Stepan Vesely

Relationship Between Age, Prostate Volume, Prostate-specific Antigen, Symptom Score and Uroflowmetry in Men with Lower Urinary Tract Symptoms

Objectives: To estimate the relationship between age and the values of different diagnostic tests in men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic enlargement (BPE) and to compare prostate growth curves between the normal population sample, healthy men and men with LUTS. Material and Methods: A series of 354 men (mean age 70.2 years; range 45-91 years) with LUTS due to BPE were stratified into seven age groups and reviewed retrospectively. All patients underwent a standard evaluation, involving determination of the International Prostate Symptom Score (IPSS), digital rectal examination, uroflowmetry, determination of the prostate-specific antigen (PSA) level and transrectal ultrasonography. Descriptive statistics were used to describe all the variables and Spearmans correlation test was used to evaluate the relationships between them. Results: The mean prostate volume was 40.1 (±23.9)u2005cm[Formula: See Text] and mean PSA concentration 3.9 (±4.2)u2005ng/ml. Both values increased progressively from 27.5u2005ml and 1.5u2005ng/ml, respectively in the <54 years age group to 48.2u2005ml and 5.4u2005ng/ml, respectively in the <80 years age group. However, in the 75-79 years age group there was a decrease in both prostate volume and symptom score; PSA concentration remained unchanged and maximal flow rate increased slightly. A statistically significant but weak correlation was found between prostate volume and age (ru2005=u20050.25, pu2005<u20050.0001) and between PSA and age (ru2005=u20050.28, pu2005<u20050.0001). Prostate volume correlated positively with serum PSA (ru2005=u20050.54, pu2005<u20050.0001). The correlations between maximum flow rate and age, prostate volume, PSA and IPSS were ru2005=u2005−0.21, pu2005<u20050.0001; ru2005=u2005−0.18, pu2005<u20050.0006; ru2005=u2005−0.29, pu2005<u20050.0001; and ru2005=u20050.14, pu2005<u20050.0098, respectively. Conclusions: These data confirm that prostate volume and serum PSA concentration are significantly correlated and increase with advanced age. The correlations between uroflowmetry (Qmax) and age, prostate volume, serum PSA and IPSS were also significant. However, there was no relationship between symptoms and objective measures of BPE. The increase in different parameters of the severity of benign prostatic hyperplasia with advanced age is not continuous. The prostate volume alone is not useful in the estimation of disease severity.

Influence of tumour-associated symptoms on the prognosis of patients with renal cell carcinoma

Objective. To evaluate the prognostic significance of symptoms related to renal cell carcinoma (RCC) in comparison with incidentally detected tumours in a group of long-term observed patients. Material and methods. The study included 396 patients operated for RCC between 1982 and 2001. The patients were classified according to age, gender, detection mode, pathological stage and grade, tumour size, nodal involvement and Eastern Cooperative Oncology Group (ECOG) performance status. Special attention was given to the analysis of duration and quality of symptoms. The endpoint of the study was overall survival, which was assessed with univariate and multivariate analyses using the Kaplan–Meier method, log-rank test and Cox proportional hazards model. Results. Of the 396 patients, 135 (34%) and 261 (66%) presented with incidental and symptomatic RCC, respectively. Compared with incidental cases, symptomatic tumours had significantly larger size (p<0.0001), and higher pathological stage (p<0.0001) and grade (p<0.02). Five-year survival in patients with incidental and symptomatic tumours was 88.1% and 59.4% (p<0.0001), respectively. In relation to the quality of symptoms, the 5-year survival in patients with local and systemic symptoms was 75.4% and 44.4% (p<0.0001), respectively. In the group of patients with a history of tumour-related symptoms shorter and longer than 3 months, the 5-year survival was 62.2% and 55.6% (p<0.0001), respectively. Multivariate analysis found tumour size [hazard ratio (HR) 1.22, p=0.05] tumour grade (HR 1.44, p=0.002), tumour stage (HR 1.35, p=0.001), presence of symptoms (HR 1.36, p=0.004) and ECOG (HR 1.25, p=0.005) to be independent prognostic variables. Conclusion: Preoperative somatic symptoms and performance status in patients with RCC provide readily available prognostic information in addition to tumour size, stage and grade.

Intraurethral prostate injections with mepivacaine epinephrine: effects on patient comfort, treatment time and energy consumption during high-energy transurethral microwave thermotherapy.

Objective. To investigate the effects of intraprostatic mepivacaine epinephrine injections administered by the Schelin catheter™ during high-energy transurethral microwave thermotherapy (TUMT) using the CoreTherm® Prostalund Feedback Treatment® (PLFT) system. Material and methods. The study included 85 men with lower urinary tract symptoms due to benign prostatic enlargement. One group had intraprostatic injections with mepivacaine epinephrine by the new Schelin catheter, while patients in the other group were treated without intraprostatic injections. All men were treated by TUMT using the PLFT system. Before treatment, transrectal ultrasound (TRUS) volume was measured. During the procedure, treatment time, energy consumption, cell-kill parameter and maximal prostate temperature were recorded. Patients who needed perioperative intravenous analgesics and the rate of perioperative and postoperative complications were registered. Results. The patients who had intraprostatic and periprostatic injections with mepivacaine epinephrine had shorter effective treatment time and reduced energy consumption. There was also a difference between the two groups in that 70% of patients without intraprostatic injections and only 11% of injected patients needed intravenous analgesics. No differences were found in TRUS volume, estimated cell-kill, maximal prostate temperature or complication rates. Conclusions. Intraprostatic injections with mepivacaine epinephrine distributed by the Schelin catheter reduce the number of patients needing intravenous analgesics during PLFT, as well as the treatment time and energy consumption during treatment. Besides improved patient comfort, intraprostatic and periprostatic injections condense the treatment time without side-effects, making PLFT less cumbersome for most patients.

