Psychological distress in Japanese men with localized prostate cancer

OBJECTIVE: To investigate: (i) the level of psychological distress; and (ii) the relationships between the level of psychological distress and general or disease-specific HRQOL of Japanese men with localized prostate cancer following surgery or radiotherapy. PATIENTS AND METHODS: The study was a retrospective cross-sectional survey of 253 men with localized prostate cancer treated with radical prostatectomy and 87 with external beam radiotherapy were collected. The measures used four questionnaires including: (i) the Medical Outcomes Study 36-Item Health Survey; (ii) The University of California, Los Angeles Prostate Cancer Index; (iii) International Prostate Symptom Score; and (iv) Hospital Anxiety and Depression Scale (HADS). RESULTS: Mean anxiety and depression scores were 4.0 and 4.7, respectively (standard deviation, 3.3 and 3.7). On the anxiety section of HADS, 291 patients (85%) scored 7 points or less; and on the depression scale, 183 (54%) patients scored 4 points or less. Those 'cases' (HADS total, >10) with psychological distress scored lower in all domains of the general and disease related health-related quality of life (HRQOL) than the 'non-cases' (HADS total, 相似文献   

Preoperative predictors of cancerous involvement of the neurovascular bundles in patients with localized prostate cancer

BACKGROUND: The purpose of this study was to identify preoperative variables that would be useful in objectively selecting prostate cancer patients for nerve-sparing prostatectomy. METHODS: Twenty-six patients with clinical T1c-T2c cancers were evaluated for cancerous involvement in the region of the neurovascular bundles (NVB) from prostatectomy specimens. Preoperative prostate-specific antigen (PSA) and pathologic features in systematic biopsy specimens also were reviewed. RESULTS: A total of eight (31%) patients had cancerous involvement in the region of the NVB, including four on the right side, three on the left side and one on both sides. The percentage of each biopsy specimen occupied by the cancer was scored from zero to four and defined as the positive biopsy score. Preoperative PSA (P = 0.046), mean positive biopsy score (total sum of positive biopsy score divided by number of biopsy specimens; P = 0.001), number of cores containing cancer (P = 0.011), percentage of cores involved (P = 0.036) and maximum positive biopsy score (P < 0.001) were significant for predicting cancerous involvement in the NVB region using univariate analysis. However, only the mean positive biopsy score was independently significant according to multivariate analysis. To predict cancerous involvement in the region of each NVB, we found that ipsilateral mean positive biopsy score (total sum of corresponding positive biopsy score divided by number of ipsilateral biopsy specimens), number of cores involved on the ipsilateral side, percentage of cores involved on the ipsilateral side and maximum positive biopsy score on the ipsilateral side were significant predictive variables: the ipsilateral mean positive biopsy score being most appropriate for clinical practice. CONCLUSION: Ipsilateral mean positive biopsy score in systematic biopsy specimens can be an appropriate variable for selecting patients with localized prostate cancer for nerve-sparing prostatectomy.     

The impact of prostatectomy and brachytherapy in patients with localized prostate cancer

PURPOSE: to compare urinary incontinence and erectile dysfunction symptoms reflecting quality of life and the willingness to undergo treatment again in patients treated by radical retropubic prostatectomy and low dose radiation (LDR) brachytherapy. MATERIALS AND METHODS: from July 1992 to November 2001, 158 patients with clinical localized prostate cancer were treated by radical retropubic prostatectomy with or without nerve sparring or LDR brachytherapy. To all the 158 patients we mailed a self-reporting questionnaire with 5 questions to access sexual function, 4 questions for urinary continence, and 2 for the satisfaction with the treatment and willingness to undergo treatment again. Patients had no form of adjuvant radiation therapy, or neoadjuvant or adjuvant androgen suppression therapy. A total of 56 patients (43%), 34 of the prostatectomy and 22 patients of the brachytherapy group answered the questionnaire. Questionnaire results were independently analyzed by someone else not involved with patients' treatment. RESULTS: patients self-reported some degree of erectile dysfunction in 84.8% (p = 0.01) in the group treated by prostatectomy and 23.07% (p = 0.86) in the brachytherapy group. Urinary incontinence occurred in 17.6% in the group treated by prostatectomy (p = 0.01) and in 9.5% (p = 0.52) in the brachytherapy group. Urinary incontinence and impotence significantly affected treatment satisfaction. However, considering satisfaction with the treatment and willingness to undergo treatment again, 88.2% of patients would elect surgery again and 95.5% brachytherapy again.     

