Biomedical subjects

R Whittington

Publications and source records attributed to R Whittington.

At least 55 records · Page 3Linked to original sources

PubMed1998

Endorectal coil magnetic resonance imaging identifies locally advanced prostate cancer in select patients with clinically localized disease.

OBJECTIVES: Endorectal coil magnetic resonance imaging (erMRI) has been reported to improve the prediction of pathologic Stage T3 disease in patients with clinical Stage T1,2 disease, prostate-specific antigen (PSA) of 10 to 20 ng/mL, biopsy Gleason score of 7 or less, and at least 50% of the biopsy specimens positive from a sextant sampling. This study examines the performance characteristics of the erMRI to predict established extracapsular extension (ECE), seminal vesicle invasion (SVI), and PSA failure-free survival (bNED) in this subgroup. METHODS: The sensitivity, specificity, positive and negative predictive value, and accuracy of the erMRI to predict established ECE and SVI were calculated in the proposed subgroup. PSA failure-free survival stratified by the erMRI-defined stage was estimated by using the method of Kaplan and Meier. RESULTS: The sensitivity, specificity, positive and negative predictive value, and accuracy to predict established ECE and SVI in clinical Stage T1,2 patients was 65%, 100%, 100%, 79%, and 84%, respectively. No patient would have been excluded from surgery on the basis of a false-positive study. Moreover, the percent of patients with pathologic organ-confined disease would have increased from 32% to 61%, and the 3-year bNED rate would have increased from 12% to 45% (P = 0.07) if only patients with erMRI Stage T2 disease were selected for surgery. CONCLUSIONS: The erMRI may significantly improve the identification of established ECE and SVI in select patients with prostate cancer preoperatively. Further study of the erMRI in these select patients is warranted and ongoing.

Disease-Free Survival↗

PubMed1998

A prostate gland volume of more than 75 cm3 predicts for a favorable outcome after radical prostatectomy for localized prostate cancer.

OBJECTIVES: Both the benign and malignant prostatic epithelial components of the prostate gland contribute to the serum prostate-specific antigen (PSA) level. Therefore, for a given PSA, the presence of benign hyperplastic prostate tissue (BHPT) may indicate a lower cancer burden. This study was performed to assess the impact of varying amounts of BHPT on PSA failure free (bNED) survival after radical prostatectomy for localized prostate cancer. METHODS: Cox regression multivariable analyses were performed to assess the ability of the clinical stage, PSA, biopsy Gleason score, and prostate gland volume to predict time to postoperative PSA failure in 885 patients. RESULTS: In addition to the PSA (P < 0.0001), biopsy Gleason score of 8 to 10 (P < 0.0001) and of 7 (P = 0.05), and clinical Stage T2c,3a (P < 0.0001) and T2b (P = 0.0016), the prostatectomy prostate gland volume (P < 0.0001) was a significant predictor of time to postoperative PSA failure. Patients with a prostatectomy prostate gland volume greater than 75 cm3 had a 100% 4-year bNED survival and favorable pathologic characteristics (pathologic Stage T2, 85%; prostatectomy Gleason score 6 or less, 78% and 7, 22%; and negative margins, 95%) despite a preoperative PSA of 10 to 20 ng/mL and more than 20 ng/mL in 28% and 13% of these men, respectively. In 75% of these cases, lead time bias because of PSA driven repeat biopsies provided an explanation. CONCLUSIONS: Lead time bias because of PSA driven repeat biopsy accounted for the high 4-year bNED survival and favorable pathologic findings for most patients who had prostate cancer coexisting in a prostate gland comprised of BHPT and a total gland volume in excess of 75 cm3. An additional explanation is needed, however, for the remaining patients.

Follow-Up Studies↗

PubMed1998

The combination of preoperative prostate specific antigen and postoperative pathological findings to predict prostate specific antigen outcome in clinically localized prostate cancer.

