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Biomedical subjects

J E Fowler

Publications and source records attributed to J E Fowler.

At least 55 records · Page 3Linked to original sources
PubMed1996

Cancer diagnosis with prostate specific antigen greater than 10 ng./ml. and negative peripheral zone prostate biopsy.

PURPOSE: We assessed the results of additional diagnostic procedures in men with prostate specific antigen (PSA) more than 10 ng./ml. and a peripheral zone prostate biopsy negative for cancer. MATERIALS AND METHODS: A total of 68 men with PSA more than 10 ng./ml. and a peripheral zone biopsy negative for cancer was investigated with 1 or more peripheral zone biopsies (17), prostatectomy (18), or 1 or more peripheral zone biopsies and needle biopsy of the transition zone or prostatectomy (33). RESULTS: Cancer was detected in 20 of 68 patients (29%) with 1 or more additional diagnostic procedures. Of 51 patients whose transition zone was biopsied or who underwent prostatectomy 16 had cancer, and in 8 the malignancy appeared to be isolated to the transition zone. Mean PSA density and proportion of patients with PSA density more than 0.15 were significantly greater and mean prostate volume was significantly less in the 20 patients with compared to 31 without identifiable cancer. CONCLUSIONS: At least 30% of men with PSA more than 10 ng./ml. and a negative peripheral zone biopsy have prostate cancer. In approximately 50% of cases the cancer appears to reside in the transition zone, and transition zone biopsy or prostatectomy is required for diagnosis.

Adult↗
PubMed1996

Co-morbidities and survival of men with localized prostate cancer treated with surgery or radiation therapy.

PURPOSE: We determined the impact of preexisting co-morbidities on survival of men with clinical stages T1b and T2NXM0 prostate cancer treated with surgery or radiation therapy. MATERIALS AND METHODS: A weighted co-morbidity score was determined for 276 consecutive men treated with surgery (138) or radiation therapy (138) at a Veterans Affairs medical center and was correlated with actuarial freedom from death due to co-morbid disease. RESULTS: After a median potential followup of 7.0 years 91 patients (33%) died of co-morbid disease and 20 (7%) died of cancer related causes. There were highly significant correlations between actuarial survival and weighted co-morbidity (p < 0.000001), and the 10-year actuarial survivals in men with no or severe co-morbidities were 66 and 9%, respectively. Associations between patient age and co-morbidity score were highly significant (p < 0.0001). The age adjusted risk of co-morbid death was 5.7 times greater in men with severe compared to no co-morbidities. There were also significant correlations between actuarial survival and weighted co-morbidity among patients treated with surgery (p = 0.02) and radiation therapy (p = 0.0002). Patient age and severity of co-morbidities were significantly greater among men treated with radiation therapy compared to surgery, and age adjusted risk of co-morbid death among men with a co-morbidity score of 1 was 3.8 times greater among men treated with radiation therapy (p = 0.025). CONCLUSIONS: Cancer related deaths are unusual within 5 to 10 years after surgery or radiation therapy in men with stages T1b and 2 prostate cancer. The risk of death during this interval is directly related to the severity of co-morbid conditions, which should be factored in an individual when assessing the advisability of therapeutic intervention. Since patient co-morbidities impact all cause survival, quantitative assessment of co-morbidities using validated instruments offers a method to control partially for the variabilities of health status among men receiving different treatments for localized prostate cancer.

Aged↗
PubMed1995

Müllerian duct cyst masquerading as chronic prostatitis: diagnosis with magnetic resonance imaging using a phased array surface coil.

Prostatitis is a common clinical syndrome that on rare occasions may result from mass lesions in the pelvis. This report concerns a man with debilitating prostatitis that was caused by a müllerian duct cyst. The diagnosis was facilitated by examination with magnetic resonance imaging using a pelvic phased array surface coil and a small field of view.

Adult↗
PubMed1995

Prostate specific antigen after gonadal androgen withdrawal and deferred flutamide treatment.

PURPOSE: We assess the impact of deferred flutamide treatment on the serum prostate specific antigen (PSA) level in patients with localized or metastatic cancer. MATERIALS AND METHODS: The study included 45 patients with localized cancer and 50 with metastatic cancer with an increasing (87) or stable (8) PSA level after gonadal androgen withdrawal. RESULTS: Of 40 evaluable patients with localized cancer and 50 with metastatic cancer 32 (80%) and 27 (54%), respectively, had a PSA decrease of 50% or more of baseline during flutamide treatment (p = 0.014). Among patients with localized cancer actuarial analysis of freedom from PSA elevation during flutamide treatment favored those with a 50% or greater PSA decrease (p = 0.006) but in patients with metastatic cancer the analysis revealed no significant difference. CONCLUSIONS: The relative density of tumor cells that are dependent on adrenal androgen after gonadal androgen withdrawal may be greater in patients with localized cancer and deferred flutamide treatment may enhance cancer control in those with localized disease.

