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Biomedical subjects

H B Carter

Publications and source records attributed to H B Carter.

At least 37 records · Page 2Linked to original sources
PubMed1999

Prostate cancer sampled on sextant needle biopsy: significance of cancer on multiple cores from different areas of the prostate.

OBJECTIVES: To determine the relationship between the location of positive sites, when more than one sextant site shows prostate cancer in a given patient, and pathologic stage, tumor volume, and margin status if radical prostatectomy is performed. METHODS: We performed biopsies using a spring-loaded biopsy gun on 343 Stage T1c (nonpalpable) radical prostatectomy specimens from each sextant site. RESULTS: In 56 cases, carcinoma was identified in two separate sextant sites. In 38 cases, the sites were vertical to each other (ie, left apex, left mid); in 8 cases, the sites were diagonal (ie, left apex, right mid); in 5 cases, the sites were horizontal (ie, left apex, right apex); and in 5 cases, they were not contiguous but were separated by an uninvolved sextant site (ie, left apex, left base). Tumors were more likely to be multifocal in cases with diagonally positive biopsies (P <0.0001) and horizontally positive biopsies (P <0.0001) than in those with vertically positive biopsies. No significant differences were found in organ-confined status and margin positivity among cases with different positive biopsy locations. The dominant tumor nodule was larger (mean 2.76 cc) in cases with noncontiguously positive biopsies than in all other groups combined (mean 1.44 cc) (P = 0.017). CONCLUSIONS: When more than one sextant site shows cancer, there are differences in terms of whether the tumors sampled are multifocal versus solitary depending on which sites are positive. However, no significant differences were found in predicting pathologic stage and margin positivity.

Biopsy, Needle↗
PubMed1999

The significance of prior benign needle biopsies in men subsequently diagnosed with prostate cancer.

PURPOSE: We determine the relationship between a history of benign needle biopsies, and the volume and location of cancer. MATERIALS AND METHODS: We evaluated 395 men who underwent radical prostatectomy for stage T1c (nonpalpable) prostate cancer. RESULTS: Of the men 74 had 1 or more prior benign needle biopsies. Prior benign biopsy correlated with tumor in the anterior or lateral portion of the radical prostatectomy specimen (p = 0.044) and prostate weight (p = 0.002). The likelihood of prior benign biopsy was 32.5% for men with a 75 gm. or greater prostate compared to 15.2% for those with a less than 75 gm. prostate. Although prior benign biopsy correlated with "very limited" tumor in the prostate (less than 0.2 cc, no Gleason pattern 4 or 5 and organ confined disease) (p = 0.005), only 28.4% of patients with prior benign biopsy had "very limited" tumor. In a multivariate analysis prior benign biopsy correlated only with anterior or lateral distribution and enlarged prostate size. Of the prior benign biopsy cases 12% had positive margins, average tumor volume was 1.15 cc and 27% had nonorgan confined disease. These figures were not different from those in cases with cancer on the first biopsy. In prior benign biopsy cases although PSA velocity predicted tumor volume and "very limited" tumor, a specific clinically useful cutoff value was not present. Needle biopsy grade and number of positive cores were not predictive of tumor volume or "very limited" cancer. CONCLUSIONS: Prior benign biopsy in men subsequently diagnosed with prostate cancer does not indicate indolent tumor. Benign biopsies are more likely in larger prostate glands and when cancer is in the anterior and lateral regions of the gland, suggesting the need for different biopsy strategies to improve cancer detection.

Biopsy, Needle↗
PubMed1998

Isolated vasculitis of the seminal vesicle.

We present 2 cases of histologically identified necrotizing vasculitis found in the seminal vesicles of radical prostatectomy specimens containing prostatic adenocarcinoma. In neither case did the patient suffer from symptoms nor show signs of systemic vasculitis. In 1 case, the vasculitis correlated clinically with dense adhesions noted at surgery that simulated extraprostatic tumor extension. Isolated vasculitis of the seminal vesicle is similar to reports of isolated vasculitis limited to other organs, in that local clinical findings may or may not be present, but the patient is free of systemic disease. Careful clinical follow-up is warranted to exclude the subsequent development of systemic vasculitis in these patients.

Aged↗
PubMed1998

Nonpalpable stage T1c prostate cancer: prediction of insignificant disease using free/total prostate specific antigen levels and needle biopsy findings.

