Robert C Dean

University of California, San Francisco, San Francisco, California, United States

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Publications (18)37.37 Total impact

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    ABSTRACT: The authors describe how a "traditional" clinical center and research organization was transformed into a multidisciplinary clinic for patients with prostate cancer. How and why the clinic was designed and implemented, as well as benefits to patients, staff, and research initiatives, are detailed.
    Urologic nursing: official journal of the American Urological Association Allied 01/2008; 27(6):491-8.
  • Robert C. Dean, Tom F. Lue
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    ABSTRACT: Multiple surgical procedures have been developed for the treatment of Peyronie’s disease. With these penile-straightening surgeries, two broad surgical categories have emerged. These categories are penile-shortening procedures (plication) and penile-lengthening procedures (penile grafting). With the penile-grafting procedures, different grafting materials have been used. Presented here is the use of the autologous saphenous vein graft. The venous graft has many advantages, including (1) similar thickness of the replacing tunica albuginea, (2) an endothelial lining that prevents hematoma formation, (3) elasticity of the graft, and (4) the wall of the saphenous graft can establish a blood supply from the lumen of the corpus cavernosum, thus preventing graft ischemia and contracture. Also, there is decreased inflammation or reaction to the graft because it is autologous. With careful patient selection, the saphenous vein graft for Peyronie’s disease is an excellent therapy for penile curvature.
    11/2007: pages 201-207;
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    ABSTRACT: Classically Peyronie's disease presents with penile curvature and/or pain, and is associated with a palpable penile plaque. We frequently examine patients with suspected Peyronie's disease ultrasonographically and have noted a subset of patients in whom we could identify only a circumscribed septal lesion. We identified characteristics of these patients. Of our series of approximately 650 patients with Peyronie's disease 47 were identified with these lesions. Of the 47 patients 22 presented with penile curvature with or without accompanying or preceding pain. Of the 47 patients 17 had a significant history of trauma, although only had the classic stigmata of penile fracture. A total of 16 patients had no history of curvature, 7 presented with only penile shortening or focal lack of rigidity and 5 were incidentally found to have lesions during assessment for other complaints. Three patients presenting after trauma were noted to have septal liquefied hematomas, which we aspirated under ultrasound guidance. Followup ultrasound revealed minimal septal thickening. In 1 of these patients the hematoma was adjacent to more typical-appearing septal fibrosis. We theorize that these hematomas are due to septal fractures and may represent a forme fruste or possibly a precursor lesion of more typical septal fibrosis. Ultrasonographic evaluation may allow earlier identification and treatment of occult septal injuries or lesions and prevent subsequent fibrosis and its associated symptoms.
    The Journal of Urology 02/2007; 177(1):179-82; discussion 183. DOI:10.1016/j.juro.2006.08.065 · 3.75 Impact Factor
  • William O Brant, Robert C Dean, Tom F Lue
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    ABSTRACT: A 51-year-old male presented with a penile deformity without obvious etiology. Physical examination revealed hard plaques in the dorsal and ventral penis. Physical examination, penile ultrasound. Peyronie's disease. Oral pentoxifylline.
    Nature Clinical Practice Urology 02/2006; 3(2):111-5; quiz 116. DOI:10.1038/ncpuro0409 · 4.07 Impact Factor
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    Robert C Dean, Tom F Lue
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    ABSTRACT: This article reviews the physiology of penile erection, the components of erectile function, and the pathophysiology of erectile dysfunction. The molecular and clinical under-standing of erectile function continues to gain ground at a particularly fast rate. Advances in gene discovery have aided greatly in working knowledge of smooth muscle relaxation/contraction pathways. The understanding of the nitric oxide pathway has aided not only in the molecular understanding of the tumescence but also greatly in the therapy of erectile dysfunction.
