The Prostate. Supplement最新文献

{"title":"An overview of current clinical experience with strontium-89 (Metastron).","authors":"S D Bos","doi":"10.1002/pros.2990250708","DOIUrl":"https://doi.org/10.1002/pros.2990250708","url":null,"abstract":"<p><p>Prostate cancer is one of the most common tumors in men. At presentation, 50% of patients have advanced disease and 25% have bone metastases. Hormonal palliation is the treatment of choice for metastatic bone pain, with a pain-free response rate of 75% for a period of 16-18 months. Second-line treatment with chemotherapy has a moderate and short-term effect. Once endocrine therapy and chemotherapy cease to be effective, radiotherapy is a good option for recurrent painful bone metastases. Diffuse painful metastases can be treated with half-body irradiation with a response rate of up to 70%, but there is considerable toxicity. Strontium-89 (Metastron) is a calcium analog radionuclide that is selectively absorbed at bone locations with increased osteoblastic activity. It is a pure beta-emitter with bone penetration of 0.8 cm, and it has been used in multiple trials with response rates of up to 80%. Results are reported with Metastron in 28 patients with diffuse painful bone metastases, in whom a response rate of 82% was seen.</p>","PeriodicalId":77436,"journal":{"name":"The Prostate. Supplement","volume":"5 ","pages":"23-6"},"PeriodicalIF":0.0,"publicationDate":"1994-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/pros.2990250708","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19163453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of prostate-specific antigen as a predictor of outcome in prostate cancer.","authors":"G R Blackledge,&nbsp;K Lowery","doi":"10.1002/pros.2990250710","DOIUrl":"https://doi.org/10.1002/pros.2990250710","url":null,"abstract":"<p><p>Prostate-specific antigen (PSA) has been shown over the past few years to be a useful and sensitive marker for prostate cancer. During Phase III studies of the nonsteroidal antiandrogen, Casodex, in which different doses were compared with castration (either surgical or medical), serum PSA was measured on a regular basis. Attention was focused on the change in serum PSA from baseline after 3 months Casodex treatment and also on the number of patients receiving Casodex whose PSA returned to the normal range. Data from trials comparing Casodex, 50 mg/day, with castration showed a clear shortfall for Casodex compared with castration, in terms of percentage fall in PSA at 3 months, and also in the number of patients whose PSA fell into the normal range after 3 months. Subsequent analysis showed, however, that the PSA level was related to outcome in terms of time to progression. These data allowed the use of PSA to determine dose selection in a subsequent trial comparing Casodex, 100 mg/day or 150 mg/day, with castration. At the time of dose selection, changes in PSA showed a statistically significant difference between Casodex, 100 mg/day, and castration, but no significant difference between Casodex, 150 mg/day, and castration, either for the change in PSA at 3 months or for the proportion of patients whose PSA had fallen into the normal range. The idea that serum PSA levels can predict outcome in prostate cancer and that they are correlated with other measures of outcome, such as time to progression, is supported by these data. A decrease in PSA is not a true surrogate endpoint in that it cannot predict the outcome for an individual patient with complete accuracy, but it does correlate well with other measures of outcome, such as time to progression, for patient populations.</p>","PeriodicalId":77436,"journal":{"name":"The Prostate. Supplement","volume":"5 ","pages":"34-8"},"PeriodicalIF":0.0,"publicationDate":"1994-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/pros.2990250710","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"18521494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current clinical studies with a new nonsteroidal antiandrogen, Casodex.","authors":"A V Kaisary","doi":"10.1002/pros.2990250709","DOIUrl":"https://doi.org/10.1002/pros.2990250709","url":null,"abstract":"<p><p>The efficacy of Casodex (ICI 176,334; Zeneca Pharmaceuticals, Macclesfield, UK), a nonsteroidal antiandrogen, in the treatment of advanced prostate cancer has been compared in two trials with castration, either surgical (bilateral orchitectomy) or medical, with the gonadotropin-releasing hormone agonist Zoladex (goserelin acetate; Zeneca Pharmaceuticals). The half-life of Casodex is 7 to 10 days, and allows once-daily dosing. The first trial was a prospective, randomized study involving 150 patients receiving Casodex, 50 mg once daily p.o., and 154 patients undergoing castration. There were no significant differences between the two groups in subjective responses, time to treatment failure, or time to objective evidence of disease progression. The other study involved higher doses, the dose being selected after patients had received one of two doses of Casodex, 100 mg/day or 150 mg/day, in a double-blind study. On statistical analysis, it was clear that the higher dose was more effective, and thus most patients taking 100 mg/day were switched to 150 mg/day. Again, Casodex treatment was compared with medical or surgical castration. The higher dose of Casodex is well tolerated with a similar adverse event profile as the lower dose of 50 mg/day. Follow-up is as yet too short for an analysis of efficacy.