Biomedical subjects

Piyush K Agarwal

Publications and source records attributed to Piyush K Agarwal.

7 recordsLinked to original sources

PubMed2007

Prostate cancer progression in the presence of undetectable or low serum prostate-specific antigen level.

BACKGROUND: The serum prostate-specific antigen (PSA) level after definitive treatment for prostate cancer (PC) is a powerful predictor of outcome. Occasionally, PC progression can occur despite low or undetectable PSA levels. The authors report on the clinical and pathologic characteristics of patients who experienced PC progression with undetectable or low PSA levels. METHODS: From an electronic database of all patients with PC who were treated at The University of Texas M. D. Anderson Cancer Center between 1999 and 2004, a group of 46 patients was identified who had progression to metastatic PC detected with concomitant PSA levels from 0.1 ng/mL to 2 ng/mL. Patient charts were reviewed for tumor stage, Gleason score, pretreatment PSA level, and the presence of atypical histologic variants (ie, ductal, sarcomatoid, or small cell cancers). The nadir PSA level after treatment and the PSA level at the time metastatic PC was detected were determined. The patients were followed semiannually, and imaging studies were obtained at the discretion of treating physicians. The sites of metastasis and histologic confirmation were reported when available. RESULTS: Twenty-three of 46 patients underwent radical prostatectomy, 11 patients received radiation therapy, and 12 received hormone treatment as their initial form of therapy. Progression to metastatic disease with concomitant, undetectable PSA levels occurred in 10 patients, including 3 patients who had not received treatment with hormones. The sites of metastasis included bone (n = 35 patients), liver (n = 7 patients), retroperitoneal lymph nodes (n = 5 patients), lungs (n = 4 patients), and brain (n = 1 patient). Aggressive and locally advanced PC were common features in these patients: Eighty-five percent had Gleason scores >or=7, 63% had clinical T3 or T4 tumors, and 41% had pretreatment PSA levels >10 ng/mL. Atypical histologic variants were observed in 21 patients (46%) and in 8 of 10 patients who progressed with undetectable PSA levels. In 10 patients (22%), metastasis were detected in the presence of an undetectable PSA level. Eight of those patients had small cell carcinoma. In 19 patients (41%), progression to metastasis occurred without any increase in their PSA from the nadir level. Thirty-one patients (67%) were asymptomatic at the time metastasis was detected, and the detection of metastasis in these patients occurred only because of routine imaging studies. CONCLUSIONS: Progression of PC may occur despite undetectable or low PSA levels. Complete physical evaluation and imaging studies may be indicated in the surveillance of patients with high-grade, locally advanced tumors, especially when atypical histologic variants are present.

Aged↗

PubMed2006

Testicular and paratesticular neoplasms in prepubertal males.

PURPOSE: We reviewed the current diagnosis, staging and management of testicular and paratesticular neoplasms in prepubertal males. MATERIALS AND METHODS: We performed a medical literature search in English using MEDLINE/PubMed that addressed testicular and/or paratesticular neoplasms in prepubertal males. We then analyzed the literature with respect to individual tumors. We present a concise approach toward the management of these individual tumors. RESULTS: There is still a predominance of yolk sac tumors in prepubertal males, although some studies suggest that teratomas are more common but underreported due to their benign course in children. Prepubertal males are diagnosed in a fashion similar to that in adult patients with an appropriate history and physical examination. A palpable, nontender mass suggests the diagnosis and prompts scrotal ultrasound and tumor markers. Although treatment for most primary tumors has historically been radical inguinal orchiectomy, most benign tumors can now be managed by testis sparing surgery. The addition of radiation, chemotherapy and/or retroperitoneal lymph node dissection depends on tumor stage and histological type. CONCLUSIONS: Although it is rare in children, any solid scrotal mass in prepubertal males warrants evaluation for possible testicular or paratesticular neoplasm.

Age Factors↗

PubMed2006

Ultrasonographic evaluation of renal infections.

Renal sonography can be easily performed and provides valuable information concerning the underlying disease process, helping to decide appropriate management. This article reviews the important renal infections, such as pyelonephritis, emphysematous pyelonephritis, renal abscess, hydatid disease, renal tuberculosis, pyonephrosis, and HIV-associated nephropathy.

Abscess↗

PubMed2006

Retractile testis--is it really a normal variant?

