摘要:

Controversies abound in relation to the treatment of every stage of prostate cancer and its natural history. We critically evaluate the controversies and information that exist. An ongoing autopsy project at Wayne State University aims to: define the prevalence of incidental cancer in subjects between 20 and 70 years of age; study the potential difference between Caucasians and Blacks; and to analyze other associated histological lesions such as prostatic intraepithelial neoplasia (PIN) and atypical adenomatous hyperplasia. Initial results note that there was only a weak correlation between high-grade PIN and incidental carcinoma, both lesions started to present at an early age with a progressive increase after the seventh decade, and there was no racial difference observed among Caucasians and African-American males. These results pose several questions which need further explanation. Most studies use digitorectal examination, transrectal 7-MHz ultrasonography and prostate-specific antigen for the early diagnosis of prostate cancer, we attempt to determine the best and most economical combination presently available. In discussing the therapeutic options for patients with localized prostate cancer, we review our personal experience with surgery and radiotherapy.

ISSN:0042-1138    

DOI:10.1159/000282860

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

The effects of pharmacotherapeutic complete androgen deprivation treatment for 2 months before radical retropubic prostatectomy (RRP) were investigated in an open study in 375 patients. Prostate volume, tumor staging and prostate-specific antigen (PSA) were investigated as clinical parameters. The RRP specimens were analyzed particularly in terms of tumor cell regressions, pathological tumor staging and grading. Before neoadjuvant therapy (NAT) the 375 patients were classified according to stage: 36 (9.6%) were Tm; 137 (46.1%) were T2, and 166 (44.3%) were T3 stage. After NAT, the clinical investigation (digital rectal examination + transrectal ultrasonography) gave an impression of a T0 stage in 11 % of the T2 patients, and a T2 tumor stage in 39% of the T3 patients. The histopathological analysis of the initial Tib and T2 cases did not reveal any tumor in the RRP specimen in 11 (3.8%) cases, a pT2 tumor in 153 (73%) cases, and a pT3 tumor in 48 (23.5%) cases. In the patients initially classified as T3, a tumor was no longer found in 1 (0.6%) case, and a pT2 tumor was found in 48 (29.3%) cases and a pT3 tumor in 113 (67.7%) cases. Under NAT, the prostate volume fell by 34% in T3 tumors and by 24% in T2 tumors. The fall in PSA averaged 85% without significant differences in the individual tumor stages. A statistically significant correlation could not be demonstrated between the fall of PSA and the definitive pathological tumor stage. Tumor cell regressions were found in all preparations. The degree of regression was predominantly RII. These results document the direct effect on tumor cells of an inductive androgen-ablative pharmacotherapy. Regression and volume reduction of the tumor might lead to an improvement of the local surgical control. A final clinical evaluation of NAT will only be possible after long-term analysis of ongoing prospective, randomized studies.

ISSN:0042-1138    

DOI:10.1159/000282861

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Androgen deprivation based on hormone manipulation is the treatment of choice in advanced prostatic cancer. The unequivocal role of adrenal androgens in the growth of prostatic cancer after medical or surgical castration requires a new logical approach (complete androgen blockade) in the treatment of advanced prostate cancer. One hundred and fifty patients with biopsyproven advanced prostatic cancer were randomized into two groups. One group (74 patients) received leuprolide + fiutamide (complete androgen blockade); the second group (76 patients) received only leuprolide and, during the first 3 weeks of treatment, cyproterone acetate (150 mg/day) to prevent flare-up phenomena. The aim of the study was to evaluate the differences between the two groups on overall survival and time to progression (log-rank test). One hundred and twenty-five patients were evaluable, 62 in the leuprolide-only group and 63 in the leuprolide + fiutamide group. Median duration of follow-up was 102 weeks. No statistical difference between the two groups was observed in overall survival, in time to disease progression, and in time to treatment failure. In the combination (leuprolide + fiutamide) treatment group, a positive trend for overall survival and in time to progression was observed in a subgroup of patients with good performance status and no bone metastases. We observed mild gastrointestinal toxicity (diarrhea, nausea) in the group treated with leuprolide + fiutamide. The aim of this study was to compare the effectiveness of total androgen withdrawal with medical testicular suppression in advanced prostatic cancer. No significant statistical difference was observed between the two groups in overall survival and in time to progression, but probably too few patients were enrolled in each treatment arm to give a statistical interpretation of our results. We conclude that there is a positive trend in the combination treatment arm in patients with good prognostic factors.

ISSN:0042-1138    

DOI:10.1159/000282863

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

In order to clarify the role of 1, 25-dihydroxyvitamin-D [1, 25-(OH)2-D] in calcium stone formation, correlations between l,25-(OH)2-D serum levels and levels of calcium, phosphate and uric acid (UA) in serum or urine and between the l,25-(OH)2-D serum level and age were analyzed in Ill formers of urinary stones (57 Ca stones) and in 44 controls. Furthermore, 1,25-(OH)2-D serum levels as well as levels of Ca, phosphate and UA in serum and urine from formers of different urinary stones and controls were compared. 1,25-(OH)2-D serum levels were determined by a radio-receptor assay based on a calf thymus receptor. l,25-(OH)2-D serum levels correlated positiviely with urinary UA excretion in formers of Ca stones and with urinary Ca excretion in formers of Ca stones and controls. In formers of Ca stones urinary Ca excretion was higher and serum phosphate was lower than in controls. 1,25-(OH)2-D serum levels did not differ. l,25-(OH)2-D serum levels decreased with increasing age in controls, but not in stone formers. Our results show that urinary UA and 1,25-(OH)2-D in serum co-influence Ca stone formation, and they suggest that there is an increased sensitivity to l,25-(OH)2-D in formers of Ca stones.

ISSN:0042-1138    

DOI:10.1159/000282801

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Androgen suppression, using gonadotrophin-releasing hormone analogues (leuprorelin), is being developed as an effective treatment of advanced prostate carcinoma. Treatment with leuprorelin acetate 1-month depot is already well established all over the world. In order to increase patients’ acceptability of this treatment, by reducing frequency of administration, a 3-month depot formulation has been developed in Takeda’s research laboratories. A single-shot pharmacokinetic study was conducted to confirm efficacy in terms of hormone suppression and safety of the 3-month depot formulation. Thereafter, a parallel-group, open-labelled, randomized trial was performed to compare clinical efficacy and safety profiles of the 1- and 3-month depot formulations. Patients with a histologically and/or cytologically confirmed advanced prostate carcinoma, without prior hormonal or surgical androgen deprivation, are included. According to 1:2 randomization, patients are treated with either the 1- or 3-month depot for 9 months. To prevent initial flare-up, a concomitant antiandrogen therapy might be administered within 2 weeks prior to first injection and continued for up to 3 weeks. The clinical efficacy of the formulations is assessed by both objective response, EORTC and NPCTG response criteria, and subjective response by using WHO performance status. In addition, the level of prostate-specific antigen is determined every 3 months. The efficacy of the two formulations is also evaluated by determination of serum testosterone, dihydrotestosterone, luteinizing hormone and follicle stimulating hormone. To date, 106 patients have been treated with the 3-month depot and 53 patients with the 1-month depot. Preliminary evaluation shows a satisfying level of testosterone suppression with both the 3- and 1-month depot formulations. Therapeutic equivalence was assumed. The 3-month depot is tolerated as well as the 1-month de

ISSN:0042-1138    

DOI:10.1159/000282864

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

A total of 150 patients presenting with stone in the middle iliac ureter were treated with extracorporeal shock wave lithotripsy using a Dornier HM-4 litho-triptor. For adequate radiological stone visualization and excellent fragmentation, the prone position was used in all patients. In 45 patients (30%) an ureteral stent was placed before treatment. The overall success rate was 82% (123 of 150 patients). All patients were treated on an outpatient basis without anesthesia.

