... Diseases ofthe Prostate Benign andMalignant Diseases ofthe Prostate: Introduction Benign andmalignant changes in the prostate increase with age. Autopsies of men in the eighth decade of life ... although thedisease remains the second leading Chapter 091. BenignandMalignant Diseases ofthe Prostate (Part 1) Harrison's Internal Medicine > Chapter 91. BenignandMalignant Diseases ... in >90% and malignant changes in >70% of individuals. The high prevalence of these diseases among the elderly, who often have competing causes of morbidity and mortality, mandates a risk-adapted...
... proviso that the risks and benefits ofthe performance of these Chapter 091. BenignandMalignant Diseases ofthe Prostate (Part 2) Diagnosis and Treatment by Clinical State The disease continuum—from ... were high-grade [37% (280 of 757 cancers) vs. 22% (237 of 1068 cancers) for the placebo group] have been shown to be an artifact ofthe reduced volume ofthe malignant epithelial cells in finasteride-treated ... assessment, the decision to offer treatment andthe specific form of treatment is based on the risk posed by the cancer, relative to Prevention Several agents are under investigation for their...
... biopsy. Each core ofthe biopsy is examined for the presence of cancer, andthe amount of cancer is quantified based on the length ofthe tumor within the core and the percentage ofthe core involved. ... evolved over time. The goal is to increase the sensitivity ofthe test for younger men more likely to die ofthediseaseand to reduce the frequency of detecting cancers of low malignant potential ... localized, 40% are not palpable, andof these, 70% are pathologically organ-confined. The Chapter 091. BenignandMalignant Diseases ofthe Prostate (Part 3) The PSA criteria used to recommend...
... confined to the gland (T2), and those that have extended outside the gland (T3 and T4) (Table 91-1). DRE alone is inaccurate with respect to the extent ofthedisease within the gland, the presence ... absence of capsular invasion, involvement of seminal vesicles, and extension ofdisease to lymph nodes. Because ofthe inadequacy of DRE for staging, the staging system was modified to include the ... Chapter 091. BenignandMalignant Diseases ofthe Prostate (Part 4) Pathology The noninvasive proliferation of epithelial cells within ducts is termed prostatic intraepithelial neoplasia....
... evidence for the superiority of any one treatment. Comparison of outcomes of various forms of therapy is limited by the lack of prospective trials, referral bias, and differences in the outcomes ... localized disease are managed by radical surgery, radiation therapy, or active surveillance. Choice of therapy requires the consideration of several factors: the presence of symptoms, the probability ... Chapter 091. BenignandMalignant Diseases ofthe Prostate (Part 5) TRUS is theimaging technique most frequently used to assess the primary tumor, but its chief use...
... disruption ofthe vascular supply and not the nerve fibers. Neoadjuvant hormone therapy has also been studied in combination with radiation therapy. The aim is to decrease the size ofthe prostate and, ... intensity-modulated radiation therapy Chapter 091. BenignandMalignant Diseases ofthe Prostate (Part 6) Radical Prostatectomy The goal of radical prostatectomy is to excise the cancer completely ... patients who received >70 Gy. The frequency of erectile dysfunction is related to the quality of erections pretreatment, the dose administered, andthe time of assessment. Postradiation erectile...
... evidence ofdisease on scan. For these patients the central issue is whether the rise in PSA results from persistent disease in the primary site, systemic disease, or both. In theory, disease in the ... disease had spread outside ofthe area ofthe prostate bed and is unlikely to be controlled with radiation therapy. disease. The practice evolved from studies of predominantly ... radiation therapy. The decision to recommend radiation therapy after prostatectomy is often made on the basis ofthe pathologic findings at surgery, as imaging studies such as CT and bone scan...
... Chapter 091. BenignandMalignant Diseases ofthe Prostate (Part 8) For patients with a rising PSA after radiation therapy, salvage prostatectomy can be considered if thedisease was "curable" ... hormone and follicle-stimulating hormone followed by a downregulation of receptors in the pituitary gland, which effects a chemical castration. They were approved on the basis of randomized ... disease was "curable" at the outset, if persistent disease has been documented by a biopsy ofthe prostate, and if no metastatic disease is seen on imaging studies. Unfortunately, case...
... 091. BenignandMalignant Diseases ofthe Prostate (Part 9) Antiandrogens Nonsteroidal antiandrogens such as flutamide, bicalutamide, and nilutamide block the binding of androgens to the ... metastatic disease. Nevertheless, some men may accept the trade-off of a potentially inferior cancer outcome for an improved quality of life. Combined androgen blockade the administration of an antiandrogen ... analogue receive an antiandrogen for the first 2–4 weeks of treatment to protect against the flare. Intermittent Hormone Therapy Another way to reduce the side effects of androgen depletion is...
... significantlyincreases the cost ofthe purification, andthe require-ment for HPLC increases the length and complexity of the purification procedure. Moreover, as with the studies by Lee et al. [21] and Subramanian ... Subramanian and Shree[42], there was no rigorous assessment ofthe purity of the product or the correctness ofthe sequence. In con-trast, the purification protocol that we have developedis quick and ... line) and 9 lM (triangles, dashed line). Each datapoint is the mean of eight replicates ± the standard error; where error bars are not visible, the standard error was smaller than the size of the...
... organs. Due to their physiologic role as capillaryfilters and their vast capillary volume, the liver and lungare most often affected. The brain, the muscle s or the bones are the more frequently ... allaroundthehip(Figure5).ShewasgiventheoptionofFigure 1 Radiograph showing involvement of Right ilium and hip by the Hydatid disease. Figure 2 CT scan showing destruction ofthe hip with superiormigration ofthe femoral head into the ... involves liver and lung. Thereare many reports on Hydatid disease w ith the involve-ment ofthe musculoskeletal system [1-11]. Involvement of the musculoskeletal system occurs in 1% to 4% of allcases...
... able to locate the aneurysm neck and iliac arteries, thus adding to the visual evaluation ofthe anatomy and quality of the tissues. The internal hand also compensates for lack ofthe tri-dimensional ... lies in the semi-decubitus position on the right. The operating surgeon (*) stands on the right ofthe patient. After retrocolic dissection the operating surgeon (*) stands on the left ofthe patient ... complete treatment of aneurysmal disease with obliteration ofthe aneurysmal sac and debridement of its clot and atheromatous debris and most importantly is of proven durability. Of all the technical...