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

During the last decade 452 patients have undergone pelvic lymphadenectomy as a staging procedure for apparently localized prostatic cancer. Of these patients 105 (23 per cent) had pelvic node metastasis. Node involvement occurred in no patient with a stage A1, 24 per cent with stage A2, 12 per cent with stage B1, 28 per cent with stage B2 and 53 per cent with stage C tumor. Correlation with tumor grade revealed nodal metastasis in 10 per cent of the patients with well differentiated tumors, 24 per cent with moderately differentiated lesions and 54 per cent with poorly differentiated tumors. The incidence of positive nodes is low enough to preclude lymphadenectomy in patients with stage A1 (0 per cent) and well differentiated stage B1 tumors (4 per cent), and high enough to assume metastatic disease without lymphadenectomy in those with poorly differentiated stage C tumors (93 per cent). All other patients with apparently localized prostatic cancer should undergo a staging pelvic node dissection before definitive treatment.
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PMID:Pelvic lymph node metastasis from prostatic cancer: influence of tumor grade and stage in 452 consecutive patients. 687 75

Histological grading and pathological staging are relevant factors in the prognosis of patients with prostatic cancer. Of 115 consecutive patients with carcinoma of the prostate that was staged fully before treatment 16 had stage A2 disease. Low grade neoplasms were present in 6 of these patients and evidence of nodal metastases was documented at lymphadenectomy in 2. Similarly, 4 of 35 patients with low grade stage B1 disease had nodal metastases. With the enzymatic and/or radioimmunoassay techniques for acid phosphatase determination we were unable to select those patients with nodal metastases. From these studies we believe that low grade, low stage carcinoma of the prostate retains a potential for metastatic disease and that acid phosphatase determinations are unreliable in detecting bulky regional nodal involvement.
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PMID:The prognostic significance of histological grading and pathological staging in carcinoma of the prostate. 688 59

The inaccuracy of clinical staging as a predictor of the biologic potential of prostatic cancer has prompted evaluation of additional methods of assessment. We reviewed 228 patients with prostatic adenocarcinoma who presented during a 4-year period. Of the 228 patients 144 with no detectable bony disease underwent staging pelvic lymphadenectomy with or without preliminary bilateral pedal lymphangiography. Histopathologic specimens of the primary diagnostic prostatic biopsy were classified with Gleason's grading system of tumor differentiation. Of the patients with Gleason's sum of 8, 9 or 10, 93 per cent had regional nodal metastases, regardless of preliminary clinical stage. Furthermore, no patient with Gleason's sum of 2, 3 or 4 had nodal metastatic disease. The incidences of falsely positive and falsely negative lymphangiograms were 29 and 35 per cent, respectively, reflecting the unreliability of pedal lymphangiography to predict nodal involvement accurately in patients with prostatic cancer. The Gleason system of histopathologic grading was reliable and reproducible, and afforded an accurate prediction of the surgical stage of disease.
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PMID:Experience with Gleason's histopathologic grading in prostatic cancer. 699 22

Carcinoma of the prostate is the second most common cancer in men, yet no significant change in overall survival has occurred since the original description of the results of castration by Huggins and Hodges. Many important questions about the disease remain unanswered. The cause of prostatic cancer is unknown, and few specific environmental or viral agents have been linked with the tumor. Increased recognition of the importance of frequent digitial rectal examination has resulted in more tumors being diagnosed in early stages. Developments in sonography suggest that it may be useful in detecting the presence of prostatic cancer and whether extraprostatic extension has occurred. Recent inprovements in the sensitivity of prostatic acid phosphatase assays have been made, but their use as a screening tool remains limited. In patients with clinical stage B lesions that are microscopically confined to the prostate, treatment by radical prostatectomy appears to confer greatest survival. The exact role of radiotherapy remains to be defined. However, when the tumor extends beyond the prostate and is localized to the pelvis, external beam ro interstitial radiation is appropriate. Pelvic lymphadenectomy has significant morbidity, but less invasive methods of pelvic nodal evaluation are less accurate. Lymphadenectomy has not been shown to have any therapeutic effect. Whether hormonal therapy improves survival needs further investigation, and efforts must continue to develop means of predicting hormonal responsiveness. Those patients unlikely to respond to hormonal therapy should be treated with early chemotherapy.
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PMID:Overview of past and current philosophy of prostatic cancer. 702 54

The interrelationships among tumor grade, local tumor extension, lymph node involvement and early treatment failure were examined in 96 consecutive patients with clinical stage A (11 patients) or B (85 patients) prostatic cancer who were considered potential candidates for radical prostatectomy. In this series 20 of the 82 patients (24 per cent) who underwent radical prostatectomy had local tumor extension beyond the prostatic capsule and 27 of the 88 patients (31 per cent) who had lymph node dissections had nodal involvement. Of the entire group of 96 patients 38 (40 per cent) had either local extension and/or nodal involvement. A direct correlation was observed between clinical stage and the incidence of local tumor extension but not between clinical stage and nodal involvement. However, there was a striking correlation between surgical stage and lymph node involvement in patients who underwent radical prostatectomy. A direct correlation also was observed between tumor grade, and local extension and nodal involvement. Analysis of multiple parameters revealed that clinical grade of tumor considered together were more predictive of nodal involvement than either parameter alone. Early treatment failures occurred in 5 patients, all of whom were understaged clinically.
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PMID:Staging errors in clinically localized prostatic cancer. 706 16

To examine the accuracy of frozen sections in the detection of pelvic lymph node metastases in patients with prostatic cancer, the results of frozen and paraffin sections were compared in 75 consecutive patients with clinical stage A or B prostatic cancer. Frozen sections were positive for cancer in 16 patients (21 per cent), 14 of whom had gross lymphadenopathy, and in all cases cancer was confirmed on paraffin sections. Of 59 patients with negative frozen sections 11 (19 per cent) had paraffin sections positive for cancer. However, in 10 of these 11 patients there were only 1 or 2 microscopic metastases. Thirteen other patients with normal-appearing lymph nodes did not have frozen sections obtained at the time of operation and metastases were not found on paraffin sections. There was a direct correlation between tumor grade and nodal involvement. The results suggest that frozen sections are of limited reliability in identifying lymph node metastases in patients who do not have gross lymphadenopathy. The extent to which this inaccuracy may result in the selection of inappropriate therapy remains to be determined.
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PMID:Accuracy of frozen section detection of lymph node metastases in prostatic carcinoma. 706 18

Between January 1978 to March 1980, 25 patients with biopsy-proven prostate carcinoma were evaluated by computerized tomography (CT). CT differed from clinical stage in 7 of 25 patients (28%). In 6 of the 7 patients, change in stage resulted because of demonstration of extracapsular extension and/or pelvic lymph node involvement. Twelve of the 25 patients (48%) underwent surgery with histological confirmation of CT findings. Ct identified nodal involvement accurately in 10 of 12 patients (83%). We recommend use of CT for initial staging, treatment planning and assessment of response in the management of prostate cancer.
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PMID:Role of computed tomography in the evaluation and management of carcinoma of the prostate. 708 84

To examine how accurately needle biopsies reflect the true histologic grade of prostatic cancers the histologic grade of needle biopsy specimens was compared to that of the radical prostatectomy specimen in 66 consecutive patients. Needle biopsies were given a lower grade than the prostatectomy specimen in 21 patients (33 per cent) and a higher grade in 5 patients (8 per cent). To examine how accurately the tumor grade of needle biopsy specimens predicts lymph node metastases in patients with clinical stage B prostatic cancer the needle biopsy grade was compared to lymph node metastases in 78 consecutive patients who underwent staging pelvic lymphadenectomy. Thirteen per cent of the patients with well differentiated cancer, 50 per cent with moderately differentiated cancer and 64 per cent with poorly differentiated cancer had pelvic lymph node metastases. In most cases grading errors did not influence the capacity of needle biopsies to predict nodal involvement. We conclude that although prostatic needle biopsies are associated with significant errors in grading they do provide valuable information about the predominant histologic pattern, which reflects the biologic potential of the tumor.
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PMID:Grading errors in prostatic needle biopsies: relation to the accuracy of tumor grade in predicting pelvic lymph node metastases. 708 93

In the last decade pelvic lymphadenectomy has gained in popularity as a staging maneuver designed to improve the selection of patients with localized prostatic cancer for curative treatment, by uncovering lymph node metastases. The presence of tumor in the regional nodes portends substantial risk for the later appearance of distant metastases. With rare exceptions, lymphadenectomy is widely regarded as a staging procedure without therapeutic benefits. Unfortunately, the operation as routinely performed carries a significant complication rate. The survival results of total prostatectomy for well-selected nodules of prostatic cancer are excellent without preliminary lymphadenectomy. The morbidity of lymphadenectomy is compounded by superimposed external irradiation. Because of the low complication rate from external radiation alone, it is suggested that patients selected for pelvic radiation be spared the discomfort of lymphadenectomy. Clinical trials of adjuvant chemotherapy in patients with minimal nodal disease may answer the question of whether pelvic lymphadenectomy should ever be performed. It is predicted that noninvasive imaging will improve to the point that staging lymphadenectomy may be relegated to the surgical archives.
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PMID:Whither pelvic lymphadenectomy in prostatic cancer? 710 4

We reviewed retrospectively 90 patients with prostatic cancer to assess Gleason grading as a predictor of pelvic nodal metastases and to compare our results to previous studies. Positive nodes occurred in 0 and 20 per cent of patients with Gleason sums of 2 to 4 and 5 to 6, respectively, which is consistent with previous data. However, nodes were involved in only 44, 60 and 44 per cent of patients with a Gleason sum of 7 to 9, respectively, and nodes were negative in the sole patient with a Gleason sum of 10. These results contrast greatly with previous reports. More experience is required in evaluating the need for staging pelvic lymphadenectomy or treatment in a patient with a given Gleason grade of prostatic cancer.
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PMID:Prediction of lymphatic metastases by Gleason histologic grading in prostatic cancer. 717 58


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