Prostatic Neoplasms: Pow-Sang JM

Mohler J, Babaian RJ, Bahnson RR, Boston B, D'Amico A, Eastham JA, Hauke RJ, Huben RP, Kantoff P, Kawachi M, Kuettel M, Lange PH, Logothetis C, MacVicar G, Pollack A, Pow-Sang JM, Roach M, Sandler H, Shrieve D, Srinivas S, Twardowski P, Urban DA, Walsh PC, Anonymous00332. · No affiliation provided · J Natl Compr Canc Netw. · Pubmed #17692170 No free full text.

This publication has no abstract.

Bahnson RR, Hanks GE, Huben RP, Kantoff P, Kozlowski JM, Kuettel M, Lange PH, Logothetis C, Pow-Sang JM, Roach M, Sandler H, Scardino PT, Taylor RJ, Urban DA, Walsh PC, Wilson TG, Anonymous00207. · James Cancer Hospital and Solove Research Institute at Ohio State University, Columbus, Ohio, USA. · Oncology (Williston Park). · Pubmed #11195405 No free full text.

Abstract: Systemic therapies for prostate cancer are likely to improve, and as they do, they will have enormous impact on the treatment of high-risk and locally advanced cancers. Further technical improvements in radiotherapy and alternative local modalities, such as cryoablation, are also likely, and will bring even more options for local control. It is certain these guidelines will continue to evolve.

Pow-Sang JM. · No affiliation provided · Cancer Control. · Pubmed #11807417 links to  free full text

This publication has no abstract.

Pow-Sang JM. · No affiliation provided · Cancer Control. · Pubmed #11326166 links to  free full text

This publication has no abstract.

Pow-Sang JM, Velasquez J, Myers MD, Rodriguez AR, Kang LC. · Genitourinary Oncology Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA. · Cancer Control. · Pubmed #17615531 links to  free full text

Abstract: BACKGROUND: Until recently, open radical prostatectomy was the only approach for the surgical management of prostate cancer. Laparoscopy is now increasingly used as an alternative approach. The procedure can be performed directly or with robot assistance. METHODS: We review the relevant literature regarding oncologic and functional outcomes with laparoscopic surgery in the management of localized prostate cancer. RESULTS: Oncologic and functional outcomes are similar between open and laparoscopic radical prostatectomy. Pure laparoscopic prostatectomy and robotic assisted laparoscopic prostatectomy result in less blood loss and shorter convalescence. Costs associated with the initial investment, disposables, and maintenance of the robot system are higher than for pure laparoscopic prostatectomy. CONCLUSIONS: Laparoscopic radical prostatectomy, either pure or robotic, is becoming the preferred approach for the surgical management of localized prostate cancer. Oncologic and functional outcomes are similar to the open approach.

Rodriguez A, Kang L, Politis C, Wade M, Sexton WJ, Miranda-Sousa A, Pow-Sang JM. · Genitourinary Oncology Program, Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, Florida 33612-9497, USA. · Urology. · Pubmed #16527593 No free full text.

Abstract: Renal cell carcinoma metastatic to the prostate is a rare entity. We report a delayed (9 years) metachronous solitary metastasis presentation of renal cell carcinoma to the prostate. Including our patient, only 5 cases of metastatic renal cell carcinoma to the prostate have been reported. Four patients presented with hematuria and two with bladder outlet obstruction; one had an incidental finding after prostate biopsy. Radical prostatectomy could be considered for patients with the prostate as the only site of disease.

Patterson SG, Balducci L, Pow-Sang JM. · Genitourinary Oncology Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA. · Cancer Control. · Pubmed #12228757 links to  free full text

Abstract: BACKGROUND: Management of metastatic prostate cancer continues to evolve. The widespread use of the prostate-specific antigen (PSA) assay has led to earlier diagnosis and earlier detection of recurrent disease. Debates continue regarding the proper use and timing of endocrine therapy with orchiectomy, estrogen agonists, luteinizing hormone-releasing hormone (LHRH) analogs, LHRH antagonists, and androgen antagonists. METHODS: The authors reviewed the significant published materials of the last 20 years that have shaped hormonal management of metastatic and progressive prostate cancer. Major areas of controversy were also identified. RESULTS: The present approach to hormonal management is summarized. Five potential pathways to the development of androgen-independent prostate cancer are described. Controversial topics of hormonal management, including immediate vs delayed hormonal therapy, monotherapy vs maximal androgen blockade (MAB), and intermittent hormonal therapy, are discussed. CONCLUSIONS: Orchiectomy, estrogen agonists, and LHRH analogs have therapeutic equivalence. Patients who have a rising PSA after definitive treatment for prostate cancer and high risk of recurrent disease may warrant early androgen deprivation. MAB does not appear to be significantly better than single-agent LHRH analog therapy. Intermittent therapy may delay emergence of androgen independence and maintain or improve quality of life.

Bukkapatnam R, Pow-Sang JM. · Genitourinary Oncology Program, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, USA. · Cancer Control. · Pubmed #11807419 links to  free full text

Abstract: BACKGROUND: Several management options are available when prostate cancer is diagnosed at an early stage. However, the optimal treatment for localized prostate cancer is unknown, and reports in the literature are controversial regarding the best treatment modality for this early presentation. METHODS: The authors review improvements in surgical technique that have decreased complications, and they address long-term outcomes of surgery related to cancer control. RESULTS: Improvements in surgical techniques allow for decreased intraoperative complications. The incidence of long-term complications such as incontinence and impotency is also reduced. The 5- and 10-year progression-free survival with radical prostatectomy has improved. CONCLUSIONS: Surgery today is safer with improvements in techniques. The long-term outcomes with surgery are excellent and, in several series, better than outcomes achieved with other treatment modalities.

Hoff B, Pow-Sang JM. · Division of Urology, University of South Florida, Tampa, FL 33612, USA. · Cancer Control. · Pubmed #11326169 links to  free full text

This publication has no abstract.

Rodriguez AR, Kapoor R, Pow-Sang JM. · Department of Interdisciplinary Oncology, Division of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, Florida 33612-9497, USA. · J Urol. · Pubmed #17437812 No free full text.

Abstract: PURPOSE: Patients with a high body mass index, previous pelvic surgery or large prostate size are not considered ideal candidates for radical prostatectomy. We assessed the impact of body mass index, previous pelvic surgery and prostate weight on perioperative and pathological outcomes in patients treated exclusively with laparoscopic extraperitoneal radical prostatectomy. MATERIALS AND METHODS: From January 2004 to May 2005, 300 patients underwent laparoscopic extraperitoneal radical prostatectomy. Patients were divided into groups, including body mass index groups 1 (25 kg/m(2) or less), 2 (25.1 to 30), 3 (30.1 to 36) and 4 (greater than 36); prostate weight groups 1 (20 gm or less), 2 (20.1 to 40), 3 (40.1 to 60) and 4 (more than 60); and prior surgery groups 1 (no previous pelvic or prostatic surgery) and 2 (previous pelvic or prostatic surgery). RESULTS: Logistic regression demonstrated that body mass index, large prostate size and previous pelvic surgery did not affect margin status. The Kruskal-Wallis test was performed to analyze if body mass index, large prostate size and previous pelvic surgery had an effect on perioperative variables. Only prostate weight correlated with a delay in Foley catheter removal (3 days, p=0.0005). The Wilcoxon rank sum test showed that patients with a higher body mass index had a slightly prolonged hospital stay (16 hours, p=0.02). Patients with a prostate of more than 40 gm had slightly increased blood loss (56 cc, p=0.03), which did not affect the transfusion rate. CONCLUSIONS: Laparoscopic extraperitoneal radical prostatectomy can be performed in complex surgical cases without increased perioperative morbidity. Obese patients and those with a large prostate who prefer surgery as a treatment option for localized prostate cancer may benefit from the advantages that laparoscopic extraperitoneal radical prostatectomy offers.

