RESUMEN
OBJECTIVE: Management of lymph nodes in radiotherapy for prostate cancer is an issue for curative intent. To find the influence of lymph nodes, patients with T1-T3 prostate cancer and surgically confirmed negative nodes were treated with radiotherapy. METHODS: After lymphadenectomy, 118 patients received photon beam radiotherapy with 66 Gy to the prostate. No adjuvant treatment was performed until biochemical failure. After failure, hormone therapy was administered. Follow-up period was 57 months (mean). RESULTS: Biochemical failure occurred in 47 patients. Few failures were observed in patients with low (24%) and intermediate risks (14%). In contrast, 64% of high-risk patients experienced failure, 97% of whom showed until 36 months. Most patients with failure responded well to hormone therapy. After 15 months (mean), a second biochemical failure occurred in 21% of patients who had the first failure, most of them were high risk. Factors involving failure were high initial and nadir prostate-specific antigen, advanced stage, short prostate-specific antigen-doubling time and duration between radiation and first failure. Failure showed an insufficient reduction in prostate-specific antigen after radiotherapy. Factor for second failure was prostate-specific antigen-doubling time at first failure. CONCLUSIONS: Half of high-risk patients experienced biochemical failure, indicating one of the causes involves factors other than lymph nodes. Low-, intermediate- and the other half of high-risk patients did not need to take immediate hormone therapy after radiotherapy. After failure, delayed hormone therapy was effective. Prostate-specific antigen parameters were predictive factors for further outcome.
Asunto(s)
Neoplasias de la Próstata/radioterapia , Anciano , Anciano de 80 o más Años , Humanos , Escisión del Ganglio Linfático , Metástasis Linfática , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Neoplasias de la Próstata/mortalidad , Neoplasias de la Próstata/patología , Resultado del TratamientoRESUMEN
OBJECTIVE: Detection of prostate cancer needs a biopsy of the prostate. Suspecting cancer from an increase in prostate-specific antigen (PSA) has a high negative rate at an initial prostate biopsy. Cases with negative initial biopsy may be the candidates of subsequent biopsy. For lowering unnecessary repeat biopsy, the use of predictive factors before a repeat biopsy is applied for indication. METHODS: Seventy-seven cases with negative initial prostate biopsy received a repeat biopsy and factors for the detection of cancer were examined. RESULTS: PSA doubling time distinguished a part of cancer cases. Its sensitivity of 30, 50 and 70 months was 36.6%, 30.4% and 10%, respectively. Cancer case did not show PSA doubling time of >100 months in general. Values of PSA transition zone density, %Free/total PSA and PSA velocity were similar between cancer and no cancer cases. CONCLUSIONS: PSA doubling time was one of the predictive factors for the detection of prostate cancer and was valuable for avoiding unnecessary repeat biopsy in some cases.
Asunto(s)
Biomarcadores de Tumor/sangre , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/diagnóstico , Neoplasias de la Próstata/inmunología , Anciano , Biopsia , Detección Precoz del Cáncer , Humanos , Japón , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Sensibilidad y Especificidad , Factores de Tiempo , Procedimientos Innecesarios/tendenciasRESUMEN
This is an additional report of a case which Kinsui, et al. reported in 2000. A primary testicular tumor metastasized to the para-aortic lymph node in 6 years after the first high orichietectomy. In this case, we performed retroperitoneal lymph node dissection. After 4 months, the levels of 5-hydroxy indole acetic acid (5-HIAA), serotonin, urinary 5-HIAA were normalized without recurrence. This indicates testicular carcinoid needs long-term follow up.
