OBJECTIVES:Pelvic muscle tenderness occurs often in patients with urologic chronic pelvic pain syndrome; symptoms frequently can be reduced with pelvic myofascial physical therapy. This open-label pilot study evaluated the safety of a personal wand that enables patient's self-treatment of internal myofascial trigger points in the pelvic floor and its effect in reducing pelvic muscle tenderness.METHODS:A specially designed curved wand served as an extended finger to locate and release painful internal myofascial trigger points; an integrated algometer monitors and guides appropriate applied point pressure. Patients used the wand several times weekly after education and careful supervision. Evaluations for adverse events and assessments of pain sensitivity were conducted at 1 and 6 months after commencing use.RESULTS:One hundred and thirteen of the enrolled 157 patients completed 6 months of wand use-106 men and 7 women; 44 patients withdrew before study completion but none for adverse events. Median age was 41 years and 93% were male. Baseline median sensitivity visual analog scale score (1 to 10, 10=most sensitive) was 7.5 and decreased significantly at 6 months to 4 (P<0.001, Wilcoxon matched-pairs signed-rank test). Most patients (95.5%) reported the wand as either very or moderately effective in alleviating pain. No serious adverse events occurred.CONCLUSIONS:A multimodal protocol using an internal pelvic therapeutic wand seems to be a safe, viable treatment option in select refractory patients with pelvic pain.

This study documents the voluntary reduction in medication use in patients with refractory chronic pelvic pain syndrome utilizing a protocol of pelvic floor myofascial trigger point release with an FDA approved internal trigger point wand and paradoxical relaxation therapy. Self-referred patients were enrolled in a 6-day training clinic from October, 2008 to May, 2011 and followed the protocol for 6 months. Medication usage and symptom scores on a 1-10 scale (10 = most severe) were collected at baseline, and 1 and 6 months. All changes in medication use were at the patient's discretion. Changes in medication use were assessed by McNemar's test in both complete case and modified intention to treat (mITT) analyses. 374 out of 396 patients met inclusion criteria; 79.7 % were male, median age of 43 years and median symptom duration of 5 years. In the complete case analysis, the percent of patients using medications at baseline was 63.6 %. After 6 months of treatment the percentage was 40.1 %, a 36.9 % reduction (p < 0.001). In the mITT analysis, there was a 22.7 % overall reduction from baseline (p < 0.001). Medication cessation at 6 months was significantly associated with a reduction in total symptoms (p = 0.03).

The opportunity for first-year health sciences student to interact with patients is usually limited. The challenge for health sciences academics teaching first year foundation courses is to demonstrate to students the relevance and links to professional practice of these courses. In the sciences and health sciences practical classes provide students with a social environment, opportunities for collaborative learning and student faculty interaction. Novel strategies which may be used in lecture and practical class formats to motivate students include structuring an activity using familiar materials or processes in order to explain the unfamiliar. Selection of familiar materials to explain new or difficult concepts can introduce an element of fun into the learning experience. These types of activities represent a form of "experiential learning" where knowledge acquisition results from peer interaction and feedback in an entertaining and low risk environment. The focus of this paper is to examine a number of practical class learning opportunities where the activity was structured using familiar materials or processes in order to explain the unfamiliar. These learning opportunities demonstrated obvious links to professional practice. These classes also provided an environment that facilitated active learning within a social context. These examples were collaboratively evaluated against models for motivation strategies. A summary of key points for each of the learning opportunities and a comparative table for the individual learning opportunities, using the framework of instructional questions associated with ARCS motivational categories (attention, relevance, confidence and satisfaction) is presented. These novel practical classes can be used to demonstrate the professional relevance of foundational health sciences courses and fulfil criteria to be motivating, and therefore potentially engaging for students in a social environment. More importantly, as each of these examples indicates, the practical class can provide a scaffold for students to be able to meet learning objectives. Our observations align with those of others who have observed that learning opportunities such as those described in this paper make abstract ideas more tangible.

