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J C Presti

Publications and source records attributed to J C Presti.

At least 37 records · Page 2Linked to original sources
PubMed1997

Cryosurgical ablation of prostate cancer: patterns of cancer recurrence.

PURPOSE: We determined the rate of biochemical and biopsy failure in relation to the prostate specific antigen (PSA) nadir, the effect of neoadjuvant androgen blockade and the pattern of residual tumor after cryosurgical ablation of prostate cancer. MATERIALS AND METHODS: From July 1993 to April 1996, 134 patients underwent 147 cryosurgical ablation procedures. Of those patients, 110 had adequate followup and did not receive post-treatment androgen deprivation. Followup included PSA determination at 3, 6 and 12 months, and every 6 months thereafter. Biopsies were performed at 6 months or with biochemical failure defined as PSA nadir 0.5 ng./ml. or greater or subsequent biochemical failure (PSA increase 0.2 ng./ml. or greater). Biochemical and biopsy failures were correlated with PSA nadir values following cryosurgery (less than 0.1 ng./ml., 0.1 to 0.4 and or greater 0.5). A total of 68 patients had careful ultrasound guided mapping biopsy preoperatively and postoperatively to define the sites of disease. The likelihood of residual disease was correlated with the initial site(s) of the cancer in an attempt to identify if areas of the prostate and/or seminal vesicles were more likely to be sites of treatment failure. RESULTS: At a mean followup of 17.6 months biochemical failure (subsequent rise in PSA 0.2 ng./ml. or greater) was lowest in those who achieved PSA nadirs less than 0.1 ng./ml. (21%) but it was noted in 48% of patients with nadirs between 0.1 and 0.4 ng./ml. Those patients with PSA nadirs 0.5 or greater had either immediate local failure (46%), subsequent local or biochemical failures (43%) or extremely high PSA nadirs (greater than 30 ng./ml.) necessitating hormonal therapy (11%). Biopsy failure was lowest in those with nadirs less than 0.1 ng./ml. (7%) and those with nadirs 0.1 to 0.4 ng./ml. (22%). In contrast, 60% of the patients with nadir values 0.5 ng./ml. or greater had biopsy failure. Biochemical and biopsy failure tended to occur within the first 18 months after treatment. Neoadjuvant androgen blockade appeared to reduce subsequent biochemical failure in patients with stages T1 and T2 cancers (11% versus 50% in those without androgen deprivation) but not in those with T3 and T4 cancers. Recurrence was more common in cancers at the apex (9.5%) and seminal vesicles (44%), in contrast to those located in the mid gland (4%) and base (0%). CONCLUSIONS: A PSA nadir of 0.4 ng./ml. or less should be achieved following cryotherapy. Higher values are associated with a significant risk of continued PSA elevation and a high likelihood of residual disease detected on prostatic biopsy. Local failure tends to occur at the apex and seminal vesicles. Neoadjuvant androgen blockade reduces the risk of biochemical failure in patients with stages T1 and T2 cancers.

Adenocarcinoma↗
PubMed1997

Focal therapy for prostate cancer 1996: maximizing outcome.

OBJECTIVES: To summarize improvements in patient selection and the results of focal therapy for the management of localized prostate cancer. METHODS: A contemporary series of patients managed with wide surgical excision, radiation therapy (three-dimensional conformal radiation, interstitial radiation, and charged-particle or proton therapy), and cryo-therapy were reviewed. RESULTS: We used preoperative cancer grade, transrectal ultrasound, and serum prostate-specific antigen (PSA) in all patients, and cross-sectional imaging and bone scans in selected patients to allow for reasonably accurate cancer staging and selection of patients most likely to be cured by radical prostatectomy or radiation. In patients with extracapsular extension of prostate cancer, wide surgical excision and achievement of a clear surgical margin had therapeutic value. Newer radiation techniques resulted in a higher likelihood of prostate cancer control than previous techniques. Cryotherapy for patients with stages T1 through 3 prostate cancer was associated with a posttreatment undetectable PSA rate of 48% and a positive biopsy rate of 23%. CONCLUSIONS: Patients with organ-confined and, therefore, curable prostate cancer can be identified. Well-performed radical prostatectomy, radiation, and cryotherapy are alternative treatments for the management of localized prostate cancer.

