Superficial transitional (Ta/T1/CIS) cell carcinoma of the bladder.
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Administration, Intravesical↗
Biomedical subjects
Badrinath R Konety
Publications and source records attributed to Badrinath R Konety.
Contemporary management of superficial bladder cancer in the United States: a pattern of care analysis.
OBJECTIVES: To assess the practice preferences among urologists treating superficial bladder cancer in the United States. METHODS: We surveyed 226 urologists using a specially designed survey instrument. The type of practice, number of urologists in group practice, annual volume of patients with bladder cancer, and those treated with intravesical therapy were assessed. We also obtained information on the American Urological Association section and year of graduation from urology residency training. RESULTS: Of the 226 contacted urologists, 105 (46%) returned a completed survey instrument. Seventeen percent were practicing in academic institutions and 63% were in independent community practice. Forty-five percent had graduated from urology training in or before 1985. Thirty-six percent were in small and 37% were in moderate-size groups. Thirty-five percent were treating a moderate number of patients with bladder cancer, and 44% were treating a large number of patients annually. Thirty-two percent had a moderate number and 40% had a large number of patients receiving intravesical therapy annually. Immunotherapy was preferred in patients at high risk of recurrence. Intravesical chemotherapy was preferred by many for immunotherapy failure. The type of practice and year of graduation were the factors most frequently affecting treatment choice. CONCLUSIONS: Practice preferences for the management of superficial bladder cancer are in general agreement with the American Urological Association Bladder Cancer Guidelines Panel recommendations. However, 81% of surveyed urologists were still reluctant to refer patients with high-grade Ta-T1 disease with failure after intravesical immunotherapy twice for more aggressive therapy such as cystectomy or radiotherapy.
Administration, Intravesical↗
Extent of pelvic lymphadenectomy and its impact on outcome in patients diagnosed with bladder cancer: analysis of data from the Surveillance, Epidemiology and End Results Program data base.
PURPOSE: The benefit of pelvic lymphadenectomy in patients with bladder cancer remains controversial. We analyzed the impact of lymphadenectomy on disease specific survival in a population based sample of patients with bladder cancer who underwent radical cystectomy. MATERIALS AND METHODS: Analysis included data on 1,923 patients who underwent radical cystectomy for bladder cancer between 1988 and 1996 obtained from the Surveillance, Epidemiology and End Results program cancer registry. We analyzed the impact of the number of lymph nodes examined, number of positive lymph nodes and ratio of positive-to-total number of lymph nodes resected on disease specific and overall survival independent of patient age, gender, stage, race, radiation and chemotherapy. RESULTS: Median followup in cystectomy cases was 63.5 months (range 0 to 131). Patients with 0 to 3 lymph nodes examined were at significantly higher risk of death from bladder cancer than those with greater than 3 (HR 1 to 1.2 versus 0.41 to 0.58). Patients with stages I/in situ, III and IV disease benefited from more extensive lymphadenectomy. In stage IV cases, while the total number of positive lymph nodes removed did not correlate with increased survival, the proportion of excised lymph nodes positive for metastatic bladder cancer tended to correlate with the risk of death from the disease. CONCLUSIONS: These results indicate significantly increased survival rates after cystectomy in patients with bladder cancer diagnosed with stages III or IV disease who have relatively more lymph nodes examined, suggesting that even some with higher stage disease may benefit from extended pelvic lymphadenectomy at cystectomy.
Adult↗
Factors influencing aggressive therapy for bladder cancer: an analysis of data from the SEER program.
PURPOSE: We examined the association of various demographic, geographic and disease related factors, and the use of aggressive therapy defined as radical cystectomy or radiation therapy for bladder cancer. We also examined the correlation between these factors and disease specific survival such aggressive therapy. MATERIALS AND METHODS: Data from the Surveillance, Epidemiology and End Results (SEER) program public use files from 1992 to 1999 were used to analyze the demographic and disease related variables of patient age, sex, race, reporting SEER site/geographic region, disease stage, number of lymph nodes examined and number of positive lymph nodes. Cox proportional hazards model analysis was used to test for associations with disease specific survival and logistic regression was used to test the predictors of aggressive therapy. RESULTS: In multivariate models age, SEER site and disease stage were predictors of radical cystectomy while race, age, sex, SEER site and disease stage were significant factors predicting likelihood of radiation therapy. Disease stage and number of nodes examined were significantly associated with survival after radical cystectomy, while age, sex, SEER site and stage significantly affected survival after radiation therapy. CONCLUSIONS: Demographic, geographic and disease related characteristics of the patient population can significantly affect treatment choice in patients with bladder cancer. Disease specific survival after radical cystectomy appears to be influenced only by disease related factors (stage and extent of lymphadenectomy) compared to radiation therapy, where survival is influenced by nondisease related factors such as age, sex and SEER site. A significant number of patients who are older or live in certain geographic areas who are being denied aggressive therapy for bladder cancer would benefit from such therapy.
