The value of early detection, via screening and/or treatment of localised prostate cancer has not been established in well-designed clinical trials. However, radical prostatectomy in localised disease can be justified for a number of reasons. Cure of localised prostate cancer is necessary: 3% of men over 50 years of age will die of prostate cancer. Cure is possible: prostate tumours take 10-15 years to grow from 0.5 cm3 to, for example, 8 cm3--the window where cure is possible by radical prostatectomy. Large series of studies show that the probability of remaining progression free, as determined by prostate specific antigen, can be up to 90% for pT2 tumours and 60-75% for pT3a/b tumours. A radical, anatomic technique is necessary with a low positive margin rate (zero in pT2 tumours) to achieve such results. Radical prostatectomy has a low morbidity: perioperative mortality is far below 1%, complete continence rate is 80-90%, complete incontinence rate 4%, stricture rate 6%, and relaparotomy rate <5%. To conclude, in suitable patients (for example, younger than 70 years of age) with tumours at suitable stages, cure is necessary, possible, and safe using the right technique of radical prostatectomy.

Aged↗

PubMed1996

Preoperative prediction of tumor heterogeneity and recurrence after radical prostatectomy for localized prostatic carcinoma with digital rectal, examination prostate specific antigen and the results of 6 systematic biopsies.

PURPOSE: Digital rectal examination, preoperative serum prostate specific antigen (PSA) concentration and results of 6 ultrasound guided systematic sextant biopsies in 257 consecutive patients with clinical stages T2 and T1c prostatic carcinoma were evaluated for their use in predicting pathological stage and tumor recurrence. MATERIALS AND METHODS: Each of the 257 consecutive specimens was examined using the 3 mm. step section technique. Results of preoperative digital rectal examination, PSA and 6 systematic sextant biopsies were correlated with pathological stage, margin status and postoperative PSA during a mean followup of 2 years. Patients were considered to have disease progression based on elevated PSA level by a supersensitive assay. RESULTS: Digital rectal examination could not predict pathological stage and tumor recurrence. Preoperative PSA concentration, number of positive biopsies and tumor grade in the biopsy specimens correlated well with pathological stage. The best predictor of tumor recurrence was the biopsy result. However, a precise prediction of outcome (87% probability of being PSA negative versus 0%) was possible only in a third of the patients if the biopsy results were used. Use of preoperative PSA concentration did not improve this probability. CONCLUSIONS: Preoperative PSA concentration and/or biopsy results correlate significantly with pathological stage and margin status. Precise prediction of tumor recurrence is possible in only approximately a third of the patients with clinical stage T2 prostatic carcinoma.

Aged↗

PubMed1996

Urethral closure pressure changes with age in men.

PURPOSE: The natural history of external urethral sphincter function in elderly men is unknown. MATERIALS AND METHODS: In 257 men 45 to 88 years old external sphincter function changes with aging were analyzed by urodynamic studies, including functional urethral length, maximal urethral pressure, sphincter length and maximum urethral pressure during voluntary contraction. RESULTS: Mean functional urethral length was 51.9 mm. and there was no statistical decrease with age. However, sphincter length decreased with age from 24.3 to 14.8 mm., maximal urethral pressure from 88.7 to 55 cm. water and maximal urethral pressure during voluntary contraction from 221.4 to 166.3 cm. water. CONCLUSIONS: Sphincter function according to urethral pressure profile decreases with patient age.

Aged↗

PubMed1995

[Status of PSA determination for early detection of prostate carcinoma].

Prostate Specific Antigen (PSA) appears to be useful in the early detection of prostate cancer when used in conjunction with digital rectal examination (DRE) and transrectal ultrasonography (TRUS). Recent studies suggest that the addition of PSA to the routine digital rectal examination leads to detection of prostate cancer at an earlier stage than when digital rectal examination is used alone. In patients with elevated PSA or abnormal DRE prostate biopsies are recommended. However, the routine use of PSA to detect early prostate cancer is limited due to the PSA elevation in patients with prostatic hyperplasia. Possibilities to distinguish BPH from prostate cancer among men who have minimal PSA elevation (4.0 to 10.0 ng/ml) are the use of PSA velocity, PSA density, age adjusted PSA, and analysis of free and complexed PSA. Screening programs for prostate cancer will increase the percentage of localized prostate cancer, which can be cured by radical prostatectomy.

