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Biomedical subjects

L J Denis

Publications and source records attributed to L J Denis.

At least 19 recordsLinked to original sources
PubMed1995

European School of Oncology Advisory report to the European Commission for the "Europe Against Cancer Programme" European Code Against Cancer.

A European School of Oncology Advisory Group has reviewed the European Code Against Cancer after its initial use over a 6-year period. With minor modifications, the original ten recommendations were found to be adequate, although it was agreed that an Annex was necessary to explain the scientific evidence supporting each point, and is presented herewith. Tobacco smoking clearly remains the most important cause of cancer, and now it can be quantified better than ever before. It is also clear that it is never too late to stop smoking: stopping even in middle age, prior to the onset of serious illness has a beneficial effect on life expectancy. Alcohol drinking is an important cause of cancer, and yet modest consumption levels protect against cardiovascular disease mortality. The optimal strategy seems to be a consumption not exceeding 2-3 drinks per day, although this limit may be lower for women. Increased consumption of fruits and vegetables, reduction in consumption of fatty foods, reduction of obesity and increased physical activity can all be recommended to reduce cancer risk. Exposure to excessive sunlight remains a problem which should be limited. Control of occupational cancer is a three-way partnership: legislation identifies and limits exposure to known carcinogens, employers enact the legislation and workers should respect the measures introduced. There are a number of signs and symptoms which may lead to cancer being diagnosed earlier, and patients with these should be referred to a doctor. For women, participation in organised programmes of cervical cancer and breast cancer (after 50 years of age) should lead to a reduction in mortality from these forms of cancer. The key element is organised programmes, where quality control and quality assurance are in force. These revised recommendations are the result of an agreement following advice, review and dialogue with cancer experts throughout Europe. They were approved by the European Community Cancer Experts at their meeting in Bonn on 28-29 November 1994. Their implementation by the European population should greatly reduce cancer incidence and mortality.

Alcohol Drinking↗
PubMed1995

Prostate cancer screening and prevention: "realities and hope".

Case finding and population screening for early prostate cancer are extensively debated issues. The increasing incidence and mortality of prostate cancer, although largely in older patients, suggests that some type of preventive measures should be undertaken to reverse this trend. The basic requirements for initiation of a population screening program were established by Wilson and Jungner in 1968. Based on available data, the following requirements are considered to be realities in this article: the importance of the health problem, the effectiveness of available treatment, the availability of the facilities, the identification of latent stages of the disease, the existence of effective screening methodology, and the acceptability of screening by the population to be screened. For choice of treatment and the stage of the tumor at the time of diagnosis, the data analysis is positive but caution is advised. Errors of commission and omission do occur in daily practice. The answers to the remaining four requirements are less clear. There is hope--but no certainty--that we are able to predict the natural history of the disease, that early treatment does reduce mortality, that treatment strategies avoid overlap, and that the cost of population screening has been appropriately calculated. The lack of a positive answer to these questions leads us to advise against general screening but to support definitively a randomized screening trial to provide answers in the next decade.

Humans↗
PubMed1995

Urodynamic effects of Prolase 2 laser prostatectomy in benign prostatic hyperplasia.

This prospective study was undertaken to evaluate the safety and efficacy of visual laser ablation of the prostate with the Prolase 2 sidefiring neodymium: YAG laser fiber in patients with symptomatic bladder outlet obstruction due to benign prostatic hyperplasia (BPH). The Prolase 2 fiber is a non-contact sidefiring fiber, producing coagulation of the prostatic tissue. Our study describes the results obtained in 30 patients who underwent VLAP with a mean follow-up of 6 months. The evaluation of symptoms according to the WHO International Prostate Symptom Score and Quality of Life Score (IPSS and QL) demonstrated a significant subjective response rate (p < 0.001). Objective assessment of treatment with peak and average urinary flow rates, post-void residual urine volumes and pressure-flow urodynamic studies showed a significant improvement after treatment (p < 0.001). Ultrasonic assessment of prostatic volumes at 6 months showed a mean decrease in total volume of 37% after laser prostatectomy. The early and late complications of the treatment are presented but overall toxicity is low. Laser prostatectomy performed with the Prolase 2 fiber seems to be safe and efficacious for BPH patients but long term efficacy and retreatment rates have to be awaited.

Aged↗
PubMed1994

Future implications for the management of benign prostatic hyperplasia.

Benign prostatic hyperplasia (BPH) is a growing medical problem in terms of morbidity, mortality, and health care costs. Renewed research has highlighted the lack of standardized parameters available with which to define and evaluate BPH and its treatment. The many treatments available, ranging from surgery to watchful waiting, point to the complex pathophysiology of BPH and the subjectivity of the treatment decisions. Workup of patients with micturition disorders, coupled with use of the International Prostate Symptom Score evaluation, permits the development of criteria for evaluating treatment efficacy and acceptable treatment options. Based on double-blind, placebo-controlled trials, a-blockers and finasteride have been accepted as treatment options. The former produce relaxation of the smooth muscle by inhibiting adrenergically induced increases in intracellular calcium. The latter blocks the 5a-reductase system, which effectively stops the conversion of testosterone to dihydrotestosterone. a-Blockers improve symptoms and flow immediately while finasteride diminishes the prostate volume, specifically of glandular tissue, leading to improved symptoms and flow. All other medical and nonmedical treatments require further evaluation by randomized, prospective trials to determine their safety profile and efficacy.

Humans↗
PubMed1994

The TNM system of 1992. Comments from the TNM working group. Consensus Conference on Diagnosis and Prognostic Parameters in Localized Prostate Cancer. Stockholm, Sweden, May 12-13, 1993.

The TNM working group acknowledges the multinational agreement reached in the 1992 TNM classification, but nevertheless gives some suggestions for modifications. The main interest of the group has been to evaluate parameters suitable for further ramification of the system. The group found that parameters such as DNA ploidy, PSA, nuclear roundness factor, are not yet ready for this purpose. Grade is an established parameter and should be incorporated into the TNM-categories of localized disease. In metastatic disease a number of parameters are available to subdivide this category according to prognosis, and these will be more uniformly and extensively studied in the several large trials that are now in progress.

Alkaline Phosphatase↗
PubMed1993

Goserelin acetate and flutamide versus bilateral orchiectomy: a phase III EORTC trial (30853). EORTC GU Group and EORTC Data Center.

Maximal androgen blockade (MAB), the eradication of the effects of adrenal androgens on prostate cancer cells after castration, has been used with differing success in the treatment of prostatic carcinoma. The aim of this randomized phase III study was to compare the efficacy and side effects of bilateral orchiectomy versus a combination of a luteinizing hormone-releasing hormone agonist (LHRH-A) depot formulation, goserelin acetate (3.6 mg s.c. once every four weeks), and flutamide (250 mg three times daily), in patients with metastatic cancer. Treatment usually continued until disease progression (or for a minimum of three months). Efficacy was assessed by response, time to disease progression, and duration of survival. Clinical evaluations, standard laboratory tests, and imaging examinations were carried out regularly. A total of 327 patients were entered in this study. There was a difference in response only for prostatic acid phosphatase (PAP) with a more frequent decrease of the serum values to normal in the serum in patients assigned to MAB treatment. The MAB treatment, however, proved significantly better for time to subjective progression, time to objective progression, time to first (subjective and objective) progression, and duration of survival. The most frequent side effects for both treatments included hot flushes and gynecomastia. In conclusion, significant time to progression and survival benefits are achieved by adding flutamide to an LHRH-A regimen, probably improving the quality of life of patients with metastatic cancer.

Aged↗
PubMed1993

Staging and prognosis of prostate cancer.

The tumor node metastasis (TNM) classification is the universal staging system for malignant tumors. The 1992 revised TNM classification for prostate cancer is presented and reviewed. The trend from an anatomical to a biological classification is supported by the development of this classification and the definition of prognostic factors. Histological grade is already accepted into the classification for adenocarcinoma, but restricted to the stage grouping. Other prognostic factors will be added to the scheme in a separate axis after multivariate analysis and confirmation of their value in randomized trials. Progress in prognosis depends on proper selection and validation of prognostic factors. Revalidation in prospective trials is, therefore, needed and justified.

Humans↗
PubMed1993

Workshop summary: screening policies and procedures.

The question of screening for prostate cancer has, since the advent of prostate-specific antigen testing, become a major source of contention. Important issues include: (1) should such screening become part of routine health checks for men; (2) if routine screening is implemented, at what age should it be started, and (3) can the early detection of prostate cancer facilitated by such screening actually benefit the patient in the long run? These were some of the topics put to the audience and debated by the panel of experts in the discussion forum on screening.

Aged↗
PubMed1992

To screen or not to screen?

This paper aims to present a case for screening for prostate cancer, though medical committees from many countries have recently decided against it. It is clear that prostate cancer fails many of the criteria for an effective screening program. There is certainly no single test that can be used reliably to detect prostate cancer. All the available tests have advantages and disadvantages. The sensitivities of the three widely used screening tests--digital rectal examination (DRE), prostate specific antigen (PSA), and transrectal ultrasound (TRUS)--vary from 50% to 85% in a number of studies, but the positive predictive value fluctuates around 30%. The use of all three tests must improve the detection rate. The European Cancer Programme is funding a pilot study in Antwerp and Rotterdam on screening for prostatic diseases. In Rotterdam, a pre-screen PSA is performed and then patients are randomized to no screening or DRE with TRUS. The Antwerp section of the study includes screening for benign prostatic hyperplasia and employs a questionnaire on urinary symptoms as a pre-screen test. Patients are then randomized to controls or DRE with TRUS and, if results are suspicious, PSA measurement. It will be about 8 years before it becomes clear whether there is a resulting drop in mortality from prostate cancer.

Humans↗
PubMed1992

Clinical staging: its importance in therapeutic decisions and clinical trials.

International collaboration has resulted in a revised and unified 1987 formulation for the TNM classification in solid tumors. The simplification and eliminations of most variables caused difficulties for the clinical use of the system in some tumors such as bladder cancer. The approval of the proposed adaptation covering the tumor mass, subdividing the T4 category and adapting the stage grouping, resolves these difficulties. Published reports demonstrate support for the TNM system as a clinical base for treatment decisions and prognosis. The TNMG stage and grade are important basic prognostic factors, but other prognostic factors, especially biologic tumor activity, are under clinical investigation. The TNM classification is the initial evaluation after histologic confirmation of cancer to guide treatment and prognosis. The quality of the evaluation is enhanced by precise communication on the employed methodology.

Clinical Trials as Topic↗
PubMed1989

Use of ketoconazole in the treatment of a virilizing adrenocortical carcinoma.

Ketoconazole, an oral antimycotic agent, is known to have a potent inhibitory effect on adrenal steroid production. It was given at a dose of 1200 mg/day to a 52-year-old female patient with a virilizing adrenocortical carcinoma in order to achieve better metabolic control pre-operatively. Together with a rapid normalisation of hypertension and hyperglycemia, a dramatic fall was noticed in serum and urinary adrenal steroids after a few days. Levels of total testosterone (20 nmol/l), androstenedione (greater than 35 nmol/l) and DHEA-sulphate (greater than 28 nmol/l) fell to normal levels in 6 days. By contrast, levels of 17-OH-progesterone (30 nmol/l) and progesterone (2.45 nmol/l) increased slightly, indicating inhibition of adrenal 17,20-lyase. Cortisol (620 nmol/l at 08.00 h) fell to very low levels (50 nmol/l) on day 6 of the trial. We conclude that ketoconazole is very effective in suppression of adrenal tumoural steroidogenesis and merits consideration in pre-operative use. We warn against dangerous hypoadrenalism which seems to occur earlier in tumoural than in normal adrenal metabolism.

Adrenal Cortex Hormones↗