PubMed Health⌕ Search

Biomedical subjects

D F Paulson

Publications and source records attributed to D F Paulson.

At least 55 records · Page 3Linked to original sources
PubMed1993

Squamous cell carcinoma of the prostate: 2 cases of a rare malignancy and review of the literature.

Primary squamous cell carcinoma of the prostate is an extremely uncommon malignancy, accounting for less than 1% of all prostatic cancers. We report on 2 patients with primary squamous cell carcinoma of the prostate: 1 with organ-confined disease and 1 with metastatic disease. Both patients presented with urinary obstructive symptoms and carcinoma was not suspected on digital rectal examination. Serum acid phosphatase and prostate specific antigen levels were normal. From a review of the literature and our 2 cases it is apparent that squamous cell carcinoma of the prostate is biologically more aggressive than adenocarcinoma.

Carcinoma, Squamous Cell↗
PubMed1993

Is prostate specific antigen of clinical importance in evaluating outcome after radical prostatectomy.

Current bias would conclude that elevation of serum prostate specific antigen (PSA) after radical prostatectomy infers failure of the procedure. Since April 1987 preoperative and postoperative serum PSA levels have been obtained on 226 patients who underwent radical perineal prostatectomy for presumed organ confined prostate cancer (stage T1-2N0M0). Clinical failure as defined by elevation of serum acid phosphatase, biopsy proved local recurrence or evidence of malignant disease on bone scan has occurred in 3.9% of the patients with organ confined, 7.0% with specimen confined and 13.2% with margin positive disease. However, when a PSA elevation of greater than 0.5 ng./ml. was used as an indicator of failure the failure rate became 9.8% for the organ confined group, 39.4% for the specimen confined group and 66.0% for margin positive group. Of the patients who failed clinically the interval from initial elevation of postoperative PSA to clinical detection of failure ranged from 2 to 28 months (median 16). Among the patients with an elevated postoperative PSA level but who have not clinically failed followup ranged from 4 to 46 months (median 23). A total of 11 patients had no evidence of failure at greater than 36 months despite the elevated postoperative serum PSA level. These PSA elevations in patients who undergo supposed curative therapy are distressing. However, at this time the majority of these patients have not failed. In the clinically cured patient biochemical evidence of failure may not be sufficient to change the treatment course.

Adult↗
PubMed1993

Critical review of radical cystectomy and indicators of prognosis.

The data would strongly suggest that, if local control can be established by either radical cystectomy or by transurethral resection, and if no distant disease is existing, that transurethral resection and radical cystectomy provide equivalent survival advantage. Our current dilemma lies in the inability to accurately determine the extent of disease as evidenced by the upstaging error that occurs following radical cystectomy. Thus, the treating physician must decide whether to abandon a therapeutic procedure such as radical cystectomy, which has the potential to cure higher local stage disease than may transurethral resection. It would appear that radical cystectomy as a single therapy remains the treatment of choice.

Carcinoma in Situ↗
PubMed1993

Prognostic factors in renal cancer.

In conclusion, the accumulated data indicate that the local extent of a renal carcinoma at the time of surgical intervention is the most important single variable in determining survival. Nuclear grade and cell type of the tumor appear to be of additional prognostic value, especially in patients whose tumor has spread beyond the anatomic confines of the kidney, because these variables may reflect the biologic virulence of the particular tumor in the individual host. Nuclear morphometry and cellular DNA content may play a more important role in the future by identifying that population of patients with clinically localized disease in whom radical nephrectomy will not be not curative, presumably because of concurrent undetectable micrometastases. This distinction will become increasingly important as more effective adjuvant therapies are identified.

Adult↗
PubMed1992

Accuracy in staging of renal cell carcinoma involving vena cava.

Accurate preoperative staging of renal cell carcinoma is necessary to determine patient prognosis and surgical approach, particularly when tumor thrombus invades the vena cava. The pathologically-confirmed tumor stage was compared with the radiographic preoperative stage in 44 patients undergoing surgery for renal cell carcinoma invading the vena cava (T3cNxMx). Nine patients (20%) were upstaged as the result of extracapsular tumor extension. Twelve patients (27%) were upstaged due to unrecognized regional lymphadenopathy, and 1 patient was downstaged. Only 1 patient was upstaged as the result of unrecognized metastases. The level of tumor thrombus extension for surgical approach was accurately determined in all but 2 patients. Overall, 15 patients (34%) were upstaged as a result of pathologic studies, 28 patients (64%) were correctly staged, and 1 patient was downstaged. Radiographic staging of extracapsular tumor extension and regional lymphadenopathy is unreliable, but current radiographic techniques delineate the level of thrombus extension for surgical approach with high accuracy.

Adult↗
PubMed1992

Total prostatoseminal vesiculectomy in the treatment of debilitating perineal pain.

