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Biomedical subjects

J E Oesterling

Publications and source records attributed to J E Oesterling.

At least 127 records · Page 7Linked to original sources
PubMed1994

Natural history of prostatism: impact of urinary symptoms on quality of life in 2115 randomly selected community men.

OBJECTIVES: To assess the impact of urinary symptoms on health-related quality of life (QoL), including degree of bother, worry, interference with daily activities, psychological well-being, sexual function, and general health in a community-based cohort of men. METHODS: Eligible white men (n = 2115) aged 40 to 79 years who had not undergone previous prostate surgery or had prostate cancer were randomly selected from county residents. These subjects completed a questionnaire, which asked them about frequency and bother of urinary symptoms, interference with daily activities, psychological well-being, worry about urologic disease, sexual functioning, and general health. RESULTS: Men with moderate to severe voiding symptoms reported, on average, four to six times the degree of bother and interference with daily activities and twice the level of worry of men with mild symptoms. Nearly five times the degree of bother and interference was reported for those with mild than with no symptoms. A higher percentage of men with moderate to severe symptoms (26% to 33%) than mild symptoms (< 8%) reported limiting fluids before bed, travel, or driving 2 hours. Receiver operating characteristic curves support the recommended symptom index cutpoint for moderate symptoms (= 8) by differentiating men with and without bother, interference with daily living, or dissatisfaction with urinary condition. CONCLUSIONS: Moderate to severe urinary symptoms have a significant impact on men's lives in terms of degree of bother, worry, interference with daily living, and psychological well-being. The recommended cutpoint on symptom index differentiates men with and without decrement in health-related quality of life.

Activities of Daily Living↗
PubMed1994

The natural history of prostatism: the effects of non-response bias.

BACKGROUND: In epidemiological studies, non-response may raise the question of generalizability to the target population. Most investigations have not been able to access data that could provide information about the potential impact of non-response bias. METHODS: A 55% response rate was realized at baseline for a prospective cohort investigation of the natural history of benign prostatic hyperplasia in Olmsted County, Minnesota, during 1989-1991 (the Olmsted County Study of Urinary Symptoms and Health Status Among Men). This prompted a preliminary study of potential non-response bias among full participants, partial participants and complete non-responders. The medical diagnostic index maintained by the Rochester Epidemiology Project was used to ascertain the prevalence of specific conditions in the 9 years prior to study inception. RESULTS: The age-adjusted period prevalence rate for benign prostatic hyperplasia (%) was 9.6 (95% confidence interval [CI]: 8.1-11.0) for full participants, 8.2 (95% CI: 5.8-10.6) for partial participants and 5.3 (95% CI: 3.6-6.9) for complete non-responders. Other urologic diagnoses followed the same pattern. However, age-adjusted prevalence rates for general medical examination history and major non-urologic morbidities were decidedly similar across response groups. CONCLUSIONS: These data suggest response may have been driven, in part, by concerns about urologic disease. However, the similarity in non-urologic diagnoses and general medical examinations provide some preliminary reassurance that the 55% response rate did not necessarily compromise generalizability.

Adult↗
PubMed1994

Serum prostate-specific antigen discriminates weakly between men with benign prostatic hyperplasia and patients with organ-confined prostate cancer.

To determine if serum prostate-specific antigen (PSA) can identify those patients harboring an organ-confined prostate cancer prior to treatment for symptomatic benign prostatic hyperplasia (BPH), we examined retrospectively the preoperative serum PSA level for two groups of men. Group 1 consisted of 187 consecutive patients with a histologic diagnosis of BPH as determined from complete pathologic analysis of the transurethral resection of the prostate (TURP) specimen. Group 2 included 198 consecutive patients with histologically confirmed organ-confined prostate cancer as determined from step-section analysis of the retropubic radical prostatectomy specimen. The median serum PSA value for group 1 was 3.9 ng/ml (range 0.2-55 ng/ml), whereas the median serum PSA level for group 2 was 5.9 ng/ml (range 0.4-58 ng/ml). Although this difference was statistically significant (p < 0.001), the distribution of serum PSA values for group 1 overlapped considerably with the distribution for group 2. For both groups, there was a clustering of PSA values below 10.0 ng/ml (group 1: 90%; group 2: 73%). The area under the receiver operating characteristic curve for log PSA values to discriminate men with BPH from patients with organ-confined prostate cancer was 0.66 (95% confidence interval: 0.60-0.72); a 'perfect' test has an area of 1.0, whereas a test with 'no information value' has an area of 0.5. These findings suggest that serum PSA has only a modest ability to distinguish men with BPH from patients with organ-confined prostate cancer. As a result, some symptomatic BPH patients choosing a non-TURP therapy may harbor a clinically significant prostate cancer despite being evaluated with a serum PSA determination.

