The importance of prognostic factors in advanced prostate cancer

Article Abstract:

In 1989, about 103,000 cases of prostate cancer were diagnosed in the United States. The disease is a major contributor to illness and death among men over the age of 50. Newer diagnostic techniques, such as transrectal ultrasound, may improve the chances of early detection and the success of treatment. However, at present, the majority of cases of prostate cancer have already spread beyond the gland at the time of initial diagnosis. Once the disease has spread, the deprivation of androgens, or male hormones, is the most widely used treatment. About 75 percent of patients may be expected to respond, but most will relapse within three years. The identification of prognostic factors is important for two reasons, both in prostate cancer and in cancer in general. First, the identification of patients unlikely to be helped by the conventional therapy may permit the use of more aggressive therapy earlier for those most likely to require it. Second, the stratification of patients into different risk categories makes the analysis of clinical trials more reliable, and also permits the comparison of patient populations among different trials conducted at different medical centers. Efforts to identify the prognostic factors of prostate cancer revealed that performance status may be the most important factor. Performance status is the degree to which the patient is affected in his activities of everyday living. The number of metastatic tumors seen upon bone scan are also important; men with fewer than six metastases in their bones are likely to survive longer. The level of testosterone is also an important prognostic factor; men with higher levels of testosterone, greater than 300 nanograms per deciliter, are also likely to survive longer. Presumably, cancers growing in the presence of low testosterone are less likely to be affected when deprived of testosterone by treatment. Unfortunately, prognostic factors like performance status are difficult to ascertain objectively. Other studies have indicated that the level of alkaline phosphatase in the blood may be a prognostic factor, but it may only reflect the number of bone metastases and may, therefore, add little to the overall confidence level of the prognosis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prognosis, Prostate cancer

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Lewis system alterations in gastric carcinogenesis

Article Abstract:

Blood group antigens are not restricted to blood cells, although that is where they were first identified. Blood group antigens may exist on a variety of tissues, and indeed, may be altered in the development of tumors. While the ABO blood group system is always the first that comes to mind, there are many systems of blood group antigens, including the Lewis system. Similar to the ABO system, the Lewis system has two antigens, a and b, that may be present or absent. Unlike the ABO system, however, the Lewis antigens are actually not a constitutive part of blood cells, but float freely in the blood and stick to blood cells. Researchers examining the expression of Lewis antigens on stomach cancer cells have discovered that a surprising anomaly is relatively common. They examined 80 specimens of stomach cancer tissue. Forty-nine were from individuals with a Lewis blood type a-b+ (symbolized Le(a-b+)). Eleven patients were Le(a+b-) and 10 were Le(a-b-). The researchers were not surprised to find that often an antigen that can be identified in the blood is not present on the cancer specimen. However, 36 of 49 patients with the Le(a-b+) phenotype were found to express the a antigen on their stomach cancer cells. Since the blood cells did not show the presence of the a antigen, it is not known how this antigen can be present on the cancer cells, and thus this expression is termed anomalous. In a series of 249 stomach biopsies, a similar anomalous expression was never seen in normal tissue, but was present in varying percentages of abnormal but nonmalignant tissues; anomalous antigen expression was most common in intestinal metaplasia and gastric dysplasia, which are regarded as premalignant histological conditions. The frequency with which the anomaly was observed among stomach cancer patients with the Le(a-b+) phenotype, and the frequency with which the same anomaly seems to be present in premalignant conditions suggest that the Lewis a antigen may in some way be intimately involved in the cancerous transformation of stomach tissues. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Blood groups, ABO blood-group system

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Sex hormone receptors in gastric cancer

Article Abstract:

The incidence of gastric adenocarcinoma, the most common form of stomach cancer, is perhaps twice as common in men as women. This dramatic sex difference may well be related to the levels of sex hormones in the patients. Because tissues respond to sex hormones via the action of sex hormone receptors on the cell surface, hormone receptors for three major sex hormones, estrogen, androgen, and progesterone, were measured in stomach adenocarcinomas removed from 16 patients. The measurements were compared with normal gastric mucosa obtained from the same patients. No significant differences were found between the normal and cancerous tissue specimens for any of the receptors measured. All the cancerous tissues contained progesterone receptors, as did 94 percent of the normal tissue. Roughly half of the specimens, normal or cancerous, contained estrogen receptors, and about 12 percent of the normal and cancerous tissues contained androgen receptors. The results indicate that the stomach mucosa is probably a target for progesterone influence, and that this influence may be independent of estrogen. However, there is no indication of the relationship of this influence to the actual development of cancer within the tissue. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Hormone receptors

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