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K J Tveter

Publications and source records attributed to K J Tveter.

At least 37 records · Page 2Linked to original sources
PubMed1995

Histopathological grading and DNA ploidy as prognostic markers in metastatic prostatic cancer.

The present study compares the prognostic potential of tumour grade and DNA ploidy status in patients with advanced-stage prostatic cancer. Two outcome groups were selected on the basis of time to progression and survival after orchiectomy. A poor-outcome group consisted of 32 therapy-resistant patients who experienced disease progression during the first year after orchiectomy and subsequently death due to prostatic cancer during the following year. A good-outcome group consisted of 27 therapy-responsive patients who showed disease regression and no signs of progression during a 3 year follow-up. The primary tumours were graded twice according to WHO and Gleason classification systems by two pathologists. Final agreement between the pathologists was obtained after a consensus meeting. The analysis revealed no prognostic importance of the two histological classification systems (P = 0.62 and P = 0.70) and disclosed weak inter- and intra-observer reproducibility (kappa < 0.70). DNA ploidy analyses were performed by image cytometry on formalin-fixed, paraffin-embedded samples of the primary tumours. Overall, 48% of the tumours were diploid, 20% tetraploid and 32% anueploid. DNA ploidy status did not discriminate between the two outcome groups (P = 0.46). Histological grade and DNA ploidy showed no prognostic importance in patients with prostatic cancer and skeletal metastases.

Adult↗
PubMed1995

Effects on the endocrine system of long-term treatment with the non-steroidal anti-androgen Casodex in patients with benign prostatic hyperplasia.

OBJECTIVE: To study the hormonal changes resulting from long-term use of the non-steroidal anti-androgen Casodex. PATIENTS AND METHODS: A randomized, placebo-controlled study was carried out on 27 patients with benign prostatic hyperplasia (BPH). Fourteen patients received Casodex 50 mg daily for 24 weeks and 13 received a placebo. The patients were followed up for a further 24-week period. RESULTS: Serum concentrations of luteinizing hormone (LH) increased by an average of 40% while follicle-stimulating hormone (FSH) remained unchanged. Testosterone increased by 35%, oestradiol by 29% and oestrone by 23%; all changes were statistically significant. Levels of androstenedione and dihydrotestosterone increased by 11% and 15%, respectively, but these increases did not reach statistical significance. A non-significant increase was also observed for sex hormone-binding globulin. The hormonal changes were reversible upon discontinuation of therapy. Prolactin and dehydroepiandrosterone-sulphate levels did not change. CONCLUSION: This study indicates that Casodex, due to competitive inhibition of central androgen receptors, increases LH secretion, thus causing increased production and increased metabolism of testosterone.

Aged↗
PubMed1995

Extent of disease based on initial bone scan: important prognostic predictor for patients with metastatic prostatic cancer. Experience from the Scandinavian Prostatic Cancer Group Study No. 2 (SPCG-2).

The skeleton is the most frequent site of metastases from prostate cancer. Quantitation of the amount of tumor burden has a great prognostic value and is of importance for clinical trials. The present study reviews 194 bone scans from the SPCG-2 study which consisted of 294 patients entered into a randomized prospective multicenter trial, comparing total androgen suppression with standard treatment in patients with metastatic prostatic cancer (orchiectomy plus cyproterone acetate vs. orchiectomy plus placebo). Evaluation of the initial bone scans based on the extension of the disease (EOD) as proposed by Soloway and associates gives a convenient stratification of the patients. With regard to time to progression and cancer-related as well as overall survival, this EOD grading system had a significant prognostic value (p < 0.001). There was no statistical difference between the two treatment arms in the different categories of the EOD grading system with regard to time to progression and time to death. By analyzing exclusively the subgroup of patients with minimal disease (EOD I) and good performance status (WHO score 0), there was a nonsignificant trend toward a better 2-year progression-free survival as well as a better 2-year cancer-related survival for those who were subjected to total androgen suppression as compared with the patients subjected to the standard treatment (orchiectomy).

