J.M. Wolff

Metabolic Imaging of Untreated Prostate Cancer by Positron Emission Tomography with sup 18 Fluorine-Labeled Deoxyglucose

PURPOSE We evaluated positron emission tomograph (PET) with 18fluorine (18F)-labeled deoxyglucose for metabolic grading of untreated primary prostate cancer, and differentiation of benign and malignant prostatic disease. MATERIALS AND METHODS A total of 48 patients with untreated prostate cancer of different stages and 16 with histologically confirmed benign prostatic hyperplasia (BPH) underwent static PET after intravenous injection of 150 to 300 MBq. 18F-deoxyglucose. 18F-deoxyglucose accumulation was quantitated by calculating differential uptake ratios and prostate-to-skeletal muscle ratios. RESULTS Low 18F-deoxyglucose uptake was noted in the majority of primary tumors (81%). 18F-deoxyglucose accumulation did not correlate with increasing tumor grade or stage. There was a significant overlap in uptake values in BPH and malignant prostatic disease. A trend towards statistical significance was noted with lower prostate-to-skeletal muscle ratios in patients with BPH (p < 0.07). Increased 18F-deoxyglucose accumulation was detected in some patients with BPH and malignant prostatic disease, as well as in those with lymph node and bone metastases of prostate cancer. CONCLUSIONS 18F-deoxyglucose PET does not allow for metabolic labeling in the majority of untreated primary prostate cancers. BPH and primary prostate cancer cannot be reliably differentiated on the basis of PET. Increased 18F-deoxyglucose accumulation occurs in some primary prostate tumors and in metastatic deposits of prostate cancer.

Intermittent hormonal therapy in the treatment of metastatic prostate cancer: a randomized trial.

Study Type – Therapy (RCT)

Prostate-specific antigen as a marker of bone metastasis in patients with prostate cancer

OBJECTIVE Staging in patients with newly diagnosed untreated cancer of the prostate has significant ramifications on the management of the disease. Currently measurement of the serum prostate-specific antigen (PSA) concentration and radionuclide bone scan are two important procedures in the metastatic workup of these patients. We retrospectively evaluated the efficacy of PSA as a staging marker to discriminate prostate cancer patients with bone metastases from those without bone metastases. MATERIALS AND METHODS In a retrospective study 158 prostate cancer patients with (n = 21) and without (n = 137) bone metastases were analyzed. In all patients the initial PSA measurement as well as the radionuclide bone scan were evaluated. RESULTS Patients with bone metastases demonstrated a median serum PSA concentration of 151 ng/ml and only 1 patient revealed a serum PSA concentration of <10 ng/ml. This resulted in a negative predictive value of 98%. In addition 67% of these patients demonstrated a serum PSA concentration of >100 ng/ml, which resulted in a positive predictive value of 74% and an overall accuracy of 92%. CONCLUSION The serum PSA concentration seems to provide useful information with regard to the presence of bone metastasis in patients with newly diagnosed cancer of the prostate. A serum PSA value of <10 ng/ml nearly excludes bone metastases, whereas a serum PSA value of> 100 ng/ml is highly predictive of bone metastases.

Evaluation of Possible Tissue Damage in Patients Undergoing Extracorporeal Shock Wave Lithotripsy Employing C-reactive Protein

Extracorporeal shock wave lithotripsy (ESWL) has become the most common treatment for stones in the upper urinary tract. Tissue injury related to ESWL has been documented. C-reactive protein (CRP) is the classical acute-phase protein most recognized as an early marker in diseases characterized by inflammation and tissue injury. Possible tissue trauma by ESWL was evaluated by serial CRP determinations in 150 patients with kidney stones, whose follow-up was uneventful. The mean CRP-concentration prior to ESWL was 6.34 mg/l. The majority of patients did not show any further elevation of CRP-levels. Mean CRP-levels were 7.62 mg/l on the first, 6.12 mg/l on the third and 5.09 mg/l on the fifth day after ESWL. No correlation was observed between the number of shock waves and CRP levels. Judged by CRP-determinations tissue damage induced by ESWL can be considered to be minimal as no marked CRP-elevations could be observed in patients with an uneventful follow-up after ESWL.