PURPOSE: The independent clinical and pathological predictors of time to postoperative prostate specific antigen (PSA) failure were used to identify prostate cancer patients at high risk for this end point. MATERIALS AND METHODS: A Cox regression multivariate analysis was used to determine the prognostic significance of preoperative PSA, pathological stage, prostatectomy Gleason score and margin status in predicting the time to postoperative PSA failure in 862 men with palpable (T2) or PSA detected (T1c) prostate cancer. The 2-year PSA failure rates with 95% confidence intervals were calculated using the results of Cox regression analysis and a bootstrap procedure with 2,000 replications, respectively, and are presented in nomogram format stratified by preoperative PSA, pathological stage, prostatectomy Gleason score and margin status. RESULTS: Preoperative PSA (p = 0.0001), pathological stage (p< or =0.002), margin status (p = 0.0001) and prostatectomy Gleason score (p = 0.034) were independent predictors of time to postoperative PSA failure. CONCLUSIONS: Patients at high risk for early PSA failure could be identified postoperatively on the basis of preoperative PSA and prostatectomy pathology. Adjuvant therapy trials in these select patients may be justified.

Follow-Up Studies↗

PubMed1998

Calculated prostate cancer volume greater than 4.0 cm3 identifies patients with localized prostate cancer who have a poor prognosis following radical prostatectomy or external-beam radiation therapy.

PURPOSE: Patients with palpable extraprostatic disease (T3) have a poor prostate-specific antigen (PSA) failure-free (bNED) survival rate after radical prostatectomy (RP) or external-beam radiation therapy (RT). This study was performed to validate or refute the prognostic value of the previously defined calculated prostate cancer volume (cV(Ca)). PATIENTS AND METHODS: For patients with clinically localized disease (T1c,2), a Cox regression multivariable analysis was used to assess the ability of the cV(Ca) value to predict time to posttherapy PSA failure following RP or RT. RESULTS: The cV(Ca) value was a significant predictor (P < or = .0005) of time to posttherapy PSA failure in both an RP and RT data set independent of the one used to derive the cV(Ca)-based clinical staging system. In both RP- and RT-managed patients, estimates of 3-year bNED survival were not statistically different for patients with either T1c,2 disease and a cV(Ca) greater than 4.0 cm3 (RP, 27%; RT, 18%) or T3 disease (RP, 37%; RT, 34%). Despite pathologic T2 disease, the 3-year estimate of bNED survival was at most 51% in RP-managed patients with T1c,2 disease and cV(Ca) greater than 4.0 cm3. CONCLUSION: A cV(Ca) greater than 4.0 cm3 identified patients with T1c.2 disease whose bNED survival was poor after RT or RP despite pathologic T2 disease that suggests the presence of occult micrometastatic disease in many of these patients. Prospective randomized trials to evaluate the impact on survival of adjuvant systemic therapy in these high-risk patients are justified.

Disease-Free Survival↗

PubMed1997

The use of combined radiation therapy and hormonal therapy in the management of lymph node-positive prostate cancer.

PURPOSE: To determine the rate of tumor response and patterns of relapse following combined hormonal-radiation therapy of adenocarcinoma of the prostate and to measure the survival in a group of men with tumor metastatic to pelvic lymph nodes. METHODS AND MATERIALS: 66 patients with adenocarcinoma of the prostate with pathologically confirmed pelvic lymph node involvement were treated with combined radiation therapy and hormonal therapy. An additional five patients declined hormonal therapy. The patients treated with combined therapy represented a group with locally advanced disease including 44 patients (67%) with T3 or T4 tumors and 51 patients (80%) had N2 or N3 lymph node metastases. The pelvic lymph nodes were treated to a dose of 45 Gy and the prostate was boosted to a dose of 65 to 71 Gy. Hormonal therapy began up to 2 months before radiation and continued indefinitely. Patients were allowed to select their hormonal therapy and could choose DES (2 patients), orchiectomy (21 patients), LHRH agonist (7 patients) or combined androgen blockade (34 patients). RESULTS: Median follow-up is 49 months (range 12 to 131 months) and 21 patients have been followed for longer than 5 years. There have been 15 recurrences the entire group including three local recurrences in the prostate, seven patients with distant metastases, four patients with biochemical recurrences without clinical evidence of disease, and one patient where the location was unknown. Two of the PSA recurrences occurred in patients who elected to discontinue hormones after less than 3 years of therapy. The overall survival at 5 and 8 years is 94 and 84%, the clinical disease free survival is 85 and 67%, and the biochemical disease-free survival is 78 and 47%. There was no increased toxicity of the combined modality regimen compared to the expected effects of radiation and hormonal therapy. CONCLUSION: Combined hormonal and radiation therapy represents an effective treatment option for patients with adenocarcinoma of the prostate metastatic to pelvic lymph nodes. Combined modality therapy appears to extend the disease-free survival and allow patients to maintain their independent function.

