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

To determine if patients with bladder cancer have a higher incidence of unsuspected prostate cancer, 40 cases were studied. All except one case had no evidence of prostate cancer on preoperative clinical assessment. Detailed pathological evaluation of cystoprostatectomy specimens with sections at 2- to 3-mm intervals was done. Adenocarcinoma of the prostate was identified in 18 of 40 patients (45%). Multifocal prostatic intraepithelial neoplasia (PIN) was present in 19 cases (47.5%); 4 (10%) without an associated prostate cancer and 15 (37.5%) in conjunction with adenocarcinoma of the prostate. Twelve cases of unsuspected prostate cancer were stage pT1a, 4 were pT1b, and 2 were pT3. No patients exhibited nodal or distance metastases by the prostate cancer. At a mean follow-up of 15.2 months (range 3-34 months), 37 of the 40 patients are alive. Among prostate cancer patients, no clinical or biochemical evidence of disease recurrence or prostate cancer related mortality has been observed. Our findings support the previously reported high incidence rate of prostate cancer in patients undergoing cystoprostatectomy for bladder cancer. This, though, may not be higher than the observed incidence in an age-matched general population. We recommend DRE and PSA as part of the bladder cancer workup in males, and complete removal of the prostate at cystoprostatectomy to prevent the dilemma of residual prostate cancer.
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PMID:Incidental prostatic adenocarcinoma in patients undergoing radical cystoprostatectomy for bladder cancer. 893 64

Genetic alterations, such as mutation, methylation and aneuploidy, are thought to underlie the multistep genesis and progression of many human cancers. However, the genetic events occurring in prostatic oncogenesis are still relatively poorly understood. This is especially so in early-stage tumours, in which mutations of known oncogenes or tumour-suppressor genes appear to be quite infrequent. Allelic losses of chromosome arms 7q, 8p, 10, 16q and 18q suggest the involvement of novel suppressor loci on these chromosomes; allelic losses of chromosome arm 8p are especially frequent and may be detected even in early-stage tumours. We have used a positional approach to seek novel genetic targets in prostate cancer, including allelic-loss mapping of chromosome 8p and physical mapping of chromosome band 8p22 around the MSR gene. A homozygous somatic deletion in one prostatic nodal metastasis was mapped in this region and spanned 730-970 kb. This region was then examined in detail for expressed sequences. One novel gene, called N33, was found to be silenced by a methylation mechanism in most colon cancer cell lines and some primary colorectal tumours. Characterization of additional chromosome 8p22 candidates is in progress.
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PMID:Tumour-suppressor genes in prostatic oncogenesis: a positional approach. 908 70

We performed a retrospective review of surgical pathology specimens and clinical data for all patients with node-positive prostate cancer diagnosed in our institutions between 1985 and 1994. We used adjusted actuarial survival analyses and univariate and multivariate analyses to evaluate the clinical significance of extracapsular perinodal tumor extension. Sixty patients with histologically confirmed prostate cancer metastatic to regional lymph nodes were reviewed. Forty-two patients (70%) had evidence of extracapsular extension of the tumor into perinodal tissue. The 5-year adjusted cumulative survival rates for patients with extracapsular nodal extension was 54.6%, compared with 71.4% for patients with histologically confined nodal metastases (P < .05). Univariate and multivariate analyses revealed the presence of extracapsular nodal tumor extension to be an independent predictor of patient survival. In this study, only the histologic grade (Gleason score) of the primary tumor was a stronger predictive factor. These data suggest that histologic evidence of extracapsular tumor extension from lymph node metastases into perinodal tissue might be an important prognostic factor in patients with node-positive adenocarcinoma of the prostate. Development of a pathologic substage to include this feature might be warranted.
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PMID:Prognostic implications of extracapsular extension of lymph node metastases in prostate cancer. 926 23

