National Cancer Institute®
Last Modified: May 1, 2002
UI - 10737471
AU - Critz FA; Williams WH; Benton JB; Levinson AK; Holladay CT; Holladay DA
TI - Prostate specific antigen bounce after radioactive seed implantation followed by external beam radiation for prostate cancer.
SO - J Urol 2000 Apr;163(4):1085-9
AD - Radiotherapy Clinics of Georgia and Georgia Urology, Decatar, USA.
PURPOSE: Prostate specific antigen (PSA) may temporarily increase following radiotherapy for prostate cancer without signaling cancer recurrence. We describe this phenomenon which is called PSA bounce. MATERIALS AND METHODS: From 1984 to 1995, 779 stage T1T2N0 cancer cases were treated with simultaneous radiotherapy with a 125iodine prostate implant followed by external beam radiation. Median pretreatment PSA was 7.7 ng./ml. (range 0.3 to 188). PSA bounce was defined as an increase of 0.1 ng./ml. or greater above the preceding PSA level after simultaneous radiation followed by a subsequent decrease below that level. Disease-free status was defined as the ability to achieve and maintain posttreatment PSA 0.2 ng./ml. or less. RESULTS: PSA bounce was observed in 35% of men (273 of 779). Median time to PSA bounce was 18 months from the time of implant and 92% of bounces were observed within 36 months. Median pre-bounce PSA was 0.7 ng/ml. (range 0.1 to 8.9) and median bounce height (increase above the pre-bounce level) was 0.4 ng./ml. (range 0.1 to 15.8). No distinguishing characteristics were observed between men with PSA bounce and those with cancer recurrence, and bounce had no prognostic significance relative to recurrence. CONCLUSIONS: PSA bounce is common following seed implantation for prostate cancer. It produces anxiety in men previously treated for prostate cancer and confounds the diagnosis of recurrence.
UI - 11061918
AU - Frankel G
TI - Re: Radical prostatectomy for localized prostate cancer provides durable cancer control with excellent quality of life: a structured debate.
SO - J Urol 2000 Dec;164(6):2030-1
UI - 11764662
AU - von Knobloch R; Wille S; Hofmann R
TI - Clinical side effects after radical prostatectomy.
SO - Front Radiat Ther Oncol 2002;37():191-5
AD - Department of Urology, Philipps University Medical School, Marburg, Germany. email@example.com
UI - 11764663
AU - Nutting CM; Dearnaley DP
TI - Prostate cancer--the Royal Marsden conformal experience.
SO - Front Radiat Ther Oncol 2002;37():196-9
AD - Academic Unit of Radiotherapy and Oncology, Institute of Cancer Research, Royal Marsden NHS Trust, Sutton, UK. firstname.lastname@example.org
UI - 11173142
AU - Teh BS; Mai WY; Augspurger ME; Uhl BM; McGary J; Dong L; Grant WH 3rd;
TI - Lu HH; Woo SY; Carpenter LS; Chiu JK; Butler EB Intensity modulated radiation therapy (IMRT) following prostatectomy: more favorable acute genitourinary toxicity profile compared to primary IMRT for prostate cancer.
SO - Int J Radiat Oncol Biol Phys 2001 Feb 1;49(2):465-72
AD - Department of Radiology/Radiation Oncology, Baylor College of Medicine and The Methodist Hospital, Houston, Texas, USA. email@example.com
PURPOSE: To report our initial experience on postprostatectomy IMRT (PPI), addressing acute genitourinary (GU) toxicity in comparison to primary IMRT (PI) for prostate cancer. METHODS AND MATERIALS: From April intensity modulated radiation therapy (IMRT) to a median prescribed dose of 64 Gy (mean dose of 69 Gy). The Radiation Therapy Oncology Group (RTOG) scoring system was used to assess acute GU toxicity. Target volume and maximum and mean doses were evaluated. The mean doses to the bladder and irradiated bladder volume receiving >65 Gy were assessed. These were compared to those of 125 patients treated with PI to a prescribed dose of 70 Gy (mean dose of 76 Gy). RESULTS: The acute GU toxicity profile is more favorable in the PPI group with 82.5% of Grade 0-1 and 17.5% of Grade 2 toxicity compared to 59.2% and 40.8%, respectively, in the PI group (p < 0.001). There was no Grade 3 or higher toxicity in either group. The target volume was larger in the PPI group, while the maximum and mean doses to the target were higher in the PI group. The mean dose delivered to the bladder was higher in the PPI group. The irradiated bladder volume receiving >65 Gy was significantly larger in the PI group (p < 0.001). CONCLUSIONS: PPI can be delivered with acceptable ute GU toxicity. The larger PPI target volume may be related to the difficulty in delineating prostatic fossa. Despite a larger target volume and a higher mean dose to the bladder, PPI produced a more favorable acute GU toxicity profile. This may be related to a combination of lower mean and maximum doses and smaller bladder volumes receiving >65 Gy in the PPI group, as well as urethral rather than bladder irradiation. The findings have implications in the evaluation of IMRT treatment plan for prostate cancer, whereby the irradiated bladder volumes above 65 Gy may be more meaningful than the mean dose to the bladder. Longer term toxicity results are awaited.