Androgen Antagonists↗
PubMed1997

Systematic sextant biopsies in the prediction of extracapsular extension at radical prostatectomy.

OBJECTIVES: To evaluate the clinical utility of transrectal ultrasound-guided systematic sextant needle biopsies in the prediction of extracapsular extension (ECE) at radical prostatectomy. METHODS: A retrospective analysis of 104 men who underwent systematic biopsy and radical prostatectomy at our institution was performed. All patients underwent preoperative staging by transrectal ultrasound and transrectal ultrasound-guided systematic sextant biopsy. The presence of pathologic ECE was correlated to the number of positive core biopsies on each side of the prostate by chi-square analysis. Sensitivity, specificity, positive and negative predictive values, and likelihood ratios (LRs) were calculated for both positive (two or three biopsies positive per side) and negative (no or one positive biopsy per side) test results. RESULTS: Forty-two (20.2%) of 208 sides demonstrated evidence of ECE at radical prostatectomy. Chi-square analysis demonstrated a significant correlation between the number of positive biopsies and the presence of ECE at radical prostatectomy (P = 0.001). Overall, the finding of multiple positive core biopsies (two or three per side) had predictive value with regard to the presence of ECE (sensitivity 62%, specificity 77%, positive predictive value 40%, negative predictive value 89%). The corresponding LRs were 2.5 for a positive and 0.5 for a negative test result. CONCLUSIONS: The probability of ECE at radical prostatectomy can be more accurately assessed preoperatively by the combined use of transrectal ultrasound and systematic sextant needle biopsies.

Aged↗
PubMed1997

Prostate-specific antigen after cryosurgical ablation of the prostate. Defining the appropriate response.

The ability of prostate-specific antigen (PSA) to predict long-term cure after cryotherapy for localized prostate cancer is not known because experience with this treatment modality is limited; however, it appears that a PSA value of 0.5 ng/mL or less at 6 months or longer after cryotherapy is associated with a high probability of a negative post-treatment biopsy (greater than 95%). An undetectable PSA (less than 0.1 ng/mL) 3 months after the procedure is associated with a likelihood of a negative biopsy at 6 months and low, stable PSA levels up to 2 years.

Biopsy↗
PubMed1997

Cholesterol crystals in hydroceles: sonographic detection and possible significance.

OBJECTIVE: The aim of this study of seven patients who had elective surgical repairs of a hydrocele was to try to differentiate by microscopy and chemical analysis hyperechoic hydrocele fluid from the more typical anechoic hydrocele fluid. CONCLUSION: Hyperechoic hydrocele fluid is related to the presence of cholesterol crystals. Cholesterol crystals were noted on microscopic examination in all three patients with hyperechoic hydrocele fluid. No cholesterol crystals were evident in the four patients with typical anechoic hydrocele fluid.

Adult↗
PubMed1997

Prospective evaluation of prostate specific antigen and prostate specific antigen density in the detection of carcinoma of the prostate: ethnic variations.

PURPOSE: We evaluated prospectively the ethnic variations in prostate specific antigen (PSA) and prostate specific antigen density in the detection of carcinoma of the prostate. MATERIALS AND METHODS: A total of 297 consecutive patients with an elevated serum PSA and/or abnormal digital rectal examination underwent transrectal ultrasound with lesion directed and systematic biopsy (6 if the prostatic volume was 50 cc or less and 12 if it was greater than 50 cc). Receiver operating characteristic curves, predictive values and likelihood ratios were calculated for PSA and PSA density for white and black patients. Ethnic analysis was performed for the entire group, patients with a normal digital rectal examination, and those with a normal digital rectal examination and PSA of 4 to 10 ng./ml. RESULTS: Of the 297 patients 131 (44%) had cancer, including 48 of 97 black (50%) and 83 of 200 white (42%) patients. Median PSA, PSA density and prostate size did not differ between the positive or negative biopsy groups, or between the ethnic groups in any of the analyses. If all digital rectal examinations were considered PSA density was superior to PSA by receiver operating characteristic analysis for cancer detection in both ethnic groups when all values or PSA of 4 to 10 ng./ml. were considered. However, the significance was lost if only patients with a normal digital rectal examination were considered. In general, predictive values were greater in black patients. Likelihood ratios for a negative test result in black patients demonstrated significant changes in the post-test probability if a PSA density cutoff of 0.1 was used to determine the need for biopsy. Many unnecessary biopsies could be avoided and few cancers would be missed. CONCLUSIONS: A PSA density cutoff of 0.1 may be warranted in determining the need for prostate biopsy in black men with a normal digital rectal examination.

