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

The relation of prostatic intraepithelial neoplasia (PIN) or ductal dysplasia and the development of invasive prostate cancer is not clear. PIN, especially high grade, is usually associated with coexisting invasive cancer. Although some investigators have identified micro foci of invasive cancer evolving from PIN, the two are usually anatomically separated. Because of these distinct anatomic patterns, many investigators have concluded that PIN represents a "field effect" or marker of potential cancer progression, and is not directly involved in or leads to the development of invasive prostate cancer. We measured the DNA content in 49 foci of invasive cancer and 87 foci of PIN identified in 34 radical prostatectomies containing both PIN and invasive cancer. In addition, we examined 13 prostatectomies and 5 TUR specimens containing only PIN. We found that the majority of low grade PIN had normal or diploid range DNA and that approximately half of the high grade PIN were abnormal or aneuploid. Prostates with coexisting diploid range PIN and invasive cancer had an approximately equal number of diploid range and aneuploid invasive cancers. Conversely, almost all of the aneuploid PIN (usually high grade) had coexisting aneuploid invasive cancers. This would support the hypothesis that events in the progression of prostate cancer may be operative in both the development of PIN and invasive cancer.
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PMID:DNA quantitation of intraepithelial neoplasia and invasive carcinoma of the prostate. 845 53

The prevalence of BPH is high in elderly men with more than 60% of patients over the age of 60 experiencing some form of prostatism. Balancing the superior benefit of TUR/P are the small but significant risks and complications of surgery and the high cost of the procedure. The WHO guidelines recommend finasteride or alpha-blockers as treatment options for men with bothersome symptoms. Finasteride therapy reduces the volume of the hyperplastic prostate gland by more than 20%, improves the urinary flow rate and the symptoms associated with bladder outlet obstruction. Although statistically significant, results obtained with finasteride are just slightly better than placebo and TUR/P still offers the greatest improvement of symptoms. Finasteride is well tolerated and adverse events are rare. However, it decreases serum PSA (prostate specific antigen) by 50%, suggesting careful monitoring and exclusion of prostate cancer before initiation and during therapy. Current research is focusing on developing new 5-alpha-reductase inhibitors (type I and II) using polyunsaturated fatty acids and nonsteroidal inhibitors. Given the multifactorial nature of BPH, further clinical trials combining 5-alpha-reductors inhibitors and 5-alpha-receptor blockers are still needed.
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PMID:[The effect of 5-alpha-reductase inhibitors on benign prostatic hyperplasia]. 876 1

PSA is currently the best marker in the diagnosis and staging of prostate cancer, although it has a low specificity when trying to distinguish between BPH and prostate cancer. Between January 1994 and December 1995, 243 BPHs were diagnosed after prostate TUR and retropubic adenomectomy. A selection of 131 cases were analyzed based on PSA higher than 4 and normal rectal examination pre-surgery. After surgery PSA was determined again with a time interval from the earlier one ranging between 103-211 days, noting that in about 70% cases PSA levels were normalized and 64% of these also presented focused acute prostatitis, chronic prostatitis, prostate infarction, lithiasis or areas of abscess formation. In spite of a significant number of patients with high PSA levels, this elevation should be interpreted cautiously considering the large percentage of cases where posterior pathological anatomy is a sign of BPH. We believe that among the conditions that could justify such abnormal PSA elevations are those described of areas of chronic or acute prostatitis, prostate infarctions, areas of abscess formation and presence of intraprostate lithiasis.
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PMID:[Impact of prostatic benign hyperplasia and prostatic inflammation on the increase of prostate specific antigen levels]. 921 4

Serum prostate specific antigen (PSA) levels were measured using an ACS-PSA kit in 147 systematic biopsy cases (61 with prostate cancer (PC)) and 96 transurethral resection of prostate (TUR-P) cases (2 with PC). In the 147 biopsy cases, the sensitivity for PSA using 3.0 and 10.0 ng/ml as cut-off values was 91.8 and 90.2%, while the specificity was 9.30 and 30.2%, respectively. The sensitivity for PSAD (A) (calculated by transabdominal ultrasound) using 0.25 and 0.5 ng/ml/cm3 as cut-off values was 91.8 and 90.2%, while the specificity was 22.1 and 50.0%, respectively. These data indicated that PSAD (A) provided better information for detecting PC than PSA alone. No statistical difference was found between PSAD (A) and PSAD (R) (calculated by transrectal ultrasound) in the utility of detecting PC. PSA below 15.0 ng/ml was seen in sixteen patients with PC. Five of these sixteen patients had a PSA level of < 3.0, and they underwent prostate biopsy based on the abnormality by digital rectal examination (DRE). The other eleven patients had PSAD (A) level of > 0.3 ng/ml/cm3. In all 243 cases, PC was not found in the 49 patients (PSA < 3.0 ng/ml) or 91 patients (PSAD (A) < 0.25 ng/ml/cm3) who had no abnormal findings by DRE and transabdominal ultrasonography. These results suggested a criterion in the use of the ACS-PSA kit for the indication of prostate biopsy and TUR-P.
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PMID:[Clinical evaluation of chemiluminescence immunoassay PSA (ACS-PSA) for detection of prostate cancer]. 975

