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Biomedical subjects

E Rogers

Publications and source records attributed to E Rogers.

At least 37 records · Page 2Linked to original sources
PubMed1996

The role of digital rectal examination, biopsy Gleason sum and prostate-specific antigen in selecting patients who require pelvic lymph node dissections for prostate cancer.

OBJECTIVE: To examine the usefulness of clinical stage, tumour differentiation and prostate-specific antigen (PSA) level, alone and in combination, to predict regional nodal metastases in individual patients with localized prostate cancer. PATIENTS AND METHODS: The usefulness of digital rectal examination (DRE), biopsy Gleason sum and PSA, alone and in combination, to predict nodal metastases in an individual patient was examined. The study included 689 patients who had laparoscopic or open pelvic lymph node dissection for clinical stage T1-3 prostate cancer. The Kruskal-Wallis test, Mantel-Haenszel test, chi-squared test and logistic regression were used for continuous, ordinal, categorical, and multivariate analysis, respectively. RESULTS: Of the 689 patients who underwent radical prostatectomy, 52 (8%) had nodal metastases. Although clinical stage, DRE, pre-operative PSA level and biopsy Gleason sum were significantly related in the univariate analysis, only pre-operative PSA level and biopsy Gleason sum were significant predictors of lymph node status in a multivariate analysis. However, based on a receiver operating characteristic curve, a model with satisfactory sensitivity and specificity could not be obtained. CONCLUSION: Current estimations of primary prostate cancer biology using pre-operative PSA level, clinical stage and biopsy Gleason sum are not sufficiently sensitive to predict nodal metastases, and pelvic lymphadenectomy remains the definitive method of detection.

Adult↗
PubMed1996

Impalpable prostate cancer: clinicopathological features.

OBJECTIVE: To determine the clinicopathological features of impalpable prostate cancer. PATIENTS, MATERIALS AND METHODS: The numbers of T1a and T1b cancers detected in transurethral resections of the prostate (TURP) performed before and after the advent of the test for serum prostate-specific antigen (PSA) were compared and the incidence of T1 disease in specimens from 400 consecutive radical prostatectomies examined. RESULTS: The incidence of T1b disease detected at TURP decreased significantly between the periods examined, but that of T1a was unaffected. Similarly, in radical prostatectomy specimens, T1b cancers were largely replaced by T1c and impalpable T2 cancers detected by ultrasonography. CONCLUSIONS: Cancers detected incidentally at TURP tend to be small T1a tumours, possibly suitable for conservative management. T1b cancers are likely to be detected by PSA level and treated radically. T1c and impalpable T2 cancers are morphologically unlike T1b disease and justifiably belong in separate stages in the current UICC staging system.

Aged↗
PubMed1996

Retroviral transduction of transforming growth factor-beta1 induces pleiotropic benign prostatic growth abnormalities in mouse prostate reconstitutions.

Transforming growth factor-beta1 (TGF-beta1) plays an important role in the normal growth and differentiation of the mouse prostate with accumulations of extracellular TGF-beta1 in fetal and neonatal prostate tissues particularly at epithelial-mesenchymal interfaces. We have demonstrated increased accumulation of TGF-beta1 in areas of human prostates with benign prostatic hyperplasia and adenocarcinoma by immunohistochemistry. To study the role of TGF-beta1 in pathologic processes, we constructed retroviruses that express the cDNA for murine TGF-beta1 along with either a dominant selectable geneticin (G418) resistance (Neo) gene, BabeTGF-beta1Neo, or a histochemically detectable beta-galactosidase gene, BabeTGF-beta1Gal. The biologic activity of these retroviruses was evaluated in vitro in NIH3T3 fibroblasts and in vivo using the mouse prostate reconstitution (MPR) model. Expression of the retrovirus in MPR was confirmed by beta-galactosidase staining and by reverse transcription followed by PCR for the virus-encoded RNA. Pathologic evaluation of hematoxylin and eosin-stained sections was complemented by immunohistochemical analysis of cytokeratin and neuronal markers. TGF-beta1 transducing retrovirus infection did not have an effect on total growth of the MPR; however, changes in the growth and distribution of specific cell types were observed. A phenotype of benign hyperplasia that involved increased numbers of cytokeratin 14-positive cells characteristic of basal epithelial cells was observed. Immunohistochemical studies colocalized an increased accumulation of extracellular TGF-beta1 with these cytokeratin 14 expressing hyperplastic lesions, An increase in stromal abnormalities was also observed and included a significant increase in the density of neuronal cells. The TGF-beta1-induced hyperplastic response involving basal epithelial cells may be the result of paracrine stimulation of growth of specific cell types in the prostate and may represent a divergence of normal growth processes. Benign growth abnormalities of basal epithelial cells in the human prostate have also been reported. An increased density of neuronal cells and other stromal abnormalities in response to TGF-beta1 retroviral transduction is also consistent with benign growth abnormalities in the human prostate.

