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Basaran E, Kucukoztas N, Aktepe HO, Atak Tel B, Aktas G. An exceptional prostate cancer case: Importance of cancer screening. PRECISION MEDICAL SCIENCES 2022. [DOI: 10.1002/prm2.12063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Elif Basaran
- Department of Internal Medicine Abant Izzet Baysal University Hospital Bolu Turkey
| | - Nadire Kucukoztas
- Department of Medical Oncology Abant Izzet Baysal University Hospital Bolu Turkey
| | - Halit Oktay Aktepe
- Department of Medical Oncology Abant Izzet Baysal University Hospital Bolu Turkey
| | - Burcin Atak Tel
- Department of Internal Medicine Abant Izzet Baysal University Hospital Bolu Turkey
| | - Gulali Aktas
- Department of Internal Medicine Abant Izzet Baysal University Hospital Bolu Turkey
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Lu X, Wu M, Wang S, Qin J, Li P. Synthesis and preliminary exploration of a NIR fluorescent probe for the evaluation of androgen dependence of prostate cancer. Talanta 2021; 239:123058. [PMID: 34823861 DOI: 10.1016/j.talanta.2021.123058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 11/03/2021] [Accepted: 11/10/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Castration resistance prostate cancer patients showing resistance to the androgen deprivation therapy always have low five-year survival rate and worse prognosis. A responsive NIR fluorescent probe was designed to report the androgen dependence and monitor the development of castration resistance for prostate cancer. METHODS Intratumoral H2S in prostate cancer was closely related to castration resistance. A H2S-responsive NIR probe (HM) was developed as a dependent indicator to report the androgen dependence of prostate cancer. The specificity of HM to H2S and the influence of normal intracellular substrates to the response between H2S and HM were determined. Cell/in vivo animal imaging were performed on PC-3 and LnCAP cell/tumor bearing mice, which presented with androgen independence and androgen dependence, respectively. RESULTS When HM responded to H2S, strong fluorescence at 770 nm could be rapidly turned on in 5 min with the stokes shift as large as 200 nm. The recognition between HM and H2S showed high specificity. Neither other common substrates showed capacity to turn on HM's fluorescence, nor their existence demonstrated competition. The fluorescence intensity was linearly dependent to the H2S concentration and the limited of detection was 0.15 μM. When HM was applied to PC-3/LNCaP prostate cancer cell and tumor, the intracellular and intratumoral H2S could be clearly imaged and monitored. CONCLUSION HM showing obvious fluorescent behaviors in androgen dependence and independence prostate tumor, which could work as an indicator to reported the androgen dependence of prostate cancer and monitor the development of castration resistance.
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Affiliation(s)
- Xinmiao Lu
- Department of Nuclear Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Muyu Wu
- Department of Nuclear Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Siwen Wang
- Department of Nuclear Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Jingcan Qin
- School of Medicine, Shanghai Jiao Tong University, South Chongqing Road, Shanghai, 200025, China.
| | - Peiyong Li
- Department of Nuclear Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, China.
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Llukani E, Lepor H. Aetiology and management of earlier vs later biochemical recurrence after retropubic radical prostatectomy. BJU Int 2017; 120:505-510. [PMID: 28220652 DOI: 10.1111/bju.13816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To examine the characteristics and management of earlier (within 5 years) vs later (after 5 years) biochemical recurrence (BCR) after radical prostatectomy (RP). MATERIALS AND METHODS Between October 2000 and October 2009, 1597 men underwent open retropubic RP. BCRs were managed using salvage radiation therapy (SRT), androgen deprivation therapy (ADT) or active surveillance (AS). BCR-free survival was assessed using Kaplan-Meier analysis. Factors predicting earlier or later BCR and BCR after SRT were assessed using logistic regression and Cox proportional hazard models, respectively. RESULTS The probabilities of developing BCR within 5 years and 10 years were 12.3% (95% confidence interval [CI] 10.7-13.9) and 18.4% (95% CI 16.2-20.6), respectively. On multivariate analysis, prostate-specific antigen doubling time, positive surgical margins and pathological Gleason score significantly differentiated earlier from later BCR. Overall, 74.5, 12.7 and 12.7% of men developing BCR underwent SRT, ADT or AS, respectively. A significantly greater proportion of men in the earlier BCR group underwent SRT (80.8 vs 59%) and ADT (14.6 vs 8.2%), and a significantly greater proportion of men in the later BCR group underwent AS (32.8 vs 4.6%; P<0.001). The response to SRT was independent of time to BCR. On multivariate analysis, clinical stage and pathological stage significantly predicted failure of SRT. CONCLUSIONS Approximately one third of BCRs occurred between 5 and 10 years after RP. The aetiology and management of BCR was dependent on time to BCR, whereas response to SRT was independent of time to recurrence. Long-term follow-up is mandatory beyond 5 years for all men after RP.
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Affiliation(s)
- Elton Llukani
- Department of Urology, New York University Langone Medical Center, New York, NY, USA
| | - Herbert Lepor
- Department of Urology, New York University Langone Medical Center, New York, NY, USA
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Tissue-scale, personalized modeling and simulation of prostate cancer growth. Proc Natl Acad Sci U S A 2016; 113:E7663-E7671. [PMID: 27856758 DOI: 10.1073/pnas.1615791113] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Recently, mathematical modeling and simulation of diseases and their treatments have enabled the prediction of clinical outcomes and the design of optimal therapies on a personalized (i.e., patient-specific) basis. This new trend in medical research has been termed "predictive medicine." Prostate cancer (PCa) is a major health problem and an ideal candidate to explore tissue-scale, personalized modeling of cancer growth for two main reasons: First, it is a small organ, and, second, tumor growth can be estimated by measuring serum prostate-specific antigen (PSA, a PCa biomarker in blood), which may enable in vivo validation. In this paper, we present a simple continuous model that reproduces the growth patterns of PCa. We use the phase-field method to account for the transformation of healthy cells to cancer cells and use diffusion-reaction equations to compute nutrient consumption and PSA production. To accurately and efficiently compute tumor growth, our simulations leverage isogeometric analysis (IGA). Our model is shown to reproduce a known shape instability from a spheroidal pattern to fingered growth. Results of our computations indicate that such shift is a tumor response to escape starvation, hypoxia, and, eventually, necrosis. Thus, branching enables the tumor to minimize the distance from inner cells to external nutrients, contributing to cancer survival and further development. We have also used our model to perform tissue-scale, personalized simulation of a PCa patient, based on prostatic anatomy extracted from computed tomography images. This simulation shows tumor progression similar to that seen in clinical practice.
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Abstract
This article discusses MR imaging of the normal prostate and of disease conditions of the prostate including prostatitis, cystic lesions, amyloidosis, calculi, hematospermia, benign prostatic hyperplasia, and malignancy.