Adenocarcinoma↗

PubMed1997

Equivalent 5-year bNED in select prostate cancer patients managed with surgery or radiation therapy despite exclusion of the seminal vesicles from the CTV.

PURPOSE: Prostate Specific Antigen (PSA) failure free survival was determined for select prostate cancer patients managed definitively with external beam radiation therapy to the prostate only or radical retropubic prostatectomy. METHODS AND MATERIALS: A logistic regression multivariable analysis evaluating the variables of PSA, biopsy Gleason score, and clinical stage was used to evaluate the endpoint of pathologic seminal vesicle invasion (SVI) in 749 consecutive prostate cancer patients managed with a radical retropubic prostatectomy. In a subgroup of 332 surgically and 197 radiation managed patients who did not have the clinical predictors of SVI, PSA failure free survival (bNED) was determined. Comparisons were made using the log rank test between surgically and radiation managed patients in this subgroup. In this subgroup, radiation managed patients were treated to a median dose of 66 Gy (66-70 Gy) to the prostate only. RESULTS: The pretreatment PSA (> 10 ng/ml), biopsy Gleason score (> or = 7), and clinical stage (T2b, 2c, or 3) were found to be significant independent predictors (p < 0.001) of SVI. Only 2% of patients without any of these factors had SVI and 17% had extracapsular extension (15% microscopic; 2% macroscopic). In this subgroup the 5-year bNED rates were equivalent [84 vs. 89% (p = 0.67)] for surgically and radiation managed patients, respectively. CONCLUSIONS: Conventional dose external beam radiation therapy directed at the prostate alone resulted in 5-year bNED rates equivalent to surgery on retrospective comparison in patients with clinical stage T1,2a, PSA < or = 10 ng/ml, and biopsy Gleason < or = 6 prostate cancer.

Biopsy↗

PubMed1997

Equivalent biochemical failure-free survival after external beam radiation therapy or radical prostatectomy in patients with a pretreatment prostate specific antigen of > 4-20 ng/ml.

PURPOSE: Biochemical failure-free survival stratified by the pretreatment prostate-specific antigen (PSA) and biopsy Gleason score (bGl) is determined for prostate cancer patients managed definitively with external beam radiation therapy or radical retropubic prostatectomy. METHODS AND MATERIALS: A Cox regression multivariable analysis evaluating the variables of PSA, bGl, and clinical stage was used to evaluate the end point of time to PSA failure in 867 and 757 consecutive prostate cancer patients managed definitively with external beam radiation therapy or radical retropubic prostatectomy, respectively. PSA failure-free survival was determined using Kaplan-Meier analysis. Comparisons were made using the log rank test. RESULTS: The pretreatment PSA, bGl, and clinical stage (T3,4 vs. T1,T2) were found to be independent predictors of time to post-treatment PSA failure for both surgically and radiation managed patients using Cox regression multivariable analysis. Patients with a pretreatment PSA of > 4 ng/ml and < or = 20 ng/ml could be classified into risk groups for time to post-therapy PSA failure: low = PSA > 4-10 ng/ml and bGl < or = 4; intermediate = PSA > 4-10 and bGl 5-7; or PSA > 10-20 ng/ml and bGl < or = 7; high = PSA > 4-20 ng/ml and bGl > or = 8. Two-year PSA failure-free survival for surgically managed and radiation-managed patients, respectively, were 98% vs. 92% (p = 0.45), 77% vs. 81% (p = 0.86), and 51% vs. 53% (p = 0.48) for patients at low, intermediate, and high risk for post-therapy PSA failure. CONCLUSIONS: There was no statistical difference in the 2-year PSA failure-free survival for potentially curable patients managed definitively with surgery or radiation therapy when a retrospective comparison stratifying for the pretreatment PSA and bGl was performed.