UI - 11867200
AU - Jackson KM; DeLeon M; Verret CR; Harris WB
TI - Dibenzoylmethane induces cell cycle deregulation in human prostate cancer cells.
SO - Cancer Lett 2002 Apr 25;178(2):161-5
AD - Winship Cancer Institute, Emory University School of Medicine, 1365-B Clifton Road, NE Rm. # 5204, Atlanta, GA 30322, USA.
Dibenzoylmethane (DBM), a minor beta-diketone constituent of licorice and sunscreens, has been shown to exhibit anti-neoplastic effects in chemically induced skin and mammary cancers in several animal models. To date, no mechanism for the growth inhibitory effects of DBM on prostate cancer cells has been proposed. In this study, we examined the effects of DBM on the growth and cell cycle kinetics of several human prostate carcinoma cell lines. Using an MTT cytotoxicity assay, IC50 values of 25-100 microM were observed following 72 h exposure to DBM. LNCaP, DU145, and PC-3 prostate carcinoma cell lines were particularly sensitive in comparison to the cells with the vehicle alone. Flow cytometric analyses showed deregulation of the cell cycle, which correlated with the observed cytostatic effects of DBM in prostate carcinoma cells. These data suggest a potential role for DBM in the prevention and treatment of prostate cancer.
UI - 11588893
AU - Neuhouser ML; Kristal AR; Patterson RE; Goodman PJ; Thompson IM
TI - Dietary supplement use in the Prostate Cancer Prevention Trial: implications for prevention trials.
SO - Nutr Cancer 2001;39(1):12-8
AD - Cancer Prevention Research Program, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA. firstname.lastname@example.org
Nutrients included in commonly used dietary supplements, such as vitamins C and E, may affect cancer risk. To better understand how supplement use may affect the interpretation of cancer prevention trials, we examined dietary supplement use among participants in the Prostate Cancer Prevention Trial, a double-blind, placebo-controlled trial of the drug finasteride (Proscar) for the primary prevention of prostate cancer. Of 15,387 men who completed food frequency questionnaires and dietary supplement questionnaires, 44.3% used a multivitamin, 35% used single supplements of vitamin C or E, and 10-15% used antioxidant mixtures or single supplements of vitamins A and D, zinc, or beta-carotene at least three times per week. The strongest correlates of supplement use were higher education and lower body mass index (p < 0.001), and whites and Asians were more likely to use multivitamins and single supplements of vitamins C and E than were blacks and Hispanics. Supplement users obtained 87% of their total daily vitamin E intake, 61-64% of vitamins A, C, and D, and about half of beta-carotene, folate, and zinc from supplements. Because supplements, especially antioxidants, may confer independent cancer-preventive effects, analytic models of study findings should include exposure measurement of dietary supplements with appropriate tests for interaction. Our results can be generalized to similar chemoprevention trials.
UI - 11880864
AU - Lissoni P; Malugani F; Casu M; Bukovec R; Egardi R; Bordin V; Fumagalli
TI - E; Mengo S; Gardani G Effect of bicalutamide therapy on prolactin response to L-dopa in metastatic prostate cancer patients.
SO - Neuroendocrinol Lett 2002 Feb;23(1):61-3
AD - U.O. di Oncologia Medica e Radioterapia, Ospedale San Gerardo dei Tintori, 20052 Monza (MI), Italy.
OBJECTIVES: The secretion of prolactin (PRL), which is a growth factor for prostate cancer cell proliferation, has been proven to present profound alterations in advanced prostate cancer patients, consisting of abnormally elevated baseline levels and paradoxical response to L-dopa. Moreover, the efficacy of standard therapies for prostate cancer may be mediated at least in part by changes in PRL secretion. The present study was carried out to analyze the effects of the new antiandrogen agent bicalutamide on basal levels of PRL and on its response to L-dopa in metastatic prostate cancer patients. MATERIAL & METHODS: The study included 10 metastatic prostate cancer patients. They were treated with bicalutamide at a dose of 50 mg/day orally. They were investigated with L-dopa test before therapy and after one month of treatment. L-dopa was given orally at 500 mg, by collecting blood samples before and at 60, 120 and 180 minutes after L-dopa administration. Serum levels of PRL were measured by the RIA method. RESULTS: Abnormally basal levels of PRL were seen in 4/10 (40%) patients. Mean PRL basal levels decreased after bicalutamide therapy, without, however, significant differences. Before therapy, a paradoxical increase in PRL levels after L-dopa occurred in 4 patients, 3 of them showed basal concentrations of PRL within the normal range. Moreover, bicalutamide therapy significantly reduced PRL increase in response to L-dopa. CONCLUSIONS: This study would suggest that the measurement of the only basal levels is not sufficient to define as normal the secretion of PRL in advanced prostate cancer, because of the possible existence of altered response to the dynamic tests for PRL secretion. Moreover, the study shows that the antitumor therapy with the new anti-androgen bicalutamide may reduce PRL secretion and improve its paradoxical secretion in response to L.-Dopa. Further studies will be required to better define the possible prognostic impact of changes in PRL secretion on the efficacy of treatments for metastatic prostate cancer.