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Affiliation(s)
- Ekta Gupta
- Department of Radiology, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, 3400 Spruce Street, Philadelphia, PA 19104, USA
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A Phase I Dosing Study of Ferumoxytol for MR Lymphography at 3 T in Patients With Prostate Cancer. AJR Am J Roentgenol 2015; 205:64-9. [PMID: 26102381 DOI: 10.2214/ajr.14.13009] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The objective of our study was to determine the optimal dose of ferumoxytol for performing MR lymphography (MRL) at 3 T in patients with prostate cancer. SUBJECTS AND METHODS This phase I trial enrolled patients undergoing radical prostatectomy (RP) with bilateral pelvic lymph node dissection (PLND). Three groups of five patients each (total of 15 patients) received IV ferumoxytol before RP with bilateral PLND at each of the following doses of iron: 4, 6, and 7.5 mg Fe/kg. Patients underwent abdominopelvic MRI at 3 T before and 24 hours after ferumoxytol injection using T2- and T2*-weighted sequences. Normalized signal intensity (SI) and normalized SD changes from baseline to 24 hours after injection within visible lymph nodes were calculated for each dose level. Linear mixed effects models were used to estimate the effects of dose on the percentage SI change and log-transformed SD change within visible lymph nodes to determine the optimal dose of ferumoxytol for achieving uniform low SI in normal nodes. RESULTS One patient who was excluded from the study group had a mild allergic reaction requiring treatment after approximately 2.5 mg Fe/kg ferumoxytol injection whereupon the injection was interrupted. The 15 study group patients tolerated ferumoxytol at all dose levels. The mean percentage SI change in 13 patients with no evidence of lymph metastasis was -36.4%, -45.4%, and -65.1% for 4, 6, and 7.5 mg Fe/kg doses, respectively (p = 0.041). CONCLUSION A dose level of 7.5 mg Fe/kg ferumoxytol was safe and effective in deenhancing benign lymph nodes. This dose therefore can be the starting point for future phase II studies regarding the efficacy of ferumoxytol for MRL.
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Sturzu A, Klose U, Sheikh S, Echner H, Kalbacher H, Deeg M, Nägele T, Schwentner C, Ernemann U, Heckl S. The gastrin/cholecystokinin-B receptor on prostate cells--a novel target for bifunctional prostate cancer imaging. Eur J Pharm Sci 2013; 52:69-76. [PMID: 24211650 DOI: 10.1016/j.ejps.2013.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 10/22/2013] [Accepted: 10/22/2013] [Indexed: 10/26/2022]
Abstract
The means of identifying prostate carcinoma and its metastases are limited. The contrast agents used in magnetic resonance imaging clinical diagnostics are not taken up into the tumor cells, but only accumulate in the interstitial space of the highly vasculated tumor. We examined the gastrin/cholecystokinin-B receptor as a possible target for prostate-specific detection using the C-terminal seven amino acid sequence of the gastrin peptide hormone. The correct sequence and a scrambled control sequence were coupled to the fluorescent dye rhodamine and the magnetic resonance imaging contrast agent gadolinium (Gd)-1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid (DOTA). Expression analysis of the gastrin receptor mRNA was performed by reverse transcriptase polymerase chain reaction on PC3 prostate carcinoma cells, U373 glioma, U2OS osteosarcoma and Colo205 colon carcinoma cells. After having confirmed elevated expression of gastrin receptor in PC3 cells and very low expression of the receptor in Colo205 cells, these two cell lines were used to create tumor xenografts on nude mice for in vivo experiments. Confocal lasers scanning microscopy and magnetic resonance imaging showed a high specificity of the correct conjugate for the PC3 xenografts. Staining of the PC3 xenografts was much weaker with the scrambled conjugate while the Colo205 xenografts showed no marked staining with any of the conjugates. In vitro experiments comparing the correct and scrambled conjugates on PC3 cells by magnetic resonance relaxometry and fluorescence-activated cell sorting confirmed markedly higher specificity of the correct conjugate. The investigations show that the gastrin receptor is a promising tumor cell surface target for future prostate-cancer-specific imaging applications.
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Affiliation(s)
- Alexander Sturzu
- Department of Neuroradiology, University of Tübingen, Germany; Peptide Synthesis Laboratory, Interfaculty Institute of Biochemistry, University of Tübingen, Germany.
| | - Uwe Klose
- Department of Neuroradiology, University of Tübingen, Germany
| | - Sumbla Sheikh
- Peptide Synthesis Laboratory, Interfaculty Institute of Biochemistry, University of Tübingen, Germany
| | - Hartmut Echner
- Peptide Synthesis Laboratory, Interfaculty Institute of Biochemistry, University of Tübingen, Germany
| | - Hubert Kalbacher
- Peptide Synthesis Laboratory, Interfaculty Institute of Biochemistry, University of Tübingen, Germany
| | - Martin Deeg
- Mass Spectrometry Laboratory, Medicinal Research Centre, University of Tübingen, Germany
| | - Thomas Nägele
- Department of Neuroradiology, University of Tübingen, Germany
| | | | - Ulrike Ernemann
- Department of Neuroradiology, University of Tübingen, Germany
| | - Stefan Heckl
- Department of Neuroradiology, University of Tübingen, Germany
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Froehlich JM, Triantafyllou M, Fleischmann A, Vermathen P, Thalmann GN, Thoeny HC. Does quantification of USPIO uptake-related signal loss allow differentiation of benign and malignant normal-sized pelvic lymph nodes? CONTRAST MEDIA & MOLECULAR IMAGING 2012; 7:346-55. [PMID: 22539405 DOI: 10.1002/cmmi.503] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Ultrasmall superparamagnetic iron oxide (USPIO) particles are promising contrast media, especially for molecular and cellular imaging besides lymph node staging owing to their superior NMR efficacy, macrophage uptake and lymphotropic properties. The goal of the present prospective clinical work was to validate quantification of signal decrease on high-resolution T(2)-weighted MR sequences before and 24-36 h after USPIO administration for accurate differentiation between benign and malignant normal-sized pelvic lymph nodes. Fifty-eight patients with bladder or prostate cancer were examined on a 3 T MR unit and their respective lymph node signal intensities (SI), signal-to-noise (SNR) and contrast-to-noise (CNR) were determined on pre- and post-contrast 3D T(2)-weighted turbo spin echo (TSE) images. Based on histology and/or localization, USPIO-uptake-related SI/SNR decrease of benign vs malignant and pelvic vs inguinal lymph nodes was compared. Out of 2182 resected lymph nodes 366 were selected for MRI post-processing. Benign pelvic lymph nodes showed a significantly higher SI/SNR decrease compared with malignant nodes (p < 0.0001). Inguinal lymph nodes in comparison to pelvic lymph nodes presented a reduced SI/SNR decrease (p < 0.0001). CNR did not differ significantly between benign and malignant lymph nodes. The receiver operating curve analysis yielded an area under the curve of 0.96, and the point with optimal accuracy was found at a threshold value of 13.5% SNR decrease. Overlap of SI and SNR changes between benign and malignant lymph nodes were attributed to partial voluming, lipomatosis, histiocytosis or focal lymphoreticular hyperplasia. USPIO-enhanced MRI improves the diagnostic ability of lymph node staging in normal-sized lymph nodes, although some overlap of SI/SNR-changes remained. Quantification of USPIO-dependent SNR decrease will enable the validation of this promising technique with the final goal of improving and individualizing patient care.
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Affiliation(s)
- Johannes M Froehlich
- Department of Radiology, Neuroradiology and Nuclear Medicine, University Hospital and Inselspital, University of Bern, Bern, Switzerland
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Triantafyllou M, Studer UE, Birkhäuser FD, Fleischmann A, Bains LJ, Petralia G, Christe A, Froehlich JM, Thoeny HC. Ultrasmall superparamagnetic particles of iron oxide allow for the detection of metastases in normal sized pelvic lymph nodes of patients with bladder and/or prostate cancer. Eur J Cancer 2012; 49:616-24. [PMID: 23084842 DOI: 10.1016/j.ejca.2012.09.034] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 09/25/2012] [Indexed: 12/12/2022]
Abstract
AIM Lymph node metastases influence prognosis and outcome in patients with bladder and prostate cancer. Cross sectional imaging criteria are limited in detecting metastases in normal sized lymph nodes. This prospective study assessed the diagnostic accuracy of ultrasmall superparamagnetic particles of iron oxide (USPIO)-enhanced magnetic resonance imaging (MRI) for the detection of metastases in normal sized lymph nodes using extended pelvic lymph node dissection (ePLND) and histopathology as the reference standard. METHODS Seventy-five patients (bladder cancer, n=19, prostate cancer n=48, both, n=8) were examined using 3T MR before and after USPIO-administration. A preoperative reading with two readers in consensus and a second postoperative reading with three independent blinded readers were performed. Results were correlated with histopathology and diagnostic accuracies were calculated for all readings. RESULTS A total of 2993 lymph nodes were examined histopathologically. Fifty-four metastatic nodes were found in 20/75 patients (26.7%). The first reading had a sensitivity of 55.0%, specificity of 85.5%, positive predictive value (PPV) of 57.9%, negative predictive value (NPV) of 83.9%, and diagnostic accuracy (DA) of 77.3% on a per patient level. The second reading had a mean sensitivity of 58.3%, specificity of 83.0%, PPV of 58.0%, NPV of 84.4% and DA of 76.4% on a per patient level. The majority of missed metastases were smaller than 5mm in short axis diameter. CONCLUSIONS USPIO-enhanced MRI in bladder and prostate cancer patients allows detection of metastases in normal sized lymph nodes and might guide the surgeon to remove suspicious lymph nodes not included in standard PLND.
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Affiliation(s)
- Maria Triantafyllou
- Department of Radiology, Institute for Diagnostic, Interventional, and Pediatric Radiology, Inselspital University Hospital Bern, Switzerland
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Gao X, Li LY, Zhou FJ, Xie KJ, Shao CK, Su ZL, Sun QP, Chen MK, Pang J, Zhou XF, Qiu JG, Wen XQ, Yang M, Bai XZ, Zhang H, Ling L, Chen Z. ERG rearrangement for predicting subsequent cancer diagnosis in high-grade prostatic intraepithelial neoplasia and lymph node metastasis. Clin Cancer Res 2012; 18:4163-72. [PMID: 22696228 DOI: 10.1158/1078-0432.ccr-11-2449] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE We aimed to analyze whether ERG rearrangement in biopsies could be used to assess subsequent cancer diagnosis in high-grade prostatic intraepithelial neoplasia (HGPIN) and the risk of lymph node metastasis in early prostate cancer. EXPERIMENTAL DESIGN Samples from 523 patients (361 with early prostate cancer and 162 with HGPIN) were collected prospectively. On the basis of the cutoff value established previously, the 162 patients with HGPIN were stratified to two groups: one with an ERG rearrangements rate ≥1.6% (n = 59) and the other with an ERG rearrangements rate <1.6% (n = 103). For the 361 prostate cancer cases undergoing radical prostatectomy, 143 had pelvic lymph node dissection (node-positive, n = 56 and node-negative, n = 87). All ERG rearrangement FISH data were validated with ERG immunohistochemistry. RESULTS A total of 56 (of 59, 94.9%) HGPIN cases with an ERG rearrangements rate ≥1.6% and 5 (of 103, 4.9%) HGPIN cases with an ERG rearrangements rate <1.6% were diagnosed with prostate cancer during repeat biopsy follow-ups (P < 0.001). There were significant differences in ERG rearrangement rates between lymph node-positive and -negative prostate cancer (P < 0.001). The optimal cutoff value to predict lymph node metastasis by ERG rearrangement was established, being 2.6% with a sensitivity at 80.4% [95% confidence interval (CI), 67.6-89.8] and a specificity at 85.1% (95% CI, 75.8-91.8). ERG protein expression by immunohistochemistry was highly concordant with ERG rearrangement by FISH. CONCLUSIONS The presence of ERG rearrangement in HGPIN lesions detected on initial biopsy warrants repeat biopsies and measuring ERG rearrangement could be used for assessing the risk of lymph node metastasis in early prostate cancer.
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Affiliation(s)
- Xin Gao
- Department of Urology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
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Chung JS, Choi HY, Song HR, Byun SS, Seo SI, Song C, Cho JS, Lee SE, Ahn H, Lee ES, Hwang TK, Kim WJ, Chung MK, Jung TY, Yu HS, Choi YD. Nomogram to predict insignificant prostate cancer at radical prostatectomy in Korean men: a multi-center study. Yonsei Med J 2011; 52:74-80. [PMID: 21155038 PMCID: PMC3017711 DOI: 10.3349/ymj.2011.52.1.74] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE Due to the availability of serum prostate specific antigen (PSA) testing, the detection rate of insignificant prostate cancer (IPC) is increasing. To ensure better treatment decisions, we developed a nomogram to predict the probability of IPC. MATERIALS AND METHODS The study population consisted of 1,471 patients who were treated at multiple institutions by radical prostatectomy without neoadjuvant therapy from 1995 to 2008. We obtained nonrandom samples of n = 1,031 for nomogram development, leaving n = 440 for nomogram validation. IPC was defined as pathologic organ-confined disease and a tumor volume of 0.5 cc or less without Gleason grade 4 or 5. Multivariate logistic regression model (MLRM) coefficients were used to construct a nomogram to predict IPC from five variables, including serum prostate specific antigen, clinical stage, biopsy Gleason score, positive cores ratio and maximum % of tumor in any core. The performance characteristics were internally validated from 200 bootstrap resamples to reduce overfit bias. External validation was also performed in another cohort. RESULTS Overall, 67 (6.5%) patients had a so-called "insignificant" tumor in nomogram development cohort. PSA, clinical stage, biopsy Gleason score, positive core ratio and maximum % of biopsy tumor represented significant predictors of the presence of IPC. The resulting nomogram had excellent discrimination accuracy, with a bootstrapped concordance index of 0.827. CONCLUSION Our current nomogram provides sufficiently accurate information in clinical practice that may be useful to patients and clinicians when various treatment options for screen-detected prostate cancer are considered.