Disease-Free Survival↗

PubMed1997

Development of prostate cancer after pituitary dysfunction: a report of 8 patients.

OBJECTIVES: Eight patients with a history of pituitary dysfunction were seen in the Department of Radiation Oncology at the Hospital of the University of Pennsylvania for evaluation of their prostate carcinoma. Because prostate cancer is a hormonally responsive cancer, hormonal abnormalities from pituitary dysfunction may have played a role in its development. In addition, many patients with pituitary dysfunction receive exogenous hormonal replacement. The histories of these 8 patients were reviewed to look for any common underlying factor in the development of their prostate cancer. METHODS: The radiation oncology charts, hospital charts, and pathology reports were reviewed. The cause and treatment of the pituitary disorder were reviewed. Hormonal dysfunction, hormonal replacement, and treatment duration were recorded. The interval to the development of prostate cancer, stage at diagnosis, prostate-specific antigen level, Gleason score, treatment, and treatment outcome were also investigated. RESULTS: We found a variety of pituitary disorders and treatments. However, all patients received testosterone replacement therapy prior to the development of their prostate cancer (median of 30 months). The time to the development of the cancer ranged from 26 to 250 months (median 98). Patients had Stage T2 or T3 tumors at diagnosis. Patients were treated either with radical prostatectomy or radiation therapy. Six of the 8 patients were alive and doing well at their last follow-up examination. CONCLUSIONS: Prostate cancer has been shown to be androgen responsive. All the patients in this series were placed on physiologic testosterone replacement for pituitary dysfunction. The role of testosterone in the initiation of prostate cancer has been debated. However, at the present time, it seems appropriate to establish close monitoring for prostate cancer in patients receiving androgen therapy for pituitary dysfunction.

Aged↗

PubMed1997

Combined modality staging of prostate carcinoma and its utility in predicting pathologic stage and postoperative prostate specific antigen failure.

OBJECTIVES: This study was performed to predict the factors that can optimize preoperative staging for clinically localized prostate cancer patients. METHODS: Logistic and Cox regression multivariable analyses were performed on 480 surgically-managed prostate cancer patients to evaluate the ability of clinical stage, prostate specific antigen (PSA), biopsy Gleason sum, percent positive biopsies, and endorectal coil magnetic resonance imaging (erMRI) results to predict for pathologic established extracapsular extension (ECE), seminal vesicle invasion (SVI), and time to postoperative PSA failure. RESULTS: The characteristics of clinically organ-confined prostate cancer patients at high risk (> 67%) for postoperative PSA failure within 3 years include: (A) PSA > 20 ng/mL; (B) Biopsy Gleason sum > or = 8; or (C) erMRI positive for extraprostatic disease and intermediate risk disease. For patients at intermediate risk (ie, either a PSA < 4 and biopsy Gleason sum of 7; PSA > 4 to 10 ng/mL and biopsy Gleason sum 5 to 7; or a PSA > 10 to 20 ng/mL and biopsy Gleason sum 2 to 7), despite 100% positive biopsies, 50% of patients had pathologic organ-confined disease. However, in the subset of intermediate-risk patients with a positive erMRI for either ECE or SVI and at least 50% positive biopsies, all had extraprostatic disease and failed biochemically by 47 months postoperatively. Intermediate-risk patients with < 50% positive biopsies had pathologic organ-confined disease in at least 77% of the cases. CONCLUSIONS: Combined modality staging using the PSA, biopsy Gleason sum, percent positive biopsies, and endorectal coil MRI findings in select patients can predict pathologic stage and postoperative PSA failure. Therefore, this combined modality staging may optimize patient selection for phase 3 trials examining the role of neoadjuvant androgen ablative therapy for patients with clinically localized disease.

Genital Neoplasms, Male↗

PubMed1997

Prostate imaging may not be necessary in nonpalpable carcinoma of the prostate.

