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PubMed1975

Current status of carcinoembryonic antigen assay.

The carcinoembryonic antigen (CEA) is a glycoprotein that can be measured by radioimmunoassay and other immunologic techniques. The CEA reagent is currently commercially available in kit form and has been found to be satisfactory for laboratory use. The highest percentage of elevated plasma CEA and the highest CEA titer have been found in patients with entodermally derived tumors. CEA has also been detected in patients with other tumors and in patients with nonneoplastic disease, as well as in heavy cigarette smokers. The present CEA assay cannot be used to screen for cancer in the general population. The greatest clinical usefulness of current CEA assay is in assessing prognosis, in the detection of residual tumors and recurrent disease, and in monitoring chemotherapy and radiotherapy. The use of anti-CEA antiserum as a tumor-localizing agent may be of potential value in the future.

Adenocarcinoma↗
PubMed1976

The role of radionuclides in clinical oncology.

The major role of radionuclides in clinical oncology is, in the broadest sense, "tumor scanning". This includes evaluating specific organs for the presence of tumor (usually with different radiopharmaceuticals for each organ) or the entire body (generalized tumor searches with radiopharmaceuticals with 67Ga-citrate or 111Inlabeled bleomycin). The clinician uses these agents in the initial evaluation of the extent of tumor (staging) and in the subsequent management of the patient with cancer to assess response to treatment, to detect early relapse, and to assist in making decisions concerning treatment. The uses and limitations of the agents currently available for tumor scanning are summarized in this review (by major tumor type) from the perspective of the practicing oncologist. Other potential roles for radionuclides, including use as components of combined modality treatment programs, use as labels for antibodies or as drugs for both diagnosis and treatment, and use in the prediction of response to treatment, which are of great interest now and which will become realities for the oncologist in the future, are also considered.

Bleomycin↗
PubMed1985

Nuclear magnetic resonance in oncology.

The application of nuclear magnetic resonance (NMR) techniques to the diagnosis of cancer was first explored by Damadian, who proposed that benign and malignant tissues could be differentiated on the basis of characteristic differences in spin-lattice and spin-spin relaxation times (T1 and T2) as determined in vitro with NMR spectrometers. Damadian's thesis was very controversial and never gained widespread acceptance. Not all investigators were able to confirm his findings. Moreover, it was improbable that NMR would ever play an important role in the diagnosis of malignancy as long as biopsy was necessary to obtain material for analysis. However, the potential usefulness of NMR in oncology was enhanced considerably by the work of Lauterbur, who showed that NMR signals could be spatially encoded to produce images of the examined object. NMR imaging has made feasible the measurement of the T1 and T2 of lesions without biopsy. Unfortunately, initial efforts at characterizing tissues by in vivo determination of proton relaxation times have yielded disappointing results. Nonetheless, NMR imaging will be a powerful tool for evaluating patients with malignant disease because of the unique anatomic information it can provide without exposure of the patient to ionizing radiation. In vivo NMR spectroscopy of 31P and other sensitive nuclei may add a new dimension to clinical and experimental oncology.

Animals↗
PubMed1997

PET in oncology: will it replace the other modalities?

Medical imaging technology is rapidly expanding and the role of each modality is being redefined constantly. PET has been around since the early sixties and gained clinical acceptance in oncology only after an extreme number of scientific publications. Although PET has the unique ability to image biochemical processes in vivo, this ability is not fully used as a clinical imaging tool. In this overview, the role of PET in relation to other tumor imaging modalities will be discussed and the reported results in the literature will be reviewed. In predicting the future of PET, technical improvements of other imaging modalities need to be dealt with. The fundamental physical principles for image formation with computed tomography (CT), ultrasound (US), magnetic resonance imaging (MRI), photon-emission tomography (PET), and single photon emission CT (SPECT) will not change. The potential variety of radiopharmaceuticals which may be developed is unlimited, however, and this provides nuclear imaging techniques with a significant advantage and adaptive features for future biologic imaging. The current applications of PET in oncology have been in characterizing tumor lesions, differentiating recurrent disease from treatment effects, staging tumors, evaluating the extent of disease, and monitoring therapy. The future developments in medicine may use the unique capabilities of PET not only in diagnostic imaging but also in molecular medicine and genetics. The articles discussed in this review were selected from a literature search covering the last 3 years, and in which comparisons of PET with conventional imaging were addressed specifically. PET studies with the glucose analogue fluorine-18-labeled deoxyglucose (FDG) have shown the ability of detecting tumor foci in a variety of histological neoplasms such as thyroid cancer, breast cancer, lymphoma, lung cancer, head and neck carcinoma, colorectal cancer, ovarian carcinoma, and musculoskeletal tumors. Also, the contribution of the whole body PET (WBPET) imaging technique in diagnosis will be discussed. In the current health care environment, a successful imaging technology must not only change medical management but also demonstrate that those changes improve patient outcome.

