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

Therapeutic considerations for prostatic cancer are determined by the stage and the differentiation of the tumor and by the patient's age. Local treatment (radical prostatovesiculectomy, external or interstitial irradiation) is reserved for T1-T2 N0 M0 tumors. The best cure rate in these tumor stages achieves the radical prostatectomy, which is indicated up to the 70th year of life, provided a good general condition. Impotentia after radical prostatectomy appears in almost 100% while urinary incontinence occurs in about 5%. External or interstitial irradiation can also be used in stage T1-T3 N0 M0, if radical surgery is not possible. The 5- and 10-year survival rate after high voltage or interstitial radiation therapy for stage T1-T2 reaches up to 75% and 47%, respectively, while for stage T3 the survival rate lies between 50% after 5 years and 30% after 10 years. Prostatic cancer proceeding across the border line of the prostate or metastasizing tumors can be treated by systemic therapy modalities. The contrasexual therapy (orchiectomy with or without estrogens) and the employment of antiandrogens are palliative methods. The efficacy of these therapy modalities depends on the hormone receptors in the neoplastic tissue, although these receptors are difficult to prove until now. Cytostatics are used in hormone resistant tumors, but the success rate is rather low. Adjuvant procedures (hypophysectomy and bilateral adrenalectomy) are of no importance anymore. Hyperprolactinemia is an indication for bromocriptine, and cortisone can reduce pain by reduction of perimetastatic edemas.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Prostatic cancer--what to do?]. 663 26

Data are drawn from the pertinent literature supporting diethylstilbestrol for initial endocrine treatment of advanced prostatic cancer. When diethylstilbestrol is given in a dosage of 2 mg daily, the risk of cardiovascular complications is low. Bilateral orchiectomy is reserved for high-risk patients or those intolerant of estrogen. To prevent possible complications of uncontrolled tumor growth and perhaps to increase survival time, endocrine treatment of advanced prostatic cancer should be started early.
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PMID:Endocrine treatment of prostatic cancer. 686 24

64% of all patients with newly diagnosed prostatic carcinoma present with metastases. Hormone application with or without orchiectomy appears to be the adequate form of primary treatment. The most common therapeutic modality is estrogen administration, which has, however distinct disadvantages: The patient is protected up to 5 years only, there is a 27% cardiovascular mortality, it induces a prolactin surge, and is immunosuppressive. Phase III-studies of the EORTC and VACURG have demonstrated that medroxyprogesterone acetate and cyproterone acetate parallel the effectiveness of estrogens. In a phase II-trial adjunctive bromocriptine was found to be necessary to suppress estrogen or antiandrogen induced hyperprolactinemia. The following concept is derived: In disseminated untreated prostatic cancer estrogens or antiandrogens in combination with bromocriptine or high dose injectable gestagens are effective means of primary treatment. Distinct clinical parameters determine the "hormone of first choice". Orchiectomy is reserved for patients with ureteral compression or progressing disease.
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PMID:[Hormone therapy of prostatic cancer (author's transl)]. 719 68

The following endocrine treatment modalities have been used in advanced prostatic carcinoma: 1. orchiectomy plus estrogens; 2. primary orchiectomy with delayed estrogen employment; 3. initial estrogen therapy with delayed orchiectomy; 4. initial cyproterone acetate or medroxyprogesterone acetate; 5. a combination treatment: estramustine phosphate, cyproterone acetate or estrogens plus bromocriptine. The application of phase-III studies permits the subsequent conclusions: Simultaneous orchiectomy is to no advantage (exception: urinary stasis). Cyproterone acetate does neither yield better nor worse results regarding survival than estrogen alone, but has fewer side effects. Estrogens and cyproterone acetate produce a rise of serum prolactin justifying the use of bromocriptine (or lisuride). Estramustine phosphate should be reserved for relapsing prostatic cancer.
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PMID:[Current aspects of hormonal therapy in prostate cancer]. 728 76

The experience after 10 years with anatomical radical retropubic prostatectomy at The Johns Hopkins Hospital is reviewed. Between April 1982 and March 1991, 955 men with clinically localized prostate cancer (clinical stages T1 to T2) underwent staging pelvic lymphadenectomy and anatomical radical retropubic prostatectomy. Using actuarial analysis, at 10 years the likelihood of an undetectable prostate specific antigen (PSA) level was 70%, isolated elevation of PSA 23%, distant metastases 7% and local recurrence 4%. The actuarial likelihood of an elevated serum PSA increased with increasing pathological stage: the 10-year likelihood of freedom from PSA relapse was 85% for men with organ confined disease, 82% with focal capsular penetration, 54% with established capsular penetration and Gleason score 2 to 6 disease, 42% with established capsular penetration and Gleason score 7 to 10 disease, and 43% with seminal vesicle involvement. These data indicate that radical prostatectomy cures the majority of men with organ confined disease or with well to moderately well differentiated tumors that have penetrated the prostatic capsule to the extent where it is possible to obtain a clear surgical margin. Radical prostatectomy should be reserved for patients who can be cured and who will live long enough to benefit from it. These are also the patients who have the best quality of life postoperatively.
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PMID:Cancer control and quality of life following anatomical radical retropubic prostatectomy: results at 10 years. 793 40

