Mitchell H. Sokoloff

Randomized, Double-Blind, Placebo-Controlled Trial of Polyphenon E in Prostate Cancer Patients before Prostatectomy: Evaluation of Potential Chemopreventive Activities

Compelling preclinical and pilot clinical data support the role of green tea polyphenols in prostate cancer prevention. We conducted a randomized, double-blind, placebo-controlled trial of polyphenon E (enriched green tea polyphenol extract) in men with prostate cancer scheduled to undergo radical prostatectomy. The study aimed to determine the bioavailability of green tea polyphenols in prostate tissue and to measure its effects on systemic and tissue biomarkers of prostate cancer carcinogenesis. Participants received either polyphenon E (containing 800 mg epigallocatechin gallate) or placebo daily for 3 to 6 weeks before surgery. Following the intervention, green tea polyphenol levels in the prostatectomy tissue were low to undetectable. Polyphenon E intervention resulted in favorable but not statistically significant changes in serum prostate-specific antigen, serum insulin-like growth factor axis, and oxidative DNA damage in blood leukocytes. Tissue biomarkers of cell proliferation, apoptosis, and angiogenesis in the prostatectomy tissue did not differ between the treatment arms. The proportion of subjects who had a decrease in Gleason score between biopsy and surgical specimens was greater in those on polyphenon E but was not statistically significant. The studys findings of low bioavailability and/or bioaccumulation of green tea polyphenols in prostate tissue and statistically insignificant changes in systemic and tissue biomarkers from 3 to 6 weeks of administration suggests that prostate cancer preventive activity of green tea polyphenols, if occurring, may be through indirect means and/or that the activity may need to be evaluated with longer intervention durations, repeated dosing, or in patients at earlier stages of the disease. Cancer Prev Res; 5(2); 290–8. ©2011 AACR.

BILATERAL LAPAROSCOPIC INGUINAL HERNIA REPAIR CAN COMPLICATE SUBSEQUENT RADICAL RETROPUBIC PROSTATECTOMY

We report a case in which pelvic lymphadenectomy and radical retropubic prostatectomy were aborted because the pelvic side walls and Retzius’ space were obliterated by polypropylene mesh that had been placed during bilateral laparoscopic inguinal hernia repair 3 years previously. To our knowledge our case represents the first report of this problem, and we believe that bilateral laparoscopic inguinal hernia repair makes subsequent radical retropubic prostatectomy more difficult, if not impossible.

INDICATIONS AND CONTRAINDICATIONS FOR NERVE-SPARING RADICAL PROSTATECTOMY

Nerve-sparing radical prostatectomy can be performed safely in most men undergoing radical prostatectomy. As is true in many aspects of prostate cancer diagnosis and therapy, the key element is patient selection. With many prostate tumors diagnosed at an earlier stage, the authors have seen a shift toward more favorable pathologic findings at the time of surgery. Concomitant with the success of early detection of prostate cancer is the realization that men are younger at the time of diagnosis and more interested in preserving sexual function. This article has described factors associated with an increased risk for extraprostatic tumor and, subsequently, an increased possibility of postprostatectomy cancer recurrence. Except for the previously mentioned absolute contraindications, none of these factors, by themselves, should be used to exclude a patient from nerve-sparing prostatectomy. Instead, meticulous attention must be given to the surgical dissection. If any doubt remains regarding residual tumor, the surgeon should err on the side of caution and remove the neurovascular bundle. The use of standardized intraoperative frozen-section analysis can help guide these decisions. The patient must be informed before surgery regarding the risks of nerve-sparing surgery, the potency rates of the surgeon, and the possibility that, to ensure adequate cancer control, the nerves may be sacrificed despite any preoperative optimism favoring the potential for their salvage.

Surgical and postoperative factors affecting length of hospital stay after radical prostatectomy

Radical prostatectomy continues to comprise the mainstay of therapy for localized prostate carcinoma. However, caring for radical prostatectomy patients accounts for approximately half of the

Current management of renal cell carcinoma

1.7 billion annual cost of prostate carcinoma treatment. Length of stay (LOS) after surgery appears to be one of the main components of this cost. The first step in reducing cost is to identify those variables associated with LOS. Radical prostatectomy can be performed using two very different surgical techniques and with each technique different costs are incurred. The objective of the current study was to identify factors associated with LOS as a function of surgical approach. To reduce potential biases due to patient requests for longer hospitalization or physician preferences in that regard, secondary objectives were to identify factors associated with time to fluid intake (TTF) and time to consume solid foods (TTS).

Characterizing prostatic adenocarcinomas in men with a serum prostate specific antigen level of <4.0 ng/mL

Renal cell carcinoma is the most common malignancy of the kidney and accounts for about three percent of all adult neoplasms. This article reviews the clinical presentation, diagnosis, staging, and treatment of this disease.

Targeting Angiogenic Pathways Involving Tumor–stromal Interaction to Treat Advanced Human Prostate Cancer

To characterize prostate cancer in men undergoing radical prostatectomy who have a prostate‐specific antigen (PSA) level of < 4.0 ng/mL, hypothesising that a low PSA is not caused by diminished tumour production of PSA, nor does it signify clinically insignificant disease.

A phase II study of high-dose calcitriol combined with mitoxantrone and prednisone for androgen-independent prostate cancer

Interfering with and preventing tumor angiogenesis is an attractive therapeutic approach for treating cancer metastases. This commentary presents treatment strategies that may enhance the effectiveness of anti-angiogenic therapy by selectively targeting newly sprouting and immature vessels, inhibiting the production of angiogenic factors, and disrupting extracellular matrices. We propose several clinical paradigms, including hormonal ablation, intermittent androgen suppression, chemotherapy, and radiation therapy, that ‘injure’ nascent vasculature and interrupt the cancer cell–stromal relationship, thereby potentiating the efficacy of experimental anti-angiogenic agents. These stromal–epithelial interactions play an important role in the development, proliferation and dissemination of prostate cancer, as well as guiding the processes of tumor neovascularization. Successful utilization and targeting of tumor angiogenesis requires an increased understanding of tumor cell–stromal cell–endothelial cell relationships, most notably the intricate intracellular signalling cascades mediated by growth factors and the extracellular matrix.

The Basic Biology of Metastasis

To evaluate the preliminary efficacy, safety, and impact on quality of life (QoL) of high‐dose calcitriol (DN‐101) combined with mitoxantrone and glucocorticoids in androgen‐independent prostate cancer (AIPC).

Defining the biologic role of genes that regulate prostate cancer metastasis.

It is the ability to metastasize that makes cancer a fatal disease. Of the 555,500 cancer-related deaths expected this year in the United States, the vast majority are due to the development of metastatic disease rather than the primary tumor (Jemal et al., 2002). Although treatment is available for patients with metastatic cancer, options are limited and responses can be quite variable. Furthermore, complete remissions tend to be limited in both scope and duration.