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Biomedical subjects

M S Austenfeld

Publications and source records attributed to M S Austenfeld.

12 recordsLinked to original sources
PubMed1999

Have complication rates decreased after treatment for localized prostate cancer?

PURPOSE: The American Urological Association Prostate Cancer Clinical Guidelines Panel reviewed 12,501 publications on prostate cancer from 1955 to 1992 to determine whether the complication rates of external beam radiation therapy, interstitial radiotherapy and radical prostatectomy have decreased. MATERIALS AND METHODS: Complications reported in at least 6 series, study duration and sample sizes were extracted. Year specific study weighted mean patient ages and complication rates were computed. Regression analysis was performed of the study year on weighted mean patient age and complication rate. RESULTS: Study year had a significant effect on mean patient age and rate of the majority of complications examined. Data indicated a gradual increase in study patient age and a simultaneous decrease in complications from 1960 to 1990. CONCLUSIONS: Complication rates in the treatment of localized prostate cancer have decreased during the last 20 to 40 years. This decrease occurred despite evidence that the average age of treated patients had increased during the same period.

Aged↗
PubMed1995

Prostate Cancer Clinical Guidelines Panel Summary report on the management of clinically localized prostate cancer. The American Urological Association.

PURPOSE: The American Urological Association convened the Prostate Cancer Clinical Guidelines Panel to analyze the literature regarding available methods for treating locally confined prostate cancer, and to make practice policy recommendations based on the treatment outcomes data insofar as the data permit. MATERIALS AND METHODS: The panel searched the MEDLINE data base for all articles from 1966 to 1993 on stage T2 (B) prostate cancer and systematically analyzed outcomes data for radical prostatectomy, radiation therapy and surveillance as treatment alternatives. Outcomes considered most important were survival at 5, 10 and 15 years, progression at 5, 10 and 15 years, and treatment complications. RESULTS: The panel found the outcomes data inadequate for valid comparisons of treatments. Differences were too great among treatment series with regard to such significant characteristics as age, tumor grade and pelvic lymph node status. The panel elected to display, in tabular form and graphically, the ranges in outcomes data reported for each treatment alternative. CONCLUSIONS: In making its recommendations, the panel presented treatment alternatives as options, identifying the advantages and disadvantages of each, and recommended as a standard that patients with newly diagnosed, clinically localized prostate cancer should be informed of all commonly accepted treatment options.

Humans↗
PubMed1995

Preoperative estimate of extent of disease in T1c: how well can we predict?

Serum prostate-specific antigen testing and systematic ultrasound-guided biopsy has improved our ability to diagnose low-stage, nonpalpable prostate cancer. With improvement of diagnostic sensitivity, the risk of finding clinically insignificant or "latent" prostate cancer has likewise increased. The potential morbidity and expense of overdiagnosing and treating latent prostate cancer has necessitated the search for better methods of determining tumor extent and significance. This information may then be used for development of individual treatment strategies. Serum prostate-specific antigen level, prostate-specific antigen density, and characterization of biopsy tissue appear to be reasonably accurate methods of estimating tumor extent.

Biopsy, Needle↗
PubMed1994

Meta-analysis of the literature: guideline development for prostate cancer treatment. American Urological Association Prostate Cancer Guideline Panel.

Medical interventions are identified to be in need of practice guidelines based on several criteria, including uncertainty of therapeutic benefit, economic impact, variation in practice patterns and lack of objective data for new developments. Treatment of localized adenocarcinoma of the prostate meets these criteria and has been identified as an issue in need of practice guideline development. The American Urological Association began working toward establishing prostate cancer treatment guidelines in 1989. An explicit method based on collection of scientific data was adopted, which requires complete review of the literature and analysis of the evidence collected. An update on the progress toward this data analysis and guideline document is presented.

Adenocarcinoma↗
PubMed1993

Mutant p53 expression in prostate carcinoma.