    Urologic Clinics of North America 12/2005; 32(4):379-95, v. DOI:10.1016/j.ucl.2005.08.007 · 1.35 Impact Factor
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    ABSTRACT: Some men with primary erectile dysfunction (ED) have maldevelopment of the crura of the penis. We report our experience with crural ligation for primary venous leakage ED in the last 5 years. Between December 1998 and March 2004, 11 patients with primary ED underwent crural ligation surgery for congenital venous leakage. All patients were evaluated with pertinent history and physical examinations, color duplex ultrasound, nocturnal penile tumescence study with RigiScan, cavernosometry and cavernosography. Localized crural leakage was the pathognomonic feature in these patients. Surgery involved reflection of the dorsal and cavernous arteries and nerves off of the crura, followed by ligation of the 2 crura proximal to the entrance of the cavernous artery with umbilical tapes. Followup was performed by telephone interview or personal interview at the clinic. A retrospective preoperative and postoperative questionnaire, that is the abridged 5-item version of the 15-item International Index of Erectile Function, was given at the time of the interview. Statistical analysis was performed with the paired t test. Median patient age at surgery was 28 years (range 22 to 39) and mean followup after surgery was 34 months (range 6 to 58). Mean International Index of Erectile Function +/- SD preoperatively and postoperatively was 8.9 +/- 4.5 and 17.5 +/- 5.0, respectively. For questions 2, 3 and 5 mean postoperative scores were significantly better than postoperative scores (p <0.05). Marked improvement in erectile function was noted in 9 of our 11 patients. Penile venous surgery may not have a lasting result in men in whom venous leakage is due to systemic diseases or penile smooth muscle atrophy. However, in patients with a congenital venous leak abnormality of the crura ligation of the proximal crura with umbilical tapes seems to have a satisfactory, durable result.
    The Journal of Urology 07/2005; 173(6):2064-6. DOI:10.1097/01.ju.0000158447.12163.f5 · 3.75 Impact Factor
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    Robert C Dean, Tom F Lue
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    ABSTRACT: Patients with erectile dysfunction (ED) following radical prostatectomy (RP) continue to present to practicing urologists. Although nerve-sparing RP has decreased the rates of ED significantly, new therapies for cavernosal nerve protection and recovery are now being developed. This report discusses the many agents available in neuroregeneration and neuroprotection to aid in the recovery of erectile function. Multiple agents and strategies have been used for neuroprotection and neuroregeneration of the cavernosal nerve following RP and in nerve injury models. Many of these agents display promise for the treatment of impotence. Early treatment for patients recovering from RP is becoming the standard of care. Natural recovery of erections may take as long as 18 to 24 months post RP; however, treatment plans may reduce the time to erectile recovery.
    Reviews in urology 02/2005; 7 Suppl 2:S26-32.
  • Robert C Dean, Tom F Lue
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    ABSTRACT: The aim of this review is to discuss the recent advances in surgical techniques for the correction of Peyronie's disease. A review of the literature published in 2002 and 2003 regarding surgical treatment was performed in preparation for this article. The surgical treatment of Peyronie's disease remains a debated topic. Generally, surgical therapy for Peyronie's disease can be divided into three main categories: wedge resection/plication surgeries; plaque excision/incision with grafting procedures; and the placement of a penile prosthesis. New reports have investigated suture selection, graft acceptability, and new surgical approaches. These new surgical enhancements will give urologists a greater choice in the surgical management of Peyronie's disease. This will aid the ability of the urologist to tailor the therapy necessary for each individual patient. The correction of acquired penile deformity seen in Peyronie's disease patients can be a challenge for the practising urologist. Newer advancements in surgical techniques and materials will allow the urologist greater treatment options. The degree of curvature, the type of deformity, erectile dysfunction, and penile length are all characteristics that are assessed in choosing the best surgical intervention in Peyronie's disease. Surgical therapy can be quite beneficial for patients who suffer from penile deformity and can greatly improve their quality of life.
