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

Pelvic lymph node metastases indicate a poor prognosis for patients with clinically localized prostate cancer but the significance of minimal nodal metastases still is debated. We determined the progression and cancer specific survival rates based on the extent of nodal metastases in 511 patients followed for a mean of 8.6 years (range 2.5 to 17.5 years) after bilateral pelvic lymph node dissection and irradiation therapy. The patients were divided into 4 groups based on the extent of nodal metastases: NO--negative nodes (359 patients), N1--a single microscopic positive node (37), N2--multiple microscopic positive nodes (86) and N3--grossly positive or juxtaregional nodes (29). The risks of distant metastases and of dying of prostate cancer were much greater in the 152 patients with positive nodes (N+) than in those with negative nodes (p less than 0.00005). The risk of metastatic disease at 10 years was only 31 +/- 7 per cent for the NO patients compared to 83 +/- 7 per cent for the N+ patients, and the risk of dying of prostate cancer was only 17 +/- 6 per cent at 10 years for the NO group and 57 +/- 11 per cent for the N+ patients. Patients with a single microscopic node (N1) had a pattern of progression and cancer specific mortality rate similar to patients with more extensive nodal metastases and markedly worse than patients with negative nodes. The risk of distant metastases was 80 +/- 15 per cent at 10 years for the N1 group, 84 +/- 11 per cent for the N2 group and 88 +/- 13 per cent for the N3 group, while the risk of dying of prostate cancer at 10 years was 40 +/- 19, 66 +/- 15 and 58 +/- 24 per cent, respectively. The finding of a single pelvic lymph node containing microscopic metastatic disease markedly worsened the prognosis of our patients with prostate cancer. Once prostate cancer is found within the pelvic lymph nodes the patient has systemic disease unlikely to be controlled by pelvic lymph node dissection and radiotherapy.
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PMID:Prognostic significance of lymph nodal metastases in prostate cancer. 250 18

Percutaneous ultrasound-guided interstitial radiotherapy is an attractive and elegant technique for the administration of high-dose local radiotherapy to the prostate. The complications of seed implantation are those associated with the radiation rather than with the technique of implantation. However, radiotherapy has not provided impressive local control of the disease or prolonged survival. The poor disease control was not attributed to poor seed placement, but rather to the inadequacy of 125I in controlling the cancer. The essence of nonsurgical treatment for prostate cancer is the use of effective imaging. Experience in the field of minimally invasive surgery has shown that ultrasound is the ideal imaging system for targeting treatments because of its ease of use and the absence of adverse effects. As the newer techniques of implantation come to be accepted, it is hoped that the complications of rectal and bladder radiation injury will decrease and the therapeutic benefits increase. The clinical trials required to define the precise role of each of the modalities of treatment must take nodal staging into account and must be compared with the gold standard of radical prostatectomy in the treatment of early confined disease.
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PMID:Ultrasound-guided implantation techniques in treatment of prostate cancer. 268 4

The investigators of the National Prostatic Cancer Treatment Group (NPCTG) have entered 212 patients with surgically confirmed stage D-1 prostate cancer in studies to determine the efficacy of adjuvant therapy after either definitive surgery (Protocol 900) or definitive radiotherapy (Protocol 1000). Follow-up indicates that this group represents 70% of all patients with recurrent disease. Because patients with less than 20% nodal involvement were found to have a statistically significant better progression-free-survival (PFS) than those with greater than 20% nodal involvement, we examined the exact anatomic sites of nodal metastases. The status of obturator, external iliac, internal iliac, and common iliac nodes was compared to PFS and overall survival in 198 patients with D-1 disease in both protocols. Results demonstrate no significant difference in either PFS or overall survival relative to anatomic sites of positive nodes. These data suggest that although minimal pelvic nodal metastasis is consistent with improved PFS, there is no predictable anatomic distribution of disease consonant with that better prognosis.
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PMID:Prognosis in stage D-1 prostate cancer relative to anatomic sites of nodal metastases. National Prostatic Cancer Treatment Group. 279 Jun 88

Recently we treated 54 patients with clinically localized prostate cancer: 8 had Stage A disease, 13 had Stage B1, 32 Stage B2, and 1 Stage C. Fifty of these patients underwent bilateral pelvic lymphadenectomy and retropubic radical prostatectomy, while the other 4 patients underwent bilateral pelvic lymphadenectomy only. Pathologic staging revealed pelvic lymph node metastases in 12 patients. We reviewed these 12 Stage D1 cases to see whether or not the intraprostatic tumor location influenced the locoregional metastatic nodal pattern. We found that metastases occurred ipsilaterally in 5 cases, while the other 7 patients experienced bilateral pelvic involvement. We failed to find any case in which contralateral nodal involvement occurred without the tumor also involving the pelvic lymph nodes ipsilateral to the intraprostatic tumor. The data suggest that it would be reasonable to perform pelvic lymphadenectomy only on the same side of the prostatic lesion. This modified approach potentially could reduce morbidity and cost to the patient.
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PMID:Intraprostatic tumor location and pelvic lymph node metastatic pattern in early prostate cancer. 291 75

