Ralph J. Veenema

Radical retropubic prostatectomy for cancer: a 20-year experience.

A review of 159 patients treated by radical retropubic prostatovesiculectomy from 1951 through 1970 has reinforced our belief that this is a satisfactory method of treatment for prostatic cancer confined to the prostate. A 10-year survival of 55 per cent and a 15-year survival of 45 per cent compare well to the results reported for perineal prostatectomy. The postoperative mortality rate was 2.5 per cent and total incontinence was 12.5 per cent after radical retropubic prostatectomy. Completely normal voiding occurred in 108 of the 159 patients. Stress incontinence but no need for an incontinence device occurred in 31 patients. Improved methods for preoperative staging of the disease give promise for even higher cure rates in the future.

Penile cancer Clinicopathologic study of 64 cases

Abstract The clinical records of 64 patients with penile cancer admitted to the urologic services at the Presbyterian and Francis Delafield Hospitals from 1947 through 1969 have been reviewed. The pertinent data are analyzed and included in this report. The relationship between cancer of the penis and phimosis, and age and race are discussed. The treatment of choice was partial or total penectomy followed by external radiotherapy. Radical dissection of the inguinal lymph nodes did not seem to improve results while it contributed to increased morbidity. Survival rates were evaluated according to the types and stages of penile cancer, as well as to the methods of treatment. The over-all five-year survival rate was 49 per cent. Autopsy studies in 9 patients who died of penile cancer revealed the inguinal and pelvic lymph nodes were involved in 8 patients.

Mitomycin C intravesical therapy in noninvasive bladder cancer after failure on thiotepa.

Mitomycin C 40 mg in 40 ml water was administered intravesically every week for 8 consecutive weeks to 60 patients with superficial bladder cancer. All patients had failed treatment with intravesical thiotepa and had evaluable disease. An objective response of 50% or greater reduction in measured tumor mucosal involvement was obtained in 68% of patients. Forty‐two percent of the patients achieved a complete response, and this included 50% of patients with Grade III disease and 70% of patients with a Tl tumor. Median response duration in complete responders was 12.2 months with a range of 3.5 to 24.3+ months. Fifty‐five percent of patients are still responding. Therapy was generally well tolerated, and in contrast to thiotepa, myelosuppression was not the dose‐limiting effect. One third of all patients experienced symptoms of local irritation, and skin reactions were seen in 12% of patients. Cancer 53:1025‐1028, 1984.

Bone Marrow Acid Phosphatase: Prognostic Value in Patients Undergoing Radical Prostatectomy

Preoperative bone marrow acid phosphatase determinations were elevated in 18 of 31 patients who underwent radical prostatectomies. A review of the surgical pathology and clinical followup demonstrated a higher incidence of metastasis in these patients.

Carcinoembryonic Antigen and Bladder Carcinoma

The 24-hour urinary carcinoembryonic antigen determinations were performed on 61 patients with different stages of bladder carcinoma. Elevated titers were found in 81 per cent of the patients with active tumors and falsely positive studies were found in 7 per cent. High stage lesions were found to have high carcinoembryonic antigen levels. Plasma carcinoembryonic antigen determinations were elevated in only 45 per cent of the patients with active tumors but further study may be warranted in advanced bladder cancer cases. The 24-hour urinary carcinoembryonic antigen measurements yield the highest percentage elevations in bladder carcinoma and further investigation is required to better define its clinical application.

Spontaneous regression of pulmonary metastases following palliative nephrectomy. Case report

A case of spontaneous regression of pulmonary metastases following palliative nephrectomy has been presented. The unusual clinical course of this case has been noted. The occasional strange behavior manifested by metastatic renal carcinoma is discussed and a rational approach to this problem is suggested.

External radiotherapy in ureteralobstruction secondary to locally invasive prostatic cancer

Sixteen patients with unilateral or bilateral hydroureteronephrosis due to ureteral obstruction secondary to locally invasive prostatic cancer (Stage III) were given 5,000 to 6,000 rads of external radiotherapy to the prostate utilizing Cobalt-60. External radiotherapy was used in 10 patients after they either refused to undergo orchiectomy or had been refractory to orchiectomy and hormone therapy for at least three months. Unilateral nephrostomy was required in 3 patients prior to radiotherapy. Within six months 9 of 10 patients showed a response. The encouraging effects of external radiotherapy on ureteral obstruction secondary to locally invasive prostatic cancer are discussed.

Chemotherapy for bladder cancer

Abstract Systemic therapy for bladder neoplasms has thus far been ineffective and toxicity has outweighed benefits. Topical therapy by bladder instillations of Thiotepa and Epodyl has been effective for treatment of multiple superficial bladder tumors and appears to be helpful as a prophylactive measure to reduce recurrences of such tumors. Topical therapy is not recommended for invasive tumors. Careful attention to dosage regimens and adjustment of doses as indicated by white blood cell and platelet counts minimizes toxic effects from treatment.

Positive random iliac bone biopsy in advanced prostatic cancer

Abstract Forty-one patients with biopsy proved prostatic cancer and with biopsy proved bone metastases were retrospectively evaluated. In 16 per cent of the patients, bone biopsy was positive in spite of negative skeletal survey. Positive skeletal survey and increased serum acid phosphatase levels were found in 78 per cent of the patients, although bone marrow acid phosphatase was elevated in all patients. The determination of bone marrow acid phosphatase was found to be the most sensitive parameter in detection of bone metastases in patients with advanced prostatic cancer.

Increased serum amylase levels in prostatic diseases

Abstract Serum amylase levels were found to be increased in 95 per cent of patients with benign prostatic hypertrophy and in 70 per cent of patients with prostatic cancer. No known causes for high serum amylase levels were present in these patients. Investigation of a possible relationship between amylase activity and prostatic diseases suggested that benign prostatic hypertrophy and prostatic cancer should be considered in the differential diagnosis of disorders associated with increased serum amylase levels.