PubMed Health⌕ Search

Biomedical subjects

G van Andel

Publications and source records attributed to G van Andel.

13 recordsLinked to original sources
PubMed2004

A prospective longitudinal study comparing the impact of external radiation therapy with radical prostatectomy on health related quality of life (HRQOL) in prostate cancer patients.

BACKGROUND: The objective of the present study is to compare the impact on the general and disease-specific health related quality of life (HRQOL) of external radiation therapy (ERT) with radical prostatectomy (RP) in patients with localized prostate cancer, and to explore which factors, and to what extent, contribute to the assessed changes in HRQOL. METHODS: One hundred and thirty eight patients participated in this prospective longitudinal study. They completed before treatment (T0) and after 12 months (T1) a questionnaire constructed of validated instruments, measuring HRQOL and several psychosocial factors (PF). Among other things, multiple regression analyses including all baseline characteristics, HRQOL and PF were executed in order to meet the objectives. RESULTS: RP patients showed significantly more improvement in their emotional function, while they reported more incontinence and a worse sexual function. There was significantly more improvement in the overall HRQOL of ERT patients, while the changes in the gastrointestinal function of these patients were significantly worse. Only the differences with respect to incontinence can be attributed to the treatment itself. Almost all HRQOL change scores are primarily influenced by their own baseline score. The influence of other factors, like age, socioeconomic status, and several PF, is limited. CONCLUSIONS: The impact on HRQOL of ERT is similar to that of RP, except for incontinence. RP patients suffer more from incontinence than ERT patients. Changes in the assessed HRQOL are mainly influenced by the pre-treatment HRQOL scores.

Adaptation, Psychological↗
PubMed2003

[Follow-up investigation in urologic oncology, in particular nephrectomy due to renal cell carcinoma].

Follow-up investigations in urologic oncology have a number of different objectives, with the literature possibly placing too much emphasis on the early detection of recurrences. Although everyone considers this to be the most important goal, it often lacks a solid scientific basis. Apart from the detection of recurrences, the literature presents other goals with respect to the follow-up of patients after nephrectomy due to renal cell carcinoma: evaluation of the therapy, advice and counselling, and training. These objectives provide sufficient reason to see the uro-oncologic patient for outpatients' check-ups on a regular basis. The follow-up scheme can often be specifically tailored to the individual patient.

Carcinoma, Renal Cell↗
PubMed2003

A randomized study comparing epirubicin in a 4-weekly versus a weekly intravenous regimen in patients with metastatic, hormone resistant, prostatic carcinoma: effects on health related quality of life.

The treatment of hormone resistant prostate cancer) with epirubicin 25 mg/m(2)(Epi25) on a weekly intravenous regimen may be better in terms of health related quality of life (HRQOL) than with 100 mg/m(2)(Epi100) on a 4-weekly regimen. A total of 79 patients who filled out the EORTC-QLQ-C30 questionnaire for the assessment of HRQOL could be evaluated. Compared with the baseline, no changes in HRQOL function scales or significant changes in the following HRQOL symptom scales were found. The Epi25 group reported less pain during the first 3 months and the Epi100 group more dyspnoea after 4 weeks and less pain and less insomnia but more loss of appetite after 8 weeks. In both groups, toxicity was comparable, except for World Health Organisation grade II-III alopecia occurring in 82% in the Epi100 versus 31% in the Epi25 group. There were no significant differences between groups in response rates and survival. In this study, HRQOL was not improved which is in line with other studies using only epirubicine. Epirubicin as single agent therapy should not be used in future treatment of patients with HRPC.

Adult↗
PubMed2003

The impact of androgen deprivation therapy on health related quality of life in asymptomatic men with lymph node positive prostate cancer.