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Prostate & Genitalia1 Apr 20111431 SAFETY AND EFFECTIVENESS OF AN INTERNAL PELVIC MYOFASCIALTRIGGER POINT WAND FOR UROLOGICAL CHRONIC PELVIC PAIN SYNDROMES Rodney Anderson, David Wise, Timothy Sawyer, and Brian Nathanson Rodney AndersonRodney Anderson Stanford, CA , David WiseDavid Wise Sebastopol, CA , Timothy SawyerTimothy Sawyer Sebastopol, CA , and Brian NathansonBrian Nathanson Longmeadow, MA View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1343AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urologic chronic pelvic pain syndromes challenge physicians seeking adequate treatment alternatives. Pelvic muscle tenderness phenotypes occur often in these patients and pelvic myofascial physical therapy is helpful. We evaluated safety and tolerability of an internal therapeutic trigger point wand to enable patient self-treatment and determined effectiveness in decreasing pelvic muscle tenderness. METHODS A curved wand served as an extended finger to locate and release painful myofascial trigger points; an integrated algometer sensor monitors point pressure to prevent excessive or dangerous force. Patients used the wand weekly after education and careful supervision by a physical therapist. Assessments of pain sensitivity were conducted at pretreatment, 1 and 6 months; adverse events were documented. There were 169 patients enrolled in the study from October 2008 through mid-December 2009 with intent to obtain a 6-month follow-up. 92% of patients were men and 8% women with a median age of 41 years (25th percentile, 75% percentile; 32.5, 52.5). RESULTS 113 of the enrolled 169 patients completed 6 months of wand use; 56 patients withdrew but none for adverse events. Pelvic muscle sensitivity scores relative to pretreatment were available for 109 patients at 6 months. The median (25thpercentile, 75th percentile) sensitivity before wand use was 7.5 (6, 8.5); it decreased significantly after one month of wand use to a median of 5 (4, 6.5), p<0.001 (paired Wilcoxon matched-pairs signed-ranks test). At 6 months the median sensitivity decreased further to 4 (2.5, 5.5); the median difference in sensitivity was 2.5 (1.5, 4) compared with pretreatment values (p<0.001). Eighty-seven percent (95/109) of patients reported some (>0) reduction in muscle sensitivity and 93% indicated they were very satisfied or moderately satisfied with use of the wand. There were no serious side effects and rare transient episodes of mucosal bleeding. CONCLUSIONS This pilot trial represents an attempt to relieve the painful symptoms of UCPPS in a select population who were seeking treatment beyond the unsuccessful traditional multi-modal therapies they had previously received. Patient self-treatment utilizing a therapeutic wand for myofascial TrP release appears to be a safe, viable and economical chronic pelvic pain management option. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185 Issue 4S April 2011 Page: e573 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.Metrics Author Information Rodney Anderson Stanford, CA More articles by this author David Wise Sebastopol, CA More articles by this author Timothy Sawyer Sebastopol, CA More articles by this author Brian Nathanson Longmeadow, MA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

A crucial aspect of the teaching of professionalism relates to the provision of learning experiences that will promote the achievement of this affective learning domain. The development and trial of a learning opportunity to scaffold learning concepts of professionalism is described in this paper. Peer reviewed literature was used to construct a survey, administered to students (n=79). The scenarios for which there was student disagreement, or for which there was disagreement with literature provided a basis for tutorial discussions. Students attended a short clinical placement; subsequent post placement survey completion (n=35) focussed tutorial discussions on compilation of students' own understandings of professional behaviours. The scenarios developed could be used for other health sciences students; the approach is a model for affective domain learning in all professions.

PURPOSE:Chronic prostatitis/chronic pelvic pain syndrome continues to elude conventional therapy. Evidence supports the concept that phenotypes of pelvic muscular tenderness and psychosocial distress respond to myofascial trigger point release and specific relaxation training. This case series reports long-term outcomes of a 6-day intensive combination of such therapies in refractory cases.MATERIALS AND METHODS:A total of 200 men with pain for a median of 4.8 years referred themselves to Stanford University Urology for participation in an established protocol. Daily 3 to 5-hour sessions including intrapelvic/extrapelvic physiotherapy, self-treatment training and paradoxical relaxation training provided a solid introduction to facilitate self-management. Subjects answered baseline and followup questionnaires at variable intervals after initiation of therapy including the National Institutes of Health Chronic Prostatitis Symptom Index, global response assessment and a psychological query.RESULTS:We followed 116 men for a median of 6 months. Baseline total symptom index was 26 out of a maximum 43 points. Scores decreased by 30% (p <0.001) at followup with 60% of subjects demonstrating a 6-point or greater decrease (range 6 to 30). Domains of pain, urinary dysfunction and quality of life showed significant improvement (p <0.001). Global response assessment revealed that 82% of subjects reported improvement (59% marked to moderate, 23% slight).CONCLUSIONS:Men with chronic pelvic pain refractory to traditional treatment benefit from intensive myofascial trigger point therapy and concomitant paradoxical relaxation training. Education in techniques for self-administered trigger point release and continued pelvic muscle relaxation help patients reduce pain and dysfunction. Refinement of clinical phenotyping and selection of patients with pelvic muscle tenderness should enhance the success rate with this treatment modality.

