ISSN:8756-0437    

DOI:10.1002/ssu.2980110102

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY

摘要:

AbstractThe natural history of clinically localized prostate cancer is controversial. However, the data that is available suggests outcomes are good for men with well and moderately differentiated disease, but relatively poor for men with poorly differentiated cancer. For example, in one synthesis of individual‐patient level data from six series, ten‐year prostate cancer‐specific mortality for men with well, moderate, and poorly differentiated disease was estimated at 13%, 13%, and 66%, respectively. Tumor grade is the dominant predictor of prognosis. Few studies report on risks of morbidity due to local cancer progression; the data available suggest this risk is relatively low. Cancer‐specific mortality figures overestimate the impact of disease among older men with competing causes of mortality. Given the available data on prognosis of men with localized prostate cancer not treated for cure, clinical trials designed to measure the effectiveness of aggressive therapy will need to be large. © 1995 Wiley

ISSN:8756-0437    

DOI:10.1002/ssu.2980110103

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY

摘要:

AbstractMany of the difficulties in understanding diseases of the prostate have arisen through poor understanding of the anatomy of the prostate. The recent description of histologically separate zones in the prostate has been an important advance, allowing evaluation of separate cancers arising in the transition and peripheral zones of the prostate. While the majority of cancers sampled at transurethral resection of the prostate (TURP) are of transition zone origin, most of these prostates contain separate cancers in the peripheral zone. The peripheral zone cancers have a higher grade‐to‐volume ratio and are more frequently associated with histological features of progression (extracapsular extension, seminal vesicle invasion) than transition zone cancers. Furthermore, peripheral zone cancers are frequently associated with prostatic intraepithelial neoplasia, in contrast to transition zone cancers. These findings suggest a greater biological activity for cancers arising in the peripheral zone. The majority of cancers detected by digital rectal examination are of peripheral zone origin. While associated transition zone cancers are less frequently present than in TURP sampled prostates, a similarly high association of peripheral zone cancers with histological indicators of biological activity is seen. DNA ploidy analysis of separate foci in radical prostatectomy specimens confirms a significantly higher rate of non‐diploidy in cancers of peripheral zone origin, some of very small volume, which further suggests a greater biological activity compared to transition zone cancers. © 1995 Wiley‐L

ISSN:8756-0437    

DOI:10.1002/ssu.2980110104

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY

摘要:

AbstractThe optimal tumor marker for prostate cancer would be effective for early detection, staging, and monitoring patients after definitive treatment. This marker would have a high sensitivity, specificity, and positive predictive value for distinguishing men with benign prostatic hy‐perplasia (BPH) from men with early prostate cancer. Such a marker would consistently detect biologically significant disease, correlate with clinical and pathologic staging, and predict prognosis. In addition, this marker would be accurate at indicating cure or progression of disease after treatment. Certainly, the ideal marker also would be reproducible, inexpensive, generate results rapidly, be easy to perform, be accessible to clinicians, and tolerable to patients. Unfortunately, such a “super” marker does not exist at this time. However, prostate‐specific antigen (PSA) has many of the aforementioned capabilities. This article will describe the current utility of PSA in the diagnosis and staging of prostate cancer. © 1995 Wiley

ISSN:8756-0437    

DOI:10.1002/ssu.2980110105

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY

摘要:

AbstractTransrectal ultrasonography (TRUS), digital rectal examination (DRE), and quantification of serum prostate‐specific antigen (PSA) are accepted and evaluated methods for detecting prostate cancer. Positive predictive values (PPV) of DRE and TRUS are low, and only slightly enhanced when used in combination with PSA. PSA lacks sufficient sensitivity and specifity to be used alone as a screening test for prostate cancer. The parameters PSA‐density and PSA‐velocity make PSA a better tumor marker, but they are not reliable on an individual basis. Age‐specific reference ranges have the potential to make PSA a more sensitive tumor marker for men less than 60 years of age and a more specific one for men beyond 60 years. With currently available diagnostic methods approximately 10% of patients undergoing transurethral or open resection of the prostate for presumed benign prostatic hyperplasia will have carcinoma detected in the histologie material. In 392 patients successively treated in our clinic for presumed BPH and thoroughly investigated to exclude prostatic carcinoma (DRE, TRUS, biopsy when PSA>4 ng/ml or PSA‐D>0.15), the tumor was found incidentally in 4%. Another finding in this study was the detection of prostatic carcinoma by random biopsy in patients without a palpable or visible tumor by imaging and without PSA increase (>4 ng/ml). Biopsies were performed because of a hypoe‐choic zone in the opposite lobe which turned out to be negative. Such tumors cannot be properly classified in the current TNM system. Treatment options for patients with incidental prostatic carcinoma are age‐ and stage‐dependent. Patients less than 60 years old may be treated with a curative approach, irrespective of the T category (Tla or Tib); patients with a life expectancy longer than 10 years and a pTlb incidental carcinoma likewise should be offered a curative therapy. © 1995