Asunto(s)
Tumor Carcinoide/patología , Metástasis Linfática/patología , Neoplasias Testiculares/patología , Aorta Abdominal , Tumor Carcinoide/cirugía , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Testiculares/cirugía , Factores de TiempoRESUMEN
OBJECTIVE: Most patients with advanced prostate cancer after prostate-specific antigen (PSA) relapse following maximum androgen blockade rapidly progress to death. The present study was aimed to predict the survival of these serious patients after PSA relapse. METHODS: Sixty-eight patients with M1b and 20 patients with T3b, who relapsed and died of cancer within a short period, were studied. PSA-doubling time (PSA-DT) at PSA relapse influenced the outcome after PSA relapse [hazard ratio (CI): 2.000 (1.283-3.226)]; thus, on the basis of the median values of PSA-DT (>2 months) and additionally nadir PSA in previous treatment (2 months and nadir PSA of
Asunto(s)
Recurrencia Local de Neoplasia/mortalidad , Neoplasias Hormono-Dependientes/mortalidad , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/mortalidad , Anciano , Antineoplásicos Hormonales/uso terapéutico , Humanos , Masculino , Recurrencia Local de Neoplasia/sangre , Recurrencia Local de Neoplasia/patología , Neoplasias Hormono-Dependientes/sangre , Neoplasias Hormono-Dependientes/patología , Pronóstico , Neoplasias de la Próstata/sangre , Neoplasias de la Próstata/patología , Tasa de Supervivencia , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVE: Most of the metastatic diseases initially respond to maximum androgen blockade, but then relapse and lose response, and finally die. After relapse, the disease progresses in various courses. The present study was aimed to establish the predicting factors influencing the survival period of patients at prostate-specific antigen (PSA) relapse (entering the hormone refractory state). MATERIALS AND METHODS: Fifty-six patients with prostate cancer and bone metastasis, who were treated during the entire disease period at the same hospital and died were studied. To calculate PSA-doubling time, assay of PSA was carried out every 3 months or less. RESULTS: The period between PSA relapse and death was related with PSA-doubling time at relapse, nadir PSA and the period between the start of treatment and PSA relapse. The PSA-doubling time of 2 months or less at relapse was suggestive of a poor outcome. Final PSA-doubling time was not correlated with the survival period after PSA relapse. CONCLUSION: The PSA-doubling time at relapse is one of the relevant factors for predicting the survival period after PSA relapse.
Asunto(s)
Neoplasias Óseas/sangre , Neoplasias Óseas/secundario , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/sangre , Anciano , Anciano de 80 o más Años , Antagonistas de Andrógenos/uso terapéutico , Hormona Liberadora de Gonadotropina/agonistas , Humanos , Masculino , Persona de Mediana Edad , Orquiectomía , Neoplasias de la Próstata/mortalidad , Neoplasias de la Próstata/patología , Tasa de Supervivencia , Factores de Tiempo , Insuficiencia del TratamientoRESUMEN
AIM: Although the histopathological findings obtained from biopsy specimens are important for choosing the appropriate management of prostate cancer, there have been some discrepancies in Gleason grade and consequently, score between biopsy and surgical specimens. A comparison of findings between these two kinds of specimens was performed. METHODS: Radical prostatectomy was performed at Asahi General Hospital on 223 cases of T1b-T3 without previous cancer treatment, and the Gleason grade and score of the biopsy and surgical specimens were compared. RESULTS: A 37% coincidence in Gleason score was obtained between biopsy and surgical specimens; coincidence including one digit difference in score was approximately 70%. Upgrading was more than downgrading. Disagreement in secondary grade was greater than that in primary grade. Disagreement in Gleason score was roughly similar among different score items and was not influenced by level of prostate-specific antigen, however, the small volume of the cancer tissues more affected the discrepancy in score. CONCLUSION: The use of biopsy findings is required to be taken into account regarding the discrepancy.
Asunto(s)
Biopsia , Prostatectomía , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/cirugía , Anciano , Anciano de 80 o más Años , Humanos , Masculino , Persona de Mediana Edad , Estadificación de NeoplasiasRESUMEN
BACKGROUND: We conducted a case-control study to examine the impact of coronal heart disease (CHD) risk factors on calcium oxalate (CaOX) stone formation. METHODS: Variables included body mass index (BMI), current alcohol use, smoking habit, hypertension, hypercholesterolemia, diabetes mellitus, and hyperuricemia. Data suf fi cient for analysis were obtained for 181 CaOX stone formers and 187 controls. RESULTS: Seven of 181 stone formers (3.9%) had a history of CHD compared with none of 187 control subjects (P = 0.007). In univariate logistic regression analysis, smoking habit (OR 4.41, 95% CI 2.85-6.84, P < 0.0001), hypertension (OR 4.24, 95% CI 2.61-6.91, P < 0.0001), hypercholesterolemia (OR 3.03, 95% CI 1.77-5.20, P < 0.0001) and BMI (OR 1.10, 95% CI 1.04-1.17, P = 0.007) reached statistical signi fi cance. In a multivariate logistic regression analysis, smoking habit (OR 4.29, 95% CI 2.68-6.86, P < 0.0001), hypertension (OR 3.57, 95% CI 2.11-6.07, P < 0.0001), and hypercholesterolemia (OR 2.74, 95% CI 1.51-5.00, P = 0.001) reached statistical signi fi cance, while BMI (OR 1.06, 95% CI 0.99-1.12, P = 0.09) did not. CONCLUSIONS: CaOX stone formers are signi fi cantly associated with several CHD risk factors, including smoking habit, hypertension, hypercholesterolemia, and obesity.