Biomedical subjects

J E Oesterling

Publications and source records attributed to J E Oesterling.

At least 163 records · Page 9Linked to original sources

PubMed1993

Using PSA to eliminate the staging radionuclide bone scan. Significant economic implications.

The findings of these two large-scale clinical studies indicate that serum PSA is an accurate and reliable predictor of the bone scan findings for 40% of the patients presenting with newly diagnosed, untreated prostate cancer. For these patients with no skeletal symptoms and a serum PSA value of 10 ng/mL or less by either the Tandem-R or the IMx assay, a staging radionuclide bone scan is not necessary, as it provides no additional useful information over what is learned from the serum PSA value. If these bone scans were eliminated for these selected patients, approximately $38 million could be saved annually in the United States. As the incidence of newly diagnosed prostate cancer continues to increase, so will the economic savings associated with using the serum PSA concentration to predict the bone scan findings in appropriate patients.

Adult↗

PubMed1992

Benign prostatic hyperplasia. Its natural history, epidemiologic characteristics, and surgical treatment.

Benign prostatic hyperplasia is a nonmalignant enlargement of the prostate that is due to both epithelial and stromal hyperplasia. Although the exact origin of this condition is not well defined, it is thought to arise as microscopic nodules in the periurethral tissue of the prostate gland as early as the late '20s. With advancing age and the presence of androgens, this histologically identifiable hyperplastic tissue progresses to a macroscopic state, which is a palpably enlarged prostate. This enlarged prostate causes clinically significant obstruction of the bladder outlet in many men, necessitating therapeutic intervention. Currently, prostatectomy is the standard treatment with successful long-term results. Nevertheless, much information has become available recently on its indications, outcomes, associated morbidity and mortality, and effect on quality of life. Because of these findings as well as the rising healthcare costs and the desire among patients to avoid surgery if possible, there is much enthusiasm for developing less expensive, less invasive, but effective treatments for symptomatic benign prostatic hyperplasia. To appreciate the tremendous advances being made with regard to the treatment of benign prostatic hyperplasia, it is necessary to have a complete understanding of the disease process itself and its traditional therapies. This clinical report provides a comprehensive review of the natural history, epidemiologic characteristics, and outcomes of both open and transurethral surgery for benign prostatic hyperplasia.

Age Distribution↗

PubMed1992

Prostate-specific antigen and diagnosing early malignancies of the prostate.

Prostate-specific antigen is a kallikrein-like serine protease that is produced exclusively by the epithelial cells of all types of prostatic tissue, benign and malignant. Physiologically, it is present in the seminal fluid at high concentration and functions to cleave the high molecular weight protein responsible for the seminal coagulum into smaller polypeptides. This action results in liquefaction of the coagulum. Prostate-specific antigen is also present in the serum and can be measured reliably by several different assays. Although the protein is prostate-specific, it is not prostate-cancer-specific. As a result, benign conditions such as benign prostatic hyperplasia, prostatitis and infarction, as well as prostatic intraepithelial neoplasia, can be associated with elevated serum levels of prostate-specific antigen. Approximately 25% of men with benign prostatic hyperplasia have an elevated serum value of prostate-specific antigen, whereas 35% to 40% of patients with organ-confined prostate cancer have a level within the reference range. Prostate-specific antigen can identify some cancers not detectable by digital rectal examination; alternatively, this examination can identify cancers not detectable from the serum prostate-specific antigen concentration. Thus, the most complete evaluation of the prostate gland is achieved when both the prostate-specific antigen value and the digital rectal examination are used. The density and the rate of change of serum prostate-specific antigen are new concepts to improve the ability of prostate-specific antigen to detect early prostate cancer. Preliminary results are encouraging, but additional studies are required to determine the true usefulness of these new variables. Thus, in 1992, determination of the prostate-specific antigen value is a valuable new tool for the practicing physician and will be instrumental in our campaign to diagnose clinically significant prostate cancer at an early, curable stage.

