Scott M. Gilbert

Re-evaluation of the Tumour-Node-Metastasis staging of locally advanced renal cortical tumours: absolute size (T2) is more significant than renal capsular invasion (T3a)

Authors from Iowa City report on the incidence of RCC; they compared the rate of these tumours at autopsy and felt that the decrease found was a result of better antemortem detection, and an increase with time in the frequency of clinically detected renal cancer.

Evaluation of DD23 as a marker for detection of recurrent transitional cell carcinoma of the bladder in patients with a history of bladder cancer

OBJECTIVES To determine whether DD23 increases the sensitivity of urinary-based detection of transitional cell carcinoma (TCC) recurrence. The murine monoclonal antibody DD23 recognizes a 185-kDa tumor-associated antigen that is expressed in human bladder cancer cells in vitro and in vivo but is not detected in normal urothelium. METHODS Using alcohol-fixed urinary cytology, matched voided urine and bladder wash specimens were evaluated for the contribution of DD23 antigen expression in the detection of recurrent TCC. The selected patient population had a history of bladder cancer, and urine cytology analysis was performed in a single commercial reference laboratory. DD23 antigen expression in a cohort of 81 patients was compared with urine cytology findings, and the sensitivity and specificity for each urine-based test was determined. The presence of recurrent disease was determined by positive pathologic biopsy. RESULTS The 81-patient cohort produced 151 urine specimens for which both biopsy and cytology information were obtained. Of these specimens, 64 were confirmed by a tissue diagnosis for TCC recurrence. These biopsy-proven recurrences were used as the dependent variable to assess the accuracy of cytology testing. For the detection of TCC, the DD23 antigen had a sensitivity of 70.3% and a specificity of 59.8%. Combined with cytopathologic findings, DD23 enhanced the sensitivity for the detection of TCC from 43.8% (cytology alone) to 78.1%. For low-grade TCC (n = 20) DD23 enhanced the sensitivity from 20.0% (cytology alone) to 55.0%. For high-grade TCC (n = 25), DD23 enhanced the sensitivity from 64.0% (cytology alone) to 76.0%. In patients with a prior history of intravesical treatment, DD23 had a sensitivity of 94.7% and a specificity of 33.3% compared with a sensitivity of 52.6% and a specificity of 83.3% for cytology. CONCLUSIONS DD23 antigen expression can be used as an adjunct to cytopathologic evaluation to enhance the sensitivity of urinary cytology detection of TCC. In addition, DD23 does not appear to lose sensitivity in patients with a prior history of bladder cancer treated with intravesical agents.

Evidence of increased prostate cancer detection in men aged 50 to 59: a review of 324,684 biopsies performed between 1995 and 2002.

OBJECTIVES To analyze the age-specific detection rate of prostate cancer diagnosed from 324,684 biopsies submitted to a single laboratory and to assess the degree of prostate cancer in younger men. The advent of prostate-specific antigen (PSA) testing and increased prostate cancer screening has led to increased evaluations for prostate cancer. The initial stage and age at presentation in prostate cancer has shifted. METHODS From 1995 through 2001, all prostate biopsies submitted to the laboratory were reviewed and analyzed for the diagnosis of prostate cancer, cancer detection rate, and age at diagnosis. RESULTS The overall detection rate of prostate cancer increased by 15% from 29% to 34% for all biopsies submitted during the study period. For the age group 50 to 59 years, a 45% increase occurred in the detection of prostate cancer from a baseline of approximately 11% in 1995 to greater than 16% in 2001. For the age group 70 to 79 years, the detection of prostate cancer decreased from a baseline of 41% in 1995 to 36% in 2001. CONCLUSIONS The increase in prostate cancer diagnosis among younger men in the United States has been significant. The increase is likely multifactorial and may be attributable to the impact of PSA and prostate cancer screening efforts. This has led to a greater number of younger men undergoing evaluation for prostate cancer. Thus, a heightened awareness regarding the diagnosis of prostate cancer among younger men is needed.