Moreira SG, Seigne JD, Ordorica RC, Marcet J, Pow-Sang JM, Lockhart JL. · Division of Urology, Department of Interdisciplinary Oncology Group and Surgery, H. Lee Moffitt Cancer Research Institute, University of South Florida Health Sciences Center, Tampa, Florida, USA. · BJU Int. · Pubmed #14678363 No free full text.

Abstract: OBJECTIVE: To report a retrospective chart review of patients who developed recto-urethral fistula (RUF) or several bladder neck contracture (BNC) recurrences after brachytherapy for treating localized prostate cancer. PATIENTS AND METHODS: In the past 3 years 18 patients with devastating complications after prostate brachytherapy were referred to our centre (RUF in 11, BNC in seven; mean age 63 years, range 60-81). All patients with RUF initially underwent diverting colostomy (six cystoprostatectomy with closure of the fistula, omental interposition and urinary diversion; one prostatectomy, bladder neck closure, fistula closure with omentum flap and continent vesicostomy). Three patients had the fistula closed with gracilis muscle flap using the York-Mason approach (one had a bladder neck closure and suprapubic tube; one elected to have no treatment). All patients with BNC had received three or more procedures to resect or incise their contracture. Four had diversion with a catheterizable segment, two used an indwelling Foley catheter and one uses intermittent catheterization. RESULTS: All six patients who had cystoprostatectomy with urinary diversion have had no recurrence of their RUF. All three treated with the York-Mason procedure healed well. One developed recurrent prostate adenocarcinoma and two a secondary neoplasia in the prostate or rectum (leiomyosarcoma and neuroendocrine, respectively). The enterocystoplasty patient developed sepsis after colostomy reversal and subsequently died. In those patients with BNC, the four who underwent urinary diversion fared well; two tolerate the indwelling catheter poorly, and the seventh uses intermittent catheterization with occasional difficulty. CONCLUSIONS: Brachytherapy with or without external irradiation can be associated with severe complications. RUF managed with aggressive anterior pelvic exenteration and urinary diversion can be associated with excellent results. The York-Mason procedure in patients with an adequate urinary continence mechanism and bladder dynamics may provide good functional results. The presence of a secondary malignancy in patients deserves further investigation. Many recurrences of a BNC tend be refractory to transurethral resection/incision; indwelling catheters are then poorly tolerated and patients may require a major reconstructive procedure.

Thurman SA, Robinson LA, Ahmad N, Pow-Sang JM, Lockhart JL, Seigne J. · Department of Interdisciplinary Oncology, University of South Florida and H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA. · J Urol. · Pubmed #12629356 No free full text.

Abstract: PURPOSE: We evaluated the technique of intraoperative gamma probe directed rib biopsy in patients with suspected metastatic prostate adenocarcinoma. This technique can be used to identify accurately the rib in question, reliably obtain sufficient tissue for diagnosis, be performed with minimal patient morbidity and potentially alter the course of therapy. MATERIALS AND METHODS: From 1996 to 2001, 8 patients with biopsy proved adenocarcinoma of the prostate and suspicious rib lesions on radionuclide bone scanning underwent open rib biopsy as part of the evaluation for metastatic disease. Mean prostate specific antigen in the patient population was 17.1 ng/ml (range 6.1 to 36.5) and clinical stage was T1c to T3c. A new technique of intraoperative gamma probe directed biopsy was used to localize and resect the rib in question. At 6 to 12 hours before the operation each patient received an intravenous injection of 28 mCi. (99m)technetium-oxidronate. The hand held, pencil sized gamma probe in a sterile sleeve was used to localize the area of greatest activity in the target bone and 3 cm. of bone were resected. RESULTS: Of the 8 patients who underwent the procedure 2 had metastatic prostate cancer on final rib pathological findings. Four of the remaining 5 patients had benign rib lesions (an old rib fracture) and 1 had metastatic lung cancer. The hot spot on bone scan was localized with 100% accuracy using our technique and a pathological diagnosis was made in all cases. Mean operative time was 61 minutes and estimated blood loss was less than 20 ml. in all cases. Seven of the 8 patients were discharged home the same day, while 1 required overnight hospitalization. There was 1 intraoperative complication of inadvertent entry into the pleural cavity, resulting in a small pneumothorax, which was treated with small chest catheter drainage and observation. CONCLUSIONS: Intraoperative gamma probe directed rib biopsy of suspected metastatic lesions in patients with prostate cancer can be safely and accurately performed with minimal patient morbidity. The information obtained using this technique can be used to tailor treatment decisions for this subset of patients with prostate cancer.

