Speciality
Spotlight

 




 

Urology


 

 






Prostate Cancer

      

  • JBW Rietbergen, AEB Kruger, RF Hoedemaekar, et al [ Erasmus Univ, Rotterdam, The Netherlands; Academic Hosp, Rotterdam, The Netherlands]


    Repeat Screening for Prostate Cancer After 1-year Follow-up in 984 Biopsied Men : Clinical and Pathological Features of Detected Cancer


    J Urol 160: 2121-2125, 1998

         



    Conclusion-
    This article describes the tumor and prostate characteristics of 984 men who underwent repeat screening 1 year after having a negative biopsy of the prostate.

         


    Eleven percent of men undergoing a second biopsy were found to have prostate cancer. The only difference between men whose cancer was discovered at the first biopsy and those discovered at the second biopsy was prostate size [42.6 vs. 34.9 cc]. There were no differences in other parameters such as prostate-specific antigen, pathologic tumor stage, or tumor grade.

         


    This finding underscores the limitations of standard biopsy techniques as applied to a heterogeneous group of men with prostates of varying sizes and shapes. 

         


    In this study, a standard sextant biopsy technique was utilized for all men regardless of prostate size and configuration. One wonders whether tailoring the specific biopsy approach according to prostate size or configuration would be more helpful in identifying prostate cancers during the initial biopsy session. Computer-simulated models suggest that this is indeed possible, but as of yet no firm guidelines have been established to enhance cancer detection on an initial US-guided biopsy of the prostate.

         

  • F Rabbani, N Stroumbakis, BR Kava, et al [ Mem Sloan-Kettering Cancer Ctr. New York]


    Incidence and Clinical Significance of False-Negative Sextant Prostate Biopsies


    J Urol 159: 1247-1250, 1998

       


    Conclusion – 23% of patients with known prostate cancer had negative repeat sextant biopsies despite a diagnosis of prostate cancer and despite receiving no therapy.

       


    These results underscore the limitations of using biopsy, after cryotherapy or interstitial radiation therapy, as a surrogate for exclusion of prostate cancer.

       

  • AS Robbin, AS Whittemore, SK Van Den Eeden [Stanford Univ, Calif; Kaiser Permante Med Care Program, Oakland, Calif]


    Race, Prostate Cancer Survival, and Membership in a Large Health Maintenance Organization


    J Natl Cancer Inst 90: 986-990, 1998

       


    Conclusion – The data are consistent with those reported from most settings, that is, that African American men have poorer survival than white men, even after adjustment for stage of diseases. Whether this reflects differences in virulence or higher levels of co-morbidities among African American is not known.

       


    It is suggested in this study that causes of death other than prostate cancer are unlikely to account for the findings as cancer-specific death rates were also evaluated. 

        

  • K Brasso, S Friis, K Juel, et al [univ of Copenhagen; Danish Cancer Society and the Danish Inst of clinical Epidemiology, Copenhagen]


    Mortality of Patients with Clinically Localized prostate Cancer Treated with Observation for 10 years or Longer: A Population Based Registry study


    J Urol 161-524-528, 1999

       


    Conclusion – In this study, patients who had clinically localized prostate cancer for 10-years or longer and who were likely candidates for curative therapy as the time of diagnosis had significant excess mortality when treated expectantly.

       


    This study from Denmark is interesting because prior to 1995 no radical prostatectomy was performed for potentially curable disease and less than 1% of patients were subjected to radiation

       

  • R
    O Roberts, EJ Bergstralh, SK Jatusic, et al [Mayo Clinic and Mayo Found, Rochester, Minn]


    Decline in Prostate Cancer Mortality from 1980 to 1997, and an Update on Incidence Trends in Olmsted County, Minnesota


    J Urol 161: 529-533, 1999

       


    Conclusion – The rates of prostate cancer mortality, which increased in the early years of PSA testing may have declined in recent years to levels lower than those of the early 1980s. Increased screening may account for this change.

       

  • O P Heinonen , D Albanes, J Virtamo et al [ Univ of Helsinki; Natl Cancer Inst Bethesda, Md; Natl Public Health Inst, Helsinki; et al]


    Prostate Cancer and Supplementation With a -Tocopherol and b- Carotene: Incidence and Mortality in a Controlled Trial


    J Natl Cancer Inst 90: 440-446, 1998

       


    Conclusion – Long term a -Tocopherol supplementation may markedly decrease the incidence of and mortality from prostate cancer in smokers. Further research is needed to verify these results.

       

  • LN Nguyen, A Pollack , GK Zagars [Univ of Texas, Houston]


    Late Effects after Radiotherapy for Prostate Cancer in a Randomized Dose-Response Study: Results of a Self-Assessment Questionnaire


    Urology 51: 991-997, 1998

       


    Conclusion – the incidence of incontinence after radiotherapy [30%] is similar to that after radical prostatectomy as reported in the literature [31%]. Only a few patients required urinary protective devices after radiotherapy.

       


    The percentage of patients who could achieve full erection after radiotherapy [36%]. Compares favorably with that after radical prostatectomy [39%].

       


    Conformal boost radiotherapy with 78 Gy is a safe and effective treatment for prostate cancer that is associated with few significant late effects 2 years or more after radiation therapy.

        

  • JD Slater, Yonemoto LT, CJ Jr Rossi, et al [ Loma Linda Univ Med Ctr Calif] 


    Conformal Proton Therapy for Prostate Carcinoma


    Int J Radiat Oncol Biol Phys 42: 299-304, 1998

       


    Conclusion – Proton therapy at doses of 74 to 75 CGE was associated with minimal treatment related toxicity and excellent outcomes in patients with low initial PSA levels.

       


    At 5 years, 91% of patients who achieved a PSA nadir of 0.5 ng/ml or less had no clinical or biochemical evidence of disease.

       

  • MA Elsenberger, BA Blumenstein , Ed Crawford, et al [Johns Hopkins Hosp, Baltimore, Md;
    Southwest Oncolofy Group Statistical Ctr, Seattle, Univ of Colorado, Denver; et al]

    Bilateral Orchiectomy with or Without Flutamide for Metastatic Prostate Cancer


    N Engl J Med 339: 1036-1042, 1998

       


    Conclusion – This is a well defined study that suggests that the benefit of combined androgen blockade in patients with prostate cancer is negligible. It also points out that using prostate specific antigen as a response criterion is hazardous, as patients receiving flutamide had a higher prostate-specific antigen response rate compared with the placebo group but no benefit in survival

        

  • Tyrrel CJ, Kaisary AV, Iversen P, et al [Derriford Hosp, Plymouth, England: Royal Free Hosp, London; Univ of Copenhagen; et al


    A Randomized Comparison of ‘Casodex’TM [Bicalutamide] 150 mg Monotherapy Versus Castration in the Treatment of Metastatic and Locally Advanced Prostate Cancer


    Eur Urol 33: 447-456, 1998

       


    Because of concern over hot flashes, sexual dysfunction, and other constitutional side effects with castration therapies, increased interest in antiandrogen monotherapies has evolved.

       


    It is worth to maintain sexual interest and function if it means a shorter life expectancy, breast pain, and gynecomastia for men with advanced prostate cancer?

       

  • Yasunaga Y, Shin M, Fujita MQ, et al [Osaka Univ, Suita, Japan; Osaka City Univ; Japan


    Different Patterns of p53 Mutations in Prostatic Intraepithellial Neoplasia and Concurrent Carcinoma : Analysis of Microdissected Specimens


    Lab Invest 78: 1275-1279, 1998

       


    Conclusion – Approximately 25% prostate cancer manifest mutations of the P53 gene and that 19% of cases of high grade prosthetic intraepithelial neoplasia also demonstrate P53 abnormalities. 

       


    This study confirms the association between high grade PIN and prostate cancer and the lack of association of low-grade PIN with prostate cancer.

       

  • GD Grossfeld , DM Stier, SC Flanders, et al [Univ of California, San Francisco; Technology Assessment group, San Francisco; TAP Holdings Inc, deefield, III


    Use of second Treatment Following Definitive Local Therapy for Prostate Cancer; Data From the CaPSURE Database


    J Urol 160: 1398-1404, 1998

       


    Conclustion – Registry data suggest that about one fifth of patients with prostate cancer receive some from of second treatment a mean of 3 years after their initial local treatment.

       


    Patients whose primary treatment is radical prostatectomy, particularly those at low risk, are least likely to require second treatment.

       


    In this study, 14% radical prostatectomy patients, 27% of radiation patients and 22% of cryosurgery patients underwent second therapies within 2 1/2 to 3 years of completing their initial treatment.

       

  • Radical Protatectomy


    E Worwag, GW Chodak


    Overnight Hospitalization After Radical Prostatectomy : The impact of two pathways on patient satisfaction, Length of Hospitalization and Morbidity.


    Anesth analg 87 62-67, 1998

        


    Emphasis on cost control has spurred attempts to decrease hospital stays. The efficacy of overnight hospitalization for radical prostatectomy using complications and patient satisfaction as measures were reported for 100 consecutive patients.

         


    A standard retopubic radical prostatectomy was performed on all patients under epidural anesthesia followed by epidural morphine [ n=47] or combined spinal anesthesia using bupivacaine and fentanyl followed by 10 to 20 mg of IM methadone [n=53]. Length of hospital stay, postsurgical morbidity and patient satisfaction were compared.

         


    Duration of surgery was significantly longer for the methadone group as compared to the morphine group. The median period of hospital stay was same for both groups [ 1.2 to 1.34 days]. Only 17% of the patients stayed longer than one night. There were no complications attributable to surgery, anesthesia or analgesia. Only 21% of patients believed their stay was too short.

         

  • Felnyk O, Zimmerman M, Kim KJ, et al [ Univ of California at San Francisco, Genentech Inc, South San Francisco, Calif

    Neutralizing Anti-Vascular Endothelial Growth Factor Antibody Inhibits Further Growth of Established Prostate Cancer and Metastases in a Pre-clinical Model

    J Urol 161: 960-963, 1999

         

    Angiogenesis i.e. deriving blood supply from the existing vasculature promotes tumor growth metastasis. Vascular endothelial growth factor [
    VEGF], a potent angiogenic factor and vascular permeability mediator, promotes tumor growth through
    neovascularisation. Inhibitors of VEGF would reverse this process has been well-studied in previous experimental studies. This study also gives an insight that inhibitors of VEGF through monoclonal anti VEGF neutralizing antibody suppressed the primary tumor growth in mice and also inhibited metastatic dissemination to the lung in human prostate cancer cell line study.

        

  • Levesque PE, Nieh PT, Zinman
    LN, et al [ Lahey Clinic Ctr, Burlington, Mass]

    Radiolabeled Monoclonal Antibody Indium 111-Labeled CYT-356 Localizes Extraprostatic Recurrent Carcinoma After Prostatectomy

    Urology 51: 978-984, 1998

      

    Elevated prostate-specific antigen [PSA] can detect recurrence but not the locations of the disease. Murine monoclonal antibody, 7E11-C5. 3-glycyl-tyrosyl-[N,
    e-diethylenetriamine pentaacetic acid] – lysine [CYT-356], linked to 111In was used to localize primary and metastatic prostate cancer. A large majority with elevated
    PSA, the CYT-356 was taken up outside the prostate
    fossa. Approximately, two third have activity in pelvic lymph nodes. Even when the lymph node dissections were negative at the time of
    prostatectomy.

        

    Scan failed to localize the disease in 21% of the patients with elevated PSA possibly because the antibody fail to bind to all the tumors or is unable to find small foci.

