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Biomedical subjects

H Ballentine Carter

Publications and source records attributed to H Ballentine Carter.

At least 19 recordsLinked to original sources
PubMed2006

Detection of life-threatening prostate cancer with prostate-specific antigen velocity during a window of curability.

BACKGROUND: Prostate-specific antigen (PSA) level is typically used as a dichotomous test for prostate cancer, resulting in overdiagnosis for a substantial number of men. The rate at which serum PSA levels change (PSA velocity) may be an important indicator of the presence of life-threatening disease. METHODS: PSA velocity was determined in 980 men (856 without prostate cancer, 104 with prostate cancer who were alive or died of another cause, and 20 who died of prostate cancer) who were participants in the Baltimore Longitudinal Study of Aging for up to 39 years. The relative risks (RRs) of prostate cancer death and prostate cancer-specific survival stratified by PSA velocity were evaluated in the three groups of men by Cox regression and Kaplan-Meier analyses. Statistical tests were two-sided. RESULTS: PSA velocity measured 10-15 years before diagnosis (when most men had PSA levels below 4.0 ng/mL) was associated with cancer-specific survival 25 years later; survival was 92% (95% confidence interval [CI] = 84% to 96%) among men with PSA velocity of 0.35 ng/mL per year or less and 54% (95% CI = 15% to 82%) among men with PSA velocity above 0.35 ng/mL per year (P<.001). Furthermore, men with PSA velocity above 0.35 ng/mL per year had a higher relative risk of prostate cancer death than men with PSA velocity of 0.35 ng/mL per year or less (RR = 4.7, 95% CI = 1.3 to 16.5; P = .02); the rates per 100,000 person-years were 1240 for men with a PSA velocity above 0.35 ng/mL per year and 140 for men with a PSA velocity of 0.35 ng/mL per year or less. CONCLUSIONS: PSA velocity may help identify men with life-threatening prostate cancer during a period when their PSA levels are associated with the presence of curable disease.

Adult↗
PubMed2006

Metabolic factors associated with benign prostatic hyperplasia.

CONTEXT: Benign prostatic hyperplasia poses a significant public health problem, but its etiology remains unclear. Obesity and associated abnormalities in glucose homeostasis may play a role in benign prostatic hyperplasia development by influencing prostate growth. OBJECTIVE: The objective of this study was to determine whether obesity, fasting plasma glucose concentration, and diabetes are associated with radiologically determined prostate enlargement, an objective measure of benign prostatic hyperplasia. DESIGN: This study was a cross-sectional analysis with robust variance estimates to account for multiple measures over time in the same individuals. SETTING: This prospective cohort study was composed of community volunteers. PATIENTS: Patients studied were 422 adult men enrolled in The Baltimore Longitudinal Study of Aging. MAIN OUTCOME MEASUREMENTS: Total prostate volume as determined by pelvic magnetic resonance imaging was measured. RESULTS: Among 422 participants, 91 (21.6%) had prostate enlargement (defined as total prostate volume >/= 40 cc) at first visit. Compared with men of normal weight [body mass index (BMI) < 25 kg/m(2)], the age-adjusted odds ratio (OR) for prostate enlargement for overweight men (BMI, 25-29.9 kg/m(2)) was 1.41 (95% CI, 0.84-2.37), for obese men (BMI, 30-34 kg/m(2)) was 1.27 (95% CI, 0.68-2.39), and for severely obese men (BMI >/= 35 kg/m(2)) was 3.52 (95% CI, 1.45-8.56) (P = 0.01). Men with elevated fasting glucose (>110 mg/dl) were more likely to have an enlarged prostate than men with normal fasting glucose (</=110 mg/dl) (OR, 2.98; 95% CI, 1.70-5.23), as were men with a diagnosis of diabetes (OR, 2.25; 95% CI, 1.23-4.11). CONCLUSIONS: Obesity, elevated fasting plasma glucose, and diabetes are risk factors for benign prostatic hyperplasia.

Adult↗
PubMed2006

Delayed versus immediate surgical intervention and prostate cancer outcome.

