Onkologie
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Multicenter Study
Clinical usefulness of free PSA in early detection of prostate cancer.
Measurement of serum prostate-specific antigen (PSA) is widely used as an aid in early detection of prostate cancer. Most patients with prostate cancer and a PSA level less than 10.0 ng/ml have early-stage disease. Thus, the detection of prostate cancer in its potentially curable stages requires the use of low PSA cutoffs, inevitably leading to many unnecessary biopsies. The combined use of free PSA and total PSA increases specificity of early detection. To develop risk assessment guidelines and a cutoff value of ratio of free (f) to total (t) PSA with a high predictive value for prostate cancer in men to whom the test would be applied in real life practice, a multicenter early detection trial was initiated. ⋯ Using % fPSA in early detection of prostate cancer reduces the number of unnecessary biopsies, especially in men with negative rectal examination in the PSA range of 4.0-10.0 ng/ml. In order to diminish biopsy rate in men 70 years or older a cutoff of 16% fPSA should be used. A cutoff of 20% fPSA in men younger than 70 years is recommended to increase sensitivity in that age group.
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Up to 10% of all cervical lymph node metastases present without a known primary site. Between 70 and 80% of the found primary tumors are located in the head and neck region, because cervical lymph nodes represent the lymph drainage of the head and neck. ⋯ Following a thorough physical examination, radiologic imaging, i.e., computed tomography and/or magnetic resonance imaging, of the head and neck region as well a chest X ray, panendoscopy with biopsy of the most probable tumor sites, and diagnostic tonsillectomy should be performed. Further diagnostic procedures as gastroenterologic, urogenital and gynecological examinations should be performed, depending on histology and location of the node and under consideration of cost-benefit analysis. Curative treatment should at least include ipsilateral neck dissection and adjuvant irradiation of the complete cervical lymph drainage. In the literature, radiation of the laryngopharyngeal mucosa is still discussed controversially: some authors recommend the irradation of the pharyngeal mucosa extending from the nasopharynx to the upper esophagus, whereas others regard the resulting side effects as too high compared to the expected benefit.