Androgen Antagonists↗
PubMed1995

alpha-blockade in the treatment of symptomatic benign prostatic hyperplasia.

PURPOSE: The clinical and urodynamic effects of oral alpha 1-selective adrenoceptor blockers in the treatment of symptomatic benign prostatic hyperplasia were quantified, and side effects and patient tolerance were assessed. MATERIALS AND METHODS: A total of 29 original reports of placebo controlled clinical trials of alpha-blockers in which results were adequately presented was identified and reviewed, along with additional pertinent literature. We assumed that the efficacy of the different alpha-blockers was basically the same and the weighted average treatment effect was calculated in comparison with placebo. RESULTS: The average improvement in maximum urine flow rate was 1.5 ml. per second but this rate would probably approach 1.8 to 1.9 ml. per second if all dosages had been titrated up to the highest level tolerated. Overall symptom score decreased by 14% and residual urine volume decreased by 29%. A slight decrease in detrusor pressure during voiding was suggested. CONCLUSIONS: alpha-Blockers were beneficial in the treatment of benign prostatic hyperplasia. Tolerance to treatment appeared to develop in a large proportion of patients after 6 months of therapy. However, for patients who benefit from long-term use of alpha-blockers effective treatment might be maintained for years.

Adrenergic alpha-Antagonists↗
PubMed1995

Complications of invasive, urodynamic examinations and prostate biopsies in patients with benign prostatic hyperplasia.

We studied 85 men with moderate to severe symptoms of benign prostatic hyperplasia (BPH) who completed two placebo-controlled studies of drug therapy. During the 48 week period of treatment and follow-up the patients underwent 164 procedures which included urethral instrumentation, predominantly without antibiotic prophylaxis, and 187 procedures of urethral instrumentation in combination with transperineal prostate biopsy with antibiotic prophylaxis. The risk for a patient to acquire clinically significant urinary tract infection was 2.4% after urethral instrumentation alone and 7.5% when urethral instrumentation was combined with prostate biopsy. Invasive urodynamic examinations of prostate biopsies in studies of new treatment modalities for BPH should only be performed when necessary to obtain important information, and after full informed patient consent. The combination of prostate biopsy and urethral instrumentation increases the infection rate considerably and should be avoided.

Aged↗
PubMed1994

[Clinical significance of prostate-specific antigen].

Prostate-specific antigen has replaced acid phosphatase as a more sensitive marker of prostatic cancer. It is organ-specific but not cancer-specific. However, high serum level is more often indicative of cancer than of benign hyperplasia. The authors discuss the value of prostate-specific antigen in diagnosis and prognosis, and the indications for its use. This test should be included in the examination of men with prostatic symptoms and in men below age 70-75 with a suspicious finding in the prostate on digital rectal examination. At present, we do not recommend it for screening purposes, except in men with a family history of cancer of the prostate gland.

Aged↗
PubMed1994

[Screening for early diagnosis of prostatic cancer].

Early diagnosis is a prerequisite for permanent cure of prostatic carcinoma, and screening of asymptomatic men has been suggested. This proposal is discussed in relation to criteria for meaningful screening, and we conclude that most of these criteria are not fulfilled. While prostatic carcinoma is a major health problem, it has not been proved that early diagnosis and treatment, although undoubtedly useful for some, is profitable for the population as a whole. Many cases of early disease represent latent or slowly growing disease, for whom radical surgery or irradiation, with possible complications, would mean overtreatment. At present, screening cannot be advised for the general population, but should be considered for men at risk because of a history of prostatic cancer among close relatives.

Evaluation Studies as Topic↗
PubMed1994

[Radical treatment of localized prostatic cancer?].

Prostatic carcinoma, if detected early, may be cured by radical surgery or radiotherapy. In Norway, only a minority of patients (about 5%) received this treatment in 1988. However, diagnosis of possibly localised cancer was made in 31% of patients, most of whom were probably only observed and not treated unless progression occurred. This conservative attitude is representative of European practice but conflicts with the current approach in the United States. In view of the possible complications of such treatment there is no material to prove that radical treatment would benefit the populations as a whole. Nor has this been disproved. Such treatment should only be considered on the basis of strict criteria and for strongly motivated patients, who should be fully informed of the possibilities of complications and of being cured, and also about alternative treatment, including watchful waiting.

