Lawson L Douglas

THE EPIDEMIOLOGY OF PROSTATE CANCER IN JAMAICA

PURPOSE Before this study, the highest reported incidence of prostate cancer in the world was thought to be among United States black men. The age adjusted rates in 1992 for United States black and white men were 249 and 182/100,000 respectively. The epidemiology of prostate cancer in Jamaica, a country of 2.5 million people of primarily African descent, was studied and compared with that of white and black Americans. MATERIALS AND METHODS The study included 1,121 cases of prostate cancer diagnosed from 1989 to 1994. Sources of information included the Jamaican Cancer Registry, government pathology laboratory, hospital and clinic records, and physician office records. Incidence rates were computed using data from the 1991 Jamaican census. Age adjustments were made using the 1970 United States standard population. RESULTS The average age adjusted incidence of prostate cancer in Kingston, Jamaica was 304/100,000 men. Median patient age at diagnosis was 72 years. More than 80% of the cases were pathologically confirmed. Of the patients 30% presented with acute urinary retention, 16% presented with bone metastases, 15% had gross hematuria at the time of diagnosis and an abnormal rectal examination suspicious for cancer was noted in 42%. Prostate specific antigen was measured in only 7% of cases in 1989 but in 48% of cases by 1994. CONCLUSIONS These data demonstrate that Jamaican men in Kingston have a high incidence of prostate cancer, much higher than even black Americans during a similar period. Furthermore, the cancers are more significant clinically with greater morbidity in Jamaica than in the United States.

Familial study of prostate cancer in Jamaica

OBJECTIVES Rates of prostate cancer in Kingston, Jamaica are extremely high (occurring in more than 300 men out of 100,000 in 1989 to 1993). This article addresses the familial aggregation of prostate cancer in Jamaica. Early evidence for familial prostate cancer was found in the Utah Mormon population. Increased risk of prostate cancer in men with a family history of prostate cancer has been consistently observed in subsequent studies. There have been few studies, however, involving black men, who are known to have an overall higher risk of developing prostate cancer. METHODS Two hundred sixty-three patients with prostate cancer documented by histology were studied. Two hundred sixty-three age-matched control patients were used for comparison. Extensive pedigrees were obtained for both patients with cancer and controls. Data on other malignancies including lung, breast, colon, stomach, and uterine were also collected. RESULTS The patients with cancer and the controls were comparable with respect to age and family size. Thirty patients with cancer had a first degree relative (ie, brother, father, or son) with prostate cancer compared to 15 controls. The odds ratio is 2.1 (95% confidence interval 1.1 to 4.4). Nine patients with cancer had a second degree relative (ie, grandfather, grandson, or uncle) affected compared to 3 controls. The odds ratio is 3.1 (95% confidence interval 0.8 to 17.8). There was no statistically significant difference in the rates of any of the other cancers studied. CONCLUSIONS Familial aggregation of prostate cancer is clearly evident in black Jamaican men. A man with one first degree relative with prostate cancer is twice as likely as the general population to develop prostate cancer. In addition, there may be a statistical difference in the risk of developing prostate cancer if an individual has one second degree relative affected.

Easy Visualization of the Membranous Urethral Stump in Radical Prostatectomy

PURPOSE Access to the urethral stump is sometimes difficult during radical retropublic prostatectomy. MATERIALS AND METHODS A 20F Foley catheter with the 5 ml. balloon inflated with 10 ml. in the bulbous urethra was used to elevate the urethral stump into the operative field. RESULTS Easy access to the urethral stump was achieved in all patients, which assisted with accurate anastomosis. There was decreased leakage of urine and no anastomotic stricture. No urethral trauma or incontinence was attributable to the technique. CONCLUSIONS This simple and safe technique allowed easy access to the urethral stump.

Case Report: Congenital Ureteral Diverticulum and Solitary Kidney

A case of true congenital diverticulum of the ureter associated with a solitary kidney is reported. The diverticulum was producing hydroureteronephrosis. Treatment consisted of excision of the diverticulum and repair of the narrowed area in the ureter. At 4-year followup there was no deterioration on excretory urography and renal function tests have remained normal.

Plexiform neurofibroma of the penis and facial nerve.

A case of plexiform neurofibroma of the penis is presented. It is a rare condition often found in association with congenital neurofibromatosis. This case is unique because of the accompanying lesion of the facial nerve above the right eye, an association not previously reported. The patient was managed effectively by adequate resection of the penile lesion.

Anesthesia penile tumescence test

This article describes a simple method which we have found useful in helping to diagnose psychogenic impotence.