PubMed Health⌕ Search

Biomedical subjects

M S Soloway

Publications and source records attributed to M S Soloway.

At least 109 records · Page 6Linked to original sources
PubMed1993

Relapse on endocrine treatment in patients with stage D2 prostate cancer. Does second-line hormonal therapy affect survival?

Patients with Stage D2 prostate cancer relapsing on endocrine treatment have a grim prognosis. The role of a second-line hormonal treatment is debatable. We analyzed retrospectively, response and survival among 119 men (57 black, 62 white) progressing on a variety of first-line hormonal therapy. Sixty-one received a second-line hormonal treatment. Fifty-eight received only supportive therapy after first line therapy was discontinued. Age and race were not a factor in survival. Based on this retrospective study the optimal management for progressive metastatic prostate cancer cannot be delineated. However, the best results were in patients treated with diethylstilbestrol (DES) as a single treatment or when employed as either first or second treatment in patients receiving two therapies. The other modalities, e.g., bilateral orchiectomy, LH-RH analogues, and anti-androgens resulted in comparable outcomes when used either as single treatment or in combinations. Further clarification of the trends shown in this report require randomized controlled studies.

Adenocarcinoma↗
PubMed1993

Bladder neck preservation and its impact on positive surgical margins during radical prostatectomy.

To modify the bladder neck dissection during radical prostatectomy, in an effort to improve continence and diminish the incidence of anastomotic stricture, without compromising the primary surgical objective of complete cancer removal. Between December 1991 and August 1992, 50 patients underwent radical retropubic prostatectomy with anatomic dissection and preservation of the bladder neck and most proximal portion of the prostatic urethra, thus creating a mucosal cuff for anastomosis to the urethral stump. There was tumor at the inked margin in 18 patients (36%), however, in only 3 instances (6%) was there tumor at the bladder neck margin. In no instance was the bladder neck margin the only positive margin. At a minimum follow-up of six months, all patients are fully continent during routine activities, and in no patient has an anastomotic stricture developed. Anatomic dissection and preservation of the bladder neck and proximal urethra does not compromise surgical margins. We believe this technique may play a role in preservation of continence after radical prostatectomy and probably decreases the likelihood of anastomotic stricture, by allowing for a circumferential mucosa-to-mucosa anastomosis without the need for bladder neck reconstruction.

Aged↗
PubMed1993

How reliable is a single measurement of urinary flow in the diagnosis of obstruction in benign prostatic hyperplasia?

Twenty-six elderly patients with obstructive symptomatology and an initial low peak urinary flow rate (< 15 ml/s) were observed for 6 to 12 months. Repeated assessments were made of flow rates and residual volumes. Within patients variation of the maximal urinary flow was significant; the standard deviation (SD) varied from 0.8 to 5.5 ml/s. The SD varied with the mean peak flow rates and this suggests that the precision of a single determination of a patient's peak flow is inversely related to the peak flow itself. In all, 333 determinations of peak flow were obtained. Only 80% were below 2 SD of the mean Siroky nomogram. Multiple determinations were used to estimate the sensitivity rate for each patient, i.e. the proportion of peak flows that were less than 2 SD below the mean of Siroky's nomogram. The average sensitivity for all of the flow values was 0.813 when applied to voided volumes and increased only slightly to 0.838 when applied to total bladder volume. Given a prevalence of 0.70 of obstruction ascribed to benign prostatic hyperplasia (BPH) among elderly men, the positive predictive value of an abnormally low peak flow was 0.97. A single low peak flow based on assessment of voided volume may serve as an almost sure indication of obstruction. If a patient has a single normal peak flow rate, he still has a 0.31 probability of having evidence of obstruction in his following uroflow determinations. Using total bladder volume does not make a difference in most patients and is not worth the effort and discomfort. The only patients who require accurate residual measurements are those with a normal uroflow but clear-cut obstructive symptomatology or with borderline peak flow. The results of this study are relevant to everyday clinical practice and to the evaluation of studies on alternatives to surgery in BPH.