Aged↗
PubMed1997

Accelerated tumor proliferation rates in locally recurrent prostate cancer after radical prostatectomy.

PURPOSE: We compared the growth rates of primary cancer and prostatic fossa recurrence after radical prostatectomy. MATERIALS AND METHODS: Tumor proliferative rates were studied in 26 patients with biopsy proved prostatic fossa recurrences after radical prostatectomy. Proliferation was calculated in the prostatectomy specimens and in recurrent cancer using Ki-67 antibody to detect dividing cells. RESULTS: Mean and median labeling indexes for radical prostatectomy specimens were 2.96 and 2.51, respectively. Labeling indexes in locally recurrent tumors were significantly higher (mean 6.47, median 5.59, p < 0.001). The increase in labeling index between parent and recurrent tumors was unrelated to pathological staging at prostatectomy or interval from radical prostatectomy. CONCLUSIONS: Tumors that recur locally after radical prostatectomy appear to have a higher proliferative rate compared to parent tumors.

Cell Division↗
PubMed1996

Genetic aberrations detected by comparative genomic hybridization are associated with clinical outcome in renal cell carcinoma.

The clinical behavior of renal cell carcinoma (RCC) cannot be predicted by histological and other markers. In this study, comparative genomic hybridization was used to evaluate whether the number of genomic aberrations has prognostic significance in 41 nonmetastatic clear cell RCC extending beyond the renal capsule. Losses were most prevalent at 3p (56%) and 9p and 13q (24% each). The number of DNA losses per tumor was associated with recurrence-free survival (P = 0.03). DNA gains most often involved chromosome 5q (17%) and chromosome 7 (15%). The number of DNA gains was not associated with clinical outcome. Loss of chromosome 9p was the only individual locus associated with recurrence (P = 0.04), suggesting that a tumor suppressor gene on chromosome 9p may play a role in RCC progression.

Carcinoma, Renal Cell↗
PubMed1996

Comparative genomic hybridization for genetic analysis of renal oncocytomas.

Renal oncocytomas are uncommon tumors of the kidney that are considered to be of low malignant potential. Neither conventional cytogenetic nor restriction fragment length polymorphism analyses have identified consistent genetic alterations in their genomic DNA. The purpose of the present study was to identify the genetic alterations associated with the development of renal oncocytomas. We studied 13 renal oncocytomas by using comparative genomic hybridization, and we identified loss of genetic material from chromosomes 1 and/or 14 in six of these tumors. These alterations may represent early genetic events in the development of these tumors.

Adenoma, Oxyphilic↗
PubMed1996

L-MYC allelotype in renal cell carcinoma.

The L-MYC restriction fragment-length polymorphism (RFLP) revealed by EcoR1 has been suggested to be of prognostic significance in lung, breast, and kidney cancer. The presence of the smaller allele, in either the homozygotic (S-S) or heterozygotic form (L-S), is felt to convey a worse prognosis than the homozygotic form for the larger allele (L-L). The significance of this relationship in lung cancer has been questioned recently. The objective of the present study was to test the prognostic significance of the L-MYC allelotype in a group of renal cell carcinoma (RCC) patients. Tumor and normal tissue were obtained from 59 patients who underwent radical nephrectomy for RCC between 1986 and 1990. EcoR1 restriction digests were performed on isolated DNA and hybridized with the L-MYC probe. Allelotypes were correlated with pathologic parameters and clinical outcome using the chi 2 test. The L-MYC alleolotype (L-L versus L-S and S-S) did not correlate with any pathologic parameter or likelihood of disease recurrence and does not offer any clinical utility in patients with RCC.

Alleles↗
PubMed1996

Local recurrence after radical prostatectomy: characteristics in size, location, and relationship to prostate-specific antigen and surgical margins.

