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B J Miles

Publications and source records attributed to B J Miles.

At least 19 recordsLinked to original sources
PubMed1997

A decision analysis for treatment of clinically localized prostate cancer.

OBJECTIVE: To determine the preferred treatment of clinically localized prostate cancer. DESIGN: Cancer grade, patient age, and comorbidities are considered in a Markov model with Monte Carlo sensitivity analyses. Large and recent pooled analyses and patient-derived utilities are included. RESULTS: Principal findings suggest benefit for radical prostatectomy relative to watchful waiting for men under 70 years of age with low to moderate comorbidity. Men older than 70 with high comorbidity and disease of low to moderate grade do better with watchful waiting. CONCLUSIONS: Cohort-level sensitivity analyses suggest a quality-based treatment benefit for radical prostatectomy for younger men and treatment harm for older men. Tailored patient and clinician decisions remain necessary, especially for men older than 70 in good health but with aggressive cancers.

Adenocarcinoma↗
PubMed1996

A national survey of attitudes regarding participation in prostate carcinoma testing.

BACKGROUND: The prevalence of prostate carcinoma testing is rapidly changing. Little is known about the frequency of testing in the non-Medicare population in the United States. The current study was conducted for a better understanding of who is being tested and some of the reasons why. METHODS: A randomized national telephone survey was administered to 800 men by the George H. Gallup International Institute. Questions in the survey were evaluated for their association with participation in prostate carcinoma testing reported by the men interviewed. RESULTS: Participation in prostate carcinoma testing approximated the frequency of colon carcinoma testing Eighty-six percent of the men surveyed believed that prostate carcinoma is a serious malignancy, and 78% believed that it could be cured often if detected early. Multivariate logistic regression models identified six factors that increased the likelihood of men in the survey being tested: white race, willingness to be tested, previous conversation with a physician or health professional, having had serum cholesterol tested, having been tested for colon carcinoma, and belonging to successively advanced age groups. CONCLUSIONS: Prostate carcinoma testing is commonly performed in men older than 40 years. Physician counsel and patient prevention consciousness appear to be the major influences when a patient decides to be tested. If early detection is considered beneficial, special efforts would be needed to reach the nonwhite population.

Adult↗
PubMed1996

Optimized microvessel density analysis improves prediction of cancer stage from prostate needle biopsies.

OBJECTIVES: Clinical staging of prostate cancer is inaccurate, often with significant upstaging on final pathologic review. We previously demonstrated the ability to predict extraprostatic extension of cancer by use of the Gleason score and serum prostate-specific antigen (PSA) measurements. Herein we present an interim analysis of data from an ongoing multi-institutional study to determine the predictive power of an enhancement of microvessel density analysis in combination with Gleason score and serum PSA to predict extraprostatic extension. METHODS: We evaluated a total of 186 randomly selected biopsy samples and matched totally embedded radical prostatectomy samples with preoperative PSA concentrations and patient demographics. Gleason score and optimized microvessel density (OMVD) were determined from the needle biopsy samples; pathologic stage was verified by independent review of the radical prostatectomy samples. An automated digital image analysis system measured microvessel morphology and calculated the OMVD in the biopsy samples (Biostage; Bard Diagnostic Sciences, Seattle, Wash). RESULTS: Prediction of extraprostatic extension was increased significantly when OMVD analysis was added to Gleason score and serum PSA concentration (P = 0.003). CONCLUSIONS: Optimized microvessel density analysis significantly increases the ability to predict extraprostatic extension of cancer preoperatively when combined with Gleason score and serum PSA concentration. This method appears to be a useful tool that can assist with treatment decisions in selected patients.

Aged↗
PubMed1995

Current controversies in the management of localized prostate cancer.

As longevity has improved and mortality from cardiovascular and other diseases has declined, the risk of death from prostate cancer has increased steadily. Though slow growing, prostate cancer is not a benign disease. Nearly 10% of men in Western countries will be diagnosed with prostate cancer sometime during their life and 3% will die of the disease. The prospects for long-term control of prostate cancer diminish rapidly once the cancer has spread beyond the immediate periprostatic tissue. The 5-year survival rate for men with metastases is less than 30% and almost all will eventually die of their disease. A simple blood test, prostate-specific antigen (PSA), is available. This test, when used in conjunction with ultrasound-guided systematic needle biopsy of the prostate, will detect potentially lethal prostate cancers earlier than digital rectal examination (DRE). Definitive treatment, especially with radical prostatectomy, can eradicate the tumor in 90% of patients if the cancer is still confined to the prostate pathologically, regardless of the tumor grade. Randomized, prospective clinical trials are now underway to demonstrate conclusively whether screening or early definitive therapy will substantially reduce the mortality rate from this disease. Until the results of these trials are available, we recommend that healthy men over age 50, who have a life expectancy of 10 years or longer, have an annual PSA and DRE to detect prostate cancer while it is still curable.

Age Factors↗
PubMed1995

Computer modeling of prostate cancer treatment. A paradigm for oncologic management?

This article discusses the relevance of computer modeling to the management of prostate cancer. Several computer modeling techniques are reviewed and the advantages and disadvantages of each are discussed. An example that uses a computer model to compare alternative strategies for clinically localized prostate cancer is examined in detail. The quality of the data used in computer models is critical, and these models play an important role in medical decision making.

