Prostatic Neoplasms: Philip J

Philip J. · Department of Urology, Leighton Hospital, Crewe, Cheshire, United Kingdom. · Eur Urol. · Pubmed #17997013 No free full text.

This publication has no abstract.

Philip J, Manikandan R, Javlé P, Foster CS. · Department of Urology, Leighton Hospital, Crewe, Cheshire, CW1 4QJ UK. · Cancer Detect Prev. · Pubmed #19193497 No free full text.

Abstract: BACKGROUND: Trans-rectal ultrasound (TRUS) guided systematic prostate biopsy is a standard tool in prostate cancer (CaP) diagnosis. Extended biopsy techniques using 10-12 cores are the norm. Controversy exists on extended TRUS biopsy in men with PSA>10ng/mL. We evaluated cancer detection rates on an individual core basis, to stratify prostate biopsy protocols based on PSA levels. PATIENTS AND METHODS: Over a five-year period, 1036 patients underwent TRUS guided prostate biopsy for raised serum PSA (>2.5ng/mL). 436 patients had PSA>10ng/mL. Patients with PSA<50ng/mL underwent a 12-core TRUS guided prostate biopsy including six peripheral biopsies. The six peripheral biopsies were directed laterally towards the base, mid-zone and apices. Remainder were standard para-sagittal sextant biopsies. Patients were stratified into three groups (PSA 10-20ng/mL, 20-50ng/mL and >50ng/mL). RESULTS: Mean age of 436 patients with PSA>10ng/mL was 70.3years. 270 (62%) men had cancer. Cancer detection rates for different PSA levels were 46% (10-20ng/mL), 76% (20-50ng/mL) and 93% (>50ng/mL). Higher PSA levels and advanced clinical stage were associated with increased cancer detection rates. All patients with clinical T3 and T4 disease had biopsy diagnosed CaP. CONCLUSION: TRUS guided prostate biopsy in patients with PSA>10ng/mL did not require 12 cores to diagnose CaP. CaP diagnosis required 8 cores in men with PSA 10-20ng/mL. These cores were right and left peripheral basal and apical, and right and left para-sagittal basal and apical biopsy. Only 6 cores were necessary to diagnose CaP in men with PSA>20ng/mL which were right and left peripheral basal and apical, and para-sagittal apical biopsies. We suggest limited TRUS prostate biopsy protocols for men with PSA>10ng/mL.

Manikandan R, Qazi HA, Philip J, Mistry R, Lamb GH, Woolfenden KA, Cornford PA, Parsons KF. · Department of Urology, The Royal Liverpool University Hospital, Liverpool, U.K. · J Endourol. · Pubmed #17949319 No free full text.

Abstract: PURPOSE: To assess the role and implications of MRI in the management of patients with stage T(1c) prostate cancer. PATIENTS AND METHODS: Data were collected from our oncology database, where all new prostate cancers are recorded, for a period of 3 years ending December 2005. A total of 915 patients were found to have prostate cancer. Of the 204 patients with stage T(1c) disease, 144 were considered eligible for radical treatment and underwent cross-sectional imaging in the form of an MRI scan. Gleason grade, clinical stage, cross-sectional imaging results, and subsequent treatment were recorded. The results were analyzed to see whether the MRI findings altered the modality of treatment offered to the patient. RESULTS: Of the 144 patients, 137 had scans that showed no extracapsular invasion, while five scans were equivocal. All five patients had further investigation, either by CT scanning or targeted biopsies, which confirmed the cancer to be localized. In the remaining two cases, the MRI findings upstaged T(1c) disease to T(3) disease, as there was evidence of extracapsular involvement. The imaging result therefore affected treatment choice in only two patients in that radical surgery was not offered because of the scan findings. CONCLUSIONS: The role of MRI in the management of clinical stage T(1c) prostate cancer is limited, as it altered the management of only 1.3% of our patients. The cost v the value of this study should be discussed with the patient before MRI is prescribed.