The Prostate Cancer Intervention Versus Observation Trial (PIVOT) is a randomized controlled trial sponsored by the Department of Veterans Affairs and the National Cancer Institute. PIVOT will enroll 2,000 participants from at least 80 Veterans Administration and National Cancer Institute medical centers. The purpose of PIVOT is to determine which of 2 strategies is superior for managing clinically localized prostate cancer (stage T1/T2NXM0) of all histological grades. Patients less than 75 years old will be randomized to either radical prostatectomy with early intervention for disease persistence/recurrence or expectant management with palliative therapy reserved for symptomatic or metastatic disease progression. Participants will be excluded if they have received prior therapy for prostate cancer (except transurethral resection of the prostate) or are judged not to be candidates for radical prostectomy. All patients with newly diagnosed prostate cancer will be recorded on the PIVOT screening log. Registry information will include patient age, race, prostate specific antigen level, clinical stage, histological tumor grade, initial therapy, and vital status. Patients meeting eligibility criteria will watch an information and randomization video tape developed for PIVOT. Participants will be randomized over a 3-year period and followed for a minimum of 12 years. Data collected at followup will include urological symptoms, disease and treatment related morbidity, and disease specific and overall quality of life. Evidence of symptomatic or asymptomatic disease persistence, recurrence or progression will be measured by questionnaire, physical examination, digital rectal examination, prostate specific antigen and annual bone scan. The primary study end point will be all cause mortality. Secondary outcomes will include prostate cancer and treatment specific morbidity and mortality rates, health status, predictors of disease specific outcomes and cost-effectiveness. PIVOT will provide a 90% power to detect a 15% relative decrease in all cause mortality and a 35% relative decrease in prostate cancer specific mortality rate by either treatment strategy.
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PMID:The Prostate Cancer Intervention Versus Observation Trial: a randomized trial comparing radical prostatectomy versus expectant management for the treatment of clinically localized prostate cancer. 793 47

In this article, we review the current status of early detection of prostate cancer. From existing data in the medical and urologic literature, we developed an algorithm that uses the three current methods of detection: digital rectal examination (DRE), determination of the prostate-specific antigen (PSA) value, and transrectal ultrasonography (TRUS). Prostatic malignant disease is an increasing medical problem in the United States. The potential for cure is optimized by early detection and treatment of organ-confined disease. Mass screening for prostate cancer in asymptomatic men cannot be advocated until a decrease in the mortality rate is established by randomized, controlled studies; however, these data will be unavailable for at least 15 years. In the meantime, clinicians must prudently use DRE, PSA, and TRUS for early detection. Current data indicate that the PSA level is as effective as or more effective than DRE for the detection of prostate cancer. These two methods do not always detect the same malignant tumor; therefore, the combined use of DRE and PSA testing provides a more complete evaluation of the prostate gland for malignant involvement. TRUS is more costly and does not add appreciable detectability when results of both the DRE and the PSA determination are normal. Thus, TRUS is best reserved for patients who have abnormal results of DRE or increased PSA values.
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PMID:Prostate-specific antigen, digital rectal examination, and transrectal ultrasonography: their roles in diagnosing early prostate cancer. 768 39

Prostate cancer has become one of the most important national health problems, as its incidence increases yearly. Conventionally, single-modality local therapy has been the standard of care for clinically localized stage disease and systemic therapy, in the form of primary or combined androgen deprivation, is reserved for advanced, usually metastatic, prostate cancer. Despite improvements in local therapy, a significant number of patients with clinically localized prostate cancer will suffer a systemic relapse after potentially curative local therapy and, despite 50 years of experience in hormone therapy, significant survival prolongation for patients with metastatic prostate cancer remains a challenge. This paper explores potential future systemic therapy strategies in the treatment of prostate cancer. Specifically, the role of adjuvant systemic therapy as part of a multimodality treatment approach for localized prostate cancer and alternative applications of hormone and chemohormone therapies for patients with metastatic disease are discussed.
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PMID:Future directions in prostate cancer treatment: an oncologist's perspective. 863 Feb 25

The role of free (F) and complexed serum PSA is now under investigation. In the present study, we evaluated the clinical significance of F-PSA and F/Total (T) PSA ratio in a preliminary series of samples from 88 patients with prostate cancer (PC), 113 with benign prostatic disease (BPD), and 98 with non-prostatic disease (NP). We used the F-PSA and third generation T-PSA (DPC, Los Angeles, USA) chemiluminescent enzyme immunometric assays with the IMMULITE automated system. At the 10 ng/ml cutoff for T-PSA levels, we obtained a sensitivity of 83% with a specificity of 100% in NP and 80% in BPD. The addition of the F/T ratio--rather than F-PSA levels--was useful to better discriminate PC and BPD in the cases erroneously classified by T-PSA alone: 44/68 samples (65%) were correctly diagnosed. Moreover, the F/T ratio was particularly effective in the critical T-PSA range between 4.1-9.9 ng/ml; 26/40 cases (65%) were correctly evaluated. In conclusion, the F/T ratio seems to be an interesting auxiliary test to T-PSA, to be reserved for selected cases where additional diagnostic information is necessary.
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PMID:Preliminary clinical evaluation of free/total PSA ratio by the IMMULITE system. 874 Jun 38

Both bladder and prostate cancer could be treated successfully when diagnosed at the early period of their natural history. Cystoscopy is the most important diagnostic test for the early detection of bladder cancer, particularly in patients complaining of asymptomatic macrohematuria. Superficial bladder cancers (Stage Ta or T1) could be treated by either transurethral resection or intravesical instillation of anticancer drugs with the bladder function reserved. Among diagnostic modalities for prostate cancer, transrectal sonography (TRS) offers the most reliable information in staging the disease. Organ-confined prostate cancer (Stage A or B) is expected to have good prognosis when treated by either radical prostatectomy or hormonal manipulation. Mass screening using digital rectal examination, prostate specific antigen and TRS is promising for the early detection of prostate cancer.
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PMID:[Diagnosis and treatment of bladder and prostate cancer in early stages]. 896 75


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