Publications (15)45.38 Total impact
-
Article: A randomized controlled trial investigating the effects of celecoxib in patients with localized prostate cancer.
[show abstract] [hide abstract]
ABSTRACT: Cyclooxygenase-2 (COX-2) is associated with tumour promotion, inhibition of apoptosis, angiogenesis and metastasis. Celecoxib, a selective COX-2 inhibitor was investigated, in patients with clinically localized prostate cancer using immunohistochemistry. Patients with cT1-2 prostate cancer (n=45) were randomized to celecoxib 400mg b.d. or no treatment for four weeks prior to radical prostatectomy. Histological sections of preoperative biopsy and matched radical prostatectomy specimens were stained for markers of cell proliferation (MIB-1/Ki-67), microvessel density (CD-31 with Weidner scoring), COX-2, apoptosis (TUNEL analysis), angiogenic factors (VEGF and KDR) and HIF-1. Celecoxib decreased tumour cell proliferation, microvessel density, angiogenesis and HIF-1 whilst enhancing apoptosis. These effects approached statistical significance in a multivariate model and the cell proliferation index approached statistical significance on univariate analysis. In this pilot study a 4 week regimen of celecoxib resulted in measurable biological effects in prostate cancer tissue. These findings warrant further investigation.Anticancer research 06/2009; 29(5):1483-8. · 1.73 Impact Factor -
Article: Reply by the authors.
Urology 03/2009; 73(2):449. · 2.43 Impact Factor -
Article: Hand-assisted laparoscopic nephrectomy for renal cell cancer with renal vein tumor thrombus.
[show abstract] [hide abstract]
ABSTRACT: To assess outcomes after hand-assisted laparoscopic nephrectomy (HALN) for renal cell cancer tumor thrombus confined to the renal vein and to compare outcomes with published series in this setting. Thirteen patients underwent HALN for radiologic T3b disease (tumor thrombus confined to the renal vein on preoperative computed tomography) under the care of three surgeons at two centers between 1997 and 2006. Median patient age was 69 years. Median duration of surgery was 176 minutes. Median blood loss was 250 mL. Median postoperative stay was 3 days. Two patients were converted to open surgery: 1 owing to unsuspected invasion of the subdiaphragmatic vena cava requiring vascular clamping with direct excision and suture, and 1 for control of bleeding. No patients suffered major morbidity associated with surgery, and there was one minor complication (aside from blood transfusion in 5 patients). After 2.7 years median follow-up, 3 of the 12 patients with pT3bN0 disease had metastases, but there were no local recurrences. These data demonstrate that HALN for renal cell cancer with tumor thrombus limited to the renal vein is feasible. Our outcomes compare favorably to published data on open surgical radical nephrectomy in this setting, and HALN should be considered in centers with experience with this technique.Urology 06/2008; 72(2):268-72. · 2.43 Impact Factor -
Article: A novel method of obtaining prostate tissue for gene expression profiling.
[show abstract] [hide abstract]
ABSTRACT: Gene expression profiling by DNA microarray analysis is a technique with great promise in cancer biology. The multifocality and heterogeneity of many prostate cancers makes the collection of adequate biological samples for such profiling particularly challenging. Current methods, such as laser capture microdissection, are not widely available and can have significant limitations. In this article, a novel method of prostatic sampling, which does not affect the histopathological assessment of the surgical specimen and provides adequate RNA yield for microarray analysis is described. This method is simple, inexpensive, easily reproducible, and has been validated as having >95% sensitivity and 99% specificity for histological prediction of tissue obtained. This method can be adopted by other investigators to perform DNA microarray analysis on prostate tumors.International Journal of Surgical Pathology 06/2008; 17(3):238-43. · 1.00 Impact Factor -
Article: Current management strategies for testicular microlithiasis.
[show abstract] [hide abstract]
ABSTRACT: The association of testicular microlithiasis with testicular tumor and the management of incidentally detected testicular microlithiasis have generated a great deal of interest. We review the current literature on testicular microlithiasis with regard to its association with testicular tumor. This association seems complex. The available data suggest that men with incidental findings of testicular microlithiasis but who have otherwise normal testes are at low risk of developing testicular cancer. The only follow-up recommended is regular testicular self-examination. Testicular microlithiasis is, however, associated with a high risk of developing testicular malignancy in men with subfertility, history of contralateral testicular tumor or history of cryptorchidism. Regular testicular self-examination is recommended for follow-up of high-risk patients, but the role of surveillance with serial ultrasonography and measurement of tumor markers is still not clear.Nature Clinical Practice Urology 10/2007; 4(9):492-7. · 4.07 Impact Factor -
Article: Biochemical (prostate-specific antigen) relapse-free survival and toxicity after 125I low-dose-rate prostate brachytherapy.