Adrenal Gland Neoplasms↗
PubMed1994

Ultrasound-guided four quadrant biopsy of the prostate: efficacy in the diagnosis of isoechoic cancer.

Five hundred and eighty men underwent transrectal ultrasound-guided biopsy of the prostate using the four quadrant biopsy (4QB) technique. Four hundred and three men had focal hypoechoic lesions of the peripheral gland but the other 177 men referred because of concern for the presence of cancer had no discrete sonographic lesion. Cancer was found from 4QB in only 32 of these 177 men (18.1%) compared to 158 of the 403 men (39.2%) with focal hypoechoic lesions (P < 0.001). Additional biopsy evidence of cancer was found in contralateral isoechoic (sonographically normal) quadrants in 41 men with focal hypoechoic cancerous lesions. In 17 men with hypoechoic lesions that were biopsy-benign, cancer was found in other isoechoic quadrants. There was no difference between the average Gleason scores of hypoechoic cancers and isoechoic cancers, other than when cancers were incidentally found in men with benign focal hypoechoic lesions. These had significantly lower scores (P = 0.02). Cancer yield in the 177 men without hypoechoic lesions increased as a function of prostate-specific antigen (PSA) level; 11% if PSA < 10ng/ml, 32% if > 20ng/ml. Prostatitis was the most common abnormal biopsy finding in these men. 4QB increases the yield of prostate cancer compared to simple biopsy of hypoechoic lesions and improves knowledge of local disease extent. 4QB is recommended for men with elevated PSA levels but no peripheral gland sonographic abnormality.

Adult↗
PubMed1984

Evaluation of the role of computed tomography in radiotherapy treatment planning.

The role of computed tomography (CT) in radiotherapy treatment planning was assessed in a series of 231 patients in whom treatment was planned with radical intent. For each patient, a treatment plan was produced by the best conventional techniques in use at the Middlesex Hospital. Each patient then underwent a CT scan in which the treatment conditions were closely simulated. As a result of the CT scan images, alteration was made to the planned treatment in 47% of 198 assessable patients. Large differences were seen in the usefulness of CT treatment planning for tumours in different sites, with the greatest contribution made to treatment of tumours of the sinuses and nasopharynx and of the bladder. Although its unit cost is high, computed tomography can be a very useful tool in radiotherapy treatment planning and can contribute uniquely to improved patient management for adequately selected patients.

Bronchial Neoplasms↗
PubMed1984

The respective roles of the simulator and computed tomography in radiotherapy planning: a review.

The advent of computed tomography (CT) scanners and the development of a CT facility on treatment simulators has provided an array of expensive equipment for use in radiotherapy treatment planning. The object of this paper is to review the requirements necessary for accurate radiotherapy planning and to present guidelines regarding the system which appears best suited to plan individual tumour sites, based on our experience of CT scanning and related techniques over the past 6 years.

Brain Neoplasms↗
PubMed1999

The transrectal ultrasound and MRI appearances of granulomatous prostatitis and its differentiation from carcinoma.

AIMS AND METHODS: Granulomatous prostatitis is a benign inflammatory condition of the prostate which can be mistaken for prostatic carcinoma both clinically and on ultrasound, but is distinguishable histologically. The transrectal ultrasound (TRUS) and magnetic resonance imaging (MRI) appearances of 10 patients with histologically confirmed granulomatous prostatitis were evaluated to try and identify any correlation between the two techniques or any specific features on MRI to help distinguish it from carcinoma. Clinical findings and serum prostatic specific antigen (PSA) levels were also evaluated. RESULTS: In five patients, both TRUS and MRI were concordant, showing only changes of benign prostatic hypertrophy (three patients) or showing no abnormality (two patients). In a further three patients, both TRUS and MRI were abnormal, with appearances suggestive of carcinoma. One of these patients had tuberculous prostatitis and had a past history of tuberculosis. In the remaining two patients, there was a discrepancy between TRUS and MRI findings, carcinoma being suspected on TRUS in one with a normal MRI, and carcinoma suspected on MRI in the other with a normal TRUS. CONCLUSION: There is no pattern of clinical, biochemical, ultrasound or MRI findings that allows a specific diagnosis of granulomatous prostatitis to be made, or differentiation from prostatic carcinoma.