OBJECTIVES: Stage T1c carcinoma of the prostate is defined as a nonpalpable carcinoma (NPC-P) that is not visible by imaging and is identified by needle biopsy performed because of elevated prostate-specific antigen (PSA) concentrations. The purpose of this study was to define the incidence of normal findings on transrectal ultrasound (TRUS) and/or endorectal coil magnetic resonance imaging (EMRI) among patients with NPC-P, as well as to investigate the value of differentiating patients with Stage T1c disease from all other patients with NPC-P. METHODS: The records of 2211 patients diagnosed with prostate carcinoma between 1988 and 1995 were reviewed to identify 291 men with NPC-P. TRUS and EMRI reports were analyzed with regard to the presence and laterality of hypoechoic nodules or low-signal areas reported on T2-weighted images, respectively. Ninety percent of patients (n = 262) had at least six prostate biopsies, 185 patients (64%) underwent both TRUS and EMRI, 224 (77%) had TRUS, and 251 (86%) had an EMRI study. RESULTS: Results were considered normal in 101 (47%) of 214 patients undergoing TRUS, in 58 (23%) of 249 undergoing EMRI, and in 22 (12%) of 185 undergoing both TRUS and EMRI. For the side of the prostate with positive biopsy results, correlation with imaging abnormalities was better for EMRI than for TRUS (39% versus 24%). There was no significant difference in mean PSA value, distribution of Gleason score, or unilateral versus bilateral positive biopsy results among patients with normal versus abnormal findings on both TRUS and EMRI. CONCLUSIONS: (1) Only 12% of men with NPC-P have no TRUS or EMRI abnormalities, fulfilling the criteria for Stage T1c prostate carcinoma. (2) Those patients with Stage T1c disease do not differ from patients with NPC-P up-staged by TRUS or EMRI, with regard to pretreatment PSA levels, Gleason scores, and the probability of having bilateral rather than unilateral positive biopsy results. (3) The value of classifying patients with NPC-P into Stage T1c versus higher stages of prostate carcinoma on the basis of imaging should be questioned.

Adenocarcinoma↗

PubMed1997

Prostate-specific antigen failure despite pathologically organ-confined and margin-negative prostate cancer: the basis for an adjuvant therapy trial.

PURPOSE: A multivariable analysis to evaluate the potential clinical and pathologic factors that predict for early biochemical failure in patients with pathologically organ-confined and margin-negative disease was performed to define patients who may benefit from adjuvant therapy. PATIENTS AND METHODS: Three hundred forty-one prostate cancer patients treated with a radical retropubic prostatectomy between January 1989 and June 1995 and found to have pathologically organ-confined and margin-negative disease comprised the study population. A logistic regression multivariable analysis to evaluate the predictive value of the preoperative prostate-specific antigen (PSA) level, pathologic (prostatectomy) Gleason score, and pathologic stage on PSA failure occurring during the first postoperative year was performed. RESULTS: Predictors of PSA failure during the first postoperative year in patients with pathologically organ-confined disease included pathologic Gleason score > or = 7 (P = .0007) and preoperative PSA level greater than 10 (P < .0001). Corresponding 3-year freedom-from-PSA-failure rates for these pathologic organ-confined patients with both, one, or neither of these factors were 60%, 75% to 84%, and 95%, respectively (P < .0001). CONCLUSION: Prostate cancer patients with pathologically organ-confined and margin-negative disease and a preoperative PSA level greater than 10 ng/mL or a pathologic Gleason score > or = 7 have significant decrements in short-term PSA-failure-free survival. Therefore, these patients should be considered for adjuvant therapy in the setting of a phase III clinical trial.

Humans↗

PubMed1997

Nefazodone. A review of its pharmacology and clinical efficacy in the management of major depression.

