Health and Prostate

Chemotherapy Cytotoxic chemotherapy remains the mainstay of systemic treatment for most solid cancers. Renal cell carcinoma however is a characteristically unresponsive tumour and at present, these agents are not routinely used. A comprehensive review of chemotherapy in Renal cell carcinoma, performed by Yagoda etal., included 4093 patients in 83 trials between 1983 and 1993. The trials included every class of anticancer agent. The overall RR was 6% (1.3% complete response (CR); 4.7% partial response (PR)). Similarly, a review of published literature between 1990 and 1998 showed no survival benefit for any single-agent chemotherapy drug. Vinblastine is a cytotoxic drug with some activity in Renal cell carcinoma. For a time it was regarded as the best available agent. However, it is clear that response rates are low, typically between 2% and 7%, and Vinblastine is no longer routinely used in the treatment of Renal cell carcinoma. 5-Fluorouracil is a cytotoxic drug that has some single-agent activity (approximately 10% RR) in Renal cell carcinoma. Introduced in the 1950s, it represents Read more [...]

Anti-angiogenesis agents Angiogenesis refers to the formation of new blood vessels and is an important step in tumour growth. It is estimated that most tumours need to trigger angiogenesis in order to grow beyond 2 mm in diameter. The initiation and promotion of angiogenesis is under the control of a variety of cytokines and hormones, termed angiogenic factors, and include vascular endothelial growth factor, basic fibroblast growth factor, IL-8 and a tumour necrosis factor. Renal tumours are highly vascular and this makes them an attractive target for inhibitors of angiogenesis. The development of anti-angiogenesis agents is the focus of much research, both in Renal cell carcinoma and in other solid malignancies. These novel approaches have burgeoned over recent years. Two such agents are discussed below. Thalidomide is infamous as a drug that was prescribed to pregnant women in the late 1950s to combat morning sickness, which resulted in birth defects in thousands of children. We now know that thalidomide possesses anti-angiogenic properties and in utero this impaired limb development, with Read more [...]

The cure rate for patients with non-seminomatous tumours in clinical stage I exceeds 95%. About 20% of patients with stage I disease without lymphatic or vascular invasion or without invasion into the tunica albuginea, spermatic cord or scrotum are discovered to have regional lymph node metastases at surgery. Nerve-sparing retroperitoneal lymph node dissection and surveillance are both standard treatment options. Nerve-sparing retroperitoneal lymph node dissection A primary retroperitoneal lymph node dissection after orchiectomy allows careful pathological staging, while at the same time offering a therapeutic benefit if the retroperitoneal lymph nodes are positive. A nerve-sparing retroperitoneal lymphadenectomy that preserves ejaculation in virtually every clinical stage I patient appears to be as effective as the standard retroperitoneal lymphadenectomy. Despite the improved accuracy of clinical staging methods about 20% of patients with clinical stage I have pathological stage II disease at retroperitoneal lymphadenectomy. Many of these patients are cured surgically without subsequent chemotherapy. Read more [...]