McCabe JE, Hanchanale VS, Philip J, Javle PM. · Michael Heal Department of Urology, Leighton Hospital, Crewe, UK. · BJU Int. · Pubmed #17535278 No free full text.

Abstract: OBJECTIVES: To evaluate the use of topical glyceryl trinitrate (GTN) ointment as an adjunct to periprostatic nerve block in reducing pain associated with transrectal ultrasonography (TRUS)-guided prostatic biopsy. PATIENTS AND METHODS: In all, 148 consecutive patients (mean age 67.0 years) having their first TRUS-guided biopsy were randomized to receive either 0.2% GTN ointment or placebo 10 min before biopsy. All patients had a biopsy preceded by an injection with 10 mL of 1% lidocaine local anaesthesia. A 10-point visual analogue score was used to record 'Overall discomfort due to the presence of the probe', the biopsy itself and pain after the procedure. RESULTS: There was no significant difference in age, PSA level and prostate volume between the groups. There was a significantly lower mean pain score due to probe insertion in the GTN than placebo group (1.94 vs 3.24, P < 0.01); pain perception was lower for the whole procedure in the GTN group, and was most pronounced in men aged <60 years (2.13 vs 4.61, P < 0.005). CONCLUSIONS: Topical GTN ointment is safe and effective in reducing the discomfort associated with TRUS-guided biopsy of the prostate, in particular the insertion of the ultrasound probe. It might be of maximum benefit in the younger patient and those having a repeat biopsy who previously failed to tolerate the procedure well.

Philip J, Hanchanale V, Foster CS, Javlé P. · Department of Urology, Leighton Hospital, Crewe, UK. · BJU Int. · Pubmed #16925754 No free full text.

Abstract: OBJECTIVE: To assess cancer-detection rates in repeat 12-core biopsy protocols, as extended multicore prostate biopsy protocols have become standard when investigating men with a raised prostate-specific antigen (PSA) level, but repeat prostate biopsy protocols are still developing. PATIENTS AND METHODS: During a 4.5-year period, 241 of 590 patients with persistently high age-specific PSA levels of 2.6-10 ng/mL and an initial benign biopsy were invited for repeat transrectal ultrasonography-guided 12-core prostatic biopsy. The protocol for repeat biopsy was identical to the first biopsy, and included a periprostatic nerve block. The first six biopsies were obtained from the periphery of the gland directed more laterally at the base, mid-zone and apices. The remainder were parasagittal sextant biopsies. Pathological findings were analysed on an individual core basis. RESULTS: The mean age of the 241 men was 63.4 years; cancer was diagnosed in 40 (16.6%) on repeat biopsy. Men with cancer were older and had a higher median PSA level. The median Gleason score was 6, with a median of two cores positive for cancer. Maximum cancer detection rates were from peripheral apices (37.5%), basal biopsies had the lowest detection rates (23.8% and 16.3%), and parasagittal biopsies missed 35% of detected cancers. Patients with cancer also had significantly lower prostate volumes and higher PSA densities (both P < 0.001). CONCLUSION: A low cancer yield from both peripheral basal and parasagittal basal specimens on repeat biopsy indicates adequate sampling at initial biopsy. The maximum cancer yield in the peripheral mid-zones and apical zones suggests the necessity for concentrated sampling of these zones in repeat biopsy protocols.

Philip J, McCabe JE, Roy SD, Samsudin A, Campbell IM, Javlé P. · Department of Urology, Leighton Hospital, Crewe, UK. · BJU Int. · Pubmed #16430625 No free full text.

