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- Aus, Gunnar, 1958
(författare)
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Current status of HIFU and cryotherapy in prostate cancer--a review.
- 2006
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Ingår i: Eur Urol. - : Elsevier BV. ; 50:5, s. 927-934
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To evaluate the current status of high-intensity focused ultrasound (HIFU) and cryosurgery as the primary treatment option in patients with prostate cancer. Method A MedLine search using specified search terms was done on February 28, 2005. This search rendered 150 papers related to HIFU and 566 papers related to cryosurgery. Very few of these papers presented original outcome data and are included in the present review. Results No controlled trial was available for analysis, and no survival data were presented. No validated biochemical, surrogate end point was available for any of the two therapies. HIFU showed progression-free survival (based on prostate-specific antigen ± biopsy data) of 63–87% (projected 3- to 5-yr data), but median follow-up in the studies ranged from 12–24 mo. Negative postoperative biopsies was seen in 82–94% of patients. Complications have been reduced by the combination of transurethral resection of the prostate and HIFU. Cryosurgery showed a progression-free survival of 36–92% (projected 1–7 yr data), depending on risk groups and definition of failure. Negative biopsies were seen in 72–87%, but no biopsy data were available for the currently used third-generation cryotherapy machines. Complications seem to be lower with the third-generation machines. Conclusions None of the evaluated therapies has enough data available to support their use as an alternative to established therapies (surgery, radiation) for localised prostate cancer. Until further data become available, the use of both treatments should be restricted to patients unfit for established therapies who still have the need for local therapy. Take Home Message Both HIFU and cryotherapy are used in the treatment of prostate cancer, but there is a profound lack of long-term follow-up data for the currently used treatment modalities. Their use should be limited to patients unfit for conventional therapies.
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- Aus, Gunnar, 1958, et al.
(författare)
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EAU Guidelines on Prostate Cancer.
- 2005
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Ingår i: Eur Urol. - : Elsevier BV. ; 48:4, s. 546-551
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The first summary of the European Association of Urology (EAU) guidelines on prostate cancer was published in 2001. These guidelines have been continuously updated since many important changes affecting the clinical management of patients with prostate cancer have occurred over the past years. The aim of this paper is to present a summary of the 2005 update of the EAU guidelines on prostate cancer. Methods: A literature review of the new data has been performed by the working panel. The guidelines have been updated and level of evidence/grade of recommendation added to the text. This enables readers to better understand the quality of the data forming the basis of the recommendations. Results: A full version is available at the EAU Office or at www.uroweb.org. Systemic prostate biopsies under ultrasound guidance is the preferred diagnostic method and the use of periprostatic injection of a local anaesthetic can significantly reduce pain/discomfort associated with the procedure. Active treatment (surgery or radiation) is mostly recommended for patients with localized disease and a long life expectancy with radical prostatectomy being the only treatment evaluated in a randomized controlled trial. Follow-up is at large based on prostate specific antigen (PSA) and a disease-specific history with imaging only indicated when symptoms occur. Cytotoxic therapy has become an option for selected patients with hormone refractory prostate cancer. Conclusion: The knowledge in the field of prostate cancer is rapidly changing. These EAU guidelines on prostate cancer summarize the most recent findings and put them into clinical practice.
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- Aus, Gunnar, 1958
(författare)
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Editorial comment on: Additional Surgical Intervention after Radical Prostatectomy, Radiation Therapy, Androgen-Deprivation Therapy, or Watchful Waiting
- 2007
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Ingår i: European Urology. - : Elsevier BV. - 0302-2838. ; 52:4
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Tidskriftsartikel (refereegranskat)abstract
- Editorial Comment Scott Eggener, Memorial Sloan-Kettering Cancer Center, New York, NY, United States eggeners@mskcc.org ‘‘Now that we’ve got PSA velocity, what are we going to do with it’’ Prostate-specific antigen velocity (PSAV) was introduced nearly 15 yr ago as men diagnosed with prostate cancer were found to exhibit more rapid rises in PSA years prior to their diagnosis compared to those without clinically evident prostate cancer [1]. Recently, interest in PSAV has been rekindled, because the rate of PSA change in the year prior to radical prostatectomy or radiation therapy has been directly associated with the likelihood of disease- specific death [2,3]. Although these and other studies have generated much ‘‘publicity’’ for PSAV, physicians still lack sound guidance on whether, or how, to use PSAV in clinical practice. For instance, debate exists whether PSAV is a valuable adjunct to PSA alone to determine prostate cancer risk [4,5] or prompt diagnostic procedures. Further, in men considering treatment options or, alternatively, following primary therapy, how should pretreatment PSAV be appropriately integrated into their care? Should a markedly elevated level prompt multimodal therapy, a lower threshold for instituting secondary therapies, or not be considered at all? Simply and concisely, we do not know. This article, similar to another publication [6], shows that formulas used to calculate PSAV are generally inconsistent and highlights that as we continue to decipher the appropriate role for PSAV, a uniform methodologic language is mandatory. Linear regression has been anointed the de facto ‘‘gold standard’’ to calculate PSAV. With adequate measurements over an adequate period of time (both yet to be definitively determined), linear regression is assumed to best control for shortterm physiologic fluctuations in serum PSA levels and most fairly represent the ‘‘big-picture’’ PSAV. However, as a point-of-care tool, not all physicians have the resources to quickly perform linear regression. This study suggests a simple arithmetic method that may suffice. Studies like this should trigger further work to explore how PSAV is affected by the absolute PSA
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- Aus, Gunnar, 1958
(författare)
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Editorial Comments
- 2008
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Ingår i: J Urol. ; 180:2
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Recension (övrigt vetenskapligt/konstnärligt)
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- Aus, Gunnar, 1958, et al.
(författare)
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Individualized screening interval for prostate cancer based on prostate-specific antigen level.
- 2005
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Ingår i: Arch Intern Med. ; 165:16, s. 1857-1861
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Tidskriftsartikel (refereegranskat)abstract
- Background The aim of the present study was to evaluate the future cumulative risk of prostate cancer in relation to levels of prostate-specific antigen (PSA) in blood and to determine whether this information could be used to individualize the PSA testing interval. Methods The study included 5855 of 9972 men (aged 50-66 years) who accepted an invitation to participate in a prospective, randomized study of early detection for prostate cancer. We used a protocol based on biennial PSA measurements starting from 1995 and 1996. Men with serum PSA levels of 3.0 ng/mL or more were offered prostate biopsies. Results Among the 5855 men, 539 cases of prostate cancer (9.2%) were detected after a median follow-up of 7.6 years (up to July 1, 2003). Cancer detection rates during the follow-up period in relation to PSA levels were as follows: 0 to 0.49 ng/mL, 0% (0/958); 0.50 to 0.99 ng/mL, 0.9% (17/1992); 1.00 to 1.49 ng/mL, 4.7% (54/1138); 1.50 to 1.99 ng/mL, 12.3% (70/571); 2.00 to 2.49 ng/mL, 21.4% (67/313); 2.50 to 2.99 ng/mL, 25.2% (56/222); 3.00 to 3.99 ng/mL, 33.3% (89/267); 4.00 to 6.99 ng/mL, 38.9% (103/265); 7.00 to 9.99 ng/mL, 50.0% (30/60); and for men with an initial PSA of 10.00 ng/mL or higher, 76.8% (53/69). Not a single case of prostate cancer was detected within 3 years in 2950 men (50.4% of the screened population) with an initial PSA level less than 1 ng/mL. Conclusions Retesting intervals should be individualized on the basis of the PSA level, and the large group of men with PSA levels of less than 1 ng/mL can safely be scheduled for a 3-year testing interval.
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- Aus, Gunnar, 1958, et al.
(författare)
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Prostate biopsy and anaesthesia: an overview.
- 2005
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Ingår i: Scand J urol Nephrol. - : Informa UK Limited. ; 39:2, s. 124-129
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Forskningsöversikt (refereegranskat)abstract
- Objective. To evaluate the efficacy of different methods for decreasing pain and discomfort in men undergoing transrectal ultrasound-guided prostate biopsies and to propose a clinical standard useful for pain relief. Material and methods. A MEDLINE search using the search terms "anaesthesia" and "prostate biopsy" was performed in November 2004. The search yielded 198 papers, 45 of which were found to relate to the subject and were in the English language. Results. Intravenously administered sedoanalgesia seems to be effective but is cumbersome to handle in everyday practice. In one study, i.v. tramadol has been shown to be effective, and the same goes for diclofenac 100 mg given as a suppository 1 h prior to the biopsy. Inhaled nitrous oxide (Entonox®) works well but is not widely available. A rectally administered gel containing local anaesthetic seems to have very limited efficacy. Periprostatic injection of a local anaesthetic was used in most studies, nearly all of which showed that it was effective in comparison with placebo or rectal gel. A minimum of 10 cm3 seems to be necessary for optimal effect. Conclusion. At the present time, perirectal injection of a local anaesthetic is the preferred method of pain relief in conjunction with transrectal prostate biopsies.
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