Based on autopsy and epidemiologic data the lifetime risk of developing prostate cancer for a 50-year-old man is 42%, but only 9.5% will develop a clinically manifest disease and only 2.9% will die from this disease. The actual rate of carcinoma detection using PSA, digital rectal examination and transrectal ultrasound is 1%-3%. The majority of prostate carcinoma never progress to clinically significant disease, a minor portion remains confined to the prostate for many years and other carcinomas progress rapidly to a life threatening disease. The dilemma for clinicians and pathologists dealing with this tumor is how to distinguish these three biologically different types. Pathologists play an important role in preoperative diagnosis and in the postoperative prognosis oriented evaluation of the prostatectomy material. Volunteer PSA screening trials have led to an enormous increase in core-needle biopsies of the prostate. Since biopsies are often performed in men without palpable or ultrasound-visible nodules, are now faced with an increasing number of equivocal morphological features which can not be clearly defined, even with standardized criteria. Further investigations are also required to elucidate the clinical importance of PIN detection in biopsies. The heterogeneous histomorphology of prostate carcinoma can not be used as a prognostic factor. Therefore the histological grading is a very important factor for the assessment of prognosis. Carcinoma grading in biopsies is also of limited value in predicting tumor stage. Currently, several different grading systems are in use. Gleason's grading is the most favored, although its reproducibility is very low. The stage of the prostate carcinoma is still the best prognostic factor. In order to accurately assess the pTNM stage, TUR or prostatectomy material must be subject to extensive and standardized processing. Additionally, the volume of the tumor, the vascular invasion, the amount of extension of the tumor through the prostate capsule and perhaps the neoangiogenesis might be valid prognostic factors for disease progress and for survival. The value of novel methods (p53, bcl-2, apoptosis, microvessel density, interphase cytogenetics, androgen receptor mutation, neuroendocrine cells, E-Cadherin) remains to be proved. DNA ploidy is a good prognostic factor after prostatectomy and can be used to plan adjuvant hormone therapy.
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PMID:Pathology of prostate cancer. Old problems and new facts. 1035 66

Transrectal high intensity focused ultrasound (HIFU) as a minimal invasive treatment approach of localized prostate cancer was evaluated concerning its efficacy and security. Post-operative monitoring included PSA-levels and histological results of control random biopsies. Seventy-three HIFU sessions were performed on 62 patients during the period from November 1997 to April 2000. Patients were classified in 4 indication groups: 1) localized prostate cancer, T1-T2, initial PSA < 15 ng/ml, Gleason score < 7, volume < 30 cc, no more than 4 of 6 random biopsies affected by cancer, not suitable for radical prostatectomy; 2) localized prostate cancer, T1-T3, no PSA or Gleason score limitation; 3) local recurrence after first line therapy (RPE, radiation, hormonal ablation); 4) for local debulking. Mean plus or minus standard deviation for patient age was 67.5 +/- 7.48 years, for PSA was 7.64 +/- 5.26 ng/ml and for prostate volume was 21.3 +/- 7.9 cc. Median follow up was 15 months (range 5-29) and included PSA development, control sextant biopsies and transrectal color coded duplex sonography (TCCDS) at 1, 3, 6, 12 and 24 months. At least 1 control biopsy result was available in 48 patients. We evaluated the therapy in 3 categories: 1) group 1 (complete response) included 33/48 patients (68.7%) with no residual cancer and PSA < 4 ng/ml; 2) group 2 (biochemical control) 8/48 patients (16.7%) with small residual cancer and PSA < 4 ng/ml; 3) group 3 (failure) 7/48 patients (14.6%) with residual cancer and PSA > 4 ng/ml (4 of them received hormone therapy). As major complications 2 urethrorectal fistulas occurred, both in post-radiation patients, 3 stress-incontinences II-III after TUR post HIFU. In 20 patients (32.3%) transurethral manoeuvres were necessary to remove obstructive necrotic tissue or because of bladderneck or urethral strictures. 11 of these patients were among the first 20 treated patients. Regarding the individual learning curve about technique, indication and the technical developments HIFU treatment can currently be considered as a valid alternative treatment strategy for patients with localized prostate cancer, who are not suitable for radical surgery. HIFU treatment can be repeated depending on biopsy result and PSA development. Local control of the localized prostate cancer was observed in group 1 and 2 (85%).
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PMID:Local control of prostate cancer by transrectal HIFU-therapy. 1122 Oct 62