Quality of life in patients with localized prostate cancer

To date, there are no studies conclusively documenting that one treatment for localized prostate cancer is superior to another in terms of overall survival. Therefore, patients must consider other outcomes when choosing primary therapy for localized disease. One of the most important factors patients consider when choosing their treatment is the effect of therapy on their quality of life (QOL). Over the past decade, there have been an increasing number of studies assessing health related QOL (HRQOL) outcomes in localized prostate cancer. The goal of this article is to review our current understanding of HRQOL in this disease. We will begin by examining the established HRQOL instruments for use in localized prostate cancer. We will then discuss the effect of various treatments on QOL and review the literature comparing HRQOL outcomes between therapies.     

Post-brachytherapy transurethral resection of the prostate in patients with localized prostate cancer

PURPOSE: We assessed the rate and results of transurethral resection of the prostate (TURP) in patients previously treated with brachytherapy as monotherapy for localized prostate cancer. MATERIALS AND METHODS: From May 1998 to May 2003, 600 patients with localized prostate cancer were treated with brachytherapy at our institution. Brachytherapy was performed as monotherapy with curative intent for clinically localized prostate cancer without adjuvant treatment in patients with clinical stages T1c (68.4%) or T2a (31.6%) disease. -Iodine and palladium implants were used in 583 and 7 patients, respectively. A real-time interactive implantation technique was used in all but the first 17 patients, who were treated using a preplanned technique. RESULTS: Of the 600 patients 19 (3.1%) underwent TURP after brachytherapy. Among the patients with acute urinary retention the median interval between prostate brachytherapy and urinary retention was 2 months (range 0.5 to 32). No TURP was done within 6 months after implant. The median interval between prostate brachytherapy and TURP was 7 months (range 6 to 41) and median prostate specific antigen (PSA) before TURP was 0.5 ng/ml (range 0.04 to 3.4). In the 19 patients the median weight of resected prostatic tissue was 8 gm (range 2 to 19) and 1 to 11 seeds were removed (median 5). The perioperative and postoperative courses were uneventful. There was no TURP related incontinence. With a median followup of 28 months after brachytherapy (range 7 to 48) no patient had clinical or biochemical evidence of disease progression, and for the group of 19 patients who underwent TURP median serum PSA at the end of followup was 0.38 ng/ml (range 0.03 to 3.4). CONCLUSIONS: After brachytherapy as monotherapy, TURP can be done safely if indicated. In our experience the resection of prostatic tissue along with a limited number of seeds at least 6 months after implantation did not impair PSA based biological and clinical results of brachy-therapy.     

Innovative concepts in early cancer detection and staging of localized prostate cancer

Prostate cancer is the most common malignancy in males. Men aged 50 years and older are recommended to undergo an annual digital rectal examination (DRE) and determination of prostate-specific antigen (PSA) in serum for early detection. Fortunately, disease-specific mortality continues to decline as a result of advances in screening, staging, and patient awareness. However, about 30% of men with a clinically organ-confined disease show evidence of extracapsular extension or seminal vesicle invasion on pathological analysis. Consequently, there is a need for more accurate diagnostic tools for planning tailored treatment. A variety of modern imaging techniques has been implemented in an attempt to obtain more precise staging, thereby allowing for more detailed counseling, and instituting optimum therapy. This review highlights developments in prostate cancer imaging that may improve staging and treatment planning for prostate cancer patients.     

