Seminars in urologic oncology最新文献

{"title":"Relevant patient and tumor considerations for early prostate cancer treatment.","authors":"B. Leak, John T. Wei, M. Gabel, J. Peabody, M. Menon, R. Demers, A. Tewari","doi":"10.1053/SURO.2002.30397","DOIUrl":"https://doi.org/10.1053/SURO.2002.30397","url":null,"abstract":"Prostate cancer remains the most commonly diagnosed noncutaneous malignancy in American men. Currently, there are 3 standard treatment options available to men with early prostate cancer: expectant management, radiation therapy, and radical prostatectomy. Although a number of studies have evaluated survival after treatment for early prostate cancer, the optimal choice of therapy for any given patient remains a difficult decision and requires the consideration of a variety of patient and tumor factors. The final selection of therapy for early prostate cancer should be based on an informed discussion between the physician and patient. To accomplish this goal, patients must be made familiar with the pertinent factors that affect survival. We review the factors most relevant for patients to understand as they consider their treatment options for early prostate cancer and summarize the data for physicians who counsel them.","PeriodicalId":79436,"journal":{"name":"Seminars in urologic oncology","volume":"20 1 1","pages":"39-44"},"PeriodicalIF":0.0,"publicationDate":"2002-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58397917","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":"Shared decision-making strategies for early prostate cancer.","authors":"John T. Wei, R. Uzzo","doi":"10.1053/SURO.2002.30401","DOIUrl":"https://doi.org/10.1053/SURO.2002.30401","url":null,"abstract":"Prostate cancer remains one of the most prevalent and least understood of all human malignancies. Pathologic evidence suggests that neoplastic changes of the prostate epithelium begin early in a man's adult life, but do not become clinically evident or relevant until decades later. The natural history of this enigmatic disease is heterogeneous, ranging from a benign and indolent course to one that rapidly progresses, causing significant morbidity and mortality. The divergent aspects of prostate cancer are underscored by vast differences in incidence and mortality statistics, causing consternation among clinicians and patients regarding the relative value of early detection, screening, and treatment strategies. Competing risks and perceived benefits of proposed treatment options including surgery, radiation therapy, hormonal deprivation, watchful waiting, and newer technologies are complex. Given these uncertainties, how should patients integrate these data and what role must physicians play in the process? Here we present a summary of shared decision making for men with localized prostate cancer. We approach this task by using a clinical case scenario to discuss issues relating to incidence and mortality trends, uncertainty regarding natural history, biopsy techniques and concerns, relevant tumor and clinical data, patient information gathering through Web-based resources, as well as support and advocacy groups, outcomes implications, and methods patients use to approach treatment decisions. We present a unified platform for shared decision-making strategies regarding prostate cancer in clinical practice.","PeriodicalId":79436,"journal":{"name":"Seminars in urologic oncology","volume":"20 1 1","pages":"74-8"},"PeriodicalIF":0.0,"publicationDate":"2002-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58398284","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":"Clarifying uncertainty regarding detection and treatment of early-stage prostate cancer.","authors":"T. Wilt","doi":"10.1053/SURO.2002.30393","DOIUrl":"https://doi.org/10.1053/SURO.2002.30393","url":null,"abstract":"Detection and treatment of prostate cancer can theoretically identify and cure a potentially disabling and deadly disease. However, controversy exists primarily because of the absence of randomized controlled trials (RCTs) documenting that these strategies improve survival and quality of life. In the absence of definitive information from RCTs, patients seek information and recommendations from many sources. Physicians have an opportunity to help patients and their families sort through the vast array of conflicting and confusing information. Rather then recommending for or against routine prostate-specific antigen (PSA) testing, physicians should provide men who are interested in prostate cancer testing, 50 years of age and older, and have a life expectancy of at least 10 to 15 years, with balanced information about the potential benefits and established harms of screening, diagnosis, and treatment. Validated informational materials can effectively and efficiently promote shared decision making. For early prostate cancer detection, the minimum information should include: the likelihood that prostate cancer will be diagnosed, possibilities of false-positive and false-negative results, anxiety associated with a positive test, and uncertainty regarding whether screening reduces the risk for death from prostate cancer. For men with localized prostate cancer, acceptable treatment options include radical prostatectomy, radiation therapy, cryotherapy, early androgen-suppression therapy, and watchful waiting. These are all considered acceptable options because data do not provide clear-cut evidence for the superiority of any 1 treatment. The only RCT comparing surgery to watchful waiting, though of relatively small size and conducted before PSA testing, showed no difference in survival after 23 years of follow-up. Watchful waiting does not remove prostate cancer, may miss an opportunity to cure or delay disease progression, and may lead to increased patient anxiety. However, watchful waiting avoids the harmful side effects