OBJECTIVES: To define the sonographic characteristics of local cancer recurrence after radical prostatectomy. METHODS: in 114 patients with an elevated prostate-specific antigen (PSA) and negative bone scan, 156 ultrasound-guided prostate fossa biopsies were carried out. RESULTS: in 53.5%, biopsy proved local recurrence. More than one ultrasound-guided biopsy session was required to make the diagnosis in 33% of patients. Local recurrence was seen on ultrasound at the anastomotic site (66%), the bladder neck (16%), and posterior to the trigone (13%). in 5% of patients there was a normal-appearing anastomotic site. Transrectal ultrasound was greater than 90% sensitive in detecting local recurrence, but lacked specificity. Examination of the radical prostatectomy specimens in patients with local recurrence showed positive surgical margins in 66% and organ-confined disease in 20%. CONCLUSIONS: Transrectal ultrasonography is a useful adjunct to PSA and digital rectal examination in the detection of local recurrences following radical prostatectomy.

Biopsy, Needle↗
PubMed1996

Should cryosurgery be considered a therapeutic option in localized prostate cancer?

Cryosurgical ablation of the prostate currently is under investigation as a potential treatment for localized prostate cancer. Results to date indicate that the majority of patients have negative biopsies and a marked reduction in prostate-specific antigen levels following cryotherapy. This treatment, however, is associated with significant side effects, notably bladder outflow obstruction, impotence, and incontinence, and its long-term durability is still unknown.

Cryosurgery↗
PubMed1996

Local staging of prostatic carcinoma: comparison of transrectal sonography and endorectal MR imaging.

OBJECTIVE: We compared the results of transrectal sonography and endorectal MR imaging in the local staging of prostatic carcinoma. SUBJECTS AND METHODS: 56 patients (mean age, 61.1 +/- 7.3 years) with the diagnosis of prostate cancer who by transrectal sonography had no evidence of gross extracapsular extension underwent endorectal coil MR imaging prior to radical prostatectomy. Imaging findings prospectively evaluated in each patient were cancer laterality, extracapsular extension, and seminal vesicle invasion. Twenty-one of 56 (38%) patients had extracapsular extension on final pathology. A total of 100 sides and five seminal vesicles were involved with cancer, and 27 sides (21 patients, six with bilateral extracapsular extension) demonstrated extracapsular extension. Imaging results were correlated with step-sectioned, radical prostatectomy pathologic data, and statistical analysis was expressed at a p = .05 level of significance. Retrospective readings of the images were used to construct receiver operating characteristic curves for the detection of extracapsular extension. RESULTS: For tumor laterality, transrectal sonography was compared with endorectal coil MR imaging for sensitivity (70% versus 97%; p < .001), specificity (58% versus 58%), positive predictive value (93% versus 95%) and negative predictive value (18% versus 70%). For extracapsular extension, transrectal sonography was compared with endorectal coil MR imaging for the entire prostate and individually for each side of the prostate. The respective results for sensitivity (48% versus 91%, p < .01 and 37% versus 78%, p < .005), specificity (71% versus 49% and 87% versus 73%), positive predictive value (50% versus 51% and 48% versus 48%), and negative predictive value (69% versus 90% and 81% versus 91%). The receiver operating characteristic analysis of retrospective data demonstrated endorectal coil MR imaging to be superior to transrectal sonography in the detection of extracapsular extension. The small number of seminal vesicles involved by cancer (n = 5) precluded meaningful comparisons between the imaging techniques. CONCLUSIONS: Endorectal coil MR imaging is more sensitive but less specific than transrectal sonography for detecting extracapsular extension of carcinoma of the prostate. Both procedures have low positive predictive values yet similarly high negative predictive values when each side of the prostate is assessed independently for extracapsular extension.

Humans↗
PubMed1996

Cryosurgical treatment of localized prostate cancer (stages T1 to T4): preliminary results.

PURPOSE: We determined the posttreatment biopsy results, prostate specific antigen (PSA) levels and complications associated with cryosurgical ablation of the prostate performed for localized prostate cancer. MATERIALS AND METHODS: Within 18 months 102 patients underwent cryosurgery as definitive therapy for localized prostate cancer. Mean patient age was 68 years and 57% had advanced local disease (stage T3 or T4). Mean preoperative PSA was 21.8 ng./ml. RESULTS: PSA was undetectable at 6 months in 48% of patients who received no androgen deprivation therapy following cryosurgery. Of 91 patients with postoperative biopsies 77% had no evidence of cancer but 71% had benign epithelial a elements. The complication rate (excluding impotence) was 51%. Biopsy and PSA results improved with experience and changes in technique, that is double freezing, more lateral placement of cryoprobes and more aggressive freezing beyond the prostatic capsule. The most recent cohort of 77 patients had a detectable PSA rate of 23% and a positive post-cryosurgical biopsy rate of 11%. The most common serious complication encountered was bladder outflow obstruction requiring transurethral resection in 23% of the patients. Impotence occurred in 84% of patients potent preoperatively. CONCLUSIONS: Cryosurgical ablation of the prostate can result in negative posttreatment biopsies and undetectable serum PSA levels. However, it is associated with significant side effects and the long-term durability of the procedure is unknown.