Aged↗
PubMed2005

Efficacy and complications of covered Wallstents in malignant distal biliary obstruction.

BACKGROUND: This study evaluated the efficacy and the complications associated with the use of the covered Wallstent in the setting of unresectable malignant biliary obstruction. METHODS: Between March 2001 and January 2003, all patients with distal malignant biliary obstruction that required drainage were treated with a covered Wallstent. Every 2 months, the patients were evaluated clinically and biochemical tests of liver function were obtained. Data were recorded for the following variables: early complications (within 30 days of stent placement), early and late stent occlusion, duration of stent patency, need for subsequent biliary intervention, and patient survival. RESULTS: A total of 88 covered Wallstents were inserted in 80 patients. Stent patency rates at 3, 6, and 12 months were 90%, 82%, and 78%, respectively. Complications included stent migration (5), stent occlusion (12), episodes of cholecystitis (3), and episodes of post-ERCP pancreatitis (5). Biliary intervention was required in 9 patients subsequent to placement of the initial covered Wallstent. CONCLUSIONS: Deployment of a covered Wallstent is safe and relatively easy. It achieves biliary drainage with an acceptable risk to benefit ratio in the majority of patients with distal malignant biliary obstruction.

Adult↗
PubMed2006

A novel serum marker, total prostate secretory protein of 94 amino acids, improves prostate cancer detection and helps identify high grade cancers at diagnosis.

PURPOSE: New biomarkers for prostate cancer are needed. We determined whether a novel serum marker, total PSP94 can be used to accomplish these goals. MATERIALS AND METHODS: We conducted a case-control study of 1,212 men with no previous history of prostate cancer and who underwent a prostate biopsy from 1998 to 2000 because of an increased PSA or an abnormal DRE. Serum PSP94 levels were assessed using a sandwich enzyme-linked immunosorbent assay technique. Cases were patients with prostate cancer, and controls were patients who had no evidence of cancer. Multivariate logistic regression analysis was used to determine whether or not PSP94 levels improved the predictive value for prostate cancer. RESULTS: Of the 1,212 men 596 (49.2%) had cancer detected. The median PSP94 level was significantly lower among cases (2.60 ng/ml) than among controls (3.40 ng/ml, p <0.0001). The adjusted odds ratios for the presence of prostate cancer for patients with the lowest quartile of PSP94, compared to patients in the highest quartile was 2.70 (95% CI 1.8 - 4.0, p <0.0001). Among a subgroup of 649 men in whom PSA had a low predictive value (PSA less than 20 ng/ml, normal DRE and less than 70 years), 260 (40.1%) were found to have cancer. In this subgroup total PSP94 levels helped discriminate between patients with high grade disease (Gleason score 8 or more, median 1.90 ng/ml), moderate grade disease (Gleason score 7, median 2.34 ng/ml) and low grade disease (Gleason score 6 or less, median 2.60 ng/ml, p = 0.007). PSA and the FTPSA were not able to distinguish between patients with different grades in this group. CONCLUSIONS: Patients with low total PSP94 levels had a high probability for having prostate cancer detected at biopsy. The total PSP94 level was able to help identify patients with high grade disease among a subset of patients in whom PSA and FTPSA are least informative.

Adult↗
PubMed1993

HLA expression by benign and malignant prostatic epithelium: augmentation by interferon-gamma.

Chronic prostatitis is a poorly understood entity that is characterized by lymphocytic infiltration of benign prostatic epithelium. Previously, we and others have shown that prostatic epithelium involved by prostatitis is phenotypically different from uninvolved epithelium. In addition, we have shown that malignant prostatic epithelium is rarely, if ever, infiltrated by lymphocytes. We now report that benign prostatic epithelium expresses HLA-DR only in the presence of lymphocytic inflammation, and that benign epithelium without chronic prostatitis and malignant prostatic epithelium do not express HLA-DR. In order to determine whether HLA-DR expression is inducible on malignant prostatic epithelium and therefore, at least theoretically, susceptible to immune regulation, we studied the DU-145 cell line in culture under various conditions. DU-145 cells did not express HLA-DR under routine culture conditions. However, the addition of interferon-gamma (100 to 6000 U/ml.) resulted in HLA-DR expression by DU-145 cells at 24 hours with maximal expression by 72 hours. In contrast, other cytokines (tumor necrosis factor, interleukin-1, interleukin-2) had no effect on HLA-DR expression. These investigations show that interferon-gamma induces HLA-DR expression on the DU-145 prostatic adenocarcinoma cell line, raising the theoretical possibility that malignant prostatic cells may be induced in vivo to express HLA-DR and thus become susceptible to immune regulation.

