Tuesday, May 27, 2014

Historical Contribution: 1932, Colston & Lewis, Clinical Review of Prostate Cancer

1932

Carcinoma of the Prostate: A Clinical and Pathological Study J. Colston and L. Lewis Southern Medical Journal 1932  25: 696-703

Lloyd G. Lewis, MD
John Archibald Campbell (JAC) Colston was a John Hopkins urologist who worked closely with HH Young during the early 1900's.  Along with Young, he performed perineal prostatectomies and shaped the treatment and understanding of prostate cancer during this time period.  He served with the allied forces during World War I.

LLoyd G. Lewis graduated the Brady Residency in 1933.  He was remembered as a superb surgeon and co-author of The Physiology of Micturation, 1940 after undertaking a number of laboratory experiments involving the innervation of the feline bladder.  During World War II, Lewis served as Chief of Urology at Walter Reed General Hospital in Washington, DC and succeeded in having Walter Reed approved for residency training during his time there.

-----

In the early 1930's, the only means for detection of prostate cancer was a palpable lesion or symptomatic presentation, namely urinary obstruction.  As such, Colston and Lewis review the history of prostate cancer treated at the Brady since its founding in 1915 through 1932 and note that most prostate cancers "will be found to have progressed beyond the limits of the capsule or into the seminal vesicles so that a complete removal is impossible."  In fact, in 1,040 cases of prostate cancer over 17 years, only 36 cases were found to be eligible for radical prostatectomy.  When they reviewed the over 3,700 prostate operations, they found an additional 58 cancers that  were found during operations for presumed benign growth.

Through their thorough review, they were able to make a number of important observations that describe the understanding of prostate cancer at the time, but help shape our modern understanding of the disease today.  Some of the important observations are detailed below.

Colston and Lewis were able to classify prostate cancer patients into one of three categories:

  1. cases suitable for radical prostatectomy
  2. cases too extensive for radical surgery, but asymptomatic
  3. cases too extensive for radical surgery, but with significant symptoms that require palliative treatment; either:
    • radiation treatment
    • intra-urethral treatment (or suprapubic diversion)
    • palliative, perineal prostatectomy
Colston and Lewis were able to describe the anatomic location of prostate cancer within the gland by examining whole prostate glands removed during radical surgery.  They found the "posterior lamella involved in all cases;" and the lateral lobes involved in the majority.  


They described metastatic and local growth patterns.  Thirty percent of men presenting with prostate cancer had metastases at this time.  For the men with local extension, they reviewed infiltration patterns through the seminal vesicles and never into Denonvillier's fascia "explained by the lack of lymphatics in this thick fascial membrane."  In addition, they noted that, "The rapidity of growth depends on the particular type of tumor, and it may be said that the more cellular the tumor, the more rapid the extension," an early description of the grading of prostate cancer.

In addition, they review the available treatments for the symptoms associated with advanced prostate cancer: urinary obstruction, hematuria and pain.  These symptoms could be treated radiation, transurethral and/or perineal procedures.

Finally, they conclude that, "Every effort should be made by earlier diagnosis to increase the percentage of cases suitable for radical operation, which gives normal micturation with perfect control in most cases."

To read the entire manuscript click on the link above or click here.


HISTORICAL CONTRIBUTIONS highlight the greatest academic manuscripts from the Brady Urological Institute over the past 100 years.  As the Brady Urological Institute approaches its centennial, we will present a HISTORICAL CONTRIBUTION from each of the past 100 years.  In the most recent experience, the most highly cited article from each year is selected; older manuscripts were selected based on their perceived impact on the field.  We hope you enjoy! 

4 comments:

  1. We are urgently in need of KlDNEY donors for the sum of $500,000.00 USD, WhatsApp or Email for more details:
    hospitalcarecenter@gmail.com
    WhatsApp +91 779-583-3215

    ReplyDelete
  2. HOW DR AZIBA HELPED ME ENLARGE MY PENIS SIZE FROM 3.5 INCHES TO 11INCHES LONG AND 8.0 GROWTH
    I got married 2 years ago and it just seemed that there was no excitement in my sex life. My dysfunction to perform to the best of my abilities in bed made it harder for my wife and me to have a good time during sex. And i was having the feelings that she may decide to get a divorce one day. I knew something had to be done in order to improve my sex life and to save my marriage because my marriage was already falling apart, so when i was on my Facebook page i came across a story of how Dr Aziba helped him enlarged his penis to 8ins better.so i Immediately copied the Email address of the Dr and explained to him my problem,he gave me some simply instruction which i must follow and i did easily and my friends Today, i am the happiest man on Earth, All Thanks to Dr Aziba for saving my marriage and making me a real man today.i asked him about some popular diseases like HERPES,HIV AIDS,HEPATITIS, DIABETICS, CANCERS, WART, Get Ex back ,etc....... which are affecting most people he said there is no disease without a cure , he has it all...You can as well reach the Dr below for help on your problem, for he has the solution to all...
    Email:[ PRIESTAZIBASOLUTIONCENTER@GMAIL COM ]
    WhatsAPP DR [ +2348100368288 ]





    HOW DR AZIBA HELPED ME ENLARGE MY PENIS SIZE FROM 3.5 INCHES TO 11INCHES LONG AND 8.0 GROWTH
    I got married 2 years ago and it just seemed that there was no excitement in my sex life. My dysfunction to perform to the best of my abilities in bed made it harder for my wife and me to have a good time during sex. And i was having the feelings that she may decide to get a divorce one day. I knew something had to be done in order to improve my sex life and to save my marriage because my marriage was already falling apart, so when i was on my Facebook page i came across a story of how Dr Aziba helped him enlarged his penis to 8ins better.so i Immediately copied the Email address of the Dr and explained to him my problem,he gave me some simply instruction which i must follow and i did easily and my friends Today, i am the happiest man on Earth, All Thanks to Dr Aziba for saving my marriage and making me a real man today.i asked him about some popular diseases like HERPES,HIV AIDS,HEPATITIS, DIABETICS, CANCERS, WART, Get Ex back ,etc....... which are affecting most people he said there is no disease without a cure , he has it all...You can as well reach the Dr below for help on your problem, for he has the solution to all...
    Email:[ PRIESTAZIBASOLUTIONCENTER@GMAIL COM ]
    WhatsAPP DR [ +2348100368288 ]

    ReplyDelete
  3. Are you in need of Urgent Loan Here no collateral required all problem regarding Loan is solve between a short period of time with a low interest rate of 2% and duration more than 20 years what are you waiting for apply now and solve your problem or start a business with Loan paying of various bills I think you have come to the right place just contact us We Are Here To Show You A Better Way To Financial Freedom !!!
    Contact Us At : abdullahibrahimlender@gmail.com
    whatspp Number +918929490461
    Mr Abdullah Ibrahim

    ReplyDelete

  4. I was diagnosed as HEPATITIS B carrier in 2013 with fibrosis of the
    liver already present. I started on antiviral medications which
    reduced the viral load initially. After a couple of years the virus
    became resistant. I started on HEPATITIS B Herbal treatment from
    ULTIMATE LIFE CLINIC (www.ultimatelifeclinic.com) in March, 2020. Their
    treatment totally reversed the virus. I did another blood test after
    the 6 months long treatment and tested negative to the virus. Amazing
    treatment! This treatment is a breakthrough for all HBV carriers.

    ReplyDelete