For prostate cancer patients with small, lower-grade tumors, expectant management with delayed surgical intervention (active surveillance) is a rarely used therapeutic option because the opportunity for cure may be lost. We compared outcomes of 38 patients with small, lower-grade prostate cancer in an expectant management program who underwent delayed surgical intervention at a median of 26.5 months (95% confidence interval [CI] = 17 to 32 months; range = 12.0-73.0 months) after diagnosis with 150 similar patients who underwent immediate surgical intervention at a median of 3.0 months (95% CI = 2 to 4 months; range = 1.0-9.0 months) after diagnosis. Noncurable cancer was defined as adverse pathology associated with a less than 75% chance of remaining disease-free for 10 years after surgery. Noncurable cancer was diagnosed in nine (23%) of the 38 patients in the delayed intervention cohort and in 24 (16%) of the 150 men in the immediate intervention group. After adjusting for age and prostate-specific antigen (PSA) density (i.e., PSA value divided by prostate volume) in a Mantel-Haenszel analysis, the risks of noncurable cancer associated with delayed and immediate intervention did not differ statistically significantly (relative risk = 1.08, 95% CI = 0.55 to 2.12; P = .819, two-sided Cochran-Mantel-Haenszel statistic). Age, PSA, and PSA density were all statistically significantly associated with the risk of noncurable cancer (P = .030, .013, and .008, respectively; two-sided chi-square test). Thus, delayed prostate cancer surgery for patients with small, lower-grade prostate cancers does not appear to compromise curability.

Aged↗
PubMed2006

The discovery of prostate specific antigen as a biomarker for the early detection of adenocarcinoma of the prostate.

PURPOSE: Prostate specific antigen is the most widely used oncological biomarker in medicine today. Before its implementation as an early diagnostic marker, urologists were limited to prostatic acid phosphatase, digital rectal examination and transrectal ultrasound for the detection of prostate cancer. We review the history of the discovery of prostate specific antigen as a biomarker for the early detection of adenocarcinoma of the prostate. MATERIALS AND METHODS: We performed a structured literature review, searching PubMed for papers on the subject of prostate specific antigen limited to humans between the years 1970 to 2005. We found a total of 8,365 articles. RESULTS: While the use of prostate specific antigen in evaluating newly diagnosed prostate disease, and followup of men after treatment for prostate disease is accepted practice, prostate specific antigen screening for prostate cancer remains controversial. CONCLUSIONS: In the next decade the results of randomized trials of screening may answer some of the questions posed at the beginning of the prostate specific antigen era. To what extent does prostate specific antigen screening affect prostate cancer mortality and at what cost?

Adenocarcinoma↗
PubMed2006

Efficacy of periprostatic local anesthetic for prostate biopsy analgesia: a meta-analysis.

OBJECTIVES: To perform a meta-analysis of available randomized trials investigating the analgesic efficacy of periprostatic block with local anesthetic. METHODS: The National Library of Medicine's PubMed database was searched for the time period 1966 to August 16, 2005 for all relevant articles. Inclusion criteria included subjects undergoing prostate biopsy, trials that were randomized with one arm of the randomization using local anesthetic for periprostatic block before prostate biopsy, and where the assessment of biopsy pain was measured and available in a form compatible for statistical analysis in our meta-analysis. RESULTS: Our search resulted in 107 abstracts, of which a total of 16 articles met all inclusion criteria. There were 660 subjects who received local anesthetics for a periprostatic block and 616 subjects who did not. The weighted mean difference between the groups indicates that subjects receiving local anesthetic periprostatic block would have a statistically lower pain score compared with those who did not (weighted mean difference in visual analogue pain of -1.66 [95% confidence interval -2.03 to -1.29]). CONCLUSIONS: Our meta-analysis suggests that periprostatic block with local anesthetic for prostate biopsy might result in significantly lower levels of pain during the biopsy procedure. Because periprostatic block with local anesthetic is relatively easy to administer and does not seem to be associated with increased morbidity, clinicians performing prostate biopsies should consider using this technique on a routine basis.