The expression of the mutant p53 tumor suppressor gene was evaluated in 33 human prostate carcinomas. Using an immunohistochemical method with monoclonal antibodies PAb 1801 and PAb 240, 26 (79%) tumors demonstrated positive immunostaining for mutant p53. Only areas of glandular tumor were positive, with adjacent stromal elements and areas of glandular hyperplasia being negative. The predominant staining pattern was cytoplasmic. This pattern may be related to p53 binding to certain heat shock proteins (HSP 72/73), as a monoclonal antibody to these proteins demonstrated a cytoplasmic location as well. These results demonstrate that abnormal p53 expression is a frequent event in prostate cancer.

Adenocarcinoma↗
PubMed1993

Combined cholecystectomy and radical genitourinary cancer surgery.

We have routinely performed simultaneous cholecystectomy in patients with cholelithiasis undergoing selected radical genitourinary cancer surgery. A total of 31 patients have undergone cholecystectomy at the time of radical nephrectomy (25), radical cystectomy (5), and radical prostatectomy (1). Operative time was increased twenty-five to forty-five minutes. There was no significant increase in blood loss, postoperative total bilirubin, or number of complications. No complications were directly attributable to the cholecystectomy except for 1 patient who had prolonged drainage from a closed suction drain in the gallbladder fossa. We conclude that concomitant cholecystectomy at the time of radical genitourinary cancer surgery does not significantly increase morbidity and recommend that it be performed in the presence of cholelithiasis.

Adult↗
PubMed1993

Flow cytometric DNA ploidy pattern for predicting metastasis of clinical stage I nonseminomatous germ cell testicular tumors.

The best treatment of patients with clinical Stage I nonseminomatous germ cell testicular tumors (NSGCTT) remains controversial. Archival formalin-fixed paraffin-embedded testicular tumor specimens from 23 patients diagnosed between 1977 and 1988 were available for analysis. All patients had clinical Stage I NSGCTT, and the specimens were prepared using Hedley's technique and propidium iodide staining prior to flow cytometric ploidy analysis. Tumors from 3 patients (13%) were classified as DNA diploid; the remaining 20 tumors had DNA aneuploid patterns. Eleven patients had retroperitoneal lymph node dissection (RPLND); 2 (18%) were upstaged to pathologic NSGCTT Stage IIA, and 1 had a subsequent relapse in the contralateral testicle. Among 12 patients in the surveillance protocols, 3 (25%) had tumor recurrence. All patients who were either upstaged to pathologic NSGCTT Stage IIA or had tumor recurrence while under surveillance had DNA aneuploid patterns. The 3 patients with DNA diploid tumor patterns had been in the surveillance protocols. To date, with fifteen months minimum follow-up, none has had tumor recurrence. Such data suggest that flow cytometric DNA ploidy analysis, when used as an adjuvant to more traditional prognostic parameters, may help to identify a group of patients with clinical Stage I NSGCTT at very low risk for recurrence and perhaps well-suited for surveillance management.

Adult↗
PubMed1993

Comparison of patient-controlled analgesia versus intramuscular narcotics in resolution of postoperative ileus after radical retropubic prostatectomy.

Patient-controlled analgesia has become standard practice after major abdominal operations. The benefits of patient-controlled analgesia have been well documented. However, its possible effect of prolonging postoperative ileus has not been well examined. To determine if patient-controlled analgesia prolongs postoperative ileus when compared to conventional intramuscular narcotics, a retrospective review of length of postoperative ileus in 98 consecutive patients (62 using patient-controlled analgesia and 36 using intramuscular narcotics) undergoing bilateral pelvic lymphadenectomy and radical retropubic prostatectomy was done. The patients receiving patient-controlled analgesia resolved the postoperative ileus an average of 1.0 day later than the intramuscular injection group (5.2 days versus 4.2 days p < 0.0001). Overall hospital stay was not significantly affected. Our results show that patient-controlled analgesia use prolongs postoperative ileus.

Analgesia, Patient-Controlled↗
PubMed1993

Treatment of stage A1 prostate cancer: the case for observation.