胃癌患者心理痛苦的研究进展

综述心理痛苦的概念与内涵,胃癌患者的心理痛苦水平、评估工具、影响因素及干预措施。提出需构建胃癌患者心理痛苦模型,实施针对性的护理措施以减轻胃癌患者心理痛苦水平,提高生活质量。     

The risk of dying of prostate cancer in patients with clinically localized disease

From 1966 to 1979, 360 patients with clinical stages A2, B and C1 prostate cancer underwent staging pelvic lymphadenectomy, and completed a course of combined interstitial radioactive gold seeds and external beam radiotherapy. All patients had a normal serum prostatic acid phosphatase level and a bone scan negative for metastases. All patients were followed until death or for a mean of 7.3 years (range 1.2 to 18.25 years) for those alive at analysis. To determine the risk of dying of prostate cancer we reviewed the records of the 142 patients (39%) who died. At analysis 21% of the patients had died of prostate cancer and 17% of other known causes. The cause of death could not be determined in 4 patients (1%). Cardiovascular disease accounted for a fifth of all deaths. The actuarial risk of death of prostate cancer for all patients was 8 +/- 3% (+/- 2 standard errors) at 5 years and 30 +/- 7% at 10 years. The risk of death of all causes was 16 +/- 4% at 5 years and 46 +/- 7% at 10 years. An increased risk of cancer death was associated with established risk factors, including advanced local disease, poorly differentiated histology, pelvic nodal metastases and distant recurrence. We also noted a substantial risk of cancer death in patients who had local tumor recurrence. While previous studies have reported a relatively low incidence of cancer deaths (4 to 17%) in patients initially diagnosed with localized disease, our data suggest that prostate cancer is the major cause of mortality in such patients. Aggressive curative therapy, regardless of treatment modality, should be considered for localized prostate cancer in men with a life expectancy of 10 or more years.     

Laparoscopic pelvic lymphadenectomy in patients with localized prostate cancer]

Laparoscopic pelvic lymphadenectomy is a newly developed technique of lymph node dissection in patients with malignancy of the pelvic organs. Three patients with localized prostatic cancer underwent laparoscopic pelvic lymphadenectomy. The patients were 77 years old with stage C disease, 73 with stage B1, and 65 with stage A2. Five to ten lymph nodes were removed from each patient after laparoscopic procedures lasting 220 to 270 minutes. There were no complications during the procedures and their convalescence was uneventful. All lymph nodes were negative by pathological examination and a radical retropubic prostatectomy was done 2 weeks after the lymphadenectomy in two patients. The other patient was treated with external radiotherapy and bilateral orchiectomy. Patients with stage C cancer, a high serum level of prostate specific antigen or a high grade tumor are the best candidates for this less invasive staging procedure. The disadvantage of this procedure is long operation time and complications due to CO2 pneumoperitoneum.     

Transperitoneal endosurgical lymphadenectomy in patients with localized prostate cancer.

The main appeal of radiotherapy for carcinoma of the prostate lies in the low morbidity and good subsequent quality of life. The handicap of this approach is the absence of adequate staging through pelvic lymphadenectomy. A new operation with minimal morbidity for the patient is presented and described in detail: endosurgical (laparoscopic) pelvic lymphadenectomy. This operation can be performed on an outpatient basis and is extremely well tolerated by the patient. The results of the first 12 consecutive cases indicate that, with experience, the procedure can be performed within a reasonable time limit (90 to 205 minutes) and that the number of lymph nodes removed (right and left obturator fossae mean 7.6 and 7.1, respectively) is adequate. Endosurgical lymphadenectomy adds only minimal morbidity to the radiotherapeutic treatment of prostatic cancer but permits more accurate staging and, therefore, counseling of the patients.     