    Current Opinion in Urology 12/2004; 14(6):339-43. · 2.12 Impact Factor
  • Derek J Bochinski, Robert C Dean, Tom F Lue
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    ABSTRACT: A 46-year-old man presented with erectile dysfunction following a blunt perineal injury sustained 1 year previously. Oral phosphodiesterase type 5 inhibitors failed to improve his erections. The remainder of the patient's history, physical examination and laboratory tests were unremarkable except for a moderate tenderness in the left perineum and some 'fullness' in the corpora cavernosa during physical examination. Physical examination, color duplex ultrasound of the penis and perineal area and Sexual Health Index for Men questionnaire. Non-ischemic priapism due to a ruptured left helicine artery, intermittent penile turgidity and erectile dysfunction. Open suture ligation of the helicine artery and imbrication of the pseudocapsule.
    Nature Clinical Practice Urology 12/2004; 1(1):49-53; quiz 1 p following 53. DOI:10.1038/ncpuro0022 · 4.07 Impact Factor
  • Robert C Dean, Tom F Lue
    Current Opinion in Urology 01/2004; 14(6):339-343. DOI:10.1097/00042307-200411000-00008 · 2.12 Impact Factor
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    ABSTRACT: A wide range of p53 mutations (5-65%), detected by various methods, has been reported in primary prostate cancers (CaP). IHC staining of radical prostatectomy specimens shows marked heterogeneity of focally distributed p53-positive cells. However, a significant relationship between the focal staining of p53 and cancer recurrence after radical prostatectomy has been noted. Increased frequency of p53 mutations has been generally observed in advanced stage CaP and metastatic prostate cancer cell lines. The significance of focal p53 immunostaining in primary CaP remains uncertain with respect to the p53 gene mutation or tumor progression. The goal of this study was to evaluate p53 gene mutations in focal regions of primary prostate cancers positive by p53 immunostaining. Whole-mount prostates from men with clinically organ-confined prostate cancer were immunostained for p53 protein. Laser capture microdissection (LCM) was used to harvest p53 positive cells from areas of tumor and prostatic intraepithelial neoplasia and benign gland. DNA from microdissected cells were amplified for p53 exons 5-8 by polymerase chain reaction (PCR) and analyzed for mutations by single strand conformation polymorphism and DNA sequencing. Mutation analysis of the p53 gene exons 5-8 was performed in the p53 immunostaining positive focal regions (1+ to 4+) of whole-mount prostate sections from 16 patients. Of 16 patients with p53 IHC positive tumors, 11 (69%) had p53 gene mutations as determined by DNA sequence analysis. However, randomly microdissected tumor cells from 4 of 18 patients (22%) negative for p53 IHC also demonstrated mutations in the p53 gene. A significant fraction of prostate tumors with focally positive immunostaining for p53 have been confirmed to contain mutations in the p53 gene. p53 immunostaining guided LCM combined with DNA-based analyses emphasizes the presence of focal p53 mutations in primary prostate cancers and underscores the significance of previous observations showing a correlation between focal p53 immunostaining in primary CaP and cancer recurrence after radical prostatectomy.
    Prostate Cancer and Prostatic Diseases 02/2003; 6(4):281-5. DOI:10.1038/sj.pcan.4500665 · 2.83 Impact Factor
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    ABSTRACT: Laser-capture microdissection is a recently discovered state-of-the-art method to obtain cells for genetic analysis. It is a one-step procedure that allows capture of selected cells under direct microscopic visualization.