Feygelman V, Pow-Sang JM, Friedland JL, Sanders RM. · H. Lee Moffitt Cancer Center and Research Institute at the University of South Florida, Tampa 33612, USA. · Tech Urol. · Pubmed #10527257 No free full text.

Abstract: As demonstrated by water phantom experiments and clinical observations, the reverberation artifact associated with the ultrasound needle image during permanent prostate implants is extremely useful in determining precise radioactive seed positioning. It also serves as an independent quality assurance check of the number of seeds in the strand.

Diaz JI, Mora LB, Austin PF, Muro-Cacho CA, Cantor AB, Nicosia SV, Pow-Sang JM. · Department of Pathology, University of South Florida College of Medicine and H. Lee Moffitt Cancer and Research Institute, Tampa 33612, USA. · Urology. · Pubmed #10223486 No free full text.

Abstract: OBJECTIVES: To evaluate the relationship of DNA ploidy and cell proliferation (CP) with Gleason score (GS) and clinical outcome in prostate cancer. METHODS: Sixteen patients with benign prostatic hyperplasia (BPH) and 65 patients with prostate cancer classified by GS (four groups: 2 to 4, 5 to 6, 7, and 8 to 10) were studied. All patients with carcinoma underwent prostatectomy and were separated into prostate-specific antigen (PSA) failure and nonfailure groups (failure if PSA 0.1 ng/mL or more three times after surgery). Tumoral CP (Ki-67 inmunostaining and SG2M phase) and DNA ploidy were evaluated by computerized cytometry. RESULTS: BPH were diploid with low CP (8% SG2M cells or less). Carcinomas were either diploid with high CP (greater than 8% SG2M cells) or aneuploid. CP was significantly higher (P <0.001) in tumors with GS 7 or greater than in tumors with GS less than 7 (mean percent Ki-67 cells 18.3% versus 7.8%, respectively). PSA failure increased with GS (7.1% in GS 2 to 4, 21% in GS 5 to 6, 28.6% in GS 7, and 50% in GS 8 to 10), as well as with aneuploidy (18.5% in diploid tumors versus 72.7% in aneuploid tumors). Those experiencing PSA failure had significantly higher (P <0.001) CP than those not failing (mean percent Ki-67 cells 24% and mean percent SG2M 30.4% versus 8.7% and 13.5%, respectively). Cox regression analysis showed GS, DNA ploidy, Ki-67, and SG2M to each be univariately prognostic for time to PSA failure; however, Ki-67 and SG2M were more highly significant (P <0.0001 for both) than GS (P = 0.007) or DNA ploidy (P = 0.002). After adjusting for either SG2M or Ki-67 measures of CP, neither ploidy nor GS contained additional prognostic value. CONCLUSIONS: Tumor CP and DNA ploidy can be reliably determined in prostate cancer by computerized cytometry. On the basis of our preliminary results, CP correlates well with GS and predicts PSA failure better than DNA ploidy or GS.