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Affiliation(s)
- Jae Seung Chung
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Han Yong Choi
- Department of Urology, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hae-Ryoung Song
- Department of Biostatistics and Research Affairs, Yonsei University, Seoul, Korea
| | - Seok-Soo Byun
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seong Il Seo
- Department of Urology, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Cheryn Song
- Department of Urology, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Seon Cho
- Department of Urology, Hallym University College of Medicine, Chuncheon, Korea
| | - Sang Eun Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hanjong Ahn
- Department of Urology, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Sik Lee
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Tae-Kon Hwang
- Department of Urology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Wun-Jae Kim
- Department of Urology, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Moon Kee Chung
- Department of Urology, Pusan University School of Medicine, Busan, Korea
| | - Tae Young Jung
- Department of Urology, Seoul Veterans Hospital, Seoul, Korea
| | - Ho Song Yu
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Deuk Choi
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
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Abstract
Around a quarter of those in the developed world die of cancer. Most cancers present to primary care with symptoms, even when there is a screening test for the particular cancer. However, the symptoms of cancer are also symptoms of benign disease, and the GP has to judge whether cancer is a possible explanation. Very little research examined this process until relatively recently. This review paper examines the process of primary care diagnosis, especially the selection of patients for rapid investigation. It concentrates on the four commonest UK cancers: breast, lung, colon, and prostate as these have been the subject of most recent studies.
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Vaccination with agonist peptide PSA: 154-163 (155L) derived from prostate specific antigen induced CD8 T-cell response to the native peptide PSA: 154-163 but failed to induce the reactivity against tumor targets expressing PSA: a phase 2 study in patients with recurrent prostate cancer. J Immunother 2009; 32:655-66. [PMID: 19483644 DOI: 10.1097/cji.0b013e3181a80e0d] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We conducted a clinical trial of peptide prostate specific antigen (PSA): 154-163 (155L) vaccination in human leukocyte antigen (HLA)-A2 patients with detectable and rising serum PSA after radical prostatectomy for prostate cancer (Clinicaltrials.gov identifier NCT00109811). The trial was a single dose-level, phase 2 pilot trial of 1 mg of PSA: 154-163 (155L) emulsified with adjuvant (Montanide ISA-51). The primary endpoint was the determination of immunogenicity of the vaccine; secondary outcomes were determination of toxicity and effect on serum PSA. The vaccine was given subcutaneously 7 times on weeks 0, 2, 4, 6, 10, 14, and 18. Peptide-specific CD8 T-cell responses in the peripheral blood mononuclear cells (PBMC) of patients were measured by interferon (IFN)-gamma enzyme-linked immunosorbent spot assay. CD8 T-cell cultures were also established by in vitro stimulation with the peptide presented by autologous dendritic cells. Five patients were enrolled and completed all vaccinations. No IFN-gamma response to PSA: 154-163 (155L) was detected in unfractioned PBMC in any patient either before or after vaccination. Three of 5 patients demonstrated strong IFN-gamma responses to PSA: 154-163 (155L) and native PSA: 154-163 peptides in CD8 T-cell cultures derived from postvaccination PBMC. However, peptide-specific T cells failed to recognize HLA-A2 positive targets expressing endogenous PSA. There were no significant changes in serum PSA level in any subject. No serious adverse events were observed. PSA: 154-163 (155L) is not an effective immunogen when given with Montanide ISA-51. The PSA: 154-163 peptide is poorly processed from endogenous PSA and therefore represents a cryptic epitope of PSA in HLA-A2 antigen-presenting cells.
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14
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The value of appropriate assessment prior to specialist referral in men with prostatic symptoms. Ir J Med Sci 2009; 178:281-5. [DOI: 10.1007/s11845-009-0337-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Accepted: 03/16/2009] [Indexed: 10/20/2022]
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15
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Baade PD, Youlden DR, Krnjacki LJ. International epidemiology of prostate cancer: Geographical distribution and secular trends. Mol Nutr Food Res 2008; 53:171-84. [DOI: 10.1002/mnfr.200700511] [Citation(s) in RCA: 405] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Chang IH, Byun SS, Hong SK, Lee SE. Assessing the body mass index of patients might help to predict blood loss during radical retropubic prostatectomy in Korean men. BJU Int 2007; 99:570-4. [PMID: 17166243 DOI: 10.1111/j.1464-410x.2006.06637.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine the intraoperative blood loss and patient characteristics in patients treated with radical retropubic prostatectomy (RRP), to determine the independent risk factors that predict increased blood loss and transfusion requirements in Korean men. PATIENTS AND METHODS We retrospectively analysed the records of 264 consecutive patients who had RRP; all medical records were reviewed for various factors before RRP, including prostate volume and body mass index (BMI), and during RRP, e.g. operative duration, estimated blood loss (EBL), calculated blood loss (CBL) and neurovascular bundle preservation. We evaluated differences in clinical characteristics and intraoperative factors in patients categorised by BMI. Multivariate logistic regression analysis was used to establish the relationship between preoperative independent variables and endpoints related to a high CBL. RESULTS The mean EBL was lower than the CBL (387.3 vs 716.9 mL). When the group of men was stratified by BMI, although the difference in mean EBL (P = 0.160) and transfusion rate (P = 0.511) among normal, overweight and obese categories were not statistically significant, the difference in mean CBL (P = 0.011) and operative duration (P = 0.022) was statistically significantly higher in overweight and obese men. Patients who had their neurovascular bundles preserved had no statistically differences in CBL, EBL and operative duration from those with did not. The multivariate logistic regression analysis showed that BMI was the only preoperative variable that predicted a high CBL. CONCLUSIONS The EBL was underestimated by the CBL, and the BMI was the only predictor before RRP of blood loss during RRP in these Korean men.
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Affiliation(s)
- In Ho Chang
- Department of Urology, Seoul National University Bundang Hospital, Gumi-dong, Bundang-gu, Seongnam, Kyunggi-do, Korea 463-707
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Abstract
Hematospermia is an anxiety provoking but otherwise generally benign and self-limited condition that is infrequently associated with significant underlying pathology, and is most often considered to be idiopathic in nature. Management with routine clinical evaluation, watchful waiting, and reassurance generally suffice without further diagnostic workup or treatment. Noninvasive imaging may play an important role in the diagnostic workup of men with hematospermia, particularly in those who are >40 years old, have other associated symptoms or signs of disease, or have persistence of hematospermia. Many entities may be encountered in association with hematospermia at imaging, and specific therapeutic interventions may be used if certain treatable underlying pathologies are coincidentally detected. In this comprehensive review, we discuss the potential etiologies, diagnostic workup, imaging techniques, relevant male pelvic anatomy, imaging appearance of specific associated pathologies, and treatment for hematospermia.
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Affiliation(s)
- D A Torigian
- Department of Radiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA.
