John T. Grayhack

The Accuracy of Diagnostic Biopsy Specimens in Predicting Tumor Grades by Gleason’s Classification of Radical Prostatectomy Specimens

We reviewed the tissue histology of 115 patients with clinically localized carcinoma to determine the correlation between tumor grades in the biopsy and the prostatectomy specimen. Gleasons primary and secondary pattern score systems were used, and each specimen was graded on a scale of 2 to 10 by a referee pathologist in a blind fashion. If the difference in the summed primary and secondary grades in the 2 specimens was no more than 1 grade, the discrepancy was regarded as insignificant. In all but 32 cases initial diagnostic biopsy specimens predicted accurately the final prostatectomy specimen score. The discrepancy was 3 grades in 7 cases and 2 grades in 25 cases. As a result, the lesions in 19 cases were changed from a well differentiated (2 to 4), a moderately differentiated (5 to 7) or a poorly differentiated (8 to 10) lesion to another of these categories. The lesions were upgraded from a well differentiated to a moderately differentiated category in 9 cases and from a moderately to a poorly differentiated category in 4 cases. The lesions were downgraded from a moderately differentiated to a well differentiated category in 6 cases. In 13 other cases the discrepancy was 2 but the lesion remained within the moderately differentiated group. Although in 19 cases the cancerous tissue occupied less than 10 per cent of the biopsy specimen, accurate prediction could be made in 16. The results indicate that diagnostic biopsy specimens will predict the grade of the primary tumor in a majority (72 per cent) but not all of the cases.

Carcinoma of the prostate. Hormonal therapy

A selective review of the literature regarding hormonal therapy for patients with carcinoma of the prostate is presented to assess the current status of the following: (1) therapeutic advantages, disadvantages and risks of alternate approaches to hormonal therapy; (2) observations to predict the magnitude and duration of response to therapy; (3) indications for initiating hormone therapy; (4) the short‐term and long‐term effects of therapy; and (5) role of hormone therapy in patients with recurrent tumor activity after initial hormonal measures.

Prevalence and Significance of Prostatic Inflammation

AbstractProstatic fluid specimens were collected by digital massage from 325 consecutive men. White blood cells per high power microscopic field were counted under a cover slip. Lactate dehydrogenase isoenzymes in the fluid were separated by acrylamide disk electrophoresis and the ratio of lactate dehydrogenase-5/lactate dehydrogenase-1 was used as a parameter of epithelial cellular damage. Diagnoses were based on history, physical examination, and urine and fluid cultures, irrespective of the prostatic fluid white blood cells per high power field and lactate dehydrogenase-5/lactate dehydrogenase-1. The prostatic fluid of 31 patients with no urologic disease had 0.7 ± 0.41 white blood cells per high power field (mean ± standard error); 30 (97 per cent) of the specimens had less than 2 white blood cells per high power field. The prostatic fluid of 88 patients with non-inflammatory urologic disease had 3.8 ± 0.83 white blood cells per high power field; 76 (86 per cent) of the specimens had less than 10 whit...

Elevated transferrin receptor content in human prostate cancer cell lines assessed in vitro and in vivo

Transferrin receptors (TfR) were measured in benign and malignant prostatic cells by performing Scatchard analysis following the administration of 125I-transferrin. Established human prostate cancer cell lines (PC-3 and DU-145) as well as biologically aggressive variants (PC-3 ASC and PC-3 DES) were shown to possess significant levels of high affinity TfR when assessed in vitro. In contrast, TfR content was negligible in cultured stromal cell fractions derived from human benign prostatic hyperplasia (BPH) specimens. Scatchard analysis was also performed on in vivo derived prostatic tissues: tumors resulting from the subcutaneous xenografting of PC-3 ASC cells into athymic, nude mice and fresh BPH surgical specimens. These tissues were dissociated and their stromal and epithelial components separated. TfR were only detected in the epithelial component of both malignant and benign epithelial cells. PC-3 ASC tumor cells exhibited TfR levels comparable to their in vitro expression and these levels were 10-fold greater than in the BPH cells. These findings suggest that elevated TfRs may serve as another useful marker of the transformed phenotype within human prostate tumor systems.

Radiographic Assessment of the Vesicourethral Anastomosis Directing Early Decatheterization Following Nerve-Sparing Radical Retropubic Prostatectomy

Early decatheterization directed by postoperative gravity cystography in 55 consecutive radical prostatectomy patients is described. The catheter-free status was 22 per cent by postoperative day 8, 62 per cent by postoperative day 11 and 80 per cent by postoperative day 14. Cystograms performed beginning on postoperative day 7 identified 3 groups of patients and dictated their management: 1) no extravasation resulting in immediate catheter removal (36 patients), 2) moderate extravasation requiring repeat cystography leading to decatheterization by postoperative day 15 (9 patients) and 3) severe extravasation necessitating prolonged catheter drainage (8 patients). A decatheterization protocol is presented.

