical treatment is made as a result of objective findings and the symptoms reported by the patient. Preoperative evaluation of BPH must include digital rectal examination (DRE), measurement of peak flow rate, sonographic estimation of residual urine, transrectal ultrasound (TRUS), urethrocystography and the assessment of subjective complaints using symptom scores. Prostatic carcinoma is the most common malignancy in men. An abnormal DRE, increased PSA level and/or hypoechogenic lesions in TRUS are indications for prostate biopsy. The sensitivity of TRUS is superior to that of CT and MRI. New MRI techniques are promising with regard to local tumour extent. Whereas CT and MRI are not useful in screening of patients, these methods are valuable diagnostic tools in the follow-up of prostate cancer.
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PMID:[The value of diagnostic imaging in benign prostatic hyperplasia and prostatic cancer]. 751 94

The natural history of prostate cancer has long been regarded as unpredictable. The discrepancy between histologically identifiable (40%) and clinically diagnosed carcinomas (8%) led to the term of "latent" prostate cancer and to considerable diagnostic and therapeutic dilemmas. Based on our previous studies showing that biological aggressivity of prostate cancer is a direct function of tumor volume and that tumor volume and serum PSA are proportional, we evaluated two basically different groups of patients. The first group consisted of 43 patients with untreated carcinomas of the prostate followed with serial PSA determinations. The exponential (log-linear) rise in PSA led us to the conclusion of an exponential tumor growth rate. The median doubling time of clinically organ-confined tumors was 4 years and became shorter with higher clinical stages and poorly differentiated histological grades. The second group consisted of 139 patients who underwent cystoprostatectomy for bladder cancer and had no evidence for simultaneously identifiable prostate cancer. In 55 patients (40%), unsuspected prostate cancer was found in the specimen; the volume distribution of these carcinomas was exponential. These 139 men included 11 (7.9%) who had a prostate cancer with a volume greater than 0.5 cm3, corresponding to the 8% risk for a man being diagnosed within his lifetime with a clinically significant carcinoma of the prostate. We conclude that the other 44 carcinomas, which were less than 0.5 cm3 in volume, will never reach clinical significance because of their small size and their long doubling time; in this sense they can be considered latent.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Effect of the natural history on management of adenocarcinoma of the prostate]. 751 16

Fifteen years after its discovery, PSA is the most useful marker for prostate cancer. We summarize the biomolecular characteristics of PSA and the various PSA assays. We define its role in the diagnosis of prostate cancer, and we discuss its value in the monitoring of treated patients.
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PMID:[Prostate-specific antigen: an evaluation 15 years after its discovery]. 751 5

PATIENTS with T1/T2 prostate cancer are well served by external beam radiation. 1. T1/T2, N0, M0 PATIENTS: The 10-year outcome of N0 patients is equal to that obtained by radical prostatectomy in similar patients without the operative mortality or incontinence that accompanies the latter procedure. Ten-year cure has been confirmed by PSA studies in irradiated patients, while this has not yet been demonstrated in surgical patients. 2. T1, NX, M0 PATIENTS: After radiation therapy these patients show no excess mortality as long as 15 years after treatment, an outcome confirming a strict criteria of cure. 3. T2, NX PATIENTS: After radiation therapy, these patients show continuing excess mortality to 15 years, but most 15-year survivors are NED, again supporting the concept of long-term cure. 4. T1/T2 N+, M0 PATIENTS: We must have clinical trials in these patients that study the roles of radiation, androgen deprivation, and surgery. 5. Conformal treatment technology is improving the technical delivery and dose administered by radiation therapy and decreasing both the acute and late side effects of treatment. It remains to be proved whether the increased dose and accuracy will improve local control and cure as hoped.
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PMID:Treatment of early stage prostate cancer: radiotherapy. 751 42

The serological results from apparently healthy individuals and prostate cancer patients were evaluated with a new assay called TPAcyk ELISA. This assay has a biochemical specificity for fragments of cytokeratins 8 and 18, and exhibits a low within- and between-assay imprecision. The data indicate a significant difference between the results of males and females, but no significant age-dependent relation was found. The cut-off value (95% specificity) for healthy individuals was estimated to be 1.27 ng/mL (n = 190) for males and 0.95 ng/mL (n = 81) for females. When using a cut-off value of 1.27 ng/mL, we found a sensitivity for prostate cancer patients with T2-3 N0M0 of about 20%. For patients with metastatic disease, a sensitivity of 75% was found. A higher sensitivity was obtained with patient sera analyzed with PSA than with TPAcyk, particularly in patients with early stages of the disease. We conclude that the results from this new TPAcyk assay were significantly elevated in patients initially diagnosed with poorly differentiated tumors, that patients with localized tumors exhibited low concentrations, and that patients with metastatic disease showed, on average, 8 times higher concentrations than patients with localized disease. The combination of the TPAcyk and PSA results increased the sensitivity for prostate cancer, particularly in patients with metastatic disease.
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PMID:Evaluation of a new tumor marker for cytokeratin 8 and 18 fragments in healthy individuals and prostate cancer patients. 751 71

