Seminars in urologic oncology最新文献

英文中文

Chemotherapy for androgen-independent prostate cancer. 雄激素非依赖性前列腺癌的化疗。

Seminars in urologic oncology

Pub Date : 2002-08-01 DOI: 10.1053/suro.2002.35052

D. Petrylak

While men with metastatic prostate cancer frequently show a good initial response to androgen ablation, few options have been available for progressive hormone-refractory prostate cancer, and survival following chemotherapy has not exceeded 9 to 12 months. The combination of prednisone and mitoxantrone has significant palliative effects on bone pain but does not extend survival. The combination of estramustine phosphate (EMP) with the taxanes paclitaxel or docetaxel produces greater than additive cytotoxicity in vivo, and phase I and II studies of taxane-based therapy demonstrate improved survival in hormone-refractory prostate cancer compared to historical controls. Docetaxel appears to have relatively high activity as a single agent and in combination with EMP. Further studies are needed to clarify the optimum dose of EMP, taking into account potential cardiovascular toxicity. Phase III studies of its combination with docetaxel are in progress.

虽然男性转移性前列腺癌患者通常对雄激素消融术表现出良好的初始反应，但对于进展性激素难治性前列腺癌，很少有选择，化疗后的生存期不超过9至12个月。强的松联合米托蒽醌对骨痛有明显的缓解作用，但不能延长生存期。磷酸雌二醇(EMP)与紫杉醇或多西紫杉醇联合使用在体内产生的细胞毒性大于添加剂，紫杉醇为基础的I期和II期研究表明，与历史对照组相比，激素难治性前列腺癌患者的生存率提高。多西他赛作为单一药物和与EMP联合使用时似乎具有相对较高的活性，考虑到潜在的心血管毒性，需要进一步的研究来阐明EMP的最佳剂量。其联合多西紫杉醇的III期研究正在进行中。

引用次数: 57

Detection and characterization of renal masses and staging of renal cancers: new considerations in the era of helical computed tomography. 肾肿块的检测、表征和肾癌的分期:螺旋ct时代的新考虑。

Seminars in urologic oncology

Pub Date : 2002-08-01 DOI: 10.1053/suro.2002.35332

Richard H Cohan

With the introduction of helical CT and its ability to acquire images very rapidly, new problems are being encountered, which can profoundly affect the quality of CT examinations performed for evaluation of known or suspected renal masses. In this article, these problems are summarized and recommendations made for CT techniques that will maximize sensitivity and specificity in renal mass detection, accuracy in renal mass characterization, and accuracy in staging of renal cancer.

随着螺旋CT的引入及其快速获取图像的能力，遇到了新的问题，这些问题可以深刻影响评估已知或疑似肾脏肿块的CT检查质量。本文对这些问题进行了总结，并对CT技术提出了建议，以最大限度地提高肾肿块检测的敏感性和特异性、肾肿块表征的准确性和肾癌分期的准确性。

引用次数: 1

Imaging for nephron-sparing surgery. 肾保留手术的影像学检查。

Seminars in urologic oncology

Pub Date : 2002-08-01 DOI: 10.1053/suro.2002.35330

Erick M Remer, Brian R Herts, Joseph C Veniero

Nephron-sparing surgery is more technically demanding than conventional nephrectomy. The urologist can benefit from modern radiological methods to plan and monitor surgery and to provide post-surgical surveillance. This article describes how 3D volume renderings of CT and MRI data can be useful in planning nephron-sparing surgery, how intraoperative imaging can guide surgery and tumor ablation, and how CT and MRI can be used to monitor for recurrent disease and postoperative complications.