        

  • Djavan B, Kadesky K, Klopukh B, et al
    [Univ of Vienna; Presbyterian Hosp of Dallas; Univ of Texas,
    Dollas]

    Gleason Scores From Prostate Biopsies Obtained with 18-Gauge Biopsy Needles Poorly Predict Gleason Scores of Radical Prostatectomy Specimens

    Eur Erol 33 : 261-270, 1998

      

    The Gleason grading system is a well accepted prognostic factor for prostate cancer. This study has correlated with Gleason score from needle biopsy with that from radical
    prostatectomy. For needle biopsy 37.2% of patients had no scoring change, 12.7% were
    overgraded, and 50.1% undergraded. To conclude 50% of all gleason score when obtained from needle biopsy specimen had to be revised in the direction of a worse. The clinician have to keep this in mind when advising patients when gleason grading system is taken into consideration for planning the therapy.

  • D. Feldman Stewart, M.D. Brundage, J.C. Nickel, and W.J. Mackillop [ Radiation Oncology Research Unit, Department of Oncology, and Department of Psychology, Community Health and Epidemiology and Urology, Queen’s University, Kingston, Canada]

    The Information Required by Patients with Early-Stage Prostate Cancer in Choosing Their Treatment 

    BJU International, volume 87, Number 3, February 2001, Pg.Nos. 218-223



    Information Items Necessary for the Decision –



    1. Treatment options if initial treatment unsuccessful.

    2. Treatment options if cancer progresses. 

    3. Chances of cancer disappearing, at least at first.

    4. Treatment options if cancer comes back after initial treatment.

    5. Chances of cancer progressing with no treatment for now.

    6. Effect on bladder functioning.

    7. How each treatment works.

    8. Chances of causing bleeding.

    9. Chances of dying from cancer with treatment.

    10. What parts of body cancer might spread to.

    11. Chances of cancer causing future symptoms with treatment.

    12. What cancer is.

    13. Life expectancy with treatment.

    14. Length of time to decide on treatment.

    15. Personal treatment preference of doctors.

    16. Chances of causing fatigue.

    17. Waiting time for each treatment.

    18. Chances of treatment related mortality.

    19. Chances of causing fall in blood counts 

    20. Chances of causing nausea.

    21. Opportunity to seek second opinion.

    22. Method of detecting response to treatment.

    23. Method of detecting cures.

    24. Effect of skin.

    25. Effect on sexual functioning.

    26. Effect on hair loss.

    27. Chances of losing testicles.

    28. Change in physical appearance with treatment.



    The above items are in accordance with “agreement” from the respondents of a questionnaire. 





    Actual information provided for the top of three items –


       








    Abbreviated
    Item


    Information


     


    1] 
    Treatment options if
     
    initial

        
    treatment

    unsuccessful


    If
    surgery does not remove all the
    cancer, some patients can then have
    radiation. There are more side effects
    of radiation after surgery. Hormone
    treatment can also be used if surgery
    does not remove all the cancer.

     

    If the cancer does not disappear after
    radiation, some patients can then have
    surgery. There are more side effects
    from surgery after radiation.
     

     

    Hormone
    treatment can also be used if the
    cancer does not disappear after
    radiation.

     


    2] 
    Treatment options if

         cancer

    progresses


    If
    you choose no treatment now, you might
    still be able to have either surgery
    or radiation later as long as the
    cancer has not spread beyond the
    prostate. If the cancer does spread
    beyond the prostate, there is still
    effective hormone treatment that can
    keep it under control for many months
    or years.


     


    3] 
    Chances of cancer 

        
    disappearing,
    at least

         initially


    The
    cancer does not disappear on its own
    in patients who choose no treatment.
    Surgery removes all detectable cancer
    in 80 of 100 patients. In some
    patients, the cancer comes back even
    if it is completely removed. Radiation
    makes the cancer disappear in about 80
    of 100. In some patients, the cancer
    comes back even if it seems to
    disappear completely with radiation.

     
     


     

  • E.O. Olapade- Olaopa [ Leicester General Hospital, Leicester, UK]

    The Expression of a Mutant Epidermal Growth Factor Receptor in Prostatic Tumours

    BJU International, volume 87, Number 3, February 2001, Pg.Nos. 224-226



    Methods – The present project assessed the hypothesis that, in addition to the normal receptor, prostatic tumours also express an abnormal EGFR and that the contradictory findings in previous studies arise through the detection of this mutant receptor by some but not all the different techniques used.



    Normal [19], BPH [19], high-grade PIN[14], prostate cancer [38], and metastatic prostate tissues [12] were scrutinized retrospectively for the presence of EGFRvIII and LOT-EGFR using western blotting and immunohistochemical techniques. 



    Results – Despite the relatively few samples included in this study their findings confirm the hypothesis that prostatic tumors express a mutant EGFR [EGFRvIII] that may be a useful histological marker for prostatic cancer cells.



    The expression of this constititively active receptor represents a potential mechanism for the hormone independent proliferation in prostate cancer and could be predictive of an aggressive disease phenotype.



    This variant EGFR may be of clinical significance and could be a target for modern anticancer regimens.

       

  • Pannek J, Rittenhouse HG, Chan DW, et al [The Johns Hopkins Med. Inst., Baltimore, Md; Hybritech Incorporated, San Diego, Calif.]

    The Use of Percent Free Prostate Specific Antigen for Staging Clinically Localized Prostate Cancer

    J. Urol 159: 1238-1242,1998



    Free to total serum prostate specific antigen [PSA] ratio is clinically useful for early detection of prostate cancer in men with total PSA levels of 4 to 10 ng/ml.



    Total PSA and free PSA were determined prospectively in 263 men with clinically localized prostate cancer who were undergoing radical prostatectomy.



    With a 12% cutoff, free PSA had positive and negative predictive values of 72% and 52% respectively for favorable pathologic findings. With a 15% cutoff, free PSA has positive and negative predictive values of 76% and 58% respectively for organ confined disease.



    Conclusion – What is unique about this study is that it is the first to attempt to establish a cutoff level for the detection of relatively favorable histology. A value of 12% has a positive value of almost 70% for predicting pathologically organ confined disease.



    A study will be necessary to define the precise PSA cutoff point that will be clinically useful in predicting pathologically localized disease.

       

  • Schroder FH, for the Rotterdam Section of the European Randomized Study of Screening for Prostate Cancer [Erasmus Univ, Rotterdam, The Netherlands]

    Evaluation of the Digital Rectal Examination as a Screening Test for Prostate Cancer

    J Natl Cancer Inst 90: 1817-1823, 1998



    The efficacy of DRE alone and in combination with serum prostate specific antigen assay [PSA] and transrectal US was evaluated.



    The overall prostate cancer detection rate in the study population was 4.5%. The detection rate of DRE alone was 2.5%. The positive predictive value of 



    DRE ranged from 4% to 11% in men with PSA levels below 2.9 ng/ml to 33% to 83% in men with PSA levels of at least 3.0 ng/ml. Most tumors detected with 

    DRE in men with PSA levels of less than 4.0 ng/ml were small and well differentiated.

       

  • McGregor M, Hanley JA, Boivin J-F, et al [McGill Univ, Montreal; Royal Victoria Hosp, Montreal; Sir Mortimer B Davis-Jewish Gen Hosp, Montreal; et al]

    Screening for Prostate Cancer : Estimating the Magnitude of Overdetection

    Can Med. Assoc. J. 159 : 1368-1372, 198



    Conclusion – The analysis suggests that an average only 16 of every 100 men with screen detected prostate cancer could have their lives extended by surgery. Prostate cancer would not cause death in the remaining men before the age of 85 years.



    These data from a review of literature are in striking contrast to the data reported by Catalona and others suggesting markedly higher rates of benefit with early detection.

       

  • Catalona WJ, Partin AW, Slawin KM, et al [Washington Univ, St Louis; Johns Hopkins Hosp, Baltimore, Md; Baylor College of Medicine, Houston; et al]

    Use of the Percentage of Free Prostate -Specific Antigen to Enhance Differentiation of Prostate Cancer from Benign Prostatic Disease : A Prospective Multicenter Clinical Trial

    JAMA 279: 1542-1547, 1998



    Conclusion – Free PSA percentage is a significant predictor of prostate cancer, with a sensitivity of 95% below a cutoff of 25%. Patients with prostate cancer and free PSA levels above the cutoff had less aggressive disease. Percentage of free PSA is an independent predictor of prostatic cancer. 



    The knowledge of the percentage free PSA can help predict the probability of cancer among men with total serum PSA levels between 4 and 10.



    The probability of cancer varied inversely with the percentage of free PSA.

       

  • Epstein JI, Chan DW, Sokoll LJ, et al [ Johns Hopkins Univ, Baltimore, Md; Beckman Instruments Inc, San Diego, Calif]

    Non Palpable Stage TIC Prostate Cancer : Prediction of Insignificant Disease Using Free/Total Prostate Specific Antigen Levels and Needle Biopsy Findings

    J. Urol 160: 2407-2411, 1998



    Between 26% and 29% of stage T1C prostate cancer are small and proportionately insignificant.



    A group of T1C prostate cancer was analyzed to determine whether free/total PSA either alone or together with needle biopsy findings, could be used to identify relatively insignificant stage T1C tumors. 



    Conclusion – Free/Total PSA combined with needle biopsy findings yielded higher positive and negative predictive values than did total serum PSA.



    An aggressive treatment strategy may be warranted in younger men with presumed unsignificant tumors, whereas a conservative approach may be appropriate in older men.

       

  • Eskew LA, Woodruff RD, Bare RL, et al [ Wake Forest Univ. Winston-Salem, NC]

    Prostate Cancer Diagnosed by the 5 Region Biopsy Method is Significant Disease

    J Urol 160 : 794-796, 1998



    The authors have developed a 5-region method in which sextant biopsy specimens are taken along with additional biopsy material in the far lateral and middle aspects of the prostate.



    Compared to the sextant method, the 5-region method increases the cancer detection rate by 35%. It is especially valuable in patients with prostate specific antigen levels of less than 10.



    Conclusions – Prostate cancer detected by the 5-region biopsy method and the standard sextant methods are similar in their pathological characteristics. Whereas the 5-region method has a higher cancer detection rate, the cancers detected are not clinically significant.

       

  • Rodriguez LV, Terris MK [Stanford Univ, Calif; Veterans Affairs Palo Alto Health Care System, Calif]

    Risks and Complications of Transrectal Ultrasound Guided Prostate Needle Biopsy: A Prospective Study and Review of the Literature

    J Urol 160: 2115-2120, 1998



    128 consecutive men with an average age of 70 underwent transrectal US-guided needle biopsy for the evaluation of prostate cancer. Before the biopsy, patients completed a questionnaire and the PSA 7-symptom and bothersome score. Preoperative PSA studies were done in all. 



    An enema was administered 1 hour before procedure and a prophylaxis of 500 mg Ciprofloxacin and 500 mg metronidazole was given for antibiotic prophylaxis.



    The only major complication was a vasovagal episode with seizures.



    In 77 patients, 135 minor complications occurred, gross haematuria was the most common complication.



    The amount of discomfort was proportional to the amount of bleeding, but was not associated with the prostate volume or location of biopsies. 



    Conclusion – A screening procedure for otherwise healthy patients should be safe and cause minimal morbidity. Patients need to be informed that the morbidity of the procedure is significant.

       

  • Albertsen PC, Hanley JA, Gleason DF, et al [Univ of Connecticut, Farmington; McGill Univ, Montreal; Massachusetts Gen Hosp, Boston]

    Competing Risk Analysis of Men Aged 55 to 74 Years at Diagnosis Managed Conservatively for Clinically Localized Prostate Cancer

    JAMA 280: 975-980, 1998



    767 men with localized prostate cancer were diagnosed between 1971 and 1984. They did not undergo surgery, external beam radiation or brachy therapy; some received immediate or delayed hormonal therapy .



