The American Cancer Society National Prostate Cancer Detection Project: findings on the detection of early prostate cancer in 2425 men

Article Abstract:

Next to lung cancer, prostate cancer is the leading cause of cancer death for men in the United States. About 122,000 men are likely to be diagnosed with prostate cancer this year and 32,000 will die. Unfortunately, many cases of prostate cancer are not diagnosed until the disease has already begun to spread. Since the prognosis of the disease is better if it is caught in the early stages, prostate cancer may be an excellent candidate for improved methods of early detection. The American Cancer Society National Prostate Cancer Detection Project (ACS-NPCDP) was organized to evaluate the practicality and potential success of early detection of this cancer. Currently, the only recommended procedure for screening men who do not have symptoms is the digital (finger) rectal examination. However, ultrasound imaging techniques may prove to be more sensitive in detecting cancer of the prostate. In a continuing study, 2,425 men have so far been examined with both the digital method and transrectal ultrasound (TRUS); none of these men were suspected of having prostate cancer at the time of their initial examination. A total of 396 men, or 16.3 percent of the total, had some abnormality which suggested that a biopsy should be performed; biopsies were performed on 330 of these men. A total of 52 cancers were identified on the basis of biopsy. Overall, this represents a rate of prostate cancer of about two percent among the patients, but the likelihood of prostate cancer varied greatly depending upon age. The rate of prostate cancer was 1.3 percent among men between the ages of 55 and 60, while the rate among the patients over 65 was 3.3 percent. The rectal ultrasound method proved to be more sensitive than the digital exam; 44 patients, or 84.6 percent of the cancer cases, were detected by ultrasound, in contrast with 33 cases (63.5 percent) which were detected by digital examination. It remains to be determined how effective these procedures might be when used in a larger-scale mass screening program, but the preliminary results seem encouraging. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Statistics, Medical screening, Health screening

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Stage D1 prostate carcinoma: the histologic appearance of nodal metastases and its relationship to survival

Article Abstract:

The stage and grade of a prostatic cancer has value in predicting whether the cancer will spread to the lymph nodes. But there are few indicators of prognosis for stage D1 prostate cancers, those which have already spread to the nodes. Rather than concentrate on the histological features of the primary tumor, the researchers examined the nodal metastases themselves to see if they yielded any new insight into the probable outcome. Of 307 consecutive lymph node removals, 82 had metastatic tumors that had spread from the primary prostate cancer. The specimens were graded on a scale of 1 to 4, with 1 being well-differentiated tumors and 4 being poorly differentiated tumors. The patients with moderately differentiated nodal metastases had 5- and 10-year survival rates of 79 and 34 percent respectively. On the other hand, the 15 patients with grade 4 poorly differentiated tumors had 5- and 10-year survival rates of 13 and 0 percent. Only three patients had well-differentiated tumors; one was last seen at six years, one died after eight years, and one is alive at 10 years. It is not possible to determine whether there is any difference between the outcome of the moderately differentiated tumors and the outcome of the well-differentiated tumors, because there were so few cases of the latter. In stage D1 prostate carcinoma, evaluation of the histological appearance of nodal metastases in order to determine the degree of differentiation may be clinically significant. (Consumer Summary produced by Reliance Medical Information, Inc.)

Cancer metastasis, Lymph nodes

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Prognosis in stage D-1 prostate cancer relative to anatomic sites of nodal metastases

Article Abstract:

The researchers of the National Prostatic Cancer Treatment Group have followed 212 patients with confirmed stage D-1 prostatic cancer. Fifty-one of these patients were treated with surgery, and 161 with radiotherapy. All patients received some sort of adjuvant chemotherapy. The anatomical locations of involved lymph nodes were tabulated to discover if this information has prognostic value. There has been some controversy regarding the involvement of lymph nodes and the prognosis of prostate cancer; in the present study the involvement of fewer than 20 percent of the examined nodes had a significantly better prognosis than did the involvement of more than 20 percent. It is worth noting that if the data are examined in terms of actual number of nodes involved, there is no prognostic value. That is, if the involvement of one to three nodes is compared with the involvement of more than 3, there is no significant difference in the survival. The data gave no indication that the location of the involved lymph nodes was of any prognostic value. (Consumer Summary produced by Reliance Medical Information, Inc.)

Cancer, Lymphatic metastasis

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