An opportunity to determine optimal treatment of pT3 prostate cancer: the window may be closing.
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Combined Modality Therapy↗
Biomedical subjects
I M Thompson
Publications and source records attributed to I M Thompson.
Bacillus Calmette-Guérin immunotherapy for refractory interstitial cystitis.
OBJECTIVE: To determine whether or not patients with refractory interstitial cystitis who had failed conservative therapy might benefit from intravesical bacillus Calmette-Guérin (BCG) immunotherapy. METHOD: Five patients with refractory interstitial cystitis who had failed conservative therapy underwent six weekly treatments with intravesical BCG. All 5 patients were evaluated before therapy and quarterly thereafter by water cystometry and symptom questionnaire. RESULTS: The average number of medications used daily per patient decreased from 3.2 to 1.2 after therapy. Average volumes of both first desire to void and cystometric capacity doubled after BCG. Improvement in cystometric capacity, average daytime urinary frequency, nocturia, and global pain/discomfort were statistically significant (P = 0.0277, P = 0.0131, P = 0.0199, and P = 0.0317, respectively). Three patients experienced near total relief of their symptoms with six to twelve months' follow-up (average follow-up equals 33.6 weeks). CONCLUSIONS: Although the mechanism of action of BCG in interstitial cystitis is unknown, we recommend a double-blind placebo controlled trial to confirm these results and determine an optimal dosage and treatment schedule.
Adult↗
Phase II trial of amonafide for the treatment of advanced, hormonally refractory carcinoma of the prostate. A Southwest Oncology Group study.
Amonafide (benzisoquinolinedione; NSC 308847) was subjected to a Phase II trial for the treatment of advanced hormone-refractory carcinoma of the prostate. In addition to adequate baseline organ functions, patients were required to have a favorable performance status, bidimensionally measurable disease and no prior chemotherapy. Amonafide was given at a dose of 225 mg/m2 intravenously daily for 5 days. Treatment cycles were repeated every 21 days. Dose escalation and reduction schema were used based upon toxicities from preceding cycles. Of 47 patients enrolled, 43 were evaluable. The most common toxicities were hematologic to include leukopenia (72%), granulocytopenia (32.6%), and thrombocytopenia (44.2%). There were no complete responses and only 5 partial responses for an overall response rate of 12% (95% confidence interval: 4-25%). The results indicate that Amonafide, in the dose and schedule tested, lacks sufficient activity against hormone-refractory prostate cancer to warrant further trials.
Adenine↗
Military rank as a measure of socioeconomic status and survival from prostate cancer.
Previous studies have shown an association between cancer survival and socioeconomic status. In the United States Armed Forces, military rank is a measure of socioeconomic status. To determine whether an association exists between socioeconomic status (as measured by military rank) and prostate cancer, we carried out a retrospective review of the clinical data from 237 patients entered into the Tumor Registry. There was no statistically significant association between rank and the stage of disease at diagnosis or actual 5-year survival. In the military, health care is provided free of charge, independent of rank, and this study showed that when there is equal access to health care, socieconomic status does not correlate with prostate cancer outcome. Future studies comparing outcomes of prostate cancer should control for accessibility to health care.
Humans↗
Neoadjuvant hormonal therapy and radical prostatectomy for clinical stage C carcinoma of the prostate.
OBJECTIVE: To determine whether hormonal therapy prior to radical prostatectomy (neoadjuvant hormonal therapy) leads to improved results in patients with stage C prostate cancer. PATIENTS AND METHODS: Thirty patients received neoadjuvant hormonal therapy for stage C carcinoma of the prostate. Eighteen patients who responded to treatment subsequently underwent extirpative surgery. RESULTS: Fourteen of the 30 patients (47%) were diagnosed as being downstaged to clinical stage B disease following therapy. No major complications occurred. Pathology staging revealed only three patients (10%) to have organ-confined disease after radical prostatectomy. CONCLUSIONS: Neoadjuvant hormonal therapy prior to radical prostatectomy offers little probability of rendering patients with clinical stage C carcinoma of the prostate free of disease. Further investigation of the efficacy of this treatment should be accomplished in randomized trials.
Adenocarcinoma↗
Urologic prostheses.
Urologic prosthetics have become increasingly complex and include an assortment of urinary catheters, penile prostheses, artificial urinary sphincters, and testicular prostheses. The majority of urologic prosthetics are constructed of silicone because it is relatively inert, easily sterilized, maintains its strength, and has not been linked to malignancy. Nevertheless, silicone causes some local tissue reaction and deteriorates with time; thus, it is not the ideal prosthetic material. This article provides the clinician with an overview of the most common of these prostheses, their function, and a guide for the management of associated acute urologic complaints.
Emergencies↗
Cryptic presentations of germ cell tumors.