Aged↗
PubMed1994

Radical prostatectomy for clinically localized prostate cancer: long-term results of 1,143 patients from a single institution.

PURPOSE: To determine the efficacy and complication rate of radical prostatectomy (RP) as a treatment option for clinically localized prostate cancer (clinical stage < or = T2c). METHODS: The study was a retrospective analysis of 1,143 consecutive patients (median age, 64 years; range, 38 to 79 y) who underwent RP at one institution (mean follow-up time, 9.7 years). Complications for this study population were compared with those of a contemporary group of 1,000 consecutive patients. RESULTS: Of 1,143 patients, 83 (7%) had a low clinical stage (T1) and 160 (14%) had a low histologic grade (Gleason score < or = 3); 648 (57%) had a high clinical stage (T2b or T2c) and 204 (18%) had a high histologic grade (Gleason score > or = 7). Only 113 (10%) died of prostate cancer, and 177 (15%) developed metastasis. Adjuvant treatment (androgen deprivation or radiation therapy) was given in 197 (17%) patients (> or = pT3) and provided virtually identical results as without adjuvant treatment. The 10- and 15-year crude survival rates for 1,143 patients were 75% +/- 1.5% (SE) and 60% +/- 2.2%, respectively; the cause-specific survival rates were 90% +/- 1.1% and 83% +/- 1.9%, respectively; and the metastasis-free survival rates were 83% +/- 1.3% and 77% +/- 1.9%, respectively (398 men at risk at 10 years and 138 men at risk at 15 years). The 10-year survival rate for patients with Gleason score > or = 7 was 74% +/- 3.9%. Only tumor grade was a significant predictor for disease outcome. The hospital mortality rate decreased from 0.7% for the 1,143 study patients to 0% for the more recent 1,000 patients. Severe incontinence declined to 1.4% for the more recent 1,000 patients. Most patients who underwent RP were healthy (Charlson comorbidity index). CONCLUSION: Survival at 15 years was similar to the expected survival rate. Current morbidity and mortality rates associated with RP were extremely low. Thus, RP has been a viable management option for men with clinically localized prostate cancer who have a life expectancy of more than 10 years.

Adult↗
PubMed1994

Patient evaluation if prostate-specific antigen becomes elevated following radical prostatectomy or radiation therapy.

Prostate-specific antigen (PSA) is the most sensitive and clinically useful method for monitoring patients following definitive therapy for prostate cancer. A "detectable" value following radical prostatectomy and an increasing level following radiation therapy are both indicative of recurrent/residual disease. The persistent cancer may be local or distant; the rate of increase of serum PSA can be useful in distinguishing between local and metastatic disease. A computed tomography or magnetic residence imaging scan may be useful for evaluating abdominal and pelvic lymph nodes, and the radionuclide bone scan is an effective tool for assessing the skeleton when the serum PSA concentration becomes elevated following treatment.

Adenocarcinoma↗
PubMed1994

Correlation between urinary flow rate, voided volume, and patient age in a community-based population.

This investigation is unique in that is the first study to use a large number of randomly chosen men from the community to establish the relationship between: 1) urinary flow rate and voided volume, 2) urinary flow rate and patient age, 3) voided volume and patient age, and 4) the time to achieve peak urinary flow rate and patient age. The results clearly indicate that both the peak and mean urinary flow rate decreases with advancing age. The voided volume also diminishes with increasing age. The time required to achieve the peak urinary flow rate, however, appears to be independent of the patient's age. Irrespective of age, approximately 9 seconds are required to achieve the maximum urinary flow rate. Because the urinary flow rate is dependent upon both the quantity of urine voided and the patient's age, it is necessary to account for the influence of both parameters when establishing the "normal range" for peak urinary flow rate. To this end, nomograms estimating the peak urinary flow rate percentile as a function of voided volume and patient age have been generated and are included in this report. These nomograms, based on a large, randomly selected population, should make peak urinary flow rate a more reliable diagnostic modality for assessing bladder outlet obstruction. They also should be most useful to the practicing clinician when interpreting the results of a peak urinary flow rate determination for a patient presenting with symptoms of prostatism.