PURPOSE: Retractile testes are thought to represent a normal variant of descended testes in prepubertal boys. We studied retractile testes to determine their natural history. MATERIALS AND METHODS: We retrospectively reviewed the charts of 122 boys (mean age 5.4 years) who were referred for a suspected undescended testis and were found to have a retractile testis. A retractile testis was defined as a suprascrotal testis that could be manipulated easily into the scrotum and remained there without traction until the cremasteric reflex was induced. The boys were followed by annual examinations, which demonstrated the presence of retractile, descended (nonretractile) or undescended testes, and the presence or absence of a taut or inelastic spermatic cord in association with a retractile testis. RESULTS: Of 204 retractile testes 61 (30%) descended (became nonretractile), 66 (32%) became UDTs and 77 (38%) remained retractile. Of the 62 retractile testes with a taut or inelastic spermatic cord 35 (56%) became UDTs. Of the 61 orchiopexies performed 8 (13%) showed a patent processus vaginalis. Boys in whom UDTs vs descended testes developed were a mean of 4.9 vs 6.6 years old (p = 0.001). The chance of spontaneous descent was 58% in boys 7 years or older, compared to 21% in boys younger than 7 (p <0.0001). CONCLUSIONS: A retractile testis is not a normal variant. Retractile testes have a 32% risk of becoming an ascending or acquired undescended testis. The risk is higher in boys younger than 7 years old, or when the spermatic cord seems tight or inelastic. Boys with retractile testes should be monitored annually until the testes have clearly descended.

Adolescent↗

PubMed2006

Prepubertal male and testicular neoplasms: diagnosis and treatment.

Prepubescent testicular tumors are far more likely to be benign than adult tumors. However, malignant yolk sac tumors are still the most commonly reported testicular neoplasms in the literature. Teratomas are benign in the pediatric population and constitute the second most commonly reported tumors and, in some series, they are the most common. The remaining tumors are far more rare and often benign. Regardless of tumor type, with prompt diagnosis and treatment long-term survival is excellent. This article contains concise reviews of the various tumors, their diagnoses and management options.

Child↗

PubMed2005

Testosterone replacement therapy after primary treatment for prostate cancer.

PURPOSE: A history of prostate cancer has been an absolute contraindication for testosterone supplementation. We studied a cohort of hypogonadal patients treated with radical retropubic prostatectomy (RRP) for organ confined prostate cancer to determine if testosterone replacement therapy (TRT) could be efficacious and administered safely without causing recurrent prostate tumor. MATERIALS AND METHODS: Ten hypogonadal patients previously treated with RRP for organ confined prostate cancer were identified. They presented with low serum total testosterone (TT) and symptoms of hypogonadism after RRP. Patients had baseline serum determinations of prostate specific antigen (PSA) and TT, and were started on testosterone supplementation. They were assessed periodically for changes in PSA and TT, and for symptomatic improvement using the hormone domain of the Extended Prostate Inventory Composite Health Related Quality of Life questionnaire. RESULTS: At a median followup of 19 months no patient had detectable (greater than 0.1 ng/ml) PSA. TT increased significantly after starting TRT from a mean +/- SD of 197 +/- 67 to 591 +/- 180 ng/dl (p = 0.0002). The Hormone Domain of the Extended Prostate Inventory Composite Health Related Quality of Life questionnaire increased significantly from 38 +/- 5 to 49 +/- 3 (p = 0.00005), primarily due to a decrease in hot flashes and an increase in energy level. CONCLUSIONS: At a median of 19 months of TRT hypogonadal patients with a history of prostate cancer had no PSA recurrence and had statistically significant improvements in TT and hypogonadal symptoms. In highly select patients after RRP TRT can be administered carefully and with benefit to hypogonadal patients with prostate cancer.

Aged↗

PubMed2004

Survival of patients with hormone refractory prostate cancer in the prostate specific antigen era.

PURPOSE: The historically reported 12 to 18-month duration of survival of patients with hormone refractory prostate cancer is not consistent with current clinical experience. Furthermore, to our knowledge patient survival after serum prostate specific antigen (PSA) progressively increases from a nadir despite castrate testosterone has not been previously reported. For this reason we studied overall survival and the clinical variables that influence survival in patients with hormone refractory prostate cancer. MATERIALS AND METHODS: The study focused on 254 patients with prostate cancer on androgen deprivation therapy. Hormone refractory prostate cancer was defined as the first in a series of PSA elevations despite castrate levels of testosterone. The duration of survival in the hormone refractory phase was calculated from the date of the first PSA elevation to the date of death. RESULTS: Median survival after hormone refractory prostate cancer developed in patients initially staged with and without skeletal metastasis was 40 and 68 months, respectively. Six of more than 25 input variables were retained as significant in the final Cox model. Variables associated with longer survival were lower nadir PSA, younger age, higher pretreatment testosterone, no history of obstructive uropathy, no history of tobacco use (past or current) and lower alkaline phosphatase. CONCLUSIONS: Historical reports of survival in hormone refractory prostate cancer underestimate current survival observations. The likely explanations of this observation include delayed enrollment in clinical trials from which most survival data are derived, PSA lead time in staging and improved supportive care. Models predicting survival in patients with hormone refractory prostate cancer should consider multiple variables.

Aged↗