The records of 636 patients who were treated for carcinoma of the testis were reviewed. Of these patients, 61 (9.6 percent) presented with extratesticular complaints. In order of decreasing frequency, the complaints were pain (abdominal, back or groin), gynecomastia or mastodynia, pulmonary complaints, enlarged lymph nodes or a nontesticular mass, swelling of the lower extremity or neurologic changes. A substantial number of these patients were initially misdiagnosed and underwent a surgical procedure. Of importance, most of these patients had either abnormal testicular examination results, elevated markers or a history of cryptorchidism. The data suggest that patients with germ cell tumors, even when presenting with cryptic complaints, can readily be diagnosed if a high level of suspicion is maintained, a careful testicular examination is performed and tumor markers obtained. This frequently makes a diagnostic abdominal exploration or other surgical interventions unnecessary.
Adolescent↗
Treatment options for prostate cancer.
The reader of the prostate cancer literature is often stunned by the lack of evidence of efficacy of one form of treatment over that of others. Indeed, information suggests that "no treatment" may be an effective option. Analyzing the available literature that reports the results of treatment versus observation for prostate cancer, Fleming et al. from the Prostate Patient Outcomes Research Team found that in most cases, treatment offered less than a 1-year improvement in quality-adjusted life expectancy. Using less optimistic assumptions, the authors also found that treatment could actually reduce quality-adjusted life expectancy. The decision of what form of treatment to offer the individual patient requires considerable discussion with the patient concerning his priorities and goals of therapy. For the younger patient with localized disease, the prevailing trend in the United States is toward radical prostatectomy. As the patient approaches the age of 70 years, the advantages of treatment versus observation alone evaporate. Because the disease is often of low biologic potential with a long doubling time, the option of observation initially with serial determinations of PSA is not unreasonable. If a slow rate of rise is noted, some patients may elect observation. However, with more rapid rises in PSA, a more aggressive stance may be appropriate. Because of the uncertainties inherent to treating this disease, it is imperative that the patient be brought into the treatment planning through education and through extensive discussions with health care providers and with family members. Only through such informed and deliberate discussions can a plan for treatment be reached with which the patient will be comfortable.
Aged↗
Disease-specific survival following routine prostate cancer screening by digital rectal examination: corrected patient classification.
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Humans↗
Disease-specific survival following routine prostate cancer screening by digital rectal examination.
OBJECTIVE: To assess prostate cancer mortality in men undergoing routine screening by routine digital rectal examination. DESIGN: Cohort study with a median follow-up period of 75 months. SETTING: Population consisted of volunteers at a university clinic and men in an institutional health maintenance clinic. PATIENTS: Fifty-six men with a mean age of 65 years (range, 52 to 79 years) diagnosed with prostate cancer. INTERVENTIONS: Patients treated initially by observation, external or interstitial radiotherapy, radical prostatectomy, hormone therapy, or combination. MAIN OUTCOME MEASURES: Kaplan-Meier analysis of time to local progression, distant metastases, death from all causes, and death from prostate cancer. Mantel-Haenszel log-rank statistic was used to compare outcome in men diagnosed on initial examination with those diagnosed on subsequent examinations. RESULTS: Clinically localized prostate cancer was diagnosed in 73% during an initial examination and 83% on subsequent examinations and (P.35). Grade distribution of tumors was similar in both groups. Overall 5 and 10 year survival of all cancer patients was 85% and 67%, respectively. Death from prostate cancer was 8% (3/38) in men diagnosed on initial examination and 33% (6/18) during subsequent examinations. Five- and 10-year disease-specific survival was 97% and 86%, respectively, for men diagnosed during the first rectal examination compared with only 81% and 57%, respectively, for men diagnosed on subsequent rectal examinations (P = .02). CONCLUSION: Routine screening for prostate cancer by annual digital rectal examination alone may be insufficiently frequent and/or sensitive to prevent significant mortality from this disease [corrected].
Aged↗
Dystrophic bladder wall calcifications following intravesical BCG treatment for superficial transitional cell carcinoma of bladder.
Bacillus Calmette-Guerin has been established as one of the most active agents for the treatment of superficial transitional cell carcinoma of the bladder. Although complications do occur with this agent, they are usually transient and mild. Two cases are herein reported in which dystrophic calcification of the urinary bladder occurred following BCG therapy; one had a diffuse and severe complication. This complication can occur with other intravesical agents, and methods for management are reported.
Aged↗
Morbidity with contemporary prostate biopsy.
To determine the incidence of complications associated with contemporary prostate biopsy, a review of 670 men undergoing transrectal prostate biopsy using 18 gauge biopsy needles was conducted. Of the men 580 received 1 to 3 days of ciprofloxacin antibiotic prophylaxis. A total of 16 patients (2.1%) suffered complications of whom 4 (0.6%) required hospitalization. These data demonstrate the low morbidity associated with contemporary transrectal prostate biopsy.