Laparoscopic pelvic lymph node dissection (LPLND) is a low-morbidity procedure used to stage prostate cancer accurately prior to definitive local therapy. To better select patients for LPLND, we reviewed the clinical features of 120 patients with clinically localized prostate cancer who underwent LPLND to define significant risk factors for nodal metastases. The age ranged from 43 to 79 years (mean 68). Serum prostate specific antigen (PSA) concentration ranged from 1.3 to 329 ng/mL, Gleason score ranged from 2 to 9, and clinical stage ranged from T1b to T3c. Nodal metastases were discovered in 15 patients (13%). Among men with a Gleason score > or = 7, 21% had nodal metastases (P = 0.004). A serum PSA > 20 ng/mL and clinical stage T1b, T2b, or greater also were statistically significant predictors of lymph node metastases (20% and 19%, respectively). In multivariate analysis, Gleason score significantly predicted nodal metastases when controlling for all other clinical measures. Therefore, LPLND is indicated for any patient with a Gleason score > or = 7, PSA > 20 ng/mL, and advanced clinical T stage, independently or in combination.
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PMID:Risk of nodal metastases at laparoscopic pelvic lymphadenectomy using PSA, Gleason score, and clinical stage in men with localized prostate cancer. 937 45

A careful evaluation of local tumoral extension is mandatory in patient selected for radical surgery for prostate cancer. Nevertheless, prostatic imaging, achieved with transrectal ultrasonography (TRUS) and CT scan, is often unable to stage accurately the disease. The Authors report a retrospective analysis of 43 patients treated with radical retropublic prostatectomy: their findings support the idea that both TRUS and CT scan are unable to define the extent of the tumor, reaching respectively accuracies of 38 and 46%. From these data they conclude that CT can be excluded from the preoperatory workup of prostate cancer, except in selected patients, at high risk of nodal metastasis on the basis of PSA. TRUS is the mainstay of prostate cancer diagnosis and staging because it guides transrectal biopsies, but any conclusion made exclusively on the base of its imaging seems not reliable.
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PMID:[Value and limitations of transrectal ultrasonography and computer tomography in preoperative staging of prostate carcinoma]. 947 54

Transrectal fine-needle aspiration biopsy (FNAB) of the prostate under digital control is a cheap and rapid method for diagnostic evaluation of palpable and non-palpable nodules, yielding high sensitivity (ca. 95%) and a low complication rate (< 1%). Its specificity amounts to > 97%. The scarcity of urologists trained in the FNAB method and of pathologists experienced in cytology of the prostate limit the clinical application so far. Besides various forms of prostatitis, five different types of cancer can cytologically be differentiated. While PIN I cannot be cytologically identified, PIN II/III lesions may lead to false-positive diagnoses. Cytologic grading of adenocarcinomas of the prostate is of statistically proven prognostic validity and strictly correlated with its histologic counterpart. Preoperative, radiologically controlled FNAB of pelvic and paraortal lymph nodes has sensitivity of ca.86% and specificity of 100%. It thus helps to avoid unnecessary prostatectomies if nodal tumor spread has preoperatively been proven. Diagnostic DNA cytometry is able to identify those prostatic cancer patients who do not reveal significantly increased risk of tumor progression or decreased survival probability, even without therapy (constantly and representatively diploid and tetraploid patterns). Patients with DNA tetraplid histograms may show deteriation of prognosis under hormonal therapy. DNA-aneuploid prostatic cancers should not be subjected to a "wait and see" strategy; they do not respond to hormonal therapy.
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PMID:[Cytopathology of the prostate]. 954 42

The prognostic significance of Ki-67, p53, and Bcl-2 expression was evaluated in prostate cancer patients with lymph node metastases. Immunohistochemical staining of archived material obtained from 56 patients was performed by the streptavidin-biotin method. Univariate survival analysis showed that a Ki-67 labeling index (Ki-67 LI) of > or = 8.4 in the primary tumor identified a group of patients with a significantly poorer prognosis (P < 0.001). furthermore, a Ki-67 LI of > or = 8.7 in the nodal metastatic tumor was also associated with a poorer prognosis (P < 0.01). Multivariate analysis showed that the Ki-67 LI of primary tumors (P < 0.01) and lymph node metastases (P < 0.01) had independent prognostic value. p53 and Bcl-2 expression had no prognostic value in patients with prostate cancer and lymph node involvement. The Ki-67 LI has more prognostic value than p53 and Bcl-2 expression for patients with prostate cancer that has spread to the lymph nodes.
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PMID:Prognostic significance of Ki-67, p53, and Bcl-2 expression in prostate cancer patients with lymph node metastases: a retrospective immunohistochemical analysis. 958 63