UI - 11956172
AU - Krishnan AV; Zhao XY; Swami S; Brive L; Peehl DM; Ely KR; Feldman D
TI - A glucocorticoid-responsive mutant androgen receptor exhibits unique ligand specificity: therapeutic implications for androgen-independent prostate cancer.
SO - Endocrinology 2002 May;143(5):1889-900
AD - Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA.
The cortisol/cortisone-responsive AR (AR(ccr)) has two mutations (L701H and T877A) that were found in the MDA PCa human prostate cancer cell lines established from a castrated patient whose metastatic tumor exhibited androgen-independent growth. Cortisol and cortisone bind to the AR(ccr) with high affinity. In the present study, we characterized the structural determinants for ligand binding to the AR(ccr). Our data revealed that many of the C17, C19, and C21 circulating steroids, at concentrations that are found in vivo, functioned as effective activators of the AR(ccr) but had little or no activity via the wild-type AR or GRalpha. Among the synthetic glucocorticoids tested, dexamethasone activated both GRalpha and AR(ccr), whereas triamcinolone was selective for GRalpha. In MDA PCa 2b cells, growth and prostate-specific antigen production were stimulated by potent AR(ccr) agonists such as cortisol or 9alpha-fluorocortisol but not by triamcinolone (which did not bind to or activate the AR(ccr)). Of the potential antagonists tested, bicalutamide (casodex) and GR antagonist RU38486 showed inhibitory activity. We postulate that corticosteroids provide a growth advantage to prostate cancer cells harboring the promiscuous AR(ccr) in androgen-ablated patients and contribute to their transition to androgen-independence. We predict that triamcinolone, a commonly prescribed glucocorticoid, would be a successful therapeutic agent for men with this form of cancer, perhaps in conjunction with the antagonist casodex. We hypothesize that triamcinolone administration would inhibit the hypothalamic-pituitary-adrenal axis, thus suppressing endogenous corticosteroids, which stimulate tumor growth. Triamcinolone, by itself, would not activate the AR(ccr) or promote tumor growth but would provide glucocorticoid activity essential for survival.
UI - 11993206
AU - Habuchi T; Iinuma M; Sato K; Sato S; Matsuura S; Shimoda N; Tsuchiya N;
TI - Mitsumori K; Kato T [Early results in the initial 15 cases of laparoscopic radical prostatectomy in Akita University Medical Center]
SO - Hinyokika Kiyo 2002 Mar;48(3):139-44
AD - Department of Urology, Akita University School of Medicine.
We herein report our experience and early results of laparoscopic radical prostatectomy in 15 cases of localized prostate cancer (11 T1c operative procedure was almost identical to the Montsouris technique. Conversion to the open procedure was required only in the first case because of a widely opened bladder neck that involved the ureteral orifice. No severe intraoperative or postoperative complications were observed. The mean operating time and blood loss was 383 minutes and 640 ml including intraoperative urine, respectively. Only one patient required blood transfusion. All 14 patients with a successful procedure could take fluid and walk freely on postoperative day 1. Twelve (86%) of the 14 patients could take food on postoperative day 1 and a Foley catheter was successfully removed on day 6 to 8 in 12 (86%) cases. Histologically, positive surgical margin was observed in 5 (33%) cases and all of them were considered non-organ confined (pT3 or more). Without adjuvant hormonal therapy, biochemical (PSA) failure was observed in 5 (36%) cases (median follow-up period: 11 months). Continence has been well maintained in 12 patients with no need for a pad by 3 months postoperatively and 2 patients are using only 1 pad/day for caution's sake. In terms of early postoperative recovery, intraoperative blood loss and maintenance of continence, laparoscopic radical prostatectomy may give a satisfactory result. Although long-term follow-up is required to assess disease control and maintenance of sexual function, laparoscopic radical prostatectomy may become an alternative for the treatment of organ-confined prostate cancer.
UI - 11942169
AU - Mansueto G; Longo F
TI - [Adjuvant treatment of prostatic carcinoma after primary therapy. The "Early Prostate Cancer" Program]
SO - Recenti Prog Med 2002 Mar;93(3):175-8
AD - U.B. Oncologia Medica, Ospedale Regionale Valle D'Aosta.
