National Cancer Institute®
Last Modified: September 1, 2002
UI - 12012298
AU - Han M; Partin AW
TI - Nomograms for clinically localized prostate cancer. Part I: radical prostatectomy.
SO - Semin Urol Oncol 2002 May;20(2):123-30
AD - James Buchanan Brady Urological Institute, the Department of Urology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Many nomograms are currently available for patients' and physicians' use for prediction of pathologic stage based on preoperative parameters, such as prostate-specific antigen (PSA) level, clinical stage (tumor, node, metastasis), and Gleason score from prostate biopsy specimen. Based on the probability of final pathologic stage as well as patient comorbidity and life expectancy, patients and physicians can decide whether definitive local therapy, systemic therapy, or palliative therapy would be most appropriate. Nomograms have also been developed based on preoperative parameters for prediction of biochemical recurrence-free survival outcome following surgery. These nomograms can help patients understand the long-term cancer cure rates after radical prostatectomy. Copyright 2002, Elsevier Science (USA). All rights reserved.
UI - 12012299
AU - Potters L
TI - Nomograms for clinically localized prostate cancer. Part II: radiation therapy.
SO - Semin Urol Oncol 2002 May;20(2):131-9
AD - Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center at Mercy Medical Center, Rockville Center, NY 11570, USA.
Prostate cancer can be effectively treated with either external beam radiation techniques or with brachytherapy. This study was designed to address the methodology that is used to assess outcome data in the current radiation literature and to evaluate available nomograms that can be used to predict outcomes. A literature search was performed and 12 articles reviewed. Risk stratification was the most frequently used methodology to analyze data. This method encompasses disease-specific variables: the pretreatment prostate-specific antigen (PSA) value and the Gleason score are classified by using cut points into low, intermediate, and high-risk groups. Another methodology uses nomograms to predict outcome. The nomogram uses continuous values of each variable so that the outcome probability for a specific set of parameters is quite specific. The advantage of nomogram analysis over risk stratification analysis is presented. In conclusion, only 3 reports were identified in the radiation literature that used a nomogram to predict outcome. One of the nomograms is proprietary and difficult to interpret. The other 2 nomograms, 1 for 3-dimensional radiation and the other for brachytherapy, have been incorporated into hand-held devices that can be used at consultation with the patient to discuss outcome probabilities to assist in treatment decisions. Copyright 2002, Elsevier Science (USA). All rights reserved.
UI - 12012300
AU - Schwartz E; Albertsen P
TI - Nomograms for clinically localized disease. Part III: watchful waiting.
SO - Semin Urol Oncol 2002 May;20(2):140-5
AD - Division of Urology, University of Connecticut Health Center, Farmington, CT 06030-3955, USA.
Patients with newly diagnosed, clinically localized prostate cancer need information concerning long-term outcomes to make informed decisions regarding treatment options. Several nomograms have been developed that can help in this decision process. By using a nomogram originally published in 1998, patients and clinicians can predict the 15-year clinical outcomes in the absence of aggressive treatment based on age and Gleason score at diagnosis. These predictions are based on patients diagnosed and treated before the routine use of PSA that has accelerated the diagnosis of prostate cancer by at least 5 years. Longer follow-up of contemporary patients will determine whether this nomogram remains accurate in the prostate-specific antigen (PSA) era. In view of the lead-time bias resulting from PSA testing, the outcomes of contemporary patients are likely to be better rather than worse than the results shown. Copyright 2002, Elsevier Science (USA). All rights reserved.
UI - 12012302
AU - Smaletz O; Scher HI
TI - Outcome predictions for patients with metastatic prostate cancer.
SO - Semin Urol Oncol 2002 May;20(2):155-63
AD - Genitourinary Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Estimating prognosis with patients with metastatic disease is important for patient counseling, guiding treatment selection, and assessing treatment outcomes. For patients with noncastrate metastatic disease, androgen ablation is considered first-line therapy, with upward of 80% of patients showing clinical benefit. For these patients, information about duration of response to hormones and overall survival is important. Most patients eventually relapse, at which point the mortality from cancer greatly exceeds that from other causes. This article focuses on prognostic models for patients with progressive noncastrate and castrate metastatic prostate cancer. Copyright 2002, Elsevier Science (USA). All rights reserved.
UI - 12182171
AU - Levenson D
TI - New tactics shorten hospital stays for prostate patients.
