The first scientific presentation was made by Dr. Thomas Stamey, Chairman of the Department of Urology, and host of the conference.Dr. Stamey addressed the important issues in prostatic physiology, particularly those associated with the clinical presence of serum PSA (prostate specific antigen) values between 4.0 and 10.0 ng/ml.Only three diseases cause an elevation in serum PSA: BPH (benign prostatic hyperplasia), prostate cancer (Cap), and acute bacterial prostatitis, which is a rare, dramatic event.From 1984 to the present, more than 850 radical prostatectomy specimens have been studied at Stanford.Those with a tumor volume of more than 12 ml are never cured, and less than half are cured in the 6 to 12 ml range.The average prostate removed weighed 40 gm.Seventy percent of cancers are found in the peripheral zone.BPH occurs is found in the transition zone, is multinodular, and is located in the anterior-medial part of the prostate.BPH compresses the urethra in the anterior-posterior plane as it develops.About 25% of all cancers occur in the transition zone-BPH area and are generally found by transurethral resection.PSA is elevated in relation to BPH and to age.In the absence of Cap, most of the serum PSA can be attributed to BPH (0.3 ng/ml/gm BPH).PSA correlates poorly with peripheral zone volume and least well with the central zone prostate.The rise in serum concentration of PSA relative to cancer volume is 10 times that
Abstract Data from the American College of Surgeons' prostate cancer surveys covering nearly a decade of experience demonstrate that the problem of prostate cancer is unique among black men in the United States. These data show that the distribution of stage at diagnosis changed across the 10‐year interval. The data indicate that there have been improvements in the 5‐year survival rates of both black and white patients, but the prostate cancer‐specific survival of black patients remains significantly poorer than that of whites.
An increase in the proportion of prostate carcinomas diagnosed at early, potentially curable stages has led to several changes in treatment of patients with this disease. Greater use of radical prostatectomy and external beam radiation has been documented, and recent data suggest that the use of radiation implant (brachytherapy) also has increased. Recent results from the National Cancer Data Base (NCDB) are available to explore this trend in greater detail. Data provided by 1758 hospital cancer registries for 435,264 patients diagnosed between 1992 and 1996 were studied. Reported use of brachytherapy was analyzed by year of diagnosis, region, patient age at diagnosis, and tumor grade. The proportion of all prostate carcinoma patients treated with brachytherapy increased from 1.4% in 1992 to 3.0% in 1995. Ninety-six percent of brachytherapy patients were American Joint Committee on Cancer Stage I or II (with tumors classified as T1 or T2). As a proportion of patients in a stage group, the use of brachytherapy was greatest in Stage I; 3.7% of patients in this stage were treated by this modality. The increase in brachytherapy also was greatest among Stage I patients, rising from 2.0% in 1992 to 5.8% in 1996. Rates of use were greatest in the northeastern and southeastern U.S. and least frequently reported by institutions in the Midwest and the South. Brachytherapy was used across a wide range of patient age groups. Analysis by grade showed that 89.8% of patients treated with brachytherapy had well-differentiated or moderately differentiated tumors. Brachytherapy represented a small component of the overall pattern of care for prostate carcinoma patients in the U.S. during the interval studied. However, the rate of use of this modality for patients with localized prostate carcinoma increased substantially over the 5-year interval. This may reflect a trend toward more conservative management of prostate carcinoma. Additional monitoring and analysis of the more recent use of brachytherapy for the treatment of prostate carcinoma patients is warranted.