Watchful waiting for elderly patients with localized prostate cancer

Watchful-waiting policy is an important treatment option for some patients with localized prostate cancer and it is widely recognized in Western countries in which the prostate cancer mortality rate is 510 fold higher than that in Japan. Most men with well and perhaps moderately differentiated prostate cancer who have a life expectancy of less than 10 years will die of other causes and it is not clear whether early primary hormone therapy improves survival and the quality of life compared to androgen suppression deferred until signs and symptoms of clinical progression. There is one major question as to whether patients who do not need radical treatment should undergo early primary hormone therapy in Japan in spite of high cost and treatment-related adverse effects of hormone therapy.     

Sonographic and pathological staging of patients with clinically localized prostate cancer

We evaluated 64 patients with clinically localized prostate cancer (on the basis of rectal examination, serum acid phosphatase, bone scan and pelvic computerized tomography scan) by transrectal sonography before radical prostatectomy. Of the 48 patients with histologically proved localized prostate cancer sonography overstaged the disease in 5 (10%) and correctly staged it in 43 (90%). All overstaged cancer patients were scanned after either prostatic biopsy (4) or transurethral prostatectomy (1) established the diagnosis of prostate cancer. Of the 16 patients with histologically proved, locally advanced prostate cancer (that is extracapsular extension and/or seminal vesicle invasion) sonography understaged the disease in 10 (62%) and correctly staged the disease in 6 (38%). These data suggest that sonography is associated with considerable staging errors when used to evaluate men with clinically localized prostate cancer.     

The measurement of psychological distress in men being investigated for the presence of prostate cancer

High levels (>50%) of anxiety are reported in patients undergoing screening for prostate cancer, which may affect health-related quality of life. We aimed to determine the level and prevalence of anxiety and depression and to identify those aspects of the diagnostic pathway that induce the most stress in men being investigated for prostate cancer. A total of 159 prostate-specific antigen-unscreened men undergoing a transrectal ultrasound-guided biopsy of the prostate (TRUS-B) completed two questionnaires, prior to their biopsy and before receiving results, containing the Hospital Anxiety and Depression Scale (HADS) and a 10-point Visual Analogue Scale (VAS). Median scores and prevalence of anxiety (4-5, 4-7%) and depression (1-2, 1.4%) respectively were low for both questionnaires. Waiting for biopsy results received the highest median VAS score (6) and was the most stressful event in 65% of men. There is a low incidence of clinically significant anxiety and depression in men being investigated for prostate cancer but questionnaires such as HADS identify patients with psychological distress who may benefit from early counselling. Uncertainty about the future while awaiting biopsy results after TRUS-B seems to be the most stressful event in patients' lives and minimizing this wait should help optimize patient care.     

Obesity and prostate enlargement in men with localized prostate cancer

Study Type – Prevalence (retrospective cohort) Level of Evidence 2b What’s known on the subject? and What does the study add? Obesity is associated with prostate enlargement in men without prostate cancer. This study demonstrates an association between obesity and prostate enlargement in men with prostate cancer, and leads to possible implications for prostate cancer screening and diagnosis.

OBJECTIVE

? To determine if obesity is associated with prostate size in men with prostate cancer.

PATIENTS AND METHODS

? We examined preoperative body mass index (BMI) and whole prostate weight in a cohort of 16 325 patients undergoing radical prostatectomy for localized prostate cancer from 1975 to 2008 at a single institution. ? We used multivariable regression modelling adjusting for age, year of surgery, preoperative serum prostate‐specific antigen (PSA), pathological stage and Gleason grade.

RESULTS

? Of the entire cohort, 13 343 (82%) patients had a prostate weight of at least 40 g. These men were older (P < 0.001), had a higher preoperative BMI (P < 0.002), higher preoperative PSA (P < 0.001), and were more likely to have pT2 disease (P < 0.001). ? In multivariable regression, preoperative BMI was associated with increased prostate weight: for each 1 kg/m² increase in BMI, prostate weight increased by 0.45 g (95% CI 0.35–0.55, P‐trend < 0.001). ? Compared with men with BMI < 25 kg/m², men with a BMI ≥35 kg/m² had a 40% (odds ratio 1.40, 95% CI 1.01–1.95) increased risk of prostate weight of at least 40 g and a 70% (odds ratio 1.70, 95% CI 1.32–2.20) increased risk of prostate weight of at least 50 g.