Adult↗
Surgical enucleation for the treatment of renal tumors.
INTRODUCTION: We analyzed our institutional experience with surgical enucleation for the primary treatment of small renal tumors. MATERIALS AND METHODS: Patient demographics, histological features, effect of different types of vascular control and outcome from surgery were analyzed in 45 patients. A majority of the tumors (67%) were diagnosed incidentally. RESULTS: All were stage T(1), 77% were low grade (I-II) and 23% were high grade (III-IV). Complication occurred in 12% of patients. At a mean follow-up of 34 months (range 7-97), 28 of 33 patients (84%) with malignant tumors were alive without evidence of disease. One patient with a solitary kidney developed recurrent tumor after enucleation that required nephrectomy. Mean operative time was significantly lower with the compression technique versus direct vascular control (164 +/- 12 min vs. 233 +/- 15 min, p = 0.002). There were no differences in outcome between the two techniques. CONCLUSIONS: Surgical enucleation is a safe and viable procedure for the treatment of small renal tumors. Manual compression of the kidney appears to be at least as effective as clamping of the renal vessels in obtaining vascular control during the procedure and is more expeditious.
Adenoma, Oxyphilic↗
Evaluation of intraprostatic metabolism of 1,25-dihydroxyvitamin D(3) (calcitriol) using a microdialysis technique.
OBJECTIVES: 1,25-dihydroxyvitamin D(3) (calcitriol) inhibits prostate cancer growth in vitro and in vivo. We used a prostate microdialysis technique to better understand the intraprostatic pharmacokinetics of calcitriol, which in turn would facilitate planning for systemic calcitriol therapy in patients with prostate cancer. METHODS: Male Sprague-Dawley rats were treated with 5 microg of calcitriol intravenously. Animals were either intact (group 1, n = 6) or castrated (group 2, n = 3). Prostate microdialysis was performed by perfusing Krebs solution through a 5-mm linear probe. Effluents were collected hourly from 0 to 20 hours or until death. Serum was collected at baseline and at the end of the experiment. Serum was also obtained from untreated rats at 0, 1, 2, 3, 4, 6, 8, 12, and 24 hours after intraperitoneal injection of calcitriol. Calcitriol levels were measured by radioimmunoassay. RESULTS: The average baseline intraprostatic level of calcitriol in prostate dialysate in intact rats was 21.1 pg/mL (+/-7.5); it was 88 pg/mL (+/-98.4) after calcitriol administration. In castrated animals, the values were 16.6 pg/mL (+/-5.3) and 25.3 pg/mL (+/-10.7). Two peaks in intraprostatic calcitriol levels were observed after intravenous administration: at less than 6 hours after injection and at more than 13 hours after injection. The mean total calcitriol exposure (area under the concentration versus time curve) in the prostate was 297.6 (+/-159) pg/hr/mL (intact) and 272.7 (+/-123.6) pg/hr/mL (castrated). The baseline serum levels were 0.1 to 1 ng/mL and reached a peak of more than 100 ng/mL within 1 hour of intraperitoneal injection. CONCLUSIONS: This technique permits real-time measurement of intraprostatic pharmacokinetics of calcitriol. The ratio of the intraprostatic area under the concentration versus time curve to the serum area under the concentration versus time curve of calcitriol was less than 1:100. Hence, within 24 hours of calcitriol administration, only a fraction (less than 1%) of the serum level is detectable in prostatic tissue. A bimodal peak in intraprostatic calcitriol levels is observed. This technique could be used to determine the tissue levels of calcitriol more accurately and to conduct additional studies to better elucidate the effects of castration on the intraprostatic pharmacokinetics of calcitriol.
Animals↗
Vitamin D and prostate cancer.