ISSN:8756-0437    

DOI:10.1002/ssu.2980110106

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY

摘要:

AbstractScreening for prostate cancer has intensified, due both to increased patient and physician awareness and to the availability of new, more sensitive diagnostic tools (prostate‐specific antigen [PSA], rectal ultrasound, etc.). Consequently, the number of newly diagnosed cases of prostatic cancer is rising rapidly, whereas the frequency of death due to prostate cancer remains almost stable. It must therefore be assumed that the number of patients in whom a diagnosed prostate cancer will not be fatal is also increasing. Consequently, not every prostatic carcinoma requires radical treatment when diagnosed. Also, it must be concluded that not every man who is a long‐term survivor after radical prostatectomy owes his survival to the treatment. Long‐term survival may reflect the relatively benign biological potential of this disease in an individual patient. Therefore there is an inherent risk of overtreat‐ing patients and this must be weighed against the costs, the postoperative morbidity, and the mortality, albeit low, of a radical prostatectomy. Nevertheless, as long as we do not have diagnostic tools which, at an early stage of prostatic cancer, enable us to determine whether a carcinoma will ultimately have a fatal outcome, we are obliged to offer a radical prostatectomy to younger patients (who have a life expectancy of more than 10 years) as long as they have organ‐confined disease. © 1995 Wiley

ISSN:8756-0437    

DOI:10.1002/ssu.2980110107

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY

摘要:

AbstractRadical radiotherapy has been established as an effective modality for eradicating localised prostate cancer. No satisfactory comparisons have been made with patients treated by total prostatectomy, but in surgically staged patients with negative lymph nodes survival after radiotherapy exceeds that of an aged matched population, cancer deaths occurring in only 6–15% of patients and 85% remaining free of local recurrence after 10 years. Results are predictably less satisfactory in surgically unstaged cases and for more advanced localised presentations. Nevertheless, radical radiotherapy achieves local control of disease in the majority of patients. Improved local control may be obtained by increasing radiation dose but at the expense of increased radiation‐induced side‐effects. Conformai radiotherapy and combined modality treatment with the neoadjuvant or adjuvant androgen deprivation show considerable promise as novel methods to improve the therapeutic ratio, and prospective randomised studies are underway to test these approaches. © 1995 Wiley‐L

ISSN:8756-0437    

DOI:10.1002/ssu.2980110108

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY

摘要:

AbstractThe Southwest Oncology Group Genitourinary Committee evolved in 1978 from a combined gynecologie‐urologie cancer committee. A significant catalyst in this development was the growing interest in prosta‐tic carcinoma, with an initial focus on hormone refractory disease. Clinical studies have expanded into combined androgen blockade, untreated metastatic disease and localized prostate cancer. Since 1978, more than forty trials in prostatic carcinoma have been conducted. Currently, seven are in progress or under development. Conclusions and future directions are reviewed. © 1995 Wiley‐Lis

ISSN:8756-0437    

DOI:10.1002/ssu.2980110109

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY

摘要:

AbstractEfforts continue to improve the outlook for patients with all stages of prostate cancer. The addition of adjuvant or neo‐adjuvant hormone therapy to radical prostatectomy may improve the curability of advanced localized disease. Various novel forms of maximal androgen blockade continue to be explored, including the reintroduction of safer forms of estrogen therapy. Chemotherapy remains largely experimental but its earlier introduction, when the patient's general condition remains good, may lead to improvement in the quantity and quality of life of patients with advanced disease. © 1995 Wiley‐Liss,

ISSN:8756-0437    

DOI:10.1002/ssu.2980110110

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY

摘要:

AbstractOestrogen therapy or orchidectomy reigned supreme for the treatment of metastatic prostatic cancer for almost 40 years. In the last 15 years many alternative agents have been tested alone and more recently in combination. This contribution evaluates the results of some of these newer therapies considering relief of symptoms, toxicity, quality of life, survival, and benefit to the community. The results are compared with those of oestrogen therapy and with the way in which such treatment might be amended in light of more modern knowledge. © 1995 Wiley‐Liss, I

ISSN:8756-0437    

DOI:10.1002/ssu.2980110111

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY