Results of Clinical Studies
Many of you signed up for participation in studies that were overseen by the joint Committee on Clinical Investigation at The Johns Hopkins Hospital. I am most grateful for your participation and would like to share with you a brief summary of some of the results.
In an effort to identify spread of cancer beyond the prostate, some of you participated in our study of MRI using the endorectal coil. Although this technique provides excellent images of the prostate, it did not improve the ability of the radiologist to detect spread of cancer beyond the prostate. The reason for this is becoming increasingly clear. When prostate cancer cells escape the prostate, they creep along the edges of the gland just millimeters away from the edge as they progress toward the seminal vesicles. Unfortunately, it is almost impossible to detect this microscopic spread.
In an effort to reduce the need for autotransfusion of blood, we evaluated a technique known as hemodilution. At the time of surgery, just after the epidural anesthetic is placed, 3 units of blood were drawn acutely from the patient and the blood volume was restored using solutions containing salt and starch. At the end of the case all 3 units were readministered to the patient. We learned that this technique was as safe and as effective as the donation of 3 units of blood prior to surgery However, this technique can only be used in patients who have an excellent cardiovascular status.
- Ness, P.M., Bourke, D.L., and Walsh, P.C.: A randomized trial of perioperative hemodilution versus transfusion of preoperatively deposited autologous blood in elective surgery. Transfusion 32:226-230, 1992.
In an attempt to improve the techniques of pain control, we evaluated the use of ketorolac, a non--steroidal anti-inflammatory agent similar to Motrin or Advil that can be given intravenously. We learned that ketorolac not only improved pain control but also permitted bowel function to recover more rapidly. As a result of this study, and studies at other institutions, ketorolac is now playing a major role in the postoperative management of patients. We now understand that most of the nausea which occurred following surgery was caused by the narcotic pain medications and that by eliminating narcotics from postoperative pain control we can now discharge patients on their 4th or 5th postoperative day.
- Grass, J.A. et. al.: Assessment of ketorllacasan adjustment to fentanyl patient-controlled epidural analgesia after radical retropubic prostatcctomy. Anesthesiology 78:642-648, 1993.
Experimentally we demonstrated that nerve grafts restored sexual function in rats. We then embarked upon a study to determine whether or not nerve grafts would improve the recoverv of sexual function in men who underwent wide excision of one nerve. Many of you had 18 months of suspense waiting to find out whether or not you underwent a nerve graft. By now that suspense is over. Unfortunately, we were not able to answer the question about whether nerve grafts worked because too few patients required wide excision of their nerves. This actually is good news because it demonstrates how prostate cancer today is being detected at an earlier more curable stage. Unfortunately, we may never know the answer to this question.