Analgesia↗
PubMed2006

The importance of pelvic lymph node dissection in men with clinically localized prostate cancer.

Despite advances in noninvasive staging, pelvic lymph node dissection (PLND) remains the most accurate means of detecting lymph node metastases in men with clinically localized prostate cancer. Nomograms exist that can identify patients at low risk for lymphatic metastases according to preoperative information. In general, it seems reasonable to omit PLND in men with a biopsy Gleason sum of 6 or less and a prostate-specific antigen level of 10 ng/mL or less. Ultimately, however, this decision should be made according to physician and patient preference, considering the low contemporary morbidity associated with PLND. When PLND is performed, studies suggest that an extended dissection maximizes the detection rate of nodal involvement. Retrospective data indicate that an extended dissection might play a therapeutic role in a subset of patients with a limited lymph node burden. However, this might be an artifact of stage migration, and prospective studies are needed to evaluate this further.

Journal Article↗
PubMed2005

Prediagnostic plasma vitamin C levels and the subsequent risk of prostate cancer.

OBJECTIVE: Antioxidants, such as vitamin C, are hypothesized to prevent prostate carcinogenesis by protecting the DNA from oxidative damage. We assessed whether higher prediagnostic plasma concentrations of vitamin C were associated with a lower risk of prostate cancer in a well-nourished cohort of men. METHODS: Plasma concentrations of ascorbic acid (vitamin C) were previously determined in blood specimens collected between 1984 and 1990 in men participating in the Baltimore Longitudinal Study of Aging. Total plasma ascorbic acid (L-ascorbic acid plus dehydro-L-ascorbic acid) levels were measured by using a modification of the 2,4-dinitrophenylhydrazine method. Among the 498 male participants with measured plasma vitamin C levels, 62 men were subsequently diagnosed with prostate cancer during their lifetime. Cox proportional hazards regression models were used to estimate relative risks and 95% confidence intervals for prostate cancer. RESULTS: The median plasma concentration of vitamin C for the cohort was 1.17 mg/dL, which is in the normal to high range for older men. The age-adjusted relative risk of prostate cancer for the highest quartile (median = 1.47 mg/dL, range = 1.36-2.58) compared with the lowest quartile (median = 0.83 mg/dL, range = 0.15-0.98) of plasma vitamin C concentration was 1.31 (95% confidence interval 0.63 to 2.70, P for trend = 0.29). Adjustment for cigarette smoking status, body mass index, or plasma cholesterol concentration did not attenuate the results. CONCLUSIONS: This small but prospective study suggests that higher plasma vitamin C concentrations within the normal physiologic range are not associated with a lower risk of prostate cancer in well-nourished men.

Aging↗
PubMed2005

Obesity does not adversely affect health-related quality-of-life outcomes after anatomic retropubic radical prostatectomy.

OBJECTIVES: To study the impact of obesity on the health-related quality-of-life (HRQOL) outcomes after radical prostatectomy (RP). METHODS: Patient-reported sexual and urinary HRQOL was assessed at baseline and 3, 6, 12, and 24 months after anatomic retropubic RP using the University of California, Los Angeles, Prostate Cancer Index among a cohort of 340 men. Linear regression analysis was used to compare the longitudinal HRQOL scores by body mass index (BMI) adjusting for age, baseline HRQOL, and nerve-sparing status (non-nerve sparing versus unilateral versus bilateral). RESULTS: At baseline, the sexual and urinary function and bother scores were similar between normal-weight (BMI less than 25 kg/m2), overweight (BMI 25.0 to 29.9 kg/m2), and obese (BMI 30 kg/m2 or greater) men. Obese men were as likely to undergo bilateral nerve-sparing surgery as men with a lower BMI. After adjustment for age, baseline HRQOL, and nerve-sparing status, no statistically significant differences were found in any HRQOL score at any point among the BMI groups, except for a lower urinary function score at 24 months among overweight men (P = 0.02). CONCLUSIONS: In a select group of men undergoing RP at a tertiary care referral center, BMI was, in general, unrelated to the baseline and longitudinal postoperative HRQOL scores. Obese men (BMI 30 to 35 kg/m2) should not be selectively discouraged against RP because of concerns about HRQOL. Additional studies are needed to assess the HRQOL outcomes among men with very high BMI values (greater than 35 kg/m2).