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Heesakkers RAM, Fütterer JJ, Hövels AM, van den Bosch HCM, Scheenen TWJ, Hoogeveen YL, Barentsz JO. Prostate cancer evaluated with ferumoxtran-10-enhanced T2*-weighted MR Imaging at 1.5 and 3.0 T: early experience. Radiology 2006; 239:481-7. [PMID: 16641354 DOI: 10.1148/radiol.2392050411] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To prospectively evaluate the feasibility of ferumoxtran-10-enhanced magnetic resonance (MR) imaging at high magnetic field strength (3.0 T) and to compare image quality between 1.5- and 3.0-T MR imaging in terms of lymph node detection in patients with prostate cancer. MATERIALS AND METHODS This study was institutional review board approved, and all patients gave written informed consent. Forty-eight consecutive patients aged 51-79 years (mean, 65.5 years) with prostate cancer were enrolled. T2*-weighted 1.5- and 3.0-T MR images of the pelvis were acquired in a sagittal plane parallel to the psoas muscle 24 hours after ferumoxtran-10 administration. A pelvic and body phased-array coil was used and yielded an in-plane resolution of 0.56 x 0.56 x 3.00 mm at 1.5 T and 0.50 x 0.50 x 2.50 mm at 3.0 T. All images were evaluated by three readers for total image quality, lymph node border delineation, muscle-fat contrast, and vessel-fat contrast. Statistical significance was calculated by using the Mann-Whitney U test. Subsequently, the general linear mixed model was used to estimate the contributions of three factors-patient, reader, and technique-to the variability of the imaging results. RESULTS Significantly (P < .05) better muscle-fat contrast, vessel-fat contrast, lymph node border delineation, and total image quality were observed at 3.0-T MR imaging. The general linear mixed model revealed that the variability of all results could be attributed to the use of 3.0-T imaging. CONCLUSION Ferumoxtran-10-enhanced MR imaging can be performed at high magnetic field strengths and result in improved image quality, which may lead to improved detection of small positive lymph nodes.
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Affiliation(s)
- Roel A M Heesakkers
- Department of Radiology and Medical Technology Assessment, University Medical Center Nijmegen, Geert Grooteplein zuid 10, NL 6500 HB, Nijmegen, The Netherlands.
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19
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Vickers A. Interpreting data from randomized trials: the Scandinavian prostatectomy study illustrates two common errors. ACTA ACUST UNITED AC 2006; 2:404-5. [PMID: 16474658 DOI: 10.1038/ncpuro0294] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2005] [Accepted: 06/28/2005] [Indexed: 11/08/2022]
Affiliation(s)
- Andrew Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
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20
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Perrin P. [Screening for prostate cancer: arguments "against"]. ANNALES D'UROLOGIE 2006; 40:101-5. [PMID: 16709008 DOI: 10.1016/j.anuro.2006.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Prostate cancer screening is controversial since PSA assay has been made available. Screening supporters consider that early diagnosis allows better and less aggressive treatment. These arguments lie on longitudinal cohort studies without controls. Randomized studies are required to assess the correlation between screening and mortality lowering. Two studies are being performed and their results will be available within three or four years. Consequently, the validity of screening is unknown. Nevertheless, the analysis of various parameters demonstrates that the reduction of cancer mortality related to screening is low. According to these data and as recommended by health institutions prostate cancer screening is not required. At the present time, detection asked by the patient himself remains the good attitude between negligence and excessive attitude.
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Affiliation(s)
- P Perrin
- Centre Hospitalier Lyon Sud, Chemin Grand Revoyet, 69495 Pierre-Bénite, France.
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21
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Srigley JR. Key issues in handling and reporting radical prostatectomy specimens. Arch Pathol Lab Med 2006; 130:303-17. [PMID: 16519557 DOI: 10.5858/2006-130-303-kiihar] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Patients with prostatic adenocarcinoma commonly undergo radical prostatectomy, and it is often difficult and time consuming to handle the resulting specimens and to report the findings. Pathologic information derived from the radical prostatectomy specimen is used for selecting adjuvant therapy, such as radiotherapy and hormone therapy, and for determining a patient's prognosis. The prostate specimen must be handled in a systematic fashion to derive the appropriate prognostic parameters. OBJECTIVE To review the prognostic factors of relevance in classifying radical prostatectomy specimens, using the College of American Pathologists categorization system, including a detailed survey of the morphologic-based factors but excluding other factors such as DNA ploidy and novel phenotypic and genotypic markers. CONCLUSIONS Gleason score, pathologic stage, and margin status are considered category 1 prognostic factors, which are of proven prognostic significance and are useful in patient management. Factors such as tumor volume (intraglandular extent) and tumor subtype are considered category 2 prognostic factors, which show significant promise but require validation in multivariate analysis. Lymphovascular space invasion is a promising category 3 prognostic factor that needs additional study. Perineural invasion is an almost ubiquitous finding in radical prostatectomy specimens and is considered a category 3 prognostic factor. After prognostic factors have been analyzed at the histologic level, it is critical to report the findings in a clear and unambiguous fashion. The synoptic style of reporting is ideal for describing complex cancer resection specimens. A synoptic report based on an evidence-based checklist, such as the one developed by the College of American Pathologists, effectively communicates complex cancer-related data, such as radical prostatectomy specimen findings. This information is used not only for individual case management with respect to treatment and prognostication but also for purposes such as education, research, quality monitoring, and system planning.
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Affiliation(s)
- John R Srigley
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.
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22
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Barrett J, Hamilton W. Pathways to the diagnosis of prostate cancer in a British city. A population-based study. ACTA ACUST UNITED AC 2006; 39:267-70. [PMID: 16118101 DOI: 10.1080/00365590510031282] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To identify the pathways leading to the diagnosis of prostate cancer from a UK population perspective, including the role of prostate-specific antigen (PSA) testing. MATERIAL AND METHODS We studied all 217 prostate cancers occurring in the region covered by Exeter Primary Care Trust, Devon, UK (population 128 700) between 1998 and 2002. The general practitioner's records for 2 years before diagnosis were used to identify the category of pathway to diagnosis. RESULTS Symptomatic presentation to primary care initiated the diagnostic process in 166/217 men (76%). The presenting symptoms were lower urinary tract symptoms (LUTS) in 151 men (70%), systemic symptoms and no LUTS in 12 (6%) and bowel symptoms with a rectal examination revealing an abnormal prostate in 3 (1%). Eighteen cases (8%) were diagnosed as a result of PSA screening in asymptomatic men. Diagnosis as an inpatient accounted for 33 cases (15%), 25 of whom (11%) had been admitted with urological problems, and 4% of cases had been admitted for non-urological problems. Of the 151 men who presented with LUTS, 91 (60%) had a PSA test in primary care, 15 (10%) had one in secondary care and 39 (17%) had a prostatectomy that revealed a cancer that had not previously been suspected. Most prostate cancers were diagnosed after presentation to primary care with LUTS. Presentation with disseminated disease was rare. CONCLUSION Screening by means of PSA testing remains uncommon in this area of the UK, in contrast to the situation in other countries. Most PSA tests performed in patients with prostate cancer were diagnostic rather than screening tests.
