Health and Prostate

Even with the latest developments in cytotoxic chemotherapy for bladder cancer, many patients die from muscle-invasive disease, despite aggressive therapy with curative intent. Durable long-term remissions due to chemotherapy in metastatic disease are the exception rather than the rule, and median survival is approximately 14 months after commencement of chemotherapy. There remains a need for novel treatments that will either improve survival or increase the therapeutic ratio of systemic therapy. Potential new treatments include new cytotoxic drugs, new rationally designed 'targeted' therapies with small molecules and new 'biological' treatment modalities, including gene therapy. Oxaliplatin Given the established efficacy of cisplatin and carboplatin for patients with advanced/metastatic bladder cancer, other platinum-based cytotoxic drugs may have a role in the treatment of bladder cancer. The most promising of these is oxaliplatin, which is not associated with the nephrotoxicity of cisplatin, and is less myelosuppressive than carboplatin. However, in a small series of previously treated patients Read more [...]

Thiotepa (triethylene thiophosphoramide) Thiotepa was first used for intravesical therapy of superficial bladder cancer by Jones and Swinney. It is an alkalizing agent that acts by cross-linking nuclear acids and proteins. It has generally been administered at a dose of 1 mg/ml in either 30 mg in a 30-ml bolus or 60 mg in a 60-ml bolus, with the drug being retained for 2 h. A variety of regimens, including weekly x 6-8 followed by monthly for a year, were frequently used in the 1970s and the early 1980s. It produces complete response rates in approximately 35% of cases and partial remission rates in a further 25% which is somewhat less than other intravesical chemotherapeutic agents. It has also been utilized as a prophylactic agent, with a marked reduction of recurrence rate of 25% over the next 2 years compared with untreated tumours. Because of its low molecular rate (198 Da) thiotepa may readily be absorbed through the bladder wall and can cause marrow suppression in 50-20% of patients. Although it is still utilized occasionally as an active agent, because of its potential toxicity its utilization Read more [...]

Bacille Calmette-Guerin Morales et al. first reported the benefits of intravesical Bacille Calmette-Guerin using six weekly installations of approximately 10 cultures. This six-dose installation became the standard regimen although it appears chance alone gave Morales the opportunity to use six installations. A 60% response rate in papillary disease was reported and this has been consistently confirmed. Although useful in papillary disease, its greatest benefit is in the treatment of primary carcinoma in situ, an uncommon disease in this form although appearing much more commonly associated with aggressive papillary tumours as secondary carcinoma in situ. In the pure disease, as reported by Herr et al., in excess of 70% response rates are achieved but longer follow-ups have shown that there is a late relapse rate and lifelong follow-up in patients who have achieved a response is mandatory. Although effective Bacille Calmette-Guerin is associated with a high incidence of both local and systemic side-effects including mortality, much of this appeared to be in the early days of its usage when it Read more [...]