Adenocarcinoma↗
PubMed1994

A critique of the decision analysis for clinically localized prostate cancer.

The question of when to choose surgery over watchful waiting for treatment of clinically localized prostate cancer is difficult. Recently, the Prostate Patient Outcomes Research Team (PORT) published a decision analysis that promoted watchful waiting as a reasonable alternative to invasive treatment for many men with localized prostatic carcinoma. Criticisms were leveled at the analysis itself, its structure, and especially the probabilities and utilities used in the model. We reexamine the PORT decision analysis. Structural sensitivity of the model was conducted, as were multi-way analyses incorporating data more recent than those used in the PORT analysis. The model structure is concluded to be sound and reasonable given the available literature on prostate cancer progression. However, recent data suggest that some probabilities used in the PORT analysis may be understated, causing life expectancy for surgical treatment to be understated. Using these recent data, the decision to operate on all grades of prostate cancer is strongly supported. This finding contradicts that of the original PORT analysis, which suggested that surgery would decrease quality-adjusted life expectancy for patients with well differentiated lesions. Ethical considerations aside, a clinical trial, such as the Prostate Cancer Intervention Versus Observation Trial, would help to establish reliable progression rates. Also, additional quality of life studies with actual prostatic cancer patients are needed for accurate decision making. Decision scientists and academic urologists should collaborate on model refinement and subsequent analyses.

Aged↗
PubMed1992

Prognostic significance of DNA quantitation in stage D1 prostate carcinoma with the use of image analysis.

BACKGROUND: A characteristic feature of prostatic adenocarcinoma is its great variation in biologic behavior. This variation and the observation that most carcinomas are of intermediate grade make standard histologic grading of limited value in determining the prognosis of a patient. METHODS: DNA quantitation with the use of computer-assisted image analysis on Feulgen-stained nuclei was performed on the metastatic lymph nodes from patients with Stage D1 prostate carcinoma to determine whether ploidy was a useful predictor of survival or progression. The Gleason histologic score of the primary tumor, the number and extent of lymph node metastases, and the progression and survival intervals were documented. Treatment modalities included pelvic lymph node dissection, radical prostatectomy, external beam radiation therapy, and iodine 125 implantation. RESULTS: DNA ploidy quantitation showed that 65% (33 of 51) of cases were aneuploid, 2% (1 of 51) were tetraploid, and 33% (17 of 51) were in the diploid range. Progression to Stage D2 disease occurred in 76% of the patients with aneuploid cases and 53% of those with cases in the diploid range. CONCLUSION: There was a significant difference in progression between the two ploidy groups (Cox regression analysis, P less than 0.05).

Combined Modality Therapy↗
PubMed1992

Detection of human papillomavirus in squamous neoplasm of the penis.

Infection of the external human urogenital system with human papillomavirus has been implicated with the development of genital cancer. A modified polymerase chain reaction technique has been used to evaluate type specific deoxyribonucleic acid (DNA) sequences of unique E6 to E7 transforming regions of human papillomavirus genomes (types 6b/11, 16 and 18) in a morphological spectrum of in situ (carcinoma in situ) and invasive neoplasm of the penis. We studied 15 examples of carcinoma in situ [7 bowenoid and 8 nonbowenoid (squamoid or simplex)], 11 of invasive squamous carcinoma, 1 of verrucous carcinoma, 2 of verrucous hyperplasia, 1 of urethral adenocarcinoma and 1 solitary papilloma. Viral DNA was not detected in any of the nonbowenoid specimens of carcinoma in situ, the verrucous carcinoma, the adenocarcinoma or the papilloma of the penis. Human papillomavirus types 6b/11 and 18 specific sequences also were not detectable in any of the specimens examined. However, all 7 of the bowenoid forms of carcinoma in situ were positive for human papillomavirus type 16 DNA. The presence of human papillomavirus type 16 was also detected in 9 of 11 invasive squamous carcinomas and in both verrucous hyperplasias. Our results confirm that the bowenoid forms of intraepithelial neoplasms and most invasive squamous carcinomas contain the E6 to E7 portion of type 16 human papillomavirus genome.

Blotting, Southern↗
PubMed1992

Radical surgery in the treatment of localized carcinoma of the prostate.

New methods of early detection combined with recent advances in surgical techniques have resulted in more patients undergoing radical surgery for treatment of localized carcinoma of the prostate. Over 350 radical prostatectomies have been performed by our group since January 1987. We review the role of radical prostatectomy in the treatment of prostate cancer and our experience with 100 patients undergoing radical retropubic prostatectomy since the advent of nerve-sparing techniques to preserve potency.

Follow-Up Studies↗
PubMed1992

Maximal androgen ablation: a review.

Primary management of advanced (stage D) adenocarcinoma of the prostate is androgen ablation. Since this principle was discovered in the early 1940s, therapeutic alternatives and "progress" have centered around different ways to obtain castrate levels of androgens. The role of adrenal androgens in supporting prostate or prostatic cancer growth has been debated for decades and until recently was believed to be minimal. In the 1980s the concept of maximum androgen suppression, involving both the testes and adrenal glands, was reintroduced with some investigators claiming exceptional results. We review studies that have examined this concept, with emphasis on the largest trial which was carried out by the National Cancer Institute.

Adenocarcinoma↗