RESUMEN
INTRODUCTION: Only very few case reports exist regarding the incidence of prostate cancer in younger HIV-infected patients. PATIENTS AND METHODS: Two incidences of HIV-infected men diagnosed with prostate cancer, from a cohort of about 200 men treated at St George's Hospital aged 40 years or more are reported. DISCUSSION: On the basis of the evidence presented in both case reports and from the literature, clinicians should be aware that men with HIV infection should be considered a high-risk group for prostate cancer, and consider early PSA screening.
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Infecciones por VIH/complicaciones , Neoplasias de la Próstata/etiología , Diagnóstico Precoz , Humanos , Masculino , Persona de Mediana Edad , Antígeno Prostático Específico/análisis , Neoplasias de la Próstata/prevención & control , Factores de RiesgoRESUMEN
PURPOSE: There are a significant number of patients with asymptomatic hormone-resistant prostate cancer who have increasing prostate-specific antigen (PSA) levels but little or no evaluable disease. The immunogenicity and minimal toxicity associated with cell-based vaccine therapy makes this approach attractive for these patients. EXPERIMENTAL DESIGN: We have evaluated a vaccine comprising monthly intradermal injection of three irradiated allogeneic prostate cell lines (8 x 10(6) cells each) over 1 year. The first two doses were supplemented with bacille Calmette-Guérin as vaccine adjuvant. Twenty-eight hormone-resistant prostate cancer patients were enrolled. Patients were assessed clinically and PSA levels were measured monthly. Radiologic scans (X-ray, computed tomography, and bone scan) were taken at baseline and at intervals throughout the treatment period. Comprehensive monthly immunologic monitoring was undertaken including proliferation studies, activation markers, cytokine protein expression, and gene copy number. This longitudinal data was analyzed through predictive modeling using artificial neural network feed-forward/back-propagation algorithms with multilayer perceptron architecture. RESULTS: Eleven of the 26 patients showed statistically significant, prolonged decreases in their PSA velocity (PSAV). None experienced any significant toxicity. Median time to disease progression was 58 weeks, compared with recent studies of other agents and historical control values of around 28 weeks. PSAV-responding patients showed a titratable T(H)1 cytokine release profile in response to restimulation with a vaccine lysate, while nonresponders showed a mixed T(H)1 and T(H)2 response. Furthermore, immunologic profile correlated with PSAV response by artificial neural network analysis. We found predictive power not only in expression of cytokines after maximal stimulation with phorbol 12-myristate 13-acetate, but also the method of analysis (qPCR measurement of IFN-gamma > qPCR measurement tumor necrosis factor-alpha > protein expression of IFN-gamma > protein expression of interleukin 2). CONCLUSIONS: Whole cell allogeneic vaccination in hormone-resistant prostate cancer is nontoxic and improves the natural history of the disease. Longitudinal changes in immunologic function in vaccinated patients may be better interpreted through predictive modeling using tools such as the artificial neural network rather than periodic "snapshot" readouts.
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Vacunas contra el Cáncer/uso terapéutico , Neoplasias de la Próstata/terapia , Anciano , Antígenos CD/análisis , Antineoplásicos Hormonales/administración & dosificación , Antineoplásicos Hormonales/uso terapéutico , Vacunas contra el Cáncer/efectos adversos , Vacunas contra el Cáncer/inmunología , Línea Celular , Línea Celular Tumoral , Proliferación Celular/efectos de los fármacos , Citocinas/genética , Diarrea/etiología , Progresión de la Enfermedad , Resistencia a Antineoplásicos , Citometría de Flujo , Humanos , Inmunoterapia/métodos , Leucocitos Mononucleares/efectos de los fármacos , Leucocitos Mononucleares/inmunología , Leucocitos Mononucleares/metabolismo , Masculino , Persona de Mediana Edad , Náusea/etiología , Redes Neurales de la Computación , Neoplasias de la Próstata/inmunología , Neoplasias de la Próstata/patología , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Linfocitos T/citología , Linfocitos T/efectos de los fármacos , Resultado del Tratamiento , Vómitos/etiologíaRESUMEN
BACKGROUND: The era of patient-focused care has brought a new dimension to medical treatment. Now, as well as looking for therapies that work effectively, they must also be acceptable to patients. Previous studies in this department have shown that stone clearance rates with lithotripsy compare favourably with national standards, but very little work has been done regarding patient's own perception of the experience. METHODS: A postal survey was conducted of all patients attending the lithotripsy unit over a period of 1 year, questioning their opinion of all aspects of the treatment. The results were analysed by conversion to a numerical score. RESULTS: On the whole, patients expressed satisfaction, but they were more dissatisfied with the stone clearance than any other aspect of their treatment. In the light of a previous study, it was felt that the patients' expectations were unrealistic. As a result, we changed our practice such that patients attending the unit have a better idea of the likelihood of success. CONCLUSIONS: This was a simple and cost-effective exercise, that has generated some valuable data which can be used to improve the entire patient experience.
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Litotricia/psicología , Satisfacción del Paciente , Encuestas Epidemiológicas , Humanos , Encuestas y Cuestionarios , Cálculos Urinarios/psicología , Cálculos Urinarios/terapiaRESUMEN
BACKGROUND AND PURPOSE: Extracorporeal shockwave lithotripsy (SWL) is an effective noninvasive, outpatient method of stone clearance. In our unit, it is performed using a combination of oral analgesia and intravenous sedation, which allows us to treat to therapeutic levels in the vast majority of our patients. However, we have encountered patients who do not tolerate various elements of the analgesia protocol and thus cannot be treated to full effect. The options for these people are currently limited to either SWL under formal sedation or epidural or general anesthetic or the use of another technique of stone clearance, such as percutaneous nephrolithotomy, which may not be as appropriate, and again necessitates an anesthetic, an inpatient stay, or both. PATIENTS AND METHODS: We describe three patients who had previously failed SWL who received acupuncture in place of standard analgesia prior to the next treatment. RESULTS: All three patients were able to tolerate the procedure better and were treated at a higher level with more shocks than in the previous session. No side effects were noted. CONCLUSIONS: We propose that acupuncture may be considered in patients unable to take standard sedoanalgesia. It is a cost-effective, safe method of inducing sedation with analgesia and had no demonstrable side effects in our series. It provides an attractive alternative to the use of general or regional anesthetics in these patients.