Oishi K

Serum retinal and prostate cancer

Levels of retinol, beta carotene, and alpha tocopherol were assayed by high performance liquid chromatography (HPLC) in serum from subjects with clinical prostatic cancer (n = 94), focal prostatic cancer (n = 40), benign prostatic hyperplasia (n = 130), and from hospital controls (n = 130). Levels of beta carotene and alpha tocopherol varied for prostatic cancer patients by disease stage and by the period in the treatment sequence when blood was collected. This made any assessment of their association with prostatic cancer risk difficult. The mean level of serum retinol was significantly lower (P < 0.05) in prostatic cancer patients than in the controls. For serum retinol this difference did not appear to be attributable to age, stage of disease, period in which the blood was collected, or to several other potentially confounding factors. When the serum retinol level was considered in quintile classes, there was a statistically significant (P < 0.05) trend of increased prostatic cancer risk associated with decreasing serum retinol levels.

Laparoscopic varicocelectomy: a simple technique for clip ligation of the spermatic vessels.

Less invasive laparoscopic surgery is replacing the conventional open operation for the treatment of several conditions. We performed laparoscopic clamping of the internal spermatic vessels in 12 subfertile patients to treat varicocele of the testis. Seven operations were performed with the patient under general anesthesia, whereas a local anesthetic was used in the 5 most recent patients. The internal spermatic vessels were successfully clipped in all 12 patients. Postoperative physical examination with a Doppler stethoscope showed that the venous reflux had disappeared in all patients. Semen quality was improved in 7 patients with a followup of 3 to 10 months. Neither hydrocele nor testicular atrophy was observed postoperatively. Laparoscopic varicocelectomy was effective and minimally invasive, especially when performed with the patient under local anesthesia.

Long-term followup of the Kock and Indiana pouch procedures.

Between 1984 and 1991, 115 consecutive patients underwent cutaneous continent urinary diversion comprising 76 Kock and 39 Indiana pouch procedures. The 2 different forms of achieving continent urinary diversion were subsequently compared in a long-term followup that evaluated complications, including pouch function and the need for revisions. In the Kock pouch group there were 14 (18.4%) early postoperative complications (3 months), which required 4 subsequent reoperations (5.3%). The Indiana pouch group had a similar incidence of early complications (17.9%) but there were no reservoir related problems. The long-term study group comprised 68 Kock and 37 Indiana pouch patients who were observed for 12 months or longer (mean followup 53 and 34 months, respectively). Of 9 efferent nipple valve malfunctions observed in the Kock pouch group 5 required surgical revision. Of 16 complications related to afferent limb function 15 were caused by the use of polyester fiber fabric for the anchoring collar and 8 of these 15 complications required surgical revision. The first 2 Indiana pouch patients had pouch deformities due to incomplete detubularization of the cecum that required surgical repair. Overall, surgical revisions, including minor repairs, were performed on 15 Kock pouch patients (22.1%) and 4 Indiana pouch patients (10.8%). Both forms of the procedure preserved continence to a satisfactory degree. Urinary tract stones developed in 18 patients (26.5%) from the Kock pouch group, usually on the exposed staples or the eroded, nonabsorbable collar used to construct the nipple valves. Stone formation was rare (5.4%) in the Indiana pouch group. The incidence of ureteral implantation stricture was low in both procedures. There was no significant difference in the incidence of bacteriuria between the 2 methods of urinary diversion. These data demonstrate that the Kock pouch and Indiana pouch procedures can be accomplished with the same early postoperative complication rate. Our 8-year experience showed a high incidence of Kock afferent nipple valve malfunction. However, most of these malfunctions were due to the use of a nonabsorbable collar and can be avoided. When taking this into account, therefore, it can be concluded that the Indiana pouch functions as well as the Kock pouch with roughly the same incidence of late complications and the same reoperation rate but with a lower incidence of stone formation.

Physical characteristics and factors related to sexual development and behaviour and the risk for prostatic cancer.

A case-control study of prostatic cancer was carried out to examine the association between selected physical characteristics and factors related to sexual development and behaviour and the risk for this disease. In consideration of an endocrinologic mechanism for these putative risk factors, the association between selected factors and serum hormone level in a comparison group, free of prostate cancer, was also examined. One-hundred cases and 113 controls were included for study. An elevated risk for prostatic cancer was found for those currently married (odds ratio (OR) = 4.0), those who had been married once (OR = 2.8), and those who were currently practising a religion (OR = 2.0). Compared to subjects with one child, those with more than one child and those with no children were more common among cases than controls. Prostatic cancer risk was associated with large body size and, in particular, with greater weight (p < 0.01). Early age at attainment of adult height was also associated with prostatic cancer risk (p < 0.01). Only moderate associations were found between increased frequency of sexual intercourse and prostatic cancer risk. The levels of testosterone (T), dihydrotestosterone, salivary testosterone and T/SHBG (sex hormone binding globulin) did not vary with age. Older men had higher oestradiol levels. Further, little association between hormone levels and risk factors was found, except for married subjects having increased serum androgens (p < 0.05) and heavy subjects having decreased serum androgens (not significant).

