Genitourinary Cancers

LOS ANGELES--A survey of men with and without prostate cancer used four different instruments (see below) to get a clear picture of how treatment decisions affect quality of life, and found some surprising results, Mark S. Litwin, MD, MPH, told Oncology News International.

Complication rates in 1,000 consecutive patients who underwent radical retropubic prostatectomy for clinically localized prostate cancer between November 1989 and January 1992 were assessed and compared to complication rates in a historical group of patients operated on by primarily the same surgeons prior to 1987. In the contemporary series, there were no operative deaths, only 22% of patients required blood transfusion, and only six (0.6%) patients suffered rectal injuries. Early complications, including myocardial infarction, pulmonary embolism, bacteremia, and wound infection, occurred in less than 1% of patients. Vesical neck contracture, the most common late complication, developed in 87 patients (8.7%). At 1 year post-surgery, 80% of patients were completely continent, and fewer than 1% were totally incontinent. [ONCOLOGY 9(5):379-389, 1995]

Radical prostatectomy is not only the most common operation performed by most urologic oncologists, but also probably now represents the most common open operative procedure performed by all urologists in the United States. Much of this dramatic increase is due to the use of prostate-specific antigen (PSA) as a method for early diagnosis. My own experience is not unusual, in that approximately 50% of my male patients who underwent a radical prostatectomy last year had clinical stage T1c prostate cancer, meaning that the digital rectal exam was normal. The diagnostic biopsy was performed because of an elevated PSA.

During the past decade, there has been an increase of over 300% in the incidence of prostate cancer and a 150% increase in the death rate from this dreaded cancer. It is estimated that more than 244,000 men will be diagnosed with this neoplasm during 1995, and at least 42,000 will die as a direct result of the disease [1]. Challenged by this dramatically rising incidence and mortality, three strategies can be implemented: (1) attempt to prevent the disease; (2) find the disease early, treat it, and cure it; and (3) discover a cure for the disease once it has escaped the bounds of the prostate.

CHICAGO--Proponents of the prostate-specific antigen (PSA) test have new ammunition to support the view that the controversial screening method accurately predicts the progression of prostate cancer and the long-term survival of patients,

PHILADELPHIA--Pain from skeletal metastasis has a major impact on quality of life in patients with prostate cancer, Mary Layman-Goldstein, RN, OCN, said at the American Cancer Society's National Conference on Prostate Cancer. Ms. Layman-Goldstein, a clinical nurse specialist at Memorial Sloan-Kettering Cancer Center, served on a panel discussion on how to manage complications of prostate cancer.

CHICAGO--DNA ploidy in needle biopsy specimens is proving to be a highly accurate method of predicting local and distant spread of prostate cancer, as well as the probability of recurrence, Matthew Rifkin, MD, reported at the annual meeting of the Radiological Society of North America.

NEW YORK--Initial enthusiasm accompanying the introduction of laparoscopy in the diagnosis and treatment of prostate cancer has given way to a more realistic assessment of its value, R. Ernest Sosa, MD, said at a conference on prostate cancer at Lenox Hill Hospital. It continues to have value, but its role is limited and is unlikely to broaden.

The pharmacoeconomics of patient managementis important in the case of the critically ill. Pain palliationand improvements to quality of life are treatment goals for patientswith metastatic prostate cancer and can actually