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Biomedical subjects

Simon R J Bott

Publications and source records attributed to Simon R J Bott.

8 recordsLinked to original sources
PubMed2006

Extensive transperineal template biopsies of prostate: modified technique and results.

OBJECTIVES: To describe the modified technique and results of extensive transperineal template prostate biopsies in men with a high risk of prostate cancer in whom repeated transrectal biopsies are not diagnostic. METHODS: Men who had a rising prostate-specific antigen (PSA) level and had at least two sets of benign octant biopsies or two or more prior biopsies containing high-grade prostatic intraepithelial neoplasia or atypical small acinar proliferation were included. A biplanar transrectal ultrasound probe was attached to a brachytherapy stepping unit and a standard 0.5-cm brachytherapy template was positioned over the perineum. In the transverse image, the prostate was divided into right and left and anterior, middle, and posterior regions, and three to five transperineal biopsy cores were taken in each of the six regions through the template. RESULTS: Sixty men underwent extensive transperineal template biopsies. Their mean age was 64 years (SD 6.4), the median PSA level was 12.9 ng/mL (range 4.6 to 35.7), and the median prostate volume was 54 cm3 (range 34 to 199). Cancer was detected in 23 men (38%), of whom 17 (74%) had Gleason grade 6, 5 (21%) Gleason grade 7, and 1 (4%) Gleason grade 9 disease. Cancer was identified in the anterior region of the prostate alone in 12 men (60%). One man required overnight admission for hematuria and two developed urinary retention; no cases of sepsis developed. CONCLUSIONS: In men with a clinical suspicion of prostate cancer, but benign or equivocal prostate biopsies, extensive transperineal template biopsy of the prostate is a useful diagnostic tool. It allows sampling of the whole prostate in a systematic and safe fashion.

Biopsy, Needle↗
PubMed2005

Radical prostatectomy: pathology findings in 1001 cases compared with other major series and over time.

OBJECTIVE: To examine the preoperative features and pathological outcomes of clinical significance of 1001 consecutive essentially unscreened men who had a radical prostatectomy (RP) in the UK between 1988 and 2002, and their changes over time. PATIENTS AND METHODS: The details of men whose RP specimen was submitted for analysis were entered into the RP database held at the University College Hospital, London; the National Health Service and private patients of 17 surgeons were included. The age, mode of diagnosis, preoperative prostate specific antigen (PSA) level, biopsy and RP findings were compared over time. RESULTS: The mean (range) age of the men was 62 (40-76) years, the median PSA 8 (0.1-146) ng/mL and the median biopsy Gleason sum score 6; these preoperative features did not change over the study period. The diagnosis of prostate cancer was made by transurethral resection of the prostate alone in 48 men (5%). The maximum number of patients receiving neoadjuvant androgen ablation was 21 (33%) in 1996, and subsequently declined. The median (range) RP Gleason sum score was 7 (4-9). The biopsy Gleason score correlated with the prostatectomy Gleason score in 252 (47%) of 536 men, being lower in 170 (32%) and higher in 113 (21%). The median tumour volume was 2 mL (focus of invasive acini - 31 mL) and the incidence of positive intra- and extraprostatic margins was 52%. Both tumour volume and extraprostatic margin positivity declined with time. CONCLUSIONS: The preoperative features and pathological findings from this UK series are similar to those of other reported cohorts from unscreened populations. The incidence of positive extraprostatic surgical margins, tumour volume and stage decreased with time.

Adult↗
PubMed2004

An update on the use of 5alpha-reductase inhibitors.

Twelve years ago, finasteride, the first 5alpha-reductase inhibitor, was introduced as drug therapy for benign prostatic hyperplasia, and more recently dutasteride has emerged as an alternative. The efficacy, safety and ability of these 5alpha-reductase inhibitors to reverse the natural progression of benign prostatic hyperplasia have been convincingly demonstrated and both drugs are now well established in the medical armamentarium against the disease. Given the multifactorial etiology of benign hyperplasia, the usefulness of 5alpha-reductase inhibitors in combination with alpha adrenergic blockers has also been investigated and justified in select patients. Wider applications of 5alpha-reductase inhibitors are also emerging, though their perhaps most important new role as chemopreventive agents remains unclear.

Adrenergic alpha-Antagonists↗
PubMed2002

Benign prostatic hyperplasia: solutions to an ageing problem.

As the population ages, the demand for treatment of the symptoms of benign prostatic hyperplasia has never been higher. Equally the choice of treatments has never been greater. This review considers the medical and surgical options.

Adrenergic alpha-Antagonists↗