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Biomedical subjects

J Adolfsson

Publications and source records attributed to J Adolfsson.

At least 55 records · Page 3Linked to original sources
PubMed1997

Prostate size in hypogonadal men treated with a nonscrotal permeation-enhanced testosterone transdermal system.

OBJECTIVES: This study examined the effects of testosterone replacement using a nonscrotal testosterone transdermal (TTD) system on prostate size and prostate-specific antigen (PSA) levels in hypogonadal men. METHODS: As part of an open-label, multicenter study, prostate volume as measured by transrectal ultrasound and PSA were assessed in 29 hypogonadal men during treatment with intramuscular testosterone enanthate (+TE), followed by 8 weeks of androgen withdrawal (-T), and then during 1 year of therapy with Androderm Testosterone Transdermal System, a nonscrotal permeation-enhanced TTD system (+TTD). RESULTS: Mean prostate volume decreased significantly from the +TE period (17 g) compared with the -T period (14 g) (P < 0.001). Prostate volume increased significantly from the -T period compared with the +TTD period (18 g) (P < 0.001). Maximum prostate size, comparable to that measured during +TE (P = 0.125), was reached by month 3 of +TTD therapy; prostate volume did not increase further during the remaining 9 months of +TTD therapy. Prostate volume correlated with age (P < 0.01) during all three periods of observation (+TE: r = 0.69; -T: r = 0.64; and +TTD: r = 0.55). No patient developed symptomatic benign prostatic hyperplasia during the treatment period. PSA levels decreased during androgen withdrawal compared with levels measured during +TE treatment (P < 0.001) and rose with resumption of androgen therapy with TTD (P < 0.006). However, PSA levels during +TTD replacement remained significantly lower (P < 0.001) than during +TE replacement. CONCLUSIONS: Physiologic testosterone replacement in hypogonadal men was achieved using the TTD system. Prostate size during therapy with TTD was comparable to that reported for normal men. In these men treated with TTD, PSA levels were also within the normal range.

Administration, Cutaneous↗
PubMed1997

Deferred treatment of clinically localized low-grade prostate cancer: actual 10-year and projected 15-year follow-up of the Karolinska series.

OBJECTIVES: To review the outcome in patients with clinically localized prostate cancer managed conservatively. METHODS: A total of 122 patients with palpable, clinically localized, low-grade prostate cancer diagnosed from 1978 to 1982 at the Karolinska Hospital, Stockholm, Sweden, were prospectively followed in a surveillance protocol followed by treatment when the tumor progressed with symptoms. RESULTS: All patients but one had been observed for 10 years or more. No antitumoral therapy had been given to 58 (48%) patients at follow-up or before death. The chance of being untreated 5 and 10 years after diagnosis, if still alive, was 71% and 43%, respectively. The actual disease-specific survival rate at 10 years was 90%. Of the patients with a possible observation period of 15 years or more, 25% died of prostate cancer (ie, an actual disease-specific survival of 75%). Using a survival plot, the projected disease-specific survival rate at 15 years was 62%. The cumulative incidence of death from prostate cancer increased with possible observation time up to 15 years. CONCLUSIONS: Our data are mature up to 10 years of observation and, based on these data, deferred treatment is a valid option for patients with clinically localized low-grade prostate cancer with a life expectancy of 10 years or less. The data are not definitive beyond 10 years and firm conclusions will be speculative, but our findings indicate that there probably is room for efficacious local treatment in patients with localized prostate cancer and a life expectancy longer than 10 years.

Adult↗
PubMed1997

Assessment of endpoints for clinical trials for localized prostate cancer.

OBJECTIVES: The AUA Practice Guidelines Panel convened to address the issue of appropriate endpoints for assessment of treatment modalities for localized carcinoma of the prostate. METHODS: A review of the literature and the design of existing clinical trials produced a consensus, which was presented to and critiqued by the members of the general conference. RESULTS: The pitfalls associated with identification of local failure endpoints were discussed, and the more accurate endpoints of freedom from metastatic progression and overall survival were recognized. The strict definition that must be fulfilled for intermediate endpoints to become surrogates for metastasis free and/or survival endpoints was stressed. For more efficient and rapid conduct of future clinical trials, the urgent need to validate such surrogate endpoints by evaluation in randomized control trials is obvious. PSA, while an indicator of disease activity and a critical marker for estimating disease progression or regression in response to therapy, is not a surrogate for metastasis free or overall survival. CONCLUSION: Until surrogate endpoints are validated, the committee has evaluated the endpoints in current use, reviewed their limitations, and stressed the importance of quality-of-life assessment together with the traditional endpoint assessment.