UI - 11942170
AU - Martorana G
TI - [Adjuvant hormone therapy in prostatic cancer: after treatment with curative intent. The viewpoint of the urologist]
SO - Recenti Prog Med 2002 Mar;93(3):179-82
AD - Cattedra e Scuola di Specializzazione in Urologia, Dipartimento di Scienze Chirurgiche e Anestesiologiche, Alma Mater Studiorum, Universita di Bologna.
UI - 11942171
AU - Rigatti P; Scattoni V
TI - [Efficacy of bicalutamide in adjuvant treatment of prostatic carcinoma after primary therapy with curative aim. The viewpoint of the surgeon]
SO - Recenti Prog Med 2002 Mar;93(3):183-5
AD - Istituto Scientifico Ospedale San Raffaele, Universita Vita e Salute, Milano.
UI - 11955744
AU - Magrini SM; Bertoni F; Vavassori V; Villa S; Cagna E; Maranzano E;
TI - Pertici M; Pradella R; Spediacci MA; Chiavacci A; Ambrosi E; Livi L; Magli A; Bellavita R; Bossi A; Biti G Practice patterns for prostate cancer in nine central and northern Italy radiation oncology centers: a survey including 1759 patients treated during two decades (1980-1998).
SO - Int J Radiat Oncol Biol Phys 2002 Apr 1;52(5):1310-9
AD - Department of Radiation Oncology, Istituto del Radio, O. Alberti Brescia University, Brescia, Italy. email@example.com
PURPOSE: Prostate cancer patients in Italy are offered the choice of the full spectrum of possible treatment options for their disease, but the diffusion of the more recent technological refinements among the Radiation Oncology centers is not homogeneous and there is a need to establish a reference "historical" data source. This retrospective study describes the changing patterns in prostate cancer patient practice and the therapeutic results obtained in nine Radiation Oncology centers of Northern and Central Italy (five in Northern Italy and four in Central Italy). METHODS AND MATERIALS: A total of 1759 prostate cancer patients, radically treated in the nine radiotherapy (RT) centers between 1980 and 1998, made up the study population. Data collected for each patient included clinical, pathologic, therapeutic features, and toxicity. The overall survival, disease-specific survival (DSS), and clinical relapse-free survival (RFS) were calculated for the whole series and for the subsets of patients defined by different clinical, pathologic, and therapeutic features, according to three accrual periods (A, 1980-1990; B, 1991-1994; and C, 1995-1998). Univariate and multivariate analyses were performed to identify prognostic factors related to survival and late adverse effects (cystitis and proctitis) probability. RESULTS: Patient accrual increased markedly during the 2 decades considered, and the percentage of cases with Stage C or D disease dropped from 49% (period A) to 43% (period B) to 37% (period C) (p < 0.0001, chi-square). The baseline prostate-specific antigen value was available for 10%, 76%, and 95% of the cases treated in the three different periods. The major changes in the therapeutic options were an increase in dose to the prostate (>66 Gy in 44%, 84%, and 93% of the patients treated in period A, B, and C, respectively); a reduction in treated volumes, including pelvic lymphatic drainage (56-39% before 1995, 22% thereafter); and an increase in cases treated in association with hormonal therapy (50% before 1991, 80% thereafter). Lower energy (<10 MV) photon beams were progressively abandoned (12% before 1990 vs. 6-7% thereafter), along with an increase in the use of blocks (60% in the last 4 years of the study vs. about 30-40% before 1995) and "conformal" RT (applied in 41% of cases treated after 1994). The actuarial RFS, DSS, and overall survival rate at 5 years was, respectively, 60% +/- 2%, 75% +/- 2%, 66% +/- 2% for period A; 74% +/- 2%, 90% +/- 1%, 83% +/- 2%, for period B; and 67% +/- 5%, 90% +/- 2%, 79% +/- 5% for period C. The actuarial overall survival, DSS, and RFS rate for the whole series of 1759 patients was 77% +/- 1%, 86% +/- 1%, and 68% +/- 1% at 5 years, respectively. Multivariate analysis showed that only American Urologic Association stage, grade, dose to the prostate, accrual period, association with hormonal treatment after (or both after and before) RT (only in terms of DSS and RFS), and baseline prostate-specific antigen value (only for RFS) retained prognostic significance in the final Cox model. CONCLUSION: The increase in the accrual of prostate cancer patients radically treated with RT has been accompanied by considerable changes in the clinical features at presentation, as well as in the staging and treatment procedures. Patients treated more recently had better survival results. An earlier stage and more favorable grade were linked with better overall, DSS, and RFS at multivariate analysis. Lower prostate-specific antigen baseline values were also related to better RFS. Better results were obtained with higher radiation doses, and the dose to tumor seemed the most important treatment-related prognostic factor. The toxicity (cystitis and proctitis, every Radiation Therapy Oncology Group grade) was substantially the same in the different accrual periods, but larger treated volumes and higher doses appeared to increase the incidence of late effects.
