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Biomedical subjects

R J Babaian

Publications and source records attributed to R J Babaian.

At least 73 records · Page 4Linked to original sources
PubMed1992

The distribution of prostate specific antigen in men without clinical or pathological evidence of prostate cancer: relationship to gland volume and age.

We estimated the in vivo prostate gland volume in 408 men (320 without clinical evidence of prostate cancer, and 88 with an abnormal digital rectal examination and/or transrectal prostate ultrasound and negative biopsies) using sequential step-section ultrasound analysis and correlated it to the serum prostate specific antigen (PSA) value. Of the men 331 (81.1%) had a PSA value of 4 ng./ml. or less. The PSA value was greater than 4 but less than or equal to 10 in 64 men (15.7%) and greater than 10 in 13 (3.2%). The men were subclassified by prostate gland volume at arbitrary break points. A total of 139 men (34.1%) had a gland of 25 cm.3 or less, 2.2% of whom had a PSA value of greater than 4. Further analysis revealed that the incidence of a PSA value greater than 4 increased as the prostate volume increased (18.4% for greater than 25 but less than or equal to 50, and 65.4% for greater than 50) and as age increased. We found a statistically significant association between prostate gland volume and patient age (p less than 0.00005) to the serum PSA concentration. The finding of a PSA value of greater than 10 was uncommon regardless of the prostate gland volume. Clinical implications of these results are discussed, and a statistical model to estimate the serum PSA by gland volume and patient age was constructed.

Adult↗
PubMed1992

The effects of treatment for cancer on male fertility and sexuality.

The sequelae of some treatments for cancer, by virtue of their systemic action, adversely affect three aspects of male sexuality: desire, physical function, and cytokinetic gonadal processes. Other more localized therapies, such as surgery and radiation therapy, may affect only one aspect. Frequently, the effects of cancer therapy are interrelated, thus making it difficult to identify any single problem. This article discusses the impact of medical therapy, including chemotherapy, surgery, radiation therapy, and hormonal manipulation, as they relate to male sexuality. Interventions to promote sexual rehabilitation, either by intensive therapy or nursing actions, are discussed.

Antineoplastic Agents↗
PubMed1991

The role of prostate-specific antigen as part of the diagnostic triad and as a guide when to perform a biopsy.

The authors reviewed the results and relationship of prebiopsy prostate-specific antigen (PSA) assay, digital rectal examination (DRE), and transrectal ultrasound (TRUS) in 124 consecutive patients who underwent a prostate biopsy because of abnormal results of either DRE or TRUS. Results of the three tests (PSA, DRE, and TRUS) showed abnormalities in 54%, 75%, and 84.6% of patients, respectively; biopsy results were positive for cancer in 45.2%. Cancer detection rate increased as the PSA value increased from less than or equal to 4 ng/ml (17.5%) to more than 4 ng/ml (68.7%) to more than 20 ng/ml (83.3%), and as the number of positive tests increased (6.9% for one, 32.7% for two, and 82.6% for three). The PSA assay was the most important parameter of the diagnostic triad. These results suggested that regardless of DRE and TRUS findings, PSA less than or equal to 4 ng/ml confers a low prostate cancer risk, PSA more than 4 ng/ml but less than or equal to 10 ng/ml confers an intermediate prostate cancer risk, and PSA more than 10 ng/ml confers a high prostate cancer risk. Regardless of other findings, all patients with a PSA value more than 10 ng/ml require biopsy because of the high likelihood of cancer. All patients with abnormal DRE or TRUS results still require biopsy despite a low index of suspicion of prostate cancer when the PSA value is less than or equal to 4 ng/ml.

Adult↗
PubMed1991

Monoclonal prostate-specific antigen in untreated prostate cancer. Relationship to clinical stage and grade.

The authors evaluated 440 men with clinically staged and untreated prostate cancer with a monoclonal prostate-specific antigen (PSA) assay. The serum PSA value correlated significantly with both the stage and grade of disease (P less than 0.00005). The relationships between PSA and consecutive Stages A, B, C, and D2 (alpha = 0.15) and between progressive Gleason's scores 2 to 4, 5 to 7, and 8 to 10 (alpha = 0.15) were statistically significant. Also statistically significant was the correlation between serum PSA level and intracapsular versus extracapsular disease (P less than 0.00005), although no one value can be used to differentiate reliably between patients in these two categories. The probability of clinically detectable metastasis (Stage D2) is 85% if the serum PSA level is greater than 30; however, 12% of patients without clinical evidence of metastases (Stages A, B, and C) have such a serum PSA value. Despite the statistically significant association between PSA and tumor differentiation and volume as reflected by tumor grade and clinical stage, this marker cannot be used to determine either for an individual patient.

Aged↗
PubMed1991

Transurethral-resection zone prostate cancer detected at cystoprostatectomy. A detailed histologic analysis and clinical implications.

The authors identified incidental adenocarcinoma of the prostate in serial cross-sections of prostates from 61 of 100 patients having cystoprostatectomy for bladder cancer. In 20 patients, cancer foci were in the prostatic region accessible to transurethral resection (TUR). Eight of these 20 patients had stage A1 disease (less than or equal to 3 foci); in six of these patients all foci were located at or within the transition-zone boundary only. Twelve patients had stage A2 disease (greater than 3 foci); in none were more than three foci at or within the transition-zone boundary. Among the 20 patients, 84 tumor foci were distributed as follows: 62% in the peripheral zone, 10% in the transition zone, 3% in the central zone, and 25% in the transition zone boundary. The authors' data suggest that Stage A prostate cancer, like larger clinically detectable cancers, is multifocal, multizonal, and similarly distributed with respect to the urethra. No case of Stage A1 disease would have been reclassified as Stage A2 by repeat TUR of the entire transition zone and transition zone boundary. The authors' results confirm those of previous studies that report a high incidence of residual carcinoma in regions not accessible to TUR in patients with presumptive Stage A1 disease and suggest that ultrasonography and ultrasonographically guided biopsies, rather than repeat TUR, may more accurately define the extent of Stage A disease in some patients.

Adenocarcinoma↗
PubMed1991

Prostate-specific antigen and external beam radiation therapy in prostate cancer.

This study of 133 patients with localized prostate cancer (Stages A2 to C), treated by external beam radiation therapy (XRT), was undertaken for two reasons: (1) to investigate the usefulness of pretreatment serum prostate-specific antigen (PSA) levels in evaluating patients before XRT; and (2) to investigate post-XRT changes in PSA values and their likely clinical significance. It was found that pretreatment PSA values in patients with localized disease exhibit wide patient to patient variability with a greater than 100-fold difference between the lowest and highest values. Although mean PSA values were significantly higher in Stage C disease (51 patients; mean PSA, 17.3 ng/ml) than in Stage A2 disease (31 patients; mean PSA, 9.0 ng/ml), Stage B1 disease (23 patients; mean PSA, 9.1 ng/ml), or Stage B2 disease (28 patients; mean PSA, 10.6 ng/ml), individual values were of virtually no help in assigning individual patients to a clinical stage. PSA levels did not correlate with grade. After XRT, PSA values fell significantly and dramatically in virtually all patients (98%) by 3 months follow-up. Mean PSA fell from 12.5 to 2.6 ng/ml, and median PSA fell from 6.6 to 1.9 ng/ml. In most patients, PSA continued to fall up to 12 months after XRT and then stabilized at 21 months. Although PSA values fell dramatically after XRT, PSA was detectable in the serum of all patients. PSA values tended to transiently and mildly elevate during XRT. In a small proportion of patients, rising PSA values were observed after 6 months. The full significance of this requires further follow-up, of four such patients, one has relapsed. PSA is a more sensitive marker of prostatic radiation than prostatic acid phosphatase.

Acid Phosphatase↗
PubMed1991

Effect of ileal conduit on patients' activities following radical cystectomy.

Over the last twenty months, 110 patients who have undergone a radical cystectomy for bladder cancer at The University of Texas M. D. Anderson Cancer Center were surveyed to assess the effect of an ileal conduit urinary diversion on postoperative activity. Postoperatively, 47.3 percent of the patients were very active, 34.5 percent were moderately active, and 18.2 percent were sedentary. Chemotherapy and the patient's gender were found to have a statistically significant effect on postoperative activity level. Chemotherapy resulted in a decrease of very active patients from 55.6 percent to 27.9 percent and an increase in sedentary patients from 11.2 percent to 30.2 percent (P = 0.005). No difference in activity levels was seen in 73.9 percent of the nonchemotherapy patients. Fifty-one percent of the men were very active as compared with only 19.1 percent of the women, whereas 20 percent more women than men were moderately active and 13 percent more were sedentary. Our experience indicates that the ileal conduit had no significant negative effect on activity if the effects of chemotherapy are controlled: 82.6 percent of the patients not receiving chemotherapy experienced either no change or an increase in their activity.

Activities of Daily Living↗
PubMed1991

Percutaneous urinary diversion in patients with hormone-refractory prostate cancer.

Twenty-two patients with hormone-refractory prostate cancer underwent percutaneous urinary diversion; at the time, all but one had metastatic disease. Eleven patients received postnephrostomy therapy. The median survival time for all the patients was one hundred nineteen days. Overall, 41 percent of the patients' remaining lifetime was spent in the hospital. Six never left the hospital and 10 required rehospitalization; the remaining 6 patients were never rehospitalized. The median survival time for this group of patients was shorter than the expected survival of similar patients without ureteral obstruction. It appears that percutaneous urinary diversion does not improve the quality of life of these patients.

Adenocarcinoma↗
PubMed1991

Early detection program for prostate cancer: results and identification of high-risk patient population.

Three hundred sixty-two men underwent transrectal ultrasound of the prostate (TRUS), digital rectal examination (DRE), and serum prostate-specific antigen (PSA) determination as part of an early detection program for prostate cancer. Thirty-seven (10%) cancers were detected. DRE had the highest sensitivity and specificity, 89 percent and 84 percent, respectively. TRUS and PSA had comparable sensitivities (84% and 81%) and specificities (82% and 82%). The positive predictive values of DRE, TRUS, and PSA determination were 39 percent, 35 percent, and 33 percent, respectively. We found a cancer detection rate of 16 percent among patients with symptoms of bladder outlet obstruction and 5 percent in patients without these symptoms. The detection rate was 36 percent for physician-referred patients and 3 percent for self-referred patients. This suggests to us that at the present time the best utilization of medical resources to increase prostate cancer detection is to educate men to have annual medical evaluations by primary-care physicians who are encouraged to incorporate risk assessment and screening DRE as part of their routine practice. Any man with either abnormal findings on examination or increased risk should be referred to a urologist for further evaluation.

Antigens, Neoplasm↗
PubMed1991

Familial patterns of prostate cancer: a case-control analysis.

Epidemiological data have not yet enabled physicians to look beyond age and race to identify men at increased risk for prostate cancer. We conducted a hospital-based case-control study of familial patterns of prostate cancer with self-reported data from a risk-factor questionnaire. There were 385 patients with histologically confirmed prostate cancer, and 385 race and age-matched (+/- 5 years) controls with other cancers. Family history, available for 378 patients and 383 controls, was positive for prostate cancer in 13.0% versus 5.7%, respectively. The difference was significant at p = 0.01. The over-all age-adjusted risk estimate for men with a first-degree relative with prostate cancer was significantly elevated (odds ratio of 2.41), as were the individual risk estimates for having a father or brother with prostate cancer (odds ratio of 2.24 and 2.66). Having a second-degree relative (grandfather or uncle) with prostate cancer also conferred elevated but not statistically significant risk. These data accord well with the few previously published case-control studies of familiarity of prostate cancer. On the basis of these findings, one should consider recommending participation in early detection programs for prostate cancer in a man whose father or brother has had the disease.

Age Factors↗
PubMed1990

Prostate-specific antigen and prostate gland volume: correlation and clinical application.

We studied 103 patients seen in our Prostate Cancer Detection Clinic to determine whether a correlation exists between serum prostate-specific antigen (PSA) values and ultrasound-calculated prostate gland volume. Seventy men (68%) had a PSA value less than or equal to 4 ng/ml (our upper limit of normal). The men were subclassified by prostate gland volume at arbitrary break points. Twenty-five men (24%) had a prostate gland volume less than or equal to 25 cm3; in 96%, the PSA value was less than or equal to 4 mg/ml. Further analysis revealed that the percentage of men with a normal serum PSA value decreased as the prostate gland volume increased; 65.6% of the group with a gland volume between 25 and 50 cm3 (40 of 61) and 35.5% of the group whose prostate volume exceeded 50 cm3 (6 of 17) had PSA values less than or equal to 4 ng/ml. Four men had PSA values greater than 20 ng/ml; all had prostate cancer. Cancer was diagnosed in four additional patients, three with PSA values between 5 and 10 ng/ml and one with a PSA value less than 4 ng/ml. There appears to be a direct relationship between prostate gland volume and PSA value, as well as a cancer value threshold. The clinical implications of these findings are discussed.

Adult↗
PubMed1990

Amplification and expression of the c-erb B-2/neu proto-oncogene in human bladder cancer.

The c-erb B-2/neu gene encodes a cell-surface glycoprotein with extensive homology to, but distinct from, the epidermal growth-factor receptor. In this study, we compared the c-erb B-2/neu gene amplification and expression of tissue specimens obtained from the bladders of normal controls and patients with high-grade transitional cell bladder carcinoma. Southern blot analysis of DNAs from 24 patients and 5 controls showed 2 cases of c-erb B-2/neu gene amplification in patients and none in controls. Western blot analysis demonstrated that c-erb B-2/neu was expressed in 67.6% (23/34) of patient specimens but in none of the controls (0/5). This finding agreed with the result of immunohistochemical staining, which showed that tissue from 74.3% (26/35) of the patients and none of the controls (0/7) showed positive immunofluorescence staining. This is the first report suggesting that c-erb B-2/neu gene amplification may be associated with human bladder carcinogenesis.

Blotting, Southern↗
PubMed1990

A new 180 kDa. urine protein marker associated with bladder cancer.

We surveyed the tumor-related proteins present in the urine specimens of 118 bladder cancer patients to seek a possible marker enabling future diagnosis and prognosis of this disease. We identified a protein of 180 kDa. by sodium dodecyl sulfate polyacrylamide gel electrophoresis in urine samples subjected to prior adsorption by protein-A conjugated to a sepharose bead. This protein appears to be a glycoprotein because it binds to concanavalin A-conjugated sepharose and can be eluted by alpha-methyl D-mannoside. It does not react immunochemically with antibodies prepared against either carcinoembryonic antigen or epidermal growth factor receptor, both of which have an apparent molecular weight close to 180 kDa. We found this protein in the urine of 74.3% of the patients with transitional cell carcinoma. It was not present in age-matched controls, patients with benign prostatic hyperplasia or patients with 10 other cancers. There was 1 false positive result in a patient with prostate cancer. It does not appear to be associated with urinary tract infection, blood contamination, premedication or anesthesia.

Adult↗
PubMed1989

Benign hepatic masses mimicking metastatic renal cell carcinoma.

Making the distinction between a benign hepatic mass and renal cell carcinoma metastatic to the liver is crucial in evaluating a patient with renal cell carcinoma. The erroneous diagnosis of metastatic renal cell carcinoma may deter the surgeon from performing a potentially curative nephrectomy. In this report, we present 1 patient with cavernous hemangiomas and another patient with focal nodular hyperplasia of the liver. In each case the benign liver lesion was incorrectly diagnosed initially as metastatic renal cell carcinoma. The radiographic appearance of these lesions is discussed in detail.

Carcinoma, Renal Cell↗