Follow-Up in Prostate Cancer Patients: Which Parameters Are Necessary?

Strohmaier, Walter; Keller, Timea; Bichler, K.-H.

doi:10.1159/000019814

Cited by 12 publications

(14 citation statements)

References 11 publications

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“…The general physician should be instructed on such follow-up, which should consist of a serum PSA determination every 3 months. Other examinations are indicated only on specific clinical signs, increasing local tumour size by digital rectal examination, and after complications from surgery or radiotherapy [55].…”

Section: Hormonal Therapy: a Second Lookmentioning

confidence: 99%

Endocrine treatment in prostate cancer

Denis¹,

Griffiths

2000

Semin. Surg. Oncol.

152

116

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Over its natural course, prostate cancer is a heterogeneous tumour with a generally slow but constant rate of growth. The androgen dependence of the prostate gland was demonstrated more than half a century ago by the landmark studies of Professor C. Huggins and colleagues. They established that androgens are implicated not only in growth regulation of the normal gland but also in the pathogenesis of prostate cancer, and that this malignant tissue retains some degree of androgen dependence. This concept was supported by studies of symptomatic clinical cancer, with androgen ablative therapy bringing relief to the patient in more than 80% of the cases. The classical treatment consisted of either bilateral orchiectomy, or administration of diethylstilbestrol (DES). Other forms of therapy followed, involving successive waves of new compounds that either withdrew androgen support from the cancer or blocked the androgens from their receptors in the prostate cancer cells. Chronologically, the progestagens can be well recognised, with one in particular: The successful derivative, cyproterone acetate (CPA). There also have been a number of oral vs. parenteral estrogens, the development of the luteinizing hormone‐releasing hormone agonists (LH‐RHA), the introduction of the non‐steroidal anti‐androgens characterised by flutamide and casodex, and more recently, the introduction of the LH‐RHA. Moreover, there have been multiple possible forms of combination treatment to obtain maximal androgen blockade (MAB). However, no major differences in treatment outcome have been reported during the last 5 decades and most treatment choices have been based on tradition, associated side effects, the preferences of a particular doctor and patient, together with economic considerations. Furthermore, endocrine treatment has never been shown to cure clinical prostate cancer, which consequently has led to initiatives to defer endocrine treatment or to use it intermittently or use it as a form of neo‐adjuvant or adjuvant treatment with surgery or radiotherapy. The history of endocrine therapy is replete with clinical trials that do not represent the patient population in general, and these trials share the clinical fact that they ignore the 20% to 30% of all patients who lack an initial response to a given endocrine treatment. Thus, it is no wonder that prognostic factors determine the outcome more than the treatment itself. Important to current endocrine treatment, however, is the shift to earlier stages of prostate cancer at initial diagnosis. Integration of endocrine treatment at this earlier phase in the pathogenesis of prostate cancer will substantially alter the treatment strategy in relation to long‐term benefit with regard to survival, associated side effects, and costs. This complex adjustment is enhanced by recent discoveries in the molecular biology of the prostate which show, on the one hand, that the dihydrotestosterone‐androgen receptor (DHT‐AR) complex is important in the regulation of gene expression, but also that a nu...

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Section: Hormonal Therapy: a Second Lookmentioning

confidence: 99%

Endocrine treatment in prostate cancer

Denis¹,

Griffiths

2000

Semin. Surg. Oncol.

152

116

View full text Add to dashboard Cite

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“…After therapy, PSA values are altered, and PSA is not a useful marker to monitor for bone metastasis, but it is a very useful marker for progressive disease. Especially after radical prostatectomy PSA elevation may be the first sign of progressive disease over years [15,16]. Thus, monitoring PSA levels can be sufficient after treatment for cancer of the prostate, and only if rising PSA values are noted, further workup with AP and/or bAP or a bone scan should be performed.…”

Section: Discussionmentioning

confidence: 99%

Isoenzymes of Alkaline Phosphatase – Useful Parameters for Identification of Bone Metastasis in Prostatic Carcinoma?

Paul¹,

Bottermann²,

Breul³

et al. 2000

Oncol Res Treat

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Background: The most frequent sites of metastases in prostatic carcinoma are bones. Bone scintigraphy is the diagnostic tool of first choice for staging bone metastases in cancer of the prostate. But this examination is expensive and time-consuming.Therefore we are looking especially for serum parameters like alkaline phosphatase, the isoenzyme of bone-specific alkaline phosphatase, and prostate-specific antigen (PSA) to replace bone scintigraphy for diagnostic staging. Material and Method: We compared in 132 prostatic carcinoma patients the results of total alkaline phosphatase, bone-specific alkaline phosphatase, and PSA with the results of the bone scan. Results:All three parameters demonstrate a lower sensitivity compared to the bone scan. Although the highest specificity was obtained by bone-specific alkaline phosphatase, this parameter cannot replace the bone scan for staging cancer of the prostate because of a lack of sensitivity. In a subgroup of patients with a PSA level below 10 ng/ml and a total alkaline phosphatase within normal range there is no need to obtain a bone scan, because of the very low incidence of bone metastasis in this group. Conclusions: There is only little additional information if bone-specific alkaline phosphatase instead of total alkaline phosphatase is determined. None of the serum parameters examined can replace bone scintigraphy in staging cancer of the prostate, but PSA and alkaline phosphatase can identify patients who are at low risk for bone metastases.

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“…Other investigators recommend a much lower PSA cut–off value of 2 ng/ml after radical prostatectomy [5]. From a retrospective study it was concluded that no progressive disease could be detected on the bone scan, unless a rising PSA was observed [10]. Quantification of the bone scan results using of the Bone Scan Index (BSI) may further help to stratify patients with known bone involvement for treatment protocols, since BSI correlated well with a rapid exponential growth phase of metastasized androgen–independent prostate carcinoma [11].…”

Section: Mtc Diphosphonate Bone Scintigraphymentioning

confidence: 99%