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Schostak M, Matischak K, Schäfer M, Müller M, Schrader M, Christoph F, Miller K. [New concept minimizes bleeding in radical retropubic prostatectomy]. Urologe A 2005; 44:1332-6. [PMID: 16096742 DOI: 10.1007/s00120-005-0888-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Radical retropubic prostatectomy is an intervention known to be associated with severe bleeding. Even experienced surgeons report a blood transfusion rate of up to 20%. The perioperative concept for this intervention underwent various modifications in January 2001. This study describes the effect of these modifications on the blood loss in a retrospective analysis comparing approximately 100 operations by a single experienced surgeon before the change (group 1) with 100 operations thereafter (group 2). MATERIALS AND METHODS The new perioperative concept comprised the following points: reducing the intravenously applied volume, employing a peridural catheter (PDC), and maintaining a 25-30 degrees Trendelenburg's position. The difference in pre- and postsurgical hemoglobin (Hb) was analyzed before (group 1) and after the intervention (group 2). If transfusions were performed, this value was corrected according to the following formula: 1 ml of erythrocyte concentrate increases the patient's Hb by 0.003 g/dl. RESULTS Assessment was possible in 201 of 234 cases, 110 from the first and 91 from the second group. The mean transfusion-corrected Hb difference was 5.3 g/dl in group 1 (20% transfusion rate) and 3.52 g/dl in group 2 (1.09% transfusion rate); p>0.0001. The median intravenous volume applied was 5.960 ml in group 1 and 3.490 ml in group 2 (p>0.0001). The complication rate did not differ between groups. CONCLUSION The new perioperative concept minimizes the intraoperative blood loss during radical open retropubic prostatectomy. Transfusions are only necessary in rare cases. The complication rate remains unaltered.
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Affiliation(s)
- M Schostak
- Urologische Klinik und Poliklinik, Charité -- Campus Benjamin Franklin, Universitätsmedizin, Berlin.
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24
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Schostak M, Matischak K, Müller M, Schäfer M, Schrader M, Christoph F, Miller K. New perioperative management reduces bleeding in radical retropubic prostatectomy. BJU Int 2005; 96:316-9. [PMID: 16042721 DOI: 10.1111/j.1464-410x.2005.05622.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the effect of modifications to radical retropubic prostatectomy (RRP, known to be associated with severe bleeding) on blood loss in a retrospective analysis comparing RRPs by one experienced surgeon before and after the changes. PATIENTS AND METHODS The new method comprised reducing the intravenously applied volume, using a peridural catheter and maintaining a 25-30 degrees Trendelenburg position. The difference in haemoglobin before and after RRP was analysed before the changes (group 1) and after (group 2). If transfusions were required the haemoglobin value was corrected, whereby 1 mL of erythrocyte concentrate increased the patient's haemoglobin by 0.03 g/L. RESULTS Assessment was possible in 201 of 234 patients, 110 from group 1 and 91 from group 2. The mean transfusion-corrected difference in haemoglobin was 53 g/L in group 1 (20% transfusion rate) and 35.2 g/L in group 2 (1.09% transfusion rate; P > 0.001). The median intravenous volume applied was 5.96 L in group 1 and 3.49 L in group 2 (P < 0.001). The complication rate did not differ between the groups. CONCLUSION This new method minimizes the intraoperative blood loss during RRP; transfusions are only necessary in rare cases and the complication rate remained unaltered.
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Affiliation(s)
- Martin Schostak
- Department of Urology, Charité-Campus Benjamin Franklin, Universitätsmedizin Berlin, Germany.
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25
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Abstract
Few areas in modern medicine provide a better example of evidence-based data than the anatomic pathologists' classification of fully developed malignancies. Beginning with the Papanicolaou (Pap) smear, morphologic tools also were applied to specimens obtained in cancer screening programs directed at large, asymptomatic patient populations. The Papanicolaou test was quickly responsible for a reduction in the incidence of invasive squamous cell carcinoma of the cervix, proving the concept that screening could interdict the development of advanced malignancy. Other screening programs followed the Papanicolaou test initiative, producing a revolutionary change in the specimens submitted to pathologists. Cancer screening generates specimens containing morphologic deviations from normal that are thought to put currently healthy patients at risk of future malignancy. However, translating morphologic findings in such samples into risk estimates raises a number of statistical and ethical problems. When diagnostic thresholds are set to favor specificity, unwanted false-negative results accrue. Conversely, aiming at sensitivity over specificity is associated with biologically false-positive results, which are likewise undesirable. Pathologists interpreting these specimens find themselves facing a screening paradox. These screening programs attempt to discover the very earliest changes of neoplastic transformation, but these same earliest changes are inherently the most difficult to identify with precision and accuracy. This paper discusses these challenges.
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Abstract
There is a growing interest, as well as a booming industry, in the use of testosterone therapy for middle-aged and older men. This interest has led to the definition of a new condition, termed 'andropause', meaning the putative somatic consequences of gradually falling blood testosterone concentrations during male aging. This trend risks replicating both the rejuvenation fads of a century ago and the recent experience in estrogen therapy for menopause that has been propelled for decades by advocacy substituting for reliable scientific evidence. The current status and prospects for androgen therapy in middle-aged and older men should be evaluated critically from the perspective of male reproductive health during aging. This review appraises current knowledge with a focus on the questionable basis for using androgen therapy to improve male reproductive health during aging.
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Affiliation(s)
- David J Handelsman
- Department of Andrology, Concord Hospital, ANZAC Research Institute, University of Sydney, Sydney, NSW 2139, Australia.
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27
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Coory MD, Baade PD. Urban–rural differences in prostate cancer mortality, radical prostatectomy and prostate‐specific antigen testing in Australia. Med J Aust 2005; 182:112-5. [PMID: 15698354 DOI: 10.5694/j.1326-5377.2005.tb06609.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2004] [Accepted: 12/14/2004] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess differences in trends for prostate cancer mortality, radical prostatectomy and prostate-specific antigen (PSA) testing for Australian men aged 50-79 years living in capital cities compared with regional and rural areas. DESIGN Descriptive, population-based study based on data from official sources from 1985 to the 2002/03 financial year (depending on data availability). MAIN OUTCOME MEASURES Age-standardised rates per 100,000 men aged 50-79 years of mortality from prostate cancer, incidence of prostate cancer, PSA tests and radical prostatectomy. RESULTS We found a statistically significant and increasing (age-standardised) mortality excess for prostate cancer in regional and rural areas. In 2000-2002 the excess (compared with capital cities) was 21% (95% CI, 14%-29%). Rates of radical prostatectomy in rural and regional Australia were 29% lower (95% CI, 23% lower to 35% lower) than in capital cities. Although PSA testing is common across the whole of Australia, age-standardised rates in 2002/03 were 16% lower (95% CI, 15% lower to 17% lower) in regional and rural areas than in capital cities. CONCLUSIONS Our results show that the probability of a man having a PSA test and the management of his prostate cancer depend on where he lives. The cause or causes of the prostate cancer mortality excess in regional/rural areas cannot be established in a descriptive study, but fewer radical prostatectomies in regional and rural areas, perhaps associated with less PSA screening, remain among the several competing hypotheses. Other possibilities are related to other differences in management, perhaps associated with access to urologists. Governments and other budget holders need good evidence about the effectiveness of prostate cancer screening and early treatment, but also about the best strategies for providing equitable access to cancer services in both urban and rural areas.