Amino Acid Sequence↗

PubMed1992

Prostate-specific antigen: establishment of the reference range for the clinically normal prostate gland and the effect of digital rectal examination, ejaculation, and time on serum concentrations.

This study investigated the serum prostate-specific antigen concentration in 100 healthy men (mean age, 26.3 years; range, 20-29 years) with a clinically normal prostate gland. The effect of digital rectal examination and ejaculation on the serum concentration, and the variability of the serum concentration over 1-week and 1-month periods were examined. In the 100 subjects, the serum prostate-specific antigen concentration ranged from less than 0.1-2.6 ng/ml. The mean, median, and mode were 0.68 ng/ml, 0.6 ng/ml, and 0.4 ng/ml, respectively. The 97.5th percentile value was 2.1 ng/ml. The mean and median changes in the serum concentration after digital rectal examination were -0.013 +/- 0.11 ng/ml and 0.0 ng/ml, respectively (P = 0.59 compared with control group). The mean change after ejaculation was 0.05 +/- 0.12 ng/ml, and the median change was 0.0 ng/ml (P = 0.14 compared with control group). Diurnal variation showed minimal change in 16 patients over a 1-week period. The mean change (p.m. value-a.m. value) was 0.003 ng/ml (range, -0.2-0.06 ng/ml). In addition, the serum concentration showed minimal intrapatient variability in 20 patients throughout a 1-month period; the average coefficient of variation (standard deviation/mean) in these subjects was 16.5% (range, 6.4-45.2%). These results indicate that the range in the serum concentration of prostate-specific antigen for healthy men with a clinically normal prostate gland is significantly lower (0.0-2.6 ng/ml) than the currently employed range (0.0-4.0 ng/ml; Tandem-R PSA assay); in addition, digital rectal examination and ejaculation have no significant effect on the serum concentration. Finally, the time of day has little effect, and the variability in the serum concentration of prostate-specific antigen over a 1-week and 1-month interval is minimal.

Adult↗

PubMed1992

Anterior rectal wall hematoma: complication of transrectal ultrasound-guided biopsy of prostate.

Transrectal biopsy of the prostate, because of its directness and simplicity, is utilized by many practicing urologists to obtain prostatic tissue for histologic evaluation. Complications arising from this procedure are primarily of an infectious origin and less commonly of a vascular etiology. We report on the first known patient in whom a large hematoma of the anterior rectal wall with nearly total occlusion of the rectal lumen developed following a transrectal ultrasound-guided biopsy of the prostate. Guidelines to reduce the likelihood of vascular complications following biopsy of the prostate gland for patients consuming medications that may alter normal platelet function or interfere with the various clotting factors are described.

Aged↗

PubMed1992

Abdominal catheter holder to maintain controlled urethral catheter tension post transurethral resection of prostate.

Postoperative hemorrhage remains the most common complication associated with transurethral resection of the prostate. To reduce this venous bleeding, the urologist frequently will place the urethral catheter on traction in order to secure the balloon up against the bladder neck and thereby compress the prostatic capsule. To more effectively achieve this goal, an abdominal catheter holder has been developed that anchors the urethral catheter to the lower abdominal wall without the need for adhesive tape. This device is most effective in maintaining controlled, constant tension on the catheter, not associated with any untoward effects, and simple to use.

Abdomen↗

PubMed1992

Validation of a new quality of life questionnaire for benign prostatic hyperplasia.

In planning a longitudinal study to characterize the natural history of benign prostatic hyperplasia (BPH), we validated a new disease-specific quality of life questionnaire in a pilot study. We studied 110 men in Rochester, Minnesota who spanned the severity of BPH, from men with no known BPH to men who underwent surgery for this condition. Baseline data were obtained on all men, and the 30 who underwent prostatectomy were re-interviewed to test responsiveness. Reproducibility was examined on the pre-post responses (10 weeks apart) of the 37 men with BPH who did not undergo prostatectomy. Six of twelve question domains were retained in the final questionnaire on the basis of their responsiveness to change, reproducibility, internal consistency, and validity. These were: urinary symptoms, degree of bother due to urinary symptoms, BPH-specific interference with activities, general psychological well-being, worries and concerns, and sexual satisfaction. Most of the more generic measures were deleted.

