The risks of lymph node metastasis and the prognostic factors in carcinoma of the penis: analysis of 50 patients treated with bilateral ilioinguinal lymphadenectomy.

OBJECTIVE: To determine the risks of inguinal and pelvic lymph node metastasis as well as the prognostic factors in carcinoma of the penis. METHOD: Fifty patients with squamous cell carcinoma of the penis who consecutively underwent immediate bilateral ilioinguinal lymphadenectomy after treatment of the primary tumor. Clinical features were evaluated to determine the risk of inguinal and pelvic lymph node metastasis as well as prognostic factors. RESULTS: Patients with palpable inguinal lymph node had a high risk of inguinal lymph node metastasis compared with patients with a non palpable inguinal lymph node (p = 0.002). Patients with poor differentiated tumors had a high risk of pelvic lymph node metastasis compared with patients with well or moderately differentiated tumors (p = 0.021). Prognostic factors significantly related to survival were the clinical status of the inguinal lymph node, histological grade and the status of lymph node metastasis (N stage). None of the patients with stage N0 and N1 died with the longest follow-up at 85 and 67 months, respectively. Cumulative survivals were 0.6 at follow-up at 36 months for the patients with stage N2 and 0.5 at follow-up at 18 months for patients with stage N3. CONCLUSION: The clinical status of inguinal lymph node was related to the risk of inguinal lymph node metastasis. Histological grade was related to the risk of pelvic lymph node metastasis. The clinical status of the inguinal lymph node, histological grade and pathological N stage were the important factors affecting the prognosis.

The risks of prostate cancer detection by transrectal ultrasound guide biopsy in Thai men with abnormal prostatic-specific antigen or abnormal digital rectal examination.

OBJECTIVE: To determine the risks of prostate cancer detection in Thai men with abnormal prostatic-specific antigen (PSA) or abnormal digital rectal examination (DRE). MATERIAL AND METHOD: One hundred and forty four Thai men with abnormal PSA or abnormal DRE or both were biopsied at the prostate gland with the use of transrectal ultrasound guide biopsy (TRUSBX). The risks of prostate cancer detection were evaluated. RESULTS: Mean age was 65.7 years old (S.D. = 9.88). The risks of positive biopsy according to the PSA levels of 0-4 ng/ml, 4.1-10 ng/ml, 10.1-20 ng/ml, 20.1-50 ng/ml, 50.1-100 ng/ml and more than 100 ng/ml were 6.25 per cent, 6.67 per cent, 10.8 per cent, 33.3 per cent, 60 per cent and 100 per cent, respectively. The risks of positive biopsy according to DRE appearances of total hard consistency, nodule, induration and benign prostatic hyperplasia were 57.1 per cent, 23.5 per cent, 34.6 per cent and 10 per cent, respectively. Of 144 men, 32 had adenocarcinoma of prostate. Radical prostatectomy was performed on 15 patients with clinically localized disease. Ten patients (66.6%) had free margin on their pathological specimens and 6 (40%) had organ confined disease. CONCLUSION: PSA testing alone or DRE alone is not a perfect test to diagnose prostate cancer since prostate cancer may present in men with normal PSA or men with no suspicious cancer DRE. For early detection of prostate cancer, both PSA testing and DRE need to be performed. When either PSA testing or DRE or both is abnormal, TRUSBX should be carried out.

Five-year follow-up of prostate cancer in Siriraj Hospital.

OBJECTIVE: To determine the clinical features, tumor characteristics, and treatment outcomes of Thai men with prostate cancer. MATERIAL AND METHOD: We retrospectively evaluated the clinical features, tumor characteristics, and treatment outcomes of 95 patients who were registered in Siriraj Hospital from 1993 to 1995. A survival end point in each stage was determined. RESULTS: The mean age was 72.37. The distributions of stage were 7.5 per cent for stage A, 1.1 per cent for stage B, 67.7 per cent for stage C, and 23.7 per cent for stage D. The prognosis of a clinical localized disease appeared good. Most patients with a urinary symptom were highly associated with stage C or stage D disease and were treated by hormonal therapy. With a maximal follow-up of 60 months, the median survival of stage C and D patients was 45 and 12 months, respectively. CONCLUSION: Most Thai patients with prostate cancer were older than the life expectancy of Thai men. They presented with urinary symptoms and had locally advanced or advanced disease. With hormonal treatment, their prognoses were not impressive.

Is prostate-specific antigen still the best tumor marker for prostate cancer?

PSA has been utilized for more than a decade. Since the overwhelming benefit of PSA, the previous markers for prostate cancer have been abandoned. Even though PSA is no more an organ specific agent, its function as an organ specific marker remains in all clinical situations. PSA is significantly involved not only in screening for early detection but also in all clinical spectrums of prostate cancer. Never before has the tumor marker played such a significant role in all purposes of clinical utilization for prostate cancer as PSA has. The answer to the title of this article is absolutely positive. Nevertheless, the following question of whether PSA has an impact in decreasing the mortality rate of patients with prostate cancer is yet to be answered. In Siriraj Hospital, though PSA has been available since 1991, the majority of patients registered with the advanced stage of disease and their treatment outcomes are not always satisfactory. Since the prognoses of the patients with an early stage of disease appear very good, to improve the mortality of Thai patients with prostate cancer, screening using PSA for early detection should be introduced and widely used.

Hormonal ablation therapy for metastatic prostatic carcinoma: a review.

Hormonal therapy is the standard treatment for metastatic prostatic carcinoma. The conventional surgical or medical androgen ablation therapy seems to have a similar response. Despite a higher response of CAB compared to conventional castration in metastatic disease, the controversy of survival benefit remains unsolved. Immediate treatment should be given in metastatic disease particularly in patients who have minimal metastases. In patients who have progression after CAB, antiandrogens should be withdrawn. The choices of optimal therapies for prostate cancer depend not only on the survival but also the quality of life and cost effect. Thus, the critical factors for approaching prostate cancer are appropriate patient selection and stratification. Implicit with this approach should maximize benefit from maximal androgen ablation therapy for patients who are likely to profit from it. Finally, the development of experiments, clinical trials, and novel therapeutic strategies may provide better management for prostate cancer in the future.