The best available data indicate that, although it is imperfect, the postirradiation biopsy performed at a sufficient interval after radiotherapy can provide accurate prognostic information useful in the determination of the success or failure of radiotherapy in an individual patient as well as the measurement of overall efficacy of any particular radiotherapeutic regimen. Needle biopsy of the prostate was performed routinely in 510 patients with clinical stage A2, B, or C1 prostate cancer treated with a combination of radioactive gold seed implantation and external-beam irradiation. Of the 140 patients who had one or more needle biopsies performed 6-36 months after completion of radiotherapy, who had no evidence of local recurrence or distant metastases at the time of biopsy, and who had received no hormonal therapy before documented recurrence of the tumor, 45 (32%) had one or more biopsies positive for cancer. The frequency of positive biopsy results correlated significantly with the size of the local tumor but not with the grade. The correlation between biopsy results and the eventual development of recurrence was highly significant. If any biopsy was positive, 60% of the patients eventually developed local recurrence; if all biopsies were negative, only 19% developed local recurrence during the period of follow-up. The poor prognosis associated with a positive biopsy result was found within almost every subset of stage, grade, or nodal status examined although the results varied because of the small number of patients in some groups.
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PMID:Local control of prostate cancer with radiotherapy: frequency and prognostic significance of positive results of postirradiation prostate biopsy. 305 May 43

The goal of any treatment strategy for cancer is to improve not only patient survival but also quality of that survival. Quality of life (QL) involves individual perceptions (physical, mental, social) which are particularly germane to management of recurrent and advanced urologic cancers. Cancer therapy ideally equally documents a patient's QL as well as tumor response and survival. The QL is best achieved by optimal therapy, defined as appropriate treatment of those patients who need it and avoiding unnecessary or overtreatment of those patients who are not expected to obtain significant benefit. Specific goals of management of urologic neoplasms should strive to eradicate all existing and/or palliate symptomatic disease with the least possible morbidity while attempting to preserve function. Some examples of positive advances in this regard include reduction of therapeutic burden in good-risk patients with germ cell neoplasms; preservation of bladder and sexual function in childhood, adolescent and adult pelvic sarcomas with initial chemoradiotherapy programs and conservative surgery; improved responses of metastatic bladder cancer with combination chemotherapy; pelvic nerve-sparing techniques to preserve sexual potency and continent external or internal urinary diversions should total cystectomy become necessary; prevent or delay cystectomy with intravesical therapy in high-risk patients with polychronotopic superficial bladder tumors and ureteropyeloscopic management (rather than nephroureterectomy) of selected upper tract urothelial tumors. On the negative side, no appreciable value can yet be ascribed to nephrectomy, adjunct radiation or chemotherapy, hormonal or immunotherapy for advanced locoregional or metastatic renal cell carcinoma, aggressive radiation or chemotherapy for nodal metastases from bladder or prostate cancer or hormonal and/or chemotherapy of the asymptomatic patient with metastatic prostatic cancer. Future treatment strategies will improve tumor responses that now prove refractory but they should not be applied at the expense of QL as assessed by the patient. Valid methods for objective measurements of QL need to be devised and incorporated into multimodality curative and palliative clinical trials.
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PMID:Strategies for the management of recurrent and advanced urologic cancers. Quality of life. 329 89

Accuracy of staging of prostatic cancer is related to invasive procedures since imaging methods do not allow a reliable knowledge of the nodal status. Unfortunately lymphadenectomy is adversely affected by morbidity and mortality, therefore alternative methods should be elaborated. Post-lymphographic aspiration cytology seems to be worthwhile, having proved to be a reliable, accurate, safe procedure which can provide useful information in the management of patients with prostatic cancer. Nevertheless uncertainty exists upon the clinical significance of negative cytologic findings. In this connection correlation between grading and aspiration cytology can constitute a further improvement. In our experience the Gleason grading system has shown to be the most reliable and reproducible. 85 patients classified according to the Gleason's system, underwent staging lymphadenectomy and no nodal metastases were present when the Gleason score was lower than 5. In 50 cases even aspiration cytology was accomplished before surgery. No false positive cytologic findings were seen on histologic verification. Two false negative results were obtained in patients with Gleason score higher than 5. In conclusion we believe that when prostatic cancer shows a Gleason score lower than 5 and the lymph node aspiration cytology is negative no staging lymphadenectomy should be performed. On the contrary in cases with Gleason sum from 5 to 10 negative nodal cytologic findings are inconclusive, nevertheless this rate of patients is low and the necessity of surgical staging can be really reduced.
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PMID:[Gleason's system and pelvic lymphadenectomy in the pretherapeutic evaluation of cancer of the prostate. Apropos of 85 cases]. 339 8