</p>","PeriodicalId":77436,"journal":{"name":"The Prostate. Supplement","volume":"5 ","pages":"27-33"},"PeriodicalIF":0.0,"publicationDate":"1994-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/pros.2990250709","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19163454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical developments in prostate cancer. Proceedings of a satellite symposium at the 2nd International Congress of the Dutch Urological Association. Amsterdam, November 1993.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":77436,"journal":{"name":"The Prostate. Supplement","volume":"5 ","pages":"1-40"},"PeriodicalIF":0.0,"publicationDate":"1994-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"18908809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hormone therapy prior to radical prostatectomy in patients with clinical stage C prostate cancer.","authors":"G E Voges,&nbsp;A M Mottrie,&nbsp;M Stöckle,&nbsp;S C Müller","doi":"10.1002/pros.2990250704","DOIUrl":"https://doi.org/10.1002/pros.2990250704","url":null,"abstract":"<p><p>Seventy patients with clinical stage C carcinoma of the prostate were treated for 3 months with the gonadotropin-releasing hormone analog, goserelin acetate (Zoladex; Zeneca Pharmaceuticals, Macclesfield, UK) plus an antiandrogen (flutamide). Based on digital rectal examination (DRE), reductions of the size of the prostate and the tumor were noted in 91.4% of patients. Ultrasound demonstrated a decrease in prostatic volume between 0% and 62.5% (median 31%). Prostate-specific antigen (PSA) levels (Hybritech) decreased substantially (mean PSA of 31.3 ng/ml before, to a mean PSA of 1.4 ng/ml after hormonal treatment). A total of 64 patients subsequently underwent radical retropubic prostatectomy. Pathologically, only 9 patients (14.1%) had organ-confined disease (stage B), 34 (53.1%) had stage C tumors, and 21 (32.8%) had positive lymph nodes (stage D1). In 5 patients with nodal metastasis and 7 patients with seminal vesicle invasion, PSA levels after pretreatment were below 0.5 ng/ml. Maximal androgen blockade for a period of 3 months in clinical stage C prostate cancer induces a notable reduction in prostate size (\"downsizing\"). A \"downstaging\" effect, as suggested by DRE, ultrasound, and PSA, was not observed. Prospective studies with this treatment regimen should concentrate on a possible benefit concerning local and distant cancer control and survival.</p>","PeriodicalId":77436,"journal":{"name":"The Prostate. Supplement","volume":"5 ","pages":"4-8"},"PeriodicalIF":0.0,"publicationDate":"1994-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/pros.2990250704","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"18521495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neoadjuvant androgen blockade prior to prostatectomy: a retrospective study and critical review.","authors":"C C Schulman","doi":"10.1002/pros.2990250705","DOIUrl":"https://doi.org/10.1002/pros.2990250705","url":null,"abstract":"<p><p>The treatment of locally advanced prostatic cancer is controversial, as there are several possible treatment options. The aims of temporary androgen deprivation prior to radical prostatectomy are to achieve downgrading and downstaging of the tumor, an increase in local control, a decrease in morbidity and operative sequelae, a decrease in the time to progression, and an improvement in survival. A retrospective study has been carried out on 100 patients who underwent radical prostatectomy between 1988 and 1992. Forty patients received androgen deprivation therapy followed by prostatectomy, while the remaining 60 acted as controls, undergoing prostatectomy alone. Treated patients had a 40-50% reduction in prostate volume after 3 months, facilitating dissection of the prostate, reducing intraoperative blood loss, and reducing operation time. Of these 40 treated patients, one third showed clinical downstaging; one patient staged initially as T2/B was downstaged to PT0. The proportion of patients with positive surgical margins was 32% in the group treated preoperatively, compared with 57% in untreated patients. Treated patients also recovered full continence more rapidly after the operation than patients who underwent prostatectomy alone. After androgen blockade, serum PSA levels returned to normal (< 4 ng/ml) in 37 of the 40 patients. Of these patients, 22 had undetectable serum PSA levels (< 0.25 ng/ml), showing a definite reduction in tumor activity. PSA levels after 3 months of neoadjuvant hormonal treatment might play a useful predictive role in selecting patients before radical prostatectomy, since 86% with undetectable PSA had tumors confined to the gland (T2/B2), while patients who still had PSA > 4 ng/ml all had stage T3-T4 tumors. Although downstaging was confirmed pathologically in only 13% of patients, this is of significance when the total number of patients with locally advanced prostate cancer is considered and, therefore, may have implications for survival in the future. Prospective randomized studies should provide conclusive information on the potential benefit of this approach.