SO - Rep Med Guidel Outcomes Res 2001 Jun 28;12(13):5-7
UI - 11859652
AU - Soulie M; Villers A; Richaud P; Prapotnich D; Ruffion A; Grosclaude P
TI - [Competitive morbidity ant its impact on life expectancy: evaluation and inclusion in the therapeutic decision regarding localized prostatic cancer]
SO - Prog Urol 2001 Dec;11(6):1195-204
AD - Service de Chirurgie Urologique et d'Andrologie, CHU Rangueil, 31403 Toulouse. SOULIE.M@chu-toulouse.fr
OBJECTIVES: The treatment decision taken by a multidisciplinary meeting for patients with localized prostate cancer must take into account the clinical stage of the cancer and its histological characteristics, but also the patient's age, general state and any concomitant diseases, as treatment is only beneficial when it induces a reduction of morbidity and specific mortality. The specific survival with or without recurrence after treatment for localized prostate cancer is long, at least more than 10 years. Curative treatment is generally not proposed to men with localized prostate cancer when his probability of survival related to a competitive morbidity (intercurrent medical disease) is estimated to be less than 10 years. The objective of this study was to measure the increase or reduction of the survival probability of a patient with localized prostate cancer according to his competitive morbidity, based on the mean life expectancy of the general population. METHODS: Review of the literature. RESULTS: Studies describing the natural history of prostate cancer show that the impact of treatment on morbidity of the cancer (local and/or metastatic) requires a life expectancy of about 8 to 10 years. The impact of a treatment on specific survival requires a life expectancy of about 13 to 15 years. The exact prevalence of diseases coexisting with prostate cancer is unknown. In the USA, The Index of Coexisting Disease (ICD), which takes into account 14 diseases, appears to be the most reliable tool to measure the competitive morbidity in patients with localized prostate cancer. Each disease is classified into 4 levels of severity (score 0 to 3). A table indicates estimated life expectancies by age-group and by ICD score. All men with a high score (2 to 3) die within 10 years after diagnosis, men with a score of 0 have a better estimated life expectancy according to age than that of the general population. CONCLUSION: The upper age limit, theoretically set at 70 years, in order to propose curative treatment for localized prostate cancer needs to be reviewed (the mean life expectancy for a 70-year-old man is 12.9 years in France). According to the ICD, the life expectancy at 70 years is 14.8 years in the case of a score of 0 and 8.4 years in the case of a score of 2. In the case of a score of 2, the impact of curative treatment on localized prostate cancer would be real on morbidity, but not on specific mortality.
UI - 11859670
AU - Ameur A; Touiti D; el Mostarchid B; el Alami M; Jira H; Abbar M
TI - [Brain metastasis of prostatic cancer: regression under hormonal treatment]
SO - Prog Urol 2001 Dec;11(6):1298-301
AD - Service d'Urologie, Hopital Militaire d'Instruction Mohammed V, BP 1018, Rabat, Maroc. ahmed email@example.com
Central nervous system metastases from prostate cancer are exceptional secondary sites, reported in less than 4% of postmortem cases. The authors describe an unusual case of cerebral metastasis from prostate cancer in a 44-year-old man that temporarily regressed during endocrine therapy.
UI - 12072048
AU - Basaria S; Lieb J 2nd; Tang AM; DeWeese T; Carducci M; Eisenberger M;
TI - Dobs AS Long-term effects of androgen deprivation therapy in prostate cancer patients.
SO - Clin Endocrinol (Oxf) 2002 Jun;56(6):779-86
AD - Division of Endocrinolgy and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
BACKGROUND: Prostate cancer (PCa) is one of the most common cancers in men and has an increasing incidence. In 1999, 37 000 men died from PCa in the USA. Androgen deprivation therapy (ADT) with GnRH agonists is frequently employed in the treatment of recurrent and metastatic PCa by inducing medical castration, rendering these men hypogonadal. Because hypogonadism in men is associated with a wide range of complications, we attempted to determine the effects of long-term ADT in men with PCa. METHODS: We conducted a cross-sectional study at a tertiary care centre to determine the effect of ADT on lean body mass (LBM), muscle strength, bone mineral density (BMD), sexual function, and quality of life (QOL) in men with PCa. Three groups of men were enrolled: (1) 20 men with PCa who were undergoing medical castration with GnRH agonists for at least 12 months prior to the onset of the study (ADT group); (2) 18 age-matched men with nonmetastatic PCa who were post prostatectomy and/or radiotherapy but had not yet undergone ADT (non-ADT group); and (3) 20 age-matched normal men who were healthy and ambulatory (control group). RESULTS: Men on ADT had castrate levels of serum total testosterone (P < 0.0001), free testosterone (P < 0.0001) and oestradiol (P < 0.0001), which were significantly lower than in the other groups. Total body (P = 0.03) and lumbar spine (P < 0.0001) BMD was significantly lower in patients on ADT compared to other groups and was associated with higher levels of urinary N-telopeptide (P = 0.02). The ADT group had higher fat mass compared to the other groups (P = 0.0001) and significantly reduced upper body strength (P = 0.001) when compared to non-ADT patients. The ADT group had lower overall scores on Watt's Sexual Function Questionnaire compared to other groups (P = 0.0001), in particular a decrease in desire, arousal and frequency of spontaneous early morning erections. The ADT group also had lower overall QOL scores, resulting in significant limitation of physical function (P = 0.001), role limitation (P = 0.02) and perception of physical health (P = 0.004). CONCLUSIONS: This study suggests that osteoporosis, unfavourable body composition, sexual dysfunction and reduced quality of life are seen in patients receiving androgen deprivation therapy for at least 12 months. Longitudinal studies in this patient population will shed further light on the timing of the development and the extent of these complications. Meanwhile, this information will assist both physicians and patients with prostate cancer to make informed decisions regarding androgen deprivation therapy.
UI - 12109357
AU - Nelson MA; Reid M; Duffield-Lillico AJ; Marshall JR
TI - Prostate cancer and selenium.
SO - Urol Clin North Am 2002 Feb;29(1):67-70
AD - Arizona Cancer Center, University of Arizona, 1515 North Campbell Avenue, Tucson, AZ 85724, USA. firstname.lastname@example.org
The important progress achieved in the treatment of prostate cancer comes by exacting significant costs [11, 16-18, 20, 23, 25]. Currently, there is incomplete evidence that the radical interventions at hand significantly reduce the human costs of the disease. Surgery and radiotherapy induce substantial risks of incontinence and impotence. The PSA test has probably decreased the stage at which prostate cancer is diagnosed . Nonetheless, the PSA is a means of earlier detection; it does not elucidate quantitatively distinct modes of treatment. The PSA test is not a means of prostate cancer prevention. The continuing incidence, morbidity, and mortality imposed by this disease strongly indicate that preventive strategies for its control are necessary. Chemoprevention with selenium and other agents offers a promising approach that is undergoing intensive investigation. Randomized trials underway at the authors' center are building on the important clinical trial results reported by Dr. Larry C. Clark. These studies will evaluate the activity of selenium at several points along a continuum ranging from cancerous prostatic tissue in men with diagnosed cancer to premalignant tissue in men with high-grade PIN to healthy tissue in high-risk men with negative biopsy to long-term effects on cancerous tissue in men with frank cancer. These trials will also offer an opportunity for preliminary evaluation of the mechanisms by which selenium treatment could result in the slower development or progression of prostate cancer.
UI - 12121835
AU - Mabjeesh NJ; Zhong H; Simons JW
TI - Gene therapy of prostate cancer: current and future directions.
SO - Endocr Relat Cancer 2002 Jun;9(2):115-39
AD - Winship Cancer Institute, Department of Hematology and Oncology, Emory University School of Medicine, 1365 Clifton Road, Suite B4100, Atlanta, Georgia 30322, USA.
Prostate cancer (PCA) is the second most common cause of death from malignancy in American men. Developing new approaches for gene therapy for PCA is critical as there is no effective treatment for patients in the advanced stages of this disease. Current PCA gene therapy research strategies include cytoreductive approaches (immunotherapy and cytolytic/pro-apoptotic) and corrective approaches (replacing deleted or mutated genes). The prostate is ideal for gene therapy. It is an accessory organ, offers unique antigens (prostate-specific antigen, prostate-specific membrane antigen, human glandular kallikrein 2 etc.) and is stereotactically accessible for in situ treatments. Viral and non-viral means are being used to transfer the genetic material into tumor cells. The number of clinical trials utilizing gene therapy methods for PCA is increasing. We review the multiple issues involved in developing effective gene therapy strategies for human PCA and early clinical results.
UI - 12121833
AU - Zhang XK
TI - Vitamin A and apoptosis in prostate cancer.
SO - Endocr Relat Cancer 2002 Jun;9(2):87-102
AD - The Burnham Institute, Cancer Center, 10901 North Torrey Pines Road, La Jolla, California 92037, USA. email@example.com
Apoptosis represents an effective way to eliminate cancer cells. Unfortunately, advanced prostate tumors eventually progress to androgen-independent tumors, which are resistant to current therapeutic approaches that act by triggering apoptosis. Vitamin A and its natural and synthetic analogs (retinoids) induce apoptosis in prostate cancer cells in vitro and in animal models, mainly through induction of retinoic acid receptor-beta (RARbeta). Expression levels of RARbeta, however, are significantly reduced in hormone-independent prostate cancer cells. Recently, a new class of synthetic retinoids related to 6-[3-(1-adamantyl)-4-hydroxyphenyl]-2-naphthalene carboxylic acid (AHPN) (also called CD437) that effectively induces apoptosis of both hormone-dependent and -independent prostate cancer cells in a retinoid receptor-independent manner was identified and has drawn a lot of attention in the field. The apoptotic effect of AHPN requires expression of orphan receptor TR3 (also called nur77 or NGFI-B). Paradoxically, TR3 expression is also induced by androgen and other mitogenic agents in prostate cancer cells to confer their proliferation. The recent finding that TR3 migrates from the nucleus to mitochondria to trigger apoptosis in response to AHPN suggests that the opposing biological activities of TR3 are regulated by its subcellular localization. Thus, agents that induce translocalization of TR3 from the nucleus to mitochondria will have improved efficacy against prostate cancer. TR3, therefore, represents an unexplored molecule that may be an ideal target for developing new agents for prostate cancer therapy.
UI - 12177096
AU - Small EJ; Halabi S; Ratain MJ; Rosner G; Stadler W; Palchak D; Marshall
TI - E; Rago R; Hars V; Wilding G; Petrylak D; Vogelzang NJ Randomized study of three different doses of suramin administered with a fixed dosing schedule in patients with advanced prostate cancer: results of intergroup 0159, cancer and leukemia group B 9480.
SO - J Clin Oncol 2002 Aug 15;20(16):3369-75
AD - Comprehensive Cancer Center, University of California-San Francisco, 1600 Devisadero Street, Third Floor, San Francisco, CA 94115, USA. firstname.lastname@example.org
PURPOSE: To test the hypothesis that the efficacy and toxicity of suramin in the treatment of patients with hormone-refractory prostate cancer was dose dependent. PATIENTS AND METHODS: Patients were randomized with equal probability to receive low-, intermediate-, or high-dose suramin (total doses 3.192, 5.320, and 7.661 g/m(2), respectively). Overall survival, time to progression, and response rate (prostate-specific antigen [PSA] and objective) for each treatment arm were compared. Relationships between plasma suramin concentrations and response, toxicity, and survival were also evaluated. RESULTS: Three hundred ninety patients were randomized. For the low-, intermediate-, and high-dose arms, the median survival time was 16, 14, and 13 months, respectively (P =.49). The objective response rate was 9%, 7%, and 15%, respectively (P =.10). PSA response rates were 24%, 28%, and 34%, respectively (P =.082). Landmark analyses of a 50% decline in PSA at 20 weeks showed a significant correlation with survival. There was a dose-response relationship between dose and toxicity. After adjusting for treatment arm, the measured suramin concentration was not associated with clinical response, PSA response, survival, or toxicity. CONCLUSION: Although high-dose suramin was associated with higher objective and PSA response rates, these were not statistically significant. Overall, no dose-response relationship was observed for survival or progression-free survival, but toxicity was increased with the higher dose. Patients treated with the low-dose level experienced modest toxicity, making it the preferred arm on this study. The lack of a dose-response relationship and the toxicity profile observed raise questions regarding the utility of suramin, particularly high-dose suramin, as administered on this schedule.
UI - 12177097
AU - Kupelian PA; Elshaikh M; Reddy CA; Zippe C; Klein EA
TI - Comparison of the efficacy of local therapies for localized prostate cancer in the prostate-specific antigen era: a large single-institution experience with radical prostatectomy and external-beam radiotherapy.
SO - J Clin Oncol 2002 Aug 15;20(16):3376-85
AD - Department of Radiation Oncology, Desk 728, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA. email@example.com
PURPOSE: To review biochemical relapse-free survival (bRFS) rates after either external-beam radiotherapy (RT) or radical prostatectomy (RP) for localized prostate cancer. PATIENTS AND METHODS: All 1,682 patients had pretreatment prostate-specific antigen (PSA) levels and biopsy Gleason scores (bGS) assigned. No adjuvant therapy was administered after local treatment. RP was the treatment in 1,054 patients (63%) and RT in 628 patients (37%). Median follow-up was 51 months (range, 1 to 134). The median follow-up for RP versus RT patients was 50.5 v 51.0 months. Biochemical relapse was considered detectable PSA levels (> 0.2 ng/mL) in RP patients and three consecutive rising PSA levels in RT patients. The analysis was repeated with a more stringent definition of biochemical control after either RP or RT-namely, reaching and maintaining a PSA level < or = 0.5 ng/mL-and excluding patients receiving any androgen deprivation (AD). RESULTS: Eight-year bRFS rates for RP versus RT were 72% and 70%, respectively (P =.010). Multivariate analysis indicated T stage (P <.001), pretreatment PSA (P <.001), bGS (P <.001), year of therapy (P <.001), and neoadjuvant AD (P =.019) to be the only independent predictors of relapse. Age (P =.78), race (P =.29), prior transurethral resection of prostate (P =.81), and treatment modality (P =.96) were not independent predictors of treatment failure. Fifty-one percent of RP patients had favorable tumors (T1 to T2A, pretreatment PSA < or = 10 ng/mL, bGS < or = 7), compared with only 34% of RT patients (P <.001). Repeat analysis with a stringent definition of biochemical failure and excluding patients receiving AD indicated no impact of treatment modality on outcome. CONCLUSION: Eight-year biochemical failure rates were identical between RT and RP in any subgroup. Outcome is determined mainly by pretreatment PSA levels, bGS, clinical T stage, and, for RT patients, radiation dose.
UI - 12135863
AU - Chatelard PP; Groupe De Travail Du
TI - [Standards, options and recommendations for the management of prostate cancer: therapeutic decision criteria]
SO - Bull Cancer 2002 Jun;89(6):619-34
AD - 101, rue de Tolbiac, 75654 Paris Cedex 13.
CONTEXT: The "Standards, Options and Recommendations" (SOR) collaborative project was initiated in 1993 by the Federation of the French Cancer Centres (FNCLCC), with the 20 French Regional Cancer Centres, several French public university and general hospitals, as well as private clinics and medical specialty societies. Its main objective is the development of serviceable clinical practice guidelines in order to improve the quality of health care and the outcome of cancer patients. The methodology is based on a literature review, followed by critical appraisal by a multidisciplinary group of experts. Draft guidelines are produced, then validated by specialists in cancer care delivery. OBJECTIVES: Produce clinical practice guidelines for prostate cancer patients related to therapeutic main decision criteria, using the methodology developed by the Standards, Options and Recommendations project. METHODS: The FNCLCC and the French Urology Society (AFU) set-up a multidisciplinary group of experts which reviewed the available evidence. Following the selection of pertinent articles, synthesis of the results, and production of the draft SOR, the document was validated by independent reviewers. RESULTS: The main recommendations are: 1) Specific survival with a minimum of 15 years follow-up, is required to assess the impact of a treatment for localised prostate cancer. 2) Ten-year metastatic-free survival is a good endpoint for assessing treatment efficacy for local cancer. 3) Complete remission is defined as undetectable PSA concentration (< 0.1 mug.L- 1). 4) Progression after radical prostactectomy, external-beam radiotherapy or brachytherapy is defined as an increase PSA concentration, measured in three successive determinations, at monthly intervals. 5) Clinical stage, Gleason score and pretherapeutic PSA concentration are the prognostic factors for locoregional involvement and therefore treatment response, which should be used as an aid for therapeutic decision-making.
UI - 12149291
AU - Coen JJ; Zietman AL; Thakral H; Shipley WU
TI - Radical radiation for localized prostate cancer: local persistence of disease results in a late wave of metastases.
SO - J Clin Oncol 2002 Aug 1;20(15):3199-205
AD - Department of Radiation Oncology, Massachusetts General Hospital, 100 Blossom Street, Cox 3, Boston, MA 02114, USA. firstname.lastname@example.org
PURPOSE: To assess whether failure to maintain local control (LC) of prostate cancer after radiation therapy results in a higher incidence of distant metastasis (DM). PATIENTS AND METHODS: From 1972 to 1999, 1,469 patients with clinically localized prostate cancer were treated with radical radiation therapy. Disease outcome was retrospectively reviewed for all patients with more than 2 years of follow-up. RESULTS: The actuarial 10-year LC rate was 79%. Gleason score > or = 7, prostate-specific antigen (PSA) more than 15, and T3 to T4 tumors predicted a higher incidence of local failure (LF) (palpable recurrence or positive rebiopsy). The 10-year distant metastasis-free survival (DMFS) was 74%. Gleason score > or = 7, PSA more than 15, and T3 to T4 tumors predicted a higher incidence of distant failure. LF was the strongest predictor for DM in a multivariate model. The 10-year DMFS for LC and LF patients was 77% and 61%, respectively. Median time to distant failure was prolonged in patients with LF compared with patients with locally controlled disease (54 v 34 months). Hazard rate analysis of the time to DM revealed that patients who maintain LC have a lower rate of DM, which remains constant over time. Patients who ultimately develop LF have a higher initial rate of DM, which increases with time. CONCLUSION: Patients with locally persistent prostate cancer are at greater risk of DM. The higher initial hazard of DM is consistent either with an increased likelihood of subclinical micrometastases before treatment or with posttreatment tumor embolization. The prolonged time to appearance of DM in locally failing patients and the increasing hazard of DM over time is most consistent with a late wave of metastases from a locally persistent tumor.
UI - 12149292
AU - Graefen M; Karakiewicz PI; Cagiannos I; Quinn DI; Henshall SM; Grygiel
TI - JJ; Sutherland RL; Stricker PD; Klein E; Kupelian P; Skinner DG; Lieskovsky G; Bochner B; Huland H; Hammerer PG; Haese A; Erbersdobler A; Eastham JA; de Kernion J; Cangiano T; Schroder FH; Wildhagen MF; van der Kwast TH; Scardino PT; Kattan MW International validation of a preoperative nomogram for prostate cancer recurrence after radical prostatectomy.
SO - J Clin Oncol 2002 Aug 1;20(15):3206-12
AD - Department of Urology, Division of Solid Tumor Oncology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA.
PURPOSE: We evaluated the predictive accuracy of a recently published preoperative nomogram for prostate cancer that predicts 5-year freedom from recurrence. We applied this nomogram to patients from seven different institutions spanning three continents. METHODS: Clinical data of 6,754 patients were supplied for validation, and 6,232 complete records were used. Nomogram-predicted probabilities of 60-month freedom from recurrence were compared with actual follow-up in two ways. First, areas under the receiver operating characteristic curves (AUCs) were determined for the entire data set according to several variables, including the institution where treatment was delivered. Second, nomogram classification-based risk quadrants were compared with actual Kaplan-Meier plots. RESULTS: The AUC for all institutions combined was 0.75, with individual institution AUCs ranging from 0.67 to 0.83. Nomogram predictions for each risk quadrant were similar to actual freedom from recurrence rates: predicted probabilities of 87% (low-risk group), 64% (intermediate-low-risk group), 39% (intermediate-high-risk group), and 14% (high-risk group) corresponded to actual rates of 86%, 64%, 42%, and 17%, respectively. The use of neoadjuvant therapy, variation in the prostate-specific antigen recurrence definitions between institutions, and minor differences in the way the Gleason grade was reported did not substantially affect the predictive accuracy of the nomogram. CONCLUSION: The nomogram is accurate when applied at international treatment institutions with similar patient selection and management strategies. Despite the potential for heterogeneity in patient selection and management, most predictions demonstrated high concordance with actual observations. Our results demonstrate that accurate predictions may be expected across different patient populations.
UI - 12206841
AU - Katz AE; Rukstalis DB
TI - Introduction. Recent scientific and technological advances have challenged the traditional treatment options for patients with localized prostate cancer.
SO - Urology 2002 Aug;60(2 Suppl 1):1-2
AD - Department of Urology, Columbia-Presbyterian Medical Center, New York, New York 10032, USA.