Die erweiterte, radikale perineale Prostatektomie

Zusammenfassung125 konsekutive Patienten mit Adenokarzinom der Prostata wurden einer erweiterten radikalen perinealen Prostatektomie entsprechend der Technik von Weldon unterzogen. Diese Technik wurde durch die primäre komplette Mobilisation der Prostatahinterfläche und der Samenblasen, der Inzision der Faszia endopelvina, der queren Inzision der Denonvillier-Faszia am Apex und der partiellen Durchtrennung des dorsalen Venenkomplexes nach vorangegangener Durchstechungsligatur modifiziert.Die perioperative Morbidität war gering. Eine operative Wundrevision war bei 4 (3,2%) der Patienten wegen subkutaner arterieller Blutung aus dem Drainagekanal (n=1), Wundinfekt (n=2) und rektokutaner Fistel (n=1) erforderlich. Der Dauerkatheter wurde bei 104 (83%) Patienten am 4.–8. Tag entfernt. Positive Schnittränder fanden sich nur bei 22 (17,6%) Patienten. Es handelte sich dabei um 17 pT3- und 5 pT4-Tumoren mit Gleason-Score ≥7 (n=17), ausgedehntem, multifokalem Kapseldurchbruch (n=18), Infiltration der Samenblasen (n=11) und Lymphknotenmetastasen (n=4). Die unifokal positiven Schnittränder fanden sich am Apex (n=3), dorsolateral (n=6) und am Blasenhals (n=4); 9-mal lag ein multifokal positiver Schnittrand vor.Die Wahrscheinlichkeit des positiven Schnittrandes ist abhängig vom Serum-PSA, Gleason-Score und Tumorvolumen. Wird auf eine Potenzerhaltung verzichtet, so wird zur Vermeidung von positiven Schnitträndern die erweiterte radikale perineale Prostatektomie mit den angegebenen Modifikationen empfohlen.AbstractOne hundred and twenty-five consecutive patients with prostate cancer underwent an extended, radical perineal prostatectomy according to the technique described by VE Weldon. This technique was modified by an initial complete mobilization of the posterior aspect of the prostate and seminal vesicles from the rectum and pelvic wall, incision of the endopelvic fascia, and partial resection of the dorsal vein complex after suture ligature. The perioperative morbidity was low.An operative revision was necessary in four (3.2%) patients because of arterial bleeding from a drainage channel (n=1), wound infection (n=2), and rectocutaneous fistula (n=1). The in-dwelling catheter was removed on day 4–8 in 104 (83%) patients. Positive surgical margins were diagnosed in 22 (17.6%) patients only. These patients had pT3 (n=17) and pT4 (n=5) tumors with a Gleason score ≥7 (n=17) mostly; extensive, multifocal capsular penetration (n=18); seminal vesicle invasion (n=11); and lymph node metastases (n=4). The unifocal positive margins were localized at the apex (n=3), dorsolateral (n=6) aspect, and bladder nech (n=4). In nine patients, multifocal positive surgical margins were noted.The risk for a positive surgical margin depends on the serum PSA level, Gleason score, and tumor volume. In case potency prservation is not considered, the extended, radical perineal prostatectomy with the above mentioned modifications should be considered to guarantee a low rate of surgical margins.

Laparoscopic Bilateral Ureterolysis in Ormond’s Disease

We report a case of retroperitoneal fibrosis with dilation of the upper urinary tract on both sides and impaired renal function in a 66-year-old female. The patient was successfully treated by laparoscopic ureterolysis and intraperitonealization of both ureters with subsequent immunosuppressive medication. Due to intraoperative subcutaneous emphysema, surgical therapy had to be performed as a two-step procedure but postoperative morbidity was minimal with quick recovery. Laparoscopic ureterolysis is a reconstructive procedure and the ureters are accessible in full length either transperitoneally or retroperitoneally.

Spontaneous Kidney Rupture Due to a Metastatic Renal Tumour

Spontaneous rupture of the kidney is an uncommon entity. In most cases the non-traumatic rupture is associated with underlying diseases of the kidney, the most frequent being renal tumours. We report the case of a spontaneous kidney rupture due to a renal metastasis from an adenocarcinoma of the colon.

Is intermittent androgen-deprivation therapy beneficial for patients with advanced prostate cancer?

Use of intermittent androgen‐deprivation therapy (IADT) in patients with prostate cancer has been evaluated in several studies, in an attempt to delay the development of castration resistance and reduce side‐effects associated with ADT. However it is still not clear whether survival is adversely affected in patients treated with IADT. In this review, we explore the available data in an attempt to identify the most suitable candidate patients for IADT, and discuss factors that may inform appropriate patient stratification. ADT is first‐line treatment for advanced/metastatic prostate cancer and is also recommended for use with definitive radiotherapy for high‐risk localised prostate cancer. The changes in hormone levels induced by ADT can lead to short‐ and long‐term side‐effects which, although treatable in most cases, can significantly reduce the tolerability of ADT treatment. IADT has been investigated in several phase II and phase III studies in patients with locally advanced or metastatic prostate cancer, in an attempt to delay time to tumour progression and reduce the side‐effect burden of ADT. In selected patient groups IADT is no less effective than continuous ADT, ameliorating the impact of ADT‐related side‐effects, and, to a degree, their impact on patient health‐related quality of life (HRQL). Further comparative study is required, particularly in relation to HRQL and long‐term complications associated with ADT.

Laparoscopical Marsupialization of Symptomatic Post-Transplant Lymphoceles

Post-transplant lymphoceles after kidney transplantations occur with an incidence between 2 and 15%. In the last two years we observed four patients with symptomatic lymphoceles. After an infection or urinoma had been ruled out all cases were operated on laparascopically. All goals of open surgery in lymphoceles were achieved by this minimally invasive technique within an operating time between 40 and 70 min. No complications or recurrences occurred during a mean follow-up period of 17.8 months. Symptomatic post-transplant lymphocele is a rare event and represents an ideal indication for laparoscopic marsupialization.

Efficacy of Skeletal Alkaline Phosphatase and Prostate-Specific Antigen in the Diagnosis of Bone Metastasis in Cancer of the Prostate

Purpose: To study the efficacy of prostate-specific antigen (PSA) and skeletal alkaline phosphatase (SAP) as staging markers in discriminating patients with cancer of the prostate (CaP) with (M+) and without bone metastases (M0). Material and Methods: 73 patients with untreated CaP entered the study. After staging the patients were divided into 3 groups: group I, patients with CaP and bone metastases (n = 21); group II, patients with locally advanced CaP without bone metastases (n = 26), and group III, patients with clinically localized CaP without bone metastases (n = 26). Results: None of the M0 patients but 71% of the M+ patients exhibited an increased SAP. A corresponding cutoff point of 100 ng/ml for PSA showed that 19% of M0 patients and 71% of the M+ patients exhibited a value of >100 ng/ml. This resulted in a sensitivity and specificity of 71 and 100% of SAP and 71 and 81% for PSA, respectively. Conclusion: SAP could become a useful marker in the evaluation of patients with newly diagnosed CaP as it provides additional information concerning the skeletal status of these patients.