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Affiliation(s)
- Michael D Coory
- Health Information Centre, Queensland Health, Brisbane, QLD.
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29
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Affiliation(s)
- M Dror Michaelson
- Department of Hematology/Oncology, Massachusetts General Hospital, Boston 02114, USA.
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30
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Bott SRJ, Birtle AJ, Taylor CJ, Kirby RS. Prostate cancer management: (1) an update on localised disease. Postgrad Med J 2004; 79:575-80. [PMID: 14612600 PMCID: PMC1742848 DOI: 10.1136/pmj.79.936.575] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Prostate cancer is receiving ever more publicity with the result that more men are having their prostate specific antigen checked and a greater proportion of men are diagnosed with potentially curable localised disease. Advances in the therapeutic modalities including radical surgery, external beam radiotherapy, and brachytherapy have reduced the incidence of side effects and now offer patients a choice of treatments depending on their tumour characteristics, age, and co-morbidity. A significant proportion of men do not need intervention and may be safely kept under a "watch and wait" policy. The use of genetic markers may in the future distinguish between patients most likely to benefit from radical therapy and those in who either palliation or observation is more appropriate. This review examines the potentially curative options, as well as expectant management, outlining the pros and cons of each. The use of adjuvant and neoadjuvant therapy is also discussed.
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Affiliation(s)
- S R J Bott
- Institute of Urology, London. St George's Hospital, London, UK.
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31
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Fontana D, Destefanis P, Rosso R, Timpano M, Bisconti A, Fiori C. Early Prostate Cancer: Watchful Waiting. Urologia 2004. [DOI: 10.1177/039156030407100110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Prostate cancer is, today, the most frequent cancer and the second most frequent cause of death for cancer in USA. The watchful waiting approach, that has been traditionally proposed by urological communities in Northern Europe, is still matter of debate. The following review will consider the clinical studies published in Literature and will discuss the most controversial issues.
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Affiliation(s)
- D. Fontana
- Divisione Universitaria di Urologia II, Cattedra di Urologia, Dipartimento di Discipline Medico-Chirurgiche, Università degli Studi di Torino, Ospedale San Giovanni Battista (Molinette), Torino
| | - P. Destefanis
- Divisione Universitaria di Urologia II, Cattedra di Urologia, Dipartimento di Discipline Medico-Chirurgiche, Università degli Studi di Torino, Ospedale San Giovanni Battista (Molinette), Torino
| | - R. Rosso
- Divisione Universitaria di Urologia II, Cattedra di Urologia, Dipartimento di Discipline Medico-Chirurgiche, Università degli Studi di Torino, Ospedale San Giovanni Battista (Molinette), Torino
| | - M. Timpano
- Divisione Universitaria di Urologia II, Cattedra di Urologia, Dipartimento di Discipline Medico-Chirurgiche, Università degli Studi di Torino, Ospedale San Giovanni Battista (Molinette), Torino
| | - A. Bisconti
- Divisione Universitaria di Urologia II, Cattedra di Urologia, Dipartimento di Discipline Medico-Chirurgiche, Università degli Studi di Torino, Ospedale San Giovanni Battista (Molinette), Torino
| | - C. Fiori
- Divisione Universitaria di Urologia II, Cattedra di Urologia, Dipartimento di Discipline Medico-Chirurgiche, Università degli Studi di Torino, Ospedale San Giovanni Battista (Molinette), Torino
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Zhang Y, Glass A, Bennett N, Oyama KA, Gehan E, Gelmann EP. Long-term outcomes after radical prostatectomy performed in a community-based health maintenance organization. Cancer 2004; 100:300-7. [PMID: 14716764 DOI: 10.1002/cncr.11886] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Radical prostatectomy is used widely for the treatment of patients with localized prostate carcinoma. No long-term analysis has been reported on a series of radical prostatectomies performed in a community-based health maintenance organization. METHODS Charts and histologic slides were reviewed from 750 patients who underwent radical prostatectomy between 1970 and 1996 at a community-based health maintenance organization. The influences of a number of variables were analyzed for their impact on progression free survival (PFS) and overall survival (OS). RESULTS With a median follow-up of 6.2 years among survivors, 137 patients (18%) had progressive disease, and 149 patients (20%) died from all causes. The median OS from the date of diagnosis was 15.7 years (95% confidence interval, 13.6-17.2), similar to the expected median survival of 16.2 years. The median PFS from diagnosis was not reached, but 75% of patients were progression free > or = 10.6 years after undergoing prostatectomy. The prognostic factors included Gleason score, age at diagnosis, and T stage. Outcomes were comparable with reports of surgical series from university-based practices. CONCLUSIONS The patient characteristics that had important, favorable correlation with survival included Gleason score < or = 6, T1 or T2 tumor status, and younger age at diagnosis. Lower prostate-specific antigen values at diagnosis, together with the former two parameters, also had a favorable correlation with PFS. Radical prostatectomy in a community-based health maintenance organization was followed by long-term PFS and OS comparable to outcomes reported from university-based practices. The impact of radical prostatectomy on survival remains to be demonstrated.
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Affiliation(s)
- Ying Zhang
- Department of Oncology, Lombardi Cancer Center, Georgetown University, 3800 Reservoir Road NW, Washington, DC 20007, USA
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33
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Limitaciones en la prevención del cáncer de próstata. Semergen 2004. [DOI: 10.1016/s1138-3593(04)74353-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Luo J, Isaacs WB, Trent JM, Duggan DJ. Looking Beyond Morphology: Cancer Gene Expression Profiling Using DNA Microarrays. Cancer Invest 2003; 21:937-49. [PMID: 14735697 DOI: 10.1081/cnv-120025096] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Although molecular testing has been increasingly used in clinical practice, the precise diagnosis and prognosis of most human cancers still heavily rely on descriptive histopathological data. Identification of robust molecular markers associated with distinctive morphological parameters will assist in diagnostic and prognostic assessment. On the other hand, the diversity of morphologically identical/similar cancers can be manifested at multiple levels, most importantly at the level of clinical outcome. In the past several years, DNA microarray technology has been widely used in the context of cancer research, resulting in a deluge of new information that can be used to identify molecular alterations common to all tumors as well as signatory profiles unique to a subcategory of cancers. These new findings will very likely transform the clinical management of cancer patients in the near term. This article reviews recent advances in cancer gene expression-profiling results derived from the application of DNA microarray technology, with an emphasis on studies performed on human prostate cancer specimens. We discuss broad issues relevant to cancer expression profiling and attempt to illustrate the rapid pace of novel discoveries using prostate cancer as examples wherever appropriate.
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Affiliation(s)
- Jun Luo
- Brady Urological Institute, Johns Hopkins University, Baltimore, Maryland, USA.