Between March 1970 and December 1978 there were 366 patients with prostatic cancer treated by 125I seed implants and pelvic lymph node dissection. All had a minimum of 5 years follow-up. One hundred thirty-three patients had metastatic prostatic cancer in lymph nodes (Stage D1) at the time of lymph node dissection and seed implantation. Ninety-one of the 133 patients were judged to have sufficient metastatic prostatic cancer in their nodal tissue (greater than 50% replacement with tumor) to justify flow cytometric cellular DNA measurements on the involved paraffin-embedded nodal tissue. Nine patients were excluded due to uninterpretable DNA histograms leaving 82 patients for analysis. Forty-nine patients had aneuploid and 33 had diploid tumors. There was no statistical bias between the aneuploid and diploid groups due to age (P = 0.970, chi 2 test), time between diagnosis and implantation (P = 0.217, chi 2 test), number of positive nodes (P = 0.669, two-sample t test of means), or tumor grade (P = 0.332, chi 2 test). Median survival time of the aneuploid and diploid groups was 5.0 and 8.8 years, respectively (P = 0.0109, log rank test). Cox regression analysis confirmed the effect of aneuploidy versus diploidy on survival by controlling for other potentially confounding variables (age, time from diagnosis to implantation, number of positive nodes, and grade). Grade as a predictor of survival did not approach statistical significance in this series of relatively small size (P = 0.116). Thirty-eight of the 82 patients had moderately differentiated neoplasms. Nineteen of these were aneuploid and 19 diploid. The median survival was 5.8 and 9.1 years, respectively, for these grade-matched aneuploid and diploid groups (P = 0.039, log rank test). We conclude that flow cytometric DNA measurements on archived paraffin-embedded tumor in nodal metastases appear to be a strong predictor of survival for Stage DI prostatic cancer.
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PMID:Flow cytometry of prostate cancer: relationship of DNA content to survival. 356 34

Needle biopsy specimens of primary adenocarcinoma and surgical specimens of carcinomatous nodal tissue were obtained from previously untreated clinical D stage prostatic adenocarcinoma patients. Assessment of the relation between specimen androgen receptor site content and survival using either scatterplots or Kaplan-Meier analyses showed specimen receptor content was a poor prognostic P greater than 0.1, of survival subsequent to orchiectomy or diethylstilbestrol (DES) therapy. The possibility that heterogeneity of specimen androgen receptor site content contributed to this finding was evaluated by comparing receptor content of multiple small or large tissue specimens from the same prostate gland of patients with benign prostatic hyperplasia or nonmetastatic prostatic cancer. This evaluation showed significant microheterogeneity of human prostate androgen receptor site content which was substantially masked in large tissue specimens. We conclude that microheterogeneity of human prostate androgen receptor site content compromises the use of biopsy specimen androgen receptor measurements as a prognostic of patient survival subsequent to initiation of hormonal therapy.
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PMID:Androgen receptors in biopsy specimens of prostate adenocarcinoma. Heterogeneity of distribution and relation to prognostic significance of receptor measurements for survival of advanced cancer patients. 359 58

Regional retroperitoneal lymphadenectomy usually is performed with radical nephrectomy for renal cell carcinoma and sometimes is performed with nephroureterectomy for upper tract urothelial tumors; however, no therapeutic benefit has been proven. Pelvic lymphadenectomy usually is performed with radical cystectomy for bladder cancer and may confer therapeutic benefit on patients having only minimal nodal involvement. A limited extraperitoneal pelvic lymphadenectomy, including only the nodes surrounding the obturator nerves, is performed in prostate cancer patients who are considered to be potential candidates for radical prostatectomy, but is of doubtful therapeutic benefit. The effectiveness of chemotherapy for germ-cell testicular tumors has diminished the utilization of routine surgical staging and also has decreased the scope of lymphadenectomy when performed. The substantial complications associated with traditional ilioinguinal lymphadenectomy for carcinoma of the penis and the unreliability of aspiration or excisional node biopsy have militated against routine surgical staging of patients having clinically negative nodes. This policy should be reconsidered in light of suboptimal treatment results and newer surgical techniques.
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PMID:Surgical staging of genitourinary tumors. 359 87


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