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G L Andriole

Publications and source records attributed to G L Andriole.

At least 19 recordsLinked to original sources
PubMed1996

Who is best benefited by radical prostatectomy?

The last few years have taught us much about prostate cancer. We now recognize that prostate cancer, even if it is of low stage and low grade, is a relentlessly progressive disease, especially if found in men with prolonged (greater than 15 years) life expectancy. We now know that serum PSA is a valid endpoint after radical prostatectomy to definitively assess its ability to eradicate prostate cancer. We are learning better how to use a variety of clinical parameters to predict pathologic stage, and we are in the process of developing other markers that may be exploited to predict which patients with early-stage prostate cancer have surgically curable lesions. From these observations it is reasonable to conclude that the best candidates for radical prostatectomy are young men (those with 10 to 20 years of life expectancy) with impalpable, clinically organ-confined low- or moderate-grade prostate cancers.

Adenocarcinoma↗
PubMed1996

Antegrade collagen injection for stress incontinence after radical prostatectomy: technique and early results.

This article describes the technique and early results of antegrade collagen injection into the bladder neck and proximal urethra of men with stress incontinence postprostatectomy. Twenty men underwent collagen injection under general anesthesia. Follow-up ranges from 5 to 15 months, with a mean of 9.5 months. A mean of 14.5 cc of collagen was injected (range 5-25 cc). According to a subjective self-grading system, preoperative and postoperative urodynamics, and pad usage before and after treatment, significant improvement was seen in 14 patients (70%), and subjective cure was reported by 5 (25%). Six patients (30%) had no subjective or objective improvement after the injection. The antegrade collagen injection technique is a promising and simple method of correcting postprostatectomy stress urinary incontinence. Further study and longer follow-up is necessary to determine its precise role in the treatment of men with this problem.

Aged↗
PubMed1996

Prostate specific antigen density versus prostate specific antigen slope as predictors of prostate cancer in men with initially negative prostatic biopsies.

PURPOSE: We determined if prostate specific antigen (PSA) density and PSA slope alone or in combination could be used to predict which men with persistently elevated serum PSA and prior negative prostate biopsies will have prostate cancer on repeat evaluation. MATERIALS AND METHODS: In our PSA-1 data base we identified 327 men 50 years old or older with an initially negative prostate biopsy who had persistent PSA elevation, and compared those who did and did not have prostate cancer on subsequent serial prostatic biopsy. RESULTS: Of 70 men with a PSA density of 0.15 or more and PSA slope of 0.75 ng./ml. or more annually compared to 83 with a PSA density of less than 0.15 and PSA slope of less than 0.75 ng./ml. annually 32 (46%) and only 11 (13%), respectively, had prostate cancer on subsequent prostate biopsies (p < 0.0001). In a hierarchical logistic regression analysis PSA density and PSA slope were predictive of prostate cancer on subsequent biopsy (p = 0.001 and 0.03, respectively). PSA density of 0.15 or more alone or PSA slope of 0.75 ng./ml. or more annually alone as the indicator for repeat biopsy would have missed 35 and 40% of cancers, respectively. CONCLUSIONS: In men with persistently elevated serum PSA after an initially negative prostate biopsy, PSA density and PSA slope alone or in combination provide useful predictive information about the results of repeat prostate biopsies. However, these parameters are not sufficiently sensitive to identify all patients with detectable prostate cancer.

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PubMed1996

Early results with antegrade collagen injection for post-radical prostatectomy stress urinary incontinence.

PURPOSE: Results of retrograde transurethral collagen injection for treatment of stress urinary incontinence have been generally disappointing for men with intrinsic sphincter deficiency following radical prostatectomy. We describe a new technique of antegrade transvesical collagen injection using suprapublic percutaneous bladder access. MATERIALS AND METHODS: Between October 1994 and January 1996, 20 patients underwent antegrade collagen injection for post-radical prostatectomy stress urinary incontinence. Evaluation by pad test, urodynamics and subjective scores was performed before and after injection. RESULTS: At a mean followup of 8.5 months 9 of 20 patients (45%) had significant subjective improvement and 5 (25%) were totally dry. CONCLUSIONS: Antegrade collagen injection is a promising and simple method of correcting post-radical prostatectomy stress urinary incontinence. Further study and longer followup are necessary to determine its precise role in the treatment of this condition.

Aged↗
PubMed1995

Prostate cancer.

Explore the source record for details and available documents.

Aged↗
PubMed1995

Surgeon's workshop: antegrade collagen injection: new technique for postprostatectomy stress incontinence.

Intraurethral collagen injection has become a recognized modality to treat stress urinary incontinence. The results of this procedure using the traditional retrograde endoscopic approach have generally been disappointing for men with sphincteric incontinence after radical prostatectomy. We describe a new technique of antegrade collagen injection utilizing suprapubic percutaneous bladder access to achieve simultaneous antegrade and retrograde endoscopic views of the bladder neck. This new injection technique is a promising and simple method of correcting postprostatectomy stress urinary incontinence.

