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Biomedical subjects

G W Chodak

Publications and source records attributed to G W Chodak.

At least 55 records · Page 3Linked to original sources
PubMed1995

Bicalutamide in the treatment of advanced prostatic carcinoma: a phase II noncomparative multicenter trial evaluating safety, efficacy and long-term endocrine effects of monotherapy.

PURPOSE: The safety, efficacy and pharmacokinetics of bicalutamide were investigated in 150 patients with stage D2 prostate cancer. MATERIALS AND METHODS: Patients received 50 mg. bicalutamide daily in an open label multicenter North American trial. RESULTS: The objective response rate (modified European Organization for Research in Cancer Therapy criteria) was 70%. Of 150 patients 59 (39%) met prostate specific antigen criteria for partial response, and 88 (59%) reached treatment failure end points and withdrew. Extent of disease was a significant predictor of response but baseline testosterone was not. Breast pain and gynecomastia developed in 76% and 60% of patients, respectively. Mean drug plasma concentration was 8,528 +/- 2,928 ng/ml. CONCLUSIONS: Bicalutamide (50 mg.) daily was well tolerated and efficacious. However, suboptimal effects on prostate specific antigen have led to additional trials to evaluate monotherapy at higher doses.

Acid Phosphatase↗
PubMed1995

Goserelin versus orchiectomy in the treatment of advanced prostate cancer: final results of a randomized trial. Zoladex Prostate Study Group.

OBJECTIVES: To compare the efficacy and safety of goserelin and orchiectomy in patients with stage D2 prostate cancer. METHODS: A randomized, open, multicenter study was conducted in 283 patients. Patients were allocated to goserelin, 3.6 mg every 28 days or to orchiectomy. Study end points were endocrine response, objective response, time to treatment failure, survival, and tolerability. Objective response was based on modified criteria of the National Prostate Cancer Project. RESULTS: Serum testosterone decreased from baseline to castrate levels by week 4 in each group and remained below castrate levels thereafter. Acid phosphatase and alkaline phosphatase concentrations also decreased in each group. The goserelin and orchiectomy groups had similar results for objective response (82% versus 77%) and had similar medial times to treatment failure (52 versus 53 weeks) and survival (119 versus 136 weeks). No significant interactions between treatments and prognostic factors were observed. Adjusting for baseline testosterone concentration had no effect on survival outcome. Race had no influence on outcome or efficacy end points. Common adverse events in both groups were pain, hot flushes, and lower urinary tract symptoms. CONCLUSIONS: Goserelin is well tolerated and as effective as orchiectomy in patients with Stage D2 prostate cancer.

Aged↗
PubMed1995

Prostate cancer staging after radiation utilizing laparoscopic pelvic lymphadenectomy.

OBJECTIVES: This report assesses the feasibility of laparoscopic pelvic lymphadenectomy in irradiated patients with prostate cancer being considered for salvage therapy. METHODS: Six men, each with a prior history of external beam radiation therapy, and prostate-specific antigen or clinical failure, were selected as potential candidates for salvage therapy. Utilizing a standard diamond pattern trocar conformation, laparoscopy was performed to evaluate pelvic lymph node status. RESULTS: The procedure was successfully completed in all patients with a mean operating room time of 154 minutes. Blood loss averaged 55 cc. Serious intraoperative or postoperative complications were not encountered in the follow-up of 6 months. Metastatic disease was demonstrated in 1 patient. CONCLUSIONS: Laparoscopic pelvic lymph node dissection is technically feasible in patients who have received irradiation, and appears to confer no additional morbidity over standard laparoscopic lymphadenectomy.

Aged↗
PubMed1995

Short-term outcomes after cryosurgical ablation of the prostate in men with recurrent prostate carcinoma following radiation therapy.

OBJECTIVES: Cryosurgical ablation of the prostate represents a possibly efficacious method of treating prostate carcinoma in men failing radiation therapy. In addition to eradicating the disease, cryosurgery has the potential to avoid some of the morbidity associated with other treatment modalities. Therefore, a prospective Phase II trial was conducted to determine the safety and efficacy of cryosurgery following radiation therapy in men with local recurrence. METHODS: Cryosurgical ablation of the prostate was performed in men with prostate cancer previously treated by radiation therapy. All patients had biopsy-proven recurrent disease and no evidence of metastases. Initial follow-up occurred at approximately 3 months and included repeat biopsy and serum prostate-specific antigen (PSA) determinations. Biochemical disease-free survival defined as a PSA value less than 0.3 ng/mL was assessed using the Kaplan-Meier method. RESULTS: Thus far, 23 patients have been treated with cryosurgery with follow-up ranging between 12 and 23 months. Approximately 3 months after treatment, sextant biopsies revealed no cancer in 19 of 22 (86%) of the specimens; however, 10 of 22 (45%) showed small amounts of benign glandular tissue. The PSA at 3 months postoperatively declined in 18 of 22 (82%) patients but reached female levels in only 8 men (36%). Nineteen of 22 (86%) patients followed up a minimum of 1 year after cryotherapy have a PSA level equal to or greater than 0.3 ng/mL. Complications occurred in 100% of the patients with 12 of 22 (55%) requiring at least one transurethral resection of sloughed, necrotic tissue. CONCLUSIONS: Our preliminary results suggest that the current cryosurgical technique used in men failing radiation therapy has a low probability of biochemical cure and a high complication rate. Until more data are available, cryosurgery for men with locally recurrent disease after radiation therapy should be considered strictly experimental.

