PubMed Health⌕ Search

Biomedical subjects

M S Soloway

Publications and source records attributed to M S Soloway.

At least 145 records · Page 8Linked to original sources
PubMed1989

Patients' choice of treatment in stage D prostate cancer.

Given the current preference of many patients for an active role in decision-making regarding their care, the feasibility of patients making their own treatment choices was investigated, and the reasons for their selections were studied. Subjects comprised previously untreated Stage D prostate cancer patients for whom hormonal therapy was indicated. Thirteen institutions entered 159 patients into the study. After discussing treatment choices with their physicians, the patients took home a two-page letter explaining two options: surgical castration and therapy with Zoladex (goserelin acetate), a depot luteinizing hormone-releasing hormone (LHRH) analogue injected subcutaneously every twenty-eight days. Patients were encouraged to discuss the treatment choices with their families. After selecting a treatment approach, patients completed a "decision questionnaire" and then treatment was initiated. Of the 147 patients who completed baseline questionnaires, 78 percent selected Zoladex and 22 percent selected orchiectomy. The primary reason for selecting Zoladex included avoidance of surgery (36%), success of treatment (18%), convenience of the drug (10%), and physician's advice (10%). Patients chose surgery primarily because of convenience (32%) and success of treatment (29%). Three months later, patients and their wives completed another questionnaire, which assessed their satisfaction with their treatment choices. Ninety-three percent of patients and 91 percent of patients' wives indicated that they would select the same treatment again.

Adult↗
PubMed1989

Progression and complications after external beam radiation therapy for carcinoma of prostate.

Sixty patients with prostatic carcinoma localized to the pelvis have been treated by external beam radiation therapy: 2 patients (2%) were Stage A, 12 (20%) Stage B, 14 (23%) Stage C, and 32 (53%) Stage D1. Twenty-two patients received adjuvant therapy (11 estramustine phosphate [Estracyt] and 11 cyclophosphamide [Cytoxan]) after radiation. Progression occurred in 22 patients (37%): 6 (10%) had local recurrence while 16 (27%) failed distally. The incidence of late major complications was 12 percent.

Adenocarcinoma↗
PubMed1989

Transrectal ultrasound for staging prior to radical prostatectomy.

Transrectal ultrasound (TRUS) was used to predict tumor stage in 43 patients prior to radical prostatectomy. For assessing extracapsular extension, the sensitivity was 54 percent, specificity 58 percent, and accuracy 56 percent. For detecting seminal vesicle involvement, the sensitivity was 60 percent, specificity 89 percent, and accuracy 82 percent. The predominant tumor echo pattern was isoechoic in 37 percent of cases, mixed (hyper-, iso-, and hypoechoic) in 47 percent, and hypoechoic in 16 percent. An anterior-posterior to transverse dimension ratio of greater than 0.8 suggested diffuse involvement of the prostate with an increased chance of extracapsular spread.

Adenocarcinoma↗
PubMed1989

Prognostic factors in survival free of progression after androgen deprivation therapy for treatment of prostate cancer.

We analyzed 110 patients with metastatic prostate cancer (stage D2) to determine the associations between interval until progression and the pretreatment testosterone level, extent of bone metastases, performance status, race, age and pretreatment level of prostatic acid phosphatase. The median followup was 21 months (4 to 89 months). All patients received androgen deprivation therapy when metastases were identified. This multivariate analysis demonstrated that the pretreatment serum testosterone was the most significant variable (p less than 0.01) associated with interval until progression and the extent of bone metastases observed on the bone scan was the second most important variable (p less than 0.05). Age, race and prostatic acid phosphatase were not significantly correlated with the interval free of progression. Performance status was significantly correlated but it was nonsignificant in the multivariate analysis if the model already included testosterone level and extent of metastasis. Patients with a pretreatment testosterone level of less than 300 ng. per 100 ml. and more than 6 areas of increased uptake on the bone scan had the most rapid progression. We conclude that serum testosterone and extent of bone metastases are the most important of the analyzed factors in terms of interval to progression in patients with prostate cancer following androgen deprivation.

Acid Phosphatase↗
PubMed1989

Rationale for intravesical chemotherapy in the treatment and prophylaxis of superficial transitional cell carcinoma.

1. A thorough evaluation of the urinary tract is an integral part of the initial management of a patient with transitional cell carcinoma. The site of all urothelial abnormalities must be determined and adequate histologic material obtained and reviewed. The urothelium not involved by obvious tumor should also be evaluated by either cytology or mucosal biopsies. All patients with high grade tumor should have a biopsy from the prostatic urethra. 2. The clinician should determine the risk of progression by evaluating the tumor grade, stage, and the presence or absence of carcinoma in situ. 3. The likelihood of a recurrence following endoscopic resection of a superficial bladder tumor ranges from 20% for a solitary low grade tumor to over 90% for a patient with multifocal high grade cancer. 4. The reasons for the high incidence of a subsequent tumor include new occurrences related to the continued contact of carcinogens with the susceptible urothelium, failure to completely resect all tumor, and possibly the implantation of tumor cells on the altered urothelial surface following endoscopic resection. 5. Intravesical instillation of antineoplastic agents is capable of reducing the incidence of a subsequent tumor when used for prophylaxis. These agents are also capable of eradicating residual tumor. 6. The clinician should determine whether intravesical therapy is being used for treatment or prophylaxis. 7. Thiotepa is a relatively inexpensive and safe intravesical chemotherapeutic agent which, when used for treatment of existing tumor, will provide a complete response rate of from 35 to 45%. There is a suggestion that it is more effective in low grade than high grade tumors. Prospective randomized trials indicate that patients receiving Thiotepa are less likely to develop a subsequent tumor in a given period of time than patients who do not receive intravesical therapy. 8. Mitomycin-C will provide a complete response rate in high risk patients from 35 to 50% when used for treatment of existing tumor. Approximately 15% of such patients will progress to muscle invasion if followed for approximately three years. There are few randomized trials using Mitomycin-C to determine its efficacy for prophylaxis. 9. BCG has been used for treatment and prophylaxis of superficial bladder cancer. It is relatively inexpensive. The side effects vary with the strain. Several strains have been used but they have not been compared in randomized trials. When used for treatment, the complete response rate ranges from 50 to 65%.(ABSTRACT TRUNCATED AT 400 WORDS)

Administration, Intravesical↗
PubMed1989

Should all superficial bladder tumors be treated with intravesical therapy?

After reviewing the data on intravesical therapy for treatment or prophylaxis of urothelial tumors of the bladder, several statements seem appropriate. Bladder tumors confined to the mucosa and lamina propria represent a heterogeneous group. Papillary, grade I, noninvasive tumors (Ta) may recur frequently, subjecting the patient to numerous endoscopic procedures but these patients very infrequently have tumor progression. Treatment should not be overly aggressive and result in significant morbidity. These patients should be informed that they have a choice and may decide that they would rather take the risk of subsequent endoscopic procedures and avoid the regular visits to the office for intravesical drug instillation. High grade tumors, be they confined to the mucosa or invade the lamina propria, place the patient at significant risk of recurrence and local progression and thus require careful monitoring (Jordan et al, 1987; Torti et al, 1987). Intravesical therapy should be seriously considered, either to eradicate residual malignant cells or prevent a subsequent tumor. Thiotepa is moderately effective in delaying the development of subsequent low grade tumors when used for prophylaxis. Toxicity with Thiotepa is low and the drug is not expensive. Mitomycin C is effective for the treatment of residual tumor as well as when instilled regularly following complete transurethral resection. Side effects are primarily confined to chemical cystitis with an occasional patient having a rash. BCG may be the most effective intravesical agent in the treatment of carcinoma in situ. Randomized trials comparing BCG and chemotherapy are in progress and are eagerly awaited. The frequency and severity of local and systemic side effects are somewhat greater than with chemotherapeutic agents.

Administration, Intravesical↗
PubMed1988

Adenocarcinoma of the prostate. Stage-by-stage treatment alternatives.