UI - 11955763
AU - Dale RG; Jones B
TI - Is the alpha/beta for prostate tumors really low? In regard to Fowler et al., IJROBP 2001;50:1021-1031.
SO - Int J Radiat Oncol Biol Phys 2002 Apr 1;52(5):1427-8; discussion 1428
UI - 11977390
AU - Gershkevitsh E; Hildebrandt G; Wolf U; Kamprad F; Realo E; Trott KR
TI - Chromosomal aberration in peripheral lymphocytes and doses to the active bone marrow in radiotherapy of prostate cancer.
SO - Strahlenther Onkol 2002 Jan;178(1):36-42
AD - Department of Radiotherapy, Hematology-Oncology Clinic, Clinicum of the University of Tartu, Estonia.
BACKGROUND AND PURPOSE: Radiotherapy plays an important role in the management of prostate cancer. Epidemiological data indicate a small but significant risk of radiation-induced leukemia after radiotherapy which might be related to the high mean bone marrow dose associated with radiotherapy of prostate cancer. The purpose of the study was to investigate the relation between the mean bone marrow dose and unstable chromosome aberrations in peripheral blood lymphocytes in patients undergoing conformal radiotherapy for prostate cancer as a possible indicator of risk. Endometrial cancer patients were also included for comparison. PATIENTS AND METHODS: Nine patients, six with prostate cancer (60-73 years old) and three with endometrial cancer (61-81 years old) treated with radiotherapy were included in the study. The non-bony spaces inside the pelvic bones were outlined on every CT slice using the treatment planning system and mean doses to the bone marrow calculated. Blood samples of the patients were obtained at different times before, during and at the end of treatment. Lymphocytes were cultured in the usual way and metaphases scored for dicentric aberrations. RESULTS: 46 samples from nine patients were obtained. The mean number of metaphases analyzed per sample was 180 with a range from 52 to 435. The mean bone marrow doses for prostate cancer patients ranged from 2.8 to 4.2 Gy and for endometrial cancer patients from 12.8 to 14.8 Gy. The aberration yield increased with the planning target volume and the mean bone marrow dose. CONCLUSION: The yield of dicentric aberrations for prostate cancer patients correlated closely with the mean bone marrow dose albeit the induction of dicentrics occurred in mature T lymphocytes most of which were probably in transit through the irradiated volumes. Therefore, the observed relationship between dicentrics and mean bone marrow doses are indirect.
UI - 11872025
AU - Walsh IK; Williams SG; Mahendra V; Nambirajan T; Stone AR
TI - Artificial urinary sphincter implantation in the irradiated patient: safety, efficacy and satisfaction.
SO - BJU Int 2002 Mar;89(4):364-8
AD - Department of Urology, University of California, Davis, California, USA.
OBJECTIVE: To compare the long-term outcome of artificial urinary sphincter (AUS) implantation in patients after prostatectomy, with and with no history of previous irradiation. PATIENTS AND METHODS: The study included 98 men (mean age 68 years) with urinary incontinence after prostatectomy for prostate cancer (85 radical, 13 transurethral resection) who had an AUS implanted. Twenty-two of the patients had received adjuvant external beam irradiation before AUS implantation. Over a mean (range) follow-up of 46 (5-118) months, the complication and surgical revision rates were recorded and compared between irradiated and unirradiated patients. The two groups were also compared for the resolution of incontinence and satisfaction, assessed using a questionnaire. RESULTS: Overall, surgical revision was equally common in irradiated (36%) and unirradiated (24%) patients. After activating the AUS, urethral atrophy, infection and erosion requiring surgical revision were more common in irradiated patients (41% vs. 11%; P < 0.05); 70% of patients reported a significant improvement in continence, regardless of previous irradiation. Patient satisfaction remained high, with > 80% of patients stating that they would undergo surgery again and/or recommend it to others, despite previous irradiation and/or the need for surgical revision. CONCLUSIONS: Despite higher complication and surgical revision rates in patients who have an AUS implanted and have a history of previous irradiation, the long-term continence and patient satisfaction appear not to be adversely affected.
UI - 11889593
AU - Helpap B; Kloppel G
TI - Neuroendocrine carcinomas of the prostate and urinary bladder: a diagnostic and therapeutic challenge.
SO - Virchows Arch 2002 Mar;440(3):241-8
AD - Department of Pathology, Academic Hospital of the University of Freiburg, Postfach 720, 78207 Singen, Germany. firstname.lastname@example.org
This review addresses the various morphological, immunohistochemical and cell kinetic aspects of pure and mixed neuroendocrine carcinomas of the prostate and urinary bladder and of carcinomas with focal neuroendocrine differentiation. It is important that neuroendocrine tumours of the prostate and urinary bladder be clearly distinguished from their nonneuroendocrine counterparts because of differences in treatment and prognosis. In the case of high-grade neuroendocrine carcinomas, early diagnosis and initiation of appropriate chemotherapy may increase survival and potentially induce complete remission in individual cases.
UI - 11072184
AU - Wilkinson DA; Lee EJ; Ciezki JP; Mohan DS; Zippe C; Angermeier K;
TI - Ulchaker J; Klein EA; Mohan D Dosimetric comparison of pre-planned and or-planned prostate seed brachytherapy.
SO - Int J Radiat Oncol Biol Phys 2000 Nov 1;48(4):1241-4
AD - Department of Radiation Oncology, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA. email@example.com
PURPOSE: To compare the dosimetry of the traditional two step procedure (volume study + treatment planning several weeks later) with that of an OR-based single procedure in which these two steps follow one another immediately. Computer generated treatment plans were used in both procedures. METHODS AND MATERIALS: Several dosimetric parameters relating to target coverage were obtained from dose volume histograms of CT-based evaluation plans developed either 1 or 3 days following seed implantation. A total of 113 patients with early stage (T1C, T2A) prostate cancer were used for this retrospective study. RESULTS: The fraction of target (prostate) covered by the prescription dose (144 Gy), 90% of the prescription dose (115 Gy), and the dose encompassing 90% of the target in the evaluation plan were all statistically significantly improved for OR-based plans compared to pre-planned cases. CONCLUSION: In our hands, there is a small but significant improvement in dose coverage of the prostate when the ultrasound volume study and treatment planning are combined into a single procedure.
UI - 11181666
AU - Leventis AK; Shariat SF; Kattan MW; Butler EB; Wheeler TM; Slawin KM
TI - Prediction of response to salvage radiation therapy in patients with prostate cancer recurrence after radical prostatectomy.
SO - J Clin Oncol 2001 Feb 15;19(4):1030-9
AD - Matsunaga-Conte Prostate Cancer Research Center, Baylor College of Medicine and Methodist Hospital, Houston, TX 77030, USA.
PURPOSE: To identify factors predictive of local recurrence as defined by a complete response to salvage radiation therapy in patients whose disease recurs after radical prostatectomy. PATIENTS AND METHODS: Ninety-five patients with recurrence after radical prostatectomy who were evaluated by prostatic fossa biopsies, and a subset of 49 of these patients treated with radiation for control of presumed or biopsy-proven local recurrence, were studied. RESULTS: Biopsies were positive in 40 (42%) of the 95 biopsied patients. Multivariate analysis revealed that prebiopsy prostate-specific antigen (PSA) level, postrecurrence PSA doubling time, and positive digital rectal examination (DRE) of the prostatic fossa were all statistically significant predictors of a positive biopsy. For the 49 patients subsequently treated with salvage radiation therapy, the overall actuarial 3- and 5-year PSA relapse-free probabilities were 43% and 24%, respectively. Univariate analysis showed no differences in the PSA relapse-free probabilities associated with any pathologic features of the radical prostatectomy specimen, biopsy confirmation of local recurrence, or DRE of the prostatic fossa. In multivariate analysis, controlling for all other variables, preradiation PSA and postrecurrence PSA doubling time measured before radiation were the only statistically significant predictors of outcome. CONCLUSION: DRE of the prostatic fossa, prebiopsy PSA, and postrecurrence PSA doubling time predict which patients will have biopsy-proven local recurrence. However, response to salvage radiation therapy is associated with postrecurrence PSA doubling time and with preradiation PSA level only. DRE of the prostatic fossa and biopsy confirmation of local recurrence are not associated with salvage radiation outcome.
UI - 11966834
AU - Salmenpera L
TI - The use of complementary therapies among breast and prostate cancer patients in Finland.
SO - Eur J Cancer Care (Engl) 2002 Mar;11(1):44-50
AD - Department of Nursing, 20014 University of Turku, Finland. firstname.lastname@example.org
This study describes the use of complementary therapies (CTs) among breast (women) and prostate cancer patients (men) in Finland. The data were collected using a self-administered postal questionnaire. Responses were received from 216 women (response rate 54.9%) and 190 men (response rate 55.4%). Data analysis was based on descriptive statistics, the chi-square test and Fisher and Wilcoxon tests. Interpretation of the responses to the open-ended questions used the method of content analysis. Half the respondents (women 53%, men 50%) were interested in CTs. Women (59%) had seriously considered using CTs significantly (P = 0.006) more often than men (44%). Among the women and men who had considered the option, CT use was not started because there was not enough scientific evidence (women 56%, men 77%) or because conventional treatments had worked well enough (women 45%, men 70%). Almost one-third of all women (30%) and men (28%) either continued to use or started using CTs after they had fallen ill with cancer. They resorted to CTs in order to restore their hope in the future (women 36%, men 36%) and to do as much as they could for themselves (women 46%, men 29%). The results indicate that cancer patients are interested in CTs and use them quite frequently. This presents a major challenge to official health care: how should cancer patients be supported in the care relationship to make an informed decision about using CTs; what kind of advice should they be given; and how can patients' individual requirements be adequately met in nursing care?
