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

Prostate-specific antigen (PSA) is a protease able to bind to serum antiproteases as alpha 1 antichymotrypsin (ACT). Free PSA (FPSA) corresponds to the fraction of total PSA (TPSA) which is unbound to ACT. Specific detection of the FPSA seems to be a valuable tool in the distinction between prostatic cancer (PCa) and benign prostatic hyperplasia (BPH). Our aim was to evaluate retrospectively the FPSA/TPSA ratio in comparison to TPSA or FPSA determination, using two new immunoradiometric assays (PSA-RIACT and FPSA-RIACT, CIS bio international, Gif Sur Yvette, France) in the early diagnosis of PCa. 256 men, with TPSA levels between 0.7 and 44.7 ng/ml (median age = 69 years), including 164 sera obtained from patients with BPH and 92 sera from patients with untreated PCa were assayed. All diagnoses were histologically confirmed and patients tested before any adjuvant treatment. The evaluation of the median FPSA/TPSA ratio in the two groups showed significantly different values (BPH group: 24.2%, PCa group: 12.1%, P < 0.0001). By R.O.C. (Receiver-Operating-Characteristics) analysis, we show that the FPSA/TPSA ratio is the method of choice for discriminating BPH and PCa, since the area under curve is the greatest for the FPSA/TPSA ratio curve, as compared to the TPSA or FPSA curves (P < 0.0001). The best accuracy (number of true positive + true negative/total = 82.4%) was obtained with a FPSA/TPSA ratio < or = 15% with high odds ratio (20.5; confidence interval (CI): 11.2; 37.7). Of interest, similar results were also confirmed even in the subpopulation with serum TPSA levels between 2.5 and 10 ng/ml (161 patients including 99 BPH and 62 PCa). We thus confirm that combined serum measurement of FPSA and TPSA is of particular interest in the early diagnosis of PCa for patients with non-suspicious digital rectal examination and a TPSA value between 2.5 and 10 ng/ml. In those patients, biopsy should be reserved to the cases with FPSA/TPSA below 15%, which allows significant odds ratio (12.8; CI: 5.2; 31.4). Otherwise, to avoid the risk of missing any PCa, usual follow-up with combined TPSA and FPSA determination would be required with the same criteria of biopsy (i.e. FPSA/TPSA ratio < or = 15% when TPSA value is between 2.5 and 10 ng/ml; or TPSA > 10 ng/ml).
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PMID:Percentage of free serum prostate-specific antigen: a new tool in the early diagnosis of prostatic cancer. 901 50

This work deals with our experience of a programme of early diagnosis of prostate cancer carried out on patients suffering from dysuria through rectal-digital examination (EDR), hematic dosage of PSA (IRMA COAT-A-COUNT DPC) and transrectal echtomography. We have also quantified the costs and verified which methods, either single or combined with other methods, are most advantageous as regards costs/benefits. From Jan 1991 to Jan 1995 306 of 1185 patients (25.8%) underwent prostate biopsy by means of transperineal echograph with gauge 18 needles as in Hodge's technique. Histologic examination revealed prostate adenocarcinoma in 81 (26.5%) cases, benign prostate hypertrophy in 196 (64%), acute and/or chronic phlogosis in 26 (8.5%) and granulomatosic prostatitis in 3 (1%). The diagnostic sensitivity, preciseness and accuracy were, respectively, 92.5%, 78.3%, 79.3% for the EDR, 80.2%, 93.3% and 90% for PSA with cut-off 10 ng/ml, 91% 78.3%, and 90% for the PSA with cut-off 4 ng/ml, 100%, 30.3% and 48.6% for the echograph, 98.8%, 60% and 77% for EDR+PSA (cut-off 4 ng/ml), 98.8%, 65.8 and 79.9% for EDR+PSA (cut-off 10 ng/ml), 100%, 22% and 64.2% for EDR+echograph, 100%, 20% and 62.9% for echograph+PSA (cut-off 4 ng/ml), 100%, 26.6% and 64.9% for echograph+PSA (cut-off 10 ng/ml). We calculated that a programme of early diagnosis using the three methods, if completely at the patient's expense, would cost 207.000-437.000 lire (average 322.000) per patient for a total of 245,295,000-517,845,000 (average 381,570,000). An eco-guided prostate biopsy with a histologic examination would cost 250.000-500.000 lire (average 375.000) per patient with a total cost for 306 patients of 76,500,000-153,000,000 (average 114,750,000). We also quantified, in the light of the results reported here, the number of biopsied which would have been necessary if we had used only two methods in the screening and we also estimated the costs. The results reveal that the echograph is not to be considered as a first approach method as it gives a high number of false positive results; in fact if we had excluded it from the screening we would not have ignored any diagnosis of prostate neoplasia and we would have avoided about 141 (46.2%) biopsied with a reduction in health expenditure of 62.1%. On the contrary the EDR and the PSA have a better cost/benefit result: setting the cut-off of the PSA at 4 ng/ml or at 10 ng/ml without varying the diagnostic accuracy, the sensitivity and/or specificity of the method increase respectively. To conclude, we consider the EDR and the serum dosage of PSA necessary and adequate methods in the programme of early diagnosis and screening of prostate neoplasy. The prostate echography should be reserved for cases of doubt (hematic PSA between 4-10 ng/ml etc.) and for the exclusion of needle biopsy. These measures also result in an optimization of health expenditure.
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PMID:[Screening for prostatic carcinoma in dysuric patients: diagnostic protocols and cost-benefit analysis]. 927 88