Body Mass Index↗
PubMed2005

Utility of saturation biopsy to predict insignificant cancer at radical prostatectomy.

OBJECTIVES: To determine whether potential candidates for watchful waiting have undersampling of more substantial cancer. METHODS: A total of 103 men were studied, who were predicted to have insignificant cancer in their radical prostatectomy (RP) specimen. All had limited cancer on routine needle biopsy (no core with more than 50% involvement; Gleason score less than 7, and fewer than 3 cores involved) with a serum prostate-specific antigen density of 0.15 or less. Insignificant tumor at RP was considered organ-confined tumor, no Gleason pattern 4 or 5, and a tumor volume of less than 0.5 cm3. Saturation biopsy (average 44 cores) and an alternate biopsy saturation scheme with one half the number of cores using an 18-gauge Biopty gun was performed in the pathology laboratory on totally embedded and serially sectioned RP specimens. RESULTS: Of the tumors, 97% were organ confined. The RP Gleason score was less than 7 in 84% of the cases. The RP tumor volume was 0.01 to 2.39 cm3 (median 0.14). Of the cancer specimens, 71% were insignificant and 29% had been incorrectly classified before surgery using standard biopsy schemes. Using the full saturation biopsy scheme, if we predicted significant cancer, the probability of having insignificant cancer was only 11.5% (false-positive rate). If the model predicted insignificant cancer, the probability of significant cancer was also only 11.5% (false-negative rate; sensitivity 71.9% and specificity 95.8%). Using the alternate biopsy sampling scheme, the false-positive rate was 8% and the false-negative rate was 11.4% (sensitivity 71.9% and specificity 97.1%). CONCLUSIONS: Saturation biopsy provides accurate predictability of prostate tumor volume and grade to select suitable candidates for watchful waiting therapy.

Adult↗
PubMed2005

Health-related quality-of-life outcomes after anatomic retropubic radical prostatectomy in the phosphodiesterase type 5 ERA: impact of neurovascular bundle preservation.

OBJECTIVES: To examine the impact of neurovascular bundle preservation on longitudinal health-related quality-of-life (HRQOL) outcomes after anatomic radical retropubic prostatectomy (RP) using a validated questionnaire. METHODS: We examined patient-reported sexual and urinary HRQOL at baseline and at 3, 6, 12, and 24 months after RP using the University of California, Los Angeles, Prostate Cancer Index among 342 patients treated between 2001 and 2004 by a single surgeon. The time to return to baseline urinary and sexual function and bother were compared between men who underwent unilateral versus bilateral nerve-sparing RP using a Cox proportional hazards regression model. RESULTS: Of the 342 patients, 15 (5%), 69 (20%), and 258 (75%) had no, one, or both neurovascular bundles preserved, respectively. After adjustment for age and baseline sexual function, bilateral nerve sparing was associated with greater sexual function scores than unilateral nerve sparing at all points, although the differences only approached or reached significance at 3 (P = 0.06) and 6 (P = 0.04) months after RP. After adjustment for age and baseline sexual function, a trend was noted for an earlier return to baseline sexual function among men who underwent bilateral nerve-sparing RP (hazard ratio 1.67, 95% confidence interval 0.88 to 3.17, P = 0.12), although this did not reach significance. More than 90% of the men returned to their baseline urinary function and bother, regardless of nerve-sparing status. CONCLUSIONS: In the current study, bilateral nerve-sparing RP was associated with better postoperative sexual HRQOL scores than unilateral nerve-sparing RP, although in general the differences were slight.

3',5'-Cyclic-GMP Phosphodiesterases↗
PubMed2005

Estimation of treatment benefits when PSA screening for prostate cancer is discontinued at different ages.