    In each case, the original histological material was available for grading by the Gleason system.



    Conclusion – Those with Gleasons score of 2 to 4 are at low risk of dying of prostate cancer during 15 year follow up.



    Those with Gleasons scores of 7 to 10 are at high risk of prostate cancer death even if their cancer is diagnosed as late as age 74. For men with intermediate Gleasons scores, risk is small at first but increases gradually at follow up.

         

  • Adolfsson J, Steineck G, Hedlund PO [Huddinge Univ, stockholm]

    Deferred Treatment of Locally Advanced Nonmetastatic Prostate Cancer : A Long Term Follow-up

    J Urol 161 : 505-508; 1999



    172 men who had no signs of distant metastasis were included in a prospective surveillance protocol.



    The overall survival rate was 68% at 5 years, 34% at 10 years and 26% at 12 years, disease specific survival rates at these periods were 90%, 74% and 70%. The chance of being untreated at 5 years after diagnosis was 40%; at 10 years the chance was 30%.



    Conclusions – Survival outcomes in the deferred treatment group appears to be poorer than in similarly managed clinically localized prostate cancer. In select patients with non metastatic locally advanced tumors and a life expectancy of 10 years or less, deferred treatment may be preferable to other treatment.

         

  • DiPaola Rs, Zhang H, Lambert GH et al [Univ of Medicine and Dentistry of New Jersey-Robert Wood Johnson Med. School, New Brunswick; Cancer Institute of New Jersey, New Brunswick; Environmental and Occupational Health Sciences Inst. Piscataway, NJ]

    Clinical and Biological Activity of an Estrogenic Herbal Combination [PC-SPES] in Prostate Cancer

    N Eng J Med 339: 785-791, 1998



    Herbal therapies and other unconventional treatments are widely used by patients with cancer. A herbal combination called PC-SPES consists of chrysanthemum, isatis, licorice, Ganoderma lucidum, panax, pseudo-ginseng, Rabdosia rubescens, saw palmetto & scutellaria



    Conclusion – The herbal mixture of PC-SPES used by many patients with prostate cancer has potent estrogenic activity. However it is an unregulated product that may confound the results of therapy and cause-significant adverse effects. 

        

  • Post PN, Stockton D, Davies TW, et al [Comprehenive Cancer Centre South, Eindhoven, The Netherlands; Erasmus University Rotterdam, The Netherlands: Univ of Cambridge, England]

    Striking Increase in Incidence of Prostate Cancer in Men Aged < 60 Years without Improvement in Prognosis.

    Br J Cancer 79: 13-17, 1999

        


    Prostate cancer has been diagnosed with increasing frequency in recent years, but prognosis has improved in many countries because tumors are often detected at a preclinical stage by prostate specific antigen [PSA] testing or by transurethral resection of the prostate for treatment of benign prostatic hyperplasia.

        


    Conclusion – The hypothesis that there has been a genuine increase in the incidence of prostate cancer among men aged 40 to 59 is supported by this study.



    No improvement in prognosis was observed in the period prior to PSA testing. The rise in incidence does not appear to be related to improved diagnosis because the inclusion of more early stage cases would have led to improved survival rates.

       

  • Iversen P, Tyrrell CJ, Kaisary AV, et al [ Univ of Copenhagen: Royal Free Hosp, London; Royal Hallamshire Hosp, Sheffield, England; et al]

    Casodex [Bicalutamide] 150 mg Monotherapy Compared with Castration in Patients with Previously Untreated Nonmetastatic Prostate Cancer : Results from two Multicenter Randomized Trials at a Median Follow-up of 4 Years

    Urology 51: 389-396, 1998



    The most widely used methods of androgen deprivation for advanced prostate cancer are bilateral orchiectomy and medical castration. Because castration by any method results in loss of libido and erectile dysfunction, this option can adversely affect quality of life. Monotherapy with nonsteroidal antiandrogens might be as effective as castration but without its adverse effects.



    Conclusion – In previously untreated patients with M0 prostate cancer, bicalutamide was equivalent to castration in survival rates. Bicalmtamide 150 mg is a well-tolerated alternative to castration and offers quality of life advantages. 

       

  • Fowler JE Jr, Bigler SA, Kolski JM et al [Univ of Mississippi, Jackson, Veterans Affairs Med Ctr, Jackson, Miss]

    Early results of a Prospective study of Hormone Therapy for Patients with Locally Advanced Prostate Carcinoma

    Cancer 82: 1112-1117, 1998



    Older men with localized prostate cancer are poor candidates for radical prostatectomy.



    The study provides interesting information on early hormonal therapy for 103 men with T3-4 NXm0 prostate cancer treated with androgen ablation therapy.



    Among men with co-morbid illnesses early hormonal therapy is a reasonable option for those with localized disease who request therapeutic intervention.

         

  • Torbenson M, Dhir R, Nangia A, et al [Univ of Pittsburgh, Pa]

    Prostate Carcinoma with Signet Ring Cells : A Clinicopathologic And Immuno- histochemical Analysis of 12 Cases, with Review of Literature

    Mod Pathol 11: 552-559, 1998



    Prostatic adenocarcinoma of signet ring cell [SRC] component, must be differentiated from similar tumors of bladder or gastric origin.



    Conclusion – Prostatic adenocarcinoma with SRC components are typically associated with high grade adenocarcinomas. Such lesions are typically positive for mucin, PAS-D cytokeratins, MIB-I, bcl-2, c-MET and CD 44 comparable with that shown by high grade adenocarcinoma components. Prostatic adenocarcinomas with SRC components have a low M1B-1 proliferation index and cannot always be distinguished from SRC components of bladder and stomach carcinomas with any of the stains used in the current study including
    PSA..

       

  • Chang PL, Huang ST, Wang TM, et al [Chang Gung Univ, Taipei, Taiwan]

    Improvement of Medical Care Quality After Implementation of a Clinical Path Monitoring Program for Transurethral Prostatectomy Patients

    Eur Urol 33: 523-528; 1998



    Methods – 10 Quality indicators were :



    1. % of patients who had incomplete preoperative tests on admission day.



    2. Percentage of patients with orders for postoperative blood transfusion. 



    3. Duration of i.v. antibiotics administration.



    4. Percentage of patients ordered to have nothing by mouth after operation.



    5. Percentage of patients who required acute pain management 

    postoperatively. 



    6. Percentage of patients who received bladder irrigation post operatively with N Saline.



    7. Percentage of patients whose Foleys catheter was removed after day 2.



    8. Percentage of patients with complications.



    9. Percentage mortality.



    10. Percentage of patients readmitted within 2 weeks.



    Results –

    1. Of 1.58% to 81%.

    2. Duration of i.v. antibiotics : 1.9 to 1.0 day.

    3. Postoperative intramuscular pain relief [ 38% – 21%] [Intramuscular]

    4. Postoperative bladder irrigation [80% – 69%]

    5. Catheter removal after 2 days [23% -17%].





    Conclusion – Implementation of clinical path resulted in statistically significant improvement in quality of medical care and decrease in length of hospital stay and total admission charges. 

       

  • Litwin MS, Lubeck DP, Henning JM, et al [Univ of California, Los Angeles; Stanford Univ, Calif; Univ of California, San Francisco; et al]

    Differences in Urologist and Patient Assessment of Health Related Quality of Life in Men with Prostate Cancer : Results of the CaPSURE Database

    J. Urol 159; 1988-1992, 1998



    Conclusion – The authors suggest that physicians are likely to be poor estimates of the patients health status. It is probably more relevant to have physician assessment based on direct interviews and questionnaire, rather than assessments from reviews of medical records.



    Also patients assessments are often unstable as, for example querying an individual about his quality of life during the middle of a bad cold and subsequently after the cold has resolved.

       

  • D’Amico AV, Whittington R, Malkowicz SB, et al [Harvard Med School, Boston; Univ of Pennsylvania, Philadelphia; Univ of Millersville, Pa; et al]

    Biochemical Outcomes After Radical Prostatectomy, External Beam Radiation Therapy, or Interstitial Radiation Therapy for Clinically Localized Prostate Cancer

    JAMA 280: 969-974, 1998



    Conclusions -The results of various local therapies for clinically localized prostate cancer are reviewed. For low-risk patients 5 year PSA outcomes appear comparable whether the treatment is RP, RT or implant therapy with or without neoadjuvant androgen deprivation. However, for intermediate or high risk patients, the results are better with RP or RT than with implant therapy. There is a need for a definitive randomized trial that compares PSA and survival outcomes between the various treatment options.

       

  • Litwin MS, McGuigan KA,Shpall Al, et al [ Univ of California, Los Angeles]

    Recovery of Health Related Quality of Life in the Year After Radical Prostatectomy Early Experience

    J. Urol 161 : 515-519, 1999



    There has been a lack of objective published data on health related quality of life [HRQOL] after treatment of prostate cancer.



    Patients were asked to complete a confidential HRQOL questionnaire before surgery, at 3 month intervals during the year after surgery then at 6 month intervals until 5 years after surgery.



    Mean patient age was 60.9. Before surgery general HRQOL scores were high for the group overall exceeding 70 points. After prostatectomy there was a general decrease in the HRQOL scores, involving all domains. Return to baseline was rapid in the general and bowel domains. There was an inverse relationship between level of education and the likelihood of return to baseline.



    Men who underwent radical prostatectomy for early stage prostate cancer experienced a steady improvement in quality of life during the first year after surgery. By 12 months after prostatectomy, 86% to 97% of patients had reached baseline HRQOL during follow-up.

       

  • Haythornthwaite JA, Raja SN, Fisher B, et al [ Johns Hopkins Univ, Baltimore, Md; Univ of Chicago; Hadassah Univ, Jerusalem]

    Pain and Quality of Life Following Radical Retropubic Protatectomy

    J. Urol 160: 1761-1764, 1998



    The study determined whether preemptive analgesia reduces chronic pain, the impact of chronic pain on quality of life, and the psychological risk factors for chronic pain after RP.



    One hundred and ten patients were randomly assigned to receive epidural anesthesia, general anesthesia, or both.



    Questionnaire assessed patients 3 and 6 months post surgery on prostate symptoms, pain associated with surgery, quality of life and mood. 



    Patients with pain at 3 months used significantly more pain medication on the third postoperative day than patient without pain. Pain reported at 3 months was mild and associated with poor perception of overall health and decreased physical and social functioning.



    Conclusion – Intraoperative anesthesia technique had no apparent long-term effects. Mild pain was common after radical prostatectomy and was associated with decreased quality of life, especially social functioning.



    Preoperative distress, anxiety and postoperative pain medication use may predict chronic pain after radical retropubic
    porstatectomy.

      

  • Knight SJ, Chmiel JS, Kuzel T, et al [Northwestern Univ, Chicago; Veterans Affairs Chicago Health Care Systems: Durham Veterans Affairs Med Ctr, NC; et al]

    Quality of Life in Metastatic Prostate Cancer Among Men of Lower Socioeconomic Status : Feasibility and Criteria Related Validity of 3 Measures

    J Urol 160 : 1765-1769, 1998



    Conclusions – Individuals with low literacy levels are generally unable to comply with the traditional self-administered questionnaires on this subject.



    The Interviewer administration of these instruments appears to be feasible even in a busy clinical setting.



    Low literacy appears to be an important consideration in evaluating barriers to medical care, as well as assessing functional status outcomes for patients with prostate cancer.