PURPOSE: Approximately 25% of radical prostatectomies performed for stage T1c disease show potentially insignificant prostate cancer. We previously reported the use of serum prostate specific antigen (PSA) density and needle biopsy findings to predict potentially insignificant cancer. We now evaluate whether using free/total serum PSA levels along with needle biopsy findings can better predict tumor significance. MATERIALS AND METHODS: We studied 163 radical prostatectomy specimens of stage T1c prostate cancer in which free/total serum PSA levels were determined. Free/total serum PSA levels were measured with Tandem-MP PSA assays. Insignificant prostate cancers were organ confined with tumor volumes less than 0.5 cc and Gleason score less than 7. Advanced tumors were either Gleason score 7 or greater, established extraprostatic extension with positive margins, or positive seminal vesicles or lymph nodes. Other cases were considered as moderate tumor. Moderate and advanced tumors were considered significant. RESULTS: Of the tumors 30.7% were insignificant, 49.7% moderate and 19.6% advanced. The best model to predict preoperatively insignificant tumor was a free/total PSA of 0.15 or greater and favorable needle biopsy findings (less than 3 cores involved, none of the cores with greater than 50% tumor involvement and Gleason score less than 7). Using this model of the 18 tumors predicted to be insignificant 17 were insignificant for a positive predictive value of 94.4%. Of the 145 cases that were predicted to be significant 112 were correctly predicted for a negative predictive value of 77.2%. There was only 1 tumor predicted to be insignificant which was classified as moderate. No tumor predicted to be insignificant was advanced. CONCLUSIONS: In conjunction with needle biopsy findings, free/total PSA levels accurately predict insignificant tumor in stage T1c disease.

Biopsy, Needle↗
PubMed1997

Recommended prostate-specific antigen testing intervals for the detection of curable prostate cancer.

OBJECTIVE: To evaluate prostate-specific antigen (PSA) testing intervals that maintain the detection of curable cancer and reduce unnecessary testing. DESIGN AND PATIENTS: Historical prospective study of serial PSA measurements at 2- and 4-year intervals from frozen serum samples of 40 men who eventually developed prostate cancer and 272 men without prostate cancer who were participants in a prospective aging study (Gerontology Research Center of the National Institute on Aging, the Baltimore Longitudinal Study of Aging) and the case series of 389 consecutive men treated surgically for nonpalpable prostate cancer. MAIN OUTCOME MEASURES: Probability of a PSA conversion to 4.1 to 5.0 ng/mL and to greater than 5.0 ng/mL at 2 and 4 years and probability of detecting curable prostate cancer by age and PSA level. RESULTS: When the pretreatment PSA level was less than or equal to 4.0 ng/mL, nonpalpable prostate cancers were highly likely (34/36, 94%) to be curable (organ-confined or capsular penetration with Gleason score < 7 and negative margins), and the majority (25/36, 69%) were small cancers (confined tumor < or = 0.5 cm3 with no Gleason pattern 4 or 5). When the pretreatment PSA level was greater than 4.0 ng/mL and less than or equal to 5.0 ng/mL, cancers were highly likely to be curable (32/36, 89%), and a minority were small cancers (12/36, 33%). When the pretreatment PSA level was greater than 5.0 ng/mL, 96 (30%) of 317 cancers were noncurable. The PSA conversion (for cancer cases) to a level at which cure is less likely (> 5.0 ng/mL) is rare (0%) after 2 or 4 years when the initial PSA is less than 2.0 ng/mL. PSA conversion to a range at which cancers are likely to be curable and less likely to be small (4.1-5.0 ng/mL) is rare after 2 years (0%-4%) when the baseline PSA level is less than 2.0 ng/mL but common when the baseline PSA level is between 2.1 and 3.0 ng/mL (27%) or 3.1 and 4.0 ng/mL (36%). CONCLUSIONS: These data suggest that for men with no cancer suspected on digital rectal examination, a PSA level of 4.0 to 5.0 ng/mL is an acceptable range for maintaining the detection of curable prostate cancer and a 2-year PSA testing interval is not likely to miss a curable prostate cancer when the initial PSA level is less than 2.0 ng/mL. Recognizing that 70% of a screened population between the ages of 50 years and 70 years have PSA levels less than 2.0 ng/mL, elimination of annual PSA testing for these men would result in large health care cost savings.

Aged↗
PubMed1997

Prediction of significant cancer in men with stage T1c adenocarcinoma of the prostate.

Widespread prostate specific antigen (PSA) testing results in detection of prostate cancer 4-6 years earlier than possible with digital rectal examination. Twenty to thirty percent of prostate cancers detected with PSA testing (non-palpable disease) are small tumors (< 0.5cc) that may be unimportant in some men. Pre-treatment criteria that include PSA density and prostate biopsy findings provide the means to assess the significance of prostate cancer after diagnosis. This information is useful when counseling men regarding management options for non-palpable, PSA detected prostate cancer.

Adenocarcinoma↗
PubMed1997

Use of repeat sextant and transition zone biopsies for assessing extent of prostate cancer.

PURPOSE: Little is known why certain prostate cancers are missed on biopsy. In patients with a needle biopsy diagnosis of cancer it is also unknown whether repeat needle biopsy provides useful information to predict extent of disease. MATERIALS AND METHODS: In the pathology laboratory we performed sextant and transition zone needle biopsies on 193 radical prostatectomy specimens from men with nonpalpable cancer detected on needle biopsy (stage T1c) using an 18 gauge biopsy gun. Radical prostatectomy specimens were then serially sectioned, totally embedded, mapped and staged. RESULTS: The transition zone biopsy by itself was positive in only 2.1% of cases, demonstrating the lack of usefulness for this particular biopsy. Despite cancer on preoperative needle biopsy in all cases, 31% showed no cancer on repeat sextant transition zone biopsy. In a multivariate analysis (variables included radical prostatectomy tumor volume, radical prostatectomy tumor location, prostate gland size and radical prostatectomy grade) decreased tumor volume (p < 0.0001), increased gland size (p = 0.001), and decreased radical prostatectomy grade (p = 0.013) were each independent predictors of absence of tumor on repeat biopsy. A lack of cancer on repeat biopsy correlated with pathological stage: 90% of cases without cancer on repeat biopsy were organ confined versus 66% for cases with a single less than 3 mm. focus of cancer on repeat biopsy versus 58% for cases with more cancer on repeat biopsy. Of 38 men with a preoperative needle biopsy showing less than 3 mm. of cancer on 1 core that was not high grade and with prostate specific antigen 10 or less (men for whom urologists are most likely to repeat biopsy) the presence of cancer on repeat biopsy also correlated with extent of disease at radical prostatectomy. However, of these 38 men 6 of 16 with no cancer on repeat biopsy had moderate tumor (4 with organ confined Gleason score 5 to 6, tumor volume 0.79 to 4.5 cc; 1 with organ confined Gleason score 7, tumor volume 0.18 cc; and with 1 established penetration Gleason score 6, tumor volume 0.53) at radical prostatectomy. CONCLUSIONS: Although absence of cancer on repeat biopsy correlates with various parameters of extent of disease, there is significant overlap for the individual patient. This study also demonstrates the limits of sextant needle biopsy to evaluate tumor status in patients who elect watchful waiting or less invasive forms of therapy (cryotherapy, interstitial radiotherapy).

Adult↗
PubMed1997

Prostate-specific antigen in men born with bladder exstrophy.

OBJECTIVES: To determine serum levels of prostate-specific antigen (PSA) in men born with bladder exstrophy and to investigate the clinical utility of this test in the bladder exstrophy population. METHODS: Ten men aged 19 to 45 years with a history of bladder exstrophy underwent digital rectal examination and free and total serum PSA determinations. Immunohistochemistry for PSA and prostate-specific acid phosphatase (PSAP) was performed on archival prostate tissue from 1 man with bladder exstrophy. RESULTS: Free and total serum PSA levels for all patients were measurable and below the upper limit for established age-specific reference ranges for normal men. Both PSA and PSAP were detectable by immunohistochemistry in prostate epithelial cells of a man with bladder exstrophy. CONCLUSIONS: Men born with bladder exstrophy have detectable serum PSA levels. However, because prostate cancer in men with bladder exstrophy has not been reported, whether PSA will have a clinical role as a serum tumor marker for prostate cancer in this population remains to be determined. If so, the PSA reference range for men with the exstrophy condition will need to be defined. Because prostate histology in men with exstrophy resembles that of normal men, careful clinical monitoring for benign and malignant tumors should not be overlooked in this particular population.

Adult↗
PubMed1997

Percentage of free prostate-specific antigen in sera predicts aggressiveness of prostate cancer a decade before diagnosis.

OBJECTIVES: To evaluate serial measurements of free and total prostate-specific antigen (PSA) as a predictor of prostate cancer aggressiveness. METHODS: Twenty men diagnosed with adenocarcinoma of the prostate in the pre-PSA era had serum PSA measurements made on multiple stored frozen sera samples available for up to 18 years prior to diagnosis. Subjects were categorized as having aggressive cancer (n = 12) based on the presence of clinical Stage T3, or nodal or bone metastases (N+, M+), or pathologic positive-margin disease, or a Gleason score of 7 or greater; nonaggressive cancer (n = 8) was identified by the absence of these criteria. RESULTS: There was no statistically significant difference in free PSA levels among men with aggressive and nonaggressive prostate cancers from 0 to 15 years before diagnosis. Total PSA levels were significantly different between the groups by 5 years before diagnosis (P = 0.04). At a time when total PSA levels were not different between groups (10 years before diagnosis), there was a statistically significant difference in the percentage of free PSA between aggressive and nonaggressive cancers (P = 0.008). Among 14 men who had sera available for analysis at 10 years before diagnosis, all 8 men with aggressive cancers had a percent free PSA of 0.14 or less; this compares with only 2 of 6 men (33%) with nonaggressive cancer. CONCLUSIONS: These data suggest that the percentage of free PSA in sera is predictive of tumor behavior at a time when total PSA levels provide no information on tumor aggressiveness. Evaluation of the percentage of free serum PSA may be helpful in making the decision between expectant management and treatment for those men who are diagnosed with early prostate cancers by PSA testing.

Adenocarcinoma↗
PubMed1997

Role of prostate-specific antigen velocity in prediction of final pathologic stage in men with localized prostate cancer.

OBJECTIVES: Prostate-specific antigen (PSA) velocity prior to radical retropubic prostatectomy was evaluated to determine if men with a faster rate of rise in PSA have locally more extensive prostate cancer. METHODS: Of 368 men who underwent radical retropubic prostatectomy, 82 had two to seven PSA measurements between 1.3 and 6.7 years before prostate biopsy for evaluation of PSA velocity. PSA velocity and the pretreatment parameters of PSA, Gleason score, and T stage were evaluated as predictive parameters of pathologic stage. RESULTS: In men with pathologically organ-confined disease, PSA velocity was 1.12 ng/mL/yr; in non-organ-confined cases, it was 1.88 ng/mL/yr. There was a statistically significant relationship between a Gleason score of 7 and above and the pathologic extent of disease. There was no statistically significant relationship between T stage, the PSA at diagnosis, and PSA velocity with respect to final pathologic stage. CONCLUSIONS: PSA velocity is not a strong predictor of pathologic stage in men with localized prostate cancer.

Adult↗
PubMed1997

Prostate-specific antigen velocity and repeated measures of prostate-specific antigen.

Numerous studies evaluating different populations have shown similar findings with respect to repeated PSA measurements and PSAV. First, there is substantial within-individual variability between repeated PSA measures. Second, this variability between PSA measurements precludes the use of a simple change in PSA as a marker for prostate cancer. Third, when one adjusts the changes that occur in PSA over an elapsed time of 1.5 to 2 years (PSAV), less than 5% of men without prostate cancer will have a PSAV of 0.75 ng/mL/ y or greater, and approximately 70% of men with prostate cancer will have a PSAV of 0.75 ng/mL/ y or greater. These data strongly suggest that PSAV is a specific marker for the presence of prostate cancer.

Aging↗
PubMed1997

Prospective evaluation of men with stage T1C adenocarcinoma of the prostate.