ISSN:0042-1138    

DOI:10.1159/000282802

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

In an open, prospective clinical trial enrolling 205 patients, efficacy and safety of the gonadotropin-releasing hormone agonist leuprorelin acetate depot (LAD) in the treatment of patients with advanced prostatic carcinoma were assessed. 3.75 mg of the LAD formulation was injected subcutaneously in monthly intervals. The primary objective of this study was to evaluate the efficacy of the analogue in producing and maintaining castration levels of testosterone over a > 3-year follow-up period and to determine its safety profile. Median pretreatment serum testosterone levels fell from 350 to 21 ng/dl after 4 weeks and 20 ng/dl after 45 months. The long-term clinical efficacy of the LAD formulation can be expressed by best treatment response over time. These respective figures read as follows: 10.7% complete response; 49.8% partial response; 34.1% no change; 1.5% progression, and 3.9% no data available. The median time to progression was 12(15 ± 11) months. Median survival time calculated by Kaplan-Meier exceeded 42.5 months for patients on monotherapy and 30.9 months for those on combination therapy. Hot flushes which were related to androgen deprivation were the most common side effects. Patients and treating physicians judged tolerability of LAD in more than 90% as good. Androgen deprivation remains the mainstay of hormone-dependent advanced carcinoma of the prostate. Up to now, surgical castration has been considered the standard method. LAD is an advantage in the endocrine treatment of advanced prostatic carcinoma and is a good alternative to castration

ISSN:0042-1138    

DOI:10.1159/000282865

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

We studied whether the height of the irrigating fluid bags above the operating table and the capacity of the bladder influence intravesical pressure and fluid absorption during transurethral resection of the prostate (TURP) when evacuation is performed with Reuter’s trocar. For this purpose, the intravesical pressure was recorded continuously, and the fluid absorption was measured by the ethanol method during 30 TURP procedures. The bags were placed between 60 and 95 cm above the operating table, and the bladder capacity was measured before surgery started. The results show that the bladder capacity, but not the bag height, correlated with the intravesical pressure and the fluid absorption. Large-sized bladders were associated with lower pressures and smaller absorption. Rapid absorption ( > 30 ml/min) occurred at a maximum pressure of 2–3 kPa and a mean pressure of between 1 and 2 kPa. In conclusion, the size of the bladder is important to the intravesical pressure and to the fluid absorption during TURP when using the suprapubic tro

ISSN:0042-1138    

DOI:10.1159/000282804

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Yellow chips were sought in 206 transurethral resection specimens of prostate. 18 (9%) contained yellow chips, and 46 (22%) prostatic adenocarcinomas were present. Yellow chips showed a specificity of 100% (95% confidence interval, CI 98–100%), a sensitivity of 39% (95% CI 25–55%), and a positive predictive value of 100% (95% CI 82–100%) for prostatic adenocarcinoma. Yellow chips were more easily recognized in poorly fixed specimens. On comparing prostatic adenocarcinomas with or without yellow chips, there was no significant difference in Gleason score or percentage of chips infiltrated by tumour. Complete sampling of prostate chips may be unnecessary, if yellow chips are present and selectively sampled. Naked-eye detection of prostatic adenocarcinoma may be increased by examining the tissue before fix

ISSN:0042-1138    

DOI:10.1159/000282805

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Renovascular hypertension, caused by fibromuscular dysplasia, mainly affects young women in the third decade of life. Percutaneous transluminal angioplasty is the treatment of choice for solitary lesions with a complete functional result in 40–50% of the cases. Multiple stenoses, involving intrarenal arterioles, cannot be treated by dilatation and are mostly treated by nephrectomy. Nevertheless, those vascular stenoses are often limited to a particular renal segment so that unaffected segments could be spared. Two patients were treated with a partial nephrectomy. The short-term results are promising. We suggest that this treatment modality could be offered as a rational and effective solution to well-selected cases, with multiple, regionally limited arterial stenose

ISSN:0042-1138    

DOI:10.1159/000282806

出版商:S. Karger AG    

年代:1996

数据来源: Karger