Actuarial Analysis↗
PubMed1995

Variable histology of anastomotic biopsies with detectable prostate specific antigen after radical prostatectomy.

Progressive elevation of the prostate specific antigen (PSA) level after radical prostatectomy for adenocarcinoma is generally considered as irrefutable evidence of recurrent tumor. We assessed the results of 62 biopsies of the vesicourethral anastomosis in 41 men who had 3 or more consecutive PSA levels of 0.4 ng./ml. or greater after radical prostatectomy and no evidence of metastatic disease. The median PSA at the time of the first biopsy was 2.2 ng./ml. (range 0.4 to 50). Histological confirmation of recurrent cancer was established after 1 biopsy procedure in 39% of the patients and after 1 or more biopsy procedures in 59%. Biopsy was positive in 78% of 23 patients with an abnormal digital rectal examination, 40% of 5 with an abnormal transrectal ultrasound only, and 23% of 13 with a normal digital rectal examination and ultrasound. Among the patients with and without biopsy proved tumor recurrence there were no significant differences between the pathological stage or histological grade of the primary tumors, the month after surgery of the first detectable PSA level, the PSA doubling time, the month after surgery of the positive biopsy or the last negative biopsy, and the PSA level at the time of the positive biopsy or the last negative biopsy. In 6 cases benign prostatic tissue only was recovered from 1 or more biopsy specimens. This experience demonstrates that in patients with a detectable PSA after radical prostatectomy recurrent cancer may be difficult to document by biopsy of the vesicourethral anastomosis.

Anastomosis, Surgical↗
PubMed1995

Prostate specific antigen regression and progression after androgen deprivation for localized and metastatic prostate cancer.

To identify prostate specific antigen (PSA) functions of prognostic significance in regard to treatment with androgen deprivation for prostate cancer we analyzed the pretreatment PSA, PSA half-life, PSA nadirs, times to PSA elevation and PSA doubling times in 245 patients with localized and 78 with metastatic disease who were treated with this modality. There was a direct correlation between the pretreatment PSA and the time to PSA elevation in patients with localized cancer (p = 0.000003) but no significant correlation in those with metastatic cancer. The PSA half-life was highly variable and did not correlate with other PSA functions of prognostic significance. Incremental increases in the PSA nadir correlated with the time to PSA elevation in patients with localized and metastatic cancer (p < 0.000001 and p = 0.00009, respectively), and with other parameters of prognostic significance. The median PSA doubling time in 26 patients with localized cancer in whom distant metastases did not develop (7.5 months) was significantly longer than that in 7 in whom new metastases developed (2.5 months) and in 43 with preexisting metastatic cancer (2.5 months) (p < 0.05 and p < 0.0001, respectively). In the 7 patients with localized cancer in whom metastases developed the median of the ratios of the PSA when the metastases were manifest and the pretreatment PSA was 0.14, and in 24 patients with preexisting metastatic cancer the median of the ratios of the antemortem PSA and the pretreatment PSA was 1.2. These data show that PSA synthesis by prostate cancer is reduced after androgen deprivation but that the PSA nadir and PSA doubling time following treatment provide important prognostic information.

Actuarial Analysis↗
PubMed1995

Ultrasound guided seminal vesicle biopsies in men with suspected prostate cancer.

PURPOSE: The histology of ultrasound guided seminal vesicle biopsies is assessed and the results are correlated with clinical or pathological stage of prostate cancer. MATERIALS AND METHODS: A total of 517 consecutive men underwent bilateral (515) or unilateral (2) seminal vesicle biopsy during sextant biopsy of the prostate. RESULTS: Seminal vesicle epithelium and muscularis were identified in 490 of 1,032 biopsy specimens (47%) and smooth muscle consistent with seminal vesicle muscularis was identified in 393 (38%). The seminal vesicle biopsy was positive for cancer in 7 of 123 patients (6%) with with clinical stages T1c and T2 tumors, 27 of 60 (45%) with stages T3 to 4 disease and 9 of 13 (69%) with metastatic cancer. Of 39 patients who underwent radical prostatectomy 1 of 36 (3%) without and 0 of 3 (0%) with seminal vesicle invasion had a positive seminal vesicle biopsy. CONCLUSIONS: Seminal vesicle epithelium and muscularis or smooth muscle consistent with the seminal vesicle muscularis can be procured in most patients using contemporary ultrasound guided biopsy techniques. However, apparently false-negative seminal vesicle biopsies are not uncommon and seminal vesicle biopsies contribute little to the staging of T1c and T2 tumors.

Adult↗
PubMed1995

Experience with radical prostatectomy and radiation therapy for localized prostate cancer at a Veterans Affairs Medical Center.