Abstract: OBJECTIVE: To prospectively compare the efficacy of bi-basal vs bi-apical periprostatic nerve block (PPNB) during 12-core prostate biopsy guided by transrectal ultrasonography (TRUS), and to evaluate the pain experienced on inserting the probe compared to the biopsy procedure, as PPNB with lignocaine local anaesthesia has been used for over a decade for minimizing pain during prostatic biopsy. PATIENTS AND METHODS: In all, 143 men who were to have a TRUS-guided prostate biopsy were systematically randomized to two groups, to receive PPNB at the apex or base. A 10-cm visual analogue score was used to record the pain experienced during probe insertion, the biopsy and just before to leaving the department . RESULTS: The mean pain score on biopsy in the apical group was similar to that of the basal group (apex 1.9, base 1.6, P = 0.36). Probe introduction produced a significantly higher pain score (probe 2.2, biopsy 1.7, P < 0.001) than at the biopsy. CONCLUSIONS: Patients who experienced greater pain with the introduction of the probe also reported more pain with the biopsy procedure. The site of local anaesthetic before prostatic biopsy showed no significant difference in pain scores. Older men tolerated the procedure better. Analgesia after PPNB at near either the apex or base appears equal, regardless of the site of injection. We suggest that topical perianal anaesthetic agents could significantly reduce not only pain perception, but also improve tolerance.

Philip J, Dutta Roy S, Ballal M, Foster CS, Javlé P. · Department of Urology, Leighton Hospital, Crewe, UK. · BJU Int. · Pubmed #15839915 No free full text.

Abstract: OBJECTIVE: To assess the role of a digital rectal examination (DRE) in the clinical diagnosis of prostate cancer and in predicting the pathological stage, as the diagnosis of early prostate cancer usually comprises prostate-specific antigen (PSA) testing, a DRE and transrectal ultrasonography (TRUS)-guided biopsies. PATIENTS AND METHODS: Over the 4 years between 2000 and 2004, 408 consecutive patients (mean age 63.8 years) referred with age-specific PSA levels of 2.5-10.0 ng/mL and who had a TRUS-guided 12-core prostate biopsy were included in the study. They had a DRE by either of two experienced consultant urologists. The results of the DRE and core biopsy histology were compared with the histology and the radical prostatectomy specimen in a subset (82 men) of the study population. RESULTS: Cancer was detected on biopsy in 152 patients; of the 196 with an abnormal DRE, 47% had cancer on biopsy. In the patients with a normal DRE, 59 cancers were detected. Men with cancer were older and had a higher median PSA level. There was no correlation between the DRE and biopsy findings, and none between an abnormal DRE and histological diagnosis of cancer. Of the patients who had a radical prostatectomy, 38% had a normal DRE. CONCLUSION: There was no correlation between the DRE, biopsy findings and pathological staging. The DRE did not contribute to managing patients with prostate cancer, but this does not mean that there is no longer a place for the DRE in assessing the urological patient. If patients are appropriately counselled before PSA testing, a DRE may not be essential for patients with a PSA level of 2.5-10 ng/mL.

Philip J, Dutta Roy S, Scally J, Foster CS, Javlé P. · Department of Pathology, Royal Liverpool University Hospital, Liverpool, United Kingdom. · Prostate. · Pubmed #15712218 No free full text.

Abstract: OBJECTIVE: Patients with persistently elevated PSA and multiple negative TRUS guided 12-core biopsies, present a clinical conundrum. We evaluated the efficacy of transurethral biopsy and/or resection in abetting prostate cancer diagnosis. PATIENTS AND METHODS: Eleven patients who had prostate cancer diagnosed only on TURP following TRUS guided (24-48 cores) negative biopsies, including five who underwent radical prostatectomy were assessed. Extent and site of tumour was analysed in relation to the TURP cavity. RESULTS: Mean age was 61.8 years (PSA range: 3.8-20.9 ng/ml.). Patients had TURP for worsening LUTS with chippings diagnosing invasive prostate cancer. Organ confined anterior prostate cancer was diagnosed in five who had radical prostatectomy. CONCLUSION: Anteriorly directed transurethral biopsies and/or TURP help in the diagnosis of prostate cancer in patients with multiple negative biopsies. Patients with anterior prostate cancer tend to have organ-confined disease even with higher PSA.

Philip J, Ragavan N, Desouza J, Foster CS, Javlé P. · Department of Urology, Leighton Hospital, Crewe, UK. · BJU Int. · Pubmed #15180609 No free full text.

Abstract: OBJECTIVE: To assess the cancer detection rate per individual core biopsy in a 12-core protocol and develop an optimal biopsy regimen for detecting early prostate cancer. PATIENTS AND METHODS: The study included 445 new patients who had a 12-core transrectal ultrasonography (TRUS)-guided prostatic biopsy over a 40-month period. The 12- core biopsy protocol included parasagittal sextant and six peripheral biopsies. The cancer detection rate per individual core was evaluated to give an optimal biopsy protocol. RESULTS: Prostate cancer was detected in 142 patients (31.9%). Parasagittal sextant biopsy would have failed to detect 40 (28.2%) of the cancers. Among the various possible biopsy protocols, the optimum 10-core biopsy strategy excluding the parasagittal mid-zone biopsies from the 12-core protocol achieved a cancer detection rate of 98.6%. CONCLUSION: The cancer detection rate increased from 71.8% for parasagittal sextant biopsies to 88.7% by adding peripheral basal biopsies (8-biopsy protocol); 98.6% of cancers in the series would have been detected with a 10-biopsy strategy omitting the parasagittal mid-zone biopsies. Thus we recommend a 10-core protocol incorporating six peripheral biopsies in patients with elevated age- specific prostate-specific antigen levels (2.6-10.0 ng/mL) for maximising cancer detection.

Philip J, Armitage DW, Phillips KR, Parr NJ. · Department of Urology, Arrowe Park Hospital, The Wirral, UK. · BJU Int. · Pubmed #12656920 No free full text.

This publication has no abstract.

Philip J, Dutta Roy S, Viswanathan P. · No affiliation provided · Urology. · Pubmed #16527599 No free full text.

This publication has no abstract.

Parr NJ, Philip J. · No affiliation provided · BJU Int. · Pubmed #16469046 No free full text.

This publication has no abstract.

Philip J, Manikandan R, Viswanathan P. · No affiliation provided · BJU Int. · Pubmed #15794814 No free full text.

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Dutta Roy S, Philip J, Javle P. · Research Unit, Department of Surgery, Leighton Hospital, South Cheshire, UK. · Int J Urol. · Pubmed #16045557 No free full text.

Abstract: OBJECTIVES: Prostate cancer is currently the commonest cancer in men of all ages in UK, but robust demographic data of its distribution in various socioeconomic classes is lacking. We aimed to analyze its incidence, mortality and survival trends in West Midlands, England, from 1986 to 2000 in terms of socioeconomic deprivation. METHODS: Data were collated from the regional cancer registry database and a well-validated demographic score, the Townsend band, was employed as an indicator of social deprivation, including four variables as proxy indicators of socioeconomic status. Individual cases were allocated to one of five deprivation categories using postcode at diagnosis. Regression trend analysis at 1 and 5 years was performed and a P-value derived from the t-test statistic. RESULTS: In the mid-1980s, the incidence rate ratio in affluent:deprived classes was 0.9, with age-standardized rates of 35.23 and 39.53 per 100 000 people. This ratio increased to 1.5 by 2000 with age-standardized rates of 95.98 and 63.13, respectively (172% increase in affluent compared with 60% in deprived). The affluent groups had a 7 and 13% survival advantage at 1 and 5 years; the survival advantage at 1 year was statistically significant (P=0.03). CONCLUSIONS: The preferential changes in incidence and survival in the affluent social classes are likely to be due to heightened awareness, resulting in increased prostate-specific antigen testing, which captures early and relatively slow-growing tumors with a better overall prognosis. If these bipolar trends are allowed to persist, then the gap between the affluent and deprived will continue to widen.