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35
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Affiliation(s)
- Gerald H Jordan
- Department of Urology, Eastern Virginia Medical School, VA, Norfolk 23510, USA
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36
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Sorum PC, Shim J, Chasseigne G, Bonnin-Scaon S, Cogneau J, Mullet E. Why do primary care physicians in the United States and France order prostate-specific antigen tests for asymptomatic patients? Med Decis Making 2003; 23:301-13. [PMID: 12926580 DOI: 10.1177/0272989x03256010] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To understand why many primary care physicians in the United States and France order prostate-specific antigen (PSA) tests routinely for their asymptomatic male patients despite "evidence-based" recommendations. METHODS Thirty-two U.S. general internists and family practitioners and 33 French generalists judged, for 32 hypothetical male patients seen for routine preventive care, the probability that the patients had asymptomatic prostate cancer and the likelihood that they would order PSA tests. They were also asked about beliefs, attitudes, and knowledge related to prostate cancer. RESULTS The significant predictors of ordering more PSA tests in the scenarios were physicians' higher ratings of regret if untested patients were found to have advanced cancer, their greater discomfort if they suspected that patients had illnesses but could not know for sure, and their perceptions of official recommendations as favoring routine testing. IMPLICATIONS Nonrational factors can impede physicians' adoption of "evidence-based" recommendations.
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Affiliation(s)
- Paul Clay Sorum
- Department of Medicine, Albany Medical Center, Albany, NY, USA.
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Harisinghani MG, Barentsz J, Hahn PF, Deserno WM, Tabatabaei S, van de Kaa CH, de la Rosette J, Weissleder R. Noninvasive detection of clinically occult lymph-node metastases in prostate cancer. N Engl J Med 2003; 348:2491-9. [PMID: 12815134 DOI: 10.1056/nejmoa022749] [Citation(s) in RCA: 1318] [Impact Index Per Article: 62.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Accurate detection of lymph-node metastases in prostate cancer is an essential component of the approach to treatment. We investigated whether highly lymphotropic superparamagnetic nanoparticles, which gain access to lymph nodes by means of interstitial-lymphatic fluid transport, could be used in conjunction with high-resolution magnetic resonance imaging (MRI) to reveal small nodal metastases. METHODS Eighty patients with presurgical clinical stage T1, T2, or T3 prostate cancer who underwent surgical lymph-node resection or biopsy were enrolled. All patients were examined by MRI before and 24 hours after the intravenous administration of lymphotropic superparamagnetic nanoparticles (2.6 mg of iron per kilogram of body weight). The imaging results were correlated with histopathological findings. RESULTS Of the 334 lymph nodes that underwent resection or biopsy, 63 (18.9 percent) from 33 patients (41 percent) had histopathologically detected metastases. Of these 63 nodes, 45 (71.4 percent) did not fulfill the usual imaging criteria for malignancy. MRI with lymphotropic superparamagnetic nanoparticles correctly identified all patients with nodal metastases, and a node-by-node analysis had a significantly higher sensitivity than conventional MRI (90.5 percent vs. 35.4 percent, P<0.001) or nomograms. CONCLUSIONS High-resolution MRI with magnetic nanoparticles allows the detection of small and otherwise undetectable lymph-node metastases in patients with prostate cancer.
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Talcott JA. Quality of care in prostate cancer: important to start and too important to stop here. J Clin Oncol 2003; 21:1902-3. [PMID: 12743141 DOI: 10.1200/jco.2003.03.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Augustin H, Hammerer PG, Graefen M, Erbersdobler A, Blonski J, Palisaar J, Daghofer F, Huland H. Insignificant prostate cancer in radical prostatectomy specimen: time trends and preoperative prediction. Eur Urol 2003; 43:455-60. [PMID: 12705986 DOI: 10.1016/s0302-2838(03)00139-8] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES We analysed systematically a consecutive series of radical prostatectomy specimens performed between January 1992 and June 2002 with emphasis to time trends, tumour characteristics and preoperative prediction of insignificant prostate cancers (cancer volume < or =0.5 cm(3) and Gleason pattern < or =6). METHODS In a total of 1254 patients, prostate cancers (PC) were divided by a cancer volume of 0.5 cm(3). The two groups were compared in their clinical and pathological tumour characteristics. Correlation was determined between yearly incidence rates of T1c and insignificant PC. Furthermore, a logistic regression analysis was performed to calculate the ability to predict insignificant PC and a statistical model was established. RESULTS Overall, 73 (5.8%) of 1254 men presented with insignificant PC. The incidence of insignificant PC showed no significant linear correlation with that of T1c PC (p<0.61). PSA density and percentage of cancer per biopsy set were assessed as independent prognosticators predicting insignificant PC. Using a threshold of 1% of cancer per biopsy set and a PSA density < or =0.10, positive and negative predictive values were 45.0% and 93.3%, respectively. CONCLUSION In our series, only few men undergoing radical prostatectomy were affected by insignificant PC. Their incidence showed no statistically significant correlation with that of T1c tumours. Furthermore, insignificant PC was predictable by PSA density and percentage of cancer per biopsy set. Mainly elderly patients facing different treatment options for localized PC may benefit from this information.
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Affiliation(s)
- Herbert Augustin
- Department of Urology, University Hospital Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany
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40
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Abstract
Given that no therapy for localized prostate cancer has been proven superior to any other in well-designed clinical trials, the patient and physician may be influenced toward a particular therapy by a number of nonmedical factors. These factors can be logistic, socioeconomic, or related to the patient's perception of the disease and expectations concerning the disease. These factors, along with the absence of a clearly superior therapy, account, at least in part, for the tremendous variance in patterns of care by age, geography, race and education.
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Affiliation(s)
- Otis W Brawley
- Winship Cancer Institute, Emory University School of Medicine, 1365 Clifton Road, NE, Suite B4100, Atlanta, GA 30322, USA.
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41
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Abstract
Epidemiologically, screening is justified by the importance of the disease and the lack of prospects for primary prevention, but evidence from natural history is unhelpful since men are more likely to die with, rather than from, prostate cancer. The available screening tests do not always detect men whose lesions could result in future morbidity or mortality. Evidence is limited for the benefits of treatment for localised cancers detected through screening, whereas the evidence for harm is clear. Observational evidence for the effect of population screening programmes is mixed, with no clear association between intensity of screening and reduced prostate cancer mortality. Screening for prostate cancer cannot be justified in low-risk populations, but the balance of benefit and harm will be more favourable after risk stratification. Prostate cancer screening can be justified only in research programmes designed to assess its effectiveness and help identify the groups who may benefit.
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43
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Sroka R, Zaak D, Höppner M, Muschter R, Knüchel R, Perlmutter A, Hofstetter A. In-vivo Investigations of Photodynamic Therapy by Means of 5-ALA Induced PPIX on Canine Prostates. ACTA ACUST UNITED AC 2003. [DOI: 10.1078/1615-1615-00091] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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44
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Albertsen PC. The conundrum of prostate cancer. Cancer J 2002; 8:432-4. [PMID: 12500849 DOI: 10.1097/00130404-200211000-00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Peter C Albertsen
- University of Connecticut Health Center, 263 Farmington Avenue, Farmington, Connecticut 06030-3955, USA
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