Adult↗

PubMed1995

In vivo system to detect long-term continuous release of bioactive interleukin-2 by immunopharmacological depot preparations in nude mice with human tumors.

For continuous release of cytokines for local application at tumor sites, we developed depot preparations consisting of a carrier substance (ethylene vinyl acetate copolymer) and either natural interleukin-2 (nIL-2) at 5 x 10(5) BRMP U or natural interferon-alpha (nIFN alpha) at 3 x 10(5) IU. We transplanted human tumors in nude mice and placed depot preparations next to the tumors to confirm the in vivo long-term biological activity of the depots according to the ability of IL-2 to inhibit growth of the tumors. Five different human tumors were used. Mice with each tumor were divided into groups of six to eight receiving different treatments: control (no treatment), human serum albumin, but no cytokine, IL-2 depot, IFN alpha depot and IFN alpha plus IL-2 depot. After proven in vivo tumor growth, these depot preparations were implanted subcutaneously directly at the tumor sites. Tumor growth was significantly reduced by IL-2 and IFN alpha plus IL-2 for 3 weeks after depot implantation. Complete tumor remission was not achieved. IFN alpha alone did not influence tumor growth. Our data show that the nude mouse is a valuable model for testing biological activity and release time of IL-2 depot preparations in vivo.

Animals↗

PubMed1995

Toxicity of local, continuous and cyclic, high-dose bladder perfusion with recombinant and natural interleukin-2 in advanced cancer of the urinary bladder.

We evaluated the toxicity of high-dose local interleukin-2 (IL-2) in 18 patients not eligible for standard treatment of advanced transitional cell bladder carcinoma. Seven received continuous high-dose local natural IL-2 via pump system in the bladder for up to 420 days. 11 received cyclic high-dose local natural IL-2 or recombinant IL-2 for up to 420 days. Treatment was well tolerated and, considering the low rate of toxicity, could be offered in an outpatient setting. Except for local contrast-media hypersensitivity, no serious side-effects were observed. This study provides a basis for the non-toxic use of local IL-2 in future studies to evaluate effectiveness of the treatment or prophylaxis of patients with superficial bladder cancer in order to prevent recurrences.

Administration, Intravesical↗

PubMed1995

Long-term monitoring of 486P 3/12 antigen pattern (quantitative immunocytology) before, during, and after mitomycin C prophylaxis in patients with superficial bladder cancer.

OBJECTIVES: Quantitative pattern of 486p 3/12 antigenicity in urine cytologies (Quic) of patients with superficial bladder carcinoma during operation and chemoprophylaxis was evaluated to determine the duration of prophylaxis on an individual patient-oriented basis. METHODS: Thirty-six patients with superficial bladder carcinoma during chemoprophylaxis (43 [range, 3 to 90] weeks of mitomycin C) have been evaluated monthly for 99 (range, 36 to 141) weeks. RESULTS: Only 6 of 36 patients (16.7%) had tumor recurrence after mean follow-up of 67.5 weeks. During mitomycin instillations, only 5 patients converted from positive to repeated negative Quic. None of them developed tumor. Thirty-one did not convert and only 6 of them developed recurrent tumor. CONCLUSIONS: Quic seems not to be a reliable marker during mitomycin prophylaxis. After mitomycin prophylaxis, a repeated positive Quic, however, was associated with a high risk of recurrence occurring in 3 of 8 Quic-positive patients. A repeated negative or alternating Quic identified a lower risk group, showing 3 recurrent tumors in 28 patients only. We conclude that Quic cannot be used during, but after, prophylaxis to identify risk patients requiring further treatment. During prophylaxis, its value is limited to a subgroup of patients developing negative Quic, for whom prophylaxis can be stopped individually.

Adult↗

PubMed1995

Dyeing: a simple method for detecting positive or negative surgical margins.

Artists' pigments have been used in more than 150 radical prostatectomy specimens and many other malignant surgical specimens for detecting positive surgical margins. Their advantages are rapid drying, resistance to tissue processing, and the ability to mark many planes of excision simultaneously with different colors.

Coloring Agents↗

PubMed1995

The etiology of bladder cancer--are there any new clues or predictors of behavior?