Adult↗
The long-term risk of development of prostate cancer in patients with benign prostatic hyperplasia: correlation with stage A1 disease.
Although historical data generally attest to a relatively benign course for stage A1 prostate cancer, at least some recent studies suggest that with prolonged followup patients have a significant risk of disease progression. This study was done with the hypothesis that such disease progression is a function of patient age and close, prolonged followup, and not the mere presence of stage A1 disease. A total of 304 patients who underwent transurethral resection of the prostate for histologically confirmed benign prostatic hyperplasia was reviewed, with a minimum followup of 8 years. Of 269 patients with full followup data 187 (70%) are alive without prostate cancer and 61 (23%) died without development of the disease. A total of 21 patients (7.8%) had clinically apparent prostate cancer at a mean of 7.0 years following transurethral resection, of whom 3 (14%) died of prostate cancer and 1 died of other causes. These data suggest that the risk of progression and death from prostate cancer may not be significantly greater in patients with stage A1 disease than in those reported to have benign disease at transurethral prostatectomy.
Actuarial Analysis↗
Transparenchymal suture fixation and testicular histology in a prepubertal rat model.
We evaluate the effect on testicular histology when fine suture materials are used for transparenchymal suture fixation of the testis during orchiopexy in immature Sprague-Dawley rats. Significant inflammatory reactions were observed in all groups of animals with suture fixation regardless of suture size and material. Only 5% of the animals in the dartos pouch control group had an inflammatory response and no inflammation was noted in the nonoperative controls. Although these findings have not been documented in humans, this evidence raises concerns about the impact of surgical technique on the future reproductive capabilities of these testes. Alternatives to transparenchymal suture fixation of the testis should be considered in patients with cryptorchidism and testicular torsion. Sutureless dartos pouch placement may provide adequate fixation during most orchiopexies without risking injury to testicular structure and function.
Age Factors↗
Managing the Foley catheter.
Urethral catheterization of the bladder is a commonly performed but potentially hazardous procedure. With proper patient preparation and catheter selection, difficult catheterizations can be accomplished without injuring the patient. Complications of catheterization include infection, injury to the urethra or bladder, and catheter malfunction. Physician supervision of catheter care is essential. Most of all, prompt replacement of the urethral catheter with an alternative method of bladder drainage, such as spontaneous voiding, external condom catheterization, clean intermittent catheterization or, possibly, suprapubic catheterization, is the best way to prevent the complications of urethral catheterization.
Adult↗
The case for inguinal lymph node dissection in the treatment of T2-T4, N0 penile cancer.
The battle for the control of squamous cell carcinoma of the penis is either won or lost at the level of the inguinal lymph nodes. Few patients die of distant metastasis without prior development of ilioinguinal nodal disease. If death or recurrence does occur, it does so typically within 2 years. In clinical stage T2-T4, N0 disease, there is a high risk of nodal involvement. In those patients with positive nodes, lymphadenectomy can be curative. It is apparent that forms of therapy other than a surgical approach are distinctly inferior. Awaiting the development of nodal metastasis carries the risk of a significantly lower survival time. Unfortunately, highly sensitive and specific forms of preoperative staging do not exist. With current techniques, ILND can be accomplished with minimal morbidity. For these reasons, it is recommended that all patients with clinical T2-T4, N0 squamous cell carcinoma of the penis undergo immediate inguinal lymphadenectomy.
Carcinoma, Squamous Cell↗
The natural history of adenocarcinoma of the prostate.
All analyses of the efficacy of therapy for prostate cancer must control for the natural history of the disease. Over the past years, several long-term series involving several hundred patients have helped to describe the results of untreated disease. In general, most patients will not die of their disease, although approximately half of the patients will develop disease progression within 10 years. Predictors of progression include tumor stage, grade, and ploidy status.
Adenocarcinoma↗
When is intervention warranted?
A chemoprevention trial in prostate cancer would be a formidable but potentially rewarding study. The current status of knowledge of drug interactions with, biomarkers of, and even the natural history of prostate cancer is insufficient to study all levels of men at risk. Currently, the most promising group to study is group I--those men with a high probability of developing prostate cancer but who do not currently have evidence of the disease. This could be a placebo-controlled, prospective and randomized study with the endpoint being clinically-detected prostate cancer. In addition, much may be gained from short-term pilot studies of "chemo-active" agents on morphologic and other biomarkers of prostate cancer initiated immediately before surgical removal. It is hoped that such studies may provide rationale for future efforts directed at preventing progression of premalignant or early prostate cancer lesions.
Anticarcinogenic Agents↗