Audit and its impact in the management of early prostatic cancer

An analysis was made of a prospective database of 614 men with newly diagnosed carcinoma of the prostate who presented between January 1978 and December 1990; 3-monthly updates were available on their clinical, haematological and biochemical parameters and 6-monthly updates on chest X-rays, bone scans and skeletal X-rays. It was found that 107 men (mean age 73.5 years) had early disease at presentation. Their management was based on regular surveillance and the treatment deferred until disease progression or development of symptoms. The audit of outcome measured various clinical events. Four patients (3.7%) developed local failure, 11 (10.3%) developed bone metastases, 3 (2.8%) died of cancer with a median survival of 6.3 years, and 34 (31.8%) died of intercurrent disease with a median survival of 2.6 years. The observed survival for 12 years of the whole group was similar to the expected survival for an age-matched population in Scotland. The standardised mortality ratio was 81 (95% confidence limits 57-112).

Portable electrical stimulator for use in small animals

The detailed electronic configuration of a lightweight (7 g) battery-operated portable electrical stimulator unit is described. It has proven useful for the study of the effects of chronic stimulation on skeletal muscle in small animals (i.e., the rat). The unit requires wavelengths in the infrared region for activation. This allows for remote triggering of the stimulator and permits it to function reliably even when animals are housed in rooms illuminated by fluorescent lamps. Unique to the system is the inclusion of a visual indicator of unit function (light-emitting diode), thus providing a convenient means of monitoring unit activation. The stimulator unit described has proven to be highly reliable and very useful for the study of alterations in gene expression in muscle subject to chronic use (M. Takahashi and D. A. Hood, J. Appl. Physiol. 74: 934-941, 1993).

Is the outcome of conservative management for localized prostate cancer acceptable? An overview

The outcome of conservative management in a consecutive series of 107 localized prostate cancers (mean age 73.5 years) has been analyzed. Follow-up ranged from 1 to 12 years. Following regular surveillance and no initial treatment, 3 died from prostate cancer with a median survival of 6.3 years compared to 34 who died from intercurrent disease with a median survival of only 2.6 years. The observed survival for the whole group was similar to the expected survival for an age-matched population in Scotland. This was despite the fact that the nodal status and the capsular invasion were unknown.

Identification of metastatic disease by T category, gleason score and serum PSA level in patients with carcinoma of the prostate

Pre-operative serum prostate specific antigen (Tandem-R assay), T category, Gleason score and the metastatic (M1) status of a consecutive series of 60 patients with newly diagnosed carcinoma of the prostate were studied prospectively. The results revealed that, of these variables, pre-operative serum PSA (greater than 100 ng/ml) was the single most important indicator of metastatic disease, with 100% predictive value. With this alone, 83.3% of M1 disease could be correctly identified. For the remaining 17%, however, we advocate a high index of suspicion if the tumour is T3-T4 category on digital rectal examination (predictive value = 71.4%) and has a high grade with a Gleason score 8-10 (predictive value = 81%).