The following paper discusses the implications of introducing social networking into a university teaching environment and suggests that further understanding and investigation into the role technology plays in such an environment is needed. In examining in-class technologies such as Clickers, online teaching tools such as Centra and Moodle and social networking sites such as Facebook, the paper considers the benefits for teachers and students, as well as examining the drawbacks that may need to be addressed for successful implementation in relation to learning outcomes. After discussing the growth of networking in an educational setting, the paper presents four major aspects that describe the working of networks, and then applies this discussion to specific examples of Facebook and Clickers. While the move towards technological implementation is supported, it is emphasised here that it cannot be done without in- depth examination of the position of both teachers and students in relation to technological innovation in the classroom.

Podcasting is used commonly recreationally and is now increasingly used in education. The technology for podcasting is readily available, easy to use and inexpensive, making it an attractive option for providing additional flexible learning resources for students. However, little is known about how podcasts are used by students and the implications for learning. This paper describes how podcasts were used by students in a medical radiation program. In common with many other health science programs, the medical radiation program has a large content load, particularly in first year where courses such as anatomy and physiology are introduced. Students generally used podcasts to review lecture content, especially when they had difficulty with understanding lectures or new terminology. Students generally listened to the recordings whilst viewing the lecture PowerPoint presentations on a home computer. Results from this study indicate that academics need to contemplate the introduction of instructional methods such as podcast lectures within the broader context of instructional goals.

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Prostate & Genitalia1 Apr 2010794 6-DAY INTENSIVE PHYSIOTHERAPY AND COGNITIVE BEHAVIOR CLINIC TREATMENT FOR CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME Rodney Anderson, David Wise, Tim Sawyer, and Patricia Glowe Rodney AndersonRodney Anderson Stanford, CA More articles by this author , David WiseDavid Wise Sebastapol, CA More articles by this author , Tim SawyerTim Sawyer Sebastapol, CA More articles by this author , and Patricia GlowePatricia Glowe Stanford, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1470AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Treatment of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) remains elusive. For patients exhibiting the phenotype of pelvic musculature tenderness, manual physiotherapy and cognitive behavior relaxation training appears to be helpful. The objective of this study was to show outcome benefits of an intensive 6-day immersion clinic in treating severely refractory patients. METHODS Men referred for treatment underwent physical examination, answered pain symptom questionnaires, and then spent several hours per day for 6 consecutive days undergoing myofascial trigger point release and training in paradoxical relaxation. Many patients were taught how to perform their own manipulations. Follow-up symptom scores, psychological status (5-point survey of feelings about disorder and coping with their symptoms) and global response assessments were performed from 3 to 42 months after the training/treatment program. RESULTS We analyzed 125 men who underwent the intensive therapy regimen. Their average age was 49 years (range 20-80); pelvic pain symptom duration average was 7.7±7.8 years with a median of 4.25 years. Follow-up of outcomes occurred after an average 11.8 ± 10.5 month with a median of 7 months. Differences in NIH-Chronic Prostatitis Symptom Index (CPSI) total and domain scores before and after treatment (paired t test) are presented in the Table. Fifty-two percent of the patients self-reported moderate or marked improvements in symptoms on the global response assessment; 14 (11%) indicated no change in their symptoms. Overall psychological benefits averaged 14.2 ± 4.9 (out of maximum score of 21); 25% of patients were exceedingly positive. Sixty-seven percent of patients indicated they continue to utilize cognitive training tapes and 47% continue physical therapy. Of the men completing the therapy, 68% perceived benefit and stated they would participate again or recommend this therapy to a friend. Table 1. Changes in CPSI Symptom Scores Before and After Physiotherapy and Cognitive Behavior Training, Mean ± SD CPSI Scores Pre-treatment Post-treatment p-value Total score 25.3±6.7 18.7±9.1 <0.001 Pain 11.8±3.7 8.8±4.4 <0.001 Urinary 4.4±2.8 3.2±2.8 <0.001 Quality of Life 9.6±2.3 6.9±3.5 <0.001 CONCLUSIONS CP/CPPS patients with long-standing pain, which is refractory to traditional treatment, may benefit from focused myofascial trigger point therapy and cognitive behavior relaxation training. Refinement of phenotyping and selection of patients should enhance the success rate with this treatment modality. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e310-e311 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rodney Anderson Stanford, CA More articles by this author David Wise Sebastapol, CA More articles by this author Tim Sawyer Sebastapol, CA More articles by this author Patricia Glowe Stanford, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The following paper discusses the implications of introducing social networking into a university teaching environment and suggests that further understanding and investigation into the role technology plays in such an environment is needed. In examining in-class technologies such as Clickers, online teaching tools such as Centra and Moodle and social networking sites such as Facebook, the paper considers the benefits for teachers and students, as well as examining the drawbacks that may need to be addressed for successful implementation in relation to learning outcomes. After discussing the growth of networking in an educational setting, the paper presents four major aspects that describe the working of networks, and then applies this discussion to specific examples of Facebook and Clickers. While the move towards technological implementation is supported, it is emphasised here that it cannot be done without indepth examination of the position of both teachers and students in relation to technological innovation in the classroom.

