Localized prostate cancer. Relationship of tumor volume to clinical significance for treatment of prostate cancer

Stamey, Thomas A.; Freiha, Fuad S.; McNeal, John E.; Redwine, Elise A.; Whittemore, Alice S.; Schmid, Hans‐Peter

doi:10.1002/1097-0142(19930201)71:3+<933::aid-cncr2820711408>3.0.co;2-l

Cited by 731 publications

(405 citation statements)

References 17 publications

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“…88 One example of this approach, The Breast Cancer Prevention Trial, used the Gail model to predict the risk of breast carcinoma. 89 Almost certainly, a risk assessment for an individual man would incorporate a host of factors including PSA, age, family history of prostate carcinoma, ethnicity/race, genetic factors, diet and use of micronutri- 123 Tumor volume Ͻ 0.2 cm 3 , confined, no Gleason Grade of 4 or 5 Stamey et al 124 Tumor volume Ͻ 0.5 cm 3 Dugan et al 125 Tumor volume Յ 20 cm 3 at the time of expected death, Gleason's sum Ͻ tenths place of patient's age ents, and behavioral factors (such as exercise and obesity).…”

Section: New Directions In the Early Detection Of Prostate Carcinomamentioning

confidence: 99%

Prostate‐specific antigen: A review of the validation of the most commonly used cancer biomarker

Hernández

Thompson

2004

Cancer

279

173

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Objective To review the literature and collect expert advice for proposing preventive and curative treatments of mouth and dental involvement in patients with systemic sclerosis (SSc; scleroderma). Methods The literature pertaining to mouth and/or dental involvement related to SSc was reviewed, and recommendations were developed according to the suggestions of a French multidisciplinary working group of experts and validated by a lecture committee. Results Dentists face 3 main issues in caring for SSc patients: oral mucosa involvement, manducatory apparatus and mouth involvement responsible for limitations in mouth opening, and treatment‐related adverse events. An increased risk of tongue carcinoma has been noted. In patients with severe limitation in mouth opening (<30 mm), recommended treatments are a specific mouth‐opening rehabilitation program, flexible sectional dentures, and splint therapy. Indications for dental implants depend on the severity of SSc, comorbidities, and/or ongoing bisphosphonate treatment. Prevention of mouth infections and caries implies patient education and teaching about mouth and dental hygiene, periodontal maintenance, and treatment of sicca syndrome. Cessation of tobacco use is mandatory. Patient‐tailored rehabilitation may improve limitations in mouth opening. Systematic dental panoramic radiography allows for the early detection of dental caries. Conclusion Prevention of oral and dental complications is a major issue in patients with SSc. Dental treatment should be tailored to limitations in mouth opening, disease severity, and ongoing treatments.

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Section: New Directions In the Early Detection Of Prostate Carcinomamentioning

confidence: 99%

Prostate‐specific antigen: A review of the validation of the most commonly used cancer biomarker

Hernández

Thompson

2004

Cancer

279

173

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“…In all, 30-40% of men older than 50 years have prostate cancer, but only 8% of cancers become clinically significant. 2 Small-volume prostate cancers (0.5 ml or less) without elements of Gleason grade pattern 4 or 5 are not thought to be clinically significant. [2][3][4][5][6][7][8][9][10] However, tumor volume and other parameters, especially Gleason score, are closely related.…”

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confidence: 99%

“…2 Small-volume prostate cancers (0.5 ml or less) without elements of Gleason grade pattern 4 or 5 are not thought to be clinically significant. [2][3][4][5][6][7][8][9][10] However, tumor volume and other parameters, especially Gleason score, are closely related. Since many prostate cancer deaths occur more than 10 years after the initial diagnosis, 11 the biological behavior of small-volume prostate cancer, which some consider to be clinically insignificant, may become important in patients with a relatively long postdiagnosis life expectancy.…”

