ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1995.tb07220.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1995.tb07221.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1995.tb07222.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

ObjectivesTo assess the use and content of written information relating to transurethral resection of the prostate (TURP).Materials and methodsAll 328 full members of the British Association of Urological Surgeons (BAUS) were requested to submit any information sheets or specialized consent forms given to patients about to undergo TURP. They were asked to record when the information was given and whether this was recorded in the notes. The sheets were analysed with reference to a nominally comprehensive list of topics suitable for inclusion in such sheets.ResultsOne‐hundred and eleven replies were received (34%) which represents 44% of urological departments. Of those replying, only 56 used information sheets for TURP. The overall comprehensiveness of the information was surprisingly poor, with 12% omitting to mention retrograde ejaculation and 19% failing to discuss the need for a catheter.ConclusionThe written information given to patients about to undergo TURP appears inadequate. There is a need for a nationally accepted information sheet that can be edited locall

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1995.tb07223.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

ObjectiveTo determine the true incidence and possible aetiology of impotence following transurethral prostatectomy.Patients and methodsOver a 9‐month‐period 268 patients who were about to undergo transurethral prostatectomy were interviewed about their sexual function. Full details of each operation were recorded including size of prostate, operative time, grade of surgeon and the occurrence of capsular perforation. The interviews were repeated by letter or telephone 3 months after operation.ResultsOf the 268 men interviewed, 246 (91.8%) were suitable for inclusion in the study. Pre‐operatively, 137 (55.7%) were fully potent, 43 (17.5%) could achieve a partial erection and 66 (26.8%) were impotent. Of the fully potent patients, 20 (14.6%) became partially potent and four (2.9%) became impotent post‐operatively. Of those who were partially potent before operation, 16 (37.2%) became impotent post‐operatively. Overall, the risk of impotence was 28.1% if the prostatic capsule was breached at operation but only 10.0% if it was not (P<0.01).ConclusionIn fully potent men the risk of impotence after transurethral prostatectomy is fairly low, but it is higher in men who already have a degree of erectile failure. The risk of impotence is related to the incidence of capsular perforation at the time o

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1995.tb07224.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

ObjectivesTo examine the value of post‐operative serum prostate‐specific antigen (PSA), PSA density, incremental change in serial serum PSA (PSA slope) and transrectal ultrasound (TRUS) in the assessment of residual malignancy after the diagnosis of clinically unsuspected prostatic adenocarcinoma at transur‐ethral resection of the prostate (TURP).Patients and methodsForty‐eight untreated patients with incidental carcinoma of the prostate, demonstrated at TURP for a clinically benign gland, were evaluated post‐operatively with serum PSA and TRUS with multiple systematic prostatic biopsies. Prostatic volume was determined from TRUS measurements and PSA density was defined as serum PSA divided by gland volume. Those patients who did not undergo further treatment were monitored with serial PSA levels, and PSA slope was calculated as the overall annual percentage increase in serum PSA.ResultsAmong 36 patients staged T1A (A1), 11 (31%) had histologically proven residual carcinoma, and five of the 12 patients (42%) with T1B (A2) disease had no residual disease on biopsy. Serum PSA levels following TURP were greater in those patients with residual disease than those without (P= 0.001), but at a cut‐off of 4.0 ng/mL — providing a sensitivity of 89%— the specificity of PSA alone was 57%. PSA density had an 83% sensitivity and a 67% specificity with a cut‐off of 0.15 ng/mL/cm3. TRUS had a sensitivity of 63% and a specificity of 52%. An incremental rise in PSA exceeding 20% per year in untreated patients gave a sensitivity of 90% and specificity of 79% for biopsy proven residual malignancy.ConclusionThis study demonstrates the inaccuracy of staging incidental prostatic malignancy by TURP. Although the performance of PSA density is better than that of PSA alone, the reliability of both are limited by the lack of specificity, and TRUS imaging lacks both sensitivity and specificity. The PSA slope has sufficient sensitivity and specificity to distinguish reliably most patients with biopsy proven residual malignancy. Although ultrasound‐guided systematic biopsies provide a means for confirming residual malignancy, they may not be indicated in all patients with incidental carcinoma: for such patients, PSA progression may provide a rational basis for s

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1995.tb07225.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

ObjectiveTo assess the relationship of prostate‐specific antigen (PSA) obtained under optimal conditions with the presence or absence of organ‐confined prostate cancer following radical prostatectomy.Patients and methodsThe medical records of 300 consecutive patients who underwent radical retropubic prostatectomy were retrospectively reviewed. Ninety‐three patients were excluded who had a pre‐operative PSA level potentially altered by various factors (prostate infection, manipulation or instrumentation).ResultsA pre‐operative PSA value15 ng/mL had organ‐confined disease at surgery.ConclusionThese data demonstrate that optimal serum PSA values correlate well with patholo