Adenocarcinoma↗
PubMed1993

Iatrogenic urinary tract infection with Pseudomonas cepacia after transrectal ultrasound guided needle biopsy of the prostate.

In response to an unexplained development of Pseudomonas cepacia cystoprostatitis after transrectal ultrasound guided prostate biopsy, a retrospective review of records and biopsy protocol was performed at our institution. Between June 5, 1990 and January 9, 1991 no documented infections occurred in 272 patients undergoing transrectal ultrasound and prostate biopsy. During the next 6 months, however, 9 of 110 patients (8.2%) presented again with infectious symptomatology after transrectal ultrasound guided needle biopsy of the prostate. Culture of a majority of the specimens (67%) yielded P. cepacia. Two additional asymptomatic patients became colonized with P. cepacia. Environmental investigations revealed the ultrasound transmission gel as the source of the contamination. The proposed mechanism of infection was direct prostate or bladder seeding of contaminated transmission gel used to prepare the ultrasound transducer probe. Infections developed in immunocompetent patients despite adequate antimicrobial prophylaxis most likely secondary to underlying bladder outlet obstruction and significant direct inoculum of organisms. We currently recommend use of individualized sterile packets of transmission gel in addition to appropriate antimicrobial prophylaxis and povidone-iodine cleansing enemas when performing transrectal sonographic guided biopsies of the prostate.

Biopsy, Needle↗
PubMed1990

Adenocarcinoma of the prostate discovered in 2 young patients following total prostatovesiculectomy for refractory prostatitis.

Adenocarcinoma of the prostate gland is the most common cancer in men in the United States but it occurs rarely in men younger than 40 years. Incidental prostate cancer has been shown to exist in a significant number of patients older than 50 years, found either at autopsy or after cystoprostatectomy for a pathological condition of the bladder. We report 2 cases of unsuspected adenocarcinoma of the prostate gland discovered after total prostatovesiculectomy for refractory prostatitis in men 25 and 36 years old, respectively.

Adenocarcinoma↗
PubMed1988

Uptake of estramustine phosphate (estracyt) metabolites in prostatic cancer.

Plasma and tumour concentrations of estramustine, estromustine, estradiol and estrone, the major metabolites of estramustine phosphate (estracyt), were determined in patients with prostatic carcinoma treated between one and nine years with repeated oral doses of estracyt (560 to 840 mg./day). The last dose was given 12 to 16 hours before sampling. The binding of radioactive estramustine and estromustine was determined in the tumour tissue to examine the possible role of estramustine-binding protein for the accumulation of these metabolites into the tumour. Comparison was made with benign prostate hyperplastic tissue from untreated patients. Estromustine was the main metabolite in plasma as well as in the tumour (range 235 to 450 and 205 to 485 ng./gm., respectively), whereas estramustine (20 to 45; 95 to 370), estrone (62 to 140; 63 to 160) and estradiol (8 to 15; 7 to 36) were found in lower concentrations. Interestingly the concentration of estramustine was as an average six times higher in the tumour than in plasma contrasting with the other metabolites which were present in equal amounts of the two localities. Binding of 3H-estramustine and 3H-estromustine was two to three times higher in the tumour than in benign hyperplastic tissue and negligible in plasma samples. The present study is the first where substantial amounts of cytotoxically active estramustine and estromustine are demonstrated in tumour tissue from estracyt treated patients. Our findings suggest a mechanism for selective uptake of these metabolites in prostatic cancer (estramustine-binding protein). The uptake and binding of estramustine and estromustine in the tumour may account for the clinical effects of estracyt in prostatic carcinoma.

Aged↗
PubMed1985

Exfoliative cytology of prostatic carcinoma using a prostatic fluid collecting catheter.

In 152 patients who were suspected to have prostatic disease prostatic fluid obtained by a specially designed catheter was examined cytologically. Cytology was positive in 16 of 20 patients who initially were diagnosed clinically as having prostatic carcinoma, in 10 of 41 patients with suspected carcinoma and in 3 of 91 patients with clinical prostatic hypertrophy or other benign diseases. All but one of these cytologically positive cases finally were confirmed histologically to have prostatic carcinoma. In 4 patients initially diagnosed as having prostatic carcinoma cytology was not positive but in one the initial clinical diagnosis was incorrect and only 3 were false negative. This method of diagnosis is simple and highly effective in detecting prostatic carcinoma.

Adenocarcinoma↗