The management of incidental T1aG1 (TNM 1987) prostate cancer.
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Humans↗
Biomedical subjects
J E Altwein
Publications and source records attributed to J E Altwein.
Benign prostatic hyperplasia and erectile dysfunction: a review.
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Adult↗
ESWL of stones in the mid-ureter.
Two hundred and twenty patients with a ureteric calculus were treated by in situ ESWL; in 60 of these the stone was located in the mid-ureter. Treatment was given without anesthesia or with sedoanalgesia only. Complete or partial stone clearance at the time of discharge from hospital was achieved in 95% irrespective of the site of the stone and there were no complications. It is suggested that in situ ESWL is effective in the treatment of stones in mid ureter as well as those in upper and lower ureter.
Algorithms↗
[Conservative therapy of prostate cancer].
Treatment of carcinoma of the prostate with hormones can be carried out as partial or complete androgen deprivation. As primary therapy it may be administered palliatively in advanced carcinomas (almost always metastatic), as adjuvant treatment following radical prostatectomy, as "salvage" treatment in post-irradiation recurrent disease, or secondarily after unsuccessful primary treatment. In the case of primary treatment, androgen deprivation is more effective than chemotherapy (NPCP Protocol 1300). LHRH analogues (of the gosereline acetate type) are equally as effective as orchiectomy (standard therapy), but cause a flare-up of the patient's symptoms within the first two weeks, and are therefore given in combination with an antiandrogen. The use of a pure antiandrogen (of the flutamide type) is equally as effective as the standard therapy, but in contrast to the latter, impotence does not occur. Complete androgen deprivation (LHRH analogues plus pure antiandrogens) is more effective in the case of low-volume metastases--in terms of time-to-progression--than standard therapy.
Androgen Antagonists↗
A multicenter randomized trial comparing the luteinizing hormone-releasing hormone analogue goserelin acetate alone and with flutamide in the treatment of advanced prostate cancer. The International Prostate Cancer Study Group.
A prospective randomized trial was conducted to compare the effects of the nonsteroidal antiandrogen flutamide (250 mg. 3 times daily) plus the luteinizing hormone-releasing hormone analogue goserelin acetate (Zoladex) (3.6 mg. subcutaneous depot injection every 28 days) with goserelin acetate alone in advanced prostatic carcinoma. A total of 571 eligible patients, of whom 57% had distant metastases, showed no difference in subjective or objective response rates, interval to progression, treatment failure or survival after a median followup of 2 years. In the combination group more patients had an early decrease in elevated levels of tumor markers and the small number of patients with an increase in signs and symptoms within the first 4 weeks showed a significant decrease. However, increased gastrointestinal and hepatic toxicity in the combination group resulted in 44 patients being withdrawn from the trial. These results indicate that the combination of goserelin acetate with flutamide provides no long-term clinical benefit in patients with advanced prostatic carcinoma compared to goserelin acetate alone.
Administration, Oral↗
[Chemotherapy of prostatic carcinoma].
The overall results of chemotherapy of hormone-refractory prostate carcinomas are disappointing. In practical terms, only partial remissions are observed. Complete remissions are very rare. Prospective randomized studies revealed no advantage of primary chemotherapy over standard hormone therapy with regard to survival time of patients with metastasized prostate carcinoma. Furthermore, superiority of a combination therapy over therapy with a single cytostatic agent for prostate carcinoma has so far not been proved. These results indicate that chemotherapy of prostate carcinoma should only be applied within controlled studies, and that new substances or combination preparations should preferably be tested in such studies.
Antineoplastic Agents↗
[Tumors of the urogenital tract: clinico-epidemiologic facts].
Important data on the occurrence of urological tumours are presented. In particular, the actual values and estimations have been compiled. In the Federal Republic of Germany 19135 patients died of genitourinary tumours in 1988:81.3% of these were male and 47.5% had prostatic carcinoma. Death occurred after the age of 69 years in 71.7%, and in 36.7% after the age of 79 years. It is estimated that 37,000 persons become ill with a urological neoplasm each year, and that approximately 120,000 cancer patients are presently alive in whom a primary tumour has been diagnosed in the urinary system within the last 5 years. This means for instance, a relation of about 80 patients in posttreatment care to one practising urologist and 9% of urology beds are occupied by patients receiving primary treatment for a tumour. The trend in mortality has been inhomogeneous in recent years, insofar as a 50% decline of testis tumour mortality has been observed, whereas an increase of between 15% and 20% has been observed in the mortality of renal cell carcinoma and an increase of approximately 10% in the mortality of bladder carcinoma in women. Altogether, the position with regard to epidemiological data on tumours is still unsatisfactory in the Federal Republic of Germany.