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1995.tb07226.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

ObjectiveTo evaluate whether DNA ploidy and immunohistochemistry performed in primary prostatic carcinoma specimens give predictive information on regional lymph node metastasis in addition to T category, histological grade and serum prostate specific antigen (PSA).Patients and methodsPre‐treatment TURP specimens from 80 patients with prostatic carcinoma T0‐T3/M0 disease were retrospectively evaluated by means of DNA ploidy and histological grade, and immuno‐staining for PSA, prostatic acid phosphatase (PAP), neuron‐specific enolase (NSE) and p53 protein. Pelvic lymph node dissection was performed in all patients. Serum PSA was determined in 76 of the 80 patients before pelvic staging lymphadenectomy. Thirty‐two (40%) of the 80 patients had pN+ disease.ResultsThirty‐six patients (46%) had serum PSA values below the upper reference limit (≤ 10 μg/L). By univariate analysis the pN category correlated with the serum PSA level (P<0.001), histological grade (P<0.001), tissue PSA (P<0.001), tissue PAP (P<0.04), T category (P<0.005) and DNA ploidy (P<0.02). Multivariate analysis revealed that the serum PSA level was the most powerful independent prognosticator, followed by the T category, tissue PAP and tissue PSA. Histological grade and DNA ploidy did not reach the level of significance in the multivariate analysis.ConclusionThese data suggest that tissue PAP and tissue PSA predict the pN status in patients with T0‐T3/M0 prostate carcinoma, in addition to serum PSA and T category. Neuroendocrine differentiation and p53 protein seem to have no pr

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1995.tb07227.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

ObjectiveTo evaluate the need for ileo‐obturator node dissection in patients with localized prostate cancer who are undergoing radical retropubic prostatectomy.Patients and methodsOver a 5‐year‐period, 95 patients underwent bilateral pelvic lymphadenectomy. Ninety were performed in association with planned radical prostatectomy and five were staging procedures in clinical stage T3 patients prior to radiotherapy or hormonal therapy. The patients with localized prostate cancer were stage T1a (one patient), T1b (21), T2a (30), and T2b (38). Pre‐operative biopsies in the patients with localized cancer were well differentiated in 44 patients, moderately well differentiated in 45 and poorly differentiated in one. In the patients with T3 tumours, pre‐operative biopsies were well differentiated in one, moderately well differentiated in two and poorly differentiated in two. Prostate‐specific antigen (PSA) levels ranged from 0.4 to 110.1 ng/mL (Hybritech assay).ResultsTwo patients had positive lymph node dissections on fixed section. These two patients had well‐differentiated T1b disease with a PSA level of 72.4 ng/mL and poorly differentiated T3 disease with a PSA level of 58.5 ng/mL. There was significant upstaging (P<0.001) and upgrading (P10 ng/mL (P= 0.0618). Lymph node metastases were present in 1% of patients with well or moderately well‐differentiated prostate cancer on pre‐operative biopsy versus 33% with poorly differentiated disease (P= 0.0625). ThesePvalues strongly suggest an association, achieving significance only at the 10% level which might be the more appropriate level given the relative lack of power of the study due to the small number of patients with positive lymph nodes.ConclusionThese Results suggest that routine ileo‐obturator node dissection in patients with well or moderately well‐differentiated, localized prostate cancer and a PSA level<10 ng/mL may be unnecessary, especially as

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1995.tb07228.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

ObjectiveTo assess the Results of radiotherapy in the treatment of localized prostate cancer. End points for assessment were survival, local control, development of metastases, and the toxicity of therapy.Materials and methodsThe case notes of 191 patients who were treated with radical radiotherapy between 1982 and 1992 were reviewed. The pathology of 130 patients was reviewed by a single pathologist. A multivariate analysis was performed to identify significant prognostic factors with regard to survival and relapse.ResultsOne‐hundred and eighty‐two patients were assessable. The minimum length of follow‐up was one year (median = 40 months). The actuarial cause‐specific 5 and 10 year survival rates were 63% and 35% respectively. Local progression occurred in 41% of patients with 37% developing metastases. Multivariate statistical analysis demonstrated that T stage and Gleason Score were significant predictors for survival. Late complications were usually mild, with only 4% developing serious bladder toxicity.ConclusionRadical radiotherapy has a role in the curative treatment of prostate cancer. Survival is significantly related to T stage at the time of presentation, and to the Gleason Score of the tumour. Survival in this series was not as good as the best surgical series, but it is still not clear which patients should receive radiotherapy and which surgery as their primary man

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1995.tb07229.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY