Biomedical subjects

M K Terris

Publications and source records attributed to M K Terris.

60 records · Page 4Linked to original sources

PubMed1991

Determination of prostate volume by transrectal ultrasound.

Estimation of prostate gland volume with transrectal ultrasound may provide important information in the evaluation of benign and malignant prostatic diseases. To determine the most accurate means of volume estimation 150 patients underwent transrectal ultrasound with 15 separate methods of volume estimation. All patients underwent subsequent radical prostatectomy or cystoprostatectomy. Prostate specimen weights were compared with the results of each volume estimation method. Step-section planimetry, previously assumed to be the most accurate means of volume measurement, exhibited a Pearson correlation coefficient of 0.93. The elliptical volume, widely used as an alternative to planimetry, demonstrated a correlation coefficient of 0.90. The most accurate method to estimate prostate weight (r = 0.94) was a variation of the prolate spheroid formula, expressed as pi/6 (transverse dimension)2 (anteroposterior dimension). When different volume ranges were considered, this prolate spheroid formula provided the closest estimate of weight in glands of less than 40 gm. and those in the 40 to 80 gm. range. The most accurate method to estimate prostates weighing greater than 80 gm. was the formula pi/6 (transverse dimension)3.

Adenocarcinoma↗

PubMed1991

Utilization of bone scans in conjunction with prostate-specific antigen levels in the surveillance for recurrence of adenocarcinoma after radical prostatectomy.

Follow-up evaluation of patients who have undergone radical prostatectomy routinely consists of serial bone scintigraphy and, more recently, prostate-specific antigen (PSA) levels. The utility of serial bone scans in combination with PSA levels is retrospectively reviewed in 118 men treated by radical prostatectomy for clinical Stage A or B disease who, at the time of surgery, had no evidence of metastatic disease. Of the 118 patients, 75.4% had no abnormality on either test (mean follow-up 32.4 mo), 9.3% demonstrated a detectable or rising PSA level with negative bone scan (mean follow-up 35 mo), and 8.5% exhibited a detectable and or rising PSA level and positive bone scan (mean follow-up 30.7 mo). Follow-up bone scans were read as either positive or indeterminate with undetectable PSA levels in 6.8% of patients (mean follow-up 27.3 mo). Critical review of the equivocal studies suggests that postoperative PSA levels more truly represent the clinical situation than bone scans. Following radical prostatectomy, routine bone scintigraphy provides little additional information when PSA levels are negative. If PSA becomes detectable or the patient develops symptoms, bone scintigraphy should then be performed.

Adenocarcinoma↗

PubMed1990

Ultrasound anatomy of the prostate: the normal gland and anatomical variations.

Knowledge of the normal prostatic anatomy is paramount to understanding the pathological conditions of the gland observed on ultrasound imaging. Through transverse and sagittal histological sections of normal prostates, model ultrasound images of the prostate and periprostatic tissues were constructed. Various shades of gray were assigned to these structures depending upon the histological composition. We found that ultrasonic characteristics of the normal prostate and its surrounding tissues could be predicted accurately by knowledge of the histology of these structures. Histological sections of 100 prostates from patients who underwent transrectal ultrasound and subsequent radical prostatectomy for prostate cancer were examined. The congenital anatomical variations observed in this group are described histologically and sonographically. Caudal formation of the ejaculatory ducts within the central zone occurred in 18% of the cases, abnormal posterior penetration of the ejaculatory ducts at the rectal surface in 12% and abnormally large muscle bundles with the ejaculatory duct sheath in 6%. Concomitant ejaculatory duct and seminal vesicle dilatation was observed in 5% of the patients, whereas dilated ejaculatory ducts alone, dilated seminal vesicles alone and cystic utricles each were seen in 2%.

Adult↗

PubMed1990

Invasion of the seminal vesicles by prostatic cancer: detection with transrectal sonography.

Endorectal sonography provides a potential means of detecting seminal vesicle invasion by prostatic cancer that is too subtle for diagnosis by digital rectal examination. To assess this application of sonography, we examined 300 patients with transrectal sonography of the prostate and seminal vesicles followed by histologic examination of the seminal vesicles from core biopsies and/or prostatectomy specimens. Of the 38 patients with histologically proved seminal vesicle invasion by prostatic cancer, 35 (92%) had an abnormal appearance of the seminal vesicles on sonography. Of 167 patients with prostatic cancer without histologic evidence of seminal vesicle involvement, sonograms showed abnormal seminal vesicles in 42 (25%). In 95 patients with histologically normal prostates and seminal vesicles, sonograms showed abnormal seminal vesicles in 11 (12%). The sonographic findings correlating best with tumor invasion of the seminal vesicles were hyperechogenicity and a combination of two or more of the following abnormalities: cystic dilatation, asymmetry, enlargement, and anterior displacement. Our experience in these patients suggests that endorectal sonography can be useful in the detection of seminal vesicle involvement by prostatic cancer.

Genital Neoplasms, Male↗

PubMed1990

Transrectal ultrasound appearance of transitional cell carcinoma involving the prostate.

Prostatic involvement with transitional cell carcinoma of the bladder is common. Surveillance for prostatic invasion consists primarily of cystoscopic examination of the urethra. Unfortunately, transitional cell carcinoma may involve other regions of the prostate that are inaccessible by cystoscopy. A total of 58 men with transitional cell carcinoma of the bladder underwent transrectal ultrasound before cystoprostatectomy or, in some cases, ultrasound-guided prostate biopsies and subsequent cystoprostatectomy. Prostatic involvement was found in 20 patients (34.5%). Of those patients 10 (50%) demonstrated prostatic urethra invasion, 7 (35%) stromal invasion, 4 (20%) ejaculatory duct and seminal vesicle invasion, and 3 (15%) involvement of the periprostatic tissues. Invasion of the prostatic urethra was not detected by transrectal ultrasound but 5 of the 7 stromal lesions exhibited hypoechogenicity. All cancer-laden ejaculatory ducts were hypoechoic on ultrasound examination. All cases of periprostatic involvement were also detectable by corresponding areas of hypoechogenicity. Transrectal ultrasound may enhance the surveillance of men with transitional cell carcinoma.

Adult↗

PubMed1989

Random systematic versus directed ultrasound guided transrectal core biopsies of the prostate.

Random systematic ultrasound guided transrectal core biopsies of the prostate were compared to directed biopsies of specific hypoechoic defects in 136 men with abnormal prostates on digital rectal examination. Prostate cancer was diagnosed in 83 of 136 patients (62 per cent). In 80 of 83 individuals (94 per cent) the cancer was detected by random systematic biopsies alone. Of 57 men in whom random systematic and directed biopsies were obtained the results of biopsy agreed in 86 per cent, while in 9 per cent random systematic biopsies found cancers missed by directed biopsies and in 5 per cent directed biopsies diagnosed cancers missed by random systematic prostate biopsies. Ultrasound guided random systematic biopsy is simple and easily learned. When combined with additional directed biopsies of the rare hypoechoic areas not included in the pattern of systematic sampling, it provides a highly accurate means to diagnose prostate cancer, minimizing observer and sampling errors. This technique of prostate mapping with 6, 1.5 cm. cores provides valuable additional information on cancer volume, Gleason grade and the potential location of surgically positive margins, all without compromising the operation or the chance for a surgical cure.

Biopsy, Needle↗