CONCLUSIONS

? In men with localized prostate cancer, obesity is associated with an increased risk of prostate enlargement. ? These data validate other observations linking obesity with prostate enlargement and may have important ramifications for prostate cancer diagnosis in obese men.     

The management of localized prostate cancer

At this point in time, the only possibility of curing prostate cancer is through the early detection and treatment of localized disease. The large number of treatment options available for localized prostate cancer, including radical prostatectomy, radiotherapy (either external beam or interstitial), hormone therapy and watchful waiting, can be confusing for the patient. These treatments are associated with different adverse effects, further complicating the treatment decision. As there will inevitably be a trade-off between expected cure and acceptable adverse effects, it is important to discuss all options with the patient. The doctor and patient must together decide the appropriate treatment for him and his tumor.     

Personality, treatment choice and satisfaction in patients with localized prostate cancer

OBJECTIVES: Radical prostatectomy (RP), external beam radiation (XRT) and brachytherapy (BTX) are the most commonly used treatments for localized prostate cancer. We studied whether patient personality influences treatment choice and overall treatment satisfaction. METHODS: From 1998 to 2002, 219 consecutive patients treated with RP (n = 74), XRT (n = 73), or BTX (n = 72) at our institution who remained free of biochemical recurrence were sent the Big Five Inventory (BFI) and a satisfaction/treatment participation questionnaire. We compared personality, satisfaction and participation scores between the three groups. Correlation between personality and satisfaction was determined. Multivariate regression was used to determine association between personality and satisfaction/participation after controlling for patient- and disease-related factors. RESULTS: Higher mean satisfaction and participation scores were observed within the RP and XRT groups, respectively (P = NS). No significant differences in personality were observed between groups. XRT patients tended to have higher extroversion, openness and agreeability scores, while RP patients tended to be more neurotic and conscientious (all P = NS). After controlling for other factors, a negative correlation was found between openness scores and satisfaction and a positive correlation between conscientiousness scores and satisfaction. Specific personality traits were associated with interest in participation in care for both RP and BTX patients but not for XRT patients. CONCLUSIONS: There are mild variations in personality as measured by the BFI between patients undergoing treatment for localized prostate cancer. Certain BFI-measured personality traits may be associated with levels of satisfaction following therapy. Disease concerns and provider recommendations may override the influence of personality in the decision-making process.     

Brachytherapy versus radical prostatectomy in patients with clinically localized prostate cancer

In an effort to help physicians offer their patients unbiased advice on the best alternatives for treatment of localized prostate cancer, we present a retrospective comparison of the effectiveness of brachytherapy and radical retropubic prostatectomy in 1305 men with stage T1 and T2 adenocarcinoma of the prostate. Data from 1305 patients treated in our community-based private practice urology group from 1993 to 2002 were reviewed, and patients were classified by initial prostate-specific antigen (PSA) level and risk grouping. Risk grouping was defined by preoperative PSA levels and Gleason scores. We used time to PSA-indicated recurrence as the measure of efficacy. Brachytherapy and radical prostatectomy provided similar responses to treatment (no significant differences given the sample size, length of follow-up, and numerical differences observed) for localized prostate cancers. A prospective study is presently underway to evaluate the respective outcome of these procedures (including incidence of incontinence and impotence), and assess their impact on patient quality of life. The results presented here fail to show any superiority of prostatectomy over brachytherapy with palladium-103 (TheraSeed; Theregenics Corp., Buford, GA) with respect to time until relapse indicated by PSA level increase (> 0.2 ng/mL for prostatectomy and >1.5 ng/mL and rising for brachytherapy). In fact, any differences between treatments favor brachytherapy, particularly for intermediate- and high-risk groups. We conclude that both brachytherapy and prostatectomy should be offered, equally and without bias, to men with stage T1 or T2 organ-confined prostate cancer.