Prostatic Neoplasms: Humphrey P

Epstein JI, Srigley J, Grignon D, Humphrey P, Otis C. · The Johns Hopkins Hospital, 401 N Broadway St, Rom 2242, Baltimore, MD 21231, USA. · Virchows Arch. · Pubmed #17674043 No free full text.

This publication has no abstract.

Epstein JI, Srigley J, Grignon D, Humphrey P, Anonymous00049. · Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD 21231, USA. · Hum Pathol. · Pubmed #17707261 No free full text.

Abstract: It has been evident for decades that pathology reports are very variable even within a single institution. Standardization of reporting is the optimal way to insure that information necessary for patient management, prognostic and predictive factor assessment, grading, staging, analysis of outcomes, and tumor registries are included in pathology reports. The ADASP has chosen a pathologist expert in each field to assemble a group from within the pathology community (with clinician input if desired) to write specific cancer protocols. These were then approved by the ADASP council and subsequently by the membership. The American College of Surgery Commission on Cancer (COC) accredits cancer centers in the United States. Recently, the COC decided to require elements, deemed as essential by the CAP, to be described in all pathology reports in their accredited cancer centers as of January 2004. Importantly, they do not require that the specific College of Pathologists (CAP) protocols or synoptic reports be used. ADASP has updated all of its protocols to comply with the COC requirements in the form of uniform checklists. The checklists use the staging criteria cited in the American Joint Committee on Cancer 2002 staging manual (sixth edition) but include a variety of other references listed in each of the checklists. Moreover, the checklists are formatted for ease of use. They may be used as templates for uniform reporting and are designed to be compatible with voice-activated transcription. The different elements in these revised ADASP diagnostic checklists have been divided into Required and Optional. The term Required in this context only signifies compliance with the COC guidelines. ADASP realizes that specimens and practices vary, and it will not be possible to report these elements in every case. However, ADASP hopes that pathologists will find these checklists useful in daily clinical practice while facilitating compliance with the new COC requirements.

Epstein JI, Srigley J, Grignon D, Humphrey P, Anonymous00022. · The Johns Hopkins Medical Institutions, Baltimore, MD, USA. · Am J Clin Pathol. · Pubmed #18089486 links to  free full text

This publication has no abstract.

Andriole GL, Humphrey P, Ray P, Gleave ME, Trachtenberg J, Thomas LN, Lazier CB, Rittmaster RS. · Division of Urologic Surgery, Washington University School of Medicine, 660 S. Euclid, St. Louis, MO 63110, USA. · J Urol. · Pubmed #15310997 No free full text.

Abstract: PURPOSE: In the prostate testosterone is converted to dihydrotestosterone (DHT) by the enzymes 5alpha-reductase (5alphaR) types 1 and 2 (5alphaR1 and 5alphaR2). Suppression of DHT formation by 5alphaR inhibition may be beneficial in early treatment or prevention of prostate cancer. Although 5alphaR2 is the dominant enzyme in the prostate, evidence indicates that 5alphaR1 may be up-regulated in some prostate cancers. This suggests that dual inhibition of both isoenzymes may be more effective than suppression of 5alphaR2 alone in prostate cancer treatment or prevention. In this short-term pilot study we examined the effect of the dual 5alphaR inhibitor dutasteride on markers of tumor regression. MATERIALS AND METHODS: A total of 46 men with clinically staged T1 or T2 prostate cancer were randomized to receive 5 mg per day of placebo or dutasteride for 6 to 10 weeks before radical prostatectomy. Resected tissues were analyzed to determine the effect of dutasteride on intraprostatic androgen levels, and indices of apoptosis and microvessel density (MVD) in malignant tissue, as well as degree of atrophy in benign tissue. RESULTS: Treatment with dutasteride caused a 97% decrease in intraprostatic DHT and was associated with a trend toward increased apoptosis. In patients receiving dutasteride for 45 days or more, a significant increase in apoptosis and a trend toward decreased MVD in prostate cancer tissue was observed. Dutasteride treatment was also associated with an 18% decrease in mean benign epithelial cell width compared with placebo (p < 0.0001). CONCLUSIONS: In this pilot study dutasteride treatment resulted in almost complete suppression of intraprostatic DHT, increased apoptosis and a trend toward decreased MVD. These findings suggest that short-term treatment with dutasteride can cause regression in some prostate cancers.

Bismar TA, Humphrey P, Vollmer RT. · Department of Pathology, Montreal General Hospital, Montreal, Canada, and Washington University School of Medicine, St Louis, MO, USA. · Am J Clin Pathol. · Pubmed #17951203 links to  free full text

Abstract: In this study, we used 327 cases of localized prostate cancer to determine the information content provided by 5 popular nomograms for predicting outcomes in localized prostate cancer. All study patients underwent radical prostatectomy. For each case and each nomogram, we calculated the estimated probability of outcome, and, from this probability, we calculated the information content as 1-S, where S is the entropy. With this definition, information content is minimized at 0 and maximized at 1. We found that the average information content ranged from 0.16 for the Partin tables to 0.44 for the recent Kattan nomogram for 10-year disease-free survival. Furthermore, the Kattan 10-year nomogram provided information content greater than 0.5 for 50% of study cases, so that among these 5 nomograms, we judged its performance the best. Nevertheless, because even this nomogram provided less than 0.5 information content for 50% of our cases, we believe that it can be improved and that additional measurements or markers observed on the biopsy tissues are likely to produce better nomograms.