Ureteric stricture: an unusual presentation of metastatic prostate adenocarcinoma

We describe an unusual case of a prostatic adenocarcinoma presenting with a ureteric stricture secondary to a discrete metastatic lesion. A 76-year-old man presented with a short history of right loin pain. Initial examination was unremarkable, digital rectal examination was normal and prostate specific antigen was within normal range. Computed tomography showed right hydronephrosis and a distal ureteric stricture. A distal ureteric transitional cell carcinoma was thought to be most likely. A nephroureterectomy was carried out and histology revealed a skipped lesion of a metastatic prostate adenocarcinoma. Metastatic lesions to the ureters due to prostate cancer are rare. It was believed to be secondary to a transitional cell carcinoma as there was no evidence initially to suggest prostatic disease as the cause. A prostatic adenocarcinoma should be considered in the differential diagnosis of any lesions in the ureter believed to have a malignant origin.     

Brain metastases: a rare initial presentation of prostate cancer

Although brain metastases are common in cancer patients, carcinoma of the prostate rarely metastasizes to the brain. Cerebral metastases as an initial clinical presentation of prostate carcinoma are extremely rare. We report a patient, who presented with confusion and behavioral changes. Cranial magnetic resonance imaging revealed a large right temporal lobe lesion. The pathological diagnosis of the tumor was consistent with metastatic prostate carcinoma. Further evaluation revealed widespread bony metastases by technetium 99 bone scan and high level of prostate-specific antigen.     

Interactions in the aetiology,presentation and management of synchronous and metachronous adenocarcinoma of the prostate and rectum

Adenocarcinoma of the prostate and rectum are common male pelvic cancers and may present synchronously or metachronously and, due to their anatomic proximity. The treatment of rectal or prostate cancer (in particular surgery and/or radiotherapy) may alter the presentation, incidence and management should a metachronous tumour develop. This review focuses on the interaction between prostatic and rectal cancer diagnosis and management. We have restricted the scope of this large topic to general considerations, management of rectal cancer after prostate cancer treatment and vice versa, management of synchronous disease and cancer follow-up issues.     

Indication for nuclear medicine therapy in advanced cancer of the prostate

Summary For patients with advanced prostate cancer efficient therapy of painfull bony lesions is the primary goal of interdisciplinary treatment strategies. Preservation of quality of life appears to be the main aim rather than prolongation of life. Apart from oral pain relief and local irradiation systemic treatment with radionuclides offers low-risk radiotherapeutic strategies for the palliation of painful, multifocal osteoplastic bone metastases. Depending on the radiopharmaceutical substance chosen response and reduction of pain are described in 65–80 %. The duration of pain relief lasts between 6–12 weeks. During this time the morphine based medication can be reduced and in some cases withdrawn which positively effects quality of life. After improvement of myelosuppression treatment with radionuclides can be repeated. Patients have to be hospitalized for two days because of protection from radiation procedures.      

An analysis of radical prostatectomy in advanced stage and high-grade prostate cancer

OBJECTIVES: To clarify the role of radical prostatectomy (RP) in the treatment of locally advanced and high-grade prostate cancer. METHODS: Literature search of Medline publications on surgery for locally advanced and high-grade prostate cancer. RESULTS: In patients with locally advanced disease, the cancer-specific survival rate after RP at 5- and 10-yr follow-up was 85-100% and 57-91.6%, respectively. The overall survival rate at 5 and 10 yr was>75% and 60%, respectively. In patients with high-grade prostate cancer (Gleason score> or =8), the biochemical recurrence-free survival after RP at 5 and 10 yr of follow-up was 51% and 39%, respectively. Nomograms and modern imaging techniques are useful in predicting pathologic stage, presence of positive lymph nodes, or seminal vesicle involvement. These allow physicians to recognise those patients with locally advanced disease who are most likely to benefit from surgical treatment. Downgraded and organ- or specimen-confined high-grade tumours can have a good prognosis after surgery. The prostate-specific antigen value and the percent positive biopsy cores can be helpful in identifying men with high-grade prostate cancer most likely to benefit from RP. CONCLUSIONS: It is likely that surgery has a role in the treatment of locally advanced and high-grade tumours. However, it is necessary and urgent to have randomised trials assessing survival and quality of life when RP is and is not included in the multimodality treatment.     