The effects of three coached breathing manoeuvres on diaphragm excursion after upper abdominal surgery (UAS) were investigated using sonography: verbal instruction to deep breathe; coached diaphragmatic (abdominal) breathing; and thoracic expansion exercise (lateral costal breathing). Eighteen patients aged 34–89 years, undergoing elective UAS at the Royal Adelaide Hospital, were tested. Diaphragm displacement was measured using sonography the day before and the day after surgery. Measurements were taken during deep breaths from functional residual capacity (FRC) to maximal inspiration. There was no difference in diaphragm displacement between the three types of deep breathing manoeuvres pre-operatively. On the first post-operative day, mean diaphragm displacement from FRC to maximal inspiration fell by 58%. Post-operatively, there were differences between the manoeuvres. A simple verbal instruction to deep breathe resulted in less diaphragm movement than coached diaphragmatic breathing and thoracic expansion breathing. There was no difference between coached diaphragmatic breathing and thoracic expansion breathing. We conclude that the techniques of coached diaphragmatic breathing and thoracic expansion used in this group of patients recovering from UAS elicited a greater excursion from the diaphragm than a simple instruction to deep breathe when measured in a 60° long sitting position.

The opportunity for first-year health sciences student to interact with patients is usually limited. The challenge for health sciences academics teaching first year foundation courses is to demonstrate to students the relevance and links to professional practice of these courses. In the sciences and health sciences practical classes provide students with a social environment, opportunities for collaborative learning and student faculty interaction. Novel strategies which may be used in lecture and practical class formats to motivate students include structuring an activity using familiar materials or processes in order to explain the unfamiliar. Selection of familiar materials to explain new or difficult concepts can introduce an element of fun into the learning experience. These types of activities represent a form of “experiential learning” where knowledge acquisition results from peer interaction and feedback in an entertaining and low risk environment. The focus of this paper is to examine a number of practical class learning opportunities where the activity was structured using familiar materials or processes in order to explain the unfamiliar. These learning opportunities demonstrated obvious links to professional practice. These classes also provided an environment that facilitated active learning within a social context. These examples were collaboratively evaluated against models for motivation strategies. A summary of key points for each of the learning opportunities and a comparative table for the individual learning opportunities, using the framework of instructional questions associated with ARCS motivational categories (attention, relevance, confidence and satisfaction) is presented. These novel practical classes can be used to demonstrate the professional relevance of foundational health sciences courses and fulfil criteria to be motivating, and therefore potentially engaging for students in a social environment. More importantly, as each of these examples indicates, the practical class can provide a scaffold for students to be able to meet learning objectives. Our observations align with those of others who have observed that learning opportunities such as those described in this paper make abstract ideas more tangible.

