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Papers by Prabhakar Pandey

Scandinavian Journal of Urology and Nephrology, 1995

Seminal vesicle abscess, a rare urologic entity, is usually diagnosed with computerized tomograph... more Seminal vesicle abscess, a rare urologic entity, is usually diagnosed with computerized tomography (CT) scan. We report a case of seminal vesicle abscess that required a transrectal ultrasonography to confirm the diagnosis. An analysis of 20 cases of seminal vesicle abscess reported in the literature is also reviewed.

Surgery, 1994

The purpose of the study was to determine whether a difference is noted in the rate of prostate s... more The purpose of the study was to determine whether a difference is noted in the rate of prostate specific antigen (PSA) elevation after radical prostatectomy or radiation therapy for localized prostate cancer. PSA doubling times were calculated by linear regression analysis in 50 patients who had been treated by radical prostatectomy and who had three or more increasing PSA levels and in 55 patients who had been treated with radiation therapy and who had three or more increasing PSA levels. No significant difference was noted in the mean PSA doubling times in the two patient groups when stratified by the site of tumor recurrence or by pretreatment tumor stage, tumor grade, or acid phosphatase level. Because the PSA doubling time probably parallels the tumor growth rate, these data suggest that the malignant potentials of recurrent tumor after radical prostatectomy and after radiation therapy are equivalent.

Journal of Urology, 1995

We assess the impact of deferred flutamide treatment on the serum prostate specific antigen (PSA)... more We assess the impact of deferred flutamide treatment on the serum prostate specific antigen (PSA) level in patients with localized or metastatic cancer. The study included 45 patients with localized cancer and 50 with metastatic cancer with an increasing (87) or stable (8) PSA level after gonadal androgen withdrawal. Of 40 evaluable patients with localized cancer and 50 with metastatic cancer 32 (80%) and 27 (54%), respectively, had a PSA decrease of 50% or more of baseline during flutamide treatment (p = 0.014). Among patients with localized cancer actuarial analysis of freedom from PSA elevation during flutamide treatment favored those with a 50% or greater PSA decrease (p = 0.006) but in patients with metastatic cancer the analysis revealed no significant difference. The relative density of tumor cells that are dependent on adrenal androgen after gonadal androgen withdrawal may be greater in patients with localized cancer and deferred flutamide treatment may enhance cancer control in those with localized disease.

Journal of Urology, 1995

Progressive elevation of the prostate specific antigen (PSA) level after radical prostatectomy fo... more Progressive elevation of the prostate specific antigen (PSA) level after radical prostatectomy for adenocarcinoma is generally considered as irrefutable evidence of recurrent tumor. We assessed the results of 62 biopsies of the vesicourethral anastomosis in 41 men who had 3 or more consecutive PSA levels of 0.4 ng./ml. or greater after radical prostatedomy and no evidence of metastatic disease. The median PSA at the time of the first biopsy was 2.2 ng./ml. (range 0.4 to 50). Histological confirmation of recurrent cancer was established after 1 biopsy procedure in 39% of the patients and after 1 or more biopsy procedures in 59%. Biopsy was positive in 78% of 23 patients with an abnormal digital rectal examination, 40% of 5 with an abnormal transrectal ultrasound only, and 23% of 13 with a normal digital rectal examination and ultrasound. Among the patients with and without biopsy proved tumor recurrence there were no sigdicant differences between the pathological stage or histological grade of the primary tumors, the month after surgery of the first detectable PSA level, the PSA doubling time, the month after surgery of the positive biopsy or the last negative biopsy, and the PSA level at the time of the positive biopsy or the last negative biopsy. In 6 cases benign prostatic tissue only was recovered from 1 or more biopsy specimens. This experience demonstrates that in patients with a detectable PSA after radical prostatectomy recurrent cancer may be difficult to document by biopsy of the vesicourethral anastomosis.

The Journal of Urology, 1997

Stage T1a-b prostate cancer comprised about 44% of newly diagnosed local prostate cancer cases in... more Stage T1a-b prostate cancer comprised about 44% of newly diagnosed local prostate cancer cases in the United States before the advent of medical and minimally invasive treatments for symptomatic benign prostatic hyperplasia (BPH) and before the widespread use of prostate specific antigen (PSA) testing in men with BPH. Information about the impact of these advances on detection of T1a-b cancer is not available. Prevalence of T1a-b prostate cancer was determined in 1,554 consecutive men who underwent surgical prostatectomy for suspected BPH at a Veterans Affairs Medical Center from 1985 through 1996. Since 1991 a PSA blood test was obtained routinely before surgery and patients with PSA greater than 4.0 ng./ml. usually underwent ultrasound guided prostate biopsy. The number of T1a-b cancer cases was relatively stable during 1985 to 1990 but declined from 36 in 1990 to 9 in 1996. There were no temporal trends in proportion of prostatectomy patients with T1a-b cancer and the decline in cancer detection paralleled less frequent use of surgical prostatectomy for treatment of BPH. The proportion of prostatectomy patients with T1a-b cancer was similar in 1985 to 1990 and in 1991 to 1996 but the percentage of Gleason 7 to 10 cancers declined from 26 in 1985 to 1990 to 10 in 1991 to 1996 (p &amp;lt; 0.0001). PSA and PSA density of evaluable patients with cancer were significantly greater than in evaluable patients with BPH. Of 105 patients with PSA greater than 4.0 ng./ml. who underwent preoperative prostate biopsy 16 (15%) had T1a-b cancer. The less frequent use of surgical prostatectomy at our institution has produced marked decline in detection of T1a-b cancer. If representative of national trends this experience suggests that many men with obstructive voiding symptoms and T1a-b cancer will remain undiagnosed and that periodic monitoring to identify unsuspected cancer is important in men who are treated with medical or minimally invasive therapies for BPH. Decline in detection of T1a-b cancer may also confound the accuracy of projected incidence rates of local prostate cancer in the United States.

The Journal of Urology, 1995

Progressive elevation of the prostate specific antigen (PSA) level after radical prostatectomy fo... more Progressive elevation of the prostate specific antigen (PSA) level after radical prostatectomy for adenocarcinoma is generally considered as irrefutable evidence of recurrent tumor. We assessed the results of 62 biopsies of the vesicourethral anastomosis in 41 men who had 3 or more consecutive PSA levels of 0.4 ng./ml. or greater after radical prostatectomy and no evidence of metastatic disease. The median PSA at the time of the first biopsy was 2.2 ng./ml. (range 0.4 to 50). Histological confirmation of recurrent cancer was established after 1 biopsy procedure in 39% of the patients and after 1 or more biopsy procedures in 59%. Biopsy was positive in 78% of 23 patients with an abnormal digital rectal examination, 40% of 5 with an abnormal transrectal ultrasound only, and 23% of 13 with a normal digital rectal examination and ultrasound. Among the patients with and without biopsy proved tumor recurrence there were no significant differences between the pathological stage or histological grade of the primary tumors, the month after surgery of the first detectable PSA level, the PSA doubling time, the month after surgery of the positive biopsy or the last negative biopsy, and the PSA level at the time of the positive biopsy or the last negative biopsy. In 6 cases benign prostatic tissue only was recovered from 1 or more biopsy specimens. This experience demonstrates that in patients with a detectable PSA after radical prostatectomy recurrent cancer may be difficult to document by biopsy of the vesicourethral anastomosis.

Journal of Urology, 1995

To identify prostate specific antigen (PSA) functions of prognostic significance in regard to tre... more To identify prostate specific antigen (PSA) functions of prognostic significance in regard to treatment with androgen deprivation for prostate cancer we analyzed the pretreatment PSA, PSA half-life, PSA nadirs, times to PSA elevation and PSA doubling times in 245 patients with localized and 78 with metastatic disease who were treated with this modality. There was a direct correlation between the pretreatment PSA and the time to PSA elevation in patients with localized cancer (p = 0.000003) but no significant correlation in those with metastatic cancer. The PSA half-life was highly variable and did not correlate with other PSA functions of prognostic significance. Incremental increases in the PSA nadir correlated with the time to PSA elevation in patients with localized and metastatic cancer (p &amp;lt; 0.000001 and p = 0.00009, respectively), and with other parameters of prognostic significance. The median PSA doubling time in 26 patients with localized cancer in whom distant metastases did not develop (7.5 months) was significantly longer than that in 7 in whom new metastases developed (2.5 months) and in 43 with preexisting metastatic cancer (2.5 months) (p &amp;lt; 0.05 and p &amp;lt; 0.0001, respectively). In the 7 patients with localized cancer in whom metastases developed the median of the ratios of the PSA when the metastases were manifest and the pretreatment PSA was 0.14, and in 24 patients with preexisting metastatic cancer the median of the ratios of the antemortem PSA and the pretreatment PSA was 1.2. These data show that PSA synthesis by prostate cancer is reduced after androgen deprivation but that the PSA nadir and PSA doubling time following treatment provide important prognostic information.

Journal of Urology, 1995

Purpose: The histology of ultrasound guided seminal vesicle biopsies is assessed and the results ... more Purpose: The histology of ultrasound guided seminal vesicle biopsies is assessed and the results are correlated with clinical or pathological stage of prostate cancer. Materials and Methods: A total of 517 consecutive men underwent bilateral (515) or unilateral (2) seminal vesicle biopsy during sextant biopsy of the prostate. Results: Seminal vesicle epithelium and muscularis were identified in 490 of 1,032 biopsy specimens (47%) and smooth muscle consistent with seminal vesicle muscularis was identified in 393 (38%). The seminal vesicle biopsy was positive for cancer in 7 of 123 patients (6%) with clinical stages Tlc and T2 tumors, 27 of 60 (45%) with stages T3 to 4 disease and 9 of 13 (69%) with metastatic cancer. Of 39 patients who underwent radical prostatectomy 1 of 36 (3%) without and 0 of 3 (0%) with seminal vesicle invasion had a positive seminal vesicle biopsy. Conclusions: Seminal vesicle epithelium and muscularis or smooth muscle consistent with the seminal vesicle muscularis can be procured in most patients using contemporary ultrasound guided biopsy techniques. However, apparently false-negative seminal vesicle biopsies are not uncommon and seminal vesicle biopsies contribute little to the staging of Tlc and T2 tumors.

Journal of Urology, 1995

We assessed the actuarial survival of 357 patients with localized prostate cancer who were treate... more We assessed the actuarial survival of 357 patients with localized prostate cancer who were treated with radical prostatectomy or radiation therapy at a Veterans Affairs Medical Center between 1980 and 1991 and who were followed for a median of 59 months. During this period patients with clinical stages A2 and B tumors who had an anticipated life expectancy of 10

Scandinavian Journal of Urology and Nephrology, 1995

Surgery, 1994

Journal of Urology, 1995

The Journal of Urology, 1997

The Journal of Urology, 1995

Progressive elevation of the prostate specific antigen (PSA) level after radical prostatectomy fo... more Progressive elevation of the prostate specific antigen (PSA) level after radical prostatectomy for adenocarcinoma is generally considered as irrefutable evidence of recurrent tumor. We assessed the results of 62 biopsies of the vesicourethral anastomosis in 41 men who had 3 or more consecutive PSA levels of 0.4 ng./ml. or greater after radical prostatectomy and no evidence of metastatic disease. The median PSA at the time of the first biopsy was 2.2 ng./ml. (range 0.4 to 50). Histological confirmation of recurrent cancer was established after 1 biopsy procedure in 39% of the patients and after 1 or more biopsy procedures in 59%. Biopsy was positive in 78% of 23 patients with an abnormal digital rectal examination, 40% of 5 with an abnormal transrectal ultrasound only, and 23% of 13 with a normal digital rectal examination and ultrasound. Among the patients with and without biopsy proved tumor recurrence there were no significant differences between the pathological stage or histological grade of the primary tumors, the month after surgery of the first detectable PSA level, the PSA doubling time, the month after surgery of the positive biopsy or the last negative biopsy, and the PSA level at the time of the positive biopsy or the last negative biopsy. In 6 cases benign prostatic tissue only was recovered from 1 or more biopsy specimens. This experience demonstrates that in patients with a detectable PSA after radical prostatectomy recurrent cancer may be difficult to document by biopsy of the vesicourethral anastomosis.

Journal of Urology, 1995