We assessed the actuarial survival of 357 patients with localized prostate cancer who were treated with radical prostatectomy or radiation therapy at a Veterans Affairs Medical Center between 1980 and 1991 and who were followed for a median of 59 months. During this period patients with clinical stages A2 and B tumors who had an anticipated life expectancy of 10 years or greater were generally treated with surgery. Patients with stages A2 and B tumors who were not candidates for surgery and those with stage C tumors were generally treated with radiation therapy. There were no significant differences among the cause specific, clinical disease-free and prostate specific antigen disease-free survival curves of patients with stages A2 and B tumors who were treated with radical prostatectomy (138) or radiation therapy (138) but the all cause and metastases-free survival curves favored the surgery group (p < 0.000001 and 0.046, respectively). There was no significant difference between the all cause survival curves of the patients with stages A2 and B tumors and of 81 patients with stage C tumors who were treated with radiation therapy. However, the cause specific survival curves favored the patients with stages A2 and B tumors (p = 0.000007). This study demonstrates that there is a high risk of death from co-morbidities in a hospital based population of American veterans with localized prostate cancer who are not candidates for radical prostatectomy.

Actuarial Analysis↗
PubMed1994

Presentation, diagnosis and treatment of renal abscesses: 1972-1988.

We reviewed 61 consecutive patients with renal abscesses who were treated between 1972 and 1988 to determine whether the patient characteristics and mortality differed from those of patients treated during the preceding 2 decades. The results demonstrate that the predisposing conditions, symptomatology, abnormal physical findings, abnormal laboratory results, abnormal radiographic findings and infecting organisms of patients with renal abscesses have not changed during the last 40 years. Ultrasonography and computerized tomography, which became available in the 1970s, identified 35 of 38 (92%) and 23 of 24 (96%) abscesses, respectively. In 57 cases (97%) the abscess was drained and the patients survived. In 4 cases the abscess escaped clinical detection and contributed to patient death. The marked improvement of survival among patients with renal abscesses during the last 2 decades is attributable to improved diagnostic precision and, probably, improved antimicrobial therapy and supportive care.

Abscess↗
PubMed1994

Vesical endometriosis 12 years after a cesarean section.

Invasion of the bladder is an unusual manifestation of endometriosis. We report a case of an isolated vesical endometrioma that developed 12 years after an uncomplicated cesarean section. The intraoperative findings were consistent with the possibility that infiltration of the detrusor muscle by endometrial tissues resulted from disruption of the uterine incision.

Cesarean Section↗
PubMed1994

Prostate specific antigen progression rates after radical prostatectomy or radiation therapy for localized prostate cancer.

BACKGROUND: The purpose of the study was to determine whether a difference is noted in the rate of prostate specific antigen (PSA) elevation after radical prostatectomy or radiation therapy for localized prostate cancer. METHODS: PSA doubling times were calculated by linear regression analysis in 50 patients who had been treated by radical prostatectomy and who had three or more increasing PSA levels and in 55 patients who had been treated with radiation therapy and who had three or more increasing PSA levels. RESULTS: No significant difference was noted in the mean PSA doubling times in the two patient groups when stratified by the site of tumor recurrence or by pretreatment tumor stage, tumor grade, or acid phosphatase level. CONCLUSIONS: Because the PSA doubling time probably parallels the tumor growth rate, these data suggest that the malignant potentials of recurrent tumor after radical prostatectomy and after radiation therapy are equivalent.

Humans↗
PubMed1992

Impact of site release vaginal pH buffer cream on introital colonization by gram-negative bacilli.

Colonization of the vaginal introitus by gram-negative bacilli is a critical event in the pathogenesis of bacteriuria and is promoted by an abnormal pH elevation. To determine whether a pH reduction might inhibit colonization we conducted a placebo controlled, crossover study of a site release vaginal pH buffer cream. A total of 12 premenopausal women with a history of urinary tract infection participated in the 12-week investigation. The mean introital pH during application of the placebo and buffer was 4.87 and 4.61, respectively (p less than 0.01). However, the percentage of positive introital cultures during application of the placebo and buffer (40.3 and 35.3, respectively) and the mean density of colonization (23,600 and 22,700 bacteria per ml., respectively) were not significantly different. The percentage of positive introital cultures and the mean colonization density were also not different during application of the placebo and buffer when the patients were retrospectively stratified as light and heavy colonizers. These data suggest that alteration of the introital pH within a range of 4.5 to 5.0 does not influence the growth of uropathogens on the vaginal mucosa.

Buffers↗
PubMed1991

Secretory immunity of the prostate gland.

We investigated the immune response of the prostate to bacteriuria and bacterial prostatitis. In men with no histories of urinary tract infection the ratio of IgG:IgA in the expressed prostatic secretions was less than in the serum; most of the IgA was in the secretory form, and immunoglobulin directed against bacterial antigen was almost never detectable. In contrast antibacterial IgG and IgA were usually detectable in the expressed prostatic secretions of men with recent bacteriuria or bacterial prostatitis. The results of quantitative assays for antibacterial immunoglobulin in the expressed prostatic secretions and serum were consistent with local synthesis and secretion of antibacterial IgA. The immune response of the prostate to bacterial infection has the characteristics of secretory immunity.

Bacteriuria↗