Stage A1 prostate cancer implies indolence. If only well-differentiated low-volume tumors are considered, the rate of cancer growth, clinical progression, and prostate cancer death is exceedingly low. All but a very few of these patients will need observation alone. Younger patients (those less than 60 years of age) and those with more moderately differentiated tumors or with serological or ultrasound evidence of residual cancer need further evaluation. It is likely that patients within this group are those who have in past studies experienced a higher degree of progression and cancer mortality. A stepped-up effort to detect nonpalpable prostate cancer has included PSA and transrectal ultrasound with random biopsies. Prostate cancer screening using a serum test and/or ultrasound has allowed increased detection of otherwise clinically silent cancer (stage A). Occult prostate cancer identified by needle biopsy or detected through elevated PSA levels most often is peripheral zone cancer and more aggressive than that arising in the transitional zone. A reclassification of stage A is therefore needed and a new scheme for TNM staging was recently introduced (Table 4). Because of its more aggressive potential, the new stage T1c will likely require different treatment recommendations than those for traditional stage A1 (T1a). More time and evaluation will be needed to estimate the prognosis of those diagnosed with minimal stage T1c prostate cancer.

Aged↗
PubMed1990

New concepts in the treatment of stage D1 adenocarcinoma of the prostate.

Stage D1 disease will be encountered in 20 per cent of patients by those who treat prostate cancer. There is marked heterogeneity among cancers discovered at this stage, with 5-year disease-free survival rates ranging from 0 to 95 per cent. Generally, when prostate cancer has escaped the confines of the gland, metastasis occurs, and widespread systemic disease prevails. Any significant chance for long-term cure will then depend on systemic therapy. From maturing data in retrospective reviews, preliminary data from prospective trials, and recent well-conducted animal studies, chemotherapy and hormonal deprivation appear most effective when tumor volumes are the smallest. This evidence supports the removal of all cancer possible and the early institution of systemic treatment. Caution must be exercised in extrapolating the aforementioned evidence to include cases of more extensive prostate cancer (i.e., patients with bulky pelvic or retroperitoneal disease, distant metastasis, or significant elevation of serum markers). It is doubtful that "debulking" with removal of the prostate and lymph nodes will provide any justifiable advantages in these patients. Whether removal of the prostate affords any local palliative benefit is an issue for debate. Certainly, the primary tumor, if left untreated, will progress locally and cause symptoms necessitating further procedures in more than half these patients, whereas the incidence of local recurrence and the adverse effects of these recurrences in patients with D1 disease after radical prostatectomy and adjuvant therapy is less than 10 per cent. Surgical refinements coupled with acceptably low morbidity now associated with radical prostatectomy have led some authors to endorse the palliative benefits of removing the primary tumor in selected patients. The purpose of this article is not to endorse or disparage the aggressive treatment of patients with stage D1 prostate cancer. The evidence suggests that if long-term survival is the endpoint used to compare treatment groups, then to date no treatment option offers significant advantages. On the contrary, if progression rates or disease-free survival are compared, then cytoreductive surgery and early systemic adjuvant treatment (testosterone deprivation or chemotherapy) provides significant advantages for selected patients with stage D1 disease. Although ploidy analysis, receptor mapping, and oncogene assays are promising, today, there is no practical way to identify patients who will benefit most from multimodality treatment approaches.(ABSTRACT TRUNCATED AT 400 WORDS)

Adenocarcinoma↗
PubMed1988

Complications of pregnancy in women after reimplantation for vesicoureteral reflux.

The physiological changes of the urinary tract during pregnancy place women at increased risk of urological problems during that time. To evaluate how patients after ureteral reimplantation fared during this high risk period we contacted 67 women who had undergone ureteroneocystostomy with a minimum of 15 years of followup. Only those who underwent an operation for primary vesicoureteral reflux were included. Of the women 30 had been pregnant with 64 total pregnancies. During pregnancy 17 of the 30 women (57 per cent) had 1 or more urinary tract infections and 5 (17 per cent) had 1 or more episodes of pyelonephritis. There were 8 spontaneous abortions and 1 severe ureteral obstruction requiring cutaneous drainage until after delivery. There appears to be an increased risk of urinary infection and fetal loss in pregnant women who have undergone ureteral reimplantation as children. More frequent urinary screening and aggressive therapy during pregnancy are recommended in this high risk group.

Abortion, Spontaneous↗