PURPOSE: To evaluate the impact of androgen deprivation on health related quality of life (HRQOL) in patients with asymptomatic lymph node positive prostatic carcinoma (LPPC). MATERIALS AND METHODS: HRQOL domains were measured, using standard instruments in 91 patients with histologically proven LPPC. Most patients were randomized for immediate or deferred hormonal treatment until progression was observed. For analyses concerning the time to progression and survival the Kaplan-Meier method was used. RESULTS: Patients treated with androgen deprivation showed a significantly worse sexual, emotional, and physical function, experienced more hot flushes and a worse overall HRQOL, compared with patients receiving no therapy. Time to progression was significantly shorter in the deferred treated patients in comparison with the immediately treated patients (33 vs. 62 months, p<0.001). No significant differences were found with respect to the duration of survival. CONCLUSION: Hormonally treated patients with asymptomatic LPPC have a worse HRQOL compared with patients receiving no therapy. The duration of survival was similar, whether patients received immediate or deferred hormonal treatment. Nowadays, with patients' preferences playing an increasingly important role in therapeutic decision making, physicians should be aware of this negative impact and ought to inform the patients on this.

Affective Symptoms↗
PubMed2001

Evaluation of the diagnostic workup in young women referred for recurrent lower urinary tract infections.

OBJECTIVES: To evaluate the current practice of the diagnostic workup in The Netherlands and the clinical relevancy of the outcome of various diagnostic procedures in young women referred for recurrent lower urinary tract infections (UTIs). METHODS: A questionnaire was sent to all urologic departments in The Netherlands (n = 104) inquiring about the diagnostic procedures used for recurrent lower UTIs. Furthermore, we performed a prospective study in 100 consecutive young female patients (18 to 40 years old) referred for evaluation of recurrent lower UTIs. All patients underwent a standardized workup: questionnaire, voiding diary, physical examination, urinalysis and culture, abdominal x-ray with ultrasound or intravenous urography, and cystoscopy. RESULTS: The response rate to the questionnaires was 92%. The standard procedures were laboratory blood tests in 56%, cystoscopy in 69%, plain abdominal x-ray in 91%, and abdominal ultrasound in 59%. Only 18% of the urologists asked every patient to make a voided urine frequency volume chart. In our group of patients, the radiologic procedures revealed only one relevant abnormality. Cystoscopy confirmed cystitis in 22 patients, but never revealed relevant findings. None of these diagnostic procedures ever contributed to the diagnosis. The 24-hour urine output was less than 1.5 L in 43 patients, which was considered insufficient. The individual self-reports of fluid intake were unreliable. CONCLUSIONS: Many Dutch urologists perform an extensive routine workup in patients referred for recurrent lower UTIs. The results of our study revealed that the yield of most diagnostic procedures in these patients is low. The focus in evaluating these patients should be directed toward the behavioral aspects. Thus, the routine workup can be restricted to a voiding diary, urinalysis, and urine culture.

Adolescent↗
PubMed2000

Quality of life assessment in patients with hormone-resistant prostate cancer treated with epirubicin or with epirubicin plus medroxy progesterone acetate - is it feasible?

OBJECTIVES: The optimal palliative treatment in patients with advanced hormone-resistant prostate cancer (AHRPC) is still under investigation. We studied the effect of epirubicin, alone or combined with medroxy progesterone acetate (MPA), in this particular patient group. The aim of the study was to investigate the feasibility of quality of life (QOL) measurement and to ascertain whether MPA added to epirubicin produces a better QOL than epirubicin alone. METHODS: Of 28 randomized patients with symptomatic AHRPC, 26 were eligible for the study. Fourteen of them received epirubicin (100 mg/m(2) i.v.) every 3 weeks in combination with an oral dose of 500 mg of MPA twice daily. Twelve patients received epirubicin alone. For the QOL assessment, the Rotterdam Symptom Checkliste was used. Toxic side effects of chemotherapy were assed by the WHO criteria. Subjective responses included performance status and pain score. RESULTS: Compliance in completing QOL questionnaires was high (87.5%). In none of the QOL domains studied did any of the patients, irrespective of their treatment, experience an improvement in their QOL. Moreover, after 12 and 24 weeks, patients in both treatment arms experienced a significant worsening of physical symptom distress when compared to study entry. Toxicity was moderate to severe. A biochemical response (drop in prostate-specific antigen of more than 50%) was observed in 5 out of 26 patients (19.1%) and a subjective response in 7 out of 26 patients (26.9%). The median survival for all patients was 30 weeks. There was no statistically significant difference between the two arms. Performance status and the global QOL as judged by the patients themselves were associated with the duration of survival. No relation was found between the initial observed subjective response and survival. CONCLUSIONS: The feasibility of measuring QOL in patients with symptomatic AHRPC is demonstrated in the present study. Subjective and biochemical responses were observed in both treatment arms, but these were not translatable as improved measured QOL domains.