保留肾脏的手术在技术上比传统的肾切除术要求更高。泌尿科医生可以受益于现代放射学方法来计划和监测手术，并提供术后监测。本文介绍了CT和MRI数据的三维体积渲染如何在规划保留肾单元的手术中发挥作用，术中成像如何指导手术和肿瘤消融，以及CT和MRI如何用于监测复发性疾病和术后并发症。

引用次数: 7

Therapeutic considerations for patients with high-risk, nonmetastatic, prostate cancer. 高危、非转移性前列腺癌患者的治疗考虑。

Seminars in urologic oncology

Pub Date : 2002-08-01 DOI: 10.1053/SURO.2002.35049

M. Eisenberger

The management of patients with high-risk, early-stage, prostate cancer represents a major challenge to all disciplines involved in the treatment of this common malignant neoplasm. Definition of the natural history of this disease, including the identification of key prognostic factors, in addition to the availability of active systemic therapeutic modalities for patients with advanced disease, are among the basic requirements that allow for early intervention in high-risk patients. Emerging new antiprogression approaches, targeted at various known stages of the metastatic cascade with the potential benefit of altering the natural history of early prostate cancer are attractive alternatives for early interventions with innovative programs. Studies on the natural history of patients with evidence of biochemical relapse following local treatment provide the basis for appropriate estimation of the risk ratio for development of clinical metastasis and selection of candidates for aggressive implementation of early treatment. The study of new candidate biomarkers of disease activity should be included in the context of clinical trials. Genotypic and phenotypic characterization of patients in clinical trials may enhance future therapeutic prospects in this disease.

高风险、早期前列腺癌患者的管理是这一常见恶性肿瘤治疗中涉及的所有学科的主要挑战。确定这种疾病的自然史，包括确定关键的预后因素，以及为晚期疾病患者提供积极的系统治疗模式，是允许对高危患者进行早期干预的基本要求之一。针对转移级联的不同已知阶段，具有改变早期前列腺癌自然史的潜在益处的新出现的抗进展方法是具有创新方案的早期干预的有吸引力的替代方案。研究局部治疗后有生化复发证据的患者的自然史，为合理估计临床转移的风险比和选择积极实施早期治疗的候选者提供依据。新的候选疾病活性生物标志物的研究应纳入临床试验。临床试验中患者的基因型和表型特征可能会提高该疾病未来的治疗前景。

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引用次数: 1

Editorial: the coming revolution in the treatment of prostate cancer patients. 社论:即将到来的前列腺癌治疗革命。

Seminars in urologic oncology

Pub Date : 2002-08-01 DOI: 10.1053/SURO.2002.35050

D. Petrylak, R. de Wit

引用次数: 2

Magnetic resonance imaging of prostate cancer. 前列腺癌的磁共振成像。

Seminars in urologic oncology

Pub Date : 2002-08-01 DOI: 10.1053/suro.2002.35333

Saroja Adusumilli, E Scott Pretorius

Management of carcinoma of the prostate has traditionally been guided by digital rectal examination, and by laboratory data such as serum prostate-specific antigen (PSA) level and histopathologic tumor grade. The introduction of the endorectal coil has improved the ability of magnetic resonance imaging (MRI) to contribute to staging and treatment planning of prostate cancer, especially in cases of confined or locally invasive disease. Exciting research in the fields of magnetic resonance spectroscopy (MRS) and MR-guided intervention of the prostate may soon expand the role of MRI in the diagnosis and treatment of prostate cancer. This article reviews current MRI techniques, the MRI features of prostate cancer, the role and efficacy of MRI in prostate carcinoma staging, and the current and future uses of MR spectroscopy and MR-guided prostate brachytherapy.

前列腺癌的治疗传统上是通过直肠指检和实验室数据，如血清前列腺特异性抗原(PSA)水平和组织病理学肿瘤分级来指导的。直肠内线圈的引入提高了磁共振成像(MRI)的能力，有助于前列腺癌的分期和治疗计划，特别是在局限性或局部侵袭性疾病的情况下。磁共振波谱(MRS)和磁共振引导前列腺干预领域令人兴奋的研究可能很快扩大MRI在前列腺癌诊断和治疗中的作用。本文综述了目前的MRI技术，前列腺癌的MRI特征，MRI在前列腺癌分期中的作用和疗效，以及磁共振波谱和磁共振引导前列腺近距离治疗的当前和未来应用。

引用次数: 18

The utility of monoclonal antibodies in the imaging of prostate cancer. 单克隆抗体在前列腺癌影像学中的应用。