Europe↗
PubMed1994

Safety, side effects and patient acceptance of the luteinizing hormone releasing hormone agonist leuprolide in treatment of benign prostatic hyperplasia.

The luteinizing hormone releasing hormone agonist leuprolide was investigated in a double-blind, randomized, placebo-controlled study comprising 50 evaluable patients with moderate to severe symptoms resulting from benign prostatic hyperplasia. Patients received 3.75 mg. leuprolide depot or placebo as an injection every 28 days for 24 weeks. Hemoglobin level decreased by 0.8 gm/100 ml. (p = 0.0052) for patients receiving leuprolide. Mean testicular volume decreased by 28.9% (p < 0.001) compared to placebo. Of 26 patients receiving leuprolide 5 had a weight gain of more than 3 kg. Almost all patients receiving leuprolide experienced hot flushes. Breast changes, and loss of energy and vigor were not more pronounced than for patients receiving placebo. Erectile function and sexual activity were lost during treatment. Libido also decreased but was still partially retained. Despite this, patients receiving leuprolide were generally contented with their sexual life during treatment. Side effects were bothersome for some patients but were reversible. Of the patients in our study 73% expressed that they could repeat or continue treatment if that had been possible. The high cost of these drugs will limit their use for a benign condition, such as benign prostatic hyperplasia.

Aged↗
PubMed1994

Safety, side effects and patient acceptance of the antiandrogen Casodex in the treatment of benign prostatic hyperplasia.

Casodex, a new nonsteroidal antiandrogen, was investigated in this double-blind, randomized, placebo-controlled study comprising 28 evaluable patients with benign prostatic hyperplasia, who received Casodex at a dosage of 50 mg daily or a placebo for 24 weeks. The good safety profile of Casodex was confirmed. In common with other nonsteroidal antiandrogens, Casodex was associated with breast enlargement and/or tenderness, being reported by all patients upon direct questioning. A change in sexual function was assessed by two questionnaires, one of them revealing no statistically significant difference between the groups. However, using an alternative questionnaire, approximately half of the patients reported reduced erectile function (p = 0.002), mostly partial, and reduced sexual activity (p = 0.015), whereas libido was well maintained when compared to the placebo. Casodex was not associated with hot flushes. No other side effects of clinical significance were seen, and Casodex was well tolerated by the majority of the patients.

Aged↗
PubMed1993

A prospective, placebo-controlled study of the antiandrogen Casodex as treatment for patients with benign prostatic hyperplasia.

Casodex, a new nonsteroidal antiandrogen, is presently being investigated in phase III studies as a new hormonal treatment for advanced prostatic cancer. The safety and efficacy of Casodex at a dosage of 50 mg. daily for 24 weeks in patients with benign prostatic hypertrophy were investigated in this double-blind placebo-controlled trial, initially planned for 60 patients. Inclusion was discontinued at 30 patients after report of liver toxicity when Casodex was given long-term at high doses to mice. Prostate volume was decreased by 26.4% at the end of therapy (3.7% in the placebo group). The differences between Casodex and placebo therapy for the changes in values from baseline to 24 weeks of treatment in maximum urinary flow rate at spontaneous micturition and after instillation of saline were 0.8 and 1.4 ml. per second (not statistically significant). Pressure-flow examinations and frequency-volume charts did not show any treatment effect. Casodex patients tended to obtain more improvement in symptom scores than placebo patients, reaching statistical significance for irritative symptoms at week 24. Even if all patients had side effects, mostly mild, Casodex was well tolerated and patient compliance was excellent.

Aged↗
PubMed1993

A prospective, placebo-controlled study of the luteinizing hormone-releasing hormone agonist leuprolide as treatment for patients with benign prostatic hyperplasia.

Several physicians have used luteinizing hormone-releasing hormone agonists for small, selected groups of patients with benign prostatic hyperplasia but their clinical role in this indication is still not well defined. We investigated the effect of the luteinizing hormone-releasing hormone agonist leuprolide given as an injection every 28 days for 24 weeks in a double-blind, placebo-controlled trial with 50 evaluable patients along an extensive protocol with the main emphasis on objective parameters for outcome assessment. Prostate volume decreased by 34.5% (2.6% in the placebo group). Maximum flow rate at spontaneous micturition and after instillation of saline improved by 2.0 ml. per second (32%) and 3.0 ml. per second (54%) more than with placebo. Detrusor pressure during micturition decreased by approximately 24% for patients who received leuprolide compared to placebo and was accompanied by a 25% increase in flow rate, which indicated decreased bladder outlet resistance. Improvement in urodynamic parameters generally was of statistical significance. Symptom scores improved significantly for both groups throughout the study when compared to those before treatment. At between group comparison, the improvement for irritative symptoms in favor of leuprolide reached statistical significance at week 48. With few exceptions, leuprolide patients tolerated the treatment well even if they had side effects, such as flushing and decreased sexual function.

Aged↗
PubMed1993

Total androgen suppression: experience from the Scandinavian Prostatic Cancer Group Study No. 2.

A total of 294 patients with metastatic prostatic cancer were randomized prospectively in a Scandinavian multicenter study to either bilateral orchiectomy+placebo or orchiectomy+cyproterone acetate (CPA). The study was double blind. Patients with histologically verified prostatic cancer, with diagnosed skeletal metastases on X-ray or bone scintigrams and histological grade 1 and 2 were included: T0-4NXM1G1-2. 273 evaluable patients were followed either to progression, death or for a period of 3 years. 195 of these patients showed disease progression during the 3-year treatment period, 29 had stable disease and 49 patients experienced disease remission. The Kaplan-Meier analyses showed that time to progression as well as time to death for patients treated with castration+placebo are identical to that for patients treated with castration+PCA. Total androgen blockade with this antiandrogen was not superior to the standard orchiectomy treatment.

Bone Neoplasms↗
PubMed1992

Patient recruitment to and cost of a prospective trial of medical treatment for benign prostatic hyperplasia.

409 consecutive patients, referred by general practitioners for assumed benign prostatic hyperplasia (BPH), were evaluated for inclusion into a hormone therapy trial for BPH. 97 patients were excluded initially. Upon examination of the 312 remaining patients, 221 were found to be ineligible for various reasons and 11 refused to participate. Other patients were excluded after a second, more extensive examination and 5 patients withdrew during the trial. We are now left with 66 patients (16.1% of the patients initially referred), of which approximately 33 are receiving placebo treatment. The financial costs for the hospital to carry out a drug trial with approximately 65 evaluable patients is estimated to exceed 40,000 pounds.

Aged↗
PubMed1992

Measuring the quality of life of patients with benign prostatic hyperplasia. Assessment of the usefulness of a new quality of life questionnaire specially adapted to benign prostatic hyperplasia patients.

A questionnaire consisting of 36 questions based on a visual analogue scale for measuring the quality of life (QOL) of benign prostatic hyperplasia (BPH) patients is presented and assessed. The sensitivity of the questionnaire is demonstrated by its ability to register a statistically significant (p less than 0.01) improvement of QOL after prostate surgery (transurethral resection of the prostate). Its reliability is shown by its ability to give reproducible results in a nonoperated BPH patient group. Patient compliance has been excellent. It is discussed to what extent questions directly concerning symptoms from prostatism should be included in QOL questionnaires for BPH patients. Nonparametric statistics are applied. It is concluded that questionnaires like this are useful tools in the assessment of BPH patients, irrespective of the treatment modality. They will probably be of particular value in studies of drug therapy of BPH, complementing methods of assessment like symptom score and urodynamic parameters.

Humans↗