Zbigniew Wolski

von Willebrand factor antigen in blood plasma of patients with urinary bladder carcinoma.

Laboratory abnormalities in blood coagulation factors are common in patients with cancer but the significance is unknown (1,2). Generally, there is an equlibrium between the coagulation system and the fibrinolysis system. However, in malignant disease this equlibrium is disrupted, resulting in the abnormal activation of coagulation on hypercoagulability. Also, evidence indicates that various components of these pathways may contribute to the disorderly characteristics of malignancy, such as proliferation, invasion and metastasizing (3, 4). Recent studies have revealed a role of von Willebrand factor (vWF) in progression of neoplasms and metastasizing (5, 6, 7, 8, 9