       

  • P. Iversen, I. Melezinek and A. Schmidt [ Department of Urology, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark, Medical Affairs, AstraZeneca, Alderley Park, Macclesfield, UK and Department of Urology, University of Stellenbosch, Tygerberg, South Africa

    Nonsteroidal Antiandrogens: A Therapeutic Option for Patients with Advanced Prostate Cancer Who Wish to Retain Sexual Interest and Function

    BJU International, volume 87, Number 1, January 2001, Pg.Nos. 47-56



    Conclusion – The effect of currently available hormonal therapies on sexual interest and function varies and may therefore be an important consideration when selecting therapy for specific patients with advanced disease. 



    The data presented in this review confirm the widespread perception that monotherapy with a nonsteroidal antiandrogen offers benefit over castration for the preservation of libido and sexual potency.



    Bicalutamide 150 mg /day has been the most extensively investigated nonsteroidal antiandrogen and findings on sexual interest are consistent in patients with both locally advanced and metastatic prostate cancer, in open and blinded trials and across different methods of evaluation.

       

  • R.S. Lance, P.A. Freidrichs, C. Kane, C.R. Powell, E. Pulos, J.W. Moul, D.G. Mcleod, R.L. Cornum and J. Brantley Thrasher [Department of Surgery, Urology Service, Tacoma, Washington, Naval Medical Center San Diego, San Diego, California, and Walter Reed Army Medical Center, Washington, DC, USA]

    A Comparison of Radical Retropubic with Perineal Prostatectomy for Localized Prostate Cancer Within the Uniformed Services Urology Research Group

    BJU International, volume 87, Number 1, January 2001, Pg.Nos. 61-65



    Patients and Methods – Between 1988 and 1997, 1382 men who were treated by RRP and 316 by RPP were identified from databases of the Uniformed Services Urology Research Group.



    Results – In the 190 matched patients there were no significant differences between the RRP and RPP groups in either organ-confined, margin-positive or biochemical recurrence rates respectively. The only significant difference in complication rates was a higher incidence of rectal injury in the RPP group than in the RRP group. 



    Conclusion – RPP offers equivalent organ-confined, margin-positive and biochemical recurrence rates to RRP, while causing significantly less blood loss.

       

  • F.May, T. Treumann, P. Dettmar, R. Hartung and J. Breul [ Departments of Urology, Radiology and Pathology, Klinikum rechts der Isar, Technische Universitat Munchen, Germany]

    Limited Value of Endorectal Magnetic Resonance Imaging and Transrectal Ultrasonography in the Staging of Clinically Localized Prostate Cancer

    BJU International, volume 87, Number 1, January 2001, Pg.Nos. 66-69



    The eMRI was more sensitive than TRUS for detecting extracapsular extension and seminal vesicle invasion in organ confined prostate cancer.



    TRUS had a relatively high specificity for ECE [ Extracapsular Extension] and SVI, [Seminal Vesicle Invasion] and was better than eMRI in this regard.



    Conclusion – Whereas eMRI tended to over-stage, TRUS understaged prostate cancer. This series shows the current limited value of TRUS and eMRI for planning treatment in patients with clinically localized prostate cancer. Treatment decisions should not be altered based on TRUS or eMRI finding alone.

       

  • R.C. Ouyang, D.N. Kenwright, J.N. Nacey and B. Delahunt [ Departments of Surgery and Pathology and Molecular Medicine, Wellington School of Medicine, University of Otago,Wellington, New Zealand]

    The Presence of Atypical Small Acinar Proliferation in Prostate Needle Biopsy is Predictive of Carcinoma on Subsequent Biopsy

    BJU International, volume 87, Number 1, January 2001, Pg.Nos. 70-74



    Patients and Methods – Of 331 patients who underwent thin-core biopsy of the prostate over a 30-month period, 21 had atypical histological features and of these 17 underwent repeat biopsy. In addition, a further 20 patients, with normal histology underwent repeat biopsy for persistent abnormal clinical findings.



    Results – 9 patients with atypical histology and four with normal histology on initial biopsy were found to have carcinoma on subsequent biopsy.



    Conclusion – The presence of atypia on initial biopsy is a strong predictor of malignancy in subsequent biopsy specimens.

       

  • C-J Mclaren and E.T. Simpson [ Department of Medical Imaging and Paediatric Surgery, The Canberra Hospital, ACT Australia]

    Direct Comparison of Radiology and Nuclear Medicine Cystograms in Young Infants with Vesico-Ureteric Reflux

    BJU International, volume 87, Number 1, January 2001, Pg.Nos. 93-97



    To determine the sensitivity of the direct radionuclide cytogram [DRC] in detecting vesicoureteric reflux compared with micturating cystourethrogram [MCU] in the same initial setting in infants younger than one year.



    Result – Reflux was detected in 105 units, 96 detected on DRC and 47 on MCU, representing a sensitivity of 91% and 45% respectively.



    The DRC missed half of grade I, 20% of grade II, 6% of grade III reflux.



    Reflux at low bladder filling rates [DRC] represented 40% of all reflux units, and a half [52%] of scarred renal units detected by DMSA scintigraphy.



    Conclusion – In young infants the MCU may fail to detect the lesser grades. The combination of both cystograms in the initial investigation of reflux provides more comprehensive information. 



 Screening


      

  • M-L Essink-Bot, HJ de Koning, HFT Nijs, et al [ Erasmus Univ Rotterdam, The Netherlands]


    Short-term Effects of Population-based Screening for Prostate Cancer on Health-related Quality of Life



    J Natl Cancer Inst 90: 925-931, 1998


        


    Conclusion – The screening nihilists have suggested that widespread screening for prostate cancer is an anxiety-raising practice without proven benefit. This study shows that screening does not provoke undue anxiety among participants. Indeed, there was significant satisfaction among participants with negative screening tests and participants who underwent prostatic biopsy that did not disclose prostate cancer. 

        


    This article should quell concerns that heightened awareness of prostate cancer has materially reduced the quality of life of men participating in screening programs.

      

  • Wolf AMD, Schorling JB [Univ of Virginia, Charlottesville]

    Preferences of Elderly Men for Prostate Specific Antigen Screening and the Impact of Informed Consent

    J. Gerontol 53A : M195-M200, 1998



    Screening for prostate cancer with prostate specific antigen [PSA] can detect cancer at an earlier stage compared with digital rectal examination alone. Yet screening with PSA has not been shown to improve patient outcomes.



    Of the 205 men involved in the trial, 104 had no history of prostate cancer and had not previously undergone PSA screening. Randomization was to a scripted overview of PSA screening or to a brief control message.



    Men who received the conformational message were significantly less interested in PSA screening than men who were given the control message. Informed men perceived screening to be of less benefit than uninformed men. 



    Among the uninformed men, perceived seriousness of prostate cancer predicted interest in screening. 

      

  • C. C. Parker, M. Gospodarowicz and P. Warde (Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Canada)

    Does age influence the behaviour of localized prostate cancer?

    BJU Intl. May 2001 Vol. 87 (7) Pg. 629-637

        


    Conclusions : The review finds evidence that young age was an adverse prognostic factor in radiation series from the era before PSA testing when men presented clinically and typically with locally advanced disease, but that age has no significant prognostic effect in contemporary series of localized prostate cancer.

        


    Possible explanations for this difference include:

        


    1) Delayed diagnosis in younger men before PSA screening was available.

    2) An age bias in assessing clinical endpoints.

    3) An age dependant lead-time bias after the introduction of screening.

    4) An interaction between grade and age.

        


    The proposed effect of age on the magnitude of the benefit of neoadjuvant androgen deprivation merits further study. 

        

  • M. Tornblom, U. Norming, C. Becker, H. Lilja and O. Gustafsson (Department of Urology, Huddinge University Hospital, Karolinska Institute, Department of Urology, Stockholm South Hospital, Karolinska Institute, Stockholm, and Department of Clinical Chemistry, Malmo University Hospital, Malmo, Sweden)

    Variation in Percentage-Free Prostate-Specific Antigen (PSA) with Prostate Volume, Age and Total PSA Level

    BJU Intl. May 2001 Vol. 87 (7) Pg. 638-642

         


    Results: The f/tPSA level varied with prostate volume and age, but the decisive factor for this variation was the tPSA level. The closest correlation was in the tPSA interval 7.0-9.9 ng/mL, where volume and age together explained 47% of the variation in f/tPSA. Also, for men with tPSA levels in each of the intervals 2.0-3.9, 4.0-6.9 and 7.0-9.9 ng/mL, the f/tPSA increased with higher prostate volumes and age. In men with tPSA levels of < 2.0 ng/mL, the f/tPSA was not affected by variations in prostate volume or age.

         

  • G. Hruby, R. Choo, L. Klotz, C. Danjoux, J. Murphy, G. Deboer, G. Morton, E. Rakovitch, E. Szumacher and N. Fleshner (Toronto-Sunnybrook Regional Cancer Centre, University of Toronto, and Sunnybrook & Women’s College Health Sciences Centre, University of Toronto, Ontario, Canada)

    The Role of Serial Transrectal Ultrasonography in a ‘Watchful Waiting’ Protocol for Men with Localized Prostate Cancer

    BJU Intl. May 2001 Vol. 87 (7) Pg. 643-647

         


    Objective : To determine the value of 6 monthly transrectal ultrasonography (TRUS) in a cohort of men with localized prostate cancer who consented to a programme of watchful waiting with selected delayed intervention.

          


    Results : The group of 28 men who progressed to require radical intervention underwent 83 TRUS examinations (median number per patient, three). 2 men underwent TRUS only at baseline because of progression within 6 months.

         


    Of these 28 men only 7 had changes on TRUS that were regarded as consistent with progression. All seven consisted of the growth of an existing nodule or the appearance of a new nodule. In only one case was this accompanied by an increase of ³ 30% in gland volume. 

          


    In 136 men who underwent two or more serial TRUS examinations (median 3, maximum 9), there was no correlation between the rate of change of PSA and changes in either gland volume or the number of peripheral zone hypoechoic lesions.

        


    Conclusion : The use of serial TRUS in men with known but untreated prostate cancer is of limited value as a determinant of disease progression.

        

  • P. Li, K. Wallner, W. Ellis, J. Blasko and J. M. Corman (Departments of Urology and Radiation Oncology, University of Washington, Departments of Urology and Radiation Oncology, Puget Sound Health Care System, Department of Veterans Affairs, and Seattle Prostate Institute, Swedish Medical Center, Seattle, Washington, USA)

    Prostate Brachytherapy in Patients with a Penile Prosthesis

    BJU Intl. May 2001 Vol. 87 (7) Pg. 712-713

         


    Five patients were identified who had an indwelling penile prosthesis and who underwent interstitial prostate brachytherapy within the last 2 years.

           


    4 patients had semi-rigid implants and one had a 3 piece inflatable prosthesis. Their prostate volumes were 23-56 ml.

          


    CT of the pelvis before treatment was reviewed to exclude significant pubic arch interference to the path of the needles.

          


    The follow-up after brachytherapy was 9-23 months; one patient was lost to follow-up. None of the 3 sexually active men had prosthesis-related pain, infection or malfunction in the 1st year after brachytherapy.

         


    One patient who had a 3 piece implant, reported a malfunction in his prosthesis 13 months after seed implantation. At the time of replacement, there was a connector tube leak at the abdominal reservoir.

        


    Conclusion : A penile prosthesis is widely regarded as a contraindication to transperineal prostate brachytherapy because of the risk of infection or prosthetic malfunction from needle related damage.

          


    The lack of infectious complications in the present patients is consistent with the absence of postoperative infections in patients who undergo radical prostatectomy with a penile prosthesis in place.

         


    Some factors that may help preventing complications are:

         


    1) Pre therapy CT for correct anatomical treatment.

    2) Waiting for 6 months from surgery to brachytherapy.

    3) Bowel preparation and antibiotics prevent infection.

