Joseph D. Schmidt

Cryosurgery in prostatic cancer: Survival

From 1969 through 1976 we performed cryosurgery in 229 cases of prostatic cancer. This article presents survival in cryosurgery and other treatment groups. In every stage, despite a preponderance of large primary tumors and poor-risk patients, cryosurgery matched total prostatectomy and compared favorably to other modalities, including radiation therapy, at our center and elsewhere. According to previous authors, and in view of the present data, eradication of the local lesion is associated with better survival even in advanced cases. Cryosurgery provides a safe, effective method.

Biopsy and Clinical Course After Cryosurgery for Prostatic Cancer

Open perineal cryosurgical prostatectomy has been reported previously in 154 consecutive prostatic cancer patients at our center. In 37 of these patients post-cryosurgery biopsies of the prostate were obtained. In the present report we compare this tissue to the preoperative biopsies. The data suggest that well differentiated cancers are associated with advantageous survival in cryosurgery patients. Lymphoid and eosinophilic cell infiltrates may represent post-cryosurgical local immune responses, with improved survival. Estrogen therapy seems to suppress this local immune response. One month or more after cryosurgery cancer in the biopsy correlates with palpable local recurrence but prior to 1 month it does not correlate. Cryosurgery by the open perineal approach has been an effective method to eliminate the primary lesion in localized and extensive prostatic cancer.

Cryosurgery in prostatic cancer: Elimination of local lesion

From 1969 through 1976, we performed cryosurgery in 229 cases of prostatic cancer. Most of these patients had bulky, locally extensive primary tumors, and one-half had disseminated disease. Through the open perineal approach, which gives exposure for an adequate freeze, cryosurgery has been well tolerated. The primary surgical goal has been to reduce or eliminate the local lesion to minimize subsequent cancer-related lower urinary tract problems and to cure those patients with truly localized disease. In every case cryosurgery produced dramatic shrinkage of the local lesion. After four to eight weeks a local recurrence was suspected in 13 per cent, and 41 per cent eventually had some evidence of a recurrent cancer nodule or persistent cancer in the bladder neck. In a series of statistical analyses we have related these recurrences to other clinical factors. Cryosurgery has been a safe, effective way to reduce or eliminate the primary prostatic cancer, even in patients with large local lesions.

Paraplegia and paraparesis due to prostatic cancer: Use of intravenous diethylstilbestrol diphosphate

Abstract Diethylstilbestrol diphosphate (Stilphostrol) administered intravenously is a safe, effective drug in the treatment of prostatic carcinoma. Its dramatic effectiveness in the amelioration of paraparesis and paraplegia from epidural metastases has been demonstrated in 62 per cent of patients receiving the drug in addition to laminectomy and/or hormonal manipulation. Diethylstilbestrol diphosphate was also effective in relieving bone pain associated with metastases in 93 per cent of patients. A unique combined chemo- and radiotherapeutic aspect of diethylstilbestrol diphosphate-P 32 is suggested.

Problems in Ileal Conduit Surgery

The ileal conduit as a means of supravesical urinary diversion has been widely employed since 1950. The first operations of this nature were performed at The Johns Hopkins Hospital in 1955. All patients at the State University of Iowa Hospitals subjected to ileal diversion from 1961 through 1969 have been reviewed; many of the findings form the basis of this report.