Biomedical subjects

Brian Saltzman

Publications and source records attributed to Brian Saltzman.

3 recordsLinked to original sources

PubMed2004

A comparison of the precision of seeds deposited as loose seeds versus suture embedded seeds: a randomized trial.

PURPOSE: Brachytherapy for prostate cancer with permanent low-dose-rate seeds has been shown to be an effective treatment for early stage prostate cancer. Due to the rapid falloff of dose, accurate seed placement is critical for optimal dosimetry. One approach to achieve optimal dosimetry is the use of seeds embedded in suture material. Seeds embedded in suture may not move after implantation as much as loose seeds. This would improve implant dosimetry. To evaluate this hypothesis a formal study was conducted in which half the gland was implanted with seeds embedded in suture and half with loose seeds. Final dosimetry is compared between both halves of the prostate. METHODS AND MATERIALS: Patients entered this Investigational Review Board approved prospective trial after completion of informed consent. At time of implant, the side of the gland to be implanted with loose as opposed to suture embedded seeds was randomly assigned. The patients then underwent intraoperative preplanned implantation. None of the preplans directed seed locations outside the prostate. Both the seeds embedded in suture and the loose seeds were implanted using needles with stylettes. At 4-6 weeks post implant, seed location was determined with CT. Both sides of the gland on CT were contoured and used for final dosimetric calculations. A cost function analysis was used to determine individual seed position deviation from intended to actual seed location. RESULTS: Eight patients were enrolled in the study. A total of 549 seeds were implanted; 240 seeds embedded in suture and 309 loose seeds. Prostate volumes ranged from 24.0-45.5 cc with a mean of 38.6 cc. The average radial deviation of the loose seeds from planned position was determined to be 3.1 mm compared with the average radial deviation of the suture embedded seeds of 3.7 mm. There was no improvement in the final dosimetry when suture embedded seeds where used. The D90 and V100 values for the half of the prostate implanted with suture embedded seeds were 71-140 (mean, 92.1) and 80.2-99.5 (mean, 89.6), respectively, for the half of the prostate implanted with loose seeds. (All D90, V100 values are % of prescription dose.) CONCLUSION: Seeds embedded in suture material do not lead to superior precision in seed deposition when compared with loose seeds, when implanted inside the prostate.

Brachytherapy↗

PubMed2004

Sustained decrease in incidence of acute urinary retention and surgery with finasteride for 6 years in men with benign prostatic hyperplasia.

PURPOSE: We determined the effect of long-term treatment with finasteride on the incidence of acute urinary retention (AUR) and benign prostatic hyperplasia (BPH) related surgery in men with BPH. MATERIALS AND METHODS: The Proscar (Merck and Co., Inc., Whitehouse Station, New Jersey) Long-Term Efficacy and Safety Study (PLESS) was comprised of 3040 men with enlarged prostates, moderate to severe symptomatic BPH and no clinical evidence of prostate cancer. Patients were randomized to placebo or 5 mg finasteride daily for 4 years. Of the 3016 randomized patients with available efficacy data 62% completed the original 4-year study (1006 on finasteride and 891 on placebo) and 89% of these (908 from the original finasteride arm and 785 from the placebo arm) continued in a 2-year open extension on finasteride. Followup was attempted in discontinued patients. Complete 6-year outcomes data, including 6-year followup in 770 men who had discontinued treatment during years 1 to 6, were available for 2463 (82%) of the 3016 originally randomized patients. RESULTS: For patients on continuous finasteride treatment the decrease in incidence of AUR and/or BPH related surgery in the 4-year base study was sustained during the open extension. In patients who were switched from placebo to finasteride in the extension, the incidence of AUR and/or BPH related surgery was similar to that in the continuous finasteride arm. CONCLUSIONS: The 6-year data from PLESS confirmed and further extended the findings from the original 4-year trial, demonstrating that finasteride treatment led to a sustained decrease in the incidence of AUR and/or BPH related surgery in men with BPH and enlarged prostates.

Acute Disease↗

PubMed2002

Storage (irritative) and voiding (obstructive) symptoms as predictors of benign prostatic hyperplasia progression and related outcomes.

OBJECTIVES: To assess the utility of voiding and filling symptom subscores in predicting features of benign prostatic hyperplasia (BPH) progression, including acute urinary retention (AUR) and prostate surgery. METHODS: The Proscar Long-term Efficacy and Safety Study (PLESS) was a 4-year study designed to evaluate the effects of finasteride versus placebo in men with lower urinary tract symptoms (LUTS), clinical evidence of BPH, and no evidence of prostate cancer. A self-administered questionnaire was employed to quantify LUTS at baseline. Receiver operating characteristics (ROC) curves were used to assess baseline characteristics from patients treated with placebo as predictors of outcomes. The characteristics assessed included the overall symptom score (Quasi-AUA SI), separate voiding and filling subscores, prostate volume (PV) and serum prostate-specific antigen (PSA) levels. RESULTS: PV and PSA were superior to the symptom scores at predicting episodes of spontaneous AUR and all types of AUR. The Quasi-AUA SI and the filling and voiding subscores were effective at predicting progression to surgery; however, PSA was more effective at predicting this outcome. To better evaluate symptoms as predictors of surgery, patients who experienced a preceding episode of AUR were excluded from the surgery analysis. In the absence of preceding AUR, the best predictors of future surgery were the Quasi-AUA SI and the filling subscore. CONCLUSIONS: Among men with LUTS, clinical BPH and no history of AUR, the overall symptom score and storage subscore are useful parameters to aid clinicians in identifying patients at risk for future prostate surgery. PV and PSA were the best predictors of AUR, while PSA was the best predictor of prostate surgery (for all indications).

Acute Disease↗