Intrinsic and extrinsic factors controlling benign prostatic growth

This review will present a new concept on the etiology of the development of benign prostatic hyperplasia (BPH). Conventionally, two known etiological factors for the development of BPH have been aging and the presence of functional testes. Assignment of these two factors, although reasonable, has not been conducive to aid the research community to identify and isolate the patho‐physiological agents that are directly responsible for the development of this disease. In the present review, we proposed a broadened concept of intrinsic and extrinsic factors for BPH. This concept offers identifiable research opportunities that will facilitate our quest in search for etiological agents for BPH. A brief description of various intrinsic and extrinsic factors and justifications for their selection will be discussed. Prostate 31:131–138, 1997.

LONG-TERM RESULTS OF RADICAL RETROPUBIC PROSTATECTOMY IN MEN WITH HIGH GRADE CARCINOMA OF THE PROSTATE

PURPOSE We sought to determine the efficacy of radical retropubic prostatectomy in men with high grade adenocarcinoma of the prostate in a population that had not been screened for prostate specific antigen (PSA). MATERIALS AND METHODS An inception cohort of 116 men surgically treated for prostate cancer between 1980 and 1991 was created in April 1992 and prospectively followed thereafter. Median followup was 7 years (range 2.2 to 14.6). RESULTS The major cause of death in this group of men was prostate cancer, not competing causes. Ten-year disease specific survival was 96% for organ confined (stage pT2c or less) and 78% for unconfined (stage pT3a or greater) disease. Five and 10-year PSA progression-free survival by pathological stage was 83 and 53% for organ confined disease, and 34 and 22% for unconfined disease with negative pelvic lymph node dissection (p = 0.001). Five and 10-year metastasis-free survival was 96% for organ confined disease, and 81 and 62% for unconfined disease (p = 0.011). Men with pelvic lymph node metastasis had 70 and 30% 5 and 10-year metastasis-free survival, and 75 and 55% disease specific survival, respectively. PSA progression-free survival was 33% at 5 years. A significantly decreased risk of PSA progression was observed in men with unconfined carcinoma who received adjuvant external beam radiotherapy. CONCLUSIONS In men with high grade prostate cancer the major cause of death was prostate cancer, not competing causes. Pathologically confined carcinoma had a significantly decreased rate of metastatic progression. These observations support the bias that early detection in these men at high risk for cause specific death may favorably impact survival.

The Role of Excretory Urography and Cystoscopy in the Evaluation and Management of Women with Recurrent Urinary Tract Infection

We examined the roles of excretory urography and cystoscopy in the evaluation and management of 153 otherwise healthy women seen consecutively with recurrent urinary tract infections. The excretory urograms were entirely normal in 89 per cent of the patients; the abnormalities were incidental findings with no influence on subsequent management. These results, combined with the known expense and risks inherent in the use of iodinated radiologic contrast material, suggest that excretory urography be limited to those patients possessing other risk factors. These include a history of unexplained hematuria, obstructive symptoms, neurogenic bladder dysfunction, renal calculi, analgesic abuse, severe diabetes mellitus or bacteriologic evidence of rapid recurrence suggesting bacterial persistence within the urinary tract or an enterovesical fistula. On the other hand, cystoscopy under local anesthesia has essentially no risks and occasionally will yield information helpful in future management.

Biochemical disease-free survival following adjuvant and salvage irradiation after radical prostatectomy

PURPOSE To present the biochemical cure rates (biochemically no evidence of disease) after external irradiation (RT) in patients with high-risk prostate cancer after radical prostatectomy. METHODS AND MATERIALS Seventy-six patients who underwent radical prostatectomy and subsequent RT were included in this analysis. No patient received hormonal therapy. Adjuvant RT was administered in 35 patients (46%), and 41 patients (54%) underwent salvage RT. After prostatectomy, the Gleason score was <7 in 87%, and 24% had seminal vesicle invasion. The median RT dose in the adjuvant RT and salvage RT groups was 60 Gy and 65 Gy, respectively. The biochemical cure rate was defined as a serum prostate-specific antigen of < or =0.2 ng/mL. RESULTS The overall 5-year Kaplan-Meier biochemical control rate from the end of RT was 70%. The 5-year biochemical cure rate for adjuvant RT was significantly superior to that after salvage RT (86% vs. 57%). The significant predictors of biochemical failure were seminal vesicle invasion in the adjuvant RT group and the presence of Gleason grade 4 or 5 in the salvage RT group. The clinical local control rate in the prostate bed was 100%. CONCLUSION This report demonstrates the efficacy of RT in achieving high biochemical cure rates after radical prostatectomy. Additional clinical studies are required to determine the optimal treatment of patients at high risk of biochemical failure after postprostatectomy RT.

Survival after radical retropubic prostatectomy of men with clinically localized high grade carcinoma of the prostate

Background. This study was performed to evaluate the efficacy of radical prostatectomy for men with clinically localized, poorly differentiated (Gleason score ≥7) prostate cancer and to characterize further the prognostic significance of traditional pathologic variables. The effectiveness of adjuvant radiotherapy was assessed in a subpopulation of men for whom the pathologic assessment suggested a high risk of persistent disease.