Interactive effects of ST-T wave abnormalities on survival of patients with coronary artery disease.

Previous studies have documented a reduced survival time in patients with an electrocardiographic (ECG) ST-T wave abnormality. This study was designed to determine the clinical, hemodynamic and angiographic correlates of this observation. Data from 9,731 patients undergoing cardiac catheterization from 1976 through 1986 were analyzed; 5,531 had severe (greater than 70%) obstruction of at least one major coronary artery, 1,706 had mild (10 to 69%) obstruction and 2,494 had no obstruction. Of the patients with severe obstruction, 2,536 were treated medically and 2,995 were treated by surgical revascularization. Patients with an ST-T abnormality had more clinical risk factors (including older age and greater prevalence of diabetes mellitus, hypertension and prior myocardial infarction) and greater left ventricular dysfunction (including higher end-diastolic pressure and ventricular volume, reduced ejection fraction and greater prevalence of contraction abnormality) than did those without this ECG pattern. Survival time was significantly (p less than 0.01) reduced in subsets of patients with an ST-T abnormality and with severe or mild coronary artery disease; in those without coronary disease, ST-T changes did not correlate with reduced survival. Stepwise regression analysis was applied to each group to determine the independent predictors of 5-year survival. In patients with severe disease or no disease, an ST-T abnormality was not chosen as an independent predictor of 5-year survival; in the group with mild disease, ST-T changes were an independent predictor of reduced survival. Thus, the independent impact of an ST-T abnormality on survival is dependent on the severity of underlying coronary artery disease.

Prognostic factors in patients with advanced prostate cancer.

One hundred ten patients with metastatic prostate cancer (Stage D2) were analyzed to determine the associations among time until progression and the pretreatment testosterone level, extent of bone metastases as indicated by a semiquantitative grading scale for extent of disease, performance status, race, age, and the pretreatment level of prostatic acid phosphatase (PAP). The median follow-up period was twenty-one months, with a range of four to eighty-nine months. All patients received androgen deprivation at the time metastases were identified. A multivariate analysis demonstrated that pretreatment serum testosterone was the most significant variable associated with time until progression (P less than 0.01) and that the extent of bone metastases observed on the bone scan was the second most important variable (P less than 0.05). The following factors did not significantly correlate with progression-free intervals: age, race, and PAP. The performance status was significantly correlated, but was nonsignificant in the multivariate analysis when the model already included the testosterone level and the extent of bone metastases. Patients with a pretreatment testosterone level of less than 300 ng/dL and with more than six areas of increased uptake on the bone scan progressed more rapidly.

Prognostic significance of changes in prostate-specific markers after endocrine treatment of stage D2 prostatic cancer.

BACKGROUND: The prognostic value was determined of prostate-specific antigen (PSA) and prostatic acid phosphatase (PAP) measured before and after endocrine treatment in 57 patients with newly diagnosed Stage D2 prostatic cancer. METHODS: Therapy included orchiectomy or administration of luteinizing hormone releasing hormone analogues or an antiandrogen. RESULTS: The absolute pretreatment PSA (elevated in 100% of patients) but not PAP (abnormal in 93%) predicted disease progression (P < 0.0011), i.e., a poor response to therapy. Fifty-three patients responded to androgen deprivation with a decrease in PSA level. This declined to normal at 3 and 6 months in 25% of patients. Forty-nine percent had a greater than 90% decrease in their PSA level. By 1 year, 58% of patients had progressive disease. Both the nadir PSA level and the percent decline from the pretreatment level at 3 and 6 months predicted the progression-free interval (P < 0.001). Patients with a 90% or greater decline in PSA had a prolonged progression-free survival. Serial PAP levels were similarly prognostic. CONCLUSION: It was concluded that PSA was better than PAP in evaluating patients before and after androgen-deprivation therapy. The nadir level of both markers was an important tool to predict progression-free survival in patients with metastatic prostatic cancer.

Prognostic factors in survival free of progression after androgen deprivation therapy for treatment of prostate cancer.

We analyzed 110 patients with metastatic prostate cancer (stage D2) to determine the associations between interval until progression and the pretreatment testosterone level, extent of bone metastases, performance status, race, age and pretreatment level of prostatic acid phosphatase. The median followup was 21 months (4 to 89 months). All patients received androgen deprivation therapy when metastases were identified. This multivariate analysis demonstrated that the pretreatment serum testosterone was the most significant variable (p less than 0.01) associated with interval until progression and the extent of bone metastases observed on the bone scan was the second most important variable (p less than 0.05). Age, race and prostatic acid phosphatase were not significantly correlated with the interval free of progression. Performance status was significantly correlated but it was nonsignificant in the multivariate analysis if the model already included testosterone level and extent of metastasis. Patients with a pretreatment testosterone level of less than 300 ng. per 100 ml. and more than 6 areas of increased uptake on the bone scan had the most rapid progression. We conclude that serum testosterone and extent of bone metastases are the most important of the analyzed factors in terms of interval to progression in patients with prostate cancer following androgen deprivation.

How reliable is a single measurement of urinary flow in the diagnosis of obstruction in benign prostatic hyperplasia?

Twenty-six elderly patients with obstructive symptomatology and an initial low peak urinary flow rate (< 15 ml/s) were observed for 6 to 12 months. Repeated assessments were made of flow rates and residual volumes. Within patients variation of the maximal urinary flow was significant; the standard deviation (SD) varied from 0.8 to 5.5 ml/s. The SD varied with the mean peak flow rates and this suggests that the precision of a single determination of a patient's peak flow is inversely related to the peak flow itself. In all, 333 determinations of peak flow were obtained. Only 80% were below 2 SD of the mean Siroky nomogram. Multiple determinations were used to estimate the sensitivity rate for each patient, i.e. the proportion of peak flows that were less than 2 SD below the mean of Siroky's nomogram. The average sensitivity for all of the flow values was 0.813 when applied to voided volumes and increased only slightly to 0.838 when applied to total bladder volume. Given a prevalence of 0.70 of obstruction ascribed to benign prostatic hyperplasia (BPH) among elderly men, the positive predictive value of an abnormally low peak flow was 0.97. A single low peak flow based on assessment of voided volume may serve as an almost sure indication of obstruction. If a patient has a single normal peak flow rate, he still has a 0.31 probability of having evidence of obstruction in his following uroflow determinations. Using total bladder volume does not make a difference in most patients and is not worth the effort and discomfort. The only patients who require accurate residual measurements are those with a normal uroflow but clear-cut obstructive symptomatology or with borderline peak flow. The results of this study are relevant to everyday clinical practice and to the evaluation of studies on alternatives to surgery in BPH.