Nefazodone hydrochloride is a phenylpiperazine antidepressant with a mechanism of action that is distinct from those of other currently available drugs. It potently and selectively blocks postsynaptic serotonin (5-hydroxytryptamine; 5-HT) 5-HT2A receptors and moderately inhibits serotonin and noradrenaline (norepinephrine) reuptake. In short term clinical trials of 6 or 8 weeks' duration, nefazodone produced clinical improvements that were significantly greater than those with placebo and similar to those achieved with imipramine, and the selective serotonin reuptake inhibitors (SSRIs) fluoxetine, paroxetine and sertraline. The optimum therapeutic dosage of nefazodone appears to be between 300 and 600 mg/day. Limited long term data suggest that nefazodone is effective in preventing relapse of depression in patients treated for up to 1 year. Analyses of pooled clinical trial results indicate that nefazodone and imipramine produces similar and significant improvements on anxiety- and agitation-related rating scales compared with placebo in patients with major depression. Short term tolerability data indicate that nefazodone has a lower incidence of adverse anticholinergic, antihistaminergic and adrenergic effects than imipramine. Compared with SSRIs, nefazodone causes fewer activating symptoms, adverse gastrointestinal effects (nausea, diarrhoea, anorexia) and adverse effects on sexual function, but is associated with more dizziness, dry mouth, constipation, visual disturbances and confusion. Available data also suggest that nefazodone is not associated with abnormal weight gain, seizures, priapism or significant sleep disruption, and appears to be relatively safe in overdosage. Nefazodone inhibits the cytochrome P450 3A4 isoenzyme and thus has the potential to interact with a number of drugs. Further long term and comparative studies will provide a more accurate assessment of the relative place of nefazodone in the management of major depression. Nonetheless, available data suggest that nefazodone is a worthwhile treatment alternative to tricyclic antidepressants and SSRIs in patients with major depression.

Animals↗

PubMed1997

Outcome based staging for clinically localized adenocarcinoma of the prostate.

PURPOSE: Some patients with clinically localized prostate cancer are not cured after radical prostatectomy because of the presence of occult systemic disease. The American Joint Commission on Cancer staging classification for prostate cancer does not reliably distinguish between clinically localized patients who are likely or unlikely to be cured after local therapy. This project was undertaken to develop a staging system capable of predicting long-term outcome after radical prostatectomy on the basis of the clinical parameters obtained routinely during the standard workup for patients with adenocarcinoma of the prostate. MATERIALS AND METHODS: A total of 688 clinically localized prostate cancer patients managed with a radical retropubic prostatectomy for adenocarcinoma of the prostate between 1989 and 1996 was evaluated for clinical features predictive of time to prostate specific antigen (PSA) failure using a Cox regression multivariate analysis. A recently defined clinical factor called the calculated prostate cancer volume and its ability to predict time to PSA failure in conjunction with PSA, biopsy Gleason score and clinical stage were evaluated. RESULTS: The calculated prostate cancer volume (p <0.0001) and the pretreatment PSA (p <0.001) provided the optimal staging system for predicting freedom from PSA failure after radical prostatectomy. CONCLUSIONS: The calculated prostate cancer volume and PSA may provide clinically useful information regarding outcome after radical prostatectomy, enabling the selection of a therapeutic approach for an individual patient with clinically localized disease. Validation of this staging system is needed.

Adenocarcinoma↗

PubMed1996

Erectile dysfunction following minimally invasive treatments for prostate cancer.

OBJECTIVES: Cryosurgical ablation of the prostate (CSAP) and interstitial radiotherapy (IR) are relatively new procedures intended to be less invasive than radical prostatectomy for the treatment of prostate cancer. Despite absence of long-term or intermediate data of efficacy, many patients choose one of these therapies because they presume their potency will be maintained. We report our experience with CSAP, IR, and post-procedure erectile dysfunction. METHODS: Global sexual assessments were made in 12 months after therapy in 28 CSAP patients, and at 18 months in 37 IR patients. Each patient was contacted by telephone following his procedure. The patients were asked several questions regarding their sexual function both preoperatively and postoperatively. The questionnaire was administered only to the patient. RESULTS: Twenty-eight of 36 patients who underwent CSAP responded to the questionnaire (78%). Twenty patients were potent preoperatively (71%). The mean age of the potent group was 69 years (range 54 to 82). Following therapy, 2 of these patients (10%) reported potency at 12 months. Thirty-seven of 42 patients who underwent IR responded to the questionnaire (88%). Twenty-seven were potent preoperatively (73%). The mean age of the potent group was 70 years (range 56 to 83). The mean follow-up was 18 months (range 5 to 36). Following therapy, 15 patients reported potency (55%). All of the patients who reported potency felt that the quality of their erections had decreased following radiation. CONCLUSIONS: Our short-term results with IR and CSAP suggest a significant adverse effect on erectile function. Our results suggest that enhanced preservation of potency should not be used as an enticement in the promotion of IR or CSAP.