UI - 11980024
AU - Oudard S
TI - [Chemotherapy: principles and practice]
SO - Prog Urol 2002 Feb;12(1 Suppl 2):19-30
AD - Hopital Europeen Georges Pompidou, Departement de Cancerologie Medicale, 20 rue Leblanc Paris 75015, France. email@example.com
UI - 11978206
AU - Fisher M; Beck E
TI - Is prostate-specific antigen (PSA) screening indicated for any subgroup of men?
SO - J Fam Pract 2002 Feb;51(2):113
AD - Department of Family Medicine, University of North Carolina, Chapel Hill, NC, USA.
UI - 11958585
AU - Feleppa E J; Ennis R D; Schiff P B; Wuu C S; Kalisz A; Ketterling J;
TI - Urban S; Liu T; Fair W R; Porter C R; Gillespie J R Spectrum-analysis and neural networks for imaging to detect and treat prostate cancer.
SO - Ultrason Imaging 2001 Jul;23(3):135-46
AD - Biomedical Engineering Laboratories, Riverside Research Institute, New York, NY 10038, USA. firstname.lastname@example.org
Conventional B-mode ultrasound currently is the standard means of imaging the prostate for guiding prostate biopsies and planning brachytherapy to treat prostate cancer. Yet B-mode images do not adequately display cancerous lesions of the prostate. Ultrasonic tissue-type imaging based on spectrum analysis of radiofrequency (rf) echo signals has shown promise for overcoming the limitations of B-mode imaging for visualizing prostate tumors. This method of tissue-type imaging utilizes nonlinear classifiers, such as neural networks, to classify tissue based on values of spectral parameter and clinical variables. Two- and three-dimensional images based on these methods demonstrate potential for guiding prostate biopsies and targeting radiotherapy of prostate cancer. Two-dimensional images are being generated in real time in ultrasound scanners used for real-time biopsy guidance and have been incorporated into commercial dosimetry software used for brachytherapy planning. Three-dimensional renderings show promise for depicting locations and volumes of cancer foci for disease evaluation to assist staging and treatment planning, and potentially for registration or fusion with CT images for targeting external-beam radiotherapy.
UI - 11977805
AU - Erlichman M; Handelsman H; Hotta SS
TI - Cryosurgery for recurrent prostate cancer following radiation therapy.
SO - Health Technol Assess (Rockv) 1999;(13):i-v, 1-9
Patients with prostate cancer are commonly treated medically or undergo radical prostatectomy and/or radiation therapy. Radiation therapy is usually selected for patients with local or regional disease and patients for whom traditional surgery has failed. The local recurrence of cancer in patients treated with radiation therapy presents a difficult challenge regarding the selection of further treatment options. A commonly applied treatment is salvage prostatectomy, but it can be difficult and complicated, with positive surgical margins occurring in as many as 50 percent of patients and with significant postoperative morbidity. Hormonal therapy, which is not curative, has served as an alternative to surgery in patients who have failed to respond to radiation therapy. Cryosurgery, the destruction of diseased tissue by freezing, is increasingly used both as a first-line therapy and as a second-line therapy (salvage therapy) in patients for whom radiation therapy has failed. Recent reports suggest that cryosurgery may be a useful alternative procedure for treating some of these patients with recurrent cancers. Outcomes of cryosurgery are improving through better instrumentation, surgical technique, and experience. The available data suggest that some patients with radioresistant cancer appear to benefit from the use of cryosurgery as a salvage therapy. Use of this technique has resulted in biochemical disease-free survival for varying periods of some patients who had recurrent prostate carcinoma following radiation therapy; however, morbidity remains high and relatively few patients have had adequate followup. Salvage cryosurgery prospective clinical trials are warranted and would help determine long-term survival benefits and make possible the comparison of cryotherapy patient survival rates with those of untreated biopsy-positive patients.
UI - 11992848
AU - Chawla AK; Thakral HK; Zietman AL; Shipley WU
TI - Salvage radiotherapy after radical prostatectomy for prostate adenocarcinoma: analysis of efficacy and prognostic factors.