    4) Lithotomy portion should help to move the prosthesis anteriorly.

         


    Intraoperative TRUS was of little help in monitoring placement of
    needles.

        




 

  

Speciality Spotlight

 

 
Urology
 

 

Prostate Cancer
      

  • JBW Rietbergen, AEB Kruger, RF Hoedemaekar, et al [ Erasmus Univ, Rotterdam, The Netherlands; Academic Hosp, Rotterdam, The Netherlands]
    Repeat Screening for Prostate Cancer After 1-year Follow-up in 984 Biopsied Men : Clinical and Pathological Features of Detected Cancer
    J Urol 160: 2121-2125, 1998
         
    Conclusion- This article describes the tumor and prostate characteristics of 984 men who underwent repeat screening 1 year after having a negative biopsy of the prostate.
         
    Eleven percent of men undergoing a second biopsy were found to have prostate cancer. The only difference between men whose cancer was discovered at the first biopsy and those discovered at the second biopsy was prostate size [42.6 vs. 34.9 cc]. There were no differences in other parameters such as prostate-specific antigen, pathologic tumor stage, or tumor grade.
         
    This finding underscores the limitations of standard biopsy techniques as applied to a heterogeneous group of men with prostates of varying sizes and shapes. 
         
    In this study, a standard sextant biopsy technique was utilized for all men regardless of prostate size and configuration. One wonders whether tailoring the specific biopsy approach according to prostate size or configuration would be more helpful in identifying prostate cancers during the initial biopsy session. Computer-simulated models suggest that this is indeed possible, but as of yet no firm guidelines have been established to enhance cancer detection on an initial US-guided biopsy of the prostate.
         

  • F Rabbani, N Stroumbakis, BR Kava, et al [ Mem Sloan-Kettering Cancer Ctr. New York]
    Incidence and Clinical Significance of False-Negative Sextant Prostate Biopsies
    J Urol 159: 1247-1250, 1998
       
    Conclusion – 23% of patients with known prostate cancer had negative repeat sextant biopsies despite a diagnosis of prostate cancer and despite receiving no therapy.
       
    These results underscore the limitations of using biopsy, after cryotherapy or interstitial radiation therapy, as a surrogate for exclusion of prostate cancer.
       

  • AS Robbin, AS Whittemore, SK Van Den Eeden [Stanford Univ, Calif; Kaiser Permante Med Care Program, Oakland, Calif]
    Race, Prostate Cancer Survival, and Membership in a Large Health Maintenance Organization
    J Natl Cancer Inst 90: 986-990, 1998
       
    Conclusion – The data are consistent with those reported from most settings, that is, that African American men have poorer survival than white men, even after adjustment for stage of diseases. Whether this reflects differences in virulence or higher levels of co-morbidities among African American is not known.
       
    It is suggested in this study that causes of death other than prostate cancer are unlikely to account for the findings as cancer-specific death rates were also evaluated. 
        

  • K Brasso, S Friis, K Juel, et al [univ of Copenhagen; Danish Cancer Society and the Danish Inst of clinical Epidemiology, Copenhagen]
    Mortality of Patients with Clinically Localized prostate Cancer Treated with Observation for 10 years or Longer: A Population Based Registry study
    J Urol 161-524-528, 1999
       
    Conclusion – In this study, patients who had clinically localized prostate cancer for 10-years or longer and who were likely candidates for curative therapy as the time of diagnosis had significant excess mortality when treated expectantly.
       
    This study from Denmark is interesting because prior to 1995 no radical prostatectomy was performed for potentially curable disease and less than 1% of patients were subjected to radiation
       

  • R O Roberts, EJ Bergstralh, SK Jatusic, et al [Mayo Clinic and Mayo Found, Rochester, Minn]
    Decline in Prostate Cancer Mortality from 1980 to 1997, and an Update on Incidence Trends in Olmsted County, Minnesota
    J Urol 161: 529-533, 1999
       
    Conclusion – The rates of prostate cancer mortality, which increased in the early years of PSA testing may have declined in recent years to levels lower than those of the early 1980s. Increased screening may account for this change.
       

  • O P Heinonen , D Albanes, J Virtamo et al [ Univ of Helsinki; Natl Cancer Inst Bethesda, Md; Natl Public Health Inst, Helsinki; et al]
    Prostate Cancer and Supplementation With a -Tocopherol and b- Carotene: Incidence and Mortality in a Controlled Trial
    J Natl Cancer Inst 90: 440-446, 1998
       
    Conclusion – Long term a -Tocopherol supplementation may markedly decrease the incidence of and mortality from prostate cancer in smokers. Further research is needed to verify these results.
       

  • LN Nguyen, A Pollack , GK Zagars [Univ of Texas, Houston]
    Late Effects after Radiotherapy for Prostate Cancer in a Randomized Dose-Response Study: Results of a Self-Assessment Questionnaire
    Urology 51: 991-997, 1998
       
    Conclusion – the incidence of incontinence after radiotherapy [30%] is similar to that after radical prostatectomy as reported in the literature [31%]. Only a few patients required urinary protective devices after radiotherapy.
       
    The percentage of patients who could achieve full erection after radiotherapy [36%]. Compares favorably with that after radical prostatectomy [39%].
       
    Conformal boost radiotherapy with 78 Gy is a safe and effective treatment for prostate cancer that is associated with few significant late effects 2 years or more after radiation therapy.
        

  • JD Slater, Yonemoto LT, CJ Jr Rossi, et al [ Loma Linda Univ Med Ctr Calif] 
    Conformal Proton Therapy for Prostate Carcinoma
    Int J Radiat Oncol Biol Phys 42: 299-304, 1998
       
    Conclusion – Proton therapy at doses of 74 to 75 CGE was associated with minimal treatment related toxicity and excellent outcomes in patients with low initial PSA levels.
       
    At 5 years, 91% of patients who achieved a PSA nadir of 0.5 ng/ml or less had no clinical or biochemical evidence of disease.
       

  • MA Elsenberger, BA Blumenstein , Ed Crawford, et al [Johns Hopkins Hosp, Baltimore, Md; Southwest Oncolofy Group Statistical Ctr, Seattle, Univ of Colorado, Denver; et al]
    Bilateral Orchiectomy with or Without Flutamide for Metastatic Prostate Cancer

    N Engl J Med 339: 1036-1042, 1998
       
    Conclusion – This is a well defined study that suggests that the benefit of combined androgen blockade in patients with prostate cancer is negligible. It also points out that using prostate specific antigen as a response criterion is hazardous, as patients receiving flutamide had a higher prostate-specific antigen response rate compared with the placebo group but no benefit in survival
        

  • Tyrrel CJ, Kaisary AV, Iversen P, et al [Derriford Hosp, Plymouth, England: Royal Free Hosp, London; Univ of Copenhagen; et al
    A Randomized Comparison of ‘Casodex’TM [Bicalutamide] 150 mg Monotherapy Versus Castration in the Treatment of Metastatic and Locally Advanced Prostate Cancer
    Eur Urol 33: 447-456, 1998
       
    Because of concern over hot flashes, sexual dysfunction, and other constitutional side effects with castration therapies, increased interest in antiandrogen monotherapies has evolved.
       
    It is worth to maintain sexual interest and function if it means a shorter life expectancy, breast pain, and gynecomastia for men with advanced prostate cancer?
       

  • Yasunaga Y, Shin M, Fujita MQ, et al [Osaka Univ, Suita, Japan; Osaka City Univ; Japan
    Different Patterns of p53 Mutations in Prostatic Intraepithellial Neoplasia and Concurrent Carcinoma : Analysis of Microdissected Specimens
    Lab Invest 78: 1275-1279, 1998
       
    Conclusion – Approximately 25% prostate cancer manifest mutations of the P53 gene and that 19% of cases of high grade prosthetic intraepithelial neoplasia also demonstrate P53 abnormalities. 
       
    This study confirms the association between high grade PIN and prostate cancer and the lack of association of low-grade PIN with prostate cancer.
       

  • GD Grossfeld , DM Stier, SC Flanders, et al [Univ of California, San Francisco; Technology Assessment group, San Francisco; TAP Holdings Inc, deefield, III
    Use of second Treatment Following Definitive Local Therapy for Prostate Cancer; Data From the CaPSURE Database
    J Urol 160: 1398-1404, 1998
       
    Conclustion – Registry data suggest that about one fifth of patients with prostate cancer receive some from of second treatment a mean of 3 years after their initial local treatment.
       
    Patients whose primary treatment is radical prostatectomy, particularly those at low risk, are least likely to require second treatment.
       
    In this study, 14% radical prostatectomy patients, 27% of radiation patients and 22% of cryosurgery patients underwent second therapies within 2 1/2 to 3 years of completing their initial treatment.
       

  • Radical Protatectomy
    E Worwag, GW Chodak
    Overnight Hospitalization After Radical Prostatectomy : The impact of two pathways on patient satisfaction, Length of Hospitalization and Morbidity.
    Anesth analg 87 62-67, 1998
        
    Emphasis on cost control has spurred attempts to decrease hospital stays. The efficacy of overnight hospitalization for radical prostatectomy using complications and patient satisfaction as measures were reported for 100 consecutive patients.
         
    A standard retopubic radical prostatectomy was performed on all patients under epidural anesthesia followed by epidural morphine [ n=47] or combined spinal anesthesia using bupivacaine and fentanyl followed by 10 to 20 mg of IM methadone [n=53]. Length of hospital stay, postsurgical morbidity and patient satisfaction were compared.
         
    Duration of surgery was significantly longer for the methadone group as compared to the morphine group. The median period of hospital stay was same for both groups [ 1.2 to 1.34 days]. Only 17% of the patients stayed longer than one night. There were no complications attributable to surgery, anesthesia or analgesia. Only 21% of patients believed their stay was too short.
         

  • Felnyk O, Zimmerman M, Kim KJ, et al [ Univ of California at San Francisco, Genentech Inc, South San Francisco, Calif
    Neutralizing Anti-Vascular Endothelial Growth Factor Antibody Inhibits Further Growth of Established Prostate Cancer and Metastases in a Pre-clinical Model
    J Urol 161: 960-963, 1999
         
    Angiogenesis i.e. deriving blood supply from the existing vasculature promotes tumor growth metastasis. Vascular endothelial growth factor [ VEGF], a potent angiogenic factor and vascular permeability mediator, promotes tumor growth through neovascularisation. Inhibitors of VEGF would reverse this process has been well-studied in previous experimental studies. This study also gives an insight that inhibitors of VEGF through monoclonal anti VEGF neutralizing antibody suppressed the primary tumor growth in mice and also inhibited metastatic dissemination to the lung in human prostate cancer cell line study.
        

  • Levesque PE, Nieh PT, Zinman LN, et al [ Lahey Clinic Ctr, Burlington, Mass]
    Radiolabeled Monoclonal Antibody Indium 111-Labeled CYT-356 Localizes Extraprostatic Recurrent Carcinoma After Prostatectomy
    Urology 51: 978-984, 1998
      
    Elevated prostate-specific antigen [PSA] can detect recurrence but not the locations of the disease. Murine monoclonal antibody, 7E11-C5. 3-glycyl-tyrosyl-[N, e-diethylenetriamine pentaacetic acid] – lysine [CYT-356], linked to 111In was used to localize primary and metastatic prostate cancer. A large majority with elevated PSA, the CYT-356 was taken up outside the prostate fossa. Approximately, two third have activity in pelvic lymph nodes. Even when the lymph node dissections were negative at the time of prostatectomy.
        
    Scan failed to localize the disease in 21% of the patients with elevated PSA possibly because the antibody fail to bind to all the tumors or is unable to find small foci.
        

  • Djavan B, Kadesky K, Klopukh B, et al [Univ of Vienna; Presbyterian Hosp of Dallas; Univ of Texas, Dollas]
    Gleason Scores From Prostate Biopsies Obtained with 18-Gauge Biopsy Needles Poorly Predict Gleason Scores of Radical Prostatectomy Specimens
    Eur Erol 33 : 261-270, 1998
      
    The Gleason grading system is a well accepted prognostic factor for prostate cancer. This study has correlated with Gleason score from needle biopsy with that from radical prostatectomy. For needle biopsy 37.2% of patients had no scoring change, 12.7% were overgraded, and 50.1% undergraded. To conclude 50% of all gleason score when obtained from needle biopsy specimen had to be revised in the direction of a worse. The clinician have to keep this in mind when advising patients when gleason grading system is taken into consideration for planning the therapy.

  • D. Feldman Stewart, M.D. Brundage, J.C. Nickel, and W.J. Mackillop [ Radiation Oncology Research Unit, Department of Oncology, and Department of Psychology, Community Health and Epidemiology and Urology, Queen’s University, Kingston, Canada]
    The Information Required by Patients with Early-Stage Prostate Cancer in Choosing Their Treatment 
    BJU International, volume 87, Number 3, February 2001, Pg.Nos. 218-223

    Information Items Necessary for the Decision –

    1. Treatment options if initial treatment unsuccessful.
    2. Treatment options if cancer progresses. 
    3. Chances of cancer disappearing, at least at first.
    4. Treatment options if cancer comes back after initial treatment.
    5. Chances of cancer progressing with no treatment for now.
    6. Effect on bladder functioning.
    7. How each treatment works.
    8. Chances of causing bleeding.
    9. Chances of dying from cancer with treatment.
    10. What parts of body cancer might spread to.
    11. Chances of cancer causing future symptoms with treatment.
    12. What cancer is.
    13. Life expectancy with treatment.
    14. Length of time to decide on treatment.
    15. Personal treatment preference of doctors.
    16. Chances of causing fatigue.
    17. Waiting time for each treatment.
    18. Chances of treatment related mortality.
    19. Chances of causing fall in blood counts 
    20. Chances of causing nausea.
    21. Opportunity to seek second opinion.
    22. Method of detecting response to treatment.
    23. Method of detecting cures.
    24. Effect of skin.
    25. Effect on sexual functioning.
    26. Effect on hair loss.
    27. Chances of losing testicles.
    28. Change in physical appearance with treatment.

    The above items are in accordance with “agreement” from the respondents of a questionnaire. 


    Actual information provided for the top of three items –

       

    Abbreviated Item

    Information

     

    1]  Treatment options if  initial
        
    treatment
    unsuccessful

    If surgery does not remove all the cancer, some patients can then have radiation. There are more side effects of radiation after surgery. Hormone treatment can also be used if surgery does not remove all the cancer.
     
    If the cancer does not disappear after radiation, some patients can then have surgery. There are more side effects from surgery after radiation.
     
     
    Hormone treatment can also be used if the cancer does not disappear after radiation.
     

    2]  Treatment options if
         cancer
    progresses

    If you choose no treatment now, you might still be able to have either surgery or radiation later as long as the cancer has not spread beyond the prostate. If the cancer does spread beyond the prostate, there is still effective hormone treatment that can keep it under control for many months or years.

     

    3]  Chances of cancer 
        
    disappearing, at least
         initially

    The cancer does not disappear on its own in patients who choose no treatment. Surgery removes all detectable cancer in 80 of 100 patients. In some patients, the cancer comes back even if it is completely removed. Radiation makes the cancer disappear in about 80 of 100. In some patients, the cancer comes back even if it seems to disappear completely with radiation.
     
     

     

  • E.O. Olapade- Olaopa [ Leicester General Hospital, Leicester, UK]
    The Expression of a Mutant Epidermal Growth Factor Receptor in Prostatic Tumours
    BJU International, volume 87, Number 3, February 2001, Pg.Nos. 224-226

    Methods – The present project assessed the hypothesis that, in addition to the normal receptor, prostatic tumours also express an abnormal EGFR and that the contradictory findings in previous studies arise through the detection of this mutant receptor by some but not all the different techniques used.

    Normal [19], BPH [19], high-grade PIN[14], prostate cancer [38], and metastatic prostate tissues [12] were scrutinized retrospectively for the presence of EGFRvIII and LOT-EGFR using western blotting and immunohistochemical techniques. 

    Results – Despite the relatively few samples included in this study their findings confirm the hypothesis that prostatic tumors express a mutant EGFR [EGFRvIII] that may be a useful histological marker for prostatic cancer cells.

    The expression of this constititively active receptor represents a potential mechanism for the hormone independent proliferation in prostate cancer and could be predictive of an aggressive disease phenotype.

    This variant EGFR may be of clinical significance and could be a target for modern anticancer regimens.
       

  • Pannek J, Rittenhouse HG, Chan DW, et al [The Johns Hopkins Med. Inst., Baltimore, Md; Hybritech Incorporated, San Diego, Calif.]
    The Use of Percent Free Prostate Specific Antigen for Staging Clinically Localized Prostate Cancer
    J. Urol 159: 1238-1242,1998

    Free to total serum prostate specific antigen [PSA] ratio is clinically useful for early detection of prostate cancer in men with total PSA levels of 4 to 10 ng/ml.

    Total PSA and free PSA were determined prospectively in 263 men with clinically localized prostate cancer who were undergoing radical prostatectomy.

    With a 12% cutoff, free PSA had positive and negative predictive values of 72% and 52% respectively for favorable pathologic findings. With a 15% cutoff, free PSA has positive and negative predictive values of 76% and 58% respectively for organ confined disease.

    Conclusion – What is unique about this study is that it is the first to attempt to establish a cutoff level for the detection of relatively favorable histology. A value of 12% has a positive value of almost 70% for predicting pathologically organ confined disease.

    A study will be necessary to define the precise PSA cutoff point that will be clinically useful in predicting pathologically localized disease.
       

  • Schroder FH, for the Rotterdam Section of the European Randomized Study of Screening for Prostate Cancer [Erasmus Univ, Rotterdam, The Netherlands]
    Evaluation of the Digital Rectal Examination as a Screening Test for Prostate Cancer
    J Natl Cancer Inst 90: 1817-1823, 1998

    The efficacy of DRE alone and in combination with serum prostate specific antigen assay [PSA] and transrectal US was evaluated.

    The overall prostate cancer detection rate in the study population was 4.5%. The detection rate of DRE alone was 2.5%. The positive predictive value of 

    DRE ranged from 4% to 11% in men with PSA levels below 2.9 ng/ml to 33% to 83% in men with PSA levels of at least 3.0 ng/ml. Most tumors detected with 
    DRE in men with PSA levels of less than 4.0 ng/ml were small and well differentiated.
       

  • McGregor M, Hanley JA, Boivin J-F, et al [McGill Univ, Montreal; Royal Victoria Hosp, Montreal; Sir Mortimer B Davis-Jewish Gen Hosp, Montreal; et al]
    Screening for Prostate Cancer : Estimating the Magnitude of Overdetection
    Can Med. Assoc. J. 159 : 1368-1372, 198

    Conclusion – The analysis suggests that an average only 16 of every 100 men with screen detected prostate cancer could have their lives extended by surgery. Prostate cancer would not cause death in the remaining men before the age of 85 years.

    These data from a review of literature are in striking contrast to the data reported by Catalona and others suggesting markedly higher rates of benefit with early detection.
       

  • Catalona WJ, Partin AW, Slawin KM, et al [Washington Univ, St Louis; Johns Hopkins Hosp, Baltimore, Md; Baylor College of Medicine, Houston; et al]
    Use of the Percentage of Free Prostate -Specific Antigen to Enhance Differentiation of Prostate Cancer from Benign Prostatic Disease : A Prospective Multicenter Clinical Trial
    JAMA 279: 1542-1547, 1998

    Conclusion – Free PSA percentage is a significant predictor of prostate cancer, with a sensitivity of 95% below a cutoff of 25%. Patients with prostate cancer and free PSA levels above the cutoff had less aggressive disease. Percentage of free PSA is an independent predictor of prostatic cancer. 

    The knowledge of the percentage free PSA can help predict the probability of cancer among men with total serum PSA levels between 4 and 10.

    The probability of cancer varied inversely with the percentage of free PSA.
       

  • Epstein JI, Chan DW, Sokoll LJ, et al [ Johns Hopkins Univ, Baltimore, Md; Beckman Instruments Inc, San Diego, Calif]
    Non Palpable Stage TIC Prostate Cancer : Prediction of Insignificant Disease Using Free/Total Prostate Specific Antigen Levels and Needle Biopsy Findings
    J. Urol 160: 2407-2411, 1998

    Between 26% and 29% of stage T1C prostate cancer are small and proportionately insignificant.

    A group of T1C prostate cancer was analyzed to determine whether free/total PSA either alone or together with needle biopsy findings, could be used to identify relatively insignificant stage T1C tumors. 

    Conclusion – Free/Total PSA combined with needle biopsy findings yielded higher positive and negative predictive values than did total serum PSA.

    An aggressive treatment strategy may be warranted in younger men with presumed unsignificant tumors, whereas a conservative approach may be appropriate in older men.
       

  • Eskew LA, Woodruff RD, Bare RL, et al [ Wake Forest Univ. Winston-Salem, NC]
    Prostate Cancer Diagnosed by the 5 Region Biopsy Method is Significant Disease
    J Urol 160 : 794-796, 1998

    The authors have developed a 5-region method in which sextant biopsy specimens are taken along with additional biopsy material in the far lateral and middle aspects of the prostate.

    Compared to the sextant method, the 5-region method increases the cancer detection rate by 35%. It is especially valuable in patients with prostate specific antigen levels of less than 10.

    Conclusions – Prostate cancer detected by the 5-region biopsy method and the standard sextant methods are similar in their pathological characteristics. Whereas the 5-region method has a higher cancer detection rate, the cancers detected are not clinically significant.
       

  • Rodriguez LV, Terris MK [Stanford Univ, Calif; Veterans Affairs Palo Alto Health Care System, Calif]
    Risks and Complications of Transrectal Ultrasound Guided Prostate Needle Biopsy: A Prospective Study and Review of the Literature
    J Urol 160: 2115-2120, 1998

    128 consecutive men with an average age of 70 underwent transrectal US-guided needle biopsy for the evaluation of prostate cancer. Before the biopsy, patients completed a questionnaire and the PSA 7-symptom and bothersome score. Preoperative PSA studies were done in all. 

    An enema was administered 1 hour before procedure and a prophylaxis of 500 mg Ciprofloxacin and 500 mg metronidazole was given for antibiotic prophylaxis.

    The only major complication was a vasovagal episode with seizures.

    In 77 patients, 135 minor complications occurred, gross haematuria was the most common complication.

    The amount of discomfort was proportional to the amount of bleeding, but was not associated with the prostate volume or location of biopsies. 

    Conclusion – A screening procedure for otherwise healthy patients should be safe and cause minimal morbidity. Patients need to be informed that the morbidity of the procedure is significant.
       

  • Albertsen PC, Hanley JA, Gleason DF, et al [Univ of Connecticut, Farmington; McGill Univ, Montreal; Massachusetts Gen Hosp, Boston]
    Competing Risk Analysis of Men Aged 55 to 74 Years at Diagnosis Managed Conservatively for Clinically Localized Prostate Cancer
    JAMA 280: 975-980, 1998

    767 men with localized prostate cancer were diagnosed between 1971 and 1984. They did not undergo surgery, external beam radiation or brachy therapy; some received immediate or delayed hormonal therapy .

    In each case, the original histological material was available for grading by the Gleason system.