Collagen↗
PubMed1995

Medical therapy for benign prostatic hyperplasia.

Benign prostatic hyperplasia (BPH) is a common clinical entity in elderly men. We review the epidemiology of BPH and the mechanisms by which it causes bladder outlet obstruction. The currently available medical therapies are examined with respect to mechanism of action, effectiveness, side effects, and cost. They are briefly compared with the more traditional treatment options of watchful waiting and transurethral prostatectomy. A logical approach to the treatment of symptomatic BPH is discussed.

Adrenergic alpha-Antagonists↗
PubMed1994

Early complications of contemporary anatomical radical retropubic prostatectomy.

Anatomical radical retropubic prostatectomy is commonly performed to treat select patients with clinically localized prostate cancer. Because this recently introduced surgical technique is technically demanding, and since early detection programs have altered the age and stage distribution of men undergoing radical prostatectomy, earlier reports describing complication and death rates from radical prostatectomy may not accurately reflect contemporary experience. A retrospective review of 1,342 radical retropubic prostatectomies performed during a 5-year period showed an early complication rate of 7.4%. The most common complications were thromboembolic (pulmonary embolism) and cardiac (myocardial infarction). Patient age, mode of diagnosis (transurethral resection of the prostate versus needle biopsy) and pathological stage of the tumor did not correlate with the rate of complications. Three patients died in this series (0.2%). This retrospective review shows that contemporary anatomical retropubic radical prostatectomy may be performed with acceptably low early morbidity and mortality rates, and that appropriate selection of chronologically older patients is not associated with significantly greater rates of early complications. These data may be useful in decision analytic models evaluating the role of therapy for patients with early stage prostate cancer.

Adult↗
PubMed1994

Prostate carcinoma.

Over the last several years, the development of prostate-specific antigen (PSA) testing and technical refinements of anatomic radical prostatectomy have revolutionized the care of patients with prostate cancer. Serum PSA testing often allows early diagnosis of organ-confined prostate cancer. Anatomical radical prostatectomy has a high probability of completely eradicating these tumors, with minimal long-term morbidity. Use of PSA testing after therapy confirms the long-term ability of surgery to eradicate early-stage prostate cancer.

Carcinoma↗
PubMed1993

Laparoscopic gonadectomy in a case of testicular feminization.

Laparoscopy provides a minimally invasive technique for the accurate diagnosis of intersex problems and may also provide the opportunity for therapeutic management of these patients. Herein, we report our management of a patient with complete testicular feminization, by laparoscopic bilateral gonadectomy of fully developed intra-abdominal testes.

Adult↗
PubMed1993

T-cell subsets required for intravesical BCG immunotherapy for bladder cancer.

Intravesical bacille Calmette-Guérin (BCG) has been shown in prospective randomized clinical trials to be the treatment of choice for superficial bladder cancer. In this investigation we evaluated the role of CD4 and CD8 lymphocytes in the antitumor response. Monoclonal antibodies to thy 1.2, CD8, CD4 and an isotype control were injected intravenously to deplete T cell populations. After depletion (verified by flow cytometry), BCG therapy was initiated. The results demonstrate that the depletion of either CD4 or CD8 T cell subsets eliminated BCG-mediated antitumor activity. Footpad delayed type hypersensitivity (DTH) was aborted only in CD4 depleted mice; it was essentially unchanged in CD8 depleted mice. However, the presence of DTH was not sufficient for induction of BCG-mediated antitumor activity. Exogenous IL-2 at levels sufficient to induce lymphokine activated killer cell activity did not substitute for CD4 cells. There was no evidence for the induction of protective immunity to the tumor after BCG therapy. These results demonstrate the requirement for T lymphocytes in BCG-mediated antitumor activity and further demonstrate that the presence of both CD4 and CD8 subsets are required. CD8 depletion experiments suggest that the presence of CD4-mediated DTH is not sufficient for the induction of antitumor activity. Furthermore, these data suggest that BCG-mediated antitumor activity is a localized phenomenon that does not induce protective immunity.

Administration, Intravesical↗
PubMed1993

Using PSA to screen for prostate cancer. The Washington University experience.

The evidence is mounting that PSA-based screening for prostate cancer is rational and effective at detecting a high proportion of cancer that is both clinically significant and curable by radical prostatectomy. However, more information is necessary to define the optimal ages at which screening should be performed and to determine the appropriate role of repetitive PSA measurement, PSA density, and PSA slope in serial screening. Formal demonstration of a significant screening-induced reduction of cancer-specific morbidity and mortality is necessary to unambiguously justify screening for prostate cancer. A randomized trial evaluating prostate cancer screening will soon be started under the auspices of the National Cancer Institute. Additionally, refinements in serum PSA testing that consider the variable binding of PSA derived from benign and malignant prostatic tissues to serum proteins may further enhance the performance of PSA testing in the screening setting. For these reasons, PSA-based screening for prostate cancer seems destined to remain an important strategy for minimizing the health consequences of this disease.

Humans↗
PubMed1993

Serum PSA after antiandrogen therapy.

Patients who present with advanced prostate cancer and who are treated with primary endocrine therapy have a significantly longer time to progression and a clear survival advantage if their serum PSA concentration normalizes. The prognostic significance of normalization of PSA is independent of other prognostic measures. Normalization of serum PSA at month 3 is the earliest and most highly correlated predictor of response. Most patients (80%-85%) who have disease progression while on hormonal therapy will show a rising PSA 6 to 12 months before other clinical findings become abnormal. A rising PSA in the hormonally treated patient, even if the values are within the "normal" range, signals impending clinical progression. These patients should be considered for second-line hormonal therapies or alternative salvage protocols, as a theoretically favorable window of opportunity may exist when the PSA begins to rise. Patients treated with second-line therapies should also undergo serial PSA measurements; those responding with an 80% to 90% decrease in serum PSA are statistically more likely to enjoy a prolonged response.

Androgen Antagonists↗
PubMed1993

The case for prostate cancer screening.

Evidence is mounting indicating that screening for prostate cancer is rational and appropriate. More information is necessary to define the optimal ages at which screening should be performed and to determine the appropriate role of PSA, PSA velocity, and PSA density in serial screening. Formal demonstration of a significant screening-induced reduction in cancer-specific morbidity and mortality is necessary to unambiguously justify screening. A prospective, randomized trial evaluating prostate cancer screening will soon be underway.

Aged↗
PubMed1992

The effect of finasteride in men with benign prostatic hyperplasia. The Finasteride Study Group.

BACKGROUND: Benign prostatic hyperplasia is a progressive, androgen-dependent disease resulting in enlargement of the prostate gland and urinary obstruction. Preventing the conversion of testosterone to its tissue-active form, dihydrotestosterone, by inhibiting the enzyme 5 alpha-reductase could decrease the action of androgens in their target tissues; in the prostate the result might be a decrease in prostatic hyperplasia and therefore in symptoms of urinary obstruction. METHODS: In a double-blind study, we evaluated the effect of two doses of finasteride (1 mg and 5 mg) and placebo, each given once daily for 12 months, in 895 men with prostatic hyperplasia. Urinary symptoms, urinary flow, prostatic volume, and serum concentrations of dihydrotestosterone and prostate-specific antigen were determined periodically during the treatment period. RESULTS: As compared with the men in the placebo group, the men treated with 5 mg of finasteride per day had a significant decrease in total urinary-symptom scores (P less than 0.001), an increase of 1.6 ml per second (22 percent, P less than 0.001) in the maximal urinary-flow rate, and a 19 percent decrease in prostatic volume (P less than 0.001). The men treated with 1 mg of finasteride per day did not have a significant decrease in total urinary-symptom scores, but had an increase of 1.4 ml per second (23 percent) in the maximal urinary-flow rate, and an 18 percent decrease in prostatic volume. The men given placebo had no changes in total urinary-symptom scores, an increase of 0.2 ml per second (8 percent) in the maximal urinary-flow rate, and a 3 percent decrease in prostatic volume. The frequency of adverse effects in the three groups was similar, except for a higher incidence of decreased libido, impotence, and ejaculatory disorders in the finasteride-treated groups. CONCLUSIONS: The treatment of benign prostatic hyperplasia with 5 mg of finasteride per day results in a significant decrease in symptoms of obstruction, an increase in urinary flow, and a decrease in prostatic volume, but at a slightly increased risk of sexual dysfunction.

5-alpha Reductase Inhibitors↗
PubMed1992

MR imaging of benign prostatic hypertrophy using a Helmholtz-type surface coil.

MR examinations of the prostate were performed on six healthy volunteers and 18 patients with well-documented symptomatic benign prostatic hypertrophy, using an organ-encompassing Helmholtz-type surface coil at 1.5 T. The healthy volunteers were also imaged with a standard circumferential body coil. The morphologic features and signal intensity characteristics of the prostate and adjacent structures were analyzed in the patient group. Several recognizable patterns of benign prostate hypertrophy were identified including bilaterally symmetrical nodules in the central gland, multiple central gland nodules, and a diffusely heterogeneous central gland without appreciable nodules. The peripheral zone was of moderate to high signal intensity on T2-weighted images, and was diffusely heterogeneous in 78% of patients. The false prostatic capsule, peripheral venous plexus, and seminal vesicles were also characterized. A good correlation was shown between prostatic glandular volume and prostate-specific antigen. Calculated signal-to-noise ratios (S/N) were significantly greater on images acquired with the Helmholtz-type receiver coil than on those acquired with the body coil. We conclude that the hyperplastic prostate gland has a variety of MR appearances, but that recognizable patterns are frequently seen. High resolution imaging with a Helmholtz-type surface coil provides excellent anatomical depiction of the prostate and adjacent structures.

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