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Eric A Klein

Publications and source records attributed to Eric A Klein.

90 records · Page 5Linked to original sources
PubMed2002

Impact of biochemical failure on overall survival after radiation therapy for localized prostate cancer in the PSA era.

PURPOSE: To study the impact of biochemical failure on overall survival rates during the first 10 years after definitive radiotherapy for localized prostate cancer. METHODS AND MATERIALS: The analysis was performed on 936 cases treated at a single institution between 1986 and 1998 with definitive radiotherapy. The median age of treatment was 69 years (range: 46-86 years). Pretreatment PSA levels (iPSA) and biopsy Gleason scores (bGS) were available for all cases. The clinical stage was T1/T2A in 63%, T2B/C in 27%, and T3 in 10%. The median iPSA level was 9.6 ng/mL (range: 0.4-692.9 ng/mL). The iPSA was < or =10 in 53% and >10 in 47%. The bGS was < or =6 in 59% and > or =7 in 41%. Androgen deprivation (AD) was administered in 181 cases (19%) for a median duration of 6 months (range: 1-6 months). All 181 cases received AD neoadjuvantly, i.e., before and/or during the radiotherapy. No AD was delivered after the completion of radiation. The median radiation dose was 70 Gy (range: 60-78 Gy). The radiotherapy technique was conformal in 376 (40%) cases. The American Society of Therapeutic Radiology and Oncology definition of biochemical failure (bF) was used; 316 cases (34%) had failed biochemically, and 620 (66%) had not. The end point was overall survival (OS). Time to death was determined from the time of definitive radiotherapy. The median PSA follow-up was 58 months. The median follow-up times for bF vs. no-bF cases were 77 and 49 months, respectively. A multivariate analysis of factors affecting OS using the proportional hazards model was performed for all cases using the following variables: age (>65 vs. < or =65 years), race (African-American vs. Caucasian), clinical T stage (T1-2A vs. T2B-C vs. T3), bGS (< or =6 vs. 7 vs. > or =8), iPSA (continuous variable), use of AD (yes vs. no), year of therapy (continuous variable), radiation dose (continuous variable), radiation technique (conformal vs. standard), and biochemical failure (yes vs. no). RESULTS: The 5-year OS rate for the entire group was 89% (95% CI [confidence interval]: 86-91%). The 5-year OS rates for bF vs. no-bF patients were 89% (95% CI: 86-93%) and 89% (95% CI: 86-92%), respectively. The 10-year OS rate for the entire group was 68% (95% CI: 61-75%). The 10-year OS rates for bF vs. no-bF patients were 65% (95% CI: 56-74%) and 77% (95% CI: 69-84%), respectively. The difference between bF and no bF was not significant in predicting overall survival in univariate analysis (log-rank test, p = 0.68). On multivariate analysis, bGS (p < 0.001), T stage (p = 0.003), radiation dose (p = 0.017), year of therapy (p = 0.031), and age (p = 0.020) were independent predictors of death. iPSA levels (p = 0.33), race (p = 0.80), radiation technique (p = 0.16), and use of AD (p = 0.09) were not predictive of OS. Biochemical failure (p = 0.052) showed only a trend for independently predicting overall survival on multivariate analysis. CONCLUSION: Biochemical failure after definitive radiotherapy for localized prostate cancer is not associated with increased mortality within the first 10 years after initial therapy, although a trend toward worse outcome was observed at 10 years. Longer follow-up from initial therapy is needed to fully understand the impact of biochemical failure on overall survival. With longer follow-up, significant differences might be observed at 15 or 20 years after therapy.

Aged↗
PubMed2002

Nephron-sparing nephrectomy for giant renal angiomyolipoma associated with lymphangioleiomyomatosis.

Renal angiomyolipomas are benign tumors known to occur sporadically and in association with genetic syndromes, including tuberous sclerosis and lymphangioleiomyomatosis. Surgical removal or radiographic embolization of angiomyolipomas larger than 4 cm is usually indicated because of an increased risk of spontaneous hemorrhage. We describe successful nephron-sparing surgery for a giant angiomyolipoma and discuss relevant management issues in a patient with lymphangioleiomyomatosis who had previously undergone bilateral pulmonary transplantation.

Adult↗
PubMed2002

Orthotopic neobladder and subsequent renal transplantation.

Continent urinary diversion has become an attractive alternative to traditional conduits after cystectomy in select patients, including those awaiting renal transplantation. We report a case of a surgically anephric dialysis patient who underwent radical cystoprostatectomy with orthotopic ileal neobladder for recurrent superficial transitional cell carcinoma of the bladder and subsequent living-related renal transplantation 7 months later. We also discuss the perioperative adjuncts paramount to successful outcomes in such patients.