Adult↗
PubMed1994

Endocrine therapies for BPH: scientific rationale, clinical results, and patient selection.

In 1993, medical therapy for BPH is a reality. Androgen deprivation therapy (LHRH agonists, antiandrogens, and 5 alpha-reductase inhibitors) has been shown to be effective by reducing the static component of BPH. Of these agents, the 5 alpha-reductase inhibitors have the greatest promise because of their low toxicity profile. Aromatase inhibitors, which function via a different mechanism, however, have not been demonstrated, as monotherapy, to be effective in the treatment of symptomatic BPH. It is still theoretically possible that aromatase inhibitors could have a role in the management of prostatism if they are utilized in conjunction with an antiandrogen or 5 alpha-reductase inhibitor. Although the early results for this endocrine therapies are encouraging, several issues relating to medical treatment remain unanswered. Not everyone with significant prostatism will respond to androgen deprivation therapy. How does the physician identify pre-treatment the patient most likely to achieve a significant improvement in voiding function with 5 alpha-reductase inhibitor therapy? At the present time, there is no method--based on symptoms, DRE findings, serum hormone and PSA levels, or histopathologic criteria--for recognizing the ideal patient for androgen deprivation therapy. Without question, it is a subjective decision. As a result, the benefits and risks of these medical approaches as well as those of the minimally invasive and surgical therapies must be discussed with the patient so that he can participate in the management decision. In this manner, the expectations and needs of the patient will be best served.

5-alpha Reductase Inhibitors↗
PubMed1994

The UroLume endoprosthesis: a summary of the European and North American experience.

The UroLume Endoprosthesis, although originally developed for endovascular use, has received much interest in recent years for maintaining patency of the male urethra. It is a permanent, flexible, self-expanding device that becomes covered with epithelium and incorporated into the urethral wall. It is being investigated as an effective treatment for recurrent bulbar urethral strictures, BPH, and detrusor-external sphincter dyssynergia. Based on preliminary results, difficult strictures of nontraumatic origin can be treated very effectively with this endoprosthesis; recurrence is a rare event, even with long-term follow-up. This endoprosthesis maintains a large intraluminal diameter in the bulbar urethra, which allows for subsequent catheterization, cystoscopy, and ureteroscopy once epithelialization has occurred. Its placement in the bulbar urethra is straightforward and fast; significant complications are virtually nonexistent. Symptomatic patients with an obstructing prostate gland, in which the prostatic urethra is at least 2.5 cm in length and there is no significant median lobe, can be treated successfully with the UroLume Endoprosthesis. Improvements in obstructive symptoms and peak urinary flow rate approach those of TURP. Many patients, however, do experience irritative voiding symptoms in the immediate postoperative period. If additional studies--that have the proper control arm, a large number of patients, and long-term follow-up--demonstrate this endoprosthesis to be an effective treatment of BPH, its advantages are numerous. They include: 1) placement with the patient under regional anesthesia or with a prostatic block and intravenously administered sedative only; 2) short operating time (10-15 minutes or less) once the procedure is learned; 3) minimal to no intraoperative and postoperative hemorrhage; 4) no indwelling urethral catheter postoperatively; 5) dismissal on the same day or the following morning; 6) minimal convalescence; 7) no effect on the serum prostate-specific antigen (PSA) concentration; and 8) a one-time treatment performed by the practicing urologist. Preliminary studies evaluating the UroLume Endoprosthesis as a treatment for detrusor-external sphincter dyssynergia also have yielded positive results. It is effective in lowering intravesical voiding pressures, allowing for complete bladder emptying, preventing dilatation of the upper tracts, and maintaining stable renal function. It provides for a functional sphincterotomy without the significant complications of hematuria and erectile dysfunction that can result from the traditional endoscopic external sphincterotomy.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1994

Tumor markers. Consensus Conference on Diagnosis and Prognostic Parameters in Localized Prostate Cancer. Stockholm, Sweden, May 12-13, 1993.