Adult↗

PubMed1992

The effect of digital rectal examination on the serum prostate specific antigen concentration: results of a randomized study.

To determine the effect of digital rectal examination on the serum prostate specific antigen (PSA) concentration a prospective, randomized, controlled trial involving 143 patients was conducted. Of the patients 86 (60%) had benign prostatic hyperplasia (BPH), 47 (33%) had prostate cancer and 10 (7%) had chronic prostatitis. The study group consisted of 71 men, all of whom had a serum PSA determination followed by a digital rectal examination and then a second serum PSA determination. The control cohort consisted of 72 men, all of whom had 2 serum PSA determinations without an intervening digital rectal examination. The median change in the serum PSA level for the study group was 0.4 ng./ml. compared to -0.1 ng./ml. for the control cohort (p less than 0.0001). For 76% of the study patients the second serum PSA level was greater than the initial value; only 32% of the control patients exhibited a higher second serum PSA level than the initial level (p less than 0.0001). However, only 4 patients with an initial PSA value in the reference range (0.0 to 4.0 ng./ml.) had a post-digital rectal examination value greater than 4.0 ng./ml. and only 1 patient whose presenting serum value was less than 10.0 ng./ml. had a serum PSA level greater than this cutoff point after digital rectal examination. This minimal change in serum PSA after digital rectal examination was independent of the diagnosis (BPH, cancer or chronic prostatitis), initial serum PSA concentration and examiner. Thus, although digital rectal examination had a statistically significant effect on the serum PSA concentration, the clinical significance of a 0.4 ng./ml. median increase appears inconsequential. Based on these findings, physicians should be confident that the serum PSA concentration in the immediate post-digital rectal examination period is accurate and does not compromise clinical use of the tumor marker.

Adult↗

PubMed1992

Small cell anaplastic carcinoma of the prostate: a clinical, pathological and immunohistological study of 27 patients.

Because small cell anaplastic carcinoma of the prostate is an uncommon tumor, it has remained a poorly defined entity. To elucidate further the clinical, pathological and immunohistochemical characteristics of this cancer the 27 patients who presented to the Mayo Clinic from 1960 to 1990 were reviewed. Of these patients 18 (67%) presented with pure small cell anaplastic carcinoma, and 9 (33%) were diagnosed with small cell anaplastic carcinoma and adenocarcinoma of the prostate. Twenty-six patients (96%) had either stage C or D disease at the time of diagnosis. Two patients presented with a paraneoplastic syndrome, including 1 man with inappropriate antidiuretic hormone secretion and 1 who suffered from thyroxine intoxication. Of 24 men with long-term followup 22 (92%) died of small cell anaplastic carcinoma of the prostate despite antiandrogen therapy and the remaining 2 are alive with active, progressive disease. The median survival time following diagnosis was 17.1 months (range 2 to 90 months). All tumors with tissue available for immunohistochemical staining reacted positive for neuron-specific enolase, indicating that small cell anaplastic carcinoma of the prostate is most likely a neuroendocrine neoplasm. No tumor stained positive for either prostatic acid phosphatase or prostate specific antigen. Pathologically, small cell anaplastic carcinoma of the prostate appears to be similar to oat cell carcinoma of the lung. This series of 27 patients emphasizes that small cell anaplastic carcinoma of the prostate is highly malignant, is frequently of advanced stage at presentation, responds poorly to antiandrogen therapy and has a poor prognosis.

Adenocarcinoma↗

PubMed1992

Hormonal treatment at time of radical retropubic prostatectomy for stage D1 prostate cancer: results of long-term followup.