Carcinoma, Transitional Cell↗
PubMed2002

Management of stage I nonseminomatous germ-cell tumors.

Following orchiectomy in patients with stage 1 nonseminomatous germ-cell tumors (NSGCT), there are three treatment options. Retroperitoneal lymph-node dissection (RPLND) is currently the treatment of choice in the United States and can be both diagnostic and therapeutic but is associated with surgical morbidities. Surveillance is the least invasive but carries the highest potential for relapse and can be timely and costly for both patient and physician. Primary chemotherapy avoids the morbidity of surgery while achieving similar survival rates, albeit with potentially significant side effects. The advantages and disadvantages of each treatment modality are discussed.

Germinoma↗
PubMed2002

Brain metastases from bladder carcinoma: presentation, treatment and survival.

PURPOSE: We report the presentation of brain metastases from bladder carcinoma. We investigated the role of whole brain radiation therapy for treating this disease. MATERIALS AND METHODS: Between January 1982 and November 1999, 16 patients with brain metastases from bladder carcinoma were treated at our institution. We reviewed patient and tumor characteristics at the time of the primary diagnosis and the brain metastasis diagnosis. We analyzed treatment results in regard to survival and local metastasis control. RESULTS: Brain metastases from bladder carcinoma were commonly accompanied by uncontrolled systemic metastases. Multiple brain lesions developed in 14 of the 16 patients. Of the 16 patients 14 received radiation therapy with or without surgery, 1 was treated surgically and 1 did not receive any treatment. The 11 patients treated with whole brain radiation therapy had a median survival of only 2 months (range 0.5 to 11). A patient who received stereotactic radiosurgery survived 12 months after the brain metastasis diagnosis and 2 treated with radiation therapy after surgery survived 12.75 and 2.75 months, respectively (median 7.75). The patient treated with surgery alone survived 1.25 months after the brain metastasis diagnosis and 1 who received no treatment survived 1.75 months. Patients with multiple brain metastases had shorter survival than those with a single metastasis. CONCLUSIONS: Overall survival after brain metastasis development in patients with bladder carcinoma was poor. Although the number of patients in this study was small, results indicate that radiation therapy alone is inadequate treatment. Therefore, when possible, we advocate more effective treatment by combining radiation therapy with other treatment modalities, as recommended in ongoing clinical trials.

Adult↗
PubMed2002

Laparoscopic radical cystectomy and continent orthotopic ileal neobladder performed completely intracorporeally: the initial experience.

PURPOSE: We introduce the operative technique of laparoscopic radical cystectomy and orthotopic ileal neobladder with a Studer limb performed completely intracorporeally. MATERIALS AND METHODS: The procedure was performed in 1 man and 1 woman. Using a 6 port transperitoneal approach, radical cystectomy in the female patient and radical cystoprostatectomy in the male patient were completed laparoscopically with the urethral sphincter preserved. Bilateral pelvic lymphadenectomy was done. A 65 cm. segment of ileum 15 cm. from the ileocecal junction was isolated, and ileo-ileal continuity was restored using Endo-GIA staplers (U.S. Surgical, Norwalk, Connecticut). The distal 45 cm. of the isolated ileal segment were detubularized, maintaining the proximal 10 cm. segment intact as an isoperistaltic Studer limb. A globular shaped ileal neobladder was constructed and anastomosed to the urethra. Bilateral stented ureteroileal anastomoses were individually performed to the Studer limb. All suturing was done exclusively using free-hand laparoscopic techniques and the entire procedure was completed intracorporeally. An additional case is described of Indiana pouch continent diversion in which the pouch was constructed extracorporeally. RESULTS: Total operative time for laparoscopic radical cystectomy and orthotopic neobladder was 8.5 and 10.5 hours, respectively, with a blood loss ranging from 200 to 400 cc. Hospital stay was 5 to 12 days and surgical margins of the bladder specimen were negative in each case. Both patients with orthotopic neobladder had complete daytime continence. Postoperative renal function was normal and excretory urography revealed unobstructed upper tracts. During followup ranging from 5 to 19 months 1 patient died of metastatic disease, while the other 2 are doing well without local or systematic progression. CONCLUSIONS: Laproscopic radical cystectomy and orthotopic ileal neobladder performed completely intracorporeally are feasible.

Adult↗
PubMed2002

Prostate-specific antigen as a marker of disease activity in prostate cancer.