Study design: This was an observational, descriptive case-series study. The magnitude and direction of diaphragm movement during tidal and maximal inspiratory breaths in tetraplegic subjects were measured using B-mode sonography on a single occasion. Data were tabulated for descriptive analysis. Objective: There is a paucity of literature reporting dynamic movements of the paralyzed diaphragm. The aim of this pilot study was to investigate and record diaphragm movement in subjects with a cervical spinal cord injury (C1–C5), which had resulted in tetraplegia with partial or complete diaphragm paralysis. Subjects were patients of the Royal Adelaide Hospital in South Australia. Results: Three subjects participated in the study. The magnitude of diaphragm movement was small in two subjects and approached normal in one subject. During tidal inspiratory and maximal inspiratory breaths, the diaphragm moved in a caudal direction in two subjects. In the other subject, the diaphragm moved in a cephalad direction during a maximal inspiratory breath. Conclusion: Imaging of diaphragm movement was well tolerated by three subjects with cervical spinal cord injury. The difference in magnitude of diaphragm movement was not fully explained by the level of injury and the American Spinal Injury Association classification.

PURPOSE:A combination of manual physiotherapy and specific relaxation training effectively treats patients with chronic prostatitis/chronic pelvic pain syndrome. However, little information exists on myofascial trigger points and specific chronic pelvic pain symptoms. We documented relationships between trigger point sites and pain symptoms in men with chronic prostatitis/chronic pelvic pain syndrome.MATERIALS AND METHODS:We randomly selected a cohort of 72 men who underwent treatment with physiotherapy and relaxation training from 2005 to 2008. Patients self-reported up to 7 pelvic pain sites before treatment and whether palpation of internal and external muscle trigger points reproduced the pain. Fisher's exact test was used to compare palpation responses, ie referral pain, stratified by reported pain site.RESULTS:Pain sensation at each anatomical site was reproduced by palpating at least 2 of 10 designated trigger points. Furthermore, 5 of 7 painful sites could be reproduced at least 50% of the time (p <0.05). The most prevalent pain sites were the penis in 90.3% of men, the perineum in 77.8% and the rectum in 70.8%. Puborectalis/pubococcygeus and rectus abdominis trigger points reproduced penile pain more than 75% of the time (p <0.01). External oblique muscle palpation elicited suprapubic, testicular and groin pain in at least 80% of the patients at the respective pain sites (p <0.01).CONCLUSIONS:This report shows relationships between myofascial trigger points and reported painful sites in men with chronic prostatitis/chronic pelvic pain syndrome. Identifying the site of clusters of trigger points inside and outside the pelvic floor may assist in understanding the role of muscles in this disorder and provide focused therapeutic approaches.

PURPOSE:A perspective on the neurobehavioral component of the etiology of chronic prostatitis (CP) and chronic pelvic pain syndrome (CPPS) is emerging. We evaluated a new approach to the treatment of CP/CPPS with the Stanford developed protocol using myofascial trigger point assessment and release therapy (MFRT) in conjunction with paradoxical relaxation therapy (PRT).MATERIALS AND METHODS:A total of 138 men with CP/CPPS refractory to traditional therapy were treated for at least 1 month with the MFRT/PRT protocol by a team comprising a urologist, physiotherapist and psychologist. Symptoms were assessed with a pelvic pain symptom survey (PPSS) and National Institutes of Health-CP Symptom Index. Patient reported perceptions of overall effects of therapy were documented on a global response assessment questionnaire.RESULTS:Global response assessments of moderately improved or markedly improved, considered clinical successes, were reported by 72% of patients. More than half of patients treated with the MFRT/PRT protocol had a 25% or greater decrease in pain and urinary symptom scores, as assessed by the PPSS. In those at the 50% or greater improvement level median scores decreased 69% and 80% for pain and urinary symptoms, respectively. The 2 scores decreased significantly by a median of 8 points when the 25% or greater improvement was first observed, that is after a median of 5 therapy sessions. PPSS and National Institutes of Health-CP Symptom Index showed similar levels of improvement after MFRT/PRT protocol therapy.CONCLUSIONS:This case study analysis indicates that MFRT combined with PRT represents an effective therapeutic approach for the management of CP/CPPS, providing pain and urinary symptom relief superior to that of traditional therapy.