Aged↗
[Problems and principles of hormone therapy of advanced prostate cancer].
The availability of hormones with few side effects has enlarged the indication for their use: In the presence of metastases, primary endocrine treatment which includes orchiectomy as standard therapy is employed with palliative intent. Adjuvant endocrine treatment is given after radical prostatectomy when positive margins or lymph nodes were present. A salvage endocrine treatment is administered if the primary tumor persists after radiotherapy or recurred after prostatectomy. The term diagnostic hormone treatment is misleading and should not be used. A secondary hormone application is supported by the observation that allaged hormone resistant tumor progressed after testosterone injection. The problem of early versus delayed endocrine therapy is unsolved, however, it is conceivable that the latter therapy is confronted with a larger tumor burden. The principle of endocrine treatment is properly described as means suppressing the androgenic stimuli. There are 5 different routes of androgen deprivation, among which the antiandrogens and LH RH analogs have the highest priority. Phase III-studies are under way to clarify their efficacy.
Combined Modality Therapy↗
Efficacy and discriminative ability of prostate-specific antigen as a tumor marker.
A study was performed on 175 men to compare the level of prostate-specific antigen (PSA) in patients with benign prostatic hyperplasia (n = 83) and prostatic carcinoma (n = 92). There was a good correlation between T stage and increasing values of PSA. Using 2.5 ng/ml as the upper normal limit of PSA, the test sensitivity of PSA was 94%, but the specificity only 44%. Receiver-operator characteristic curve (ROC) analysis demonstrates that PSA is superior to prostatic acid phosphatase (PAP); this is particularly true in the higher T stages. Although ROC analysis shows that PSA is more discriminating than PAP, the sensitivity of PSA is dependent upon the choice of an appropriate cut-off point of the test. It was shown that PSA is not sufficient for detecting the presence or absence of prostatic cancer in a general population. However, PSA is the most sensitive marker in the detection of prostatic cancer.
Antigens, Neoplasm↗
[Nerve-sparing, feminizing genital reconstruction to correct genital virilism: Experience of 25 children with adrenogenital syndrome].
The reconstruction of the virilized genitalia in females with adrenogenital syndrome (AGS) is carried out sparing the dorsal neurovascular bundle either through clitoral recession or reduction with simultaneous vaginoplasty and clitoroplasty. Within seven years, 25 girls aged 6 months to 16 years (mean 2 1/2 years) with AGS had a nerve-sparing genital reconstruction with resection of the clitoral shaft in one session as described by Praetorius. 23 children had a C21-defect and 1 a C11 beta-hydroxylase defect; one child had an external virilisation. All children were followed over an average period of 50 months: 21 had a good cosmetic result, the glans had a normal blood supply and was sensitive to a prick test; in 2 girls nerve integrity was demonstrated by somato-sensory evoked potentials. 2 children had small disturbing skin folds of the newly created labia and 2 girls had a somewhat scrotal appearance of the labia. The introitus caliber measured 14 F in girls operated before 6 years of age; however, a 14- and 16-year-old required intermittent bougienage.
Adolescent↗
ESWL management of ureteral calculi without anesthesia: an alternative to invasive procedures.
We reviewed our experience with ESWL therapy in 96 patients who presented with upper, middle and lower ureteral calculi; we had 127 treatments in 96 patients, 73 men (76%) and 22 women (24%). All the treatments were performed without general anesthesia and without premedication. The average number of shock waves was 3.000. Repetition of the ESWL therapy had to be performed in 25%.
Adolescent↗
[Diagnosis of erectile impotence].
In patients with erectile dysfunction (ED), the diagnostic procedure depends on the efficiency of the method and the implications of the results for treatment. The procedures to be considered can be integrated into a flowchart. Following screening by means of intracavernous drug injection the etiology can be classified with an adequate degree of certainty into one of three main groups. A preliminary diagnosis of nonvascular ED can be confirmed by psychological (interview, psychometric tests) and neurophysiological investigations. An arterial etiology can be confirmed by Doppler ultrasonography or, if revascularization is planned, by arteriography. A venous-type ED with a high MF value on cavernosonography is suspicious of an obstructive arteriopathy. Measurement of the systemic-penile occlusion pressure gradient appears to be a sensitive test for the examination of patients with ED of vascular etiology and should be carried out before the treatment is planned.
Erectile Dysfunction↗
Multidisciplinary evaluation in erectile dysfunction after radical prostatectomy.
Radical prostatectomy is associated with a postoperative impotence rate of 90%, a sequel that is the least acceptable to the patient. The use of the nerve-sparing procedure according to Walsh (1) with 70% restoration of sexual power postoperatively is limited considering the prevalence of periprostatic tumour invasion. A method is described which satisfies the demand for both a radical surgical procedure and postoperative restoration of sexual power.
Angiography↗
[Problems of interpretation of urethral configurations on the micturition cystourogram in young girls].
The aim of the investigation was to classify urethral variability as seen on micturating cystograms of 193 young girls and to study the physiological and pathological significance of the various shapes. It was shown that significant abnormalities were associated with all types of urethral configuration. Comparison of urethral shapes and clinical symptoms (dysuria, enuresis) did not show any particular appearance. Differentiation of urethral shapes into those that were dilated, and therefore suggested a stenosis, and those that were not dilated, showed no significant correlation between clinical and radiological findings.
Adolescent↗
Late results after sclerotherapy of varicocele.
Percutaneous sclerotherapy is technically feasible in about 80% of patients with idiopathic varicocele. Persistence must be reckoned with in 3-5% of the cases. Sclerotherapy is a low-risk technique which can be applied on an outpatient basis in the vast majority of cases. In about 40% of the cases, an improvement of the fertility can be attained by raising the spermatozoal density; the total motility and morphology of the spermatozoa can only be slightly improved by this therapy. Percutaneous sclerotherapy is to be recommended as an alternative to surgery since it provides equally good results, is cheaper and causes hardly any complications.
Adult↗
Benign testicular tumors: a case for testis preservation?
Between June 1980 and June 1986, 345 inguinal explorations for intrascrotal space-occupying lesions were performed. In 47 patients benign testicular tumors were diagnosed (13.5%). In 32 of the 47 tumors (68%), the testis could be preserved by excision or enucleation of the tumor. In the remaining 15 patients a high semicastration was carried out: in 12 cases macroscopic examination or frozen section revealed doubtful benignity (6 Leydig cells tumors, 5 dermoid cysts and 1 epidermoid cyst), in 3 patients because of extensive involvement of the testis. In a follow-up period of 1-7 years none of the patients has shown evidence of tumor recurrence or metastasis. Changing the concept of not incising the parietal tunica of the testis and regarding clear-cut macroscopic and histological criteria of benignity on frozen section will safely lower the testicular loss rate from up to 80% to about 30% when benign tumors are encountered.
Dermoid Cyst↗
[Local chemolysis of occluding uric acid calculi].
Between 1984 and 1986 nineteen patients (20 renal units) were admitted with obstructing uric acid calculi. Seventy-eight percent of all patients with urolithiasis were treated endourologically: 8 kidneys were infected, 8 kidneys were non-functioning and 3 kidneys caused a status colicus. Sodium bicarbonate was used for percutaneous irrigation and all 20 kidneys were cleared within 4 to 18 days. The technique is a valuable adjunct to the ESWL.
Aged↗
[Open multicenter study of the differential diagnosis of erectile dysfunction with a papaverine-phentolamine combination (BY023)].
We report the results of an open multicenter clinical trial with 115 patients. The results of a pharmacological test using intracavernously applied mixture of papaverine and phentolamine were compared with the results of a multidisciplinary evaluation of erectile dysfunction. Sensitivity and specificity of our test were determined. The injection of our drug solution caused an increase in tumescence and/or rigidity in all patients. The evaluation of the dose dependent erectile response makes it possible to distinguish between the three main pathogenetic principles: non-vascular, arterial and venous etiology of erectile dysfunction. The pharmacological test requires one to four intracavernous injections of 0.5-3.0 ml of the drug solution (7.5-45 mg papaverine hydrochloride, 0.25-1.5 mg phentolamine mesylate).
Adolescent↗