The incidence of prostate cancer is rising worldwide, caused mainly by demographic factors, particularly the increasingly elderly population and, more importantly, the increasing number of cases identified following prostate specific antigen (PSA) testing. It is commonly quoted that many more men die with prostate cancer than of it. Autopsy/post-mortem studies show that while a very high proportion of elderly men have histological evidence of the disease, a much smaller proportion develop clinically apparent cancer. The natural history of prostate cancer is poorly understood, but progression appears to be related to stage and grade of tumour. Prostate cancer can be diagnosed by digital rectal examination (DRE), serum PSA test, and/or transrectal ultrasound (TRUS), with confirmation by biopsy. Each test identifies a proportion of cancers, with higher rates of detection when they are used in combination. The tests are also used to determine which tumours are localised within the prostate and are, thus, potentially treatable. Unfortunately, clinical staging is unreliable, with approximately one half of all tumours upstaged following surgery. Three major treatment options are available for localised prostate cancer: radical prostatectomy, radical radiotherapy and conservative management (involving monitoring and treatment of symptoms). Although radical treatment rates are rising, good quality evidence concerning their comparative effectiveness and cost-effectiveness is lacking. Observational studies of highly selected patient groups suggests that there may be a slightly lower mortality rate following radical treatments compared with conservative management, but there has been very little research into treatment complications and quality of life of men after any of the treatments. In the past, investigations of prostate cancer were reserved largely for patients exhibiting symptoms, but the introduction of the PSA test has opened up the possibility of screening healthy men for the disease. Observational studies suggest that DRE and PSA, combined with TRUS and biopsy, can identify localised prostate cancer in 3-5% of men, although the tests do result in a number of false positives and negatives. Major questions remain concerning the natural history of the disease, potential costs (financial, social and psychological) of a screening programme, and the effectiveness and cost-effectiveness of treatments for localised disease. The lack of good quality data and the strength of these concerns means that population screening for prostate cancer cannot be recommended.
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PMID:Diagnosis, management and screening of early localised prostate cancer. 941 41

Adenocarcinoma of the prostate is one of the most common malignant tumors in adult males. Hormonal therapy is the treatment of choice for patients with systemic disease concerning 80% response rate. Androgen ablation is now the first hormonal manipulation and can be achieved either by means of bilateral orchiectomy or of LH-HR agonist therapy: both are equally effective. Total androgen blockage (association between orchiectomy or LH-RH agonist and non-steroidal anti-androgens) would be reserved for controlled clinical trials only. Estrogens had the same efficacy, but revealed the serious cardio-vascular events. Endocrine therapy does not prolong survival but provides good palliation. Palliation should be given when there is something to palliate. Prostate cancer is usually not recognized as being sensitive to cytotoxic agents. Single agent or combination chemotherapy has not been shown to have a role as first line treatment of disseminated disease and is usually used for hormone refractory disseminated disease.
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PMID:[The hormonal and chemotherapy of prostatic cancer]. 945 33