OBJECTIVES: To estimate the declining benefits of screening for prostate cancer as patient age at screening increases. The benefits of prostate cancer screening decline with age because of the long natural history of prostate cancer and competing causes of death among older men. METHODS: We used a previously described Monte Carlo simulation based on a Markov model of prostate cancer detection in men aged 40 to 90 years and simulated prostate cancer screening in 1000 populations of 1,000,000 men each. The age at the final prostate-specific antigen test in the model was varied to simulate the discontinuation of screening from age 50 to 80 years. The model outputs were the number of men treated, the number of prostate cancer deaths prevented by treatment, and person-years of life saved. RESULTS: The relationship between treatments required to prevent a death was not constant but widened with age. Compared with screening to age 65 years, screening to age 75 and 80 years required twice and three times, respectively, the number of treatments per person-year of life saved. CONCLUSIONS: Our results have helped to quantify the declining treatment benefit as the patient age at screening and treatment for prostate cancer increases. We believe that men older than 70 years should be carefully counseled about the declining benefits of prostate cancer detection with screening.

Age Factors↗
PubMed2005

Radical retropubic prostatectomy. How often do experienced surgeons have positive surgical margins when there is extraprostatic extension in the region of the neurovascular bundle?

PURPOSE: We determined the frequency of positive surgical margins (PSMs) in patients with extraprostatic extension (EPE) in the region of the neurovascular bundle (NVB) who underwent open radical retropubic prostatectomy by 2 experienced surgeons. MATERIALS AND METHODS: A total of 204 men with EPE in the region of the NVB underwent surgery by 2 experienced surgeons. The frequency of PSMs in the area of the NVB as well as the nerve sparing status of each lobe of the prostate were determined through a retrospective investigation of the pathology database as well as the physician's database. The recovery of sexual function was determined and compared to controls. RESULTS: The age, clinical stage, biopsy Gleason sum and serum prostate specific antigen of the patients operated on by surgeons 1 and 2 were similar. Surgeon 1 widely excised at least 1 neurovascular bundle in 16% of the patients and surgeon 2 in 63%. The overall frequency of PSMs at the NVB was 5.9% for surgeon 1 and 5.8% for surgeon 2. Of the evaluable patients followed for 12 months or longer 83.5% of those operated on by surgeon 1 were potent compared to 63.8% of those operated on by surgeon 2. CONCLUSIONS: Visual and tactile assessment during open surgery by an experienced surgeon provides valuable information on when and where it is safe to preserve the neurovascular bundle in patients with EPE in the region of the NVB. Surgical approaches in which tactile sensation is muted or absent, laparoscopic and robotic, need to undergo a similar evaluation to determine whether magnification of the operative field is sufficient to overcome the lack of haptic feedback and ability to palpate the tissue.

Adult↗
PubMed2005

Can a baseline prostate specific antigen level identify men who will have lower urinary tract symptoms later in life?

PURPOSE: We evaluated the relationship between baseline prostate specific antigen (PSA) and subsequent lower urinary tract symptom development during 3 decades in unselected men in the Baltimore Longitudinal Study of Aging. MATERIALS AND METHODS: Urinary questionnaires were used to evaluate lower urinary tract symptoms in 704 men during 3 decades. The number of repeat evaluations was 1 to 18. We divided subjects into age groups of younger than 50 and 50 to 69.9 years at the time of the first PSA evaluation. Subjects were divided into 3 PSA groups based on initial PSA below the 25th, 25th to 75th and above the 75th percentile. A mixed effects Poisson model was used to test whether there was a significant relationship between PSA grouping and symptom score with time. RESULTS: There was no statistically significant difference in symptom score distribution across PSA percentiles in men younger than 50 years (p = 0.87) or 50 to 69.9 years old (p = 0.59). When age was used as an independent variable in the model, there was no statistically significant relationship between baseline PSA and symptom score (p = 0.38). CONCLUSIONS: These data suggest that PSA is not a useful predictor of the development of lower urinary tract symptoms in unselected, asymptomatic men.

Adult↗
PubMed2005

Nonsteroidal anti-inflammatory drugs and risk of prostate cancer in the Baltimore Longitudinal Study of Aging.