Aged↗
PubMed1999

Value of diagnostic ultrasound in patients with chronic scrotal pain and normal findings on clinical examination.

OBJECTIVES: Chronic scrotal pain is a frequent complaint. In many patients with scrotal pain, scrotal ultrasound is performed when the physical examination reveals no abnormalities. We evaluated the yield of scrotal ultrasound in patients with chronic scrotal pain and a normal physical examination. METHODS: The study involved the findings in 111 patients with scrotal pain lasting longer than 2 weeks, in whom physical examinations and urinalyses were normal and who underwent ultrasound evaluation. Follow-up data were available. RESULTS: The median age at first presentation was 37 years. The median duration of pain at presentation was 5 months. The pain in the scrotum was localized to the right side in 37% of patients, to the left in 41 %, and bilaterally in 22%. Eighty-three percent had intermittent complaints, and 17% experienced continuous pain. In searching for a cause of the scrotal pain, 65% of patients were found to have a relevant medical history, such as regional surgery, infection, trauma, and low back pain, and 57% described provocative factors. Scrotal ultrasound revealed 12 epididymal cysts less than 0.5 cm and three subclinical varicoceles, but no clinically significant abnormalities. After a median follow-up of 12 months, the pain continued in 70%, although without the development of serious scrotal pathologic features. CONCLUSIONS: Scrotal ultrasound has no diagnostic value in patients with chronic scrotal pain in whom the physical examinations and urinalyses are normal. A patient's history may suggest an extrascrotal cause of his pain.

Adolescent↗
PubMed1997

Quality of life in patients with prostatic carcinoma: a review and results of a study in N+ disease. Prostate-specific antigen as predictor of quality of life.

Clinical evaluation in oncology has typically focused on outcome indicators, while less attention has been paid to how treatment affects quality of life (QOL) of the patient. In this article some general aspects of quality of life are discussed, a short review of published data on QOL in patients with prostate cancer is given and results of a QOL study executed by the authors on patients with lymph node positive prostatic cancer are presented. The purpose of the study was to examine the impact of immediate or delayed treatment (after objective progression) in patients with prostatic carcinoma (T1-3 N1-3 M0) on quality of life parameters. To this end an extended questionnaire was constructed. Fifty-five patients participated. Assessment was performed twice, in 1994 and 1995. The comparison between patients with and patients without treatment showed in 1994 as well as in 1995 significant differences for hormonal treatment side effects such as sexual functioning and hot flushes, all of which were experienced more frequently by treated patients. In 1994 the treated patients experienced more psychological distress while in 1995 they showed worse physical function, less energy and more fatigue when compared to patients under surveillance. The premise that active treatment would improve the psychological quality of life was not sustained. In addition global health status and quality of life were identified as independent factors for progression in untreated patients with lymph node positive prostate cancer. Finally, an increase in prostate-specific antigen (PSA) in hormonally treated patients not only indicated hormonal escape but also a decrease in QOL.

Humans↗
PubMed1996

Does prostate-specific antigen density alter decision making on biopsy?

OBJECTIVE: The ability of prostate-specific antigen density (PSAD) to predict prostate cancer in biopsy specimens is evaluated in patients with benign digital rectal examination (DRE) and prostate-specific antigen (PSA) between 4.0 and 10.0 ng/ml. MATERIAL AND METHODS: 144 referred patients with a benign DRE and PSA > 4.0 ng/ml were additionally evaluated by transrectal ultrasonography and transrectal biopsies. PSAD values were calculated and statistical analysis was performed. RESULTS: The mean PSAD value was able to distinguish significantly between benign prostate conditions and prostate cancer in patients with PSA > 4.0 ng/ml. However, in 73 patients with 4.0 < PSA < or = 10.0 ng/ml no significant stratification was obtained. At a PSAD value of 0.15 the pretest probability of 18% for positive biopsy was lowered to a posttest probability of 8.1% and PSAD appeared to be of limited value regarding sensitivity and specificity at different cutoff values (ROC curve). Applying age-specific reference ranges would have reduced diagnostic procedures for men between 60 and 79 years old with 7.0% without missing prostate cancer. CONCLUSIONS: In this study PSAD was shown to have only a moderate additive value in decision making to omit biopsy for the individual patient with benign DRE and PSA between 4.0 and 10.0 ng/ml. Age-specific reference ranges of PSA can prevent unnecessary diagnostic procedures.

Adult↗
PubMed1993

C reactive protein in the diagnosis of acute appendicitis.

OBJECTIVE: To find out if the C reactive protein concentration is of any value in the diagnosis of acute appendicitis, either alone or in combination with other laboratory tests. DESIGN: Open study. SETTING: Drechtsteden Hospital, Dordrecht, and Spaarne Hospital, Heemstede, The Netherlands. SUBJECTS: 209 consecutive patients admitted with suspected appendicitis. MAIN OUTCOME MEASURES: Correlation of C reactive protein concentration with age, sex, body temperature, duration of abdominal pain, anorexia, nausea, vomiting, white cell count, neutrophil count, erythrocyte sedimentation rate, and histological appearance of the appendix. RESULTS: 125 patients of the 209 patients had their appendixes removed, and of these 101 had histologically confirmed appendicitis: A C reactive protein concentration of > or = 6 mg/1 alone had a sensitivity of 87% and a specificity of 50%. When the selected variables were subjected to multivariate analysis the most important, in decreasing order, were white blood cell count, female sex, and C reactive protein concentration. Combining the variables was of no additional value. CONCLUSION: measurement of the C reactive protein concentration can increase the accuracy in the diagnosis of acute appendicitis.

Acute Disease↗
PubMedDate not supplied

Incidental carcinoma of the prostate.

Transrectal ultrasonography (TRUS), digital rectal examination (DRE), and quantification of serum prostate-specific antigen (PSA) are accepted and evaluated methods for detecting prostate cancer. Positive predictive values (PPV) of DRE and TRUS are low, and only slightly enhanced when used in combination with PSA. PSA lacks sufficient sensitivity and specificity to be used alone as a screening test for prostate cancer. The parameters PSA-density and PSA-velocity make PSA a better tumor marker, but they are not reliable on an individual basis. Age-specific reference ranges have the potential to make PSA a more sensitive tumor marker for men less than 60 years of age and a more specific one for men beyond 60 years. With currently available diagnostic methods approximately 10% of patients undergoing transurethral or open resection of the prostate for presumed benign prostatic hyperplasia will have carcinoma detected in the histologic material. In 392 patients successively treated in our clinic for presumed BPH and thoroughly investigated to exclude prostatic carcinoma (DRE, TRUS, biopsy when PSA > 4 ng/ml or PSA-D > 0.15), the tumor was found incidentally in 4%. Another finding in this study was the detection of prostatic carcinoma by random biopsy in patients without a palpable or visible tumor by imaging and without PSA increase (> 4 ng/ml). Biopsies were performed because of a hypoechoic zone in the opposite lobe which turned out to be negative. Such tumors cannot be properly classified in the current TNM system. Treatment options for patients with incidental prostatic carcinoma are age- and stage-dependent. Patients less than 60 years old may be treated with a curative approach, irrespective of the T category (T1a or T1b); patients with a life expectancy longer than 10 years and a pT1b incidental carcinoma likewise should be offered a curative therapy.

Adult↗