Current approaches to the management of prostate cancer include surgery, radiation therapy or hormonal manipulation either individually or in combination. Diet is increasingly being recognized as playing a role in many cancers including that of the prostate. There is now considerable evidence suggesting a role for vitamin D in prostate cancer. In this article, we have reviewed the current evidence supporting the use of vitamin D in the prevention and treatment of prostate cancer.
Calcitriol↗
High prevalence of screening-detected prostate cancer among Afro-Caribbeans: the Tobago Prostate Cancer Survey.
Risk for prostate cancer is high among African Americans. We hypothesized that risk for prostate cancer is also high in other populations of African descent. Our objective was to determine the screening-detected prevalence of prostate cancer in the predominantly Afro-Caribbean population on the island of Tobago. Male residents, ages 40-79 years, were invited to participate in a population-based screening for prostate cancer using serum prostate-specific antigen (PSA) and digital rectal exam (DRE). Men with elevated PSA (>or=4 ng/ml) or abnormal DRE were offered an ultrasound-guided sextant biopsy of the prostate gland. Men (2484), ages 40-79 years, underwent prostate cancer screening between September 1997 and June 2001. Mean age was 55.9, SD was 10.6 years, and median was 54 years. Mean serum PSA was 14.8 ng/ml, SD was 376 [excluding 4 values >or= 2 SD above the mean (1,112, 1,317, 1,818, and 18,330 ng/ml) mean PSA was 5.5 ng/ml and SD was 29.6], and median PSA was 1.2 ng/ml. Elevated PSA and/or abnormal DRE were observed in 31% (759 of 2484) overall, and in age groups 40-49 (87 of 843, 10%), 50-59 (201 of 729, 28%), 60-69 (262 of 584, 45%), and 70-79 (209 of 328, 64%). Of 681 men biopsied, 259 (38%, or 10% of the 2484 screened) were diagnosed with prostate cancer. Age-specific rates of screening detected prostate cancer were: 1%, ages 40-79 years; 7%, ages 50-59 years; 18%, ages 60-69 years; and 28%, ages 70-79 years. These screening results indicate a very high screening-detected prevalence of prostate cancer in this population of West African descent. These data support the hypothesis that populations of African descent share genetic and/or lifestyle factors that contribute to their elevated risk for prostate cancer.
Adult↗
Molecular markers in bladder cancer: a critical appraisal.
The diagnosis of both primary and recurrent bladder tumors currently relies upon the urine cytology and cystoscopy. Neither of these diagnostic tools is completely accurate. Prognostication of bladder cancer is largely based on pathologic tumor grade and stage. Over the past 2 decades, there is accumulating evidence that like many other cancers, bladder cancer, too, has a distinct molecular signature that separates it from other cancers and normal bladder tissue. Bladder tumors of different grades and stages even possess unique, and specific genotypic and phenotypic characteristics. Although recognition of several of these molecular alterations is possible by analyzing tumor tissue, urine, and serum samples, few if any of these "molecular markers" for bladder cancer are widely used in clinical practice. These markers include some that can be applied during the diagnostic work-up of symptoms (e.g., hematuria), those under surveillance for recurrence of superficial disease and forecasting long-term prognosis, or response to chemotherapy. In this review of molecular markers for bladder cancer, effectiveness of markers in each of these categories that are identifiable in the urine of patients with bladder cancer was examined. Many of the diagnostic markers appear to hold an advantage over urine cytology in terms of sensitivity, especially for the detection of low-grade superficial tumors. However, most markers tend to be less specific than cytology, yielding more false-positives. This result is more commonly observed in patients with concurrent bladder inflammation or other benign bladder conditions. Although there are several candidate markers for assessing prognosis or response to chemotherapy, studies of large patient populations are lacking. Further studies involving larger numbers of patients are required to determine their accuracy and widespread applicability in guiding treatment of bladder cancer.
Biomarkers, Tumor↗
Complete response of bony metastatic bladder urothelial cancer to neoadjuvant chemotherapy and cystectomy.
We report on a 38-year-old male diagnosed with biopsy-proven bladder urothelial carcinoma metastatic to the bone, who had a complete response to neoadjuvant chemotherapy consisting of carboplatin and gemcitabine. The final pathology of his radical cystoprostatectomy revealed no residual cancer. The patient continues to be without evidence of disease 2 years postoperatively. This case shows that neoadjuvant chemotherapy with nonstandard regimens can yield responses in patients with bone metastases.
Adult↗