In this long-term study with a median followup of greater than 10 years 62 patients who underwent bilateral pelvic lymphadenectomy and radical retropubic prostatectomy for stage D1 adenocarcinoma of the prostate were subdivided with respect to nuclear deoxyribonucleic acid ploidy status of the primary cancer and according to whether they received adjuvant early antiandrogen therapy. Patients with diploid cancers who underwent the operation and received adjuvant early endocrine therapy did significantly better than a similar group without early endocrine therapy with respect to disease-free survival (p less than 0.001) and survival from prostate cancer death (p = 0.03). Among patients with nondiploid tumors early endocrine therapy was of some benefit for disease-free survival (p = 0.06) but not for prostate cancer death (p = 0.46).

Adenocarcinoma↗

PubMed1992

Idiopathic myelofibrosis with myeloid metaplasia involving the renal pelves, ureters and bladder.

Myeloid metaplasia associated with idiopathic myelofibrosis most commonly involves the reticuloendothelial organs, such as the spleen, liver and retroperitoneal lymph nodes. We report on a patient with myeloid metaplasia (extramedullary hematopoiesis) of the renal pelves, ureters and bladder. The pathogenesis, clinical characteristics, treatment and prognosis of this condition are discussed.

Adult↗

PubMed1992

Sustained, substantially increased concentration of prostate-specific antigen in the absence of prostatic malignant disease: an unusual clinical scenario.

A 60-year-old man had a persistent, marked increase in the serum concentration of prostate-specific antigen (more than 20 times the upper limit of the reference range) and no identifiable prostatic malignant involvement. To our knowledge, this is the first such case reported in the literature. Possible explanations for this increased value are described, and nonmalignant conditions that can increase serum concentrations of prostate-specific antigen are reviewed.

Antigens, Neoplasm↗

PubMed1992

A prospective randomized comparison of epidural infusion of fentanyl and intravenous administration of morphine by patient-controlled analgesia after radical retropubic prostatectomy.

In a prospective, randomized study, continuous infusion of epidural fentanyl citrate (group E) was compared with patient-controlled intravenously administered morphine sulfate (group P) for analgesia in 66 men after radical retropubic prostatectomy. Although both methods provided satisfactory analgesia, the mean comfort level scores were lower (that is, greater comfort) in group E than in group P at all observation times. The difference in mean resting comfort level scores between groups E and P was statistically significant (P < or = 0.05) at 9 of the 11 observation times. In addition, significant differences in comfort level scores were noted at 8 of the 11 observation times during deep breathing, 5 of 11 during coughing, and 3 of 9 during ambulation. Maximal and minimal comfort level scores recorded by each patient during the course of the study were significantly lower (that is, less pain) in group E than in group P for all four categories of activity. The percentage of patients who reported no pain was significantly higher in group E than in group P at 9 of 11 observation times during resting and 5 of 11 observation times during deep breathing. No significant differences were noted in side effect profiles or duration of hospital stay. In summary, when two effective methods of analgesia used after radical retropubic prostatectomy were compared prospectively, patients who received epidural infusion of fentanyl were more comfortable than those with patient-controlled intravenous administration of morphine, as evidenced by lower mean, maximal, and minimal comfort level scores and a greater proportion of patients with complete relief of pain.

Aged↗

PubMed1992

What will replace TURP?

Benign prostatic hyperplasia (BPH) is almost ubiquitous. About 25% to 40% of men in their lifetime will undergo treatment for BPH. Surgical therapy produces in excess of 400,000 prostatectomies a year at a cost of more than 4 billion dollars. Given the magnitude of the clinical problem and its overall impact on health care in the United States, the interest in alternatives to transurethral resection of the prostate (TURP) is intense. From the panoply of contenders, the panel nominates those most likely to succeed.

Adrenergic alpha-Antagonists↗

PubMed1992

Transurethral incision of the prostate: a viable alternative to transurethral resection.