Clinical trials of immunotherapy for advanced prostate cancer

There is a lack of effective therapeutic regimens for advanced hormone-refractory prostate cancer (HRPC). Recent combination regimens of chemotherapy have improved management of HRPC. Neither systemic chemotherapy nor radiation regimens have significantly improved survival. Conventional systemic cytokine therapy has had limited efficacy in the treatment of advanced prostate cancer patients and its toxicity is severe. Combinations of multiple biological response modifiers for treatment of this disease also have limited efficacy. Results from phase II trials have shown that the combination of interferon- and interleukin-2 therapy and the infusion of dendritic cells primed with peptides of prostate specific membrane antigen are promising. The former showed 31% response using the National Prostatic Cancer Project criteria, and the latter showed 27% of objective partial response with a reduction of >50% prostate specific antigen level. The toxicity of these two regimens was tolerated by patients. New approaches with tumor vaccines in conjunction with cytokine gene therapy have also been investigated. The clinical responses of these trials have been limited but promising. Immunotherapy may become an effective modality of prostate cancer treatment in the future.     

经尿道前列腺切除治疗晚期前列腺癌并膀胱出口梗阻的疗效分析

目的:探讨经尿道前列腺切除在晚期前列腺癌并膀胱出口梗阻(BOO)治疗中的作用,分析经尿道前列腺切除对患者生存时间及生活质量的影响。方法:对2001～2004年间诊断为晚期前列腺癌并BOO的患者223例进行回顾性分析,根据治疗方法分为手术组(经尿道前列腺切除加内分泌治疗)127例,单纯内分泌治疗组96例。分别在术后3、12、24个月对两组患者的IPSS评分、最大尿流率、PSA、剩余尿量、疾病相关死亡和进展人数进行统计分析。结果:手术组IPSS评分和最大尿流率在术后3个月明显低于单纯内分泌治疗组(P<0.05)。两组患者在各时间点上的PSA、剩余尿量、疾病相关死亡人数和疾病进展人数的差异无统计学意义。手术组术后有不同比例的尿道狭窄、血尿、尿路感染和尿失禁发生。结论:经尿道前列腺切除加内分泌治疗晚期前列腺癌并BOO的患者,在短期内可以迅速降低IPSS评分,提高尿流率,改善生活质量;远期效果与单纯内分泌治疗相当。同时,手术本身也可能带来一些并发症,困扰患者的正常生活。     

Atypical fibroxanthoma in a young woman: An unusual case presentation

Atypical fibroxanthoma (AFX) is an uncommon neoplasm, identified as a spindle cell tumour that is generally found in elderly patients on sun-exposed areas. The majority of cases of AFX are benign, and metastasis is a rare phenomenon. The first case in the literature of AFX is described in a young woman with no previous risk factors who presented with a three-month history of an enlarging nodule of the left nasal alar. Excision showed the lesion to be composed of hyperchromatic, pleomorphic, vacuolated spindle cells and multinucleated giant cells. The tumour cells stained positive for macrophage-histiocyte antigen alpha₁-antitrypsin, neurokinin-1, CD68 and alpha₁-antichymotrypsin. The present case report highlights the importance of correct diagnosis for AFX with adequate excision and by considering the histopathology and immunohisto-chemistry of its clinical differential diagnosis.     

Change in prostate cancer presentation coinciding with USPSTF screening recommendations at a community-based urology practice

Objective

The benefits of prostate-specific antigen (PSA)–based prostate cancer screening are controversial. We sought to determine the change in prostate cancer presentation coinciding with the release of the United States Preventative Services Task Force recommendations against screening in a high-volume community-based urology practice.

Correlation of serum PSA and Gleason score in Nigerian men with prostate cancer

Objective  Prostate cancer is an important cause of morbidity and mortality worldwide. While the predisposing factors are not fully understood, African descent is an important risk factor, and prostate cancer has become the number-one cancer in Nigerian men. This was a retrospective study of the correlation between serum prostate specific antigen (PSA) and Gleason grade and score in patients of Nigerian descent. Patients and Methods  The University College Hospital (UCH) Ibadan Cancer Registry was used to identify and quantify the incidence of prostate cancers occurring between 1998 and 2000. The histological slides of appropriate cases were reviewed to confirm the Gleason grade and score. The serum PSA values were retrieved from the patients' case notes and laboratory files. The data obtained were subjected to statistical analysis to look for associations and correlations. Results  The study included 67 men with prostate adenocarcinoma and PSA measurements who were diagnosed and treated at the UCH Ibadan between January 1998 and December 2000. There was a positive correlation between serum PSA and Gleason grade, as well as between serum PSA and Gleason score in our cohort of Nigerian African men with prostate cancer. PSA levels were significantly lower in patients with stage B disease than in patients with stage D disease. Conclusion  Serum PSA is significantly higher in metastatic than in localized disease. Further studies are necessary to determine biomarkers that complement serum PSA and the Gleason grading system in the prognostication of prostate cancer in African patients.     

Contemporary outcomes of palliative transurethral resection of the prostate in patients with locally advanced prostate cancer

Background

Advanced prostate cancer may cause significant local complications which affect quality of life, including bladder outlet obstruction and hematuria. We performed a detailed review of our outcomes of palliative transurethral resection of the prostate (pTURP) in the era of taxane chemotherapy and potent androgen receptor antagonists at our tertiary-care institution.

晚期前列腺癌患者行间歇性内分泌治疗的疗效分析

目的探讨间歇性内分泌治疗在晚期前列腺癌患者中的疗效,并分析影响疗效的相关因素。方法2004年9月到2012年7月间收治晚期前列腺癌患者首先进行6-9个月的内分泌治疗,然后进行疗效评估,将对内分泌治疗敏感的患者随机分为间歇治疗组和持续治疗组,观察两组的疗效、毒副作用及患者的生活质量评分等指标,并分析间歇治疗组中影响患者预后的相关因素。结果共收治174例晚期前列腺癌患者,有130例患者对内分泌治疗敏感,其中58例患者接受间歇性内分泌治疗,72例患者接受持续性内分泌治疗。间歇治疗组患者的生活质量KPS评分明显高于持续治疗组（80vs70,P〈0．05）,相关并发症发生率也低于持续治疗组。但两组患者的5年内发展成为非激素依赖性前列腺癌的比例（37％vs41％）及患者的5年生存率（72％vs63％）无明显差异。Cox多因素分析显示晚期前列腺癌患者的Gleason评分及第一次治疗后PSA水平与患者的预后密切相关,可作为判断能否行间歇性内分泌治疗及预后的重要指标。结论对于晚期前列腺癌患者行间歇性内分泌治疗安全可行、疗效确切,对患者的生活质量影响小,同时也可减少患者的经济压力。     

Optimal treatment of locally advanced prostate cancer

The treatment of clinically locally advanced prostate cancer (cT3–4) is subject to controversies. Patients with lymph node metastases as well as patients with overstaged localized and thus curable disease fall into this category. Radical prostatectomy, external beam radiotherapy and early or deferred hormonal therapy are possible treatment options. Multimodal treatment (i.e., a combination of these options) is frequently used. After radical prostatectomy, Gleason score-adjusted disease-specific survival does not differ meaningfully between the tumor stages pT2 and pT3–4. In the case of lymph node metastases after radical prostatectomy, but not in node-negative disease, adjuvant hormonal treatment seems to improve survival. Adjuvant radiotherapy may improve biochemical and local control in locally advanced prostate cancer, a survival benefit has, however, not yet been proven. External beam radiotherapy alone provides unfavourable survival rates in locally advanced prostate cancer. Adjuvant hormonal treatment may improve outcome in this setting. When no curative treatment is chosen, early hormonal treatment seems to provide modest benefit compared with deferred therapy.     

Subtle radiographic presentation of a pleural effusion secondary to a cancer of unknown primary: a case study

Carcinoma of unknown primary sites is a clinical syndrome that represents many types of cancer. The mortality rate associate to this type of cancer is elevated and a rapid medical referral is required for patients presenting this condition. Pleural effusion may be the only visible sign. We report a case of pleural effusion secondary to a cancer of unknown primary site in a 60-year-old man that sought chiropractic care for radiating low back pain. The radiographic studies revealed a pleural effusion as one of the only significant finding. This article will address the clinical presentation, radiographic studies and a discussion on the radiographic detection of pleural effusion.     

缓退瘤治疗晚期前列腺癌(附10例报道)

目的：探讨缓退瘤治疗晚期前列腺癌的效果。方法：行去势手术加口服缓退瘤治疗晚期前列腺癌１０例。结果：生存８例,死亡２例。生存者转移灶消失,原发灶缩小。结论：对晚期前列腺癌行去势术加缓退瘤的治疗效果较好。     

前列腺癌综合指数及临床意义初探

目的 寻求一种诊断前列腺癌（ＰＣａ）的更有效方法．方法 ＰＣａ７８例和前列腺增生症７３例临床资料进行分析,并根据前列腺特异抗原（ＰＳＡ）、直肠指检及年龄与ＰＣａ的相关性设计出一公式,将直肠指检所得到的前列腺大小、结节、硬度进行量化,所得数值称为“前列腺癌综合指数一公式,将直甩指检所得的前列腺大小、结节、硬度进行量化,所得数值称为“前列腺癌综合指数（ＩｐＣａ）”。结果 当ＩｐＣａ以５．８０为阈值时,     

Mortality among men with locally advanced prostate cancer managed with noncurative intent: a nationwide study in PCBaSe Sweden

Background

There are limited prognostic data for locally advanced prostate cancer PCa to guide in the choice of treatment.

Objective

To assess mortality in different prognostic categories among men with locally advanced PCa managed with noncurative intent.

Design, setting, and participants

We conducted a register-based nationwide cohort study within the Prostate Cancer DataBase Sweden. The entire cohort of locally advanced PCa included 14 908 men. After the exclusion of 2724 (18%) men treated with curative intent, 12 184 men with locally advanced PCa either with local clinical stage T3 or T4 or with T2 with serum levels of prostate-specific antigen (PSA) between 50 and 99 ng/ml and without signs of metastases remained for analysis.

Measurements

We followed up the patient cohort in the Cause of Death Register for ≤11 yr and assessed cumulative incidence of PCa -specific death stratified by age and clinical characteristics.

Results and limitations

The PCa -specific mortality at 8 yr of follow-up was 28% (95% confidence interval [CI], 25-32%) for Gleason score (GS) 2-6, 41% (95% CI, 38-44%) for GS 7, 52% (95% CI, 47-57%) for GS 8, and 64% (95% CI, 59-69%) for GS 9-10. Even for men aged >85 yr at diagnosis with GS 8-10, PCa was a major cause of death: 42% (95% CI, 37-47%). Men with locally advanced disease and a PSA < 4 ng/ml at diagnosis were at particularly increased risk of dying from PCa. One important limitation is the lack of bone scans in 42% of the patient cohort, but results remained after exclusion of patients with unknown metastasis status.

Conclusions

The PCa-specific mortality within 8 yr of diagnosis is high in locally advanced PCa, suggesting undertreatment, particularly among men in older age groups. Our results underscore the need for more studies of treatment with curative intent for locally advanced tumors.     

Radical prostatectomy in high-risk and locally advanced prostate cancer: Mayo Clinic perspective

PurposeMen diagnosed with high-risk prostate cancer represent the cohort of prostate cancer patients at greatest risk for subsequent disease-specific mortality. Unfortunately, however, the classification of high-risk tumors remains imprecise and heterogeneous. There has been a historical reluctance to offer such patients aggressive local treatment, and considerable debate exists regarding the optimal management in this setting.MethodsWe present here our institutional experience, as well as data from several other centers, with radical prostatectomy for high-risk tumors.ResultsWe discuss that surgery affords accurate pathological staging, thereby improving the identification of patients for secondary therapies. Moreover, prostatectomy not only provides durable local disease control but in addition numerous contemporary surgical series in high-risk patients have shown radical prostatectomy to be associated with excellent long-term cancer-specific survival. Further, although studies comparing surgical and radiotherapy modalities in high-risk prostate patients have been wrought with methodological challenges, consistently these observational studies have found equivalent to improved oncologic outcomes when surgery is utilized as the primary treatment.ConclusionsHerein, we review the advantages, long-term outcomes, and technique of surgery for high-risk prostate cancer.