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

The biological behavior of prostatic cancer is influenced by many host and tumor factors. The proliferative activity of the malignancies can be one of those parameters which serve as the basis to estimate prognosis and design treatment. Here, DNA content and S-phase fraction of prostatic cancer samples obtained by radical prostatectomy from 46 patients were related to other known tumor characteristics (PSA, staging, grading). Nuclei from the paraffin embedded materials were isolated with overnight trypsin-ribonuclease mixture digestion. DNA content and cell cycle distribution were determined by flow cytometry. A correlation was found between the PSA concentration, grading and staging on the one hand and S-phase fraction on the other. DNA content correlated with grading. No kinetic parameter correlated with the nodal involvement. Due to the association between abnormal DNA content plus SPF > 5% with advanced stage and less differentiated appearance of the tumor, we can conclude that these parameters are useful to estimate prognosis.
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PMID:DNA content of prostatic cancer measured by flow cytometry in patients undergoing radical prostatectomy. 764 37

Curative radical therapy for prostate cancer depends on accurate diagnosis of metastatic spread to pelvic lymph nodes. The authors measured prostate-specific antigen (PSA) levels in homogenized pelvic lymph nodes to determine the antigen's diagnostic value and its correlation with histologic findings. No PSA was detectable in the lymph nodes of either women or of men without prostate cancer. A dilution of prostate cancer tissue with nodal tissue showed that PSA is detectable in this assay to a concentration of 1:100,000. In 38 patients who underwent pelvic lymph node dissection for staging stage B prostate cancer the histologic findings were correlated with PSA content. All nine patients with histologic evidence of metastatic disease had measurable PSA in their nodes. Of the 29 patients with no histologic evidence of metastatic disease, 23 had no detectable PSA in their nodes. The six patients with negative histologic findings and positive findings for PSA had no progression of disease at 18-month follow-up. The authors conclude that the measurement of PSA in pelvic lymph nodes can add substantial information to that obtained by standard histologic examination.
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PMID:The value of prostate-specific antigen levels in pelvic lymph nodes for diagnosing metastatic spread of prostate cancer. 768 Feb 71

To determine the influences of transrectal ultrasonography, prostate-specific antigen (PSA), and heightened public awareness of prostate cancer stage at diagnosis, we prospectively evaluated our most recent 173 patients who had a pelvic lymphadenectomy from 1987 to 1991. All patients had clinically localized prostate cancer and underwent bilateral limited pelvic lymph node dissections (N = 173); 19 (10.7%) were found to have nodal metastasis. Pathologic tumor stage and grade information was available for 168 patients who had a simultaneous radical prostatectomy. Clinical T-stage data revealed that only one patient had a T3 lesion. Pathologic T stage showed 7.1% to be T1a (12/168), 4.1% to be T1b (7/168), 13.7% to be T2a (23/168), 34.5% to be T2b (58/168), and 40.5% to be T3 lesions (68/168). Metastatic nodal involvement was not seen in any T1a, T1b, or T2a lesions. A Gleason's score of less than 5 lesions was predictive of no nodal metastasis. The clinical stage was upstaged pathologically in none of the T1a, 16.7% of the clinical T1b, 75% of the T2a, and 73% of the T2b lesions. With regard to serum PSA, 27% of those patients with a level > 20 ng/ml had nodal metastasis (6/22) in this series. Although an elevated PSA was not predictive of tumor nodal metastasis, no patient with a normal PSA had nodal metastasis. Although the distribution of pathologic T stages is similar to that reported in the literature, our low incidence of nodal metastasis may suggest that prostate cancer is being diagnosed earlier.
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PMID:Evaluation of the current incidence of nodal metastasis from prostate cancer. 768 65

The incidence of lymphatic metastases in 229 consecutive patients with clinically localized prostatic cancer was assessed. Only 13 patients had nodal metastases, for an incidence of 5.7%. A monoclonal prostatic specific antigen value of more than 40 ng./ml. correlated with a positive predictive value of 53% for nodal metastases. Routine laparoscopic node dissection is unnecessary considering the low incidence of nodal metastases.
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PMID:The contemporary incidence of lymph node metastases in prostate cancer: implications for laparoscopic lymph node dissection. 812 82

One hundred fifty-eight consecutive patients with clinically localized prostate cancer were submitted to staging laparoscopic pelvic lymphadenectomy (LPL) at 5 cooperative centers with one or more of the following conditions which were considered as risk factors for nodal disease: clinical stage C (or T3) disease, serum prostate-specific antigen > 20 ng/ml, Gleason sum > 6. The mean number of lymph nodes removed was 11 (range 2-29). Metastases from prostate cancer were found in 41 patients (25.9%). The proportion of lymph node-positive patients increases significantly with the presence of one, two or three of the conditions considered as risk factors (p < 0.00005). The benefit of LPL is limited to the lymph node-positive patients who can be spared a second operation.
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PMID:Benefits and complications of laparoscopic pelvic lymphadenectomy for detection of stage D1 prostate cancer: a multicenter experience. 774 55

Sixty-six patients with prostatic adenocarcinoma were screened for somatic instability at 8 microsatellite marker loci on 5 chromosomes. Differences in unrelated microsatellites for tumor and normal DNA were detected in 13 (19.7%) patients. Only extraglandular spread (nodal involvement and distant metastasis) was found to show significant association with somatic instability after controlling for other clinicopathological variables (P < 0.05). Microsatellite instability may possibly occur during the early stages of neoplastic transformation in a subset of prostate cancer rather than as a late event. This may be related to a phenotype with growth advantage. The frequency of this mutator phenotype is much higher in the United States than Japan, reflecting racial differences in the molecular tumorigenesis of this malignancy.
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PMID:Genomic instability of microsatellite repeats in prostate cancer: relationship to clinicopathological variables. 775 95

The role of cross-sectional pelvic imaging with computerized tomography or magnetic resonance imaging and fine needle aspiration in the assessment of pelvic lymph nodes in patients with prostate cancer is undefined. To address this issue we used formal decision analysis, comparing an imaging arm to a no imaging arm. Patient utility values were calculated, and test parameters and complication rates were extracted from the literature. Imaging was superior to no imaging only when the pretest probability of pelvic lymph node metastases was high. The most important parameter was the sensitivity of cross-sectional imaging for lymphadenopathy. When the sensitivity was 36%, which was the baseline figure derived from the literature, the probability of lymph node metastases required for imaging to be beneficial overall was 32%. We also performed a retrospective review of magnetic resonance imaging examinations at our institution in 174 patients with newly diagnosed prostate cancer and pathological confirmation of nodal status. The sensitivity for detecting nodal metastases was 25%. With this figure, the estimated probability of nodal metastases required to make imaging beneficial would be 45%, which is possible to achieve with highly selective clinical criteria. With a policy of imaging only in select patients the marginal cost is $794 per patient benefited (aborted radical prostatectomy because of nodal metastases detected with fine needle aspiration) compared to $50,661 per patient benefited if all patients are imaged. Thus, cross-sectional pelvic imaging before radical prostatectomy, solely for the purpose of detecting pelvic lymph node metastases, is not justified routinely. However, it is worthwhile on the basis of patient use values and cost-effectiveness in a select group of patients at high risk for nodal metastases.
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PMID:The use and accuracy of cross-sectional imaging and fine needle aspiration cytology for detection of pelvic lymph node metastases before radical prostatectomy. 785 90

We described the clinical results and efficacy of laparoscopic pelvic lymphadenectomy for localized prostate cancer. This procedure was followed by radical prostatectomy, if metastasis was not found in frozen section. In the presence of positive nodes, optional treatment, such as TUR or castration, other than radical prostatectomy was performed. We performed laparoscopic lymphadenectomy on twenty seven patients between April 1992 and September 1993. They range from 52 to 78 years in age and consist of 4 patients with stage A2, 17 with stage B, and 6 with stage C. We dissected the obturator lymph nodes on bilateral sides. The average operating time was 162 minutes (range 86 to 320 minutes). The average number of nodes removed from the right side was 7.1 +/- 5.9 and 6.1 +/- 4.5 from the left side, which was comparable to the number of lymph nodes obtained by open dissection. Colon injury occurred in one patient, which was managed by laparotomy procedure. Nodal metastases were found in 6 patients by frozen section, and in 10 patients by permanent section. This discrepancy suggested that two-staged operation might be preferable for the localized prostate cancer. Six patients were given suitable therapies besides radical prostatectomy. Laparoscopic pelvic lymphadenectomy is a safe and useful procedure for prostate cancer, especially for the patients who are likely to have nodal metastasis.
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PMID:[Laparoscopic pelvic lymphadenectomy in prostate cancer]. 786 46

In an attempt to define the possible role of radioimmunoscintigraphy to assess noninvasively the pelvic lymph nodes, we studied 19 patients with prostate cancer. All 19 men underwent conventional radiographic imaging of the pelvis with computerized tomography or magnetic resonance imaging before bilateral pelvic lymph node dissection. In addition, radioimmunological scanning with 111indium-labeled monoclonal antibody CYT-356 was performed. Pathologically 8 of the 19 patients had histological confirmation of metastatic nodal disease ranging from 1 to 15 mm. The monoclonal scan was positive at a site corresponding to the histologically confirmed nodal foci in 4 of the 8 patients. Since each hemipelvis could be independently assessed for pathological disease and imaging status, we report site-specific analysis of the monoclonal antibody scan in 38 hemipelves. The overall accuracy was 76% with a sensitivity and specificity of 44% and 86%, respectively. The negative predictive value was 83% and the positive predictive value was 50%. The administration of a single dose of CYT-356 antibody is safe, feasible and capable of detecting soft tissue nodal disease. A negative scan enables the physician to predict noninvasively a low probability of nodal disease for individuals at high risk. The detection threshold of this antibody scan appears to be disease foci 5 mm. or greater.
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PMID:Radioimmunoscintigraphy of pelvic lymph nodes with 111indium-labeled monoclonal antibody CYT-356. 796 49

The diagnostic usefulness of digital rectal examination (DRE), transrectal ultrasonography (TRUS), magnetic resonance imaging (MRI) and computed tomography (CT) was compared in the differentiation of stage B from stage C prostate cancer. Eighteen patients who had undergone radical retropubic prostatectomy were included in this study. Overall, the positive predictive values (PPV) for detecting extraprostatic disease (extracapsular extension, seminal vesicle invasion) were 100% for DRE, 88.9% for TRUS and 80.0% for MRI, respectively. Corresponding figures for accuracy in detecting extraprostatic spread were 55.6%, 66.7% and 61.1%, respectively. The PPV and accuracy for detecting extraprostatic disease in 13 patients with localized cancer (< stage B) were 75.0%, 53.8% for TRUS and 66.7%, 53.8% for MRI, respectively. Both of these examinations appeared to be superior to DRE alone. The PPV and accuracy increased when findings on TRUS and MRI coincided. Computed tomography was less accurate than MRI in diagnosing nodal involvement because of the higher incidence of false positives. Further efforts should be focused on enhancing preoperative diagnostic precision in staging prostate cancer because of the limited usefulness of the current imaging techniques. Development of more reliable diagnostic modalities or designing ideal combination of these studies are desperately needed.
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PMID:[Usefulness and limitation of digital rectal examination and imaging studies in staging prostate cancer]. 802 42


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