UI - 12206843
AU - Robinson JW; Donnelly BJ; Saliken JC; Weber BA; Ernst S; Rewcastle JC
TI - Quality of life and sexuality of men with prostate cancer 3 years after cryosurgery.
SO - Urology 2002 Aug;60(2 Suppl 1):12-8
AD - Department of Oncology and Program in Clinical Psychology, University of Calgary, Calgary, Alberta, Canada.
The current study was designed to describe the long-term life quality and sexuality of men enrolled in a phase 2 clinical trial of cryosurgery for the treatment of localized prostate cancer. A total of 75 men were administered the Functional Assessment of Cancer Treatment-Prostate (FACT-P) before treatment and after treatment at 6 weeks, and at 3, 6, 12, 24, and 36 months. Additionally, these men completed a Sexuality Follow-Up Questionnaire (SFQ) 3 years after cryosurgery. By 12 months after cryosurgery, most FACT-P subscales had returned to pretreatment levels. Quality of life remained stable over the subsequent 2 years. The only exception to this general trend was persistent impairment in measures of social/family well-being. At 36 months, 13% (5 of 38) of patients had regained erectile functioning, and an additional 34% (13 of 38) of patients were sexually active with the help of aids. The 3-year quality-of-life outcomes support the renewed interest in cryosurgery. No late complications were observed. Whereas improvements in erectile function were observed between years 1 and 3 for some patients, most continue to experience erectile dysfunction. For these patients, aids are an important adjunct to the treatment of their erectile dysfunction.
UI - 12206844
AU - Rukstalis DB; Goldknopf JL; Crowley EM; Garcia FU
TI - Prostate cryoablation: a scientific rationale for future modifications.
SO - Urology 2002 Aug;60(2 Suppl 1):19-25
AD - Department of Surgery, Division of Urology, MCP Hahnemann University School of Medicine, Philadelphia, Pennsylvania 19129, USA. email@example.com
This investigation was designed to identify potential directions for future modification of the percutaneous prostate cryoablation procedure. An analysis of prostate cancer location and volume in radical prostatectomy specimens was performed to evaluate the potential clinical consequences of these proposed modifications. A list of recommendations for improvements in the prostate cryoablation procedure was compiled from informal discussions held with participants in 9 training courses and conferences on prostate cryoablation over 18 months. Subsequently, a population of 112 consecutive, sagittally sectioned whole-mount radical prostatectomy samples was evaluated for prostate cancer volume, number of individual foci, and location to examine the disease-specific outcomes of these proposed modifications. The most common areas for potential alterations in the current cryoablation technique include modifications that would further simplify the procedure, continue to reduce real and perceived toxicity, and augment efficacy. Importantly, modifications designed to reduce treatment side effects could conflict with efforts designed to improve eradication of prostate cancer. Pathologic analysis revealed multifocal cancer in 79.5% of the samples, with 66% of cases exhibiting cancer within 5 mm of the urethra. The median volume of the index cancer was 1.6 cm3, whereas the median volume of the smaller ancillary lesions was 0.3 cm3. Prostate parenchymal-sparing alterations, proposed to reduce incontinence and erectile dysfunction by targeting the index cancer, would likely eradicate clinically significant cancer in 79% of men. The recent enthusiasm for prostate cryoablation as a reasonable minimally invasive treatment option for men with clinically localized cancer is likely to result in modifications of the established surgical technique. Knowledge of the anatomic location and cancer volume within the prostate gland is an important adjunct to planning such alterations. It is possible that parenchymal-sparing modifications to total gland prostate cryoablation can eradicate clinically significant cancer in most men, with a reduction in toxicity and cost.
UI - 12206842
AU - Bahn DK; Lee F; Badalament R; Kumar A; Greski J; Chernick M
TI - Targeted cryoablation of the prostate: 7-year outcomes in the primary treatment of prostate cancer.