SO - Urology 2002 May;59(5):726-31
AD - Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
OBJECTIVES: To determine the probability of biochemical control for patients treated with salvage irradiation and identify prognostic factors associated with successful salvage. The optimal management of prostate cancer in patients with an elevated prostate-specific antigen (PSA) level after radical prostatectomy remains unclear. METHODS: We reviewed the records of 54 patients with node-negative prostate cancer treated with radiotherapy alone between 1991 and 1998 for isolated biochemical relapse after prostatectomy. The median preoperative PSA level was 15 ng/mL, and the median salvage PSA level was 1.3 ng/mL. Complete pathologic information was recorded, as was the interval to postoperative PSA failure. Radiotherapy was delivered to the prostatic fossa using appropriate techniques. The primary endpoint was biochemical failure, measured from radiotherapy initiation to the first detectable PSA level. Biochemical control rates were determined using Kaplan-Meier methods. The median follow-up was 45 months. RESULTS: The initial complete response rate was 76%. Only seminal vesicle status demonstrated borderline significance for the rate of the initial complete response. The 5-year actuarial biochemical control rate was 35%. The presence of seminal vesicle invasion, Gleason score greater than 6, and an immediately detectable postoperative PSA level all predicted for decreased 5-year biochemical control. Gleason score and detectable postoperative PSA retained significance on multivariate analysis. Those with a salvage PSA level of 1.2 ng/mL or less had a trend toward a decreased 5-year biochemical control rate (P = 0.07). CONCLUSIONS: Salvage radiotherapy yields a 76% complete response rate, with 35% of treated patients free of a detectable PSA at 5 years. Those with favorable biochemical and pathologic tumor features are most likely to remain disease free.
UI - 11992849
AU - Mayer R; Pummer K; Quehenberger F; Mayer E; Fink L; Hackl A
TI - Postprostatectomy radiotherapy for high-risk prostate cancer.
SO - Urology 2002 May;59(5):732-9
AD - Department of Radiotherapy, University Medical School, Graz, Austria.
OBJECTIVES: To assess the biochemical and clinical results of postprostatectomy radiotherapy (RT) for high-risk, mostly non-rgan-confined prostate cancer. METHODS: After radical prostatectomy, 66 consecutive patients received either adjuvant (n = 29) or therapeutic (n = 37) postoperative RT. Therapeutic RT was given for persistently elevated postoperative prostate-specific antigen (PSA) levels (n = 14), gradually rising PSA levels (n = 6), or clinical local recurrence (n = 17). The selection of time and referral for RT was at the discretion of the treating urologists. RESULTS: The mean and median follow-up after surgery was 56.8 and 54.2 months, and after radiotherapy, it was 43.2 and 35.0 months, respectively. At 5 years, the actuarial biochemical control for the whole collective was 59.7% (95% confidence interval [CI] 43.3% to 72.8%). Patients treated with adjuvant RT had statistically improved biochemical control (85.2% versus 34.0%, P = 0.001), but not disease-free survival (91% versus 73%, P = 0.09). Advanced tumor stage (pT3b-4) (relative risk 16.6; 95% CI 0.9 to 313.3; P = 0.01), poorly differentiated histologic features (relative risk 4.63; 95% CI 1.8 to 12.2; P = 0.001), and pre-RT PSA (relative risk 1.15, 95% CI 1.06 to 1.25; P = 0.003) were associated with a statistically significant increased risk of biochemical failure. CONCLUSIONS: Although adjuvant postoperative RT resulted in improved biochemical control, no significant difference in disease-free survival has been obtained to date. It therefore remains to be determined whether the better biochemical control observed will ultimately translate into a survival benefit after longer follow-up and prospective trials.
UI - 11992920
AU - Amano H; Goya N; Ryoji O; Yagisawa T; Nakazawa H; Toma H
TI - Ethanol injection therapy for locally invasive prostatic adenocarcinoma.
SO - Urology 2002 May;59(5):771-2
AD - Department of Urology, Sanyudo Hospital, Yamagata, Japan.
UI - 12011281
AU - Zaidat OO; Ruff RL
TI - Treatment of spinal epidural metastasis improves patient survival and functional state.
SO - Neurology 2002 May 14;58(9):1360-6
AD - Neurology Service and Rehabilitation and Spinal Cord Injury and Dysfunction Care Line, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Case Western Reserve University, Cleveland, OH 44106, USA.
OBJECTIVES: To determine factors affecting the success of radiation therapy (RT) of spinal epidural metastases and patient survival after RT. DESIGN/METHODS: One hundred thirty-nine male veterans with an initial spinal epidural metastases treated with dexamethasone and RT were evaluated prospectively. Patients were followed until death. RESULTS: At presentation, 84 patients could walk. After RT, 119 patients walked. The likelihood of regaining ambulation increased if treatment began <12 hours after loss of ambulation and if patients had bladder and bowel function and sacral sensory sparing. Treatment reduced pain levels, and ambulatory patients had less pain compared with nonambulatory patients. Median length of sur