[show abstract] [hide abstract]
ABSTRACT: To report our clinical experience and 5-year prostate-specific antigen (PSA) relapse-free survival rate for early-stage prostate cancer after (125)I low-dose-rate prostate brachytherapy. In all, 300 patients were treated between March 1999 and April 2003, and followed prospectively. Patients were stratified into low-, intermediate- and high-risk groups, and those receiving neoadjuvant androgen deprivation (NAAD) or not. Kaplan-Meier estimates of PSA relapse-free survival and PSA nadirs were obtained for all patients and for the risk groups. Toxicity, as urinary and erectile dysfunction (ED), were reported from a prospective database. The median (range) follow-up was 45 (33-82) months. The actuarial PSA relapse-free survival was 93% at 5 years; 21 (7%) of patients had evidence of biochemical failure as defined by the American Society of Therapeutic Radiation Oncology criteria. There was no significant difference in actuarial survival for patients in the different risk groups, or between those receiving NAAD or not (low-risk 96%, intermediate 89%, high 93%, P = 0.12; NAAD 92%, no NAAD 95%, P = 0.30). Overall the 3-year median PSA level was 0.3 ng/mL (192 men). There was no significant difference in median 3-year PSA levels for different risk groups, or for those treated with or with no NAAD. The 3- and 4-year PSA nadir of <0.5 ng/mL was achieved by 71% and 86% of men, respectively. The acute urinary retention rate was 7%; 5.6% of men developed urethral strictures requiring dilatation, while 2.7% required a transurethral resection of the prostate after implantation, for obstructive symptoms. Of patients with no ED before treatment, 62% had no ED at 2 years, and of these 60% used a phosphodiesterase inhibitor. This prospective series confirms the excellent overall biochemical survival after (125)I brachytherapy; the treatment was tolerated well, with early and late urinary toxicity and ED similar to other published results.BJU International 01/2007; 98(6):1210-5. · 2.84 Impact Factor -
Article: Extensive transperineal template biopsies of prostate: modified technique and results.
[show abstract] [hide abstract]
ABSTRACT: To describe the modified technique and results of extensive transperineal template prostate biopsies in men with a high risk of prostate cancer in whom repeated transrectal biopsies are not diagnostic. Men who had a rising prostate-specific antigen (PSA) level and had at least two sets of benign octant biopsies or two or more prior biopsies containing high-grade prostatic intraepithelial neoplasia or atypical small acinar proliferation were included. A biplanar transrectal ultrasound probe was attached to a brachytherapy stepping unit and a standard 0.5-cm brachytherapy template was positioned over the perineum. In the transverse image, the prostate was divided into right and left and anterior, middle, and posterior regions, and three to five transperineal biopsy cores were taken in each of the six regions through the template. Sixty men underwent extensive transperineal template biopsies. Their mean age was 64 years (SD 6.4), the median PSA level was 12.9 ng/mL (range 4.6 to 35.7), and the median prostate volume was 54 cm3 (range 34 to 199). Cancer was detected in 23 men (38%), of whom 17 (74%) had Gleason grade 6, 5 (21%) Gleason grade 7, and 1 (4%) Gleason grade 9 disease. Cancer was identified in the anterior region of the prostate alone in 12 men (60%). One man required overnight admission for hematuria and two developed urinary retention; no cases of sepsis developed. In men with a clinical suspicion of prostate cancer, but benign or equivocal prostate biopsies, extensive transperineal template biopsy of the prostate is a useful diagnostic tool. It allows sampling of the whole prostate in a systematic and safe fashion.Urology 12/2006; 68(5):1037-41. · 2.43 Impact Factor -
Article: Biochemical (prostate‐specific antigen) relapse‐free survival and toxicity after 125I low‐dose‐rate prostate brachytherapy
[show abstract] [hide abstract]
