Cryosurgery of the prostate revisited.
Explore the source record for details and available documents.
Cryosurgery↗
Biomedical subjects
G W Chodak
Publications and source records attributed to G W Chodak.
Screening and early detection of prostate cancer.
BACKGROUND: The value of routine screening for prostate cancer remains unknown because of the lack of randomized studies. Until such studies are completed, a sensible approach to screening is needed. METHODS: One approach is to use the method of decision analysis to model the outcome of alternative screening strategies. CONCLUSIONS: By assessing the results in terms of their effect on life expectancy and prostate cancer mortality, it may be possible to select the policy that has the greatest potential benefit for the least cost.
Age Factors↗
Disease-specific survival following routine prostate cancer screening by digital rectal examination.
OBJECTIVE: To assess prostate cancer mortality in men undergoing routine screening by routine digital rectal examination. DESIGN: Cohort study with a median follow-up period of 75 months. SETTING: Population consisted of volunteers at a university clinic and men in an institutional health maintenance clinic. PATIENTS: Fifty-six men with a mean age of 65 years (range, 52 to 79 years) diagnosed with prostate cancer. INTERVENTIONS: Patients treated initially by observation, external or interstitial radiotherapy, radical prostatectomy, hormone therapy, or combination. MAIN OUTCOME MEASURES: Kaplan-Meier analysis of time to local progression, distant metastases, death from all causes, and death from prostate cancer. Mantel-Haenszel log-rank statistic was used to compare outcome in men diagnosed on initial examination with those diagnosed on subsequent examinations. RESULTS: Clinically localized prostate cancer was diagnosed in 73% during an initial examination and 83% on subsequent examinations and (P.35). Grade distribution of tumors was similar in both groups. Overall 5 and 10 year survival of all cancer patients was 85% and 67%, respectively. Death from prostate cancer was 8% (3/38) in men diagnosed on initial examination and 33% (6/18) during subsequent examinations. Five- and 10-year disease-specific survival was 97% and 86%, respectively, for men diagnosed during the first rectal examination compared with only 81% and 57%, respectively, for men diagnosed on subsequent rectal examinations (P = .02). CONCLUSION: Routine screening for prostate cancer by annual digital rectal examination alone may be insufficiently frequent and/or sensitive to prevent significant mortality from this disease [corrected].
Aged↗
Blindness secondary to prostate cancer.
We report a case of blindness, secondary to hormone-refractory prostate cancer, occurring 7 years after the diagnosis of metastatic prostate cancer and 3.5 years after the clinical onset of the hormone-refractory state. Prolonged suppression of the disease with chemotherapy may have contributed to the unusual clinical findings. We discuss the role of supportive care in the management of prostate cancer.
Adenocarcinoma↗
Current and future roles of laparoscopic surgery in urology.
There is little doubt that laparoscopy will gain an increasing role in urologic surgery. Pelvic node dissection, varicocelectomy, and evaluation of nonpalpable undescended testes are already widely performed. As improved instrumentation is developed expressly designed for urologic applications, there will be even greater interest and wider applicability of laparoscopic techniques. However, as this occurs, it is essential that each new procedure be critically evaluated to be certain that it offers significant benefit without added morbidity as compared with standard techniques.
Biomarkers, Tumor↗
Buschke-Lowenstein tumor: therapeutic options including systemic chemotherapy.
Verrucous carcinoma of the penis (Buschke-Lowenstein tumor) is a rare variant of squamous cell carcinoma which has been reported to have limited potential for metastatic disease. We report on 2 patients who presented with locally advanced disease after prolonged intervals of neglect. In both cases, the disease was locally aggressive with extensive tissue destruction. In 1 patient, after failure to achieve tumor control with repeated aggressive surgical excision, systemic chemotherapy using bleomycin, cisplatin, methotrexate, and leucovorin led to a complete pathologic response. We believe this is the first reported case in which systemic chemotherapy has been used to successfully treat verrucous carcinoma of the penis. Surgical excision alone was successful in achieving local disease control in the second patient.
Adult↗
Questioning the value of screening for prostate cancer in asymptomatic men.
Explore the source record for details and available documents.
Humans↗
Methotrexate, vinblastine, doxorubicin and cisplatin followed by radiotherapy or surgery for muscle invasive bladder cancer: the University of Chicago experience.