It is well documented that the etiology of bladder cancer involves environmental factors. Most chemical carcinogens probably affect the urothelial cells via their presence in the urine. As an important cofactor, cell proliferative activity may be increased by urinary bladder infection, irritation by bladder stones or through the action of a variety of endogenously produced direct acting chemicals or agents. Among the known causative factors, avoidable major ones are occupational exposure to certain chemicals such as benzidine and 4-aminobiphenyl, cigarette smoking and bilharzial infection, which could be eradicated by a combination of praziquantel, antihelminth therapy, education and improvements in social welfare. An anticarcinogenic drug, cyclophosphamide, used as an immunosuppressive agent also seems to be associated with a high risk of idiopathic induction of bladder cancer and physicians should therefore pay particular attention to its diverse effects when considering its prescription. In contrast to the above, the consumption of coffee and tea including artificial sweeteners is now thought unlikely to be major risk. So far there is no good biochemical tool to predict individual exposure to bladder carcinogens/or relative risk of bladder cancer development. However, acetylation capacity can be applied to assess susceptibility to carcinogenic amines in people exposed in their working environment. Progress in molecular biological analysis will hopefully bring to light etiology-specific DNA damage in the bladder tumors and prove useful for prediction of tumor behavior in the near future.

Diet↗

PubMed1995

Autologous blood transfusion in radical prostatectomy: results in 263 patients.

The principal benefit of using autologous blood is avoidance of complications associated with conventional homologous blood transfusion such as viral infections, immunosuppression, and allogenic immunization. Since December 1991, a ruling of the Federal Supreme Court has obliged physicians to disclose to their patients the risk of contracting an infection from an intraoperative or postoperative blood transfusion and the possibility of donating their own blood for transfusion into them later. Of 263 patients with localized prostate cancer who underwent radical retropubic prostatectomy, 194 (73.8%) elected to have their blood collected for possible transfusion. Of the patients who needed transfusion, 80.7% received only autologous blood and haemodilution for substitution of haemoglobin. Nearly all patients with blood loss below 1,500 ml used only autologous blood transfusions during their operations. Increasing the number of units of autologous blood collected decreases the likelihood that homologous blood will be needed and thus the risks associated with transfusion of homologous blood.

Blood Loss, Surgical↗

PubMed1995

[Preoperative assessment of tumor aggressiveness in localized prostatic carcinoma].

In 106 consecutive patients with localized prostate cancer digital rectal examination (DRE), preoperative prostate-specific antigen (PSA) determination and results of systematic sextant biopsies (TRUS 6Bx) of the prostate were analyzed for their value in the estimation of the aggressivity of tumors. In all patients with negative pelvic lymph nodes radical retropubic prostatectomy was performed. Tumor aggressiveness was defined as capsular penetration (pT2 versus pT3) or positive surgical margins in patients with pT3 tumors. Neither DRE nor preoperative PSA level was helpful in predicting capsular penetration or positive surgical margins. However, the number of positive core biopsies and the identification of Gleason 4 or 5 tumors within positive biopsy specimens correlated with capsular penetration and positive surgical margins. These results can be used to create a score, based on DRE, PSA, TRUS 6Bx, and Gleason 4 or 5, that might be helpful in predicting tumour aggressivity in patients with localized prostate cancer.

Adult↗

PubMed1995

[Benign prostatic hyperplasia].

Explore the source record for details and available documents.

Humans↗

PubMed1995

[Transurethral laser therapy of benign prostatic hyperplasia].

During the last 4 years, transurethral laser therapy for benign prostatic hyperplasia (BPH) has become an increasingly popular alternative to transurethral resection of the prostate (TURP) for the treatment of obstructive BPH symptoms. Clinical data so far published prove the efficacy of this new therapeutic modality, although the results are up to now possibly inferior to those achieved with TURP. On the other hand, the incidence of severe perioperative complications is significantly lower in patients treated with laser prostatectomy than in those undergoing TURP. Therefore, laser prostatectomy is a reasonable adjunct to the therapeutic spectrum for BPH in high-risk patients. Nevertheless, its role in the treatment of obstructive BPH in low-risk patients cannot be defined until long-term follow-up data are available.

Contraindications↗