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At least 613 records · Page 34Linked to original sources
PubMed2004

Dosimetric impact of prostate volume change between CT-based HDR brachytherapy fractions.

PURPOSE: The objective is to evaluate the prostate volume change and its dosimetric consequences after the insertion of catheters for high-dose-rate brachytherapy. METHODS AND MATERIALS: For 13 consecutive patients, a spiral CT scan was acquired before each of the 2 fractions, separated on average by 20 hours. The coordinates of the catheters were obtained on 3 axial CT slices corresponding to apex, mid portion, and base portion of the prostate. A mathematical expansion model was used to evaluate the change of prostate volumes between the 2 fractions. It is based on the difference in the cube of the average distance between the centroid and catheter positions. The variation of implant dose-volume histograms between fractions was computed for plans produced by either inverse planning based on simulated annealing or geometric optimization. RESULTS: The average magnitude of either increase or reduction in prostate volume was 7.8% (range, 2-17%). This volume change corresponds to an average prostate radius change of only 2.5% (range, 0.7-5.4%). For 5 patients, the prostate volume increased on average by 9% (range, 2-17%), whereas a reduction was observed for 8 patients by an average of 7% (range, 2-13%). More variation was observed at the prostate base than at mid or apex gland. The comparison of implant dose-volume histograms showed a small reduction of V100 receiving the prescription dose, with an average of 3.5% (range, 0.5-12%) and 2.2% (range, 1-6%) for inverse planning based on our simulated annealing and geometric optimization plans, respectively. CONCLUSION: Small volume change was observed between treatment fractions. This translates into small changes in dose delivered to the prostate volume.

Adult↗
PubMed2005

Comparison of day 0 and day 14 dosimetry for permanent prostate implants using stranded seeds.

PURPOSE: To determine, using MRI-based dosimetry (Day 0 and Day 14), whether clinically significant changes in the dose to the prostate and critical adjacent structures occur between Day 0 and 14, and to determine to what degree any changes in dosimetry are due to swelling or its resolution. METHODS AND MATERIALS: A total of 28 patients with a permanent prostate implant using 125I rapid strands were evaluated at Days 0 and 14 by CT/MRI fusion. The minimal dose received by 90% of the target volume (prostate D90), percentage of volume receiving 100% of prescribed minimal peripheral dose (prostate V100), external sphincter D90, and 4-cm3 rectal volume dose were calculated. An acceptable prostate D90 was defined as D90 >90% of prescription dose. Prostate volume changes were calculated and correlated with any dosimetry change. A paradoxic dosimetric result was defined as an improvement in D90, despite increased swelling; a decrease in D90, despite decreased swelling; or a large change in D90 (>30 Gy) in the absence of swelling. RESULTS: The D90 changed in 27 of 28 patients between Days 0 and 14. No relationship was found between a change in prostate volume and the change in D90 (R2 = 0.01). A paradoxic dosimetric result was noted in 11 of 28 patients. The rectal dose increased in 23 of 28 patients, with a >30-Gy change in 6. The external sphincter D90 increased in 19 of 28, with a >50-Gy increase in 6. CONCLUSION: The dose to the prostate changed between Days 0 and 14 in most patients, resulting in a change in clinical status (acceptable or unacceptable) in 12 of 28 patients. Profound increases in normal tissue doses may make dose and toxicity correlations using Day 0 dosimetry difficult. No relationship was found between the prostate volume change and D90 change, and, in 11 patients, a paradoxic dosimetric result was noted. A differential z-axis shift of stranded seeds vs. prostate had a greater impact on final dosimetry and dose to critical adjacent tissues than did prostate swelling. These findings challenge the model that swelling is the principal cause of dosimetric changes after implantation. Stranded seeds may have contributed to this outcome. On the basis of these findings, a change in technique to avoid placement of stranded seeds inferior to the prostate apex has been adopted. These results may not apply to implants using single seeds within the prostate.