    Methods in molecular medicine 01/2001; 53:165-73. DOI:10.1385/1-59259-144-2:165
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    ABSTRACT: Our group has recently obtained data based upon whole- mounted step-sectioned radical prostatectomy specimens using a 3D computer assisted prostate biopsy simulator that suggests an increased detection rate is possible using laterally placed biopsies. A new 10-core biopsy pattern was demonstrated to be superior to the traditional sextant biopsy. This patter includes the traditional sextant biopsy cores and four laterally placed biopsies in the right and left apex and mid portion of the prostate gland. The objective of this study is to confirm the higher prostate cancer defection rate obtained using our simulated 10-core biopsy pattern in a small clinical trial. We retrospectively reviewed 35 consecutive patients with a pathologic diagnosis of prostate cancer biopsied by a single urologist using the 10-core prostate biopsy patterns were compared with respect to prostate cancer detection rate. Of the 35 patients diagnosed with prostate cancer, 54.3 percent were diagnosed when reviewing the sextant biopsy data only. Review of the 10-core pattern revealed that an additional 45.7 percent were diagnosed when reviewing the sextant biopsy data only. Review of the 10-core pattern revealed that an additional 45.7 percent of patients were diagnosed solely with the laterally placed biopsies. Our results suggest that biopsy protocols that use laterally placed biopsies based upon a five region anatomical model are superior to the routinely used sextant prostate biopsy pattern.
    Proceedings of SPIE - The International Society for Optical Engineering 04/2000; DOI:10.1117/12.383030 · 0.20 Impact Factor
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    ABSTRACT: NKX3.1, a member of the family of homeobox genes, exhibits prostate tissue specific expression and appears to play a role in mouse prostate development. Rapid induction of NKX3.1 gene expression in response to androgens has also been described. On the basis of the established role of androgens in prostatic growth and differentiation and studies showing an association of aberrant homeobox gene expression with the neoplastic process, we hypothesize that alterations of NKX3.1 gene expression play a role in prostate tumorigenesis. NKX3.1 expression was analyzed in matched, microdissected normal and tumor tissues from 52 primary prostate cancer specimens from radical prostatectomy by semiquantitative RT-PCR and in situ hybridization and correlated with the clinicopathologic features. NKX3.1 expression was quantified as differential expression between matched tumor and normal tissues and was grouped as overexpression in tumor tissue, reduced expression in tumor tissue and no change between tumor and normal tissues. Androgen regulation of NKX3.1 expression was also studied in LNCaP cells. Androgen receptor (AR) expression in prostate tumor and normal tissue was correlated with NKX3.1 expression. Comparison of NKX3.1 expression between normal and tumor tissues revealed overexpression in 31% tumor specimens (16 of 52), decreased expression in 21% tumor specimens (11 of 52) and no change in 48% specimens (25 of 52). When these expression patterns were stratified by organ confined and non-organ-confined tumor, a higher percentage of patients exhibited NKX3.1 overexpression in non-organ confined tumor (40%) versus organ confined tumor (22%). Elevated NKX3.1 expression significantly correlated with tumor volume and serum prostate specific antigen (PSA) level in the NKX3.1 overexpression group (p<0.05). Metastatic prostate cancer cell lines did not exhibit mutations in the protein coding sequence of NKX3.1. Additionally, the NKX3.1 expression correlated with AR expression (p<0.01) in vivo in human prostate tissues. Comparison of PSA and NKX3.1 expression in response to androgen revealed a rapid androgen mediated induction of NKX3.1 expression in LNCaP cells. In situ hybridization analysis of representative specimens confirmed RT-PCR observations. These results suggest an association of NKX3.1 with a more aggressive phenotype of carcinoma of the prostate. Correlation of AR expression with NKX3.1 in human prostate tissues underscores the androgen regulation of NKX3.1 in the physiologic context of human prostate tissues.