From January 1993 to June 1998, 319 cases were histopathologically diagnosed as prostatic cancer. In 7 of the 319 cases (2.2%) transurethral resection of the prostate (TUR-P) had been performed and a diagnosis of benign prostatic hyperplasia had been made with the resected specimens. The interval between TUR-P and the diagnosis of prostatic cancer ranged from 22 months to 15 years. All the cases showed an elevation of the prostate specific antigen (PSA) value (6.4-399 ng/ml, Tandem-R: RIA) at the time of cancer diagnosis. In 2 cases, PSA was measured in cancer screening. The clinical stage was stage B1 in 2 cases, stage B2 in 2 and D2 in 3. Only one case had been regularly followed-up after TUR-P, in which cancer was diagnosed by needle biopsy 22 months after TUR-P, because of the sustained high PSA values. Since most of such patients have an advanced stage of prostate cancer, it is of importance to have periodical follow-up examinations after TUR-P. The measurement of PSA appears the most reliable means in this way.
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PMID:[Prostatic cancer developing after transurethral resection of the prostate for benign prostatic hyperplasia]. 1123 14

At the time of diagnosis, prostate cancer is organ confined in 70% of the cases. Of these patients, 25% undergo local therapy (surgery/radiation), and 75% risk disease progression by "watchful waiting" or systemic side effects through hormonal ablation. Local high-intensity focused ultrasound (HIFU) for minimal invasive tissue coagulation (85 degrees C) ablates prostatic tissue with high precision. Follow-up sextant biopsies (1.9) showed 80% of the patients to be cancer free. In those cases with residual cancer, the tumor mass was reduced by more than 90%. The PSA nadir in 97% was < 4 ng/ml, including 61% < 0.5 ng/ml. After primary HIFU, no severe side effects occurred (no fistula, no grade II/III incontinence, no rectal mucosa burn). As auxiliary treatments, all patients received a suprapubic tube (29 days), and 33% needed a transurethral debris resection (TUR 7 g). The patients were released from the hospital within 24 h after treatment. According to the short-term follow-up, transrectal HIFU enables minimal invasive local prostate tissue ablation with high rates of negative biopsies, low PSA nadir, and low complication rate.
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PMID:[Therapy of local prostatic carcinoma with high intensity focussed ultrasound (HIFU). Outcome and side-effects]. 1140 27

Transurethral resection of the prostate (TUR-P) was performed on 463 consecutive patients with clinically diagnosed benign prostatic hyperplasia (BPH) between April 1994 and June 2000. Pathological examinations of resected prostatic tissues revealed prostatic cancer in 15 (3.2%) of them. Eight (53.3%) of them were in stage A1, and 7 (46.7%) in stage A2. Between 15 cases with prostatic cancer and those with BPH, clinical features including age, serum prostate specific antigen (PSA) levels, prostatic volume, PSA density (PSAD), and resected prostatic tissue weight were compared. As a result, age was the only parameter related with prostatic cancer with a statistically significant difference. The higher the age, prostate cancer was found more frequently. Postoperatively, radical prostatectomy and antiandrogen therapy were performed in 1 and 9 cases, respectively. The remaining 5 cases are being followed with no treatment for prostatic cancer, and have shown no findings suggesting recurrence. These 15 cases are all living disease-free at present. It seems of importance to explain preoperatively the possible detection of prostatic cancer in association with TUR-P, particularly for elderly patients aged 80 years or older.
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PMID:[Clinical study on prostatic cancer detected incidentally by transurethral resection of the prostate]. 1186 78

Nikolai Alekseevich Lopatkin, Academician of the Russian Academy of Medical Sciences, has contributed much to development of prostatic cancer (PC) diagnosis and treatment in the Russian Federation. N. A. Lopatkin headed specialists from the Research Institute of Urology who were the first in Russia to introduce into clinical practice the method of interstitial radiotherapy (brachitherapy) of local prostatic cancer (PC). A total of 58 PC patients 42 to 76 years of age were treated. They had stages T1bN0M0 (n = 5), T2aN0M0 (n = 36), T2bN0M0 (n = 11), T3aN0M0 (n = 6). Staging was made by the data of finger rectal examination, transrectal ultrasonography, NMR tomography, radionuclide osteoscintigraphy. Mean PSA was 2.5-36 ng/ml in the size of the prostatic gland 14.96-52.76 cm3. All the patients received neoadjuvant hormone therapy. Four patients one year or more before the radiotherapy had TUR of the prostate. Brachytherapy was made under peridural anesthesia which allowed implantation of 40-120 sources with activity of 0.38-0.35 mCi for 20-45 min. A total dose was 120-160 Gy. Mean hospital stay was 4 days. Spontaneous urination recovered within 6 postoperative hours. The procedure was well tolerated, complications arose on postimplantation day 2-8. We attribute complications to inadequate calculation of the doses at the stage of the method introduction. A short follow-up (3 years) is not long enough to allow conclusions about the efficacy of the method. Within 3 years biochemical recurrence occurred in 4 (6.9%) patients on months 14-26 (stage T2b and 2-T3). Four patients were lost for follow-up. Thus, brachytherapy efficacy depended much on adequate selection of the patients and planning of the procedure by the results of previous volumetry. The procedure is safe and reproducible. The studies will be continued.
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PMID:["I-125 Rapid-Strand" interstitial radiotherapy of localised prostate cancer]. 1502 39


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