Orthotopic ileal neobladder in male patients: Functional outcomes of 66 cases

Background : Orthotopic urinary diversion has become the preferred form of bladder reconstruction after cystectomy. We report on our experience with 66 male patients undergoing this procedure from November 1990 to February 1998.

QUALITY OF LIFE SURVEY OF URINARY DIVERSION PATIENTS : COMPARISON OF CONTINENT URINARY DIVERSION VERSUS ILEAL CONDUIT

Background Continent urinary reservoirs (CUR) have become one of the major options for patients requiring urinary diversion to improve their quality of life (QOL). To assess whether CUR enhanced postoperative QOL, we surveyed patients with CUR and ileal conduit (IC) using a questionnaire sent by mail.

Stage a prostatic cancer: a comparative study in Japan and the Netherlands

SummaryTo obtain more accurate information on the prevalence of stage A prostatic cancer (incidental or latent carcinoma), a prospective collaborative study was set up in Japan and the Netherlands. A total of 859 specimens were submitted for routine histological examination (Japan: 343 specimens; the Netherlands: 516 specimens). All specimens were obtained from patients more than 50 years of age showing clinical signs of obstructive benign prostatic disease. The overall prevalence of stage A cancer in both countries was almost equal (Japan 13% vs the Netherlands 14%). A relatively large number of incidental tumors were found in subcapsular prostatectomy specimens in the Netherlands. Increasing prevalence of stage A disease in subsequent age decades was not found in the Netherlands, where the highest prevalence was observed in the 70–79 age-group. Subdivision of stage A disease into A1 and A2 tumors did not reveal any significant difference in prevalence between the two countries. Of particular interest is that the number of A2 lesions found in the Netherlands was not higher than that found in Japan. In both countries almost all A1 lesions were identified as G1 tumors in stage A1 disease. Both G2 and G3 lesions were present in Japan and the Netherlands in 79% and 72% of the A2 cases respectively. Results are discussed and especially related to their possible impact upon the differences in mortality rate between the two countries.

Carcinosarcoma of the Prostate

A very rare case of carcinosarcoma of the prostate is reported. The patient was a 77-year-old man in whom both primary and metastatic tumors presented the pathology of carcinosarcoma of the prostate. The carcinosarcoma was resistant to anti-androgen therapy, and the patient showed low level of serum prostatic acid phosphatase and was free from bony metastases despite multiple metastases to the lung, liver, pancreas, para-aortic lymph nodes, spleen and penis. The sarcomatous component consisted of chondrosarcoma and fibrosarcoma, both of which were positive for vimentin. The carcinomatous component was positive for both keratin and prostatic acid phosphatase.

The role of prostatic specific antigen in monitoring prostatic cancer and its prognostic importance

SummarySerum prostatic specific antigen (PA) and prostatic acid phosphatase (PAP) levels were measured in 113 untreated patients with prostatic cancer and in 137 patients with benign prostatic hypertrophy (BPH). Of the 113 cancer patients, 81% and 69%, respectively, were detectable by means of PA or PAP assay alone. PA was a more sensitive indicator, than PAP in all stages, especially localized disease (stages A, B and C). Using the BPH group as a negative control, specificities of PA and PAP were 81% and 94% respectively, In another group of 68 patients with BPH whose blood samples were taken immediately after prostatic manipulation, both PA and PAP levels were elevated significantly. In 87 of the 113 cancer patients the two markers were serially determined, and 22 patients presented disease progression. Concerning the sensitivity within 6 months before progression, PA appears to be more reliable than PAP in early detection of disease progression. According to Kaplan-Meier projections, the patients with normal pretreatment PA levels had significantly longer intervals to progression than did those with moderate to marked PA elevation (more than 100 ng/ml) (P<0.05). This study shows that PA is more reliable than PAP for detection and monitoring of prostatic cancer. Pretreatment PA levels appear to be of a high prognostic value for time to progression, irrespective of stage and treatment regimen.

INCREASING THE THERMAL DOSE IN TRANSURETHRAL MICROWAVE THERMOTHERAPY PRODUCES NO IMPROVEMENT IN THERAPEUTIC EFFICACY

Background: