ABSTRACT
Among the issues discussed at this year's meeting on prostate cancer in Vail, Colorado, were several that specifically relate to the patient with advanced disease. Dr. E. David Crawford addressed the issue of the timing of hormone therapy, specifically reviewing several important trials that give a glimpse at the potential outcome of aggressive treatment in stage D1.5. The efficacy of antiandrogens, flutamide, bicalutamide, and nilutamide, when combined with chemical or surgical castration, was reviewed. Dr. Arturo Mendoza-Valdes reviewed the rationale behind intermittent (versus continuous) total androgen blockade, especially as related to quality of life. Dr. Paul Miller gave an update on the role of bisphosphonates as adjuvant therapy for prostate cancer. Also discussed was an important new agent for androgen deprivation, Abarelix, a sustained-release GnRH antagonist with low histamine-releasing potential which avoids testosterone and other hormone surge and flare.
ABSTRACT
This prospective trial was undertaken to determine the benefits of the combination of bilateral orchidectomy with flutamide, both in terms of survival and quality of life for patients with advanced prostatic carcinoma. All patients were previously untreated and received 750 mg/d of flutamide immediately after bilateral orchidectomy. The mean age was 68.9 +/- 9.4 years. Pain disappeared or decreased in 83% of patients at 3 months, 62% of patients at 6 months, and 25% of patients at 12 months. The survival was 62% at 12 months and 58% at 24 months. No patients discontinued treatment with flutamide as a result of side effects. In conclusion, total androgenic blockade with flutamide and bilateral orchidectomy was seen to be a safe and effective approach that increases survival and improves the quality of life of patients with advanced prostatic carcinoma. A greater number of patients and a larger follow-up is necessary to substantiate the improvement in survival.
Subject(s)
Carcinoma/drug therapy , Flutamide/therapeutic use , Orchiectomy , Prostatic Neoplasms/drug therapy , Adult , Aged , Aged, 80 and over , Carcinoma/surgery , Combined Modality Therapy , Humans , Male , Mexico , Middle Aged , Prostatic Neoplasms/surgery , Remission InductionSubject(s)
Cryptorchidism/surgery , Testis/transplantation , Child , Humans , Male , Microsurgery , Testis/blood supply , Transplantation, AutologousABSTRACT
Eighty-seven records of patients with a radiologic diagnosis of benign ulcer, cancer or non-specific gastric changes and with a final diagnosis confirmed by biopsy, surgery or follow-up were analyzed to find out whether gastroscopy was useful. In patients with radiologic diagnosis of benign ulcer, gastroscopy was useful in 87% of the cases. When radiology suspected gastric cancer, gastroscopy established the diagnosis in two thirds of the cases. When the radiologist considered a diagnosis as certain his accuracy and specificity were comparable with those of the endoscopist. In such cases endoscopy is only confirmatory. In 7 patients with a radiologic diagnosis of non-specific gastric changes gastroscopy established diagnosis in 6. We concluded that gastroscopy is useful for the patient with a diagnosis of benign ulcer, non-specific gastric changes, or suspicion of gastric cancer. When diagnosis of gastric cancer is established by radiology, gastroscopy is not useful.