Locally advanced prostate cancer patients comprise those with iatrogenic capsular injury, extracapsular extension resulting in positive surgical margins following radical prostatectomy, and tumors with lymph node metastases, thus representing stage T3,N0,M0 or T1-4,N1-2,M0 disease. Parameters can be combined, as shown below, in a nomogram to predict advanced prostate cancer: if, for example, stage T2c is coupled with a PSA of 16 ng/ml and a high Gleason grade, the patient will have an approximately 70% likelihood of having extracapsular extension; then again, if the Gleason score is known from biopsies and a PSA of 10-20 ng/ml is given, then a stage T2c prostate cancer patient with a Gleason of 7 will have a 39% probability of having positive lymph nodes. The following therapeutic considerations may be used to enhance the chance of eradicating advanced disease through radical prostatectomy: (1) Neoadjuvant hormonal therapy helps downsize the tumor and may eventually reduce the number of positive margins by almost 50%. However, it is a moot point if this will lead to a prolonged survival period. (2) Technical refinements on radical prostatectomy may be achieved through the principle of wide extension excision, a modification of current apical dissection procedures, which involves the use of panoramic magnifying loupes, and an examination of resection margins during surgery using repetitive frozen sections. (3) If positive (not simply 'equivocal' as defined by Epstein) margins are found, radical prostatectomy alone is not curative. Among the various options available is postoperative irradiation with or without adjuvant hormonal therapy. The latter should probably be reserved for patients with extracapsular extension, a high Gleason score or positive lymph nodes. Hormonal therapy may be used continuously or intermittently. The value of adjuvant treatment is currently being tested in phase-III trials. (4) Hormonal therapy may be commenced at the time of biochemical or clinical progression, although it is not clear whether this modality is inferior to adjuvant forms of treatment. Technical expertise in radical prostatectomy accumulated at major institutions can be used to the advantage of patients with locally advanced prostate cancer. In this regard, results of ongoing phase-III trials testing various options including this procedure are eagerly awaited.
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PMID:Enhancing the efficacy of radical prostatectomy in locally advanced prostate cancer. 960 52

Patients whose only sign of recurrence after local therapy for prostate cancer is a rising prostate-specific antigen level (PSA-only recurrence) have become more common. We have developed two models to predict PSA-only recurrence after radical prostatectomy, one using traditional factors (race, sigmoidal transformation of PSA, postoperative Gleason sum, and organ confinement) and a second using traditional clinical and pathologic variables combined with molecular biomarker levels. Treatment options for patients with PSA-only recurrence include observation, radiation therapy for patients who have undergone surgery, salvage surgery or cryotherapy for patients who have received radiotherapy, and traditional or nontraditional hormonal therapy. Radiation for PSA-only recurrence is likely to benefit men who have no adverse pathology, a low PSA level at recurrence, and PSA recurrence after the first year. Salvage radical prostatectomy and cryotherapy pose a relatively high risk of incontinence and other morbidity and should be reserved for carefully selected patients with a high likelihood of organ-confined disease. Hormonal therapy is probably the single most beneficial treatment for PSA-only recurrence. Nontraditional low-dose oral hormonal therapy and intermittent hormonal therapy are gaining in popularity, although their long-term efficacy is unknown. More clinical trials are needed to fine-tune prognostic models and to determine the best treatments, alone or in combination, for PSA-only recurrence.
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PMID:Rising PSA after local therapy failure: immediate vs deferred treatment. 1044 45