Aged↗
PubMed1992

Prognostic significance of changes in prostate-specific markers after endocrine treatment of stage D2 prostatic cancer.

BACKGROUND: The prognostic value was determined of prostate-specific antigen (PSA) and prostatic acid phosphatase (PAP) measured before and after endocrine treatment in 57 patients with newly diagnosed Stage D2 prostatic cancer. METHODS: Therapy included orchiectomy or administration of luteinizing hormone releasing hormone analogues or an antiandrogen. RESULTS: The absolute pretreatment PSA (elevated in 100% of patients) but not PAP (abnormal in 93%) predicted disease progression (P < 0.0011), i.e., a poor response to therapy. Fifty-three patients responded to androgen deprivation with a decrease in PSA level. This declined to normal at 3 and 6 months in 25% of patients. Forty-nine percent had a greater than 90% decrease in their PSA level. By 1 year, 58% of patients had progressive disease. Both the nadir PSA level and the percent decline from the pretreatment level at 3 and 6 months predicted the progression-free interval (P < 0.001). Patients with a 90% or greater decline in PSA had a prolonged progression-free survival. Serial PAP levels were similarly prognostic. CONCLUSION: It was concluded that PSA was better than PAP in evaluating patients before and after androgen-deprivation therapy. The nadir level of both markers was an important tool to predict progression-free survival in patients with metastatic prostatic cancer.

Acid Phosphatase↗
PubMed1992

Superficial bladder cancer: diagnosis, surveillance and treatment.

Approximately 70% of all bladder cancers are superficial at the time of presentation. Superficial bladder cancer includes tumors confined to the urothelium (clinical stage Ta) or lamina propria (stage T1) and flat carcinoma in situ (stage Tis). Because the biological behavior of bladder neoplasms is variable, several important prognostic factors must be addressed. Multivariate analyses have shown that factors predictive of tumor recurrence and tumor progression include multifocal tumors, high grade tumors, T1 tumors and positive urinary cytology after transurethral resection (TUR). The patient with superficial bladder cancer should be monitored via endoscopy supplemented by urinary cytology, using either voided or bladder irrigation specimens and urinalysis. Frequent intravenous urography is not required, even in high grade tumors, as long as the clinical and pathologic studies remain negative and the patient is asymptomatic. The "gold standard" of treatment for superficial bladder carcinoma is TUR of the entire tumor. Despite TUR, new tumors will occur in approximately 50% of all patients; those at highest risk for tumor recurrence and progression require adjuvant intravesical therapy after TUR. A variety of drugs are used as intravesical therapy, including thiotepa, mitomycin C, doxorubicin hydrochloride, Bacillus Calmette-Guerin (BCG), epirubicin, and interferon. Although associated with the most toxicity, BCG appears to be the most efficacious agent in increasing the time to recurrence and progression and in reducing the recurrence rate.

Administration, Intravesical↗
PubMed1992

Immunohistochemical evidence of the existence and localization of aromatase in human prostatic tissues.

Estrogens may be involved in normal growth of the prostate and the development of benign prostatic hyperplasia (BPH). The location of estrogen production is still unclear, and there has never been a direct evidence for the existence of the aromatase system, which converts androgens to estrogens, in the prostate. Using an avidin-biotin technique with a polyclonal anti-human placental aromatase, we demonstrated the existence of aromatase in normal prostates of young men and BPH tissue from elderly men. The staining is more pronounced in the stroma. However, positive stains were also seen in the glandular epithelium. While evidence of the existence of an enzyme system does not equal demonstration of its activity in a specific tissue site, our findings suggest that local estrogen production in the stroma and/or epithelium of the prostate may play a role in the maintenance of normal growth and development of BPH.

Adult↗
PubMed1992

Quality of life and psychosocial status in stage D prostate cancer. Zoladex Prostate Cancer Study Group.

Inasmuch as treatments for advanced prostate cancer may have identical clinical outcomes but very different meanings to patients, we sought to compare the impact of surgical and medical castration (orchiectomy versus injected goserelin acetate Zoladex) on quality of life and psychosocial status. A total of 147 men with Stage D prostate cancer participated in the study: 115 selected treatment with goserelin acetate, and 32 chose orchiectomy. Quality of life, as measured by the Functional Living Index: Cancer (FLIC), improved at both the 3 and the 6 month follow-up in the goserelin acetate group (p = 0.0001), but did not change from baseline at 6 months in the orchiectomy group (p = 0.54). These findings were paralleled by improvement from baseline in psychosocial status, as measured by the Profile of Mood States (POMS), at 6 month follow-up (p = 0.01 in the goserelin acetate group versus p = 0.60 in the orchiectomy group). This investigation, which is among the first to evaluate patients' appraisals of their lives following treatment choices for advanced prostatic cancer, argues compellingly for including quality of life in assessments of therapy.

Activities of Daily Living↗
PubMed1992

Experience with weekly doxorubicin (adriamycin) in hormone-refractory stage D2 prostate cancer.

One hundred eleven patients with endocrine-refractory Stage D prostate cancer were treated with weekly administration of 20 mg/m2 body surface area of doxorubicin hydrochloride (Adriamycin). Fifty-seven were part of a randomized study comparing doxorubicin and prednisone to prednisone alone. There were significantly more subjective responders in the doxorubicin group than in the prednisone group (p less than 0.01). The number of patients with evidence of stable disease was also higher during the chemotherapy arm compared with prednisone alone (p = 0.02). Patients taking doxorubicin had a slightly longer period of stable disease than did those taking prednisone (p = 0.08). Overall survival, however, was not prolonged (p = 0.26). Fifty-four patients took part in an open trial and 69 percent responded to treatment. All of these had clinical improvement. Side effects were minimal with cardiotoxicity noted in less than 15 percent among patients with side effects. Over 35 percent had no side effects. Thus single agent, weekly doxorubicin therapy as evaluated in our experience, while well tolerated and of subjective benefit, does not provide the patient with a significant longer progression-free survival or improved overall survival.

Adenocarcinoma↗
PubMed1992

Local tumor recurrence following "radical prostatectomy".

The resurgence of radical retropubic prostatectomy as a commonly employed treatment for organ-confined prostate cancer is largely a result of the reduction in morbidity related to the procedure. One aspect of this reduced morbidity is the potential to preserve potency. The technical points required to perform this procedure must be followed precisely or there is the potential for performing an inadequate cancer operation if these steps are not faithfully followed. We recently encountered a patient with local tumor recurrence because the initial urologist failed to adhere to these principles. A "salvage" procedure was performed.

Adenocarcinoma↗
PubMed1992

Value of urine cytology versus bladder washing in bladder cancer.

A prospective study compared the diagnostic outcome of paired urine cytology and bladder washings in 26 patients as well as the diagnostic accuracy of cytologic reading of voided urine in 43 patients, all with documented bladder cancer. We demonstrate the superiority of bladder washing over voided urine cytology and recommend its routine use in spite of the additional cost and patient discomfort.

Evaluation Studies as Topic↗
PubMed1992

Response to second-line hormonal manipulation monitored by serum PSA in stage D2 prostate carcinoma.

Changes in prostate-specific antigen (PSA) have been demonstrated to accurately assess response to initial hormone deprivation in metastatic prostate cancer patients. The role of PSA in monitoring response to second-line hormonal treatment has not been documented. In a group of 20 patients with an initial response to androgen deprivation and subsequent relapse, we monitored PSA levels before and after second-line therapy. Ten patients had a clinical response. Four had a more than 90 percent decrease in serum PSA compared with the level at initial progression. This clinical response was maintained for a mean of eighteen months. Six patients had a PSA decrease less than 90 percent; their clinical response was of a mean 5.5 months. Ten patients had no change or increase in PSA. Seven had no clinical response, and 3 responded for an average of four months. Although production of PSA might be under endocrine control, changes in PSA are useful for monitoring response to second-line hormonal therapy.

Androgen Antagonists↗
PubMed1992

Incidence and treatment of complications of bacillus Calmette-Guerin intravesical therapy in superficial bladder cancer.