To evaluate the efficacy of lymphangiography combined with fine needle aspiration biopsy and computer tomography (CT) for lymph node staging in clinically localized prostate cancer. Prospective evaluation of nodal involvement was carried out using standard bipedal lymphangiography combined with fine needle aspiration biopsy (FNAB) in 70 patients (aged 47 to 75 years, mean age 63 years) with apparently locally confined prostate cancer before intended radical prostatectomy. Sixty-four patients also underwent computer tomography. Seventeen withdrew the decision to undergo a radical prostatectomy, leaving 53 patients with pathologic examination of the lymph nodes eligible for analysis. Lymph node metastases were diagnosed in 8 patients (8/53 = 15.1%). Three were diagnosed preoperatively by FNAB, 3 peroperatively by lymph node dissection and frozen section biopsy and an additional 2 at the final pathologic assessment. The sensitivity, specificity, positive and negative predictive values for lymphangiography and lymphangiography combined with FNAB in predicting nodal disease, based on the analysis of the 53 patients with known pathologic results, were 0.63, 0.76, 0.31, 0.92 and 0.38, 1.00, 1.00, 0.90, respectively. The corresponding values for CT staging were 0.25, 0.98, 0.67 and 0.87, respectively. The efficacy of bipedal lymphangiography alone or combined with FNAB or CT alone for assessment of nodal metastases is too low to be worthwhile for lymph node staging in localized prostate cancer patients with expected low or intermediate probability of nodal disease.
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PMID:Lymphangiography combined with biopsy and computer tomography to detect lymph node metastases in localized prostate cancer. 960 83

Lymph node metastases are rarely detected during radical prostatectomy (55/647 patients in our series or 8.5%) and several authors consider that lymphadenectomy is unnecessary in most cases. Criteria based on clinical stage, PSA and tumor grade have been elaborated in order to avoid pelvic lymph node dissection in a low risk population. It is commonly admitted that patients with clinically localized prostate cancer, a PSA level < 10 ng/ml, and a Gleason score < 7 could be spared a pelvic lymphadenectomy. In our series, these patients account for 12% of positive nodes. The best treatment for prostate cancer patients with a nodal disease is controversial. We compare the evolution of two groups of patients: radical prostatectomy alone or combined with an immediate adjuvant hormonal treatment. We observe a difference between the two groups for biological progression (PSA failure) but not yet for clinical progression nor for survival as our mean follow-up in only 6 years.
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PMID:[Complete radical prostatectomy and positive lymph nodes (stages pT1 to 4, N1 to 3, M0, D1)]. 961 51

Prostate-specific antigen (PSA) is a valuable tumor marker used for diagnosis and management of prostate cancer. Recently, PSA has been found in various female tissues and body fluids. Female breasts, both normal and abnormal, including cancerous tissues, can produce PSA, and this production is regulated by androgens and progestins. Preliminary data suggested that patients with breast tumors positive for PSA may have better prognosis compared to those with PSA-negative breast tumors. This study examines the prognostic value of PSA in a large cohort study of United States patients. Using a PSA assay that has a lower detection limit of 0.001 ng/ml, we measured PSA in tumor cytosolic extracts of 953 women with primary breast cancer. Other information available for this study included age, follow-up time, survival outcome, tumor size, nodal status, steroid hormone receptor levels, DNA analysis by flow cytometry, and postoperative treatment. The median follow-up time was 73 months. During the follow-up, 200 patients relapsed and 188 died. PSA presence was found to be significantly associated with smaller tumors, tumors with low S-phase fraction, diploid tumors, younger patient age, and tumors with lower cellularity. Survival analysis indicated that the relative risks (RRs) for relapse and death were both significantly lower [RR = 0.67 (P = 0.01) for relapse; RR = 0.72 (P = 0.05) for death] in PSA-positive patients (levels higher than the 30th percentile of PSA values) than in PSA-negative patients. The reduced risks for relapse and death remained statistically significant after other clinical and pathological variables were adjusted in the multivariate analysis [RR = 0.68 (P = 0.02) for relapse; RR = 0.65 (P = 0.02) for death]. Our results suggest that the measurement of PSA in breast tumor extracts provides additional information on the prognosis of patients with primary breast cancer.
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PMID:Prognostic value of prostate-specific antigen for women with breast cancer: a large United States cohort study. 962 67


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