Aged↗
PubMed1996

Renal cell carcinoma genetic analysis by comparative genomic hybridization and restriction fragment length polymorphism analysis.

PURPOSE: To compare comparative genomic hybridization (CGH) with restriction fragment length polymorphism (RFLP) analysis in renal cell carcinoma (RCC). MATERIALS AND METHODS: Fifteen RCC specimens were analyzed by both CGH and RFLP analysis at 18 loci. RESULTS: Restriction fragment length polymorphism analysis was informative on 90 chromosomal arms. Allelic imbalance was identified on 27 chromosomal arms by RFLP and on 26 arms by CGH. Data from CGH and RFLP demonstrated a high degree of concordance (p < 0.001). Comparative genomic hybridization identified previously documented areas of interest in RCC as well as potential new areas of interest including loss of genetic material on chromosome 2 and gains of genetic material on chromosome 16p. CONCLUSIONS: Comparative genomic hybridization can successfully be performed in RCC specimens. As it surveys the entire genome simultaneously, it may be more efficient than conventional cytogenetics or RFLP analysis in analyzing RCC.

Carcinoma, Renal Cell↗
PubMed1996

Prospective evaluation of prostate specific antigen and prostate specific antigen density in the detection of nonpalpable and stage T1C carcinoma of the prostate.

PURPOSE: We evaluated prospectively prostate specific antigen (PSA) and prostate specific antigen density in the detection of prostate cancer in patients with normal findings on digital rectal examination with and without normal transrectal ultrasound. MATERIALS AND METHODS: Consecutive patients (184) with an elevated serum PSA and normal digital rectal examination underwent transrectal ultrasound with lesion directed and systematic biopsies (6 if prostatic volume was 50 cc or less and 12 if volume was more than 50 cc). Receiver operating characteristic curves, predictive values and likelihood ratios were calculated for PSA and PSA density. RESULTS: Of the 184 patients 50 (27%) with a normal digital rectal examination had cancer compared to 30 of 112 (27%) with a normal digital rectal examination and transrectal ultrasound. Median PSA or PSA density did not differ between the positive and negative biopsy groups among patients with a normal digital rectal examination (8.4 versus 7.1 and 0.22 versus 0.14 ng./ml., respectively) or a normal digital rectal examination and transrectal ultrasound (8.2 versus 7.5 and 0.21 versus 0.14 ng./ml., respectively). PSA density was superior to PSA by receiver operating characteristic analysis for cancer detection when all PSA values or those between 4 and 20 ng./ml. were considered. However, the significance was lost for a PSA of 4 to 10 ng./ml. Likelihood ratios demonstrated insignificant changes in the post-test probability if PSA density was used to determine the need for biopsy and many cancers would have been missed. CONCLUSIONS: PSA density should not be used to determine the need for biopsy in patients with a normal digital rectal examination and/or transrectal ultrasound.

Biopsy↗
PubMed1996

Use of prostate-specific antigen (PSA) and PSA density in the detection of stage T1 carcinoma of the prostate.

Serum prostate-specific antigen (PSA) has greatly enhanced our ability to detect carcinoma of the prostate. Yet, because of its lack of specificity for malignancy, approximately two thirds of the men with an elevated PSA level do not have prostate cancer. This problem is particularly relevant to men whose prostate feels normal by digital rectal examination (DRE) and appears normal by transrectal ultrasound (TRUS). Carcinoma of the prostate, if detected in these men, is staged as T1c and is usually considered to be of clinical significance. Attempts at refining PSA have included attempts to correct the serum level relative to the size of the prostate (PSA density). Although conflicting data has been reported in the literature, it appears when stratified for PSA ranges between 4 and 10 ng/mL, PSA density does not provide an advantage over PSA alone in cancer detection in patients with a normal DRE and TRUS.

Humans↗