Clinical Trials as Topic↗
PubMed1997

Conservative management of clinically localized prostate cancer.

The purpose of this paper is to review and summarize the current knowledge on conservative management of localized prostate cancer. Deferring treatment for low-grade, clinically localized prostate cancer is an acceptable treatment option for patients with a life expectancy of 10-15 y or less. The outcome of available studies on deferred treatment in selected series cannot be compared with the outcome in register studies where the patients have been managed with noncurative intent, nor can it be directly compared with the outcome of selected series on other treatments. The outcome of different treatments for localized prostate cancer can only be compared in randomized studies.

Journal Article↗
PubMed1997

Factors associated with waning sexual function among elderly men and prostate cancer patients.

PURPOSE: We identified factors that affect sexual function in men 50 to 80 years old and, therefore, may confound the comparison among groups of elderly men. In particular, we identified factors that may influence a comparison between prostate cancer patients and the general population, or confound the relationship when comparing subgroups of patients in nonrandomized studies. MATERIALS AND METHODS: A questionnaire, including the Radiumhemmet Scale of Sexual Function and modules assessing potential risk factors for waning sexual function, was sent to 431 patients 50 to 80 years old with prostate cancer diagnosed 1.5 to 2 years previously in the Stockholm area (Sweden) and a reference group of 435 age matched randomly selected men. RESULTS: Factors associated with physiological impotence included prostate cancer (relative risk 1.9), diabetes mellitus (relative risk 2.3), myocardial infarction (relative risk 1.5), medication with diuretics (relative risk 1.5), hydrogen blockers (relative risk 2.3) and warfarin type anticoagulants (relative risk 1.7). Patients treated for prostate cancer were more likely to be physiologically impotent compared to those with no initial treatment, and this was true for all treatment protocols after adjustment for confounding factors. Men treated with radical prostatectomy were more likely to be physiologically impotent than men treated with external beam radiation therapy (relative risk 1.5). CONCLUSIONS: Waning sexual function in the prostate cancer patients was largely due to side effects of the treatment and this could not be explained by confounding factors. In particular, confounding could not explain the greater risk of impotence after radical prostatectomy compared to external beam radiation therapy.

Aged↗
PubMed1996

[Delayed therapy of clinically localized prostatic carcinoma. Experiences of the Karolinska Hospital].

From 1978 to 1982, 172 patients with T1-3, Nx, M0 prostate cancer were included in a surveillance protocol with deferred treatment on symptomatic progression. The median age at diagnosis was 68 (38-89) years. The disease-specific survival at 10 years was 80% for the total series, 84% for the subgroup with T1-2 tumors, and 92% for patients with T1-2 tumors diagnosed when the patients were old less than 70 years. For the subgroup with T3 tumors, the disease-specific survival at 9 years was 70%. In all subgroups the competing mortality was higher than the prostate cancer mortality. Deferred treatment appears to be an acceptable treatment option for patients with a tumor clinically confined to the prostate with a life expectancy of 10 years or less.

Adult↗
PubMed1996

Bias due to observation of different parts of a nonconstant hazard curve over time.

OBJECTIVES: Uncontrolled data often have to be used in clinical decision marking and in the planning of clinical trials. When such data are used as a basis for comparing different treatment strategies, they tend to generate sources of bias such as inconsistent patient selection, misrepresentation, and measurement errors. A rational usage of uncontrolled data requires identification and handling of different systematic errors when comparing different treatment strategies. Therefore we sought to define a systematic error that deserves more attention in the clinical literature. METHODS: Using hypothetical examples, we illustrate the bias introduced by variations in "lead time," proportions of so-called prevalent/incident cases, and lengths of follow-up between reference and treatment groups. RESULTS: We found these three situations conceptually identical. Bias is introduced because different parts of a nonconstant hazard curve over time are observed. CONCLUSIONS: The systematic error described is potentially important in uncontrolled data provided the hazard rate over time is nonconstant. Thus the seemingly worse outcome after external beam radiation therapy as compared to the outcomes of deferred treatment of radical prostatectomy in compiled patient series of localized prostate cancer may in some part be explained by bias due to observation of different parts of a nonconstant hazard curve over time.

Bias↗
PubMed1996

Elevated nitric oxide in the urinary bladder in infectious and noninfectious cystitis.