ABSTRACT: OBJECTIVE To report our clinical experience and 5-year prostate-specific antigen (PSA) relapse-free survival rate for early-stage prostate cancer after 125I low-dose-rate prostate brachytherapy.PATIENTS AND METHODS In all, 300 patients were treated between March 1999 and April 2003, and followed prospectively. Patients were stratified into low-, intermediate- and high-risk groups, and those receiving neoadjuvant androgen deprivation (NAAD) or not. Kaplan–Meier estimates of PSA relapse-free survival and PSA nadirs were obtained for all patients and for the risk groups. Toxicity, as urinary and erectile dysfunction (ED), were reported from a prospective database.RESULTSThe median (range) follow-up was 45 (33–82) months. The actuarial PSA relapse-free survival was 93% at 5 years; 21 (7%) of patients had evidence of biochemical failure as defined by the American Society of Therapeutic Radiation Oncology criteria. There was no significant difference in actuarial survival for patients in the different risk groups, or between those receiving NAAD or not (low-risk 96%, intermediate 89%, high 93%, P = 0.12; NAAD 92%, no NAAD 95%, P = 0.30). Overall the 3-year median PSA level was 0.3 ng/mL (192 men). There was no significant difference in median 3-year PSA levels for different risk groups, or for those treated with or with no NAAD. The 3- and 4-year PSA nadir of <0.5 ng/mL was achieved by 71% and 86% of men, respectively. The acute urinary retention rate was 7%; 5.6% of men developed urethral strictures requiring dilatation, while 2.7% required a transurethral resection of the prostate after implantation, for obstructive symptoms. Of patients with no ED before treatment, 62% had no ED at 2 years, and of these 60% used a phosphodiesterase inhibitor.CONCLUSION This prospective series confirms the excellent overall biochemical survival after 125I brachytherapy; the treatment was tolerated well, with early and late urinary toxicity and ED similar to other published results.BJU International 11/2006; 98(6):1210 - 1215. · 2.84 Impact Factor -
Article: Mini-flank supra-11th rib incision for open partial or radical nephrectomy.
BJU International 10/2006; 98(3):690. · 2.84 Impact Factor -
Article: Early biochemical outcomes following permanent interstitial brachytherapy as monotherapy in 1050 patients with clinical T1-T2 prostate cancer.
[show abstract] [hide abstract]
ABSTRACT: Five European centres (France, Finland, Italy, Spain and the UK) have pooled data to generate a large patient series involving 1175 patients treated with prostate brachytherapy. This paper reports preliminary data on PSA outcome up to 4 years. Out of 1175 in the database, 1050 patients with localised prostate cancer who had received transperineal seed implantation as monotherapy between May 1998 and August 2003 were stage T1-T2. A total of 668 (63.6%) patients met the low-risk group definition, 297 (28.3%) as intermediate-risk definition and 66 (6.3%) the high-risk group definition. The majority of patients were Gleason score 6 or less (n=951) and disease stage was T1c in 557 patients. Of the 1050 patients, PSA data up to 4 years were available for 210 patients, while 364 patients with PSA values up to 36 months were evaluable by the Kaplan-Meier method for freedom from biochemical failure. The biochemical progression-free rate at 3 years was estimated to be 91%, with a 93% and 88% rate for low- and intermediate-risk groups, respectively, versus 80% for the high-risk group. PSA kinetics provide encouraging evidence of treatment efficacy. These data on 4-year PSA follow-up on patients treated with prostate brachytherapy reflect those previously reported in the literature. This patient series will be followed to provide long-term outcome in the future.Radiotherapy and Oncology 08/2006; 80(1):57-61. · 5.58 Impact Factor -
Article: Technical considerations when obtaining and interpreting prostatic biopsies from men with a suspicion of early prostate cancer.
BJU International 10/2005; 96(4):686. · 2.84 Impact Factor -
Article: Quality of life following treatment for early prostate cancer: does low dose rate (LDR) brachytherapy offer a better outcome? A review.