Anal Canal↗
PubMed2006

Targeted radionuclide therapy for solid tumors: an overview.

Although radioimmunotherapy (RIT) has been effective in non-Hodgkin's lymphoma (NHL) as a single agent, solid tumors have shown less clinically significant therapeutic response to RIT alone. The clinical impact of RIT or other forms of targeted radionuclide therapy for solid tumors depends on the development of a high therapeutic index (TI) for the tumor vs. normal tissue effect, and the implementation of RIT as part of synergistic combined modality therapy (CMRIT). Preclinical and clinical studies have provided a wealth of information, and new prototypes or paradigms have shed light on future possibilities in many instances. Evidence suggests that combination and sequencing of RIT in CMRIT appropriately can provide effective treatment for many solid tumors. Vascular targets provide RIT enhancement opportunities and nanoparticles may prove to be effective carriers for RIT combined with intracellular drug delivery or alternating magnetic frequency (AMF) induced thermal tumor necrosis. The sequence and timing of combined modality treatments will be of critical importance to achieve synergy for therapy while minimizing toxicity. Fortunately, the radionuclide used for RIT also provides a signal useful for nondestructive quantitation of the influence of sequence and timing of CMRIT on events in animals and patients. This can be readily accomplished clinically using quantitative high-resolution imaging (e.g., positron emission tomography [PET]).

Breast Neoplasms↗
PubMed2006

Expression of androgen, oestrogen alpha and beta, and progesterone receptors in the canine prostate: differences between normal, inflamed, hyperplastic and neoplastic glands.

The expression of receptor for androgen (AR), oestrogen alpha and beta (ERalpha and ERbeta) and progesterone (PR) was examined immunohistochemically in canine prostate specimens (normal, hyperplastic, inflamed [prostatitis] or neoplastic). AR immunolabelling was seen in 100% of epithelial cells of normal and hyperplastic tissue, the corresponding figures for inflamed and carcinomatous tissue being 74% and 65%, respectively. ERalpha labelling was seen in 85% of epithelial cells in normal prostate glands, the corresponding figures for hyperplastic, inflamed and neoplastic glands being 35%, 22% and 12%, respectively. ERbeta labelling was seen in 85% of epithelial cells of normal glands and in about 70% of such cells in glands showing pathological changes. On the other hand, PR expression (weak) in normal glands was observed in fewer epithelial cells (44%) than in hyperplastic (70%), inflamed (62%) or neoplastic (64%) glands.

Animals↗
PubMed2006

The influence of chronic inflammation in prostatic carcinogenesis: a 5-year followup study.

PURPOSE: We investigated an association between chronic prostatic inflammation and prostate carcinogenesis. MATERIALS AND METHODS: Initial prostate needle biopsies from 177 patients with clinical parameters suspicious for malignancy were examined. We evaluated them for the presence and extent of chronic inflammation and other pathological findings. Findings in followup biopsies during the next 5 years were reviewed and correlated with the initial results. RESULTS: Two patients subset were identified, including 144 patients with and 33 without chronic inflammation in the initial biopsies. Additional pathological findings in some cases in each group included simple atrophy, high grade prostatic intraepithelial neoplasia, adenocarcinoma and atypical small acinar proliferation. Post-atrophic hyperplasia and proliferative inflammatory atrophy were noted only in patients with chronic inflammation. A significant association between serum prostate specific antigen and the degree of inflammation was observed in needle biopsies. In repeat biopsies within 5 years in patients with chronic inflammation 29 new cancers were diagnosed, representing a new cancer incidence of 20%. Of these cancers 6 occurred in patients in whom initial biopsies showed only chronic inflammation, 15 occurred in patients with initial post-atrophic hyperplasia/proliferative inflammatory atrophy lesions, 7 occurred in patients with initial high grade prostatic intraepithelial neoplasia and chronic inflammation, and 1 occurred in a patient with initial atypical small acinar proliferation and chronic inflammation. High grade prostatic intraepithelial neoplasia was newly discovered in 9 patients in the initial chronic inflammation group, of whom 7 had post-atrophic hyperplasia/proliferative inflammatory atrophy and 2 had simple atrophy and chronic inflammation in the initial biopsies. In contrast, in 33 patients initially showing no inflammation adenocarcinoma was subsequently found in 2 (6%). One of these patients had high grade prostatic intraepithelial neoplasia and the other had atypical small acinar proliferation on initial biopsies. CONCLUSIONS: Chronic inflammation may be a significant risk factor for prostatic adenocarcinoma.