    Conclusion – Those with Gleasons score of 2 to 4 are at low risk of dying of prostate cancer during 15 year follow up.

    Those with Gleasons scores of 7 to 10 are at high risk of prostate cancer death even if their cancer is diagnosed as late as age 74. For men with intermediate Gleasons scores, risk is small at first but increases gradually at follow up.
         

  • Adolfsson J, Steineck G, Hedlund PO [Huddinge Univ, stockholm]
    Deferred Treatment of Locally Advanced Nonmetastatic Prostate Cancer : A Long Term Follow-up
    J Urol 161 : 505-508; 1999

    172 men who had no signs of distant metastasis were included in a prospective surveillance protocol.

    The overall survival rate was 68% at 5 years, 34% at 10 years and 26% at 12 years, disease specific survival rates at these periods were 90%, 74% and 70%. The chance of being untreated at 5 years after diagnosis was 40%; at 10 years the chance was 30%.

    Conclusions – Survival outcomes in the deferred treatment group appears to be poorer than in similarly managed clinically localized prostate cancer. In select patients with non metastatic locally advanced tumors and a life expectancy of 10 years or less, deferred treatment may be preferable to other treatment.
         

  • DiPaola Rs, Zhang H, Lambert GH et al [Univ of Medicine and Dentistry of New Jersey-Robert Wood Johnson Med. School, New Brunswick; Cancer Institute of New Jersey, New Brunswick; Environmental and Occupational Health Sciences Inst. Piscataway, NJ]
    Clinical and Biological Activity of an Estrogenic Herbal Combination [PC-SPES] in Prostate Cancer
    N Eng J Med 339: 785-791, 1998

    Herbal therapies and other unconventional treatments are widely used by patients with cancer. A herbal combination called PC-SPES consists of chrysanthemum, isatis, licorice, Ganoderma lucidum, panax, pseudo-ginseng, Rabdosia rubescens, saw palmetto & scutellaria

    Conclusion – The herbal mixture of PC-SPES used by many patients with prostate cancer has potent estrogenic activity. However it is an unregulated product that may confound the results of therapy and cause-significant adverse effects. 
        

  • Post PN, Stockton D, Davies TW, et al [Comprehenive Cancer Centre South, Eindhoven, The Netherlands; Erasmus University Rotterdam, The Netherlands: Univ of Cambridge, England]
    Striking Increase in Incidence of Prostate Cancer in Men Aged < 60 Years without Improvement in Prognosis.
    Br J Cancer 79: 13-17, 1999
        
    Prostate cancer has been diagnosed with increasing frequency in recent years, but prognosis has improved in many countries because tumors are often detected at a preclinical stage by prostate specific antigen [PSA] testing or by transurethral resection of the prostate for treatment of benign prostatic hyperplasia.
        
    Conclusion – The hypothesis that there has been a genuine increase in the incidence of prostate cancer among men aged 40 to 59 is supported by this study.

    No improvement in prognosis was observed in the period prior to PSA testing. The rise in incidence does not appear to be related to improved diagnosis because the inclusion of more early stage cases would have led to improved survival rates.
       

  • Iversen P, Tyrrell CJ, Kaisary AV, et al [ Univ of Copenhagen: Royal Free Hosp, London; Royal Hallamshire Hosp, Sheffield, England; et al]
    Casodex [Bicalutamide] 150 mg Monotherapy Compared with Castration in Patients with Previously Untreated Nonmetastatic Prostate Cancer : Results from two Multicenter Randomized Trials at a Median Follow-up of 4 Years
    Urology 51: 389-396, 1998

    The most widely used methods of androgen deprivation for advanced prostate cancer are bilateral orchiectomy and medical castration. Because castration by any method results in loss of libido and erectile dysfunction, this option can adversely affect quality of life. Monotherapy with nonsteroidal antiandrogens might be as effective as castration but without its adverse effects.

    Conclusion – In previously untreated patients with M0 prostate cancer, bicalutamide was equivalent to castration in survival rates. Bicalmtamide 150 mg is a well-tolerated alternative to castration and offers quality of life advantages. 
       

  • Fowler JE Jr, Bigler SA, Kolski JM et al [Univ of Mississippi, Jackson, Veterans Affairs Med Ctr, Jackson, Miss]
    Early results of a Prospective study of Hormone Therapy for Patients with Locally Advanced Prostate Carcinoma
    Cancer 82: 1112-1117, 1998

    Older men with localized prostate cancer are poor candidates for radical prostatectomy.

    The study provides interesting information on early hormonal therapy for 103 men with T3-4 NXm0 prostate cancer treated with androgen ablation therapy.

    Among men with co-morbid illnesses early hormonal therapy is a reasonable option for those with localized disease who request therapeutic intervention.
         

  • Torbenson M, Dhir R, Nangia A, et al [Univ of Pittsburgh, Pa]
    Prostate Carcinoma with Signet Ring Cells : A Clinicopathologic And Immuno- histochemical Analysis of 12 Cases, with Review of Literature
    Mod Pathol 11: 552-559, 1998

    Prostatic adenocarcinoma of signet ring cell [SRC] component, must be differentiated from similar tumors of bladder or gastric origin.

    Conclusion – Prostatic adenocarcinoma with SRC components are typically associated with high grade adenocarcinomas. Such lesions are typically positive for mucin, PAS-D cytokeratins, MIB-I, bcl-2, c-MET and CD 44 comparable with that shown by high grade adenocarcinoma components. Prostatic adenocarcinomas with SRC components have a low M1B-1 proliferation index and cannot always be distinguished from SRC components of bladder and stomach carcinomas with any of the stains used in the current study including PSA..
       

  • Chang PL, Huang ST, Wang TM, et al [Chang Gung Univ, Taipei, Taiwan]
    Improvement of Medical Care Quality After Implementation of a Clinical Path Monitoring Program for Transurethral Prostatectomy Patients
    Eur Urol 33: 523-528; 1998

    Methods – 10 Quality indicators were :

    1. % of patients who had incomplete preoperative tests on admission day.

    2. Percentage of patients with orders for postoperative blood transfusion. 

    3. Duration of i.v. antibiotics administration.

    4. Percentage of patients ordered to have nothing by mouth after operation.

    5. Percentage of patients who required acute pain management 
    postoperatively. 

    6. Percentage of patients who received bladder irrigation post operatively with N Saline.

    7. Percentage of patients whose Foleys catheter was removed after day 2.

    8. Percentage of patients with complications.

    9. Percentage mortality.

    10. Percentage of patients readmitted within 2 weeks.

    Results –
    1. Of 1.58% to 81%.
    2. Duration of i.v. antibiotics : 1.9 to 1.0 day.
    3. Postoperative intramuscular pain relief [ 38% – 21%] [Intramuscular]
    4. Postoperative bladder irrigation [80% – 69%]
    5. Catheter removal after 2 days [23% -17%].


    Conclusion – Implementation of clinical path resulted in statistically significant improvement in quality of medical care and decrease in length of hospital stay and total admission charges. 
       

  • Litwin MS, Lubeck DP, Henning JM, et al [Univ of California, Los Angeles; Stanford Univ, Calif; Univ of California, San Francisco; et al]
    Differences in Urologist and Patient Assessment of Health Related Quality of Life in Men with Prostate Cancer : Results of the CaPSURE Database
    J. Urol 159; 1988-1992, 1998

    Conclusion – The authors suggest that physicians are likely to be poor estimates of the patients health status. It is probably more relevant to have physician assessment based on direct interviews and questionnaire, rather than assessments from reviews of medical records.

    Also patients assessments are often unstable as, for example querying an individual about his quality of life during the middle of a bad cold and subsequently after the cold has resolved.
       

  • D’Amico AV, Whittington R, Malkowicz SB, et al [Harvard Med School, Boston; Univ of Pennsylvania, Philadelphia; Univ of Millersville, Pa; et al]
    Biochemical Outcomes After Radical Prostatectomy, External Beam Radiation Therapy, or Interstitial Radiation Therapy for Clinically Localized Prostate Cancer
    JAMA 280: 969-974, 1998

    Conclusions -The results of various local therapies for clinically localized prostate cancer are reviewed. For low-risk patients 5 year PSA outcomes appear comparable whether the treatment is RP, RT or implant therapy with or without neoadjuvant androgen deprivation. However, for intermediate or high risk patients, the results are better with RP or RT than with implant therapy. There is a need for a definitive randomized trial that compares PSA and survival outcomes between the various treatment options.
       

  • Litwin MS, McGuigan KA,Shpall Al, et al [ Univ of California, Los Angeles]
    Recovery of Health Related Quality of Life in the Year After Radical Prostatectomy Early Experience
    J. Urol 161 : 515-519, 1999

    There has been a lack of objective published data on health related quality of life [HRQOL] after treatment of prostate cancer.

    Patients were asked to complete a confidential HRQOL questionnaire before surgery, at 3 month intervals during the year after surgery then at 6 month intervals until 5 years after surgery.

    Mean patient age was 60.9. Before surgery general HRQOL scores were high for the group overall exceeding 70 points. After prostatectomy there was a general decrease in the HRQOL scores, involving all domains. Return to baseline was rapid in the general and bowel domains. There was an inverse relationship between level of education and the likelihood of return to baseline.

    Men who underwent radical prostatectomy for early stage prostate cancer experienced a steady improvement in quality of life during the first year after surgery. By 12 months after prostatectomy, 86% to 97% of patients had reached baseline HRQOL during follow-up.
       

  • Haythornthwaite JA, Raja SN, Fisher B, et al [ Johns Hopkins Univ, Baltimore, Md; Univ of Chicago; Hadassah Univ, Jerusalem]
    Pain and Quality of Life Following Radical Retropubic Protatectomy
    J. Urol 160: 1761-1764, 1998

    The study determined whether preemptive analgesia reduces chronic pain, the impact of chronic pain on quality of life, and the psychological risk factors for chronic pain after RP.

    One hundred and ten patients were randomly assigned to receive epidural anesthesia, general anesthesia, or both.

    Questionnaire assessed patients 3 and 6 months post surgery on prostate symptoms, pain associated with surgery, quality of life and mood. 

    Patients with pain at 3 months used significantly more pain medication on the third postoperative day than patient without pain. Pain reported at 3 months was mild and associated with poor perception of overall health and decreased physical and social functioning.

    Conclusion – Intraoperative anesthesia technique had no apparent long-term effects. Mild pain was common after radical prostatectomy and was associated with decreased quality of life, especially social functioning.

    Preoperative distress, anxiety and postoperative pain medication use may predict chronic pain after radical retropubic porstatectomy.
      

  • Knight SJ, Chmiel JS, Kuzel T, et al [Northwestern Univ, Chicago; Veterans Affairs Chicago Health Care Systems: Durham Veterans Affairs Med Ctr, NC; et al]
    Quality of Life in Metastatic Prostate Cancer Among Men of Lower Socioeconomic Status : Feasibility and Criteria Related Validity of 3 Measures
    J Urol 160 : 1765-1769, 1998

    Conclusions – Individuals with low literacy levels are generally unable to comply with the traditional self-administered questionnaires on this subject.

    The Interviewer administration of these instruments appears to be feasible even in a busy clinical setting.

    Low literacy appears to be an important consideration in evaluating barriers to medical care, as well as assessing functional status outcomes for patients with prostate cancer.
       

  • P. Iversen, I. Melezinek and A. Schmidt [ Department of Urology, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark, Medical Affairs, AstraZeneca, Alderley Park, Macclesfield, UK and Department of Urology, University of Stellenbosch, Tygerberg, South Africa
    Nonsteroidal Antiandrogens: A Therapeutic Option for Patients with Advanced Prostate Cancer Who Wish to Retain Sexual Interest and Function
    BJU International, volume 87, Number 1, January 2001, Pg.Nos. 47-56

    Conclusion – The effect of currently available hormonal therapies on sexual interest and function varies and may therefore be an important consideration when selecting therapy for specific patients with advanced disease. 

