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Query: UMLS:C0600139 (Prostate Cancer)
 4,540 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To stage accurately the extent of the disease comprehensive investigations were done on 75 patients with histologically documented carcinoma of the prostate. Estimation of bone marrow acid phosphatase appears to be the most sensitive test to detect blood-borne metastases. Serum acid phosphatase appears to be of little value in the detection of early blood spread and may have a role only in monitoring the effect of treatment on advanced disease. Bone scanning with technetium compounds has the disadvantage of non-specificity but has far greater sensitivity than a skeletal survey. Bone marrow cytology was not rewarding in the detection of early metastatic disease. Pedal lymphangiography is a highly inaccurate method to detect lymphatic spread of carcinoma of the prostate and pelvic lymphadenectomy, when indicated, remains the only truly adequate method to assess lymph node involvement. There was a 37 per cent incidence of metastatic lymph node pathology in 30 patients undergoing this procedure before either radical prostatectomy or deep x-ray therapy. A close correlation was found between stage and grade of disease and incidence of nodal pathology. There was some correlation between degree of nodal involvement and evidence of blood spread as detected by elevated bone marrow acid phosphatase levels. The significance of this finding remains unclear.
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PMID:Carcinoma of the prostate: a critical look at staging. 83 93

Pedal lymphangiography was done on 38 patients with stages O, A and B carcinoma of the prostate. The lymphangiograms were positive in 19 cases and negative in 19. Of 18 patients who underwent lymphadenectomy (9 with positive and 9 with negative studies) operative findings confirmed the lymphangiogram in 15 (83 per cent). In the 6 patients with osseous metastases and/or enzyme elevation, the lymphangiogram was positive. Furthermore, 13 patients with positive lymphangiograms had negative osseous and enzyme survey, emphasizing that nodal involvement may be the earliest finding in disseminated carcinoma of the prostate. The value of lymphangiography in staging carcinoma of the prostate prior to radical prostatectomy or irradiation seems well established.
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PMID:An evaluation of lymphangiography in staging carcinoma of the prostate. 111 5

Prospective pathologic staging by pelvic lymphadenectomy in 60 patients with clinically localized carcinoma of the prostate disclosed a high incidence (35 per cent) of clinically silent and unsuspected lymph node metastases. When present, metastatic disease was frequently bilateral (57 per cent) and most commonly involved the obturator-hypogastric lymph nodes (87 per cent). Micrometastases alone were found in 5 patients and the potential significance of this finding on survival is discussed. Although the presence or absence of metastases could not be accurately predicted by histologic analysis of biopsy or prostatectomy specimens, the finding of undifferentiated tumor, marked anaplasia and penetration through the capsule correlated positively with nodal metastases. Pelvic lymphadenectomy is a safe and important diagnostic tool in the accurate staging of these patients. Its widespread use is advocated in patients with clinical stage B1, B2 and C tumors prior to definitive therapy. Based on the prospective data generated in this study lymphatic metastasis appears to be an early event in the spread of prostatic cancer.
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PMID:Prostatic carcinoma: incidence and location of unsuspected lymphatic metastases. 124 19

Radiation Therapy Oncology Group (RTOG) protocol 7706 was a randomized Phase III study designed to test the value of elective (prophylactic) pelvic irradiation in addition to prostatic irradiation in patients with carcinoma of the prostate with no clinical evidence of tumor extension through the capsule. Eligible patients were those who had clinical Stage T1bNOMO (A2) or T2NOMO (B), who did not have curative surgery, and who had no evidence of lymph node metastases. Assessment of the regional lymphatics was mandatory but, at the discretion of the investigator, lymphangiography (LAG) or staging lymphadenectomy (SL) could be used. A total of 445 eligible and analyzable patients were entered in the study between 1978 and 1983 when the study was closed. The median follow-up was 7 years; minimum follow-up was 5 years. There were no significant differences in survival or local control whether treatment was administered to the prostate or to the prostate and pelvic lymph nodes. The nodal status for 117 (26%) patients was assessed by staging lymphadenectomy (SL) whereas for 328 (74%) patients it was assessed by lymphangiography (LAG). Pretreatment characteristics felt to have impact on survival were evaluated and found to be free of serious imbalance between the staging lymphadenectomy and lymphangiography groups. Compared to the lymphangiography group, the staging lymphadenectomy group showed better overall survival (87% to 76% at 5 years, p = .02), better disease-free survival (76% to 63% at 5 years, p = .008) and better metastases-free survival (88% to 82% at 5 years, p = .04). There was no difference between the groups in local control. The lymphangiography evaluation of pelvic nodes was clearly inferior for demonstration of the absence of pelvic node metastasis as reflected by reduced survival and increased metastasis.
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PMID:Impact of surgical staging in evaluating the radiotherapeutic outcome in RTOG phase III study for A2 and B prostate carcinoma. 280 56

From 1976 to 1983, the Radiation Therapy Oncology Group (RTOG) conducted 2 large-scale phase III trials of extended field irradiation in patients with carcinoma of the prostate. The first, RTOG 75-06, was designed to test the value of elective periaortic irradiation in patients in whom the tumor extended beyond the gland, but remained limited to the pelvis, and the second, RTOG 77-06, was designed to test the value of elective pelvic irradiation in patients without evidence of spread beyond the prostate. The results indicated no apparent benefit from elective periaortic irradiation in patients with detectable disease confined to the pelvis and no apparent benefit from elective pelvic irradiation in patients with detectable disease confined to the prostate. Patients with extracapsular extension of the primary tumor and evidence of pelvic lymph node involvement demonstrated an outcome comparable to that in patients without evidence of lymphatic involvement. This observation may reflect a beneficial effect of pelvic irradiation in patients with nodal involvement. In contradistinction to elective irradiation of regional lymphatics, therapeutic irradiation (of the involved lymphatics) may prove strongly indicated. A prospective study testing this contention needs to be conducted. No significant correlation of treatment-related morbidity and treatment volume could be identified. Analysis of the various types of treatment-related morbidity as to the time of onset and clinical course indicated that these behave as different disease entities characterized by a specific pattern of appearance, clinical course, and prognosis. Of particular interest is the observation that most appear reversible. Doses in excess of 7,000 cGy to the prostate were associated with a significantly increased incidence of bowel morbidity.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Radiation Therapy Oncology Group studies in carcinoma of the prostate. 317 4

From January 1970 to June 1983, a total of 702 patients received radical external beam radiation therapy for carcinoma of the prostate. The estimated 5- to 10-year disease-free survival are 67% and 52%. A comparison was made between those patients whose diagnosis was established by needle biopsy as compared with those who had a positive transurethral resection of the prostate (TURP). Within Stages B & C combined, the 5-year disease-free survival was 65% for needle biopsy as compared with 59% for TURP. The corresponding figures at 10 years are 50% and 43%. This difference is significant with a p-value of less than 0.01. In addition to histological grade, identifiable prognostic factors in the literature are clinical stage, serum acid phosphatase, and extent of radiation (local only or prophylactic pelvic nodal radiation). Assessment of histological grade using the Gleason method has been carried out in all except 7 cases. The amount of tissue from a needle biopsy constitutes less than 3% of the material obtained from a TURP. As a result, there is a potential sampling error. The Gleason grading can be used in at least three ways: (a) the conventional Gleason score, (b) the most malignant grade identified, or, (c) the primary (most frequent) grade identified. Analyzing use of these three methods of histological stratification yields conflicting results. The difference between the needle and TURP groups is present in late stage disease when the primary grade is used for stratification but absent when the worst grade is used. The significance of these results remains more or less constant irrespective of end point (uncorrected, disease specific or disease-free survival). However, when stratified by Gleason score, it is significant for disease specific survival, approaches significance for uncorrected survival but not for disease free survival. Since the significance can be altered by changing one stratification factor, there must be some doubt about the validity of other studies which either confirm or refute the hypothesis that TURP has an adverse influence on the disease process.
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PMID:The effect of transurethral resection on prognosis in carcinoma of the prostate: real or imaginary? 318 38

Computed tomography (CT) is currently the standard modality for staging of urologic cancer in most institutions. It is used for demonstrating nodal involvement, and for demonstrating invasion of the primary lesion into surrounding fat, muscle, or other tissues or organs. It is also useful for demonstrating hepatic metastases in renal and vesical carcinomas. The problem with computed tomography, however, is that it can only show whether the nodes are large or not; neither can it show the nodal architecture, nor can it detect metastases in normal-sized nodes. Intravesical sonography has been helpful for staging papillary bladder cancer. Transrectal sonography has been somewhat helpful for demonstrating seminal vesicle invasion in patients with prostatic carcinoma. Inferior vena cavography and renal venography can be helpful for demonstrating whether a renal, renal pelvic, or adrenal carcinoma has extended into either vein. Lymphography can show nodal architecture and metastases in normal-sized nodes, and can make possible needle biopsy of abnormal-appearing nodes even if they are normal sized. The examination cannot show very small or microscopic nodal metastases, and it can miss abnormal nodes totally if they have been completely replaced by metastases. It yields false positives when fatty or fibrous infiltration of the nodes has occurred. It is used primarily for staging patients with testis or prostatic carcinoma. Bone scans are essential for staging prostatic carcinoma. Magnetic resonance imaging (MRI) is helpful in some cases of renal cell carcinoma. Multiplanar imaging prevents overstaging. It is also accurate for showing whether the renal vein or inferior vena cava are involved. Enlarged lymph nodes are easily distinguished from vessels. For staging bladder carcinoma involving the fundus or base of the bladder, MRI is better than CT. Microscopic nodal metastases, such as are common in carcinoma of the prostate, currently are not detected by any imaging modality.
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PMID:Staging of genitourinary cancers. The role of diagnostic imaging. 329 84

A total of 500 patients with extracapsular extension (clinical Stage C) carcinoma of the prostate received definitive radiotherapy directed to the prostate and the regional lymphatics. Pretreatment evaluation of the regional lymphatics was optional and was done in 245 patients who underwent either staging laparotomy or lymphangiography. The remaining 255 patients had no nodal evaluation. In 72 of the node-evaluated patients there was evidence of spread to the pelvic lymphatics and in 173 patients lymph nodes were negative. The three populations (lymph nodes-not evaluated, lymph nodes-involved, and lymph nodes-not involved) were analyzed as to the distribution of the recognized prognostic variables and compared as to the study end points (locoregional failure, incidence of distant metastases, disease-free survival, and survival).
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PMID:Prognostic significance of nodal involvement in locally advanced (stage C) carcinoma of prostate--RTOG experience. 331 90

From 1976 to 1983 the Radiation Therapy Oncology Group conducted a study of extended field (periaortic) irradiation in carcinoma of the prostate. Eligible patients were those with clinical Stage C tumor with or without evidence of pelvic lymph node involvement and also those with Stage A-2 and B with evidence of pelvic lymph node involvement. The stratification criteria included histological grade, clinical stage, absence or presence of hormonal manipulation, and method of lymph node evaluation (lymphangiogram vs. laparotomy vs. no nodal evaluation). The patients were randomized to either receive pelvic irradiation followed by a boost to the prostate or pelvic and periaortic irradiation followed by a boost to the prostate. The prescribed daily dose was 180-200 rad to a total midplane dose to the regional lymphatics to 4000-4500 rad. The prostatic boost target volume was to receive additional 2000-2500 rad bringing the total dose to that area to a minimum of 6500 rad. A total of 523 analyzable patients have been accessioned to the protocol. Four hundred forty-eight of these are known to have received treatment per protocol. Median follow-up is 4 years and 3 months. The analyzable patients were evaluated for the incidence of distant metastases, NED survival and survival as a function of treatment arm. No statistically significant differences between the treatment arms could be documented. Similarly, no significant difference between treatment arms could be documented within a number of subpopulations such as those characterized by a particular grade, hormonal status, stage, age, acid phosphatase level, etc. The results of the study revealed no apparent benefit of elective periaortic irradiation in patients with detectable disease confined to the pelvis.
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PMID:Extended field (periaortic) irradiation in carcinoma of the prostate--analysis of RTOG 75-06. 351 55

A total of 566 evaluable patients were accessioned to a phase III RTOG study of extended field irradiation in carcinoma of the prostate from 1976 to 1983. Eligible patients were those with locally advanced disease, either clinical Stage C or clinical Stage A2 or B with pelvic lymph node involvement. The treatment consisted of irradiation of the regional lymphatics followed by a boost to the prostate. The data have been analyzed extensively to identify variables of potential prognostic significance. The assessed factors include tumor size, clinical stage, the degree of histological differentiation, nodal status, serum acid phosphatase status, hormonal management status, age, and race. These factors have been assessed as to their interdependence and correlation with the clinical course (study endpoints) using univariate analyses and Cox's Regression model. Significant interdependence of tumor size and Gleason score and tumor size and acid phosphatase was identified. The population receiving hormonal management either prior to or during radiotherapy had a significantly higher proportion of high grade tumors. Correlation of the assessed variables and the study endpoints (local control, incidence of distant metastases, NED survival, survival) singled out the degree of histological differentiation as the most powerful prognostic factor for all the endpoints. Age proved a useful predictor of local control (younger patients failed at a significantly higher rate), as did tumor size. Elevation of serum acid phosphatase correlated well with the incidence of metastatic disease but was not a useful predictor of survival. Tumor size and hormonal management status correlated well with the incidence of metastatic disease but only when analyzed separately from other factors. Their prognostic value was absent when Cox regression analysis was applied. Nodal status did not correlate well with any of the study endpoints, indicating then that in patients with clinical Stage C disease, treated with definitive radiotherapy to the prostate and regional lymphatics, this parameter may have limited prognostic usefulness. Although patients who received concomitant hormonal management had a significantly higher proportion of high grade lesions, their clinical course fared favorably in comparison with the population not receiving concomitant hormonal management. This may indicate a beneficial effect of adjuvant hormonal treatment which needs to be tested in a prospective study.
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PMID:Prognostic factors in carcinoma of the prostate--analysis of RTOG study 75-06. 355 26


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