    The Journal of Urology 03/2000; 163(3):972-9. DOI:10.1097/00005392-200003000-00082 · 3.75 Impact Factor
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    ABSTRACT: The reverse transcriptase-polymerase chain reaction (RT-PCR)-prostate-specific antigen (PSA) assay to detect presumed occult micrometastatic prostate cancer has been controversial, and this molecular staging has been thought to be clinically useful by some groups but not others. We used a sensitive nested RT-PCR assay with specific primers derived from the PSA sequence and a very stringent two-step PCR protocol with denaturing temperature of 94 degrees C annealing and extension temperature of 68 degrees C. This method enabled us to detect PSA-expressing LNCaP prostate cancer (PC) cells as low as one cell of 10 million lymphocytes (1/10(7)). Ninety-six patients with PC were studied, including 85 before radical prostatectomy (RP), and 22 controls, including healthy men and women and men with benign prostatic hyperplasia. In 85 patients undergoing RP, a minimum of two independent RT-PCR-PSA assays detected circulating prostate cells preoperatively in 27 patients (31.8%). Of 12 patients with locally advanced or advanced stage cancer, RT-PCR-PSA was positive in 5 (41.7%); of the 22 controls, no patient was RT-PCR-PSA positive. In 10 randomly selected cases, the RT-PCR product was confirmed as PSA by DNA sequencing. Of the 27 patients undergoing RP who were RT-PCR positive, 11 (40.7%) had non-organ-confined disease (pT3a or greater), and of the 58 patients who were RT-PCR negative, 32 (55.2%) had non-organ-confined disease. Patients with RT-PCR positive results also had lower margin positivity (9 of 27, 33.3%) than did patients with RT-PCR negative results (21 of 58, 36.2%). Finally, at a mean follow-up of 25.7 months, 5 (18.5%) of 27 RT-PCR positive patients had recurrence (PSA) compared with 14 (24.1%) of 58 RT-PCR negative patients. On the basis of this blinded study, RT-PCR for PSA-expressing cells in 85 patients before RP is not related to clinical stage, age, race, grade, Gleason sum, serum PSA or prostatic acid phosphatase, tumor volume, or tumor multifocality. RT-PCR positivity did not predict pathologic stage or early PSA recurrence. A standardized RT-PCR assay needs to be developed to account for interlaboratory discrepancies.
    Urology 05/1999; 53(4):714-21. DOI:10.1016/S0090-4295(98)00608-6 · 2.13 Impact Factor
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    ABSTRACT: The reverse transcriptase polymerase chain reaction (RT-PCR) assay for prostate specific antigen (PSA) expressing cells in the blood circulation has been under intense investigation since 1992. Although it has been suggested that this technology could be used as molecular staging for occult prostatic hematogenous metastases, we have been unable to confirm RT-PCR PSA positivity of peripheral blood to predict stage or recurrence in radical prostatectomy cases. We performed bone marrow RT-PCR PSA assay on a large cohort of radical prostatectomy cases and evaluate the use of this assay in improving prostate cancer staging and detecting early recurrence. Unilateral anterior iliac crest bone marrow aspirates were performed on 116 patients immediately before radical prostatectomy between February 1995 and September 1997. Radical prostatectomy specimens were processed as whole mounts. A sensitive nested RT-PCR assay with specific primers derived from the PSA sequence was used, which enabled us to detect PSA expressing LNCaP prostate cancer cells at the sensitivity of 1 cancer cell per 10 million lymphocytes (1/10(7)). A minimum of 3 RT-PCR PSA reactions were performed on all patients and at least 2 positive tests were required to define positivity. Patients were followed for PSA recurrence (mean followup 14.7 months). PSA expressing cells were detected in bone marrow of 51 of 116 patients (44.0%) when at least 2 of 3 RT-PCR PSA assays per patient were positive. A much higher rate of RT-PCR PSA positivity was noted (77/116 patients, 66.3%) when any RT-PCR PSA positivity was considered. In 10 randomly selected cases the RT-PCR product was confirmed as PSA by deoxyribonucleic acid sequencing. Of 51 bone marrow RT-PCR positive cases 25 (49%) had organ confined disease and 26 (51%) had nonorgan confined disease. Similarly, bone marrow RT-PCR PSA was not associated with age, race, grade, pretreatment PSA or prostatic acid phosphatase value, clinical stage or margin status. However, the 2-year disease-free survival was 96.6% in RT-PCR negative patients versus 77.5% in RT-PCR positive patients (p = 0.054), and bone marrow RT-PCR PSA was an independent prognostic factor in multivariate analysis including PSA, Gleason grade and pathological stage. Bone marrow RT-PCR PSA positivity in this study did not predict pathological stage, grade or margin positivity as determined from whole mount prostate cancer specimens. Furthermore, no relationship with age, grade or serum markers and bone marrow RT-PCR PSA positivity was noted. However, bone marrow RT-PCR PSA was associated with early disease recurrence. Further studies and longer followup are warranted to define the metastatic potential of the PSA expressing cells in the bone marrow of prostate cancer patients.
    The Journal of Urology 05/1999; 161(4):1070-6. DOI:10.1016/S0022-5347(01)61592-1 · 3.75 Impact Factor
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    ABSTRACT: Objectives. The reverse transcriptase-polymerase chain reaction (RT-PCR)-prostate-specific antigen (PSA) assay to detect presumed occult micrometastatic prostate cancer has been controversial, and this molecular staging has been thought to be clinically useful by some groups but not others.Methods. We used a sensitive nested RT-PCR assay with specific primers derived from the PSA sequence and a very stringent two-step PCR protocol with denaturing temperature of 94°C annealing and extension temperature of 68°C. This method enabled us to detect PSA-expressing LNCaP prostate cancer (PC) cells as low as one cell of 10 million lymphocytes (1/107). Ninety-six patients with PC were studied, including 85 before radical prostatectomy (RP), and 22 controls, including healthy men and women and men with benign prostatic hyperplasia.Results. In 85 patients undergoing RP, a minimum of two independent RT-PCR-PSA assays detected circulating prostate cells preoperatively in 27 patients (31.8%). Of 12 patients with locally advanced or advanced stage cancer, RT-PCR-PSA was positive in 5 (41.7%); of the 22 controls, no patient was RT-PCR-PSA positive. In 10 randomly selected cases, the RT-PCR product was confirmed as PSA by DNA sequencing. Of the 27 patients undergoing RP who were RT-PCR positive, 11 (40.7%) had non-organ-confined disease (pT3a or greater), and of the 58 patients who were RT-PCR negative, 32 (55.2%) had non-organ-confined disease. Patients with RT-PCR positive results also had lower margin positivity (9 of 27, 33.3%) than did patients with RT-PCR negative results (21 of 58, 36.2%). Finally, at a mean follow-up of 25.7 months, 5 (18.5%) of 27 RT-PCR positive patients had recurrence (PSA) compared with 14 (24.1%) of 58 RT-PCR negative patients.Conclusions. On the basis of this blinded study, RT-PCR for PSA-expressing cells in 85 patients before RP is not related to clinical stage, age, race, grade, Gleason sum, serum PSA or prostatic acid phosphatase, tumor volume, or tumor multifocality. RT-PCR positivity did not predict pathologic stage or early PSA recurrence. A standardized RT-PCR assay needs to be developed to account for interlaboratory discrepancies.
    Urology 01/1999; 53(4):714-721. · 2.13 Impact Factor
  • Robert C. Dean, Judd W. Moul
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    ABSTRACT: Potential tumor markers for testis cancer have become numerous with the new molecular techniques available. New protein markers have been evaluated, and histologic factors have shown correlations with stage of disease. Cytogenetic analysis studies have also shown associations with stage progression. Chromosomal markers, oncogenes, and tumor suppressor genes are possible candidates for tumor markers. These new potential tumor markers may become as commonplace as the established markers and may enhance diagnosis, staging, and treatment of testis cancer.
    Urologic Clinics of North America 09/1998; 25(3):365-73. DOI:10.1016/S0094-0143(05)70027-6 · 1.35 Impact Factor

Publication Stats

375 Citations
37.37 Total Impact Points

Institutions

  • 2004–2007
    • University of California, San Francisco
      • Department of Urology
      San Francisco, California, United States
    • University of Alberta
      Edmonton, Alberta, Canada
  • 1998–2003
    • Walter Reed National Military Medical Center
      • Department of Surgery
      Washington, Washington, D.C., United States
  • 1999
    • Uniformed Services University of the Health Sciences
      • Department of Surgery
      Bethesda, MD, United States