Aged↗
PubMed1994

The role of conservative management in localized prostate cancer.

The management of localized prostate cancer in the elderly is problematic. In many cases, death from other causes may occur before death from prostate cancer. Choosing the optimal therapy requires properly counseling patients about the relative risks and benefits from each treatment option, including watchful waiting. Conservative management is a reasonable alternative for managing this disease.

Aged↗
PubMed1994

Urology.

Both age and prostate volume appear to influence the PSA level, and a varying set of normal values may be adopted. The relative benefit of radical prostatectomy or radiation therapy over watchful waiting for treating men older than 70 years with localized prostate cancer is extremely small.

Humans↗
PubMed1994

High levels of nm23 expression are related to cell proliferation in human prostate cancer.

Reduced expression of the nm23 gene has been correlated with high metastatic potential in rodent mammary tumors and human breast cancer. The expression of this gene was studied in human prostate cancer tissue from 43 patients by immunohistochemistry using anti-nm23-H1 antibodies. Intense immunostaining was observed in 71.4% of the patients with clinical stage D disease as compared to 23.1% in clinical stage B and 18.7% in stage C disease (P < 0.05). Similarly intense immunostaining was present in 75% of poorly differentiated cancers versus only 28.6% in men with moderately differentiated cancer. nm23-H1 mRNA expression was measured by Northern blot analysis during phases of the cell cycle in DU 145, PC-3, LNCaP, and TSU-Prl human prostate cancer cell lines. Cells were synchronized in G0-G1 phases by serum deprivation and at the G1-S boundary by aphidicolin. nm23-H1 mRNA levels declined during serum deprivation and increased rapidly following serum addition. Although nm23-H1 was expressed continuously throughout the cell cycle, higher expression was observed in late G1, early S, and G2-M phases. These results indicate that nm23-H1 gene expression is related to the proliferative phase of cell growth.

Adenocarcinoma↗
PubMed1994

Results of conservative management of clinically localized prostate cancer.

BACKGROUND: The selection of treatment for patients with localized prostate cancer requires reliable information about the outcome of conservative management. Previous studies of this question are generally considered unreliable because they were uncontrolled and nonrandomized. METHODS: We performed a pooled analysis of 828 case records from six nonrandomized studies, published since 1985, of men treated conservatively (with observation and delayed hormone therapy but no radical surgery or irradiation) for clinically localized prostate cancer. A Cox regression analysis was performed to determine which factors influenced survival among patients who did not die of causes other than prostate cancer (disease-specific survival). Kaplan-Meier curves for overall and metastasis-free survival among such patients were compared with use of the log-rank method and the Mantel-Haenszel test. RESULTS: Factors that had a significant effect on disease-specific survival were grade 3 tumors (risk ratio, 10.04), residence in Israel (risk ratio, 2.48) or New York (risk ratio, 0.37), and age under 61 years (risk ratio, 0.32). Ten years after diagnosis, disease-specific survival (with data on men who died from causes other than prostate cancer censored) was 87 percent for men with grade 1 or 2 tumors and 34 percent for those with grade 3 tumors; metastasis-free survival among men who had not died of other causes was 81 percent for grade 1, 58 percent for grade 2, and 26 percent for grade 3 disease. These findings were not affected by the inclusion of men who had early-stage cancer, were older, had worse-than-average health, or underwent delayed radiation therapy or radical prostatectomy. CONCLUSIONS: The strategy of initial conservative management and delayed hormone therapy is a reasonable choice for some men with grade 1 or 2 clinically localized prostate cancer, particularly for those who have an average life expectancy of 10 years or less. New treatment strategies are needed for men with grade 3 prostate cancer.

Aged↗
PubMed1994

N-(4-hydroxyphenyl) retinamide induces cell cycle specific growth inhibition in PC3 cells.

The synthetic retinoid N-(4-hydroxyphenyl) retinamide (4-HPR) has been demonstrated to inhibit the development of primary and metastatic neoplasms in several animal models. In order to investigate the effect of 4-HPR on human prostate adenocarcinoma, we designed a series of in vitro experiments with the PC3 cell line to evaluate effects on proliferation, cell cycle kinetics, and c-myc mRNA expression. 4-HPR demonstrated cytotoxicity only at the supraphysiologic concentration of 10.0 microM. However, asynchronously growing cells exposed to 1 microM 4-HPR demonstrated a 51% reduction in proliferation rate, associated with an accumulation of cells in the G0/G1 phase of the cell cycle. PC3 cells synchronized with serum deprivation or aphidicolin exhibited significant decreases in DNA synthesis when treated with 1 microM 4-HPR. Additionally, these cells were found to accumulate in G0/G1 and S phase. Northern blots indicated a significant decrease in c-myc mRNA expression in asynchronously growing cells with continuous administration of 1 microM 4-HPR for 6 days. These data suggest that 4-HPR can inhibit growth of PC3 cells as a consequence of a block in cell cycle transition from G1 to S phase at a concentration of 1 microM, and that this inhibition is associated with a suppression of c-myc gene expression.

Adenocarcinoma↗
PubMed1994

Laparoscopic bilateral nephrectomy for renin-mediated hypertension.

Hypertension arising from retained native kidneys complicates the management of recipients of renal transplants. Reluctance to administer angiotensin-converting enzyme inhibitor (ACEI) drugs to patients taking cyclosporine has reopened the question of performing native nephrectomies for poorly controlled, renin-dependent hypertension. We report the first published cases of simultaneous bilateral laparoscopic nephrectomies in 2 patients: 1 in preparation for living-related donor transplantation and the other ten months following cadaver transplantation in a patient whose end-stage renal disease was from malignant nephrosclerosis. Both had very severe hypertension resistant to multiple drugs and both became normotensive with little or no antihypertensive medication following nephrectomies. A bilateral nephrectomy is currently feasible using a laparoscopic approach.

Adult↗
PubMed1994

Receptivity of African-American men to prostate cancer screening.

OBJECTIVE: The lifetime risk of prostate cancer among African-American men is two times higher than that of white men. Mortality from the disease is almost three times greater in African-Americans than in whites. This study assesses the receptivity of older (fifty to seventy-four years of age) African-American men (n = 86) in Chicago to periodic (annual and semiannual) prostate cancer screening. METHODS: A telephone survey conducted in January and February 1993, was used to collect data on subject sociodemographic background and medical history and to gather information on knowledge, attitudes, and beliefs about prostate cancer and screening. Univariate and multivariate analyses were carried out to identify factors associated with subject receptivity to annual and semiannual screening. RESULTS: Logistic regression analyses revealed that receptivity to annual and semiannual (every six months) examination is strongly associated with the degree to which screening is perceived as a salient and coherent (i.e., important, effective, and convenient) preventive health behavior. An additional factor independently associated with willingness to go through semiannual screening was subjects' awareness that African-American men are at increased risk for prostate cancer compared to white men. CONCLUSIONS: Findings from this study suggest that African-American men are willing to undergo prostate screening and are more receptive to annual than semiannual screening. Participation in screening may be facilitated by the provision of health education messages that emphasize the salience and coherence of early detection and elevated population risk.

Black or African American↗
PubMed1994

The role of watchful waiting in the management of localized prostate cancer.

The management of localized prostate cancer remains controversial. Watchful waiting or conservative management is frequently criticized as a poor option for this disease. However, studies have shown that a high percentage of men are free of metastases at 10 years provided they have well or moderately differentiated prostate cancer. Watchful waiting, like radiation or radical prostatectomy, has a set of advantages and disadvantages that must be compared by each patient when choosing therapy. The best approach may be to have patients select a therapy after being well informed of the outcome for each option. Watchful waiting is a valid option for all men regardless of age or health status. However, radical prostatectomy still offers the best opportunity to cure the disease.

Age Factors↗
PubMed1994

Laparoscopic pelvic lymph node dissection: a review of 103 consecutive cases.

Laparoscopic pelvic lymph node dissection is a recently introduced technique for the surgical evaluation of the regional pelvic lymph nodes in genitourinary malignancies. We report the results of a laparoscopic pelvic lymph node dissection performed on 103 consecutive patients for staging of clinically localized prostatic, bladder and penile carcinomas. In 20 patients (group 1) the adequacy of the laparoscopic pelvic lymph node dissection was evaluated with a subsequent open dissection. In this group 87 to 95% of the lymph nodes within a modified template could be reliably removed laparoscopically. In 73 patients (group 2) laparoscopic pelvic lymph node dissection was performed as a solitary operation. Mean hospitalization was 1.6 +/- 2.4 days, while postoperative narcotic requirements were minimal. Mean operative time for bilateral laparoscopic pelvic lymph node dissection was 156 +/- 41.2 minutes. The overall complication rate in these 2 groups was 13.5%. Group 3 includes 10 patients (9.7% of the total) in whom laparoscopic pelvic lymph node dissection was unsuccessful. The minimally invasive surgical techniques of laparoscopic pelvic lymph node dissection seem to provide adequate staging accuracy in patients with genitourinary neoplasms. The complication rate and recovery period appear to be decreased relative to those for open surgical lymphadenectomy.

Adenocarcinoma↗