SO - Urology 2002 Aug;60(2 Suppl 1):3-11
AD - Prostate Institute of America, Community Memorial Hospital, Ventura, California 93003, USA. firstname.lastname@example.org
The efficacy and safety of the long-term experience with targeted cryoablation of prostate cancer (TCAP) at a community hospital is retrospectively reviewed. A series of 590 consecutive patients who underwent TCAP as primary therapy with curative intent for localized or identified. Patients were stratified into 3 risk groups according to clinical characteristics. Biochemical disease-free survival (bDFS), post-TCAP biopsy results, and post-TCAP morbidity were calculated and presented. The mean follow-up time for all patients was 5.43 years. The percentages of patients in the low-, medium-, and high-risk groups were 15.9%, 30.3%, and 53.7%, respectively. Using a prostate-specific antigen (PSA)-based definition of biochemical failure of 0.5 ng/mL, results were as follows: (1) the 7-year actuarial bDFS for low-, medium-, and high-risk patients were 61%, 68%, and 61%, respectively; (2) the bDFS probabilities for a PSA cutoff of 1.0 ng/mL for low-, medium-, and high-risk patients were 87%, 79%, and 71%, respectively; and (3) the bDFS probabilities for low-, medium-, and high-risk patients using the American Society for Therapeutic Radiology and Oncology (ASTRO) definition of biochemical failure (3 successive increases of PSA level) were 92%, 89%, and 89%, respectively. The rate of positive biopsy was 13%. After a positive biopsy, 32 patients underwent repeat cryoablation. For those patients who underwent repeat cryoablation, 68%, 72%, and 91% remain bDFS using definitions of 0.5 ng/mL, 1.0 ng/mL, and the ASTRO criteria, respectively, after a mean follow-up time since repeat cryoablation of 63 months. The rates of morbidity were modest, and no serious complications were observed. TCAP was shown to equal or surpass the outcome data of external-beam radiation, 3-dimensional conformal radiation, and brachytherapy. These 7-year outcome data provide compelling validation of TCAP as an efficacious treatment modality for locally confined and locally advanced prostatic carcinoma.
UI - 12206846
AU - Ellis DS
TI - Cryosurgery as primary treatment for localized prostate cancer: a community hospital experience.
SO - Urology 2002 Aug;60(2 Suppl 1):34-9
AD - Urology Associates of North Texas, and United States Medical Development, Arlington, Texas 76012, USA. email@example.com
The technique and recent experience incorporating cryosurgery into our community practice for primary treatment of localized prostate cancer is patients underwent targeted cryoablation for localized prostate cancer. Of the 93 patients, 18 had failed radiotherapy, and cryotherapy was used as salvage therapy. The remaining 75 patients underwent targeted cryoablation of the prostate as primary therapy. A single urologist using an argon-based cryoablation system performed the procedure. Cryoprobes and thermosensors were placed under transrectal ultrasound guidance via a transperineal route. A double freeze-thaw cycle was used with anterior-to- posterior probe operation. Strategically placed thermosensors were used to monitor and control the freezing, and a warming catheter was used to protect the urethra. We achieved a nadir prostate-specific antigen level of < or =0.4 ng/mL in 84% of the entire population we studied (63 of 75 patients). Postsurgery complications were minimal. Incontinence developed in 4 patients, as did postsuprapubic catheter removal urinary retention. Erectile dysfunction developed in 28 of 34 patients who were potent preoperatively, with 6 of the 34 patients regaining potency after surgery. No rectourethral fistula formation occurred. Urethral sloughing was observed in 5 patients, 1 of whom developed a scrotal abscess during treatment of the sloughing. The use of cryoablation of the prostate for the treatment of localized adenocarcinoma of the prostate is feasible and can easily be transferred from the pioneering centers to the community hospitals without sacrificing safety or efficacy.
UI - 12074793
AU - Bogers JA; van der Maazen RW; Visser AG
TI - Conformal photon-beam radiotherapy of prostate carcinoma.
SO - Eur Urol 2002 May;41(5):515-22
AD - Department of Radiation Oncology, University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands. firstname.lastname@example.org
Three-dimensional conformal radiotherapy is the recommended radiation technique for localized or locally advanced prostate cancer. In the past decades, external beam irradiation procedures have evolved in the context of technical developments of radiation and imaging equipment. The article summarizes these developments and gives a definition of new techniques and their potential advantages over conventional irradiation. It is meant to provide urologists and medical and radiation oncologists with a better comprehension of modern radiation treatment of prostate cancer and its possible improvements in the future.
UI - 12081772
AU - Do V; Choo R; Deboer G; Herschorn S; Danjoux C; Chen CH; Barak I
TI - Urodynamic findings 3 months after radiotherapy in patients treated with conformal external beam radiotherapy for