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G S Gerber

Publications and source records attributed to G S Gerber.

80 records · Page 5Linked to original sources
PubMed1992

Local staging of prostate cancer by tumor volume, prostate-specific antigen, and transrectal ultrasound.

Conventional methods of staging prostate tumors are highly inaccurate. To improve clinical staging, prostate-specific antigen (PSA) levels (> 10 ng/mL), sonographic tumor volume (> 3 cc), maximum tumor diameter, length of capsular tumor abutment, and overall impression of capsular irregularity suggesting periprostatic tumor spread were assessed in 29 men prior to undergoing radical prostatectomy for clinically localized tumor. After surgery, 18 men had tumor confined to the prostate, while 11 men had histologic evidence of extracapsular disease. Analysis of the parameters measured showed these were the most helpful factors in predicting the presence of extracapsular disease. However, the positive and negative predictive values were only 70 to 90 percent. Therefore, the clinical usefulness of any one measurement alone in determining treatment for the individual patient is limited. However, combining these parameters yields an improved prediction of extracapsular disease. All 6 patients with PSA < 10 ng/mL, tumor volume < 3 cc, and no capsular irregularity on ultrasound had localized disease (neg. predictive value = 100%), while all 7 patients who had more than one of these parameters had extracapsular disease (pos. predictive value = 100%). Thus, using the factors in combination may provide more accurate staging and thereby help in counseling patients regarding therapy.

Humans↗
PubMed1991

Routine screening for cancer of the prostate.

The value of screening for prostate cancer remains unclear. Although digital rectal examination, transrectal ultrasonography, and determination of serum prostate-specific antigen levels may lead to early detection of a malignancy, these procedures have never been shown to reduce disease-specific mortality from prostate cancer. Unfortunately, several potential errors found in uncontrolled trials may suggest benefit from screening where none exists. Only a large, randomized, controlled clinical study demonstrating decreased mortality from prostate cancer can prove that screening is beneficial. Until such a study is performed, patients should be informed of both the potential benefits and the risks of screening and treatment.

Antigens, Neoplasm↗
PubMed1991

Pharmacological erection program using prostaglandin E1.

A total of 72 impotent patients entered into a pharmacological erection program using prostaglandin E1. Of the men 35 (49%) used prostaglandin E1 on a regular basis, while 37 (51%) failed to continue in the program beyond the in-office dose titration period. In patients who continue to use prostaglandin E1 the median duration of drug use is 7 months, with a range of 2 to 28 months. There have been no instances of cavernous fibrosis, systemic reaction or chemical priapism (erection present longer than 4 hours) in any patient. Only 8 men (11%) were unable to achieve an adequate erection with prostaglandin E1 injections. The most common adverse effect of prostaglandin E1 was penile pain after injection. The incidence of severe pain leading to drug discontinuation was 17% (12 of 72 patients) while mild to moderate pain occurred in 22% (16 of 72). Over-all, intracavernous prostaglandin E1 injections appear to be a safe, effective treatment for impotence in most men.

Alprostadil↗
PubMed1990

Prostate specific antigen for assessing response to ketoconazole and prednisone in patients with hormone refractory metastatic prostate cancer.

Serial prostate specific antigen levels were assessed in 15 patients with hormone refractory metastatic prostate cancer treated with ketoconazole and prednisone. Of the men 12 (80%) with continually increasing prostate specific antigen levels before treatment had a decrease in prostate specific antigen with a median duration of response of 3 months. Three patients (20%) had a prolonged response (greater than or equal to 8 months) as seen by a persistently decreasing prostate specific antigen and improvement in bone pain. There appears to be a small subgroup of patients with progressive prostate cancer despite androgen ablation who will benefit from ketoconazole and glucocorticoid treatment. The use of serial prostate specific antigen levels appears to help define this subgroup and avoid the need for multiple radiological procedures to assess response.

Adenocarcinoma↗
PubMed1990

Digital rectal examination in the early detection of prostate cancer.

Screening using digital rectal examination improves the clinical stage distribution of prostate cancer and prolongs survival. Unfortunately, digital rectal examination may not be sensitive enough to detect the small-volume tumors that are most amenable to cure. In several studies, approximately 50 per cent of cancers detected through screening had already spread beyond the prostate. Regardless, the key to demonstrating overall benefit from screening is a diminished disease-specific mortality rate. To date, this has not been shown. Lower mortality rates from prostate cancer can be demonstrated only through a randomized study comparing screened and unscreened populations. Such a study, which has recently been approved and funded by the National Institutes of Health, will require 10 to 15 years to complete. Until that time, the value of screening for prostate cancer by digital rectal examination or any other method will be unknown. Beyond a lack of proved benefit, screening for prostate cancer may be harmful because of the variable natural history of the disease and the morbidity and mortality rates associated with treatment. There exists a large population of patients with pathologically detectable prostate cancer who will never have clinical disease. The detection of some of these tumors may expose those patients to the risks of unnecessary treatment. Large-scale prostate cancer screening studies may ultimately be shown to be advantageous. The sooner this occurs, the earlier aggressive screening can be advocated, similar to screening for breast cancer. However, the temptation to embark on such screening programs without first demonstrating clear benefit should be resisted.

Humans↗
PubMedDate not supplied

Laparoscopic approach to retroperitoneal lymph node dissection.

Laparoscopic retroperitoneal lymph node dissection is a new surgical procedure used to enhance staging in men with clinical stage I nonseminomatous germ cell tumors of the testis. The procedure has been performed in a limited number of patients at several centers with extensive laparoscopic experience. Laparoscopic retroperitoneal lymphadenectomy is a technically demanding procedure which can be successfully completed in the majority of patients. However, the risk of complications is greater than in patients who undergo standard open retroperitoneal lymph node dissection. The primary advantage of a laparoscopic approach is shortened hospitalization and rapid return to normal activity. The role of laparoscopy in the management of patients with testis malignancy has not been defined. The use of this staging procedure may help minimize the need for surveillance studies following surgery and may be best utilized in men with a lower likelihood of nodal metastases. Ultimately, prospective study in large groups of patients will be necessary to determine the role of laparoscopic retroperitoneal lymph node dissection in patients with testis cancer.

Activities of Daily Living↗
PubMedDate not supplied

Comparative viewing modalities for CT cystography.

BACKGROUND: To define the speed and accuracy of two different reconstructive techniques using computed tomography (CT) cystography for the detection and measurement of urinary bladder masses and determine the overall ease of use. METHODS: Ten patients scheduled for cystoscopy for the evaluation of hematuria or bladder masses were studied by means of thin-section CT of the air-distended bladder. Two techniques were employed by two radiologists to blindly interpret the data: conventional two-dimensional data with interactive three-dimensional problem solving (2D3DPS) and surface-shaded display (SSD) three-dimensional images. The results were compared with the data from cystoscopy. RESULTS: Twenty-two (100%) of 22 masses detected on cystoscopy were visualized using the reconstructive techniques. Both modalities were shown to have high accuracy, but only the 2D3DPS had a sensitivity and specificity of 100% for both observers at the patient-level diagnosis. The sensitivities for detecting individual masses for the two observers were 100% and 64% for 2D3DPS and 64% and 70% for SSD. CONCLUSION: Both methods used to display the CT data had a high sensitivity and specificity for masses, but only the 2D3DPS had a sensitivity and specificity of 100% at the patient-level diagnosis, thus making it a feasible imaging modality for cystography. It was also preferred overall for ease of use, high accuracy, and relative low cost.

Aged↗