</p>","PeriodicalId":77436,"journal":{"name":"The Prostate. Supplement","volume":"5 ","pages":"9-14"},"PeriodicalIF":0.0,"publicationDate":"1994-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/pros.2990250705","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"18521496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The position of cyproterone acetate (CPA), a steroidal anti-androgen, in the treatment of prostate cancer.","authors":"H J de Voogt","doi":"10.1002/pros.2990210514","DOIUrl":"https://doi.org/10.1002/pros.2990210514","url":null,"abstract":"<p><p>Cyproterone acetate is a steroidal anti-androgen that blocks the androgen-receptor interaction and reduces serum testosterone through its weak anti-gonadotropic action. It can be regarded as the only anti-hormone that causes complete androgen blockade as monotherapy. Many animal experiments and several clinical phase II and phase III trials have demonstrated that it deserves a place in the endocrine therapy of advanced prostate cancer, particularly for those patients who find orchidectomy unacceptable and who do not have known cardiovascular risks. Additionally, cyproterone acetate can be used safely to prevent disease flare when a luteinizing hormone releasing hormone analog is the drug of choice and to suppress hot flashes in response to LHRH agonists or after orchidectomy.</p>","PeriodicalId":77436,"journal":{"name":"The Prostate. Supplement","volume":"4 ","pages":"91-5"},"PeriodicalIF":0.0,"publicationDate":"1992-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/pros.2990210514","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"12701974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rectal examination and ultrasonography in the diagnosis of prostate cancer.","authors":"W H Cooner","doi":"10.1002/pros.2990210503","DOIUrl":"https://doi.org/10.1002/pros.2990210503","url":null,"abstract":"<p><p>Most patients with prostate cancer have disease that has extended beyond the confines of the gland at the time of diagnosis. The effect of earlier detection on morbidity and death requires further study, as does assessment of prognostic factors and optimal therapy for individual patients. Recent reports indicate the utility of using prostate specific antigen and digital rectal examination as preliminary tests to identify patients in whom further study by prostate ultrasonography will improve detection rates. The algorithm presented may be a useful guide in sequencing detection approaches. The value of mass screening for prostate cancer by any existing means remains unproven.</p>","PeriodicalId":77436,"journal":{"name":"The Prostate. Supplement","volume":"4 ","pages":"3-10"},"PeriodicalIF":0.0,"publicationDate":"1992-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/pros.2990210503","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"12546848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Local staging of prostate cancer with transrectal ultrasound: a literature review.","authors":"T Lorentzen,&nbsp;H Nerstrom,&nbsp;P Iversen,&nbsp;S T Torp-Pedersen","doi":"10.1002/pros.2990210504","DOIUrl":"https://doi.org/10.1002/pros.2990210504","url":null,"abstract":"<p><p>A literature review was undertaken to investigate whether transrectal ultrasound can predict the local stage of prostate cancer. Twelve papers were found which correlated ultrasound findings with surgical findings and another paper reported on strategic staging biopsies guided by transrectal ultrasound. Eleven of these papers reported on ultrasound findings in patients in whom digital rectal examination had defined localized disease. One paper compared ultrasound findings and digital rectal findings. One paper indicated that transrectal ultrasound, though not suited to patients with clinically localized disease defined by digital rectal examination, may be superior as the initial staging tool. We conclude that transrectal ultrasound has too low a specificity to upgrade the diagnostic results of digital rectal examination, but that it may be more useful as the primary staging tool and for guidance in strategic staging biopsies.</p>","PeriodicalId":77436,"journal":{"name":"The Prostate. Supplement","volume":"4 ","pages":"11-6"},"PeriodicalIF":0.0,"publicationDate":"1992-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/pros.2990210504","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"12741555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Volume of normal prostate, of prostate cancer, and of benign prostatic hyperplasia: are correlations with prostate specific antigen clinically useful?","authors":"R Clements,&nbsp;M D Penney,&nbsp;R J Etherington,&nbsp;G J Griffiths,&nbsp;H Hughes,&nbsp;W B Peeling","doi":"10.1002/pros.2990210508","DOIUrl":"https://doi.org/10.1002/pros.2990210508","url":null,"abstract":"<p><p>This retrospective study correlated prostate volume, determined by transrectal ultrasonography, with serum prostate specific antigen (PSA), by Deming regression analysis, in patients with confirmed benign prostatic hyperplasia (BPH) and patients with non-metastatic (M0) or metastatic (M1) prostate cancer. In BPH, a highly significant correlation was found between log10[PSA] and prostate volume. When this PSA/volume regression pattern for BPH was used as a reference standard, all 17 patients with M1 prostate cancer and 83% of the 23 patients with M0 disease were discriminated from BPH.</p>","PeriodicalId":77436,"journal":{"name":"The Prostate. Supplement","volume":"4 ","pages":"51-7"},"PeriodicalIF":0.0,"publicationDate":"1992-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/pros.2990210508","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"12546850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}