Persistent perineal pain, unresponsive to antibiotics and analgesia, sufficient to produce an inability to function in any work or social environment is occasionally encountered. A total of 5 such patients underwent total prostatoseminal vesiculectomy: 3 experienced complete relief of the pain and 1 experienced symptomatic relief to the extent that he ranks the residual discomfort as 1 on a scale of 1 to 10. The remaining patient had complete absence of pain for approximately 4 months but thereafter mild, intermittent proximal urethral discomfort developed during voiding. Total prostatoseminal vesiculectomy may be occasionally applicable in the patient disabled by chronic perineal pain. We believe that psychiatric evaluation and concurrence should be a preoperative prerequisite.

Adult↗
PubMed1992

Complications of radical cystectomy and urinary diversion: a retrospective review of 675 cases in 2 decades.

A retrospective review was performed on all 675 patients who underwent radical cystectomy and urinary diversion during 2 decades. Of the patients 197 were treated from 1969 to 1979 (group 1) and 478 were treated from 1980 until 1990 (group 2). The mean age of patients in group 1 was 56.7 years versus 64.2 years in group 2 (p < 0.001). The overall operative mortality rate in both groups was 2.5%. A total of 215 patients (31.9%) experienced postoperative complications (within 30 days of surgery). The morbidity rate was nearly identical between the 2 groups (32.0% for group 1 versus 31.8% for group 2, p = 0.962). Of note, however, there was a decreased incidence of wound infections and wound dehiscence among the patients in group 2 compared to group 1. Long-term complications occurred in 198 of the 675 patients (29.3%). At followup group 1 had a 35.5% incidence of long-term complications versus 26.8% in group 2 (p = 0.022). Most notably there was significant improvement in the incidence of ureteroenteric anastomotic strictures when comparing groups 1 (11.2%) and 2 (5.2%) (p = 0.006).

Cystectomy↗
PubMed1992

Immunoreactive prostatic specific antigen in male periurethral glands.

Prostatic specific antigen (PSA) is considered an antigen unique to benign and malignant prostatic tissue. Recent evidence in the literature has raised serious doubts about the specificity of this antigen. In this study twenty male urethral specimens were evaluated for PSA and prostatic acid phosphatase (PAP) from patients without evidence of prostatic cancer. Eight of these 20 urethral specimens exhibited strong immunostaining for both PSA and PAP, localized in the periurethral glands. Five of the 17 urethral biopsies were positive for both antigens, while all three of the whole mount autopsy specimens stained positive for PSA and PAP. Within the autopsy series, there was heterogenous staining of the periurethral glands within the same specimen. This evidence disproves the fact that PSA and PAP are organ specific as previously described. More than likely any tissue of cloacal origin has potential for staining positive for prostatic specific antigen and prostatic acid phosphatase.

Acid Phosphatase↗
PubMed1992

Radical prostatectomy: the pros and cons of the perineal versus retropubic approach.

Radical prostatectomy is frequently recommended for the treatment of localized adenocarcinoma of the prostate. The use of the perineal versus the retropubic approach is mostly dependent upon the experience of the individual surgeon. This study was performed to evaluate the short-term differences between the 2 operations. Between 1988 and 1989, 173 patients were identified with organ confined prostate cancer (stage A or B) who were treated with radical prostatectomy. Of this total population 122 patients underwent radical perineal prostatectomy (group 1) and 51 patients underwent radical retropubic prostatectomy (group 2). The median estimated blood loss for group 1 was 565 cc and for group 2 it was 2,000 cc (p less than 0.001). Group 1 received a median of 0 units of blood during hospitalization, while group 2 received a median of 3 units of blood (p less than 0.001). The total operative time was slightly shorter for group 1 but the anesthesia time was similar for both patient populations. There was no difference in the incidence of positive surgical margins, and in in-hospital and long-term complication rates between the 2 groups. In light of these significant findings it is our belief that the radical perineal prostatectomy is an excellent approach for the treatment of adenocarcinoma of the prostate.

Adult↗
PubMed1992

Reappraisal of radical perineal prostatectomy.

Radical prostatectomy is frequently the treatment of choice for localized adenocarcinoma of the prostate. The procedure can be accomplished through either a perineal or a retropubic approach; both have their advantages and disadvantages. Recently, concerns over transmission of blood-borne viruses during transfusions and the advent of laparoscopic pelvic lymphadenectomy have resulted in a rejuvenation of interest in perineal prostatectomy. Herein, we discuss the history of perineal prostatectomy, the technique and its advantages and disadvantages.

Humans↗
PubMed1991

The role of radical surgery in the management of radiation recurrent and large volume prostate cancer.