TUIP has been shown to be an effective method of relieving urinary outflow obstruction caused by BPH when prostatic size is 30 g or less. This is the situation for approximately 80% of patients undergoing TURP today. The long-term results of TUIP are quite favorable when compared with those of TURP. It is an easier technique to master than TURP. In addition, TUIP has a reduced operative time, little intraoperative and postoperative hemorrhage, reduced incidence of dilutional hyponatremia (TUR syndrome), and decreased length of hospitalization. TUIP also offers a lower risk of complications, especially with regard to impotence and retrograde ejaculation. This makes TUIP particularly well suited for patients in whom maintenance of sexual function is an important consideration. TUIP is also indicated in chronically ill, debilitated patients in whom the risk of anesthesia-related complications is high. Orandi and Graversen et al have shown that TUIP can be satisfactorily performed using only local anesthesia in high risk patients. However, TUIP is not without disadvantages. It is not effective for patients with a prominent median lobe or those with a markedly enlarged prostate gland (greater than 30 g). Another disadvantage is that no tissue is obtained for pathological analysis. Thus, all patients undergoing TUIP should be evaluated preoperatively with both a serum prostate-specific antigen determination and a meticulous digital rectal examination. As cost containment becomes a key factor for our health care system, it is quite likely that TUIP, as well as other less invasive procedures, will have expanded indications. Although the role of TURP in the management of very large prostates causing bladder outlet obstruction is not in question, smaller glands might be better managed with such a treatment as TUIP. As indicated earlier in this report, 80% of patients undergoing TURP could be effectively treated with TUIP--a less invasive, more cost effective treatment that has fewer associated side effects than TURP. Without question, TUIP is a grossly underutilized procedure in 1992. However, its future appears bright as more urologic surgeons are becoming aware of its many advantages and excellent long-term results.

Clinical Trials as Topic↗

PubMed1991

Influence of age, strain, and the testes on rat prostate hormone sensitivity.

There are conflicting reports in the literature regarding the response of the rat prostate to various androgen/estrogen combinations. The reason for these conflicting results has been unclear. The purpose of the present study was to assess factors that may determine the effect of sex hormones on rat prostate growth. The results of this study demonstrate that the prostates of Lewis rats respond differently to sex hormone combinations than do those of Sprague Dawley rats. Young rats have a different prostate hormone responsiveness than do old rats. The presence or absence of the testes alters the responsiveness of the prostate gland to androgen-estrogen combinations. These results suggest that strain, age, and the presence of the testes are important factors which will influence the response of the rat prostate to hormonal manipulation. The importance of these factors should be considered in the design of experiments which deal with the response of the rat prostate to hormone manipulation.

Aging↗

PubMed1991

Non-germ cell tumors of testis.

Testicular tumors of non-germ cell origin represent from 5 percent to 10 percent of all testicular neoplasms. Included in this group are sex cord/gonadal stromal tumors, most originating from Leydig or Sertoli cells, mixed tumors, and tumors of mesenchymal or hematopoietic origin. In addition, various miscellaneous lesions, tumor-like conditions, and secondary testicular tumors may be classified as non-germ cell tumors. This review covers the presentation, diagnosis, and treatment of these rare lesions.

Humans↗

PubMed1991

Urinary symptom and quality of life questions indicative of obstructive benign prostatic hyperplasia. Results of a pilot study.

In a pilot study of a urinary symptom and health-related quality-of-life questionnaire for benign prostatic hyperplasia (BPH), responses from 64 Mayo Clinic patients with cystoscopic evidence of obstructive BPH were compared with those of 14 men with no cystoscopic evidence of BPH and a community sample of 64 comparably aged men with no medical history of prostate enlargement. Questions which best discriminated between the groups were those dealing with urinary symptom frequency, bother due to urinary symptoms, and worry and concern about urinary problems. The results suggest that urinary-symptom-bother and worry due to urinary symptoms may be important additions to the more usual questions asked about urinary frequency in the identification of men with BPH. These findings are preliminary, however, and will be verified in an ongoing natural history study of BPH.

Humans↗