3T3 Cells↗
PubMed1996

Risk factors for urinary incontinence after radical prostatectomy.

PURPOSE: We identified risk factors associated with urinary incontinence after radical retropubic prostatectomy. MATERIALS AND METHODS: The time from operation until urinary continence was achieved was determined by chart review and questionnaire in 581 patients who were continent before undergoing radical retropubic prostatectomy between 1983 and 1994. Using univariate and multivariate analyses of data gathered prospectively, we examined risk factors associated with incontinence in these patients. RESULTS: The actuarial rate of urinary continence at 24 months was 91% for the entire patient population and 95% for those treated after 1990. Many factors were associated with the risk of incontinence in univariate Cox proportional hazards regression analysis (patient age and weight, degree of obstructive voiding symptoms, prior transurethral resection of the prostate, clinical stage, intraoperative blood loss, resection of neurovascular bundles, postoperative anastomotic stricture and technique of vesicourethral anastomosis). However, in a multivariate analysis the factors that were independently associated with increased chance of regaining continence were decreasing age, a modification in the technique of anastomosis (introduced in 1990), preservation of both neurovascular bundles and absence of an anastomotic stricture. With introduction of the new surgical technique in 1990 the median time to continence decreased from 5.6 to 1.5 months and the rate of continence at 24 months increased from 82 to 95%. CONCLUSIONS: While the risk of urinary incontinence after radical prostatectomy is related to the uncontrollable factor of patient age, it is also sensitive to the surgical technique used.

Actuarial Analysis↗
PubMed1996

Hemodynamic responses to cold stress in blacks: effect of application site.

Black Americans have been shown to exhibit increased blood pressure responses to a variety of physical stressors. However, few investigators have examined hemodynamic responses to cold stress. Additionally, no studies have compared blood pressure responses to forehead and foot stress in blacks. Therefore, in this study, hemodynamic responses to cold pressor tests were compared in 30 blacks (15 males, 15 females) utilizing two application sites. Baseline comparisons of systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), forearm blood flow (FBF) and forearm vascular resistance (FVR) were not different prior to forehead and foot cold stress. Following baseline measurements, ice was applied separately to the forehead and foot for 90 seconds with hemodynamic measurements being recorded at 45 and 90 seconds. During application of ice to the forehead, FVR-90 was significantly higher (P < .002, 97.0 units vs. 66.4 units) compared to the foot. The application of ice to the foot resulted in significantly greater SBP-45 responses (P < .0001, 147 mmHg vs. 139 mmHg), HR-45 responses (P < .0043, 80, b.min-1 vs. 69 b.min-1). HR-90 responses (P < .0001, 78 b.min-1 vs. 64 b.min-1), and FBF-45 responses (P < .05, 2.74 ml.min-1.100ml-1 vs. 1.98 ml.min-1.100ml-1). These findings suggest that blacks exhibit disparate patterns of reactivity in response to cold stress as a function of application site. Therefore, investigators should consider the application site when interpreting studies examining a biracial cohort.

Adult↗
PubMed1996

Reduced levels of transforming growth factor beta receptor type II in human prostate cancer: an immunohistochemical study.

In previous studies we demonstrated that the growth of human prostatic adenocarcinoma is associated with aberrant accumulation of transforming growth factor (TGF) beta1, a growth factor that has been shown to be a potent inhibitor of epithelial cell proliferation. We investigated the expression of TGF-beta receptor II (TGFbetaR-II) in benign prostate tissue and in prostate cancer using standard immunohistochemical techniques. Quantitation of immunopositivity for TGFbetaR-II was assessed on a visual analogue scale ranging from 0 (absence of staining) to 4+ (intensely positive staining). All of the benign glandular epithelia stained intensely, either 3+ or 4+, representative of the ubiquitous nature of TGFbetaR-II in normal tissue. Overall, staining was reduced in prostate cancer sections, and there was progressively diminished staining as the histological grade of the cancer increased (P < 0.01, Kruskal-Wallis test). This immunohistochemical study indicates that a decline in the levels of TGFbetaR-II is correlated with advancing histological aggressiveness of the cancer and suggests that aberrant TGFbetaR-II function may play a role in human prostate carcinogenesis.