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Anatomic distribution and pathologic characterization of small-volume prostate cancer (<0.5 ml) in whole-mount prostatectomy specimens

et al. 2005

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Some investigators consider small-volume prostate cancer (0.5 ml or less) without Gleason pattern 4/5 elements as clinically insignificant. The objective of this study was to characterize the anatomic distribution and pathologic features of small tumors (aggregate volume of 0.5 ml or less) in whole-mount prostatectomy specimens. Between 1999 and 2003, 371 consecutive patients underwent radical prostatectomy at the Indiana University Hospitals for localized prostate cancer. Patients who received hormonal or radiation therapy prior to the surgery were excluded from the study. A total of 62 specimens with total tumor volume of 0.5 ml or less were identified and included in this study. All specimens were embedded and whole-mounted. Tumor volume was measured using the grid method. The mean age at the time of surgery was 59 years (median, 61 years; range, 37-72 years). The mean preoperative prostate-specific antigen (PSA) was 6.5 ng/ml (range: 0.3-18 ng/ml). The mean prostate weight was 53 g (range: 16-132 g). The mean tumor volume was 0.29 ml (median, 0.35 ml; range, 0.02-0.48 ml). Tumor multifocality and bilaterality were present in 69 and 37% of cases, respectively. Three (5%) had positive surgical margins. The largest tumor was located in the peripheral zone, transitional zone, and central zone in 79, 16, and 5% of cases, respectively. The largest tumor was located in the anterior prostate in 10 cases (16%) and in the posterior prostate in 52 cases (84%). The distribution of Gleason scores was 5 (12 cases, 19 %), 6 (40 cases, 65 %), and 7 (10 cases, 16 %). One case had a primary Gleason pattern 4. None had extraprostatic extension, seminal vesicle invasion, or lymph node metastasis. Small-volume prostate cancers are often multifocal and bilateral, with predilection for the peripheral zone. Of these small-volume cases, 16% had Gleason pattern 4 and might, therefore, be clinically significant.

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“…2 Radical prostatectomy is regularly proposed as curative treatment to patients with localised prostatic adenocarcinoma, although it is advocated only if the patient has an estimated life expectancy of more than 10 y. 3,4 On the initiative of the Comite Â de Cance Ârologie de l'Association FrancËaise d'Urologie (CCAFU) and the French network of Cancer Registries, a populationbased study was carried out to obtain information on practices regarding management of prostate cancer during the year 1995 in four French cancer registries. One of the aims of this investigation was to provide clinicians and epidemiologists with a recent, unbiased evaluation of the practice of RP in France and to reveal any disparities between regions and sectors of activity.…”

Section: Introductionmentioning

confidence: 99%

A population-based study on radical prostatectomy in France

Soulié

Villers

Grosclaude

et al. 2001

Prostate Cancer Prostatic Dis

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There has as yet been no descriptive study of the practice of radical prostatectomy in the general population in France. The objective of this work was to investigate the use of radical prostatectomy (RP) in France and its determinants and geographic variations. A total of 175 radical prostatectomies was identi®ed in a random sample of 798 cases of prostate cancer recorded in 1995 by four cancer registries, in the departments of Bas-Rhin, Calvados, Ise Áre and Tarn. Tumour characteristics, diagnostic procedures and histopathological results were analysed. Multivariate analysis by logistic regression was used to take into account age, prostate speci®c antigen (PSA) levels and clinical stage in order to study variations between geographical departments and sectors of activity (private or public). The mean age of the patients at the time of diagnosis was 65.3 y (range 46 ± 76). Median PSA level was 18.2 ng/ml (range 1 ± 184). Diagnosis was made by randomised biopsies in 73.8% of cases or by transurethral resection (6.9%). Clinical stage was classi®ed T 1 (22.3%), T 2 (64%), T 3 (8.6%), N (0.6%) and unknown (4.5%). The histopathological result was pT 2 N0 in 46.3% of cases, pT 3 N0 in 40%, pT 4 N0 in 1.7%, pT x N in 8.6% and unknown in 3.4%. Adjuvant therapy (radiotherapy 13.7%, hormonal treatment 13.7% or both 3%) was administered in 54 patients (31%). Logistic regression showed that the probability of undergoing RP was three times higher in one department than in the other departments, and was 2.6 times as high in the private sector. This study on the practice of RP is the ®rst performed in the general population in France. It shows that practice differs according to geographical region and sector of activity, indicating that schools of thought and medical culture vary within the same country. Prostate Cancer and Prostatic Diseases (2001) 4, 118±123.

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Localized prostate cancer. Relationship of tumor volume to clinical significance for treatment of prostate cancer

Cited by 731 publications

References 17 publications

Prostate‐specific antigen: A review of the validation of the most commonly used cancer biomarker

Prostate‐specific antigen: A review of the validation of the most commonly used cancer biomarker

Anatomic distribution and pathologic characterization of small-volume prostate cancer (<0.5 ml) in whole-mount prostatectomy specimens

A population-based study on radical prostatectomy in France

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