OBJECTIVES: A role for nitric oxide (NO) has been suggested in inflammation and host defense. At higher concentrations, this gas shows cytotoxic effects that may be directed against microorganisms, tumor cells as well as host cells. The aim of the present study was to study the relationship between bladder mucosal inflammation and local production of NO. METHODS: We measured NO directly in the urinary bladder in patients with infectious cystitis, interstitial cystitis, irradiation cystitis, and cystitis induced by antitumor treatment with bacillus Calmette-Guérin. NO-free air was introduced into the bladder during cystoscopy. The air was aspirated after 5 minutes of incubation and injected into a chemiluminescence NO analyzer. RESULTS: NO levels were 30 to 50 times higher in all varieties of cystitis as compared to controls. CONCLUSIONS: NO may contribute to host-defense mechanisms in the bladder during bacterial infection and antitumor treatment. Direct measurement of gaseous NO in the urinary bladder seems to be an attractive diagnostic method for detection of mucosal inflammation.

Aged↗
PubMed1996

Waning sexual function--the most important disease-specific distress for patients with prostate cancer.

The objective was to investigate how prostate cancer and its treatment affects sexual, urinary and bowel functions and to what extent eventual complications cause distress. A questionnaire was sent to 431 men aged 50-80 years with prostate cancer diagnosed in 1992 in the Stockholm area (Sweden) and 435 randomly selected men with a similar age distribution. Sexual function, as compared with their youth, was diminished in a majority of all men. The prostate cancer patients were, however, more likely to report low frequency and/or intensity in all aspects of sexual function. A majority of the men were distressed by a waning sexual capacity. The proportion of men with prostate cancer who were severely distressed owing to a decline in sexual function was larger than in the reference group. The willingness to trade off an intact sexual function for long-term survival varied considerably among the men in the reference group. Urinary and bowel symptoms were less common than a waning sexual function in both groups, and few appeared to be severely distressed by urinary or bowel symptoms. A decline in sexual functions was the most common cause of disease-specific distress in men with prostate cancer.

Aged↗
PubMed1996

Sexual desire, erection, orgasm and ejaculatory functions and their importance to elderly Swedish men: a population-based study.

Relevant information for clinical decision-making in a wide spectrum of diseases includes the extent to which sexual function is intact, how important it is to preserve sexual capacity and whether waning sexual function causes distress. Little information is available on elderly men. We aimed to obtain this basic information. Radiumhemmet's Scale of Sexual Function was posted to 435 randomly selected men aged 50-80 years. Assessments included sexual desire, erectile capacity, orgasm and ejaculation and to what extent waning sexual function distressed the men. The questions were answered anonymously. Information was obtained from 319 men (73%). Of these, 83% stated that sex was 'very important', 'important' or a 'spice to life'. Physiological potency for men aged 50-59, 60-69 and 70-80 amounted to 97%, 76% and 51% respectively. Among the oldest men (70-80 years), 46% reported orgasm at least once a month. Over 80% of all men who reported some level of erection stated that it was of importance to them to maintain the present level of erection stiffness. Most men who reported waning sexual function (compared with their youth) stated that this distressed them. Sex is important to elderly men. Even among the 70-80-year-olds, an intact sexual desire, erection and orgasm are common and it is considered important to preserve them. Sexual function should be considered in the clinical assessment of elderly men.

Aged↗
PubMed1995

Decreased sexual capacity after external radiation therapy for prostate cancer impairs quality of life.

PURPOSE: The aim of this study was to assess to what extent patients treated with radiation therapy for prostate cancer experience change in sexual functioning and to what extent this effects quality of life. METHODS AND MATERIALS: Information was provided by 53 men treated with radiation therapy for localized prostate cancer. Assessment was made with the "Radiumhemmets Scale of Sexual Functioning," which measures sexual desire, erectile capacity, orgasm, and to what extent a decrease in any of these aspects of sexual functioning affects quality of life. Function before treatment was assessed retrospectively. RESULTS: Sexual desire diminished among 77% after treatment. The erection stiffness decreased in 77%. Before external radiation therapy, 66% had an erection usually sufficient for intercourse. Half of the men lost this ability after treatment. Of those retaining orgasm after treatment, 47% reported a decreased orgasmic pleasure and 91% a reduced ejaculation volume. Of all men, 50% reported that quality of life had decreased much or very much due to a decline in the erectile capacity following external radiation therapy. CONCLUSION: The results of the present study indicate that external radiation therapy for prostate cancer is associated with a reduction in sexual desire, erectile capacity, and organism functions. In a majority of patients this reduces quality of life. Previously, we may have underestimated the importance an intact sexual function has for the quality of life in this patient category of elderly men.

Aged↗
PubMed1995

Modulation of smooth muscle activity by nitric oxide in the human upper urinary tract.

