Radisa Tomic

COMBINED ORCHIECTOMY AND EXTERNAL RADIOTHERAPY VERSUS RADIOTHERAPY ALONE FOR NONMETASTATIC PROSTATE CANCER WITH OR WITHOUT PELVIC LYMPH NODE INVOLVEMENT: A PROSPECTIVE RANDOMIZED STUDY

PURPOSE We compare the combination of orchiectomy and radiotherapy to radiotherapy alone as treatment for pelvic confined prostate cancer, that is T1-4, pN0-3, M0 (TNM classification). MATERIALS AND METHODS In this prospective study 91 patients with clinically localized prostate cancer were, after surgical lymph node staging, randomized to receive definitive external beam radiotherapy (46) or combined orchiectomy and radiotherapy (45). Patients treated with radiotherapy alone had androgen ablation at clinical disease progression. The effects on progression-free, disease specific and overall survival rates were calculated. RESULTS After a median followup of 9.3 years (range 6.0 to 11.4) clinical progression was seen in 61% of the radiotherapy only patients (group 1) and in 31% of the combined treatment patients (group 2) (p = 0.005). The mortality was 61 and 38% (p = 0.02), and cause specific mortality was 44 and 27%, respectively (p = 0.06), in groups 1 and 2. The differences in favor of combined treatment were mainly caused by lymph node positive tumors. For node negative tumors there was no significant difference in survival rates. CONCLUSIONS The progression-free, disease specific and overall survival rates for patients with prostate cancer and pelvic lymph node involvement are significantly better after combined androgen ablation and radiotherapy than after radiotherapy alone. These results strongly suggest that early androgen deprivation is better than deferred endocrine treatment for these patients.

Quality of life and symptoms in a randomized trial of radiotherapy versus deferred treatment of localized prostate carcinoma.

Treatment of localized prostate carcinoma (LPC) using radiotherapy (RT) can induce disturbances in a patients quality of life (QOL) and urinary and intestinal function. Late symptoms and QOL were evaluated in a randomized trial between RT and deferred treatment (DT).

Effects of External Radiation Therapy for Cancer of the Prostate on the Serum Concentrations Of Testosterone, Follicle-Stimulating Hormone, Luteinizing Hormone and Prolactin

Testosterone, luteinizing hormone, follicle-stimulating hormone and prolactin were analyzed in serum from 31 patients with carcinoma of the prostate treated primarily with megavoltage radiation therapy. The total tumor dose varied between 58 and 71 gray (mean 63.5 gray). Absorbed doses to the testes were measured at approximately 1 to more than 10 gray. We investigated retrospectively 17 patients 3 to 60 months (mean 20 months) after therapy and found significantly lower serum testosterone concentrations and significantly higher luteinizing and follicle-stimulating hormone concentrations than in age-matched controls. Of the patients 14 were followed before and after radiation treatment. Testosterone concentrations were reduced significantly 1 week as well as 3 months after treatment but pre-treatment values were found on analysis 6 and 12 months after treatment. The values for luteinizing and follicle-stimulating hormones were significantly higher 3, 6 and 12 months after radiation treatment compared to pre-treatment values. The follicle-stimulating hormone value already increased after 1 week. The greatest observed testosterone alteration occurred 1 week after treatment in patients who received more than 10 gray over the gonads. The use of lead shields protecting the testes reduced the dose absorbed to the gonads by approximately 50 per cent.

Living after radical prostatectomy for localized prostate cancer. A qualitative analysis of patient narratives

The purpose of this study was to illuminate the experience of living after radical prostatectomy (RP) for localized prostate cancer (LPC). Ten men were interviewed after RP. The interview text was qualitatively analyzed using the content analysis. The men suffered from worry, anxiety, and distress, and longed for life as they had lived it before the diagnosis. Changes in bodily functions after RP include urine incontinence (UI) and/or erectile dysfunction (ED) making the patient feel like a changed man with a lost sex life, with changes in his intimate relations with his wife, and with lowered self-esteem. Most men choose to cope on their own. Coping strategies in our study population included finding new areas of interest and a new focus in the present. In the present study, living after RP meant striving to gain control over, and become reconciled with, the new life situation as a changed man living with an altered self.

Lymph Leakage After Staging Pelvic Lymphadenectomy for Prostatic Carcinoma with and Without Heparin Prophylaxis

The effect of heparin prophylaxis on lymph leakage and lymphocele formation was observed in a randomized, prospective, consecutive study of 48 patients undergoing lymph node dissection for staging carcinoma of the prostate. Subcutaneous low-dose heparin was given to 24 patients, and 24 without heparin prophylaxis constituted the control group. Lymph leakage per day was significantly greater and the leakage period longer in the heparin group than in the controls. The total of leaked lymph was notably greater and the incidence of lymphocele seven times higher in the heparin group than in the controls. All lymphoceles disappeared spontaneously in the first postoperative year. The results suggest high risk of prolonged lymph leakage and of lymphocele formation when low-dose heparin prophylaxis is given to patients undergoing a staging operation for prostatic carcinoma.