of early intervention and does provide palliative therapy if and when symptomatic disease progression occurs. Furthermore, intervention is not necessary in the vast majority of men because most prostate cancers do not cause mortality or serious morbidity. Therefore, quality of life in many men treated with watchful waiting is superior to those treated with early intervention. For the minority of men with prostate cancer likely to cause disability or death, early intervention options may not be effective. Although commonly used in other countries, watchful waiting is rarely recommended in the United States. The opportunity exists to resolve the confusion, close the gaps in knowledge, and enhance prostate cancer care by conducting RCTs. Until these RCTs are completed, physicians can assist patients by providing a balanced presentation of the known risks and potential but unproven benefits of detection and treatment options and incorpora","PeriodicalId":79436,"journal":{"name":"Seminars in urologic oncology","volume":"20 1 1","pages":"10-7"},"PeriodicalIF":0.0,"publicationDate":"2002-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58397548","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":"Decision-making strategies for patients with localized prostate cancer.","authors":"M. Diefenbach, Jenevie Dorsey, R. Uzzo, G. Hanks, R. Greenberg, E. Horwitz, Fredrick Newton, P. Engstrom","doi":"10.1053/SURO.2002.30399","DOIUrl":"https://doi.org/10.1053/SURO.2002.30399","url":null,"abstract":"Patients diagnosed with early-stage prostate cancer not only have to cope with the impact of the cancer diagnosis, but also need to interpret complicated medical information to make an informed treatment decision. We report initial results from an ongoing longitudinal investigation examining treatment decision making among men diagnosed with early stage prostate cancer. Men (N = 654) were recruited into the assessment study after an initial treatment consultation with a urologic surgeon or radiation oncologist. Patients were, on average, 66 years old, married (85%), had at least a high school education (45%), were retired (58%), and were Caucasian (91%) or African American (7%). Guided by a cognitive-affective theoretical framework, we assessed treatment and disease-relevant beliefs and affects in addition to clinical variables. The majority of patients decided on external beam radiation therapy (52%), followed by brachytherapy (25%), prostatectomy (17%), and watchful waiting (6%). Patients who decided on prostatectomy were significantly younger (mean age, 58 yr) than patients who received radiation therapy (mean age, 67 yr) and brachytherapy (mean age, 66 yr). When asked for the most important reason influencing their treatment decision, patients indicated physician recommendation (51%), advice from friends and family (19%), information obtained from books and journals (18%), or the Internet (7%). Among cognitive variables, patients who decided on surgery perceived prostate cancer as being significantly more serious (P <.001), and had greater difficulties in making a treatment decision (P <.005) compared with patients receiving radiation therapy or brachytherapy. Surgical patients were also more distressed about their treatment decision (P <.001) and concerned that the cancer might spread (P <.005). To date, patients followed-up after treatment have not indicated significant regrets about their therapeutic choice. These data suggest that unique treatment-related beliefs and affects need to be taken into account during the treatment counseling process. Implications for the development of decision aids are discussed.","PeriodicalId":79436,"journal":{"name":"Seminars in urologic oncology","volume":"20 1 1","pages":"55-62"},"PeriodicalIF":0.0,"publicationDate":"2002-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58398060","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":"Prostate cancer and the educated consumer.","authors":"R. Uzzo, John T. Wei","doi":"10.1053/SURO.2002.30386","DOIUrl":"https://doi.org/10.1053/SURO.2002.30386","url":null,"abstract":"","PeriodicalId":79436,"journal":{"name":"Seminars in urologic oncology","volume":"20 1 1","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2002-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58397437","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":"Prostate cancer support and advocacy groups: their role for patients and family members.","authors":"S. Manne","doi":"10.1053/SURO.2002.30398","DOIUrl":"https://doi.org/10.1053/SURO.2002.30398","url":null,"abstract":"Patients and their families are profoundly affected by the diagnosis of prostate cancer. Competing treatment options and uncertainty regarding the expected course of their disease may provoke strong emotional reactions including depressive symptoms and feelings of overwhelming anxiety. Despite potentially significant implications regarding quality-of-life (QOL) issues associated with various forms of treatment, few studies have focused specifically on the psychologic reactions among men with the disease or their family members. In response to this critical lack of psychosocial information and care, many affected individuals turn to prostate cancer support or advocacy groups for their educational needs, coping strategies, assistance with concerns about medical decisions, and peer networking. This article summarizes the psychologic impact of a prostate cancer diagnosis on patients, spouses, and family members and reviews pertinent advocacy and support information available to men affected by this disease and the physicians who care for them.","PeriodicalId":79436,"journal":{"name":"Seminars in urologic oncology","volume":"20 1 1","pages":"45-54"},"PeriodicalIF":0.0,"publicationDate":"2002-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58397983","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":"Intravesical