Adenocarcinoma↗
PubMed2006

Sexual behavior, sexually transmitted diseases and prostatitis: the risk of prostate cancer in black men.

PURPOSE: Black men are diagnosed with prostate cancer more often than white men, present with more advanced disease and have worse stage specific survival. Given the high risk of incidence and mortality in this population, determining potentially modifiable factors is important. Recent studies have suggested a link between chronic inflammation and development of prostate cancer. In concurrence, population based studies of white men have revealed an increased risk of prostate cancer with history of sexually transmitted diseases and prostatitis. MATERIALS AND METHODS: We explored the chronic inflammation hypothesis of prostate cancer development among black men by examining sexual activity, sexually transmitted diseases and prostatitis in a population based study of 129 patients and 703 controls 40 to 79 years old. RESULTS: After adjusting for age, income, cigarette smoking, and history of digital rectal examination and prostate specific antigen tests in the last 5 years, we observed that a history of gonorrhea infection and prostatitis increased the odds of prostate cancer 1.78-fold (95% CI 1.13, 2.79) and 4.93-fold (95% CI 2.79, 8.74), respectively. Men reporting 25 or more sexual partners were 2.80 (95% CI 1.29, 6.09) times more likely to be diagnosed with cancer compared to men with 5 or fewer partners. CONCLUSIONS: Our findings support the significance of prior sexual practices, exposure to sexually transmitted microbial agents and history of prostatic infection in the natural history of prostate cancer in black men. Additional prospective research incorporating serological markers of infectious agents or predictive markers of chronic inflammation should serve to elucidate the possible causal pathway of recurring or persistent infection in the etiology of prostate cancer in black men.

Adult↗
PubMed2006

The application of botulinum toxin in the prostate.

PURPOSE: Botulinum neurotoxin is the most potent naturally occurring toxin known to inhibit various neurotransmitters. Injection of botulinum neurotoxin into the bladder and urethral sphincter has been used to treat bladder hyperactivity and sphincter dyssynergia. Recently botulinum neurotoxin application was extended to prostate disorders. Why would a urologist want to target the prostate? MATERIALS AND METHODS: We reviewed the literature on the mechanisms of action and clinical efficacy of botulinum neurotoxin treatment of the prostate. In addition to our personal clinical experience and basic research, information was gathered from MEDLINE and published abstracts from international meetings. We also present basic research and discuss the potential mechanism of action of botulinum neurotoxin on the prostate. RESULTS: There are 8 current peer reviewed publications on the injection of botulinum neurotoxin in the prostate. Cystoscopic transurethral or transperineal/transrectal ultrasound guided techniques have been used. Outcome improvement reported includes decreases in prostate size, prostate specific antigen and residual urine volume, and improvement in the flow rate and symptom score lasting 6 months or longer. CONCLUSIONS: Botulinum toxin has demonstrated exciting and promising preliminary results for male lower urinary tract symptoms. Translational research suggests novel mechanism of action of botulinum toxin in the prostate for benign prostatic hyperplasia and chronic nonbacterial prostatitis. It may even be considered as adjuvant treatment for prostate cancer. The use of botulinum neurotoxin in the prostate is currently Food and Drug Administration off label and in support of evidence based medicine practices caution should be applied until larger, randomized clinical studies are completed. More basic research is needed to identify the mechanisms by which botulinum toxin affects the prostate.