The aim of the study was to ascertain whether nitric oxide (NO) might regulate motility in the human upper urinary tract. Smooth muscle activity in the human renal pelvis and proximal ureter was studied in vitro in organ baths, and nitric oxide synthase (NOS) activity was studied by measurement of citrulline formation. NO, glyceryl trinitrate (GTN) and sodium nitroprusside (SNP) significantly reduced the frequency of spontaneous rhythmic contractions in renal pelvis and proximal ureter. Exogenously applied NO elicited relaxations in pre-contracted renal pelvis. Calcium-dependent NOS activity was significant in the renal pelvis but undetectable in the ureter. Also, NOS activity was absent in hydronephrotic renal pelvis. NO, SNP and GTN inhibited smooth muscle activity in the human upper urinary tract. NOS activity was obtained in normal renal pelvis but not in hydronephrotic renal pelvis. Regulation of urinary tract NO concentrations might offer a strategy for treatment of renal colic and disturbances in upper urinary tract motility.

Citrulline↗
PubMed1995

Distinguishing prognostic and treatment-predictive information for localized prostate cancer.

OBJECTIVES: To distinguish the concepts of prognostic and treatment-predictive information for localized prostate cancer. METHODS: We defined a prognostic factor as one that identifies subgroups associated with differing outcomes in untreated patients. A treatment-predictive factor identifies patients with differing outcomes as a consequence of treatment and is best identified in a large, randomized trial. Outside of such a trial, a treatment-predictive factor can be identified in prognostic subgroups or after adjustment for prognostic factors. RESULTS: The distinctions between prognostic and treatment-predictive factors are illustrated by hypothetical examples. CONCLUSIONS: The practical implication of the distinctions is that prognostic information may not provide reliable treatment-predictive information, that is, additional information may be needed before selection of patients for different treatments can be based on prognostic information. Determination of the relative treatment effect in any prognostic subgroup of patients requires a comparative setting. Until now, identified prognostic factors for localized prostate cancer at best can give guidance for clinical decisions on which patients should not be offered local aggressive therapy if the aim of the therapy is to cure the patient of the disease.

Forecasting↗
PubMed1995

Deferred treatment for clinically localized prostate cancer.

With the available data, deferred treatment is definitely an option for patients with low grade clinically localized prostate cancer if their life expectancy is 10 years or less and avoids the side-effects of treatment. Many patients will avoid the need for therapy of their prostate cancer during their remaining lifetime.

Age Factors↗
PubMed1995

Radical prostatectomy, radiotherapy or deferred treatment for localized prostate cancer?

Before considering the possible biases discussed above, the results as reported in the current literature may indicate an advantage for radical prostatectomy in disease specific survival at 10 years' follow-up when compared with external radiation therapy and deferred treatment. It appears that most of the obvious biases found in the literature work in favour of radical prostatectomy. The actual advantage of radical prostatectomy with respect to disease specific survival at 10 years may therefore be less than the data complications suggest. The magnitude of these biases is, however, impossible to assess. A probable but perhaps marginal benefit for the majority of the patients must, however, be put in relation to possible side effects and long term complications of the various treatments as well as the patient's preferences when choosing treatment. Reliable controlled data on outcome and quality of life for the various treatments of localized prostate cancer are needed, but we may have to wait for many years for such data. It must also be remembered that the results presented in this overview derive from a series started in the late 1970s of patients treated with the surgical techniques and radiotherapy technology available at that time. Today, the frequent use of prostate specific antigen in early detection or screening programmes will definitely detect a larger number of low volume prostate cancers that may be more curable by surgery or radiotherapy. This, however, remains to be proved. Moreover, new technology in radiotherapy, such as conformal therapy, may enable radiotherapists to deliver higher local doses of radiation to the prostate, which in turn may improve the cure rate for radiotherapy.

Humans↗
PubMed1994

Prognostic value of deoxyribonucleic acid content in prostate cancer: a review of current results.

A total of 115 articles on prostate cancer were reviewed for data on the prognostic value of DNA content in the tumor cells. In 44 series, data pertinent to this review were found. There was no consensus in the literature with respect to methods of analysis of DNA content or definitions of subclasses of DNA content such as categories of ploidy. The DNA content of prostate cancer cells was strongly related to tumor grade and stage. When analyzed as a single parameter in univariate analyses, the DNA content had a prognostic value with respect to overall or disease-specific survival. In multivariate analyses the additional prognostic value of the DNA content was less convincing when analysed with tumor grade and stage. The prognostic data from univariate and multivariate analyses available in the literature were mainly derived from patients with advanced disease and data on localized, potentially curable disease were scanty and conflicting.

Aged↗
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↗