Twenty-two patients seen between 1975 and 1988 were analyzed who had surgical attempts to cure locally advanced prostate cancer by exenterative procedures or salvage surgery for radiation recurrent disease. Twelve patients (Group I) underwent either a salvage cystoprostatectomy or perineal prostatectomy for radiorecurrent disease, including three patients with a Kock continent urinary diversion done in combination with the salvage operation. Five of the 12 (41.7%) recurrent disease confined to the surgical specimen and 11 of 12 (91.7%) are alive at a mean follow-up of 49 months, including four patients (25%) with a completely negative serum prostate-specific antigen (PSA) value (less than 0.2 ng/dl). All perineal prostatectomy patients are continent, and two of the three Kock pouch patients are continent. Ten of the 22 patients (Group II) had a cystoprostatectomy or exenteration for locally advanced disease that the surgeon did not think was amenable to standard radical prostatectomy. Only one of these ten patients had negative surgical margins, capsule, and seminal vesicles. Nine are alive (although only one patient has no evidence of disease) at a mean follow-up of 59 months. Morbidity was substantial with a 50% major complication rate including four patients requiring reoperation because of bleeding, abscess, bowel obstruction, or colostomy closure. Salvage procedures for radiorecurrent disease can be done safely, even with the inclusion of a continent diversion, and may be curative or provide survival benefit to carefully selected patients. Cystoprostatectomy or exenteration for locally advanced disease does not appear to be a curative endeavor for most patients and may be accompanied by significant morbidity.

Combined Modality Therapy↗
PubMed1991

Surgical management and prognosis of renal cell carcinoma invading the vena cava.

A total of 44 patients with renal cell carcinoma and vena caval tumor thrombus underwent surgical resection. Of these patients 27 had primary tumor confined within Gerota's fascia, negative lymph nodes and no distant metastases (stage T3cN0M0). Patients who underwent extraction of a mobile tumor thrombus from the vena cava had a 69% 5-year survival rate (median 9.9 years) but patients with tumor thrombus directly invading the vena cava had a 26% 5-year survival rate (median 1.2 years), which improved to 57% (median 5.3 years) if the involved vena caval side wall was resected successfully. Of these patients 17 had renal cell carcinoma with vena caval thrombus as well as extrafascial extension, regional lymphadenopathy or distant metastases, and the 5-year survival rate was less than 18% in all groups (median survival less than 0.9 years). Prognosis was determined by the pathological stage of the renal cell carcinoma and by the presence or absence of vena caval side wall invasion but not by the level of tumor thrombus extension. Patients with incomplete resection of localized renal cell carcinoma with tumor thrombus do not survive any longer than those with extensive cancer, positive lymph nodes or distant metastases. However, when partial venacavectomy establishes negative surgical margins then survival markedly improves.

Adult↗
PubMed1991

Staging relationships and outcome in early stage testicular cancer: a report from the Testicular Cancer Intergroup Study.

The Testicular Cancer Center Intergroup Study entered surgically staged patients with nonseminomatous tumor and metastases limited to the regional lymph nodes into a previously reported cooperative trial of immediate versus delayed therapy for positive retroperitoneal node disease. Patients with negative nodes (stage I) were placed in an observation registry with specified treatment strategy upon relapse. Of 264 stage I cancer patients 27 (10.2%) had recurrence: 5 of these 27 patients died after recurrence of the testicular malignancies, while 4 other nontumor-related deaths have occurred. Pre-lymphadenectomy staging characteristics observed to predict significantly node positivity are the results of radiological examinations, presence of tumor invasion, vascular invasion and tumor histology. In a multiple logistic regression analysis with these variables, misclassification still occurs in more than a fourth of the patients. Future refinements in diagnosis may allow for better prediction of these patients at risk to have positive lymph nodes and ultimately recurrence. Presently, if assessment of nodal involvement is the objective, noninvasive procedures are not an adequate substitute for surgical staging with modified lymphadenectomy.

Adult↗
PubMed1991

DNA in radical prostatectomy specimens. Prognostic value of tumor ploidy.

In a series of 94 patients with prostatic adenocarcinoma the prognostic significance of some factors was studied after radical prostatectomy. DNA ploidy was assessed by flow cytometry of cells from deparaffinized specimens. Gleason sum, seminal vesicle status and ploidy turned all out to be important predictors of disease progression. The ploidy status significantly enhanced the ability to prognostically evaluate patients with intermediate grade carcinoma compared to tumor grade alone. Patients with seminal vesicle invasion and aneuploidy had a very poor prognosis which prompts trials with alternatives of adjuvant therapy in this patient population.

Adenocarcinoma↗
PubMed1991

The relevance of stage A malignancy in prostatic cancer.

Patients with T1 (stage A) prostatic cancer detected on transurethral resection and patients with T2 (stage B) cancer, identified by palpation and needle biopsy, had similar time to failure and survival following radical prostatectomy. Transurethral resection was not associated with a higher degree of failure. The volume of the tumor and the biology of the disease were decisive of the outcome. In low-grade low-volume prostatic adenocarcinoma the risk of progression is very low.

Aged↗
PubMed1991

Radical surgery versus radiation therapy in early prostatic carcinoma.

Patients with organ-confined prostatic cancer, as determined by digital examination, bone scans and serum acid phosphatase determination, were randomized to radical prostatectomy or external-beam radiation therapy. With respect to first evidence of treatment failure, there was a significant difference in favor of the patients who had surgical treatment. In the patients given radiotherapy there was no essential difference in time to failure as compared with comparable patients in two recent observation-only trials on record.

Bone Neoplasms↗