Lloyd J. Peterson

Does long-term finasteride therapy affect the histologic features of benign prostatic tissue and prostate cancer on needle biopsy?

Abstract Objectives. Finasteride, a common agent used to treat benign prostatic hyperplasia (BPH), inhibits 5-alpha-reductase. Testosterone is converted by 5-alpha-reductase to the more potent dihydrotestosterone, which is the primary androgen in the prostate. Leuprolide is a stronger antiandrogen that is used to downstage prostate cancer before radical prostatectomy. Leuprolide induces marked atrophy of prostate carcinoma cells, which sometimes makes pathologic diagnosis of cancer difficult, although evaluation at radical prostatectomy is easier than at biopsy. It is unknown whether finasteride produces similar changes, which would result in greater diagnostic difficulty because such changes would be seen on biopsy to rule out cancer in men with suspicious clinical findings treated for BPH. The current study investigated the histologic effects of finasteride therapy on human prostate cancer and benign prostatic tissue on needle biopsy. Methods. In blinded manner, we reviewed 53 needle biopsy specimens showing prostate carcinoma (35 treated with finasteride, 18 with placebo). Also reviewed in blinded manner were 50 benign needle biopsy specimens (25 treated with finasteride, 25 with placebo). The Gleason score, number of cores involved, percentage cancer involvement in a core, percentage of atrophic changes in cancer cells, presence of mitoses, blue-tinged mucinous secretions, prominent nucleoli, and high-grade prostatic intraepithelial neoplasia were documented for each case in the cancer group. The percentage of atrophy, basal cell hyperplasia, transitional metaplasia, chronic inflammation, and stromal proliferation was documented for each case in the benign group. Results. No significant histologic differences were present in either the benign or cancer group between cases treated with finasteride and placebo. Conclusions. We conclude that finasteride treatment for BPH does not cause difficulty in the diagnosis of cancer in prostate needle specimens. It is possible that there are severely atrophic areas resulting from finasteride treatment that are undersampled. However, the conclusion that cancer seen on needle biopsy in men treated with finasteride is unaltered and readily identified as cancer remains valid.

TUBERCULOSIS OF EPIDIDYMIS AND TESTICLE PRESENTING AS HYDROCELE

Abstract An eighty-four-year-old man had an enlarging, tender hydrocele. Hydrocelectomy was performed, and the pathologic report showed caseating granulomas. Ten days later the patient underwent an orchiectomy. Microscoipic sections showed multiple foci of caseous necrosis, multinucleated giant cells, and acid fast bacilli. A search for other foci of tuberculosis was nonproductive.

Bilateral renal carcinoma in Von Hippel-Lindau disease

Von Hippel-Lindau disease, one of the phakomatoses, is believed to be a disorder of mesodermal differentiation. Renal lesions, usually cysts or adenocarcinomas with an occasional hemangioblastoma, occur in approximately two thirds of all patients. The renal neoplasms previously reported have been multiple, bilateral, and usually beyond resection. A thirty-eight-year-old white male with a cerebellar hemangioblastoma and bilateral renal adenocarcinoma underwent suboccipital craniotomy, right heminephrectomy, and left radical nephrectomy. No evidence of recurrent disease can be identified ten months postoperatively. An aggressive approach in this systemic disease appears to be warranted.

Blind-ending branches of bifid ureters

Three new cases are utilized to illustrate the anatomy, embryology, and symptomatology of blind-ending branches of bifid ureters. Diagnosis can usually be made by intravenous pyelogram. The complications are recurrent urinary tract infections, calculi, and hydroureteronephrosis. Selection of management by observation, resection, nephroureterectomy, or ureterolithotomy is discussed. The specific techniqie for simple resection is stressed.

Post-Obstructive Diuresis: A Varied Syndrome

A prospective study was undertaken to define the clinical features, natural history and etiology of post-obstructive diuresis. Studied in detail were 8 patients with a massive diuresis after relief of urinary tract obstruction. We found that urea mediated osmotic diuresis, natriuresis owing to elimination of retained sodium from the obstructed phase, tubular defects in sodium reabsorption, renal unresponsiveness to antidiuretic hormone and iatrogenic factors may play varying roles in each individual diuresis. Overzealous fluid replacement should be avoided.

Ureteral obstruction of solitary kidneys by iliac artery aneurysms

Two patients with solitary kidneys had ureteral obstruction caused by iliac artery aneurysms. Both patients were treated successfully with ureterolysis and temporary proximal diversion. Iliac artery aneurysms generally remain asymptomatic; however, patients may have urologic complaints (such as hematuria, flank pain, anuria, or a pulsatile urinary stream), and severe complications may develop as a result of an obstructive uropathy. Diagnosis is confirmed by cystoscopy when a mass is present, intravenous pyelography, retrograde pyelography, and arteriography. Treatment must be individualized with consideration of the etiology of the aneurysm and condition of the patient. Surgical correction of the aneurysm may be appropriate. Ureterolysis, with proximal diversion as a temporary safety valve, is a useful procedure particularly when the patient has a solitary kidney.

Rhabdomyosarcoma in adult prostate

Abstract A case of rhabdomyosarcoma of the adult prostate is reported. Metastatic disease in both lung fields was treated by triple-drug therapy. This regimen has been maintained to date with resolution of pulmonary nodules.

HORMONAL THERAPY IN METASTATIC HYPERNEPHROMA

Abstract One hundred eight cases of hypernephroma were reviewed. Particular attention was paid to those patients who were given hormonal therapy for progressive metastatic disease. The principal drug used was medroxyprogesterone (Provera). Emphasis was placed on the patients undergoing emission or total regression of metastatic disease. Comparison between this and alternative therapies for metastatic hypernephroma were made.

Urinary tract calculi associated with enteritis and intestinal bypass

There is a definite increased incidence of calculi associated with extensive small bowel disease or resection. Hyperoxaluria appears to play a major role and may be due to increased intestinal oxalate absorption. Forced fluids and dietary discretion are mainstays of stone prophylaxis.