Transurethral microwave thermotherapy of the prostate – Evaluation with MRI and analysis of parameters relevant to outcome

Objectives. To evaluate morphological changes in the hyperplastic prostate tissue following transurethral microwave thermotherapy and to investigate the dependence of the treatment outcome on structural and physiological features of the prostate. Material and methods. In this prospective study, 13 patients with chronic urinary retention due to benign prostatic hyperplasia (BPH) underwent Coretherm (ProstaLund, Lund, Sweden) microwave thermotherapy. Prior to the treatment and 1 week and 6 months after, the patients were examined with MRI using morphologic, contrast medium-enhanced perfusion and diffusion-weighted imaging. Such advanced MRI techniques permit an assessment of parameters that have a hypothetical influence on microwave thermotherapy (e.g. prostate blood perfusion, water content and prostate microstructure). Results. Morphologic and perfusion MRI showed a clear prostatic tissue defect in all 13 patients after 1 week and in all 12 patients at 6 months’ follow-up. The mean size of the defect was 22.5 cm3 (27%) (range 3.7–47.3 cm3) and 4.1 cm3 (1.1–10.1 cm3) at 1 week and 6 months, respectively. The cell kill volume was estimated to be 20.5±7.4 cm3 and correlated significantly with the size assessed by MRI at 1 week (r=0.8; p=0.002) and 6 months (r=0.69; p=0.05). At 6 months, the mean decrease in prostate volume was 20.1 cm3 (p<0.0001). The microstructure of the prostate expressed as the apparent diffusion coefficient was shown to have a strong influence on the treatment process. All patients (n=12) were catheter-free at 6 months. Another patient experienced persistent obstruction and underwent transurethral resection of the prostate. Conclusions. Coretherm microwave treatment leads to significant intraprostatic necrosis, which is detectable with MRI even 6 months after the treatment. Diffusion-weighted MRI is capable of identifying structural features of the prostate that can predict the length of treatment and the amount of energy needed.

30-MINUTES-TUMT

Introduction: Primary objective: to investigate if 30-MINUTES-TUMT can be performed under topical anesthesia and analgesics. Secondary objectives: to evaluate retrospectively analgesics and to study parameters connected with pain. Materials and Methods: Eighty-nine patients underwent TUMT. Patients were divided into four groups with different medications. Paracetamol and tolterodin-L-tartrate were administered in all groups. The first group was also given hydromorphone hydrochloride and atropine sulphate, the second group dextropropoxyphene, the third group morphine and diclofenac, and the fourth group morphine and dextropropoxyphene. Pain during TUMT was registered using the VAS scale. Results: Pain during TUMT was (VAS in mm), respectively, total-first-second-third-fourth group: at 5 min –30, 31, 12, 28, 35; at 15 min –30, 23, 16, 25, 34; at 25 min –30, 28, 18, 25, 35. All patients accepted the treatment. No significant difference between the different drug schedules was noticed. Conclusions: It is possible to treat patients with 30-MINUTES-TUMT with local anesthesia and analgesics. The pain can be accepted by all patients.

Diagnostic Efficiency of Serum and Urine Procathepsin B and Cathepsin B in Patients with Carcinoma of the Urinary Bladder

BACKGROUNDnThe aim of the study was to evaluate the diagnostic efficiency of cathepsins B (cathepsin B and procathepsin B) in patients with transient cell carcinoma of the urinary bladder.nnnMETHODSnSerum and urine concentrations of cathepsin B and procathepsin B were measured by two commercially available enzymatic immunoassays in a group of 125 patients with bladder cell carcinoma without metastases and in a group of 72 healthy individuals. Concentrations in urine were adjusted to creatinine.nnnRESULTSnConcentrations of both cathepsin B and procathepsin B in serum and urine were significantly elevated in patients with bladder cell carcinoma (p < 0.0001 for U-procathepsin B, U-procathepsin B/creatinine, and U-cathepsin B/creatinine, p = 0.0001 for U-cathepsin B, p = 0.0002 for S-procathepsin B and p = 0.02 for S-cathepsin B). Comparison of all diagnostic efficiencies of cathepsin B and procathepsin B in serum and in urine showed the best diagnostic accuracy for procathepsin B in urine (AUC = 0.81 vs. 0.50). The ratio of U-procathepsin B/creatinine was also more efficient than the ratio of U-cathepsin B/creatinine (AUC = 0.81 vs. AUC = 0.70). The diagnostic efficiencies of both parameters in serum were low (S-procathepsin B: AUC = 0.50, S-cathepsin B: AUC = 0.60). U-procathepsin B and U-procathepsin B/creatinine ratio show significantly better diagnostic efficiency in patients with invasive bladder tumors than other parameters (S-procathepsin B, S-cathepsin B, U-cathepsin B and U-Cathepsin B/creatinine; U-procathepsin B: AUC = 0.82, U-procathepsin B/creatinine: AUC = 0.86, S-procathepsin B and cathepsin B: AUC = 0.51 - 0.68).nnnCONCLUSIONSnProcathepsin B concentration in urine is a valuable diagnostic marker in patients with bladder cell carcinoma.