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2.
Eur Urol ; 66(5): 829-38, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23932338

RESUMO

BACKGROUND: Trials assessing the benefit of immediate androgen-deprivation therapy (ADT) for treating prostate cancer (PCa) have often done so based on differences in detectable prostate-specific antigen (PSA) relapse or metastatic disease rates at a specific time after randomization. OBJECTIVE: Based on the long-term results of European Organization for Research and Treatment of Cancer (EORTC) trial 30891, we questioned if differences in time to progression predict for survival differences. DESIGN, SETTING, AND PARTICIPANTS: EORTC trial 30891 compared immediate ADT (n=492) with orchiectomy or luteinizing hormone-releasing hormone analog with deferred ADT (n=493) initiated upon symptomatic disease progression or life-threatening complications in randomly assigned T0-4 N0-2 M0 PCa patients. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Time to first objective progression (documented metastases, ureteric obstruction, not PSA rise) and time to objective castration-resistant progressive disease were compared as well as PCa mortality and overall survival. RESULTS AND LIMITATIONS: After a median of 12.8 yr, 769 of the 985 patients had died (78%), 269 of PCa (27%). For patients receiving deferred ADT, the overall treatment time was 31% of that for patients on immediate ADT. Deferred ADT was significantly worse than immediate ADT for time to first objective disease progression (p<0.0001; 10-yr progression rates 42% vs 30%). However, time to objective castration-resistant disease after deferred ADT did not differ significantly (p=0.42) from that after immediate ADT. In addition, PCa mortality did not differ significantly, except in patients with aggressive PCa resulting in death within 3-5 yr after diagnosis. Deferred ADT was inferior to immediate ADT in terms of overall survival (hazard ratio: 1.21; 95% confidence interval, 1.05-1.39; p [noninferiority]=0.72, p [difference] = 0.0085). CONCLUSIONS: This study shows that if hormonal manipulation is used at different times during the disease course, differences in time to first disease progression cannot predict differences in disease-specific survival. A deferred ADT policy may substantially reduce the time on treatment, but it is not suitable for patients with rapidly progressing disease.


Assuntos
Antagonistas de Androgênios/administração & dosagem , Neoplasias Hormônio-Dependentes/tratamento farmacológico , Orquiectomia , Neoplasias de Próstata Resistentes à Castração/tratamento farmacológico , Neoplasias da Próstata/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Antagonistas de Androgênios/efeitos adversos , Quimioterapia Adjuvante , Progressão da Doença , Esquema de Medicação , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Hormônio-Dependentes/mortalidade , Neoplasias Hormônio-Dependentes/patologia , Orquiectomia/efeitos adversos , Orquiectomia/mortalidade , Modelos de Riscos Proporcionais , Neoplasias da Próstata/mortalidade , Neoplasias da Próstata/patologia , Neoplasias de Próstata Resistentes à Castração/mortalidade , Neoplasias de Próstata Resistentes à Castração/patologia , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
3.
Expert Rev Med Devices ; 8(5): 597-605, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22026625

RESUMO

Inadequate hemostasis is one of the most important causes of morbidity and mortality following urological surgery. Despite the long-term usage of coagulation, there is an ongoing development of new devices, including bipolar transurethral resection of the prostate or new vessel-sealing devices. A thorough understanding of the advantages and disadvantages of these new instruments can improve the operative experience for both the urologist and patient. The optimal coagulation system should be small, efficient, easy to handle and with low heat spread. In this article, we analyze different electrothermal coagulation systems and modern tissue-sealing devices in urological applications with the aim to substantiate the advantages and disadvantages of each technique in terms of efficacy and safety.


Assuntos
Eletrocirurgia/métodos , Ressecção Transuretral da Próstata/métodos , Procedimentos Cirúrgicos Urológicos/métodos , Animais , Ensaios Clínicos como Assunto , Eletrocoagulação , Eletrocirurgia/tendências , Temperatura Alta , Humanos , Laparoscopia/métodos , Masculino , Segurança do Paciente , Neoplasias da Próstata/cirurgia , Suínos , Procedimentos Cirúrgicos Urológicos/tendências
4.
Urol Int ; 86(4): 476-82, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21525721

RESUMO

INTRODUCTION: Bipolar vessel-sealing devices (VSDs) have advantages in urological surgeries (less hemorrhage, shorter operating time). However, these instruments can cause thermal injuries, which can result in neural damage and necrosis. The objectives of this study were to establish a reproducible in vitro model for standardized assessment of electrosurgical devices and to evaluate whether optimized placement of surgical instruments can reduce the thermal spread. METHODS: We evaluated thermal spread of two VSDs in vitro using thin bovine muscle strips. Thermal injury was measured using an infrared camera, temperature probes and histology. The recordings were made with the VSD alone and with a rectangular clamp next to the VSD. RESULTS: Both instruments showed a significant temperature spread of 2.5 mm lateral to the VSD. The placement of a metal clamp next to the VSD significantly reduced the temperature spread. Histological examinations were able to underline these findings. CONCLUSIONS: In this study we describe a straightforward clinically relevant in vitro model for the evaluation of future electrosurgical instruments. We demonstrated that the thermal spread of VSD could be further reduced by optimized placement of an additional surgical instrument. Our results could help surgeons protect sensitive structures like nerves in the vicinity of the VSD.