Despite the impact of prostate-specific antigen (PSA) testing on the detection and management of prostate cancer, controversy about its usefulness as a marker of disease activity continues. This review, based on a recent roundtable discussion, examines whether PSA measurements can be used rationally in several clinical settings. Following radical prostatectomy and radiation therapy, prediction of survival by PSA level is most reliable in high-risk patients. PSA doubling time after radiation therapy is the strongest predictor of biochemical failure. PSA measurements have been associated with inconsistent results following hormonal treatment; reduced PSA levels may result from antiandrogen treatment, which decreases expression of the PSA gene, and therefore, the level of PSA production. In the setting of primary and secondary cancer prevention, PSA is important in risk stratification when selecting patients for studies. Part 1 of this two-part article, which concludes in the September issue, focuses on the physiology of PSA, its measurement and use in clinical practice, and its predictive value following radical prostatectomy and radiation therapy.

Biomarkers, Tumor↗
PubMed2002

Prostate-specific antigen as a marker of disease activity in prostate cancer.

Despite the impact of prostate-specific antigen (PSA) testing on the detection and management of prostate cancer, controversy about its usefulness as a marker of disease activity continues. This review, based on a recent roundtable discussion, examines whether PSA measurements can be used rationally in several clinical settings. Following radical prostatectomy and radiation therapy, prediction of survival by PSA level is most reliable in high-risk patients. PSA doubling time after radiation therapy is the strongest predictor of biochemical failure. PSA measurements have been associated with inconsistent results following hormonal treatment; reduced PSA levels may result from antiandrogen treatment, which decreases expression of the PSA gene, and therefore, the level of PSA production. In the setting of primary and secondary cancer prevention, PSA is important in risk stratification when selecting patients for studies. Part 2 of this two-part article, which began in the August issue, discusses the role of PSA in hormonal and drug therapies and in primary and secondary chemoprevention.

Biomarkers, Tumor↗
PubMed2002

Opportunities for prevention of prostate cancer: genetics, chemoprevention, and dietary intervention.

At least five susceptibility loci for the development of prostate cancer have been identified in the last several years. Although the specific genes involved have yet to be fully characterized, these discoveries hold promise for the identification of individuals at risk for prostate cancer years before development of the disease. Individuals identified as at risk through simple genetic screening (ie, a test on peripheral blood) could have a modified screening schedule, be entered into clinical trials of chemoprevention or dietary modification, and/or be treated according to the clinical characteristics of the cancer associated with a particular gene. Several large chemoprevention trials that exploit underlying pathogenetic mechanisms for the development of prostate cancer are currently underway or about to open. The future of prostate cancer is in the genes and our ability to manipulate the molecular events they cause.

Journal Article↗
PubMedDate not supplied

Finding help for sexual problems after prostate cancer treatment: a phone survey of men's and women's perspectives.

As part of a larger postal survey, 320 survivors of prostate cancer who reported they were likely to seek help in the next year for a sexual problem were interviewed by phone about their strategies for finding help and the types of treatment that would help resolve post-cancer sexual problems. In addition, 164 sexual partners (including 160 wives, three female partners in committed relationships, and one gay male partner) were interviewed. Educational materials were used by patients and partners to answer questions about sexual dysfunction but were less useful in helping to find professional referrals or in actually resolving sexual problems, particularly for African-American couples. Men's preferred method of finding help was to consult a urologist or prostate cancer specialist to find a medical treatment for erectile dysfunction. Ninety-one percent of men had already tried to find medical help for erectile dysfunction, but previous attempts remained unsuccessful. Men wanted an oral medication that would resolve their sexual problem naturally, without major side effects. Only 43% of men said their partners had encouraged them to find help, and indeed a large minority of women had resigned themselves to having unsatisfying sex lives. These data suggest that including the partner in counseling about medical treatments for sexual function, and giving both men and partners realistic expectations about the limitations of existing treatments could boost the success of sexual rehabilitation after prostate cancer.

Aged↗
PubMedDate not supplied

Continuing trends in pathological stage migration in radical prostatectomy specimens.

Prostate-specific antigen (PSA) screening has resulted in a profound clinical stage migration. Extracapsular extension (ECE) presents a poor prognosis after radical prostatectomy (RP). In this study the trends in rate of ECE for cancers detected by PSA screening between 1987, when PSA screening became routine in the United States, and 2001, were examined. The clinical outcome of patients (total 1505; 888 clinical Tlc, 614 clinical T2, and 3 clinical T3) with prostate cancer diagnosed by PSA screening and treated with RP without neoadjuvant hormonal therapy was analyzed. The primary outcome variable was ECE rate with respect to year of treatment for a given tumor stage, preoperative PSA level, biopsy Gleason score, and surgical Gleason score. Logistic regression analysis was used to identify predictors of ECE. Biochemical relapse-free survival (bRFS) by year of treatment was analyzed by Kaplan-Meier Curve. Rate of ECE decreased from 65.8 to 25.2% during the 15-year study duration. Multivariate analysis of clinical tumor stage, age, preoperative serum PSA level, and Gleason score confirmed that year of treatment was an independent predictor of ECE. Six-year bRFS rates (by years of treatment) were 75.1% for 1987 to 1994 and 82.6% for 1995 to 2001 (P-value = 0.0022). PSA screening has resulted in a downward pathological stage migration. These observations demonstrate improved biochemical failure rates in more recently treated patients.