Living After External Beam Radiotherapy of Localized Prostate Cancer: A Qualitative Analysis of Patient Narratives

The treatment of prostate cancer induces adverse effects. Although quantitative studies have evaluated the influence of these adverse effects on the quality of life, few studies have tried to gain a deeper understanding of how men live after external beam radiotherapy of localized prostate carcinoma, which is the purpose of this study. Ten men were interviewed in their homes. The narrative interviews were tape recorded and transcribed into a text. The text was analyzed qualitatively by a content analysis. To bear the emotional experience of the illness by oneself is a self-chosen strategy. Some men expressed a sense of being exposed in meetings with female caregivers. The treatment induced changes in body functions influencing daily life. In this new life situation these men are striving to reach a sense of having control, which includes control over disease progression and waning body function. Despite the negative influence of the treatment, the men are striving to become reconciled with their new life. The experience of living after external beam radiotherapy of localized prostate carcinoma could be understood as striving to reach a sense of control and becoming reconciled with a new way of life.

Predictive Value of Prostate-specific Antigen, Tumour Stage and Tumour Grade for the Outcome of Bone Scintigraphy in Patients with Newly Diagnosed Prostate Cancer

OBJECTIVE In order to evaluate the negative predictive value of a low prostate-specific antigen (PSA) for a positive bone scan, we performed a retrospective study in a patient material from the Umea region in Northern Sweden. We also evaluated whether different tumour grades could influence this predictive value. MATERIAL AND METHODS Four-hundred-and-forty-six patients of newly diagnosed prostate cancer were reviewed. We analysed different levels of PSA, tumour grade, tumour stage and combinations of these parameters for their use in making a positive bone scintigraphy (BS) prediction. RESULTS Among 214 patients with PSA <20 ng/ml, 9 showed a positive BS. When tumours of grades 2 and 3 were excluded, the number of positive BS predictions decreased to 6. For 350 of these 446 patients, a classification according to TNM was available; 162 of these 350 had a PSA value <20 ng/ml, and when this group comprised only small and well-differentiated tumours (T1-2, G1), only one of the remaining 81 patients had a positive BS result. CONCLUSIONS We conclude that in most patients with small and well-differentiated tumours (T1-2, G1) and PSA <20, BS staging need not be carried out.

Sexual function in men after radical cystectomy with or without urethrectomy

Sexual function was evaluated in 21 patients with bladder carcinoma who had undergone radical cystectomy either with (n = 9) or without (n = 12) excision of the urethra. All patients received preoperative radiotherapy, and the cystectomy was done by a nerve-sparing surgical technique. At follow-up all patients reported normal sexual desire and tactile sexual activity. Eight of the 12 patients in whom the urethra was preserved could achieve penile erection and orgasm to tactile stimulation, and five of them had sufficient strength and duration of erection for sexual intercourse. Two of the nine patients in whom the urethra was removed-had weak erections insufficient for intercourse; three could experience orgasm. These results show that when cystectomy is done by a nerve-sparing technique and without urethrectomy there is more chance of preserving sexual function than when simultaneous urethrectomy is done.

Downstaging and survival benefits of neoadjuvant radiotherapy before cystectomy for patients with invasive bladder carcinoma

Objective. To compare the long-term outcomes of a series of patients treated with neoadjuvant radiotherapy combined with cystectomy against a later series of patients treated with immediate cystectomy. Material and methods. A total of 187 consecutive patients, surgically treated with cystectomy due to cT1–3 transitional cell bladder carcinoma with (n=90) or without (n=97) neoadjuvant radiotherapy, was included in a retrospective analysis. The clinical stage at the primary bladder resection and the pathological reports after the cystectomy were re-evaluated and progression-free, disease-specific and overall survival were calculated. Results. Seven of 97 (7%) patients treated without any neoadjuvant therapy had pT0 in the bladder specimen. In contrast, 51 of 90 patients (57%) treated with neoadjuvant radiotherapy downstaged to pT0. Among cT3 tumours none of 16 patients (0%) treated without radiotherapy downstaged to pT0, while 19 (56%) of 34 patients treated with radiotherapy did so. The progression-free survival was significantly longer for patients with pT0 than for those with a remaining tumour (pT1–4) in the cystectomy specimen (p<0.001). A high T stage correlated with adverse overall survival. Patients with cT3 tumours treated with neoadjuvant radiotherapy followed by cystectomy had significantly longer disease-specific survival time (p=0.007) than those undergoing cystectomy only. In a Cox regression analysis, cT stage as well as pT stage and occurrence of carcinoma in situ in the cystectomy specimens remained as independent prognostic factors. Conclusions. In this retrospective study neoadjuvant radiotherapy before the cystectomy resulted in significant downstaging of invasive bladder transitional cell carcinoma. This downstaging was most significant for patients with cT3 tumours leading to prolonged survival.

Binding capacity of testosterone-estradiol-binding globulin (TeBG), total and calculated unbound concentrations of testosterone in patients with carcinoma of the prostate treated with orchidectomy or estrogens

Testosterone-estradiol-binding globulin (TeBG) binding capacity, total estradiol-17β and total testosterone were measured in patients with carcinoma of the prostate treated with orchidectomy or estrogens. Comparisons were made with a control group. There was a significant increase in TeBG binding capacity in the group treated with estrogens. Both orchidectomy and estrogen-treatment decreased total testosterone significantly and to the same degree. The concentration of free testosterone was calculated using a new method, and was found to be lower in orchidectomized and estrogen treated patients when compared with the control group. When the two groups under treatment were compared, the calculated free testosterone concentration was significantly lower in the estrogen treated group.