Aged↗
PubMed1995

VIA-RAD: a blackboard-based system for diagnostic radiology. Visual Interaction Assistant for Radiology.

The work described in this article presents an approach to the integration of computer-displayed radiological images with cooperative computerized assistance for decision-making. The VIA-RAD system (Visual Interaction Assistant for Radiology) is a blackboard-based architecture, founded on extensive data collection and analysis in the domain of diagnostic radiology, together with cognitive modeling of the interaction between perception and problem-solving. The details of this system are presented in terms of domain knowledge representation and domain knowledge mapping. A small prototype of the system has been implemented and tested with radiology subjects, and the results of this study are also described.

Artificial Intelligence↗
PubMed1995

A simple ileal substitute bladder after radical cystectomy: experience with a modification of the Studer pouch.

Bladder substitution using pouches designed from detubularized bowel is gaining widespread acceptance among urologists and their patients. However, few clinical reports have described the effectiveness of the orthotopic neobladder fashioned from ileum in the manner described by Studer. Since 1988, we have used the Studer technique with minor modifications in 20 men who underwent radical cystoprostatectomy for transitional cell carcinoma of the bladder. Early morbidity from the procedure was minimal, although 2 patients later had anastomotic strictures. Significant late complications included low vitamin B12 levels in 4 patients and persistent hyperchloremia in 1. A total of 18 patients achieved diurnal continence but 9 of these had enuresis. Neobladder compliance and emptying were satisfactory in the 12 patients evaluated urodynamically. Upper tracts remained stable in all patients at a median followup of 24 months (range 9 to 60). Isolated episodes of bacteriuria occurred in 11 patients but followup urine cultures have remained sterile in all continent patients. The Studer ileal neobladder is a simple, effective alternative for urine storage, upper tract preservation and efficient voiding.

Bacteriuria↗
PubMed1995

Salvage radical prostatectomy: outcome measured by serum prostate specific antigen levels.

We reviewed our experience with salvage radical prostatectomy for locally recurrent cancer in 40 patients to assess the current complication rate and the results using prostate specific antigen (PSA) as an indicator of treatment outcome and to identify better criteria for the selection of appropriate candidates for this operation. Most recurrent cancers were detected by digital rectal examination (26 patients) or increasing serum PSA levels (10). The operation was technically challenging, with 6 rectal injuries (15%), 2 requiring temporary colostomy. Serious technical complications were more common (31%) among the 29 patients who underwent pelvic lymphadenectomy at the time of initial radiotherapy than among the 11 treated with external irradiation alone (9%). Urinary incontinence persisted in 18 of 31 evaluable patients (58%) and was successfully corrected with an artificial urinary sphincter in 9. A total of 21 patients (54%) had pathologically advanced disease (seminal vesicle invasion and/or lymph node metastases). Preoperative PSA levels but not clinical stage or biopsy grade correlated with pathological stage (p < 0.03). If the PSA was less than 10 ng./ml. only 15% of the patients had an advanced pathological stage, compared to 86% if the PSA was 10 or more. After 2 to 97 months (mean 39) 2 patients died of metastatic prostatic cancer, 5 had distant metastases and none had symptomatic local recurrence. At 5 years the actuarial nonprogression rate measured by PSA was 55 +/- 20%. The only pretreatment factor predictive of progression was the serum PSA level. If the PSA was less than 10 ng./ml. the actuarial rate of progression was significantly lower than if the PSA was greater than 10 (p < 0.05). The best results were in the subset of 18 patients with cancer confined to the prostate or immediate periprostatic tissue: 82% had no progression at 5 years. Within each of these pathological stages the results of salvage prostatectomy were similar to those for standard radical prostatectomy in patients with no prior irradiation. Although technically challenging, salvage prostatectomy provides excellent control of radio-recurrent cancer confined to the prostate or immediate periprostatic tissue and is best performed before the preoperative PSA level increases to greater than 10 to 20 ng./ml.

Aged↗
PubMed1995

Transforming growth factor-beta 1: comparative immunohistochemical localization in human primary and metastatic prostate cancer.

BACKGROUND: We have shown previously that primary prostate cancer demonstrates significant extracellular accumulation of transforming growth factor-beta 1 (TGF-beta 1). To further investigate the potential role of TGF-beta 1 in prostate cancer progression, we evaluated an expanded series of primary prostatic carcinomas and associated lymph node metastases. EXPERIMENTAL DESIGN: Prostate tissue samples from 37 patients were examined. Three were organ donors, all less than 30 years of age, whose prostates were included as normal controls. Eighteen had undergone radical prostatectomy and pelvic lymph node dissection. Eleven were without evidence of metastasis, whereas seven were found to have prostate cancer within at least one of their pelvic lymph nodes. Sixteen had undergone transurethral resection of the prostate for benign disease, yet all had prostate cancer within the resected specimen (15 were stage T1b; 1 was stage T1a). Twelve of the patients with stage T1b disease underwent pelvic lymph node dissection and implantation of radioactive gold seeds. All 12 had prostate cancer in at least one lymph node. All specimens were examined for the level of expression and localization of TGF-beta 1 by immunohistochemistry using Ab that distinguish intracellular from extracellular TGF-beta 1. RESULTS: Normal prostate tissue and benign prostatic hyperplasia demonstrated negative or weak intracellular and extracellular staining for TGF-beta 1. By comparison, 29 of 34 primary prostate cancers showed extensive extracellular TGF-beta 1 staining with pronounced intracellular accumulation within epithelial cells in 13 of 34 patients. There was no difference in the staining pattern for extracellular TGF-beta 1 between primary cancers with and without pelvic lymph node metastases. However, in primary cancers without pelvic lymph node metastases, only 1 of 15 patients showed strong intracellular staining for TGF-beta 1 compared with 12 of 19 primary tumors with metastatic disease. In addition, only 2 of 19 lymph node metastases demonstrated weak extracellular TGF-beta 1 staining, but all 19 contained intracellular TGF-beta 1. CONCLUSIONS: These findings confirm our previous observation that prostate cancer exhibits enhanced intracellular and extracellular accumulation of TGF-beta 1 relative to normal prostate tissue and benign prostatic hyperplasia. In addition, our study documented a significantly more pronounced accumulation of intracellular TGF-beta 1 in primary prostate cancer with metastasis than in primary tumors without metastasis. Moreover, although the pattern of intracellular TGF-beta 1 staining observed in the primary tumor is maintained in the metastasis, a lack of extracellular accumulation of TGF-beta 1 in the metastatic site was noted. This differential pattern may be biologically important and could conceivably reflect a role for TGF-beta 1 in disease progression.

Adenocarcinoma↗
PubMed1994

Determinants of plasma vitamins and lipids: the Working Well Study.

This study was conducted to assess the determinants of plasma concentrations of alpha-tocopherol, beta-carotene, retinol, and cholesterol fractions in a randomly selected subset of 203 workers participating in a worksite-based health intervention trial. Workers were from four companies in eastern and central Massachusetts, and all completed an 84-item semiquantitative food frequency questionnaire as part of baseline (preintervention) self-assessment instruments. At the time of fasting blood sampling, each participant also completed a short screening questionnaire for assessment of changes in dietary habits and tobacco exposure and for collection of data on use of vitamins and nutritional supplements. On the basis of the self-reported data, the authors found that they could explain 35% of the variability in plasma beta-carotene, 73% of the variability in alpha-tocopherol, 36% of the variability in retinol, and 19% of the variability in cholesterol. Plasma beta-carotene levels appeared to be affected by the use of supplements that did not contain carotene, indicating a beta-carotene sparing capability of other agents contained in these preparations. Plasma alpha-tocopherol levels were not similarly affected. These results compare favorably with those from studies that used more intensive dietary assessment techniques as the comparison criterion. Results are discussed in terms of implications for use of self-reported data in epidemiologic study analyses.

Adult↗
PubMed1994

Some small prostate cancers are nondiploid by nuclear image analysis: correlation of deoxyribonucleic acid ploidy status and pathological features.

The biological behavior of a prostate cancer can be predicted to some degree by the volume and extent (stage) of the tumor, and its histological grade. The deoxyribonucleic acid (DNA) ploidy status has been reported by some to be another independent prognostic factor for localized prostate cancer. We determined the DNA ploidy value of each individual focus of cancer in radical prostatectomy specimens using nuclear image analysis (CAS 200 system). Ploidy results were correlated with the volume, Gleason grade and zone of origin (transition zone or peripheral zone) of each tumor, and with the presence of extracapsular extension or seminal vesicle invasion. There were 141 separate cancers in 68 patients (mean 2.1 per prostate): 9 clinical stage A1, 22 stage A2, 23 stage B1 and 14 stage B2. DNA ploidy correlated significantly (p < 0.0001) with volume, grade, extraprostatic spread and zone of origin. Remarkably, some small cancers (1 cc or less) were nondiploid (3 as small as 0.03 cc). Overall, 15% of cancers 0.01 to 0.1 cc and 31% of those 0.11 to 1.0 cc in volume were nondiploid. Of 101 cancers confined to the prostate 76% were diploid, compared to only 13% of those with extraprostatic spread. Most cancers of transition zone origin (86%) were diploid, compared to only 49% of peripheral zone cancers, and ploidy and volume relationships were significantly different for peripheral zone cancers compared to transition zone cancers. All small nondiploid cancers arose in the peripheral zone, while in the transition zone the smallest nondiploid cancer was 1.17 cc. We conclude that prostate cancers that are nondiploid are highly likely to have adverse pathological features. Some small prostate cancers contain a nondiploid cell population and these cancers arise predominantly within the peripheral zone of the prostate. Ploidy and volume relationships provide further support for the hypothesis that there is a difference in malignant potential between cancers of peripheral zone and transition zone origin.

Cell Nucleus↗
PubMed1994

Apoptotic index as a biomarker in prostatic intraepithelial neoplasia (PIN) and prostate cancer.

Chemoprevention trials in prostate cancer would involve excessively long follow-up if conventional endpoints of efficacy are used. Prostatic intraepithelial neoplasia (PIN) may be an appropriate surrogate endpoint for monitoring outcome during prostate cancer chemoprevention studies. To address the question of whether PIN could be stratified into "stable" PIN and PIN likely to progress to invasive cancer, we selected patients with a single focus of peripheral zone cancer with ipsilateral and contralateral high-grade PIN. Sixteen patients met these criteria from a series of 550 patients treated by radical prostatectomy. We examined the rate of apoptosis in PIN and prostate cancer tissues by quantifying the number of apoptotic bodies per hundred cells (apoptotic index) on hematoxylin and eosin stained histological sections. Significant differences (ANOVA: p < 0.05) were detected between foci of prostatic intraepithelial neoplasia contralateral to the cancer and the cancer itself. There was no difference in the apoptotic index between a given cancer and a focus of PIN ipsilateral to the tumor in the same section. However, the range of apoptotic indices overlapped in all categories. Apoptotic indices appear to parallel the biological activity of PIN and malignant prostatic tissue, but may be of little benefit when used alone in monitoring the outcome of chemopreventive therapy in an individual patient.

Analysis of Variance↗
PubMed1993

A reappraisal of serial isotope bone scans in prostate cancer.

Carcinoma of the prostate is the commonest malignancy of the genitourinary tract in the male and is frequently associated with metastatic bone disease. Serial isotope bone scans for screening secondary deposits are not cost-effective. We have evaluated the serum prostate markers prostate-specific antigen (PSA) and prostatic acid phosphatase (PAP) as an alternative to conventional serial bone scanning in 129 patients with newly diagnosed prostate cancer over a period of 3 years. Although serum PSA did not reflect local tumour burden at presentation, it was significantly elevated in those who presented with stage D disease (p < 0.01). 45 patients presented de novo with metastatic bone deposits and a further 18 patients developed metastases during the study period. The sensitivity of PSA in detecting secondary deposits at presentation for levels in excess of 100 micrograms/l was 93.75%, the positive predictive value 95.7% and the negative predictive value for levels less than 5 micrograms/l was 90.6%. During the follow-up period the sensitivity was 94.4%, the positive predictive value 100% and the negative predictive value 100%, with a median lead time of 3 months in predicting metastases in the 18 patients with progressive disease. When compared with PAP, PSA was found to be a statistically superior marker of bone metastases both at presentation and follow-up (p < 0.05). We recommend that PAP measurements are no longer necessary and should be replaced by PSA, and that serial serum PSA estimations should determine the need for future isotope bone scans in the patient with established prostate cancer.

Acid Phosphatase↗
PubMed1992

A comparison of the perceptions of the mother-daughter relationship of black pregnant and nonpregnant teenagers.

This study examined the relationship between mothers and their teenage daughters in order to determine if there was a significant difference in perceived relationships between pregnant and nonpregnant mother-daughter dyads in a predominantly black sample. Results indicated that the nonpregnant daughters and their mothers felt significantly more intimacy toward each other than did the pregnant daughters and their mothers. However, correlations of the mother and daughter scores revealed that the intimacy scores of the mothers of the pregnant daughters were positively correlated with their daughters' attachment scores, suggesting that the mothers and their pregnant daughters were more in agreement regarding their relationship than were the nonpregnant mother-daughter pairs.

Adolescent↗