As part of the search for alternatives to transurethral resection of the prostate (TURP) attention has (re)turned to laser methods. We describe our experience with the currently available endoscopic beam deflection devices, particularly the Prolase II. 25 patients, generally with medical reasons to avoid TURP, and with proven bladder outlet obstruction (BOO) due to benign prostatic enlargement (BPH) underwent prostatic laser coagulation. Average age was 72 years (range 57-84), mean prostatic size by transrectal ultrasound (TRUS) was 48 g (15-100), average pretreatment peak flow rate (FR) was 7.6 ml/s (4.56-12.4). All patients were markedly symptomatic. Patients underwent clinical examination, Prostate specific antigen assay (PSA = 3.75, range 0.1-10.2), and TRUS preoperatively to exclude prostate cancer. After cystoscopic assessment the prostate was lasered according to the device manufacturers recommendations and clinical experience. A suprapubic catheter (SPC) and urethral catheters were inserted, the urethral for 24 hours. If voiding was satisfactory the SPC was removed after 24-48 hrs. Alternatively the patient was discharged and assessed at weekly intervals for SPC removal. Mean duration of SPC drainage was 11 days. Total mean impatient stay was 4.5 days (2-13) during a mean of 2 admissions. Blood loss was minimal and there were no other significant complications. At a minimum follow up of 3 months mean peak FR was 15.3 ml/s (9-31). Symptom scores (IPSS) fell from a mean of 21 to 10 by 3 months after treatment. There was an initial period of irritability for up to 12 weeks but symptomatic improvement was noted in all.
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PMID:[Therapy by endoscopic laser for prostatic obstruction]. 751 89

PSA is, currently, the best marker to detect prostatic changes, although it looses specificity when used in the differential diagnosis of certain pathologies of the prostate gland. Forty-four patients with benign prostate hyperplasia were analyzed and 26 (59%) of them were found to have higher than normal PSA levels. An estimate was made of the degree of correlation between serum PSA and prostatic volume in the patients examined, so as to find a formula that could be useful to apply this marker in the differential diagnoses of prostate adenoma and hidden prostate cancer. No linear relationship was found between prostate volume with benign hyperplasia and PSA (R = 0.13). This lack of relationship in a high percentage of patients with prostate adenoma induces to turn unnecessary to histopathological confirmation in order to rule out prostate cancer.
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PMID:[Relationship between serum PSA and prostate volume in benign hyperplasia]. 751 40

Correct forecasting of prostatic carcinoma by means of serum PSA is limited. Prostatic carcinoma is said to increase PSA 10 times as much as prostatic adenoma. Therefore we evaluated whether PSA in the prostatic fluid is more specific for prostatic carcinoma than the level in the serum. In 31 consecutive patients with prostatic disease blood was taken for serum PSA first and then prostatic fluid (10 microliters) was expressed. The PSA was determined by the Pros-Check test in both the serum and in the prostatic fluid. The collection of the prostatic fluid failed in 7 (22.6%) patients. Of the remaining 24 patients, 5 had documented bacterial prostatitis, 4 had prostatic carcinoma and 15 had benign prostatic hyperplasia (BPH). The serum PSA was 5.6 +/- 5.0 micrograms/l in prostatitis, 148 +/- 208 micrograms/l in prostatic carcinoma and 6.9 +/- 6.8 micrograms/l in BPH. The serum PSA was significantly higher in prostatic cancer (P < or = 0.01) than in prostatitis and BPH. The PSA levels in the prostatic fluid were 14.0 +/- 25.7 x 10(6) micrograms/l in prostatitis, 7.6 +/- 9.7 x 10(6) micrograms/l in carcinoma and 14.0 +/- 14.6 x 10(6) micrograms/l in BPH. There were no statistically significant differences. In the expressed prostatic fluid no significantly different PSA was found in carcinoma, bacterial prostatitis or BPH. In contrast to this, the serum PSA was significantly higher in cancer patients than in prostatitis or BPH. Therefore PSA in the expressed prostatic fluid is no more specific than that in the serum.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[PSA in prostatic fluid]. 751 4

To examine prospectively the usefulness of measurement of rate of change in serum prostate specific antigen levels (PSA slope) in detecting prostate cancer in a PSA-based prostate cancer screening study, we evaluated 982 serially screened men whose initial screening was negative for cancer. All men had at least 1 PSA value greater than 4.0 ng./ml. and all ultimately underwent prostatic biopsy. For those who entered the study with normal PSA levels, a PSA slope cutoff point of 0.75 ng./ml. per year or more maximized sensitivity and specificity for predicting cancer (odds ratio 7.20, 95% confidence interval 4.52 to 11.47). This cutoff point was most predictive for men 70 years old or younger. For men who entered the study with elevated PSA levels (greater than 4.0 ng./ml.) a lower PSA slope cutoff point (0.4 ng./ml. per year or more) maximized sensitivity and specificity for predicting cancer (odds ratio 2.73, 95% confidence interval 1.82 to 4.07). We conclude that PSA slope is useful for serial prostate cancer screening, although its predictive value varies with patient age and initial PSA level.
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PMID:Rate of change in serum prostate specific antigen levels as a method for prostate cancer detection. 752 Sep 50


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