A total of 29 patients with muscle invasive bladder cancer, clinical stage T2N0 (12), T3aN0 (9), T3bN0 (5), T3N2 (2) or T4N2 (1), underwent 2 to 4 cycles of neoadjuvant methotrexate, vinblastine, doxorubicin and cisplatin (M-VAC) chemotherapy followed by either radiotherapy (15), radical cystectomy (11) or no local therapy (3). The overall response rate to M-VAC chemotherapy was 69%, with 31% clinical complete responses and 38% clinical partial responses. A functioning bladder was maintained in 55% of the responding patients, although bladder wall calcifications were observed in 4 of 15 irradiated patients. Overall survival was 71% and disease-free survival was 55% at a median followup of 57 months. For the 12 stage T2N0 cancer patients overall survival was 100% at a median followup of 52 months. For the stages T3a and T3bN0 cancer patients overall survival was 63%, while all 3 node positive patients died. Neoadjuvant chemotherapy with a modified M-VAC regimen is well tolerated and may result in bladder preservation.
Antineoplastic Combined Chemotherapy Protocols↗
Value of prostate cancer screening.
The challenge for the future is to establish whether screening will lead to a decrease in prostate cancer mortality. This issue can only be settled by the performance of a properly controlled, randomized, prospective study. Due to the generally slow progression rate of prostate cancer, such a study will require an at least 15-year follow-up of a large number of men. Because of the increasing widespread use of prostate-specific antigen in the United States, finding a large control population who will not be screened for an extended period of time may no longer be possible. Nevertheless, such a study is clearly needed and is being undertaken by the National Institutes of Health. In the meantime, it is important that physicians counsel patients regarding the relative benefits and risks of screening so that they can make their own judgments regarding the aggressiveness with which the diagnosis of prostate cancer should be pursued.
Humans↗
Screening for prostate cancer.
Early-stage prostate cancer is usually asymptomatic and therefore, in the past, has often gone undetected, unless diagnosed by a digital rectal examination. More recently, new tests have been introduced, namely prostate-specific antigen and transrectal ultrasound, in order to improve the detection of early-stage disease. Considerable debate exists about the routine use of these screening tests. This article addresses issues such as which tests are the most predictable, the outcome of screening in terms of benefits (or not) to the patient and the advantages and disadvantages of screening itself.
Humans↗
Workshop summary: screening policies and procedures.
The question of screening for prostate cancer has, since the advent of prostate-specific antigen testing, become a major source of contention. Important issues include: (1) should such screening become part of routine health checks for men; (2) if routine screening is implemented, at what age should it be started, and (3) can the early detection of prostate cancer facilitated by such screening actually benefit the patient in the long run? These were some of the topics put to the audience and debated by the panel of experts in the discussion forum on screening.
Aged↗
The role of laparoscopic lymphadenectomy in staging and treatment of urological tumours.
Laparoscopic lymphadenectomy for managing a variety of urological malignancies is likely to continue to increase in popularity. It is essential that the role of these procedures be critically evaluated to ensure that they offer significant benefit without added morbidity as compared with standard techniques. The challenge for the future is to better define selection criteria for laparoscopic surgery, particularly in men with clinically localized prostate cancer, so that both staging methods and therapy can be tailored to the individual patient.
Carcinoma, Transitional Cell↗
Early diagnosis of prostate cancer.
Prostate cancer continues to be a leading cause of cancer death in American men. Since no studies have yet been reported that demonstrate a reduction in prostate cancer mortality, widespread prostate cancer screening by any modality must be considered experimental. Although, for an individual patient, screening may appear to have great potential benefit, when applied on a large scale, both the expense and potential morbidity could have a substantially negative impact on health care. These issues are too often ignored by enthusiasts of screening, but inevitably they will need to be addressed. Can society afford the expense of screening even if it does lead to reduced mortality? In addition, if health care resources are limited, is prostate cancer screening the best use of these funds? Finally, until the efficacy of prostate cancer screening is demonstrated by properly performed studies, it is essential that patients be told of both the potential risks and benefits of screening so that a fully informed decision can be made. Alternatively, should patients only be told that screening is clearly in their best interest? Currently, these questions have not been adequately addressed.
Biomarkers, Tumor↗
The application of laparoscopy to retroperitoneal surgery in urology.