therapy for superficial bladder cancer.","authors":"S B Malkowicz","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Intravesical therapy is a classic approach to the treatment of superficial bladder cancer. Bacillus Calmette-Guerin (BCG) has assumed the role of the most commonly administered agent, and clearly the most effective form of therapy for carcinoma in situ. Recent data quantify the advantage of \"booster\" treatments over a 3-year interval but suggest that current regimens are not easily tolerated by most patients. Initial studies suggest a role for intravesical interferon in potentiating the effect of BCG. Classic intravesical chemotherapy can decrease tumor recurrence by 14% to 17%, but no data exist to demonstrate any positive effect on decreasing tumor progression. Recent studies suggest a growing rationale for the intravesical administration of a single dose of a chemotherapeutic agent to decrease early tumor recurrence.</p>","PeriodicalId":79436,"journal":{"name":"Seminars in urologic oncology","volume":"18 4","pages":"280-8"},"PeriodicalIF":0.0,"publicationDate":"2000-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21925183","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":"Organ preservation by external beam and afterloading interstitial radiation in patients with muscle infiltrating bladder cancer.","authors":"A Wijnmaalen,&nbsp;C C Boeken Kruger","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In several European cancer centers, the combination of external beam and interstitial radiotherapy with the aim of bladder preservation is standard treatment in a selected group of patients with muscle-infiltrating bladder cancer. Three case reports are presented. The published local control rates at 5 years vary from 64% to 88% and the 5-year overall and disease-free survival range from 47% to 66% and from 62% to 81%, respectively. It is concluded that this approach is successful in preserving the bladder. Conditions for good results are careful selection of patients, excellent cooperation between urologist and radiation oncologist, and modern brachytherapy facilities.</p>","PeriodicalId":79436,"journal":{"name":"Seminars in urologic oncology","volume":"18 4","pages":"308-12"},"PeriodicalIF":0.0,"publicationDate":"2000-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21925187","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":"Multimodality therapy for the treatment of muscle-invasive bladder cancer.","authors":"S A Thurman,&nbsp;T L DeWeese","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In the United States, local management of muscle-invasive bladder cancer largely remains radical cystectomy with urinary diversion. However, this approach is undergoing transition. Organ-preserving approaches using a combination of multiple modalities have been successfully applied to the management of several types of cancer and clearly play an important role in the management of muscle-invasive bladder cancer as well. Since the 1980s, several single and multi-institutional trials have confirmed that a combined modality organ-preserving approach (chemotherapy administered in conjunction with radiation) consistently confers equivalent overall survival compared with survival following radical cystectomy. These trials are very encouraging and allow organ preservation to be considered an appropriate therapeutic option for patients with muscle-invasive bladder cancer.</p>","PeriodicalId":79436,"journal":{"name":"Seminars in urologic oncology","volume":"18 4","pages":"313-22"},"PeriodicalIF":0.0,"publicationDate":"2000-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21925188","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":"Indications for early cystectomy.","authors":"J P Stein","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Treatment goals for superficial bladder cancer are two-fold: (1) reducing tumor recurrence and the subsequent need for additional therapies (cystoscopy, transurethral resection, intravesical therapy) and the morbidity associated with these treatments; and (2) preventing tumor progression and the subsequent need for more aggressive therapy. The administration of intravesical therapy has become an important component in these treatment goals; however, there remains a group of patients with superficial bladder cancer that are at risk of disease progression, metastases, and death from their disease. The treating urologist must be extremely active and diligent when treating patients with superficial bladder cancer. An understanding of tumor biology and current intravesical therapies is important. Furthermore, and perhaps most important, the timely decision to abandon conservative therapy and proceed with radical cystectomy and urinary diversion should be kept in mind to prevent the potentially lethal sequelae of invasive bladder cancer. In view of the potential for recurrence, stage progression, and significant clinical understaging of patients with superficial bladder cancer, and the fact that radical cystectomy provides excellent results with regard to prevention of local recurrence and overall survival, radical cystectomy should be considered in patients with high-risk factors. Radical cystectomy may also provide important prognostic information and influence the decision for adjuvant therapy based on pathologic criteria. Finally, definite improvements in lower urinary tract reconstruction and nerve-sparing techniques have decreased the social implications of cystectomy for both men and women.</p>","PeriodicalId":79436,"journal":{"name":"Seminars in urologic oncology","volume":"18 4","pages":"289-95"},"PeriodicalIF":0.0,"publicationDate":"2000-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21925184","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}