You have accessJournal of UrologyModerated Poster, Saturday, May 21, 2005, 3:30 - 5:30 pm1 Apr 2005112: The Stanford Protocol for Male Pelvic Pain: Integration of Myofascial Trigger Point Release and Paradoxical Relaxation Training Rodney U. Anderson, Christine Chan, Timothy Sawyer, and David Wise Rodney U. AndersonRodney U. Anderson More articles by this author , Christine ChanChristine Chan More articles by this author , Timothy SawyerTimothy Sawyer More articles by this author , and David WiseDavid Wise More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)34377-5AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "112: The Stanford Protocol for Male Pelvic Pain: Integration of Myofascial Trigger Point Release and Paradoxical Relaxation Training." The Journal of Urology, 173(4S), pp. 30–31 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 173Issue 4SApril 2005Page: 30-31 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Rodney U. Anderson More articles by this author Christine Chan More articles by this author Timothy Sawyer More articles by this author David Wise More articles by this author Expand All Advertisement PDF DownloadLoading ...

Objectives. To assess the ability of pretreatment and post-treatment prostate-specific antigen (PSA) measurements, clinical tumor stage, tumor grade, Gleason sum, race, age, and radiation dose to predict the recurrence of prostate cancer following external beam radiation therapy (XRT) since the introduction of PSA as a tumor marker at one tertiary care center. Methods. The recurrence of prostate cancer among 371 evaluable patients of 389 patients treated with XRT at Walter Reed Army Medical Center was analyzed using Kaplan-Meier survival methodology and Cox multivariable regression models. Serologic (PSA) recurrence was determined using three consecutive rises in PSA after a nadir value. Clinical recurrence was defined as local recurrence (palpable or positive biopsy) and/or distant (radiographically evident) recurrence. Mean and median follow-up is 40.2 and 39.4 months, respectively (range 3.0 to 89.5), and minimum follow-up is 18 months for patients who were alive at the time of analysis. No patient received adjuvant hormonal therapy. Potential prognostic factors evaluated are pretreatment PSA, PSA nadir, age, race, clinical tumor stage, tumor grade, Gleason sum, and radiation dose. Results. Of the 371 evaluable patients, 125 had disease recurrence. The Kaplan-Meier 5-year disease-free survival (DFS) rates for significant pretreatment variables in univariate analyses are as follows: pretreatment PSA less than 4 (79%), 4.1 to 10 (67%), 10.1 to 20 (57%), 20.1 to 50 (27%), and more than 50 (0%); for clinical tumor Stage T1a-T1c (84%), T2a-T2c (51%), and T3-T4 (29%); for tumor grade well (58%), moderate (58%), and poor (30%). Four-year DFS rates for Gleason sum are 2 to 4 (82%), 5 (72%), 6 (56%), and 7 to 10 (48%). In multivariable Cox regression analysis with backward elimination of nonsignificant variables, age, race, tumor grade, and radiation dose were eliminated, leaving pretreatment PSA, clinical tumor stage, and Gleason sum as significant prognostic factors. Analysis of a Cox model that included nadir PSA as a time-dependent variable showed it to be the strongest prognostic factor variable in the analysis. Conclusions. XRT remains a suitable treatment modality for patients with pretreatment PSA less than 20.0, clinical tumor Stages T1-T2, and Gleason sum 2 to 6 prostate cancer. Patients achieving a nadir value less than 0.5 have more durable treatment outcomes.

The aim of this investigation was to establish a reliable method of measuring diaphragm movement during relaxed tidal breathing. This study follows a previous study in which test-retest reliability was established for maximal breaths but not for tidal breaths (Blaney and Sawyer 1997). Twelve normal subjects were tested in a semi-reclined long sitting position. Sonographic measurements were taken for tidal breaths during four different patterns of breathing. All breaths were controlled for inspired volume. Testing was repeated one week later under the same conditions. The results showed that the method for measuring diaphragmatic movement at tidal breathing during a given pattern of breathing was reliable. This method will allow further investigation of the diaphragm during different breathing manoeuvres at tidal volume.