Expectant management of localized prostatic cancer

Whitmore, Willet F.; Warner, John; Thompson, Ian M.

doi:10.1002/1097-0142(19910215)67:4<1091::aid-cncr2820670437>3.0.co;2-j

Cited by 172 publications

(34 citation statements)

References 6 publications

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“…From multiple series of patients who were managed with observation, there is abundant evidence that the disease is not uniformly progressive nor fatal. [72][73][74][75] Unfortunately, previous experiences with the natural history of prostate carcinoma are seriously compromised by selection bias 72 and limited follow-up, 76 and, in perhaps the most widely cited article, very few individuals were reported to be at risk at 10 years and 15 years and all participants had their disease detected using DRE because PSA screening had not yet begun to be used. 75 With the advent of PSA screening and the dramatic increase noted in the detection of organ-confined disease, the idea of "clinically-significant" disease became more important.…”

Section: Clinical Significance Of Tumors Detected By Psa-based Screeningmentioning

confidence: 99%

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

Hernández

Thompson

2004

Cancer

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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: Clinical Significance Of Tumors Detected By Psa-based Screeningmentioning

confidence: 99%

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

Hernández

Thompson

2004

Cancer

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279

173

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“…The chemical failure precedes a clinical recurrence by several years; even in patients with initial PSA of 4-30 ng/ml, 80% were clinically tumor free 4 years after treatment. Others have reported shorter lead time from rising PSA to clinical evidence of relapse (an average of approximately 6 Patients with elevated pretreatment PSA levels, stable posttreatment levels, and subsequent elevation have a 33-44% risk of subsequent distant metastasis in less than 3 years. '04 Rising PSA levels after irradiation have been correlated with clinical progression, although the time course has not been defined a d e q~a t e l y .…”

Section: Prostate-specific Antigen In Selection Of Patients For Theramentioning

confidence: 99%

Localized carcinoma of the prostate (Stages T1B, T1C, T2, and T3). Review of management with external beam radiation therapy

Pérez

Hanks

Leibel

et al. 1993

Cancer

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Background. Optimal treatment for patients with localized carcinoma of the prostate is controversial. Radiation therapy is an established modality in the management of these patients, and several reports indicate the results are comparable to those achieved with radical prostatectomy. Recently effectiveness of therapy for carcinoma of the prostate is being evaluated in light of posttreatment prostate‐specific antigen (PSA) determinations. Methods. A review was performed of multiple publications and data from selected institutions with large experience in the management of carcinoma of the prostate. Survival and clinical incidence of local recurrence and distant metastases were analyzed as well as preliminary data on postirradiation PSA levels. Factors that affect the outcome of therapy and relevant clinical trials are discussed. Results. Reported differences in the age of patients treated with radical prostatectomy (59‐63 years), irradiation (63‐69 years), or observation (69‐75.5 years) were identified. The effect of surgical staging on outcome of irradiation was significant. In multiple series of patients clinically and radiographically staged, the 5‐year disease‐free survival (DFS) with external irradiation was 95‐100% for clinical stage T1a, 80‐90% for Stage T1b,c, and 50‐70% for clinical Stage T3. A correlation has been identified between the initial PSA levels and the probability from freedom of chemical failure (PSA elevation) after definitive irradiation. In five series comprising 814 patients with Stage T1c and T2 tumors, the DFS (end point chemical failure) was 95%, with initial PSA of less than 4 ng/ml, 83‐92% with 4.1‐10 ng/ml, 35‐85% with 10.1–20 ng/ml, and 10‐63% with PSA higher than 20 ng/ml. In the various series, follow‐up ranged from a median of 1.5 years to a minimum of 4 years. In two series of 225 and 201 patients receiving doses of 7500–8000 cGy, less morbidity has been observed with three‐dimensional treatment planning conformal radiation therapy than with conventional irradiation. New directions for future clinical trials are discussed, including dose escalation studies; use of high linear energy transfer to improve locoregional tumor control; and combination of irradiation and androgen suppression to enhance local tumor control, decrease distant metastasis, and improve survival. Preliminary results of a randomized study recently reported by RTOG strongly suggest that the use of goserelin acetate and flutamide decreases the incidence of clinical local recurrence (12.4% in 225 patients) compared with a control group treated with irradiation alone (25.2% in 230 patients) and enhances disease‐free survival. Conclusions. Although modern approaches to the management of patients with localized carcinoma of the prostate with irradiation are effective, investigators must continue to critically assess policies of treatment, develop appropriately designed prospective clinical trials, and define the optimal management of patients with localized carcinoma of the prostate.

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“…However, the course of early stage prostate cancer is not very well documented and there is no proof that all, or even most, early stages of prostate cancer develop into aggressive forms. Indeed, most studies of early stage prostate cancers treated with non-curative intention have given rather optimistic results when the follow-up period was relatively short (George 1988, Whitmore et al 1991, Johansson et al 1992, Adolfsson 1993). …”

Section: Introductionmentioning

confidence: 66%

Natural evolution of prostate cancer

Hugosson¹,

Aus²

1996

Endocrine Related Cancer

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The course of untreated or only palliatively treated prostate cancer was studied in two large unselected populations. The first population comprised 514 patients (mean age 74 years at diagnosis) who were all followed to death and represented patients in different stages and grades at diagnosis. The second population included 490 men (mean age 68 years at diagnosis) with newly detected prostate cancer diagnosed during 1960 to 1980 and who survived for at least 10 years after diagnosis. Of the patients with stage MO at diagnosis 50% ultimately died of prostate cancer. In early stage prostate cancer most deaths during the first 10 years were due to unrelated causes while prostate cancer was the dominant cause of death after 10 years. All the different stages and grades had an almost strai ght\x=req-\ falling cause-specific survival curve and all curves ended close to zero after 25 years. This means that prostate cancer deaths continue to occur as long as there are patients at risk and in none of the groups examined did the risk decline after a certain time. When a comparison was made with other studies on deferred treatment (corresponding subgroups were extracted) very similar results were found. However, the overall impression of the results looked very different when follow-up was extended from 10 to 25 years. Apart from a high mortality, a high morbidity was also found in patients who died from prostate cancer; this was significantly higher than in those who died of unrelated diseases. Patients at stage M0 at diagnosis who ultimately died had more frequent problems with local tumour growth than those who were at stage M1 at diagnosis. Early prostate cancer is usually a very sl ow\x=req-\ growing disease but it has a malignant potential and if the host lives long enough he will be at high risk for prostate cancer death irrespective of stage or grade at diagnosis.

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Expectant management of localized prostatic cancer

Cited by 172 publications

References 6 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

Localized carcinoma of the prostate (Stages T1B, T1C, T2, and T3). Review of management with external beam radiation therapy

Natural evolution of prostate cancer

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