Intravesical therapy with bacillus Calmette-Guerin (BCG) has proved to be more effective in the prophylaxis and treatment of superficial bladder tumors and carcinoma in situ than most chemotherapeutic agents. Compared to intravesical chemotherapy, instillations with BCG provoke more local and systemic reactions. In addition to the commonly induced granulomatous inflammatory changes in the bladder, which produce irritative symptoms, this therapy may cause systemic side effects varying from mild malaise and fever to, in rare instances, life-threatening or fatal sepsis. We report the incidence and varieties of toxicities in 2,602 patients treated with intravesical BCG. Side effects are classified according to local and systemic toxicity. Treatment options vary according to the severity of toxicity from delaying or withholding instillations to treatment with antituberculous drugs for up to 6 months. In general, 95% of the patients have no serious side effects. Recognition of risk factors, particularly traumatic catheterization or concurrent cystitis, that result in systemic BCG absorption, as well as the prompt and appropriate treatment of early side effects should significantly decrease the incidence of severe toxicity.

Administration, Intravesical↗
PubMed1992

In vitro study of the effect of hyperthermia on normal bladder cell line and on five different transitional cell carcinoma cell lines.

Intraluminal hyperthermia is potentially useful in the management of superficial bladder cancer. The potential inhibitory effect of hyperthermia on various human bladder cancer cell lines, normal human bladder cells and the murine MBT-2 bladder cancer cell line has been studied in vitro. These cell lines were exposed for one hour to 43 +/- 0.5C and compared to controls. Cell survival was assessed comparing the cell growth curve and colony formation. The human transitional cell carcinoma (TCC) cell lines vary in their sensitivity to heat. MGH-U1 was the most heat sensitive cell line. The human A-1698, CUB-2, UM-UC-3 and the murine MBT-2 lines were heat insensitive. We conclude that the cytocidal effect of hyperthermia in bladder transitional cell carcinoma is variable. Further experiments using the combination of hyperthermia and intravesical anticancer agents are in progress.

Animals↗
PubMed1992

Efficacy of terazosin in patients with benign prostatic hyperplasia.

Terazosin, a selective, long-acting alpha 1-adrenergic blocker, was evaluated in 44 men with benign prostatic hyperplasia. The dose was titrated from 2 to 20 mg nightly depending on improvement in symptoms and flow rate. All men completed at least 3 months of therapy, 26 had 6 months and 19 received 9-12 months of terazosin. There was an average increase of 2 ml/s in the peak urinary flow rate compared to baseline. This was statistically significant at the 3-month level. Residual urine decreased under treatment at each 3-month time interval. Prior to initiation of terazosin the mean was 165 ml, and it was 62, 100, and 41 ml at 3, 6 and 9 months respectively. There was a statistically significant improvement in both the obstructive and irritative symptom scores. Side effects were minimal; only 1 patient discontinued terazosin due to a hypotensive episode. Terazosin was found to be safe and effective in the dose range of 2-20 mg taken at bedtime in men with symptoms related to benign prostatic hyperplasia. The present study did not identify any baseline parameters such as initial prostate volume, peak flow rates, or obstructive or irritative symptom scores that correlated with clinical outcome.

Adrenergic alpha-Antagonists↗
PubMed1992

Managing superficial bladder cancer: an overview.

More than 90 percent of bladder cancers are transitional cell carcinoma (TCC). Superficial TCC is defined as a transitional cell tumor that is confined to the mucosa (Stages Ta or carcinoma in situ) or that has invaded the lamina propria (Stage T1). When treating patients with superficial bladder cancer, urologists are faced with a number of important tasks. First, the initial tumor or tumors must be removed. Second, the other parts of the urothelium must be assessed for the presence of premalignant or malignant abnormalities. Third, the depth and extent of invasion (i.e., tumor stage) must be determined. Fourth, the clinician must decide whether additional treatment (e.g., intravesical chemotherapy or immunotherapy, cystectomy, or radiotherapy) is indicated. Finally, the patient must be monitored for the development of subsequent tumors. This article provides an overview of the management of superficial bladder cancer.

Administration, Intravesical↗