BACKGROUND: Laboratory and epidemiologic studies suggest that aspirin and nonaspirin nonsteroidal anti-inflammatory drugs (NSAID) reduce the risk of cancer, possibly via inhibition of the cyclooxygenase enzymes. We evaluated the association of aspirin and nonaspirin NSAIDs with subsequent prostate cancer in a prospective study. We also assessed whether use of these drugs influences serum prostate-specific antigen (PSA) concentration. METHODS: Participants were 1,244 male members of the Baltimore Longitudinal Study of Aging. Use of prescription and over-the-counter drugs was collected by questionnaire and interview at multiple study visits. One hundred forty-one prostate cancer cases diagnosed between 1980 and May 2004 were confirmed by medical record review. We used Cox proportional hazards regression to estimate the rate ratio (RR) of prostate cancer updating drug use over time and taking into account age and year. We used generalized estimating equations to calculate age-adjusted geometric mean PSA concentration by aspirin or nonaspirin NSAIDs use among 933 of the men without prostate cancer, for whom 3,749 PSA measurements in archived sera had been done previously. RESULTS: On 46.0% and 21.5% of the visits, current use of aspirin or nonaspirin NSAIDs (mostly ibuprofen) was reported, respectively. The RRs of prostate cancer comparing ever to never use were 0.76 [95% confidence interval (95% CI), 0.54-1.07] for aspirin, 0.79 (95% CI, 0.54-1.16) for nonaspirin NSAIDs, and 0.71 (95% CI, 0.49-1.02) for either medication. The association for ever use of either aspirin or nonaspirin NSAIDs was suggestively more pronounced in men <70 years (RR, 0.54; 95% CI, 0.27-1.03) than in men >/=70 years (RR, 0.78; 95% CI, 0.50-1.22; P(interaction) = 0.73). The RR for current use of either drug was attenuated relative to ever use. Mean PSA concentration did not differ between users and nonusers of either aspirin or nonaspirin NSAIDs (1.01 versus 0.98 ng/mL, P = 0.56). CONCLUSION: In this prospective study, men, in particular younger men, who had ever used aspirin or nonaspirin NSAIDs had a modest nonstatistically significant lower risk of prostate cancer. The modest inverse association was unlikely due to detection bias that might have resulted if anti-inflammatory drugs had influenced serum PSA concentration.

Acetaminophen↗
PubMed2005

Serum testosterone and the risk of prostate cancer: potential implications for testosterone therapy.

OBJECTIVE: A potential risk of testosterone replacement therapy is an increase in the incidence of prostate cancer, but it is unclear whether higher levels of serum testosterone are associated with a higher risk of prostate cancer. We prospectively evaluated serum androgen concentrations and prostate cancer risk. METHOD: Included were 794 members of the Baltimore Longitudinal Study of Aging. We estimated the rate ratio (RR) of prostate cancer by entering serial measures of serum total testosterone, dehydroepiandrosterone sulfate, sex hormone binding globulin, calculated free testosterone, and free testosterone index (FTI) into a Cox proportional hazards regression model with simple updating. RESULTS: Higher calculated free testosterone was associated with an increased age-adjusted risk of prostate cancer {RRs by quartile: 1.00, 1.52 [95% confidence interval (95% CI), 0.93-2.50], 1.16 (95% CI, 0.61-2.20), 2.59 (95% CI, 1.28-5.25); P(trend) = 0.03}, which persisted after excluding measures in men <45 years of age [RRs by quartile: 1.00, 1.33 (95% CI, 0.78-2.25), 1.26 (95% CI, 0.68-2.33), 1.89 (95% CI, 0.99-3.61); P(trend) = 0.03]. Compared to men with eugonadal FTI (> or = 0.153), men with hypogonadal FTI had a decreased risk of prostate cancer (RR, 0.51; 95% CI, 0.31-0.82). CONCLUSION: Higher levels of calculated serum free testosterone are associated with an increased risk of prostate cancer. These findings suggest that men receiving testosterone therapy should be regularly monitored for prostate cancer and underscore the need for prospective trials of testosterone therapy incorporating incidence of prostate cancer as a primary safety end point.

Case-Control Studies↗