PURPOSE: The pathological characteristics of stage T1c cancers in the era of widespread prostate specific antigen (PSA) testing were determined, and the ability of pretreatment parameters to predict tumor significance in men with stage T1c disease was evaluated. MATERIALS AND METHODS: Of 336 men with stage T1c prostate cancer seen between 1994 and 1996, 240 (71.4%) were treated with radical prostatectomy, 20 (6%) with radiation therapy and 76 (22.6%) expectantly. Recommendations for treatment were based on previously determined criteria predictive of a significant stage T1c cancer (more than 0.2 cm.3): 1) PSA density 0.15 ng./ml./gm. or more, 2) Gleason score 7 or greater, 3) 3 or more cores involved with cancer, or 4) 50% or more involvement of any core with cancer. Pathological evaluation of prostatectomy specimens allowed classification of tumors as insignificant (confined tumor smaller than 0.2 cm.3 with a Gleason score of less than 7), minimal (confined tumor 0.2 to less than 0.5 cm.3 with a Gleason score of less than 7), moderate (0.5 cm.3 or larger disease, or capsular penetration with a Gleason score of less than 7) and advanced (capsular penetration with a Gleason score of 7 or more, or positive margins, seminal vesicles or lymph nodes). Pathological characteristics of tumors in this series were compared to a previous series of 157 men with stage T1c cancers who underwent radical prostatectomy between 1988 and 1992. RESULTS: Of 240 men who underwent radical prostatectomy tumors were insignificant in 40 (17%), minimal in 29 (12%), moderate in 124 (52%) and advanced in 47 (19%). An increase in organ confined cancers (51 to 72%) and a decrease in positive margins (17 to 8%) were noted when comparing stage T1c series (1988 to 1992 versus 1994 to 1996) but the percentage of insignificant tumors remained stable (16 versus 17%) between series. Ultrasound and sextant biopsies were available for review in 72 cases (current series). If the pretreatment criteria used to recommend therapy suggested significant tumor (64 cases) then insignificant tumor was present in only 10 (16%). If pretreatment criteria suggested insignificant tumor (8 cases), insignificant or minimal tumor was present in 6 (75%) and moderate organ confined disease was present in 2 (25%). The absence of a lesion on ultrasound and measurement of total length of cancer within the biopsy specimen were not predictive of an insignificant tumor. CONCLUSIONS: In a nonscreened population stage T1c cancers are being discovered earlier with widespread PSA testing. Even with the detection of earlier cancers we demonstrated that it is possible to minimize the number of patients with small tumors who will undergo radical prostatectomy using pretreatment criteria to counsel men regarding appropriate management options.

Adenocarcinoma↗
PubMed1996

Longitudinal analysis of serial measurements of free and total PSA among men with and without prostatic cancer.

OBJECTIVES: Evaluation of free and total serum prostate specific antigen (PSA) levels before diagnosis of prostate cancer. METHODS: Free and total PSA levels were measured on frozen sera samples of 26 men with no history of prostate disease (controls), 29 men with a histologic diagnosis of benign prostatic hyperplasia (BPH) made at simple prostatectomy (BPH cases), and 23 men with a histologic diagnosis of prostatic cancer (cancer cases). Longitudinal regression analysis was used to evaluate PSA levels as a function of years before diagnosis of prostate disease. RESULTS: On average, mean total serum PSA was statistically significantly greater for subjects with cancer (5.0 ng/mL +/- 0.9) versus BPH (2.8 ng/mL +/- 0.3) and control subjects (0.8 ng/mL +/- 0.1) by 4 years before diagnosis, whereas free PSA levels were similar among groups at 4 years before diagnosis. The ratio of free to total serum PSA continuously decreased among cancer cases over the decade before cancer diagnosis. At a time when mean total and free PSA levels were similar among groups (8 years before diagnosis), the ratio of free to total PSA was statistically significantly lower for cancer cases (0.13 +/- 0.01) compared with BPH (0.17 +/- 0.01) and control cases (0.21 +/- 0.02). Use of a free to total PSA ratio of < or = 0.12 when total PSA was between 4.0 and 10.0 ng/mL resulted in the highest sensitivity (76%) and specificity (94%) for diagnosis among subjects with and without cancer. Lowering the reflex range to 2.5 ng/mL increased false positive tests more than it increased sensitivity. CONCLUSIONS: The ratio of free to total PSA is the earliest serum marker predicting a subsequent diagnosis of prostate cancer. Measurement of the free to total serum PSA ratio would appear to reduce false positive results among men without prostate cancer.

Aged↗