Samuel J. Peretsman

PROSTATE REBIOPSY IS A POOR SURROGATE OF TREATMENT EFFICACY IN LOCALIZED PROSTATE CANCER

PURPOSE Many investigators use prostate rebiopsy as an indicator of treatment efficacy and tumor response of localized prostate cancer for therapies in which the gland remains in situ. Because of the inherent sampling error of needle directed biopsies, however, some men will have a false-negative rebiopsy even if they have had no therapy or if the therapeutic intervention was unsuccessful in eradicating the malignancy. We evaluate the risk of a false-negative biopsy and the clinical factors that influence this risk. MATERIALS AND METHODS A total of 90 patients undergoing radical prostatectomy for clinically localized disease underwent sextant biopsy of the prostate immediately after removal of the gland. Data collected included prostate specific antigen (PSA), hormonal status, age and biopsy core status. RESULTS Of the total study population 67.8% received neoadjuvant hormonal therapy. While all patients had pathologically confirmed adenocarcinoma within the prostatectomy specimen, 45.6% demonstrated a false-negative rebiopsy. Within a combined predictive model, PSA and hormonal status demonstrated a statistically significant effect on the false-negative rebiopsy rate. Predictive power of this combined model was high across the spectrum of risk for a false-negative rebiopsy. CONCLUSIONS This series demonstrates that the risk of a false-negative sextant biopsy in the presence of documented prostate cancer is high and is affected by several factors, including PSA and hormonal status. These data suggest that prostate sextant rebiopsy is an inaccurate method of assessing the therapeutic efficacy of treatments for carcinoma of the prostate in which the gland remains in situ following therapy.

Inhibition of Human Transitional Cell Carcinoma in Vitro Proliferation by Fluoroquinolone Antibiotics

PURPOSE The in vitro effects of the fluoroquinolone antibiotics ciprofloxacin and ofloxacin upon 3 human transitional cell carcinoma cell lines were investigated at concentrations that are attainable in the urine of patients taking these drugs orally. MATERIALS AND METHODS Cell lines TCCSUP, T24, and J82 were exposed in culture to either ciprofloxacin or ofloxacin at concentrations ranging from 0 to 800 micrograms./ml. and at durations ranging from 24 to 120 hours. Inhibition of proliferation and DNA synthesis were assessed via MTT and tritiated thymidine assays, respectively. RESULTS From the MTT assay ciprofloxacin, at concentrations of 25 to 800 micrograms./ml., produced proliferation inhibition in the TCCSUP line ranging from 8.1% to 90.2% at 24 hours, 25.1% to 94.9% at 72 hours, and 53.8% to 96.9% at 120 hours. Inhibition of proliferation for the T24 line ranged from 8.0% to 85%, 31.5% to 96.5%, and 27.3% to 98.2%. Inhibition of proliferation of the J82 line ranged from 20.8% to 84.8%, 22.8% to 92.7%, and 37.4% to 97.1%. Inhibition of DNA synthesis (due to ciprofloxacin at the concentrations above) as measured by the tritiated thymidine assay was also significant for each of the 3 cell lines. Inhibition of proliferation and DNA synthesis due to ofloxacin was lower but not overall statistically different from that due to ciprofloxacin. In a separate experiment, enhanced cytotoxicity was observed at lower concentrations of ciprofloxacin when the initial media pH was approximated to 5.5. CONCLUSIONS Ciprofloxacin and ofloxacin inhibit proliferation and DNA synthesis of these 3 human TCC lines in vitro. Inhibition occurred in a concentration- and time-dependent manner. The concentrations that were assessed are attainable in the urine of patients taking these agents orally.

Incidence of Benign and Malignant Prostate Tissue in Biopsies of Bladder Neck After a Radical Prostatectomy

PURPOSE We determined whether bladder neck sparing radical prostatectomy may leave prostate tissue in the unresected bladder neck. MATERIALS AND METHODS We intraoperatively evaluated the presence of prostate tissue in bladder neck biopsy specimens from 73 consecutive patients undergoing bladder neck sparing radical prostatectomy. RESULTS Of the 73 specimens 14 (19%) contained prostate tissue: 9 (12%) were positive for prostate cancer and 5 (7%) contained benign prostate tissue. All patients with a positive bladder neck biopsy had a positive margin at another site. CONCLUSIONS We recommend routine bladder neck biopsies for patients undergoing a bladder neck sparing procedure.

Significance of Hematuria in Patients Infected With Human Immunodeficiency Virus

PURPOSE We determined the importance of hematuria in patients infected with the human immunodeficiency virus (HIV). MATERIALS AND METHODS The records of 1,326 HIV infected patients with yearly evaluations were reviewed for hematuria and evaluation results. Mean followup was 2.1 years. RESULTS A total of 331 patients (25.0%) had 1 episode of hematuria and 67 were evaluated with 5 significant diagnoses made. Management was affected in only 3 of these patients. No occult genitourinary tumors were found. CONCLUSIONS In young, asymptomatic, HIV infected patients with microscopic hematuria a urological evaluation can be safely omitted in the presence of normal renal function and a benign urological history.

Chylothorax as a Complication of Radical Nephrectomy

We report a case of chylo-retroperitoneum and chylothorax following an uneventful left radical nephrectomy for renal cell carcinoma, and propose the mechanism of an infradiaphragmatic lymphatic injury with fistulous connection into the chest. Treatment with oral medium chain triglycerides was unsuccessful. Subsequently, total parenteral nutrition in conjunction with chest drainage, retroperitoneal drainage and sclerotherapy successfully treated the chylothorax. To our knowledge chylothorax following radical nephrectomy has not been reported previously in the literature.

Infantile testicular cyst: Diagnosis and conservative surgical management

The authors report on a 5-month-old boy who had a simple cyst of the testis and was treated by testis-sparing cyst excision. Preoperative ultrasonography was diagnostic of a simple cyst. The patient has been without recurrence for over 2 years, and examinations have shown a normal size testis. A literature review showed only four cases of infantile simple cysts of the testis, only one of which was diagnosed preoperatively and treated by cyst excision. Four of the 5 reported cases (including ours) were diagnosed at 5 months of age. We recommend organ-preserving cyst excision in males under 1 year of age who are found to have an intratesticular lesion that is a simple cyst by ultrasound criteria.

Influence of surgical approach on cancer control following radical prostatectomy

Pathologic T3 prostate cancer (extraprostatic spread) detected following radical prostatectomy reduces the likelihood of cure. We conducted this study to determine the impact of the surgical approach (retropubic versus perineal) on risk and location of pT3 disease. A retrospective analysis of 287 consecutive radical prostatectomies [III retropubic (RRP) and 176 perineal (RPP)] was conducted. Specimens were pathologically examined for presence or absence of pT3 disease. A greater rate of pT3 disease was found with RRP than with RPP, which was likely due to patient selection. Of specimens with a single positive surgical margin, the positive margin was more common at the base of the gland with RPP than with RRP (38.5% versus 9.3%). Conversely, the percentage of specimens with a positive apical margin only was less with RPP than with RRP (12.8% versus 44.2%) (Chi-square, p ≤ 0.025). These results lead us to conclude that RPP may achieve superior cancer control for tumors located at the prostate apex, while the retropubic approach may be preferred for tumors located at the prostatic base.

Dressing for surgical wounds of the penis

We describe a simple tubular elastic gauze dressing for surgical wounds of the penis. The amount of pressure placed on the penis is consistent and reproducible. The material is elastic enough to avoid vascular occlusion and is easily applied with a plastic tube. The dressing stays in place, can be used with stents or catheters, and is easily removed by the patients at home.