Aged↗
PubMedDate not supplied

Phase II trial of GM-CSF + thalidomide in patients with androgen-independent metastatic prostate cancer.

BACKGROUND: Androgen-independent metastatic prostate cancer is a major therapeutic dilemma. Granulocyte-macrophage colony stimulating factor (GM-CSF) and thalidomide have some biologic activity as single agents in this disease subset. We performed a Phase II trial of this combination to assess its toxicity and potential utility as an immunomodulatory approach to management of advanced prostate cancer. METHODS: Twenty-two patients were treated with GM-CSF 250 microg administered SC on Monday, Wednesday and Friday of each week. Thalidomide was escalated to reach the study dose of 200 mg/day. Patients were assessed every 4 weeks with therapy continuing to a maximum of 6 months. RESULTS: All 22 patients had a decrement in PSA at 2 weeks postinitiation of therapy. Five patients had a > or =50% decline (56, 64,66,66, and 94%, respectively) from baseline verified at 4 weeks post best response. This corresponds to an observed response rate of 23% (95% confidence interval 8-45%). Therapy was well tolerated with the majority of patients experiencing only one event. CONCLUSIONS: The combination of GM-CSF + thalidomide is relatively well tolerated and has the potential to produce antitumor activity in a population of patients with metastatic, androgen independent prostate cancer. This nonchemotherapy combination should be explored in a subset of patients with less advanced disease.

Aged↗
PubMedDate not supplied

Complications of surgery and chemotherapy for testicular cancer.

Testicular cancer is a malignancy for which an interdisciplinary approach offers the highest likelihood of cure. In many patients, both chemotherapy and surgery play a prominent role in their care. Although cure can be achieved in a majority of patients, the treatment can occasionally leave the patient with late sequelae. This article discusses the long-term toxicity of curative surgical or cytotoxic therapy for germ cell tumors.

Drug-Related Side Effects and Adverse Reactions↗
PubMedDate not supplied

SELECT: the selenium and vitamin E cancer prevention trial.

PURPOSE: Growing evidence suggests that both selenium and vitamin E may reduce the risk of prostate cancer. SELECT is a randomized, prospective, double-blind study designed to determine if selenium and vitamin E can reduce the risk of prostate cancer among healthy men. MATERIALS AND METHODS: The preclinical and epidemiologic evidence regarding chemoprevention with selenium and vitamin E were reviewed. Secondary analyses from randomized trials of both agents were included in the analysis. Data from these analyses as well as evidence from the Prostate Cancer Prevention Trial were used to develop the schema of SELECT. RESULTS: Preclinical, epidemiologic, and Phase III data suggest that both selenium and vitamin E have potential efficacy in prostate cancer prevention. The experience of the Prostate Cancer Prevention Trial and the rapid accrual of SELECT during its first year demonstrate the interest and dedication of healthy men to long-term studies of cancer prevention. A total of 32,400 men are planned to be randomized in SELECT. CONCLUSIONS: SELECT is the second large-scale study of chemoprevention for prostate cancer. Enrollment began in 2001 with final results anticipated in 2013.

Adenocarcinoma↗
PubMedDate not supplied

Sexuality and health-related quality of life after prostate cancer in African-American and white men treated for localized disease.

The purpose of this study was to examine differences in sexual attitudes and quality of life of White and African-American men who have undergone radical prostatectomy or radiation therapy for localized prostate cancer. Respondents included 1,112 White and 118 African-American men. Response rates differed by race, with 51% of White men and 28% of African-American men returning the questionnaire assessing demographics, medical history, sexual functioning, attitudes about seeking help for sexual problems, sexual self-schema, and health-related quality of life. African Americans were more likely than Whites to have undergone radiation therapy (p <.0001) and were more likely to indicate that a desire to maintain sexual functioning influenced their treatment choice (p <.0001). African-American men also had more positive attitudes than did White men toward seeking help for sexual problems and were more likely to report seeking past help and intending to seek future help. African-American men reported more problems with sexual desire (p =.0003), although their sexual function scores did not differ significantly from those of Whites. African-American men may be more at risk for distress when prostate cancer treatment causes sexual dysfunction.

Adult↗