Although once reserved for the management of metastatic prostate cancer, androgen deprivation therapy (ADT) is being used increasingly to treat lower stages of disease. We sought to assess patterns of ADT use in a contemporary cohort of men newly diagnosed with prostate cancer. Men with newly diagnosed prostate cancer who had > or =12 months of follow-up evaluation were identified in a national disease registry of patients with prostate cancer. The patterns of ADT use, both primary and secondary, were characterized and stratified by risk according to prostate-specific antigen levels, clinical stage, and Gleason score. In a cohort of 1485 men, 46% underwent ADT at some point during their treatment: 41% as primary therapy (either sole therapy or neoadjuvant therapy), and 5% as secondary therapy. In all, 50% of men receiving initial ADT had low- or intermediate-risk disease characteristics. Among patients treated with radical prostatectomy and radiation therapy, neoadjuvant ADT was administered in 20% and 48% of patients, respectively. Secondary hormonal manipulation was observed in 5% and 7% of patients treated initially with surgery or radiation, respectively. ADT is commonly used to treat men with prostate cancer. Much of the use of ADT is in men with low- and intermediate-risk disease characteristics. The appropriateness of such therapy requires further study, including its effect, not only on disease endpoints, but also on resource utilization and health-related quality of life.
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PMID:Contemporary patterns of androgen deprivation therapy use for newly diagnosed prostate cancer. 1223 Oct 37

Recently, chemotherapy for prostate cancer has been primarily reserved for the palliation of symptoms secondary to prostate cancer. Chemotherapy regimens and new approaches are being developed that offer new hope of response and improved survival to men with prostate cancer. This paper discusses pharmacological strategies that are under investigation: cytotoxic agents and biological or targeted therapies, including the microtubule inhibitors (taxane/taxoids, vinorelbine) alone and in novel combinations with other experimental agents such calcitriol, thalidomide or flavopiridol (cell-cycle inhibitor) and treatment with epothilone analogues; endothelin receptor antagonists; other novel strategies such as vaccine therapy (GVAX; Cell Genesys) and prostate-specific membrane antibodies; and bisphosphonates.
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PMID:Pharmacological treatments for prostate cancer. 1245 34

It is quite likely that in every prostate cancer, at the start of clinical disease there are hormone-independent cells present. These cells may be sensitive to changes in the diet, to chemotherapeutic agents, to immunological agents, to the use of vaccines or may be sensitive to radiotherapy. The introduction of these non-hormonal therapies has classically been reserved for the time when the patient has exhausted all other treatment therapies and has a large tumour volume which will almost certainly not respond to such treatments. The purpose of this chapter will be to try to arrive at a more sensible definition of hormone-independent disease than has been used in the past, to outline some of the new treatment strategies and to make suggestions as to where in the natural history of the disease these would be most effectively and easily employed.Prostate Cancer and Prostatic Diseases (2000) 3, 290-295
Prostate Cancer Prostatic Dis 2000 Dec
PMID:New strategies for the treatment of hormone-independent prostate cancer. 1249 81

Hormonal therapy for prostate cancer has traditionally been reserved for advanced disease, but current evidence suggests that earlier use can confer a survival advantage. Survival benefit has been observed among patients with TNM stage T3 tumors who were treated with hormonal therapy plus external irradiation. Patients with nodal metastases (D1) who received immediate treatment with hormonal therapy after radical prostatectomy and pelvic lymphadenectomy also survived longer than those who were treated only after disease progression. The patients included in these studies are distinguished from those exhibiting "biochemical" failure (ie, increased levels of prostate-specific antigen, despite local therapy). It is in these patients that the use of hormonal therapy is, at present, controversial. For the purpose of identifying the subgroup of patients who might specifically benefit from early hormonal treatment, various schemas for defining predictors of poor outcome have been developed, including nomograms and artificial neural network programs. As with hormonal therapy, the use of chemotherapy in prostate cancer has been regarded as a palliative option for hormone-refractory disease. However, positive experience with early chemotherapy in other cancers suggests that such strategies might be similarly beneficial in prostate cancer. Limited clinical data show that chemotherapy combined with hormonal therapy can increase the initial response rate and prolong survival in locally advanced disease (T3 or D2), but not in metastatic tumors. An international trial is under way to evaluate the role of adjuvant chemotherapy in patients with localized prostate cancer who are at high risk of relapse after radical prostatectomy. Thus, accumulating evidence provides a rationale for continued investigation into the use of early hormonal therapy in selected patients.
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PMID:Early versus late hormonal therapy: debating the issues. 1266 82


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