Animals↗
PubMed2004

Quantitation of conventional histologic parameters and biologic factors in prostatic needle biopsy are useful to distinguish paramalignant from malignant disease.

The scope of this work was to determine the potential use of prostatic conventional histologic parameters and biologic factors in distinguishing between paramalignant and malignant prostatic disease, taking into account benign fragments of biopsies obtained from patients with prostatic cancer or from patients suspected to have cancer. Each prostate sample was semi-quantified for macronucleoli, mucin, crystalloid, collagen micronodules, and quantified for glands, stroma, AgNOR, and p53. The database covered 185 biopsy specimens from 136 patients: 56 samples from the same number of patients in whom all the biopsies were benign; 49 samples from patients whose biopsies showed malignant features, and 80 malignant samples. Discriminant analysis of the results showed statistical differences for four parameters: macronucleoli, mucin, gland volume, and AgNOR, allowing us to identify three patterns of prostate involvement: normal, paramalignant, and malignant. The discriminant function permitted an adequate classification of the three patterns in 84% of the cases. Normal areas showed glands with a mean volume of 38.93 microm3, inconspicuous nucleoli, low mucin production, and a mean AgNOR area of 1.26 microm2. Prostatic biopsies with prominent nucleoli and the presence of mucin (60%), gland volume of 22.31 microm3, and AgNOR area of 2.14 microm2 characterized the paramalignant condition. Malignant areas were characterized by mean glands with a volume of 8.11 microm3, prominent nucleoli, high mucin secretion (100%), and AgNOR area of 4.47 microm2. We concluded that modifications in prostate histoarquitecture and function, such as the presence of macronucleoli, volume of glands, abnormal secretion of acid mucin and AgNOR expression, represent important parameters that must be incorporated in the pathologist's evaluation of prostate biopsies to the purpose of indicating a subsequent biopsy, particulary in those patients with clinical suspicion of malignancy, and whose prostate biopsy specimen showed paramalignant areas.

Adenocarcinoma↗
PubMed2006

Clinical approach to the prostate: an update.

Prostatic disease continues to present clinicians with challenges. Although giant strides have been made in the medical and surgical management of benign prostatic hyperplasia, many fundamental questions about its pathogenesis, progression, and treatment efficacy remain unanswered. Prostate cancer also continues to be an area in which progress is needed despite major recent advancements. Numerous debates that include the value of prostate-specific antigen screening and appropriate roles for each of the numerous therapeutic modalities await resolution. For millions of patients who suffer from prostatitis, a major breakthrough is yet to come. Current treatment regimens for prostatitis remain ineffective at best. Contemporary approaches to the pathogenesis, diagnosis, and treatment of benign prostatic hyperplasia, prostate cancer, and prostatitis are discussed in this review.

Adenocarcinoma↗
PubMed2004

[Treatment of cancer and hematological malignancy in elderly people (Part II)].

PURPOSE: Fifty percents of cancer arise in people older than 65-year-old. Most clinical trials in cancer treatment are limited in patients younger than 65-year-old. We review literature-describing particularity of cancer treatment in elderly patients. CURRENT KNOWLEDGE AND KEY POINTS: Therapeutic decisions should be based on an estimation of the patient's life expectancy, and risks and benefits should be weighted up accordingly. Geriatric oncology is made of a geriatric evaluation of patient and of knowledge of clinical trial about elderly patients. FUTURE PROSPECTS AND PROJECTS: We present in this issue the principle of geriatric evaluation and the results of recent clinical trial on elderly cancer patients.

Acute Disease↗
PubMed2003

Human prostate cancer precursors and pathobiology.