Seminars in urologic oncology

Pub Date : 2002-08-01 DOI: 10.1053/suro.2002.36250

Daniel Yao, Edouard J Trabulsi, Lale Kostakoglu, Shankar Vallabhajosula, Maureen A Joyce, David M Nanus, Matthew Milowsky, He Liu, Stanley J Goldsmith

Monoclonal antibodies (mAbs) to prostate-specific antigens, such as PSMA, have great potential as diagnostic and therapeutic tools in the management of advanced prostate cancer. PSMA is a very attractive target for mAb-based imaging. It is expressed by virtually all prostate cancers and its expression is further increased in poorly differentiated, metastatic, and hormone-refractory carcinomas. The ProstaScint scan (Cytogen, Princeton, NJ), based on the mAb 7E11-C5.3, is currently approved for the imaging of prostate cancer in soft tissue but is not approved for imaging bone metastases. It appears superior to conventional imaging studies for soft-tissue disease but has limitations attributed to its intracellular binding site on PSMA. Overcoming this limitation, new mAbs to the extracellular domain of PSMA have been developed. The radioisotopes, (111)Indium, (90)Yttrium, and (177)Lutetium have been conjugated to one such mAb, J591. Radioimmunoscintigraphy with this immunoconjugate has demonstrated excellent tumor targeting of prostate cancer sites not only in soft tissue but also in bone.

针对前列腺特异性抗原(如PSMA)的单克隆抗体(mab)在晚期前列腺癌的诊断和治疗中具有很大的潜力。PSMA是基于单克隆抗体成像的一个非常有吸引力的目标。它在几乎所有前列腺癌中表达，在低分化、转移和激素难治性癌中表达进一步增加。基于mAb 7E11-C5.3的ProstaScint扫描(Cytogen, Princeton, NJ)目前被批准用于软组织前列腺癌的成像，但未被批准用于骨转移的成像。它似乎优于软组织疾病的传统影像学研究，但由于其在PSMA上的细胞内结合位点存在局限性。为了克服这一限制，PSMA细胞外结构域的新单克隆抗体已经被开发出来。放射性同位素，(111)铟，(90)钇和(177)镥已经偶联到一个这样的单抗，J591。使用这种免疫偶联物的放射免疫显像显示，不仅在软组织中，而且在骨骼中，前列腺癌部位的肿瘤靶向性都很好。

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引用次数: 41

Validity of prognostic models: when is a model clinically useful? 预后模型的有效性:什么时候模型在临床上有用?

Seminars in urologic oncology

Pub Date : 2002-05-01 DOI: 10.1053/SURO.2002.32521

Y. Vergouwe, E. Steyerberg, M. Eijkemans, J. Habbema

Prognostic models combine patient characteristics to predict medical outcomes. Unfortunately, such models do not always perform as well for other patients as those from whose data the models were derived. Therefore, validity of prognostic models needs to be assessed in new patients. Predicted probabilities can be calculated with the model and compared with the actually observed outcomes. We may distinguish several aspects of validity: (1) agreement between predicted probabilities and observed probabilities (calibration), (2) ability of the model to distinguish subjects with different outcomes (discrimination), and (3) ability of the model to improve the decision-making process (clinical usefulness). We discuss those aspects and show some measures by using models for testicular and prostate cancer. We conclude that good calibration and discriminative ability are not sufficient for a model to be clinically useful. Application of a prognostic model is sensible, if the model is able to provide useful additional information for clinical decision making.

预后模型结合患者特征来预测医疗结果。不幸的是，这样的模型并不总是表现得像那些从数据中得出模型的病人那样好。因此，需要评估新患者预后模型的有效性。利用该模型可以计算预测概率，并与实际观测结果进行比较。我们可以区分有效性的几个方面:(1)预测概率和观察概率之间的一致性(校准)，(2)模型区分不同结果的受试者的能力(辨别)，以及(3)模型改善决策过程的能力(临床有用性)。我们讨论了这些方面，并通过使用睾丸癌和前列腺癌模型展示了一些措施。我们得出结论，良好的校准和判别能力不足以使模型在临床上有用。如果预后模型能够为临床决策提供有用的附加信息，那么应用该模型是明智的。

引用次数: 128

The dilemma of patients with a rising PSA level after definitive local therapy for prostate cancer. 前列腺癌局部治疗后PSA水平升高患者的困境。

Seminars in urologic oncology

Pub Date : 2002-05-01 DOI: 10.1053/SURO.2002.32834

L. Lassiter, M. Eisenberger

Patients with a rising prostate-specific antigen (PSA) levels after definitive local therapy now represent one of the largest and fastest growing groups of men with prostate cancer. The great majority of these men are asymptomatic with no other evidence of disease, and their clinical outcomes have been widely variable and poorly understood. Recently, several groups have analyzed their institutions' data and reported on certain pathologic and clinical variables that have increased our understanding of the natural history of these men, and to some extent allowed for the development of predictive models to aid in deciding who should be treated more aggressively and who should be watched. This article reviews and critically evaluates the most relevant available data for this group of men, and offers a summary of the most useful models and predictive variables after both radical prostatectomy and radiotherapy. This article also offers recommendations for strategies to improve our current knowledge of the natural history of these men, to facilitate the development and implementation of clinical trials in this population, and to ultimately be able to offer the most appropriate recommendations to our patients in the clinic.

前列腺特异性抗原(PSA)水平上升的患者在经过明确的局部治疗后，现在是前列腺癌患者中最大和增长最快的群体之一。这些男性中的绝大多数是无症状的，没有其他疾病的证据，他们的临床结果变化很大，而且人们对其知之甚少。最近，几个小组分析了他们机构的数据，并报告了某些病理和临床变量，这些变量增加了我们对这些人的自然史的理解，并在一定程度上允许开发预测模型，以帮助决定哪些人应该接受更积极的治疗，哪些人应该受到关注。本文回顾并批判性地评估了这组男性最相关的可用数据，并总结了根治性前列腺切除术和放疗后最有用的模型和预测变量。本文还提供了一些策略建议，以提高我们目前对这些男性自然史的了解，促进在这一人群中开展和实施临床试验，并最终能够在临床中为我们的患者提供最合适的建议。

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引用次数: 8

Artificial neural networks for diagnosis and prognosis in prostate cancer. 人工神经网络在前列腺癌诊断和预后中的应用。

Seminars in urologic oncology

Pub Date : 2002-05-01 DOI: 10.1053/SURO.2002.32492

G. Schwarzer, M. Schumacher

The application of artificial neural networks (ANNs), especially feed-forward neural networks (FFNNs), has become very popular for diagnosis and prognosis in clinical medicine, often accompanied by exaggerated statements of their potential. The excitement stems mainly from the fact that ANNs were developed as attempts to model the decision process of the human brain. Traditionally, logistic regression models and proportional hazard regression models have been used in these applications. In this article, FFNNs are introduced as flexible, nonlinear regression models and necessary precautions for their use are discussed. Furthermore, the results of a literature survey of applications of ANNs in prostate cancer published between 1999 and 2001 are described; most applications suffer from methodologic deficiencies. It is concluded that there is so far no evidence that the application of ANNs provide real progress in the field of diagnosis and prognosis in prostate cancer.

人工神经网络，尤其是前馈神经网络在临床医学诊断和预后方面的应用已经非常普遍，往往伴随着对其潜力的夸大陈述。令人兴奋的主要原因是，人工神经网络是为了模拟人类大脑的决策过程而开发的。传统上，在这些应用中使用了逻辑回归模型和比例风险回归模型。本文介绍了ffnn作为灵活的非线性回归模型，并讨论了使用ffnn的必要注意事项。此外，还介绍了1999年至2001年间发表的关于人工神经网络在前列腺癌中的应用的文献调查结果;大多数应用程序都存在方法上的缺陷。综上所述，目前还没有证据表明人工神经网络的应用在前列腺癌的诊断和预后方面取得了真正的进展。

引用次数: 46

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