[Treatment of prostatic adenomas].
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Biomedical subjects
Publications and source records attributed to J Auvert.
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Superficial bladder tumors treated at the Henri Mondor Hospital from 1984 through 1988 were analyzed for recurrence and progression using the following prognostic parameters: stage (TNM classification, 1978), grade (G1, G2, G3), size, number of tumors, and tumor malignancy index as defined by the Besançon group. Forty-five patients were treated with transurethral resection alone (TUR group) whereas 30 had TUR followed by the prophylactic instillation of fresh Calmette-Guérin bacillus in the bladder (BCG group). In TUR patients, parameters predictive of progression included grade G3, multiple tumors, stage T1, recurrence within 6 months of TUR, and a tumor malignancy index above 455. None of these criteria were predictive of a response to BCG. Results obtained in the BCG group were comparable to those reported in the literature and confirmed the efficacy of BCG instillations to prevent recurrence and progression of superficial carcinomas of the bladder.
Development of serum assays for prostate-specific antigen (PSA) has provided physicians with a new marker for carcinoma of the prostate. PSA was compared to prostate acid phosphatases (PAP), the reference serum marker, in 162 patients including 54 patients with carcinoma of the prostate (CP), 84 patients with benign hypertrophy of the prostate (BHP), and 24 controls free of prostate disorders. PSA appeared more sensitive but less specific than PAP. Results showed that PSA is not suitable for routine screening in the population at large where BHP is common. In BPH, the rise in PSA concentrations parallels the size of the hypertrophy. However, in patients with CP, PSA seems more sensitive than PAP for evaluating tumor spread and response to treatment. The prognostic bearing of increased levels in patients with apparently localized carcinomas remains to be elucidated.
After describing the technique, the authors recall the ultrasound anatomy of the prostate with the symmetrical echoes given by the seminal vesicles, the vas deferens and the ejaculatory ducts, which often allow a distinction to be made between the cranial and caudal portions of the prostate. Calculation of the volume (normally under 20 cm3) measures the enlargement (useful in determining the choice of approach), using the formula (Formula: see text) Ultrasound also often gives some idea of the nature of the lesion. The main distinction between an adenoma and a carcinoma is the fact that the adenoma is normally confined to the cranium. Carcinomas are generally asymmetrical, and their structure is non-echogenic, giving coarse echoes. Chronic prostatis, on the other hand, leads to the existence of symmetrical hyper-echogenic areas, sometimes calcified. The main contribution of suprapubic ultrasound is the information it provides concerning the repercussions on the urinary tract (residue, straining bladder, repercussions on the kidney). It can also be used to monitor developments.
A retrospective study concerning 146 patients with prostatic cancer showed that 30 of them (20 p.cent) presented ureteral obstacles at some time during the evolution of the disease. The majority of these cases were T3-T4 tumors. When a strickly medical approach allowed to reduce the obstruction, the 1 year survived rate was 71 p.cent. When surgery became necessary due to persistent renal insufficiency, in spite of medical treatment the 1 year survival rate was 15 p.cent.
30 patients with advanced prostatic carcinomas received sequential polychemotherapy with association of vincristine (or VM 26), cyclophosphamide and 5-fluorouracil. In addition, 13 of these 30 patients received a dose of adriamycin during the first day of treatment, which did not change the results. This treatment was well tolerated and gave a good relief of bone pains.
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This report on a round table which took place at the 2nd Congress of the EAU in Prague, concerns the indications and techniques of lymphadenectomy in tumours of the testis, prostate and bladder as well as cancers of the kidney, penis and upper urinary tract.
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