The application of minimally invasive laparoscopic surgical techniques has provided the urologist with access to retroperitoneal structures previously available only through an abdominal incision. The enhanced visualization provided by video-imaging as well as the ease of access to the retroperitoneum through an incision in the posterior peritoneal envelope has facilitated the manipulation of many retroperitoneal organs. In particular these techniques have been applied to the clinical management of several urologic malignancies, such as adenocarcinoma of the prostate, transitional cell carcinoma of the bladder, and squamous cell carcinoma of the penis. A transperitoneal laparoscopic pelvic lymphadenectomy appears to provide adequate surgical staging of regional pelvic lymph nodes in these malignancies, while providing the patients with reduced morbidity. Additionally, transperitoneal access may be accomplished for an internal spermatic vein ligation, as well as approaches to the kidney, ureter and retroperitoneal lymph nodes. The surgical options are limited only by the availability of the instrumentation and the creativity of the surgeon. However, the indications for these procedures remain unclear and must await further information regarding actual benefits in the form of reduced patient morbidity and cost. The challenge for the future is to more completely define the indications and selection criteria for laparoscopic surgery.
Humans↗
Screening for prostate cancer in 1993: is it appropriate, or not?
Screening for prostate cancer is a complex problem with scientific, medicolegal, and socioeconomic consequences. Recommendations regarding screening should be based on scientific studies rather than on personal biases. At present, the value of screening is unknown, and hopefully proper studies will provide adequate information in the future. Until then, patients should be educated about the advantages and disadvantages of screening and should participate in the decision.
Bias↗
Basic fibroblast growth factor in human prostate cancer cells.
To increase our understanding of the potential role of basic fibroblast growth factor (bFGF) in malignant progression of prostate cancer, we determined the production of bFGF, the expression of FGF receptor (flg), and the response to exogenous bFGF in LNCaP, DU 145, and PC 3 cells. We observed that these three prostate cancer cell lines, which differed in their dependence on androgens for growth in vitro and in their in vivo behavior in nude mice, could be distinguished as follows: (a) androgen-sensitive LNCaP cells, which do not metastasize in nude mice, did not produce measurable amounts of bFGF, expressed small but measurable amounts of FGF receptor mRNA, and did respond to exogeneous bFGF; (b) androgen-insensitive, moderately metastatic DU 145 cells did produce measurable amounts of biologically active bFGF, expressed large amounts of FGF receptor mRNA, and responded to exogeneous bFGF and the heparin-binding fractions from DU 145 cell extracts; (c) androgen-insensitive and highly metastatic PC3 cells also produced measurable amounts of bFGF but did not demonstrate a growth response to either the heparin-binding fractions from PC3 cell extracts or exogenous bFGF, even though large amounts of FGF receptor mRNA were expressed in PC 3 cells. These results suggest the possibility that differences in production of, and response to, bFGF may be associated with different biological behavior.
3T3 Cells↗
The natural history of adenocarcinoma of the prostate.
All analyses of the efficacy of therapy for prostate cancer must control for the natural history of the disease. Over the past years, several long-term series involving several hundred patients have helped to describe the results of untreated disease. In general, most patients will not die of their disease, although approximately half of the patients will develop disease progression within 10 years. Predictors of progression include tumor stage, grade, and ploidy status.
Adenocarcinoma↗
Local staging of prostate cancer by tumor volume, prostate-specific antigen, and transrectal ultrasound.
Conventional methods of staging prostate tumors are highly inaccurate. To improve clinical staging, prostate-specific antigen (PSA) levels (> 10 ng/mL), sonographic tumor volume (> 3 cc), maximum tumor diameter, length of capsular tumor abutment, and overall impression of capsular irregularity suggesting periprostatic tumor spread were assessed in 29 men prior to undergoing radical prostatectomy for clinically localized tumor. After surgery, 18 men had tumor confined to the prostate, while 11 men had histologic evidence of extracapsular disease. Analysis of the parameters measured showed these were the most helpful factors in predicting the presence of extracapsular disease. However, the positive and negative predictive values were only 70 to 90 percent. Therefore, the clinical usefulness of any one measurement alone in determining treatment for the individual patient is limited. However, combining these parameters yields an improved prediction of extracapsular disease. All 6 patients with PSA < 10 ng/mL, tumor volume < 3 cc, and no capsular irregularity on ultrasound had localized disease (neg. predictive value = 100%), while all 7 patients who had more than one of these parameters had extracapsular disease (pos. predictive value = 100%). Thus, using the factors in combination may provide more accurate staging and thereby help in counseling patients regarding therapy.
Humans↗