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Biomedical subjects

D C Utz

Publications and source records attributed to D C Utz.

At least 19 recordsLinked to original sources
PubMed1987

Treatment options for patients with stage D1 (T0-3,N1-2,M0) adenocarcinoma of prostate.

Three hundred six patients with adenocarcinoma of the prostate underwent pelvic lymphadenectomy and had Stage D1 (T0-3,N1-2,M0) disease; 171 patients underwent radical retropubic prostatectomy with or without immediate adjuvant therapy (hormonal or radiation or both) or conservative (hormonal or radiation or both) treatment alone (n = 135). Follow-up was one-half to eighteen and one-half years (mean, 5 yrs). Immediate adjuvant orchiectomy significantly (P = 0.01) improved survival (87.4% at 10 years) and nonprogression rates for patients who underwent radical prostatectomy, but not for those who had lymphadenectomy. Overall patient survival was significantly better (P = 0.005) after prostatectomy than lymphadenectomy. Residual disease (n = 43) in patients who underwent prostatectomy and received adjuvant treatment (orchiectomy or radiation or both) did not affect disease outcome. Bilateral pelvic lymphadenectomy and radical prostatectomy with immediate adjuvant orchiectomy provided survival comparable to the expected survival; conservative treatment alone was associated with rapid disease progression and poor survival and significantly (P = 0.02) higher local morbidity.

Adenocarcinoma↗
PubMed1986

Evaluation of the prostate by magnetic resonance imaging.

Forty-seven male patients with suspected prostatic disease underwent magnetic resonance imaging (MRI) of the pelvis on a Picker resistive magnet operating at 0.15 T; 33 had histologically proved adenocarcinoma, 12 benign prostatic hypertrophy, 1 a transitional cell carcinoma, and 1 a seminoma. Eleven normal subjects also were included in the study. The study attempted to (1) define the MRI characteristics of the normal prostate, benign prostatic hypertrophy, and prostatic adenocarcinoma, (2) evaluate various pulse sequences in imaging the prostate, and (3) compare MRI findings with clinical, pathologic, and computed tomography results. Various pulse sequences, including inversion recovery and spin-echo with short and long TE and TR, were used. MRI was sensitive in detecting intracapsular and extracapsular prostatic disease. The finding of inhomogeneous signal texture throughout the gland was a sensitive but nonspecific finding for adenocarcinoma. A focal nodule with prolonged T1 and T2 relaxation times was the most specific MRI finding for adenocarcinoma. Extracapsular spread of neoplasm was often demonstrated, and because of its superior soft-tissue contrast ability, MRI was more accurate than computed tomography in delineating extracapsular extension.

Adenocarcinoma↗
PubMed1986

Testicular seminoma metastatic to the prostate.

A 43-year-old man had clinically manifest prostatic involvement by a metastatic testicular seminoma. The signs, symptoms, diagnosis and treatment of this entity, as well as a hypothesis regarding its development, are discussed.

Adult↗
PubMed1986

Bilateral pelvic lymphadenectomy and radical prostatectomy for clinical stage C prostatic cancer: role of adjuvant treatment for residual cancer and in disease progression.

A total of 101 patients with limited but unequivocal clinical stage C adenocarcinoma of the prostate underwent bilateral pelvic lymphadenectomy and radical retropubic prostatectomy. At operation 49 patients had pathological stage C and 52 had stage D1 disease. Followup ranged from 0.5 to 17 years (mean 4.9 years). The 5 and 10-year observed survival rates for patients with stages C and D1 disease were similar to the expected survival. Sixteen patients had residual cancer postoperatively but only 2 had local progression: 1 had received no adjuvant therapy, and 1 had received diethylstilbestrol and radiation. None of the others, having received adjuvant radiation and/or orchiectomy, suffered local recurrence. Over-all, local progression occurred in 17 patients, only 4 of whom had received adjuvant treatment initially (diethylstilbestrol, 1 also received radiation). Local progression occurred in 13 of 47 patients (28 per cent) without adjuvant treatment. Thus, in all patients immediate adjuvant bilateral orchiectomy or radiation (except for 1 patient) prevented local progression. In patients with pathological stage D1 disease bilateral orchiectomy significantly reduced disease progression (p less than 0.0001). Therefore, limited clinical stage C adenocarcinoma of the prostate can be successfully treated surgically (with low morbidity) when supplemented with appropriate immediate adjuvant treatment.

Adenocarcinoma↗
PubMed1985

Androgen receptor binding activity in human prostate cancer.

Androgen binding (cytosol and nucleus) was measured in tissue obtained from 223 untreated patients with proven prostate cancer (199 primary tumor, 24 malignant lymph nodes), 19 patients with hormone refractory cancer, and 46 patients with benign prostatic hyperplasia (BPH). The mean binding in both the cytosol and nucleus was significantly higher for patients with cancer than for those with BPH. Binding appeared to correlate with tumor stage. Androgen binding in malignant nodes can differ from that in the primary tissue and can vary from node to node in the same patient. Results obtained from an assay using a single saturating concentration of R1881 correlated well with those calculated from a full six-point Scatchard analysis when an adequate amount (500 mg) of tissue was available. However, binding results obtained from a single-point analysis performed on needle biopsy specimens (about 50 mg) obtained before complete surgical removal of the prostate correlated poorly with those derived from a full six-point analysis performed on tissue (500-1000 mg) removed from the center of the malignancy. Androgen binding in nuclear extracts of histologically benign tissue adjacent to the malignancy was significantly higher than in nuclear extracts of BPH tissue. Cytosolic androgen binding in tissue removed from patients who were refractory to hormonal therapy was higher than in tissue from untreated cancer patients. The binding of estradiol by extracts of benign and malignant prostate tissue was low or absent and, thus, did not appear to be a significant phenomenon.

Androgens↗
PubMed1985

Acute toxicity and preliminary therapeutic results of pelvic lymphadenectomy combined with transperineal interstitial implantation of 192IR and external beam radiotherapy for locally advanced prostate cancer.

We have developed a combined modality approach for treatment of locally advanced prostate cancer consisting of: surgical staging with lymphadenectomy; transperineal placement of afterloading needles for a course of 192Ir brachytherapy; and a course of moderate-dose external beam irradiation to tight prostatic fields. The flexibility of the treatment permits adaptation of the dose to any tumor configuration. A total of 23 patients have been treated to date; 18 are available for treatment review and 14 for acute toxicity analysis. Significant morbidity has occurred in only 2 patients, 1 with a pelvic hematoma and 1 with hematoma in the wound. Local tumor response has been excellent in all but 1 patient. A good degree of symptomatic improvement was observed at the three-month follow-up. This approach appears to be safe and effective at this time. A brief review of the technique and the rationale for its use are also presented.

Adenocarcinoma↗
PubMed1985

Pelvic lymphadenectomy and radical cystectomy for transitional cell carcinoma of the bladder with pelvic nodal disease.

Past and present methods of treatment for patients with stage D1 (T1-4 N+ MO) transitional cell cancer of the urinary bladder have proved to be largely ineffective. This report on 57 patients with stage D1 disease confirms this impression and demonstrates that radical operation alone is associated with a 5-year survival rate of only 10%. Survival is related to tumour grade and to the number of pelvic lymph nodes involved; furthermore, complete lymphadenectomy may contribute to improved patient survival. Effective treatment programmes for stage D1 bladder cancer are lacking and efforts should be directed toward developing treatment protocols that combine radical cystectomy and meticulous pelvic node dissection with an effective adjuvant systemic treatment programme.

Adult↗
PubMed1985

Review of Mayo Clinic experience with carcinoma in situ.

Experience with carcinoma in situ (CIS) of the urinary bladder during a twenty-year period at the Mayo Clinic is reviewed. The most important clinical clues for diagnosis of this disease continue to be irritative bladder symptoms in the absence of infection in elderly men and a history of transurethral resection of the prostate. The most reliable method of diagnosis is urinary cytology. When not modified by treatment, CIS is the precursor of most invasive cancers, originating probably from an area of atypical hyperplasia into CIS and, finally, into invasion. Among patients considered to have CIS who undergo cystectomy, 34 per cent may already have microinvasion. CIS has the potential to involve the entire urothelium. Prudence should guide the use of intravesical chemotherapy (mitomycin or thiotepa or doxorubicin), which may control the disease for extended periods in many patients. If primary treatment fails, immediate second-line treatment should include BCG or hematoporphyrin derivative (HpD) phototherapy or both. If such therapy fails, delay of radical cystectomy seems inadvisable. Monitoring of the prostatic urethra during intravesical treatment is mandatory; a radical surgical procedure should be performed once the prostatic urethra is involved. Results of treatment for secondary prostatic and upper urinary tract cancer are dismal. Conversely, secondary urethral disease, although it occurs frequently beyond five years, may be associated with a good prognosis.

Administration, Topical↗
PubMed1984

Observations on surgical management of carcinoma of prostate with limited nodal metastases.

One hundred patients with surgical Stage D1 (TXN + M0) adenocarcinoma of the prostate underwent pelvic lymphadenectomy and radical retropubic prostatectomy and were followed up for one-half to fifteen and one-half years. Forty-eight patients received "adjuvant" hormonal or radiation (or both) treatment; all patients were treated ("delayed") hormonally on disease progression, when this treatment had not been administered initially. Tumor grade (Mayo 1 through 4), tumor bulk (measured in cm3), or seminal vesicle involvement alone and when considered with number of positive nodes was not related to survival or disease progression. Only number of positive nodes and bilateral orchiectomy as "adjuvant" treatment affected survival and progression. For the 52 patients without "adjuvant" orchiectomy, the overall five-year rate for nonprogression was only 18.5 per cent, and the five-year rates for nonprogression were, respectively, 26, 0, and 0 per cent when 1, 2, and greater than or equal to 3 positive nodes were considered. However, for the 37 patients who received "adjuvant" orchiectomy, the overall five-year rate for nonprogression was 95 per cent, and the five-year rates for nonprogression were, respectively, 100, 100, and 80 per cent when 1, 2, and greater than or equal to 3 positive nodes were considered. Prostatic cancer with positive pelvic lymph nodes treated by pelvic lymphadenectomy and radical retropubic prostatectomy alone leads to rapid disease progression. "Adjuvant" bilateral orchiectomy is associated with projected five- and ten-year survival rates of 94 per cent and 80 per cent, respectively. Recommendation of other treatment modalities for patients with Stage D1 cancer of the prostate should be considered with reference to the results presented herein.

Adenocarcinoma↗
PubMed1984

Epidemic of pulmonary blastomycosis (Namekagon fever) in Wisconsin canoeists.

Epidemics of pulmonary blastomycosis have rarely been reported. The following epidemic occurred in a Minnesota family and several of their acquaintances after a canoeing trip in northwestern Wisconsin. The common exposure area was most likely a campsite, located along the upper reaches of the Namekagon River. The Namekagon River Valley is a known endemic area of Namekagon fever (blastomycosis) in dogs. Approximately one month after returning home, five of the eight members of the group had positive direct microscopic examinations and cultures of Blastomyces dermatitidis from their sputa, as well as abnormalities on their chest roentgenograms. Among these five patients, four were symptomatic, with fever, cough, and pleuritic chest pain. Of the three others, one had pleuritic chest pain with a transient lung infiltrate, the second was asymptomatic with a transient lung infiltrate, and the third was asymptomatic with a normal chest roentgenogram. Results of acute serologic tests (complement fixation and immunodiffusion) were negative in all five patients evaluated. None of the patients received antifungal therapy. Follow-up five years after the epidemic revealed that all eight were in excellent health, and none had evidence of continuing pulmonary or extrapulmonary disease.

Adult↗
PubMed1984

Carcinoma in situ of the urinary tract.

The identification and description of carcinoma in situ by pathologists and the recognition of its clinical features and diagnostic clues by clinicians represent a significant advancement in the struggle to conquer invasive epithelial cancer in recent times. The authors discuss symptoms, diagnosis, pathologic features, and treatment.

Carcinoma in Situ↗
PubMed1984

Radical excision of adenocarcinoma of prostate with pelvic lymph node involvement: surgical gesture or curative procedure.

From 1967 to 1981, 100 patients with carcinoma of the prostate and positive lymph node involvement underwent pelvic lymphadenectomy and radical retropubic prostatectomy. At surgery, adjuvant treatment consisted of none in 52, orchiectomy in 37, and other (radiation and/or diethylstilbestrol) in 11 subjects. Of all the variables assessed (tumor bulk, grade, seminal vesicle involvement, number of positive nodes, and adjuvant treatment), only the number of positive nodes was found to affect survival and progression when no adjuvant treatment was given. Progression was significantly limited by orchiectomy, which had an equalizing effect on all patients with positive nodes, possibly independent of the number of positive nodes.

Adenocarcinoma↗
PubMed1983

Treatment of transitional cell carcinoma of the bladder with hematoporphyrin derivative phototherapy.

The demonstration that intravenously administered hematoporphyrin derivative concentrates preferentially in dysplastic and neoplastic transitional cells in the human bladder prompted a trial of hematoporphyrin derivative phototherapy in patients with transitional cell cancer of the bladder. A dose of 2.5 mg. per kg. was given intravenously 3 to 48 hours before treatment with light of a wavelength of 630 nm. from an argon ion pumped dye laser. Total light dose approximated 150 joules per cm.2. Four patients with resistant carcinoma in situ have been treated and all have had disappearance of the tumors proved by biopsy. Although there are many technical problems we believe that hematoporphyrin derivative phototherapy holds promise as an effective treatment modality, primarily for patients with resistant, recurrent in situ transitional cell carcinoma of the bladder.

Aged↗
PubMed1983

Influence of thiotepa and doxorubicin instillation at time of transurethral surgical treatment of bladder cancer on tumor recurrence: a prospective, randomized, double-blind, controlled trial.

The influence of the instillation of thiotepa or doxorubicin hydrochloride into the bladder at the end of transurethral surgical treatment on the recurrence of bladder cancer was evaluated. We studied in a randomized, double-blind, controlled fashion 89 patients with transitional cell epithelioma (carcinoma in situ or papillary carcinoma) whose tumors were considered to have been completely removed. Of these patients 28 (the control group) received a placebo (sterile water), 30 received thiotepa and 31 received doxorubicin. By 3 to 4 months postoperatively 71 per cent of the control group, and 30 and 32 per cent, respectively, of the patients treated with thiotepa and doxorubicin had recurrences (p less than 0.01). Additional treatment during the followup interval was ineffective in all groups. Patients studied also were classified according to grade, histological findings, multiplicity of tumors and history of bladder tumor. Treatment was most effective in reducing recurrence in patients with low grade, papillary or multiple tumors and in patients with a history of bladder cancer. No effect was observed in patients with single tumors and only modest effects were found in those with high grade tumors, carcinoma in situ or new tumors. The results support the concept that recurrences may arise from tumor cell implantation at the time of transurethral management of bladder tumors and may be reduced effectively by concomitant intravesical chemotherapy.

Adult↗
PubMed1982

Nucleolar grading of prostatic adenocarcinoma: light microscopic correlation with disease progression.

Thirteen patients who had adenocarcinoma of the prostate with micrometastasis to pelvic lymph nodes were treated with radical retropubic prostatectomy and pelvic lymphadenectomy, but no adjuvant hormonal therapy, and were followed until the documented appearance of metastasis to bone or soft tissue. Sections from the initial lesion, stained with hematoxylin and eosin and examined under the light microscope, revealed that the nucleoli in the primary Gleason pattern were "prominent" or "intermediate" (regardless of the Gleason grade) in nine cases; and the mean interval to progression was shorter in this group than in the group of four in whom nucleoli were judged to be "not prominent" (P = 0.015). Since the number of cases is small, the findings should be considered preliminary and their interpretation speculative; but the study is continuing.

Adenocarcinoma↗