Aged↗

PubMed1996

An analysis of the time course of postoperative prostate-specific antigen failure in patients with positive surgical margins: implications on the use of adjuvant therapy.

OBJECTIVES: The role of adjuvant therapy in the postprostatectomy setting for positive margin patients is an unresolved issue. The purpose of this study is to provide the rationale for patient selection in Phase III trials that test the impact of adjuvant therapy on survival in positive margin prostate cancer patients. METHODS: Early (12 months or less) and delayed (more than 12 months) postoperative prostate-specific antigen (PSA) failure have been correlated with distant and local failure, respectively, as the site of first failure. In this study, a Cox regression multivariate analysis was used to determine the significant independent clinical and pathologic predictors of early and delayed postoperative PSA failure in 143 margin-positive prostate cancer patients. RESULTS: Margin-positive patients with positive pelvic lymph nodes, seminal vesicle invasion, or prostatectomy Gleason sum 8 or higher were excluded. For the remaining patients, a prostatectomy Gleason sum of 7, preoperative PSA more than 20 ng/mL, and an endorectal coil magnetic resonance imaging (erMRI) scan showing extensive disease were significant independent predictors of early postoperative PSA failure. Conversely, a prostatectomy Gleason sum of 6 or less, preoperative PSA 20 ng/mL or less, and an erMRI showing limited disease predicted delayed PSA failure. CONCLUSIONS: Preliminary data suggest that the pattern of first failure can be predicted by the time course of rise in the postoperative PSA. The preliminary results of this study suggest that patient selection for clinical trials examining the efficacy of postoperative adjuvant therapy in the positive margin patient may be determined on the basis of the clinical and pathologic characteristics that predict early versus delayed postoperative PSA failure.

Clinical Trials, Phase III as Topic↗

PubMed1996

Violence to staff in a general hospital setting.

The problem of aggression to staff in a general hospital was examined from the perspective of Poyner & Warne's (1986) model of workplace violence. A total of 396 staff (39% response rate) provided information on their experience of violence in the past year and a subsample were additionally interviewed about their current levels of mental health (GHQ). Some 72 staff (21% of respondents had been physically assaulted and 90% of these assaulted staff worked beyond the accident and emergency department, e.g. in medical wards. Nurses were physically assaulted, threatened and verbally abused at higher rates than other professionals. Employee factors (younger age, shorter National Health Service experience and attendance at violence training) were significantly associated with assault (P < 0.05). Postoperative confusion, receiving treatment and delayed treatment were common precursors of aggression. Mental health was significantly worse amongst staff exposed to threats (P < 0.01). This exploratory study establishes that violence is a problem across a number of general hospital departments and occupations and we argue that effective training should be made more available for staff at risk of assault.

Adult↗

PubMed1996

An evaluation of staff training in psychological techniques for the management of patient aggression.

Training for staff working with violent patients is frequently recommended, sometimes implemented, but rarely objectively evaluated. In this longitudinal study 47 nurses attending a training day to learn strategies for coping with violent psychiatric patients were compared with 108 non-attending control group subjects. The rate of assaults on staff on wards taking part in the study was 31% lower after implementation of the training and wards sending a majority of staff to the training experienced a particularly significant reduction in assaults. The effectiveness of this 1-day training package is discussed.

Adaptation, Psychological↗

PubMed1996

Verbal and non-verbal behavior immediately prior to aggression by mentally disordered people: enhancing the assessment of risk.

In this study we seek to enhance the assessment of imminent violence risk by providing empirical data on the types of verbal and non-verbal behaviour exhibited by 31 psychiatric inpatients immediately prior to assaulting a staff member, and 31 non-aggressive controls. Verbal abuse, high overall activity level and standing uncomfortably close to the intended victim were the most common behaviours immediately prior to the assault, but most preassault behaviours were also exhibited when patients were not assaulting staff. In the 3 days prior to the assault, aggressive patients differed from non-aggressors in terms of verbal abuse, abnormal activity level (P < 0.05), threatening gestures and threatening stance (P < 0.01). Only one patient was aggressive in the absence of any predictive behaviours. We conclude that most patients exhibit easily identifiable signs of imminent aggression, but that many of these signs occur in the absence of aggression.

Adult↗