Domenico Pescatore

Monotherapy with Nilutamide, A Pure Nonsteroidal Antiandrogen, in Untreated Patients with Metastatic Carcinoma of the Prostate

A total of 26 previously untreated patients with metastatic carcinoma of the prostate received the pure nonsteroidal antiandrogen nilutamide as a single agent. Objective response rate was 38.5 +/- 18.7% (95% confidence interval). Median progression-free survival and median survival were 9 and 23 months, respectively. Of 13 patients with progression on antiandrogen 5 showed an additional objective response to a second-line endocrine treatment. The drug was generally well tolerated, except for 2 patients who discontinued treatment because of moderate gastrointestinal symptoms. Approximately a third of the patients complained of decreased adaptation to darkness. An electroretinogram and dark adaptation test revealed the presence of functional damage and visual complaints reversed in all patients on cessation of therapy. The other most frequent side effects were slight nausea (26.9% of the patients) and alcohol intolerance (19.2%). A nonsignificant increase in testosterone levels was shown within 1 month of treatment, after which the levels remained stable. Approximately half of the sexually active men claimed maintenance of libido and sexual potency during treatment. A slightly significant increase in hemoglobin was observed during the long term, suggesting the occurrence of a trophic effect by androgens on erythropoiesis. The results indicate that nilutamide as a single agent has an acceptable toxicity and a moderate activity, and may maintain sexual interest in a discrete number of cases. Whether monotherapy with nonsteroidal antiandrogens offers a valid option in the palliation of advanced disease remains to be seen in comparative prospective trials.

Results of Radical Nephrectomy with Extensive Lymphadenectomy for Renal Cell Carcinoma

Radical nephrectomy with extensive lymphadenectomy was performed by the same surgeon on 104 consecutive patients with renal cell carcinoma. No significant differences in over-all survival owing to age, sex and preoperative embolization were noted. Only extension of the disease proved to be important as a prognostic factor. In the light of the statistical analysis of this variable the prognosis for patients with renal cell carcinoma has been classified as 1) good--patients with tumors confined to the kidney, 2) intermediate--patients with perirenal fat involvement, lymph node metastases and venous extension, and 3) poor--patients with distant metastases.

Treatment of advanced prostatic carcinoma with cyproterone acetate and orchiectomy--5-year follow-up.

We report the results from 106 patients with extracapsular (stage C) or widespread (stage D) prostatic cancer, who were treated with cyproterone acetate and orchiectomy and followed for 5 years. As controls we used 40 patients, chosen at random, with stage C and stage D cancer of the prostate gland who were treated with stilbestrol and orchiectomy. The survival rate is improved in patients treated with cyproterone acetate and orchiectomy compared to the patients treated with stilbestrol and orchiectomy. Treatment with cyproterone seems more effective in those patients with low-stage and low-grade prostatic cancer. The side effects of this therapy are less and milder than those described in estrogenic treatment alone or with orchiectomy.

Giant Echinococcal Cyst of the Kidney Associated with Hypertension Evaluated by Computerized Tomography

AbstractWe report a case of echinococcal cyst disease of the kidney associated with hypertension that was evaluated preoperatively by computerized tomography and verified at operation. The accuracy of computerized tomography, and the relationship between the cyst and hypertension are discussed.

Preoperative Evaluation of Adrenal Cortical Carcinoma Extending into the Inferior Vena Cava

Abstract We report a case of left adrenal cortical carcinoma extending into the inferior vena cava, and documented preoperatively by venacavography and computerized tomography scanning. The importance of accurate preoperative evaluation is emphasized because of the high frequency of inferior vena caval thrombosis accompanying these tumors.

Usefulness and limitation of estrogen receptor protein (ERP) assay in human renal cell carcinomas.

The presence of estrogen-binding sites in human renal cell carcinomas appears certainly demonstrated. The authors analyze the clinical contributions which may be obtained from this finding and the possibility of using the ERP assay currently for the screening of patients with estrogen-dependent tumors.

The effect of cyproterone acetate and orchiectomy on metastases from prostatic cancer.

We have studied 38 patients with previously untreated, widespread prostatic cancer, who were submitted to therapy with cyproterone acetate and orchiectomy. 70% of patients with symptoms have shown subjective improvement. Moreover, it was possible to observe the regression, stabilization or progression of metastases in 32, 50 and 18% of the cases, respectively. We conclude that such therapy is effective in the initial treatment of metastatic prostate cancer and can be continued under radiographic control until the appearance of new metastases. At this point radiotherapy and alkylating agents may be effective.

Prolactin secretion in benign prostatic hypertrophy.

Prolactin secretion was evaluated in 22 patients with benign prostatic hypertrophy, before and after thyrotropin-releasing hormone stimulation. Increased prolactin reserve was found. In 11 patients, in whom the test was performed twice, the prolactin response after surgery was higher than in the pre-surgical test. The possible role of prolactin in the genesis of benign prostatic hypertrophy is discussed.

Bivalve Nephrolithotomy in Kidneys with Ileal Ureter

We describe the surgical management of 2 patients with staghorn stones in kidneys previously operated upon and an ileal ureter. Bivalve nephrolithotomy was accomplished in situ using local hypothermia and anatrophic nephrotomy. This approach seemed to be the most suitable in these cases because other procedures could have been difficult and risky for the pelvioileo-anastomosis.