    The data presented in this review confirm the widespread perception that monotherapy with a nonsteroidal antiandrogen offers benefit over castration for the preservation of libido and sexual potency.

    Bicalutamide 150 mg /day has been the most extensively investigated nonsteroidal antiandrogen and findings on sexual interest are consistent in patients with both locally advanced and metastatic prostate cancer, in open and blinded trials and across different methods of evaluation.
       

  • R.S. Lance, P.A. Freidrichs, C. Kane, C.R. Powell, E. Pulos, J.W. Moul, D.G. Mcleod, R.L. Cornum and J. Brantley Thrasher [Department of Surgery, Urology Service, Tacoma, Washington, Naval Medical Center San Diego, San Diego, California, and Walter Reed Army Medical Center, Washington, DC, USA]
    A Comparison of Radical Retropubic with Perineal Prostatectomy for Localized Prostate Cancer Within the Uniformed Services Urology Research Group
    BJU International, volume 87, Number 1, January 2001, Pg.Nos. 61-65

    Patients and Methods – Between 1988 and 1997, 1382 men who were treated by RRP and 316 by RPP were identified from databases of the Uniformed Services Urology Research Group.

    Results – In the 190 matched patients there were no significant differences between the RRP and RPP groups in either organ-confined, margin-positive or biochemical recurrence rates respectively. The only significant difference in complication rates was a higher incidence of rectal injury in the RPP group than in the RRP group. 

    Conclusion – RPP offers equivalent organ-confined, margin-positive and biochemical recurrence rates to RRP, while causing significantly less blood loss.
       

  • F.May, T. Treumann, P. Dettmar, R. Hartung and J. Breul [ Departments of Urology, Radiology and Pathology, Klinikum rechts der Isar, Technische Universitat Munchen, Germany]
    Limited Value of Endorectal Magnetic Resonance Imaging and Transrectal Ultrasonography in the Staging of Clinically Localized Prostate Cancer
    BJU International, volume 87, Number 1, January 2001, Pg.Nos. 66-69

    The eMRI was more sensitive than TRUS for detecting extracapsular extension and seminal vesicle invasion in organ confined prostate cancer.

    TRUS had a relatively high specificity for ECE [ Extracapsular Extension] and SVI, [Seminal Vesicle Invasion] and was better than eMRI in this regard.

    Conclusion – Whereas eMRI tended to over-stage, TRUS understaged prostate cancer. This series shows the current limited value of TRUS and eMRI for planning treatment in patients with clinically localized prostate cancer. Treatment decisions should not be altered based on TRUS or eMRI finding alone.
       

  • R.C. Ouyang, D.N. Kenwright, J.N. Nacey and B. Delahunt [ Departments of Surgery and Pathology and Molecular Medicine, Wellington School of Medicine, University of Otago,Wellington, New Zealand]
    The Presence of Atypical Small Acinar Proliferation in Prostate Needle Biopsy is Predictive of Carcinoma on Subsequent Biopsy
    BJU International, volume 87, Number 1, January 2001, Pg.Nos. 70-74

    Patients and Methods – Of 331 patients who underwent thin-core biopsy of the prostate over a 30-month period, 21 had atypical histological features and of these 17 underwent repeat biopsy. In addition, a further 20 patients, with normal histology underwent repeat biopsy for persistent abnormal clinical findings.

    Results – 9 patients with atypical histology and four with normal histology on initial biopsy were found to have carcinoma on subsequent biopsy.

    Conclusion – The presence of atypia on initial biopsy is a strong predictor of malignancy in subsequent biopsy specimens.
       

  • C-J Mclaren and E.T. Simpson [ Department of Medical Imaging and Paediatric Surgery, The Canberra Hospital, ACT Australia]
    Direct Comparison of Radiology and Nuclear Medicine Cystograms in Young Infants with Vesico-Ureteric Reflux
    BJU International, volume 87, Number 1, January 2001, Pg.Nos. 93-97

    To determine the sensitivity of the direct radionuclide cytogram [DRC] in detecting vesicoureteric reflux compared with micturating cystourethrogram [MCU] in the same initial setting in infants younger than one year.

    Result – Reflux was detected in 105 units, 96 detected on DRC and 47 on MCU, representing a sensitivity of 91% and 45% respectively.

    The DRC missed half of grade I, 20% of grade II, 6% of grade III reflux.

    Reflux at low bladder filling rates [DRC] represented 40% of all reflux units, and a half [52%] of scarred renal units detected by DMSA scintigraphy.

    Conclusion – In young infants the MCU may fail to detect the lesser grades. The combination of both cystograms in the initial investigation of reflux provides more comprehensive information. 

 Screening
      

  • M-L Essink-Bot, HJ de Koning, HFT Nijs, et al [ Erasmus Univ Rotterdam, The Netherlands]
    Short-term Effects of Population-based Screening for Prostate Cancer on Health-related Quality of Life
    J Natl Cancer Inst 90: 925-931, 1998
        
    Conclusion – The screening nihilists have suggested that widespread screening for prostate cancer is an anxiety-raising practice without proven benefit. This study shows that screening does not provoke undue anxiety among participants. Indeed, there was significant satisfaction among participants with negative screening tests and participants who underwent prostatic biopsy that did not disclose prostate cancer. 
        
    This article should quell concerns that heightened awareness of prostate cancer has materially reduced the quality of life of men participating in screening programs.
      

  • Wolf AMD, Schorling JB [Univ of Virginia, Charlottesville]
    Preferences of Elderly Men for Prostate Specific Antigen Screening and the Impact of Informed Consent
    J. Gerontol 53A : M195-M200, 1998

    Screening for prostate cancer with prostate specific antigen [PSA] can detect cancer at an earlier stage compared with digital rectal examination alone. Yet screening with PSA has not been shown to improve patient outcomes.

    Of the 205 men involved in the trial, 104 had no history of prostate cancer and had not previously undergone PSA screening. Randomization was to a scripted overview of PSA screening or to a brief control message.

    Men who received the conformational message were significantly less interested in PSA screening than men who were given the control message. Informed men perceived screening to be of less benefit than uninformed men. 

    Among the uninformed men, perceived seriousness of prostate cancer predicted interest in screening. 
      

  • C. C. Parker, M. Gospodarowicz and P. Warde (Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Canada)
    Does age influence the behaviour of localized prostate cancer?
    BJU Intl. May 2001 Vol. 87 (7) Pg. 629-637
        
    Conclusions : The review finds evidence that young age was an adverse prognostic factor in radiation series from the era before PSA testing when men presented clinically and typically with locally advanced disease, but that age has no significant prognostic effect in contemporary series of localized prostate cancer.
        
    Possible explanations for this difference include:
        
    1) Delayed diagnosis in younger men before PSA screening was available.
    2) An age bias in assessing clinical endpoints.
    3) An age dependant lead-time bias after the introduction of screening.
    4) An interaction between grade and age.
        
    The proposed effect of age on the magnitude of the benefit of neoadjuvant androgen deprivation merits further study. 
        

  • M. Tornblom, U. Norming, C. Becker, H. Lilja and O. Gustafsson (Department of Urology, Huddinge University Hospital, Karolinska Institute, Department of Urology, Stockholm South Hospital, Karolinska Institute, Stockholm, and Department of Clinical Chemistry, Malmo University Hospital, Malmo, Sweden)
    Variation in Percentage-Free Prostate-Specific Antigen (PSA) with Prostate Volume, Age and Total PSA Level
    BJU Intl. May 2001 Vol. 87 (7) Pg. 638-642
         
    Results: The f/tPSA level varied with prostate volume and age, but the decisive factor for this variation was the tPSA level. The closest correlation was in the tPSA interval 7.0-9.9 ng/mL, where volume and age together explained 47% of the variation in f/tPSA. Also, for men with tPSA levels in each of the intervals 2.0-3.9, 4.0-6.9 and 7.0-9.9 ng/mL, the f/tPSA increased with higher prostate volumes and age. In men with tPSA levels of < 2.0 ng/mL, the f/tPSA was not affected by variations in prostate volume or age.
         

  • G. Hruby, R. Choo, L. Klotz, C. Danjoux, J. Murphy, G. Deboer, G. Morton, E. Rakovitch, E. Szumacher and N. Fleshner (Toronto-Sunnybrook Regional Cancer Centre, University of Toronto, and Sunnybrook & Women’s College Health Sciences Centre, University of Toronto, Ontario, Canada)
    The Role of Serial Transrectal Ultrasonography in a ‘Watchful Waiting’ Protocol for Men with Localized Prostate Cancer
    BJU Intl. May 2001 Vol. 87 (7) Pg. 643-647
         
    Objective : To determine the value of 6 monthly transrectal ultrasonography (TRUS) in a cohort of men with localized prostate cancer who consented to a programme of watchful waiting with selected delayed intervention.
          
    Results : The group of 28 men who progressed to require radical intervention underwent 83 TRUS examinations (median number per patient, three). 2 men underwent TRUS only at baseline because of progression within 6 months.
         
    Of these 28 men only 7 had changes on TRUS that were regarded as consistent with progression. All seven consisted of the growth of an existing nodule or the appearance of a new nodule. In only one case was this accompanied by an increase of ³ 30% in gland volume. 
          
    In 136 men who underwent two or more serial TRUS examinations (median 3, maximum 9), there was no correlation between the rate of change of PSA and changes in either gland volume or the number of peripheral zone hypoechoic lesions.
        
    Conclusion : The use of serial TRUS in men with known but untreated prostate cancer is of limited value as a determinant of disease progression.
        

  • P. Li, K. Wallner, W. Ellis, J. Blasko and J. M. Corman (Departments of Urology and Radiation Oncology, University of Washington, Departments of Urology and Radiation Oncology, Puget Sound Health Care System, Department of Veterans Affairs, and Seattle Prostate Institute, Swedish Medical Center, Seattle, Washington, USA)
    Prostate Brachytherapy in Patients with a Penile Prosthesis
    BJU Intl. May 2001 Vol. 87 (7) Pg. 712-713
         
    Five patients were identified who had an indwelling penile prosthesis and who underwent interstitial prostate brachytherapy within the last 2 years.
           
    4 patients had semi-rigid implants and one had a 3 piece inflatable prosthesis. Their prostate volumes were 23-56 ml.
          
    CT of the pelvis before treatment was reviewed to exclude significant pubic arch interference to the path of the needles.
          
    The follow-up after brachytherapy was 9-23 months; one patient was lost to follow-up. None of the 3 sexually active men had prosthesis-related pain, infection or malfunction in the 1st year after brachytherapy.
         
    One patient who had a 3 piece implant, reported a malfunction in his prosthesis 13 months after seed implantation. At the time of replacement, there was a connector tube leak at the abdominal reservoir.
        
    Conclusion : A penile prosthesis is widely regarded as a contraindication to transperineal prostate brachytherapy because of the risk of infection or prosthetic malfunction from needle related damage.
          
    The lack of infectious complications in the present patients is consistent with the absence of postoperative infections in patients who undergo radical prostatectomy with a penile prosthesis in place.
         
    Some factors that may help preventing complications are:
         
    1) Pre therapy CT for correct anatomical treatment.
    2) Waiting for 6 months from surgery to brachytherapy.
    3) Bowel preparation and antibiotics prevent infection.
    4) Lithotomy portion should help to move the prosthesis anteriorly.
         
    Intraoperative TRUS was of little help in monitoring placement of needles.
        

 

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