The best treatment for adenocarcinoma of the prostate depends on the patient's age, general medical condition, life expectancy, and willingness to accept such side effects as impotence. Radical prostatectomy or full-dose radiation therapy are usually curative when cancer is confined to the gland. The technique of prostatectomy has been improved and potency often can be preserved. Once the tumor extends beyond the gland, treatment alternatives are radiation or endocrine therapy. If lymph nodes are negative, radiation therapy may result in a long period without progression. If lymph nodes are positive, the expense and morbidity of radiation therapy may not be worthwhile because the likelihood of cure is low. Androgen deprivation, or endocrine manipulation, is preferred for metastatic disease. Response is varied and may depend on the patient's testosterone level when therapy is initiated. Survival is shorter in those with levels below normal.

Adenocarcinoma↗
PubMed1988

Benign prostatic hyperplasia. Universal problem among aging men.

Benign prostatic hyperplasia (BPH) is a nonmalignant, age-related condition that affects most men who enjoy a long life. The diagnosis of BPH is generally straightforward and easily established. At the present time, transurethral resection of the prostate is considered the best mode of therapy for symptomatic BPH requiring active intervention. However, since people are likely to avoid surgery when provided a reasonable alternative, it is likely that pharmacologic treatments will be tried with increasing frequency.

Adult↗
PubMed1988

Stratification of patients with metastatic prostate cancer based on extent of disease on initial bone scan.

Most patients with metastatic prostate cancer will have metastasis to bone. Such patients are best monitored by serial radionuclide bone scans. One hundred sixty six men with bone metastasis from prostate cancer who received androgen deprivation therapy had their pretreatment bone scans reviewed using a semiquantitative grading system based upon the extent of disease (EOD) observed on the scan. The EOD on the scan correlated with survival. The 2-year survival rates for EOD I to IV were 94%, 74%, 68%, and 40%, respectively. The survival of patients in categories EOD I and IV significantly differed from the other categories. Men with metastatic prostate cancer entered into trials designed to evaluate the impact of treatment on survival should be stratified based upon the EOD on the bone scan. This analysis also indicates that patients in the EOD IV category have a particularly poor prognosis and may be candidates for alternative treatments.

Bone Neoplasms↗
PubMed1988

Does invasive bladder cancer differ between women and men?

From July, 1976, to June, 1985, one hundred one radical cystectomies were performed for bladder cancer in our institution. Seventy-four were in men and 27 in women (2.7 to 1). In 87 percent of men the cystectomy was performed for transitional cell carcinoma (TCC) compared with 60 percent in women. Squamous cell carcinoma (SCC) was more prevalent in women, 30 percent versus 6 percent in men. Females also were more likely to have pT3, pT4 tumors at cystectomy, 59 percent versus 18 percent. The possible reasons for these differences are presented.

Adult↗
PubMed1988

Failure of chemotherapy to prolong life in patients with metastatic prostate cancer who have failed androgen deprivation.

Using historical controls, we analyzed the effect of chemotherapy on survival of patients with metastatic prostate cancer who failed androgen deprivation. The survival of 178 patients with metastatic prostate cancer who receive palliation only after failing hormonal therapy was compared with the survival of 27 patients who received chemotherapy on NPCP Protocol 1500. Survival was measured from the initiation of androgen deprivation. The mean survival after chemotherapy was 8.4 months which was slightly less than the group receiving palliation only. At this time, chemotherapy has not been able to improve survival in patients with metastatic prostate cancer.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1988

Transitional cell carcinoma of the prostate following intravesical therapy for transitional cell carcinoma of the bladder.

From 1983 to 1986, 63 male patients received various regimens of intravesical therapy for superficial transitional cell carcinoma of the bladder. Of these 63 patients 10 were subsequently diagnosed as having transitional cell carcinoma of the prostate. Five of the 10 patients had no tumor remaining in the bladder at diagnosis of transitional cell carcinoma of the prostate. In 3 patients tumor in the prostate was more invasive than tumor in the bladder. In 2 patients tumor involvement was greater in the bladder than in the prostate. Patients undergoing treatment with intravesical therapy for transitional cell carcinoma of the bladder, especially those receiving multiple courses for prolonged periods, should be monitored closely for the development of transitional cell carcinoma of the prostate.

Administration, Intravesical↗