P. Guinan

An evaluation of prostate specific antigen in prostatic cancer.

Prostate specific antigen levels were measured in 118 patients with prostatic cancer and 138 control individuals. Prostate specific antigen was sensitive in detecting prostatic cancer. The levels of prostate specific antigen were elevated in 10 per cent of the patients with stage A, 24 per cent with stage B, 53 per cent with stage C and 92 per cent with stage D disease. However, prostate specific antigen levels also were elevated in 9 per cent of the patients with benign prostatic hypertrophy. This lack of specificity in the presence of benign prostatic hypertrophy probably precludes prostate specific antigen from being recommended as a screening test for prostatic cancer. The ultimate role of prostate specific antigen might be as the marker of choice to monitor therapy for prostatic carcinoma.

Stage IV Renal Cell Carcinoma

Data from 104 patients with stage IV renal cell carcinoma were evaluated to investigate relationships between survival and gender, race, age, tumor size, lung versus bone metastasis, number of metastatic sites and nephrectomy. No statistically significant differences in survival were found between gender or racial groups, nor was there a statistically significant relationship between survival and patient age. Survival tended to decrease as tumor size increased. Survival was worse for patients with multiple metastatic sites compared to those with only 1 metastatic site, and for patients with bone and lung metastases compared to those with lung but no bone metastases and bone but no lung metastases. Although nephrectomy patients appeared to have somewhat better survival rates than those without nephrectomy, this difference was apparently due to better prognostic factors for nephrectomy patients.

Comparison of leuprolide and diethylstilbestrol for stage D2 adenocarcinoma of prostate

In a controlled, prospective, randomized clinical trial, we evaluated the safety and efficacy of leuprolide, a superactive analog of luteinizing hormone releasing hormone, given in a single subcutaneous injection dose of 1 mg per day, versus diethylstilbestrol (DES) 3 mg per day by mouth in patients with previously untreated Stage D2 prostatic adenocarcinoma. Eleven leuprolide patients and 10 DES patients were evaluated for therapeutic response. Eighty per cent of patients in each group experienced subjective improvement in bone pain and urinary obstructive signs and symptoms. Although the pooled percentages of complete, partial, and stable objective responses were greater for the leuprolide group than the DES group, the sums of the percentages of complete and partial objective responses were comparable for both treatment groups during the first forty-eight and sixty weeks of the study, respectively. In addition, patients not responding to leuprolide generally experienced no benefit with crossover to DES, and vice versa. Serious adverse reactions were more common in the DES group and included fatal myocardial infarction, arrhythmia, deep venous thrombosis, and gynecomastia. Vasomotor flushing, disease flare, and injection site irritation occurred most often in leuprolide patients, but did not require modification or discontinuation of treatment.

Urethral diverticular carcinoma

Background. Urethral diverticular carcinoma is an unusual finding in urologic lesion commonly found in female patients.

Bacillus Calmette-Guerin (BCG) adjuvant therapy in stage D prostate cancer

Forty-two patients with advanced cancer of the prostate were prospectively randomized to receive either bacillus Calmette-Guerin (BCG) adjuvant immunotherapy plus conventional therapy or conventional therapy alone. Conventional therapy consisted of estrogens or observation. There was a statistically significant (P = less than 0.05) longer survival in the 21 BCG-treated patients (thirty-eight weeks) than in the 21 control patients (twenty-eight weeks). There was no mortality and minimal morbidity (pruritus at injection site) from the adjuvant immunotherapy. Interestingly, the quality of life, as measured by the number of infections, was significantly less (P = less than 0.05) in the immunotherapy-treated group.

Evaluation of cytologic techniques for diagnosis of prostate cancer

Two hundred forty-eight male patients seen on a urology service were diagnostically screened using four different cytologic tests for cancer of the prostate. The tests included voided urine cytology, prostate massage cytology, aspiration cytology, and postmassage urine cytology. The aspiration cytology was the most efficient screening test for the diagnosis of prostate malignancy.

BENIGN FIBROUS URETERAL POLYPS

Benign fibrous polyps of the ureter are rare. A review of the English literature since 1930 revealed that 71 cases had been described. Three additional cases of fibrous ureteral polyps, one in a ureter with ureteritis cystica, are reported with a discussion of both the histologic findings and proposed treatment plan.

Screening tests for detection of bladder cancer

Eighty-one individuals had urine cytologic studies, urinary carcinoembryonic antigen (CEA) determinations, and urinary immunoglobulin levels performed to evaluate various screening tests for the diagnosis of bladder cancer. Urinary cytologic studies detect the presence of bladder malignancy, and while false positive tests were troublesome, remain the primary screening test for bladder cancer. Urinary CEA was of little value in detecting vesical malignancy. Urinary immunoglobulins, particularly IGG and IGA, were significantly elevated in the presence of bladder cancer.

Carcinoembryonic antigen test in renal cell carcinoma

CEA (carcinoembryonic antigen) determinations were performed on 203 blood and urine samples from 23 patients with renal cell carcinoma. Neither the blood nor the urine CEA test was able to confirm the diagnosis or predict the status of the disease in more than one half of these patients. As presently constituted, the CEA test is not accurate for the diagnosis or prognosis of renal cell carcinoma.

Prostatorectal Fistula Associated with 125Iodine Seed Radiotherapy

We report 4 cases of prostatorectal fistula following 125iodine interstitial radiotherapy. While 125iodine interstitial radiotherapy has become a popular form of treatment for localized prostate cancer, it is not without potential serious complications. Transurethral resection may be contraindicated before or after 125iodine therapy for prostate tumor.