This chapter mainly deals with biochemical aspects on prostate specific antigen (PSA) and its clinical value. To a limited extent, also other tumor markers, which might be of importance in the evaluation of patients with prostate cancer are discussed. In serum, PSA exists in a free form or bound to antichymotrypsin. Interestingly, only 10% of PSA secreted from cancer cells seems to exist in a free form, as compared to 30% of PSA secreted from cells in benign prostatic hyperplasia (BPH). PSA seems to be closely, but not absolutely, related to tumor grade and stage. The mean value of PSA in patients with tumors dominated by Gleason grades 3 or below, was 10 ng/ml, compared to 29 ng/ml in those with higher grades. Patients with PSA values of 50 ng/ml or above almost exclusively had tumor of Gleason grades 4 or 5, and this limit usually reflected a generalized disease. Patients with PSA-values below 10 ng/ml almost exclusively had tumors confined to the prostate gland. In countries where screening for prostate cancer is believed in, it is important to understand that normal cut-off values are related to patient's age. The upper normal limit of males below 50 years of age should be set at 2.5 ng/ml, as compared to 6.5 ng/ml for men over 70 years of age. To improve the value of PSA determination and for scientific purposes, the standardization of the assay is urgently needed and under way. Prostate acid phosphatase (PAP) has in most centres been replaced by PSA. An elevated PAP value, as measured by the enzymatic method, invariably indicates a generalized disease and could thus be used as a complementary informative assay to PSA. Other markers have been used mainly to achieve additional prognostic information. In a multivariate analysis, the non-specific tumor marker neopterin, which reflects the host response to tumor antigens, was closely related to short-term prognosis. Neopterin was followed by thymidine kinase, a protein reflecting the cell turn-over and tumor grade. Also PSA at diagnosis seemed to add some prognostic information, whereas other markers did not.

Adult↗
PubMed1993

Serum prostate-specific antigen in a community-based population of healthy men. Establishment of age-specific reference ranges.

OBJECTIVE: To define the characteristics of serum prostate-specific antigen (PSA) in a population of healthy men without clinically evident prostate cancer, but who are at risk for developing the malignancy. The influence of patient age and prostatic size on the serum PSA concentration was assessed in order to use PSA more appropriately to detect clinically significant prostate cancer at an early, potentially curable stage. DESIGN: Prospective, community-based study. PARTICIPANTS: Between December 1989 and March 1991, 2119 healthy men aged 40 to 79 years from Olmsted County, Minnesota, were entered into a prospective study to assess the natural history of benign prostatic hyperplasia. Of these, 537 (25%) were randomly chosen to participate in a detailed clinical examination that included a serum PSA determination (Tandem-R PSA assay), digital rectal examination, and transrectal ultrasonography. Four hundred seventy-one (88%) completed the prostatic evaluation and had no evidence of prostate cancer by any of these three diagnostic tests; these men formed the study population on which all analyses were performed. MAIN OUTCOME MEASURE: Serum PSA concentration, prostatic volume, and PSA density (serum PSA level/prostatic volume) as a function of patient age. RESULTS: The serum PSA concentration is correlated with patient age (r = .43; P < .0001) and prostatic volume (r = .55; P < .0001). Prostatic volume, in turn, is directly correlated with patient age (r = .43; P < .0001), whereas the PSA density value is only weakly correlated with patient age (r = .25; P < .001). For a healthy 60-year-old man with no evidence of prostate cancer, the serum PSA concentration increases by approximately 3.2% per year (0.04 ng/mL per year). The recommended reference range for serum PSA (95th percentile) for men aged 40 to 49 years is 0.0 to 2.5 ng/mL; for 50 to 59 years, 0.0 to 3.5 ng/mL; 60 to 69 years, 0.0 to 4.5 ng/mL; and 70 to 79 years, 0.0 to 6.5 ng/mL. CONCLUSIONS: The serum PSA concentration is directly correlated with patient age and prostatic volume, the latter of which also is directly related to age. Thus, rather than rely on a single reference range for men of all age groups, it is more appropriate to have age-specific reference ranges. These age-specific reference ranges have the potential to make serum PSA a more discriminating tumor marker for detecting clinically significant cancers in older men (increasing specificity) and to find more potentially curable cancers in younger men (increasing sensitivity).

Adult↗
PubMed1993

The use of prostate-specific antigen in staging patients with newly diagnosed prostate cancer.

OBJECTIVE: To assess the need for obtaining radionuclide bone scans in the staging evaluation of patients with newly diagnosed, untreated prostate cancer. This determination was made on the basis of presenting prostate-specific antigen (PSA) levels. DESIGN: Retrospective review. PARTICIPANTS: The medical records of 2064 consecutive patients with prostate cancer who were evaluated at the Mayo Clinic in Rochester, Minn, from January 1989 through December 1990 were reviewed. Eight hundred fifty-two patients with newly diagnosed, untreated disease and a serum PSA concentration less than 20.0 micrograms/L at presentation comprised the study population. MAIN OUTCOME MEASURE: The rate of false-negative results associated with using the serum PSA concentration to predict bone scan findings. RESULTS: Five hundred sixty-one patients had a serum PSA concentration of 10.0 micrograms/L or less; only three had an abnormal bone scan result, and one had an indeterminate scan result. Of the 467 men whose PSA value was 8.0 micrograms/L or less (two times the upper limit of the reference range), none had bone scan results that were either abnormal or indeterminate. The rate of false-negative results for an abnormal bone scan result was 0% with a serum PSA value of 8.0 micrograms/L or less and 0.5% with a cutoff level of 10.0 micrograms/L. The 95% upper confidence limit for the rate of false-negative results for all PSA cutoff levels less than 20.0 micrograms/L was less than 2%. CONCLUSIONS: For patients with newly diagnosed, untreated prostate cancer, a serum PSA concentration of 10.0 micrograms/L or less, and no skeletal symptoms, a staging radionuclide bone scan does not appear to be necessary. This clinical situation applies to 39% of all patients presenting with newly diagnosed prostate cancer. Since more than 130,000 new cases are diagnosed each year, approximately 50,000 patients are affected annually. If the $600 staging bone scan were eliminated for these patients, a significant economic savings to the health care system in this country would be effected.

Bone Neoplasms↗
PubMed1993

A population-based study of health care-seeking behavior for treatment of urinary symptoms. The Olmsted County Study of Urinary Symptoms and Health Status Among Men.

OBJECTIVE: To determine the extent to which severity of urinary symptoms predicts a man's decision to seek medical care for urinary symptoms. DESIGN: Cross-sectional, population-based survey; the baseline component of a prospective cohort study. SETTING: Olmsted County, Minnesota (1990 population, 105,720), including the city of Rochester (population, 69,995) and surrounding rural townships. SUBJECTS: A population-based sample of men aged 40 to 79 years randomly selected within age- and residence-specific strata. INTERVENTION: A previously validated questionnaire that elicited information about the frequency and bother of urinary symptoms, sociodemographic information, and information regarding use of physician services in the last year. MAIN OUTCOME MEASURE: An affirmative response to any of 12 questions asking the subject if he had seen a physician in the last year because of specific urinary symptoms. MAIN RESULT: Symptom severity, whether measured by American Urologic Association frequency or bother score or by interference with daily activities, was a significant predictor of health care-seeking behavior for urinary symptoms, but was neither as sensitive nor as specific as would be ideal. After adjusting for symptom severity and sociodemographic characteristics, men aged 70 to 79 years were 4.6 times as likely (95% confidence interval, 2.1 to 10.1) as men aged 40 to 49 years to have sought health care because of urinary symptoms in the last year. CONCLUSION: While symptom severity is an important determinant of health care-seeking behavior for men with urinary symptoms, some additional factor or factors associated with age remain that may drive men to seek care for urinary symptoms. These factors may prove important in understanding the small-area variations in treatment of benign prostatic hyperplasia that have been noted by others.

Adult↗
PubMed1993

Prostate-specific antigen and androgen deprivation therapy.

Prostate-specific antigen (PSA) is a kallikrein-like serine protease that, for all practical purposes, is specific for prostatic tissue. PSA is usually detected at low concentrations (0.0-4.0 ng/ml) in the serum and is the most important tumor marker for detecting otherwise unsuspected prostate cancer; it also useful for monitoring the response of prostate cancer to various types of therapy. Androgen deprivation therapy (ADT) includes bilateral orchiectomy, luteinizing hormone-releasing hormone (LHRH) agonists, antiandrogens, and 5-alpha-reductase inhibitors. Treatment of benign prostatic hypertrophy (BPH) or prostate cancer with ADT usually decreases the serum PSA concentration. Recent basic science research has demonstrated that the expression of the PSA gene is controlled by androgens acting via the androgen receptor. Therefore, in some patients a low serum PSA concentration will be the result of hormonal down-regulation of the genetic expression of PSA and not the result of the antitumorigenic activity of the therapy. Nevertheless, in spite of the direct effect of ADT on PSA expression, PSA remains a valuable prostate cancer tumor marker for prognosticating the response to ADT and portending clinical progression after this type of treatment for most patients.

5-alpha Reductase Inhibitors↗
PubMed1993

Prognostic implications of prostate-specific antigen in patients with locally advanced prostate cancer treated with high energy neutron beam therapy: preliminary results.

Serial serum prostate-specific antigen (PSA) levels were analyzed retrospectively for prognostic implications in 70 patients with locoregional (Stages B2, C, and D1) prostate cancer who were managed with high energy neutron beam therapy. Three groups of patients were identified. Group I included 30 patients whose serum PSA level decreased to the reference range (0-4 ng/mL) following neutron therapy and remained so subsequently: 28 (93%) remained disease-free and 2 (7%) have failed distantly. All 30 patients (100%) had no evidence of locally progressive disease. This group was categorized as having a good prognosis. The mean time for serum PSA value to decline to reference range was six months; calculated mean time to achieve a stable base-line PSA was 53 +/- 37 days. Follow-up period ranged from twelve to fifty-six months (median: 21 months). Group II consisted of 13 patients in whom there was an initial decrease in serum PSA to reference range followed by a subsequent increase: 6 of 13 (46%) have no overt clinical progression of disease; 7 (54%) have either persistent locoregional or distant metastatic disease. Follow-up period was from twelve to seventy-two months (median: 39 months). Calculated mean time to achieve stable baseline PSA for serum PSA in this group was 61 +/- 21 days. Group III patients had a persistently elevated or rising serum PSA concentration. Of 27 patients in this group, only 9 (33%) have no evidence of disease progression, while 18 patients (67%) have failed already, either locoregionally or distantly. Follow-up period ranged from twelve to sixty-nine months (median: 21 months). Mean time to achieve stable baseline of serum PSA in this cohort of patients with a poor prognosis was 108 +/- 76 days. We conclude that PSA has a predictable prognostic value in patients with locally advanced prostate cancer managed with high energy neutron beam therapy. Rapid normalization of PSA after therapy indicates a good prognosis. Persistent elevation signifies either presence of persistent locoregional disease or development of distant metastases. Subsequent elevation of the serum PSA concentration after definitive therapy signals progression of prostate cancer.

Aged↗
PubMed1993

Urologic applications of a permanent, epithelializing urethral endoprosthesis.

Recently, a flexible, self-expanding, permanent endoprosthesis has been developed to maintain patency of stenotic arteries after balloon angioplasty. This device, known as the UroLume Wallstent, is now under active investigation in both Europe and the United States as a treatment for: (1) recurrent bulbar urethral strictures, (2) benign prostatic hyperplasia, and (3) detrusor-external sphincter dyssynergia. Preliminary data demonstrate this device to be an effective treatment for all three indications in select patients and to be associated with minimal untoward effects. If the long-term results are equally encouraging, this unique endoprosthesis will represent a significant advancement for the field of urology.

Adult↗
PubMed1993

Clinical Stage B0 or T1c prostate cancer: nonpalpable disease identified by elevated serum prostate-specific antigen concentration.

A retrospective study was performed to evaluate the clinical and pathologic characteristics of 60 patients with a palpably benign prostate gland, but with biopsy-proved prostate cancer. All patients underwent prostate biopsy because of elevated serum prostate-specific antigen (PSA) concentration, and subsequently underwent radical retropubic prostatectomy (RRP). Similar analysis was performed for a randomly selected group of 60 clinical Stage B1 prostate cancers from the same period (control cohort). Patients with nonpalpable prostate cancers had a higher preoperative PSA level as compared with the clinical Stage B1 group (median value: 12.3 ng/mL versus 4.6 ng/mL, p < 0.001). There was no significant difference between the two groups with regard to clinical parameters (voiding symptoms, hematuria, age). The nonpalpable prostate cancers exhibited a significant tumor volume (mean: 7.4 cc; range: 0.3-56 cc), and 18 (30%) demonstrated capsular perforation to involve the periprostatic tissues. Of these, three (5%) had seminal vesicle invasion, and one (2%) had pelvic lymph node involvement. There was no difference between these pathologic characteristics and those of the clinical Stage B1 prostate cancers. These findings suggest that nonpalpable prostate cancers identified by an elevated serum PSA level can be of clinical significance and warrant therapeutic consideration. Although nonpalpable, these cancers are peripherally located and were clinically suspected prior to biopsy. Therefore, we propose that these cancers be classified as clinical Stage B0 in the Whitmore-Jewett staging system; in the new TNM staging system, they are designated as clinical Stage T1c.

Adult↗