Prostate cancer is among the most common malignancies. It is estimated that 1 in 6 men in the United States will be diagnosed with this disease. Despite the high prevalence and importance of prostate cancer, the molecular mechanisms underlying its development and progression remain poorly understood. This article reviews new information about the roles of oxidants and electrophiles in prostate cancer; the potential importance of chronic inflammation and atrophy in prostate carcinogenesis, and implications for chemoprevention; evidence supporting telomere shortening and genetic instability in the etiology of prostate cancer; and alpha-methylacyl-coenzyme A racemase (AMACR) as a potential marker for prostate carcinogenesis. These new results show that at least some high-grade prostatic intraepithelial neoplasias (PIN) and early adenocarcinomas appear to arise from proliferative inflammatory atrophy (PIA). Inflammation and other environmental factors may lead to the destruction of prostate epithelial cells, and increased proliferation may occur as a response to this cell death. Such proliferation may be mechanistically related to decreased p27(Kip1) observed in PIA. The decreased apoptosis associated with these events may also be related to increased expression of Bcl-2. Increased oxidant and electrophile stress in the setting of increased proliferation associated with these events may lead to elevated glutathione S-transferase P1 (GSTP1) expression as a genomic-protective measure. However, aberrant methylation of the CpG island of the GSTP1 gene promoter silences GSTP1 gene expression and protein levels, setting the stage for additional genetic damage and accelerated progression toward PIN and carcinoma. Additional results show that AMACR may be an important new marker of prostate cancer, and its use in combination with p63 staining may provide the basis for an improved method for identification of prostate cancer.

Adenocarcinoma↗
PubMed2004

Self-report of prostatitis and its risk factors in a random sample of middle-aged men.

OBJECTIVES: To determine the risk factors for the self-reported history of prostatitis and to determine whether a self-reported history of prostatitis is related to the diagnosis of prostate cancer. METHODS: Random digit dialing was used to select a group of controls aged 40 to 64 years without prostate cancer matched by age with a group of patients with prostate cancer in a study on the epidemiology of prostate cancer. Controls were divided into those who reported a diagnosis of prostatitis (cases) and those who denied ever having had prostatitis (controls). We adjusted for the time from a prostatitis diagnosis to the in-person interview. We also compared the number of men with a prostatitis diagnosis to the number of men diagnosed and not diagnosed with prostate cancer. RESULTS: Of the 645 control men without a history of prostate cancer, 58 (9.0%) reported a diagnosis of prostatitis. The men with prostatitis had a mean age of 39.5 years at diagnosis. The urinary symptoms among prostatitis cases and controls was similar. Prostatitis cases more frequently reported urinary (P < or =0.05) or urethral infections (P < or =0.01) before diagnosis. Men with prostatitis were more likely to have procedures aimed at diagnosing both prostatic and other diseases. Men with prostate cancer reported a diagnosis of prostatitis more often than the noncancer controls (13.6% versus 9.0%). After controlling for the number of prostate-specific antigen tests this difference disappeared. CONCLUSIONS: Nine percent of a randomly selected group of middle-aged men reported they had been diagnosed with prostatitis. The prevalence of a prostatitis diagnosis is similar in men with and without prostate cancer.

Adult↗
PubMed2005

Effect of prostatic massage on serum complexed prostate-specific antigen levels.

OBJECTIVES: To evaluate the effects of prostatic massage on the serum complexed PSA (cPSA) concentration in various prostatic diseases. METHODS: A total of 51 men who presented to our outpatient clinic for the first time with symptoms of lower urinary outflow obstruction were included in this study. Blood samples were obtained from each patient before and 30 minutes after prostatic massage. Total PSA (tPSA), free PSA (fPSA), and cPSA levels were measured using a chemiluminescent enzyme immunoassay. RESULTS: After prostatic massage, the tPSA and fPSA levels and fPSA/tPSA ratio increased significantly (P < 0.0001), and the increase in cPSA was minimal but statistically significant (P = 0.047). In patients with prostate cancer, no significant increase occurred in the mean forms of PSA (tPSA, cPSA, and fPSA/tPSA ratio), except for fPSA, after prostatic massage. We observed a greater increase in all PSA forms in the chronic prostatitis group. CONCLUSIONS: In this study, prostatic massage increased serum cPSA concentration, but to a lesser extent than tPSA and fPSA.

Humans↗