Assuntos
Eletrocoagulação/instrumentação , Neurônios/patologia , Animais , Bovinos , Eletrocoagulação/métodos , Eletrocirurgia/instrumentação , Desenho de Equipamento , Hemostasia , Temperatura Alta , Laparoscopia/métodos , Músculos/patologia , Necrose , Instrumentos Cirúrgicos , Temperatura
5.
Eur Urol ; 53(5): 941-9, 2008 May.
Artigo em Inglês | MEDLINE | ID: mdl-18191322

RESUMO

OBJECTIVE: EORTC trial 30891 compared immediate versus deferred androgen-deprivation therapy (ADT) in T0-4 N0-2 M0 prostate cancer (PCa). Many patients randomly assigned to deferred ADT did not require ADT because they died before becoming symptomatic. The question arises whether serum prostate-specific antigen (PSA) levels may be used to decide when to initiate ADT in PCa not suitable for local curative treatment. METHODS: PSA data at baseline, PSA doubling time (PSADT) in patients receiving no ADT, and time to PSA relapse (>2 ng/ml) in patients whose PSA declined to <2 ng/ml within the first year after immediate ADT were analyzed in 939 eligible patients randomly assigned to immediate (n=468) or deferred ADT (n=471). RESULTS: In both arms, patients with a baseline PSA>50 ng/ml were at a>3.5-fold higher risk to die of PCa than patients with a baseline PSA12 mo. Time to PSA relapse after response to immediate ADT correlated significantly with baseline PSA, suggesting that baseline PSA may also reflect disease aggressiveness. CONCLUSIONS: Patients with a baseline PSA>50 ng/ml and/or a PSADT<12 mo were at increased risk to die from PCa and might have benefited from immediate ADT, whereas patients with a baseline PSA<50 ng/ml and a slow PSADT (>12 mo) were likely to die of causes unrelated to PCa, and thus could be spared the burden of immediate ADT.


Assuntos
Antagonistas de Androgênios/uso terapêutico , Orquiectomia/métodos , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/sangue , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/sangue , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias/métodos , Neoplasias da Próstata/patologia , Neoplasias da Próstata/terapia , Taxa de Sobrevida/tendências , Fatores de Tempo , Resultado do Tratamento
6.
J Pathol ; 201(4): 603-8, 2003 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-14648664

RESUMO

Gene amplification is a common mechanism for oncogene overexpression. High-level amplifications at 11q13 have been repeatedly found in bladder cancer by comparative genomic hybridization (CGH) and other techniques. Putative candidate oncogenes located in this region are CCND1 (PRAD1, bcl-1), EMS1, FGF3 (Int-2), and FGF4 (hst1, hstf1). To evaluate the involvement of these genes in bladder cancer, a tissue microarray (TMA) containing 2317 samples was screened by fluorescence in situ hybridization (FISH). The frequency of gains and amplifications of all genes increased significantly from stage pTa to pT1-4 and from low to high grade. In addition, amplification was associated with patient survival and progression of pT1 tumours. Among 123 tumours with amplifications, 68.3% showed amplification of all four genes; 19.5% amplification of CCND1, FGF4, and FGF3; and 0.8% co-amplification of FGF4, FGF3, and EMS1. Amplification of CCND1 alone was found in 9% of the tumours, while EMS1 alone was amplified in 1.6% and FGF4 in 0.8%. Overall, the amplification frequency decreased with increasing genomic distance from CCND1, suggesting that, among the genes examined, CCND1 is the major target gene in the 11q13 amplicon in bladder cancer.


Assuntos
Cromossomos Humanos Par 11/genética , Amplificação de Genes/genética , Genes bcl-1/genética , Análise de Sequência com Séries de Oligonucleotídeos/métodos , Oncogenes/genética , Proteínas Proto-Oncogênicas/genética , Neoplasias da Bexiga Urinária/genética , Adenocarcinoma/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Pequenas/genética , Carcinoma de Células Escamosas/genética , Carcinoma de Células de Transição/genética , Cortactina , Ciclina D1/genética , DNA de Neoplasias/análise , Feminino , Fator 3 de Crescimento de Fibroblastos , Fator 4 de Crescimento de Fibroblastos , Fatores de Crescimento de Fibroblastos/genética , Humanos , Hibridização in Situ Fluorescente/métodos , Masculino , Proteínas dos Microfilamentos/genética , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Fenótipo , Prognóstico
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