[show abstract] [hide abstract]
ABSTRACT: Due to a lack of evidence from randomised studies, there is little agreement on the best form of treatment among men who require curative treatment for prostate cancer. The relative impact of the various treatments on symptoms and health-related quality of life is also controversial. We review the literature on quality of life changes following low dose rate brachytherapy (BXT) and compare BXT to other treatments for early prostate cancer. Systematic literature review 1988-2003 (Medline). Keywords: Brachytherapy; Radical prostatectomy; External beam radiotherapy; Quality of life; Symptoms. Review of the current literature suggests that radical prostatectomy, external beam radiotherapy and BXT either alone or in combination with supplementary external beam radiotherapy offer good long-term health-related quality of life. However differences exist in the toxicity of treatment in terms of erectile function, voiding difficulty, incontinence and bowel function. These differences seem to persist for at least 3-5 years post-treatment though longer-term quality of life outcomes from modern techniques are unknown. BXT offers a high probability of maintaining continence, potency and normal rectal function though both storage and voiding urinary symptoms have been reported. Addition of androgen deprivation and EBRT to BXT may increase urinary, bowel and sexual toxicity of treatment. Quality of life outcome following brachytherapy compares favourably with other radical treatment options for the management of early prostate cancer.European Urology 03/2004; 45(2):134-41. · 8.49 Impact Factor -
Article: Identification of pubic arch interference in prostate brachytherapy: simplifying the transrectal ultrasound technique.
[show abstract] [hide abstract]
ABSTRACT: We report a simplified technique allowing identification of pubic arch interference (PAI) using transrectal ultrasound (TRUS). Fifty consecutive brachytherapy patients implanted using a two-stage technique were studied. The pubic arch was outlined using a marker pen on the ultrasound monitor screen during the dose planning ultrasound. Where pubic arch interference (PAI) was identified attempted needle passage was used to confirm PAI (n = 3). Mean time to perform PAI assessment was 90 s. Three of 50 patients had PAI, which was confirmed by attempted needle passage. No patients required modification to the implant plan during the implant procedure. TRUS reliably identifies PAI. This simple technique may be used with any TRUS scanner and avoids the need for CT scanning or specific software to identify PAI. Our low incidence of PAI may be related to lower prostate volumes at implantation due to patient selection, neoadjuvant androgen deprivation, or improved patient positioning.Brachytherapy 02/2003; 2(4):240-5. · 1.47 Impact Factor -
Article: Endo-urological techniques in the management of stent complications in the renal transplant patient.
[show abstract] [hide abstract]
ABSTRACT: Complications following renal allograft transplantation have been well documented and, despite improvements in technique, continue to cause significant morbidity and mortality. The placement of indwelling ureteric stents is becoming more common both during primary neo-ureterocystostomy and in the management of subsequent ureteric complications. We present two cases of stent encrustation and urolithiasis treated by a combined percutaneous and flexible ureterorenoscopic approach. These cases illustrate the problems of stents in renal transplant patients and offer endo-urological solutions. It is imperative that stents are correctly placed in these patients and that appropriate plans are made for their removal or exchange.Transplant International 01/2003; 15(12):664-6. · 2.92 Impact Factor -
Article: A Spanner in the works: the use of a new temporary urethral stent to relieve bladder outflow obstruction after prostate brachytherapy.
[show abstract] [hide abstract]
ABSTRACT: Assessment of the Spanner, a new temporary urethral stent to relieve bladder outflow obstruction and urinary symptoms after brachytherapy. Five patients with unusually severe urinary morbidity after (125)I brachytherapy were recruited. The mean time after implant was 40 days (range 25-90). Spanner intraprostatic stents were introduced using topical anesthetic without complication. All patients were able to void spontaneously with no post-void residual volume of urine. The flow rates increased in all cases (p=0.03) and the International Prostate Symptom Scores were significantly improved after stent insertion in all patients (p=0.03). All patients experienced some degree of pain or dysuria during stent use. Bladder outflow obstruction was effectively treated with the Spanner intraprostatic stent, however pain limited the use of the device in the early post-brachytherapy patient group. Pharmacotherapy, stent design modification, or smaller stent diameter may increase the utility of stents after brachytherapy.Brachytherapy 02/2002; 1(4):211-8. · 1.47 Impact Factor
Top co-authors
Top Journals
- BJU International (3)
- Urology (3)
- Brachytherapy (2)
- Radiotherapy and Oncology (1)
- Anticancer research (1)
Institutions
-
2007
-
James Paget University Hospital NHS
Great Yarmouth, ENG, United Kingdom
-
-
2002–2007
-
Royal Surrey County Hospital NHS
Guildford, ENG, United Kingdom
-
