Pathologic features of the primary lesion and the incorporation of lymphatic mapping have improved the selection of patients who might benefit from lymph node dissection. The use of a modified lymph node dissection in selected patients has decreased morbidity. Effective chemotherapy agents are needed in the management of advanced penile cancer.
Twenty-nine patients with squamous cell carcinoma of the penis underwent bilateral ilioinguinal groin dissection 6 weeks after removal of the primary penile lesion. Eighty percent of the patients were alive and without evidence of disease at 5 years when the dissected lymph nodes were negative. When positive nodes were found, 62.5% of the patients were alive and without evidence of disease at 5 years: two of these patients had one iliac deep node positive each. The mortality rate at 5 years because of progression of disease was 6.6% when the dissected lymph nodes were negative, as compared to 37.5% when the dissected lymph nodes were positive.
One hundred and twenty-one transrectal ultrasound examinations of the prostate were performed between August and October of 1987. Indications included screening in 41 patients, evaluation of bladder outlet obstruction in 63 patients, evaluation of palpable nodules in 6 patients, and evaluation after transurethral resection of the prostate in 11 patients. A total of five patients were discovered to have prostate cancer after biopsy of a hypoechoic lesion in a normal feeling prostate by digital rectal examination. One patient was from the screening group, two patients with bladder outlet obstruction and two patients from the postransurethral resection group. All six patients with palpable nodules were diagnosed as having a cancer: Stage B2 on the rectal examination and two of the six patients were upstaged to Stage C by ultrasound criteria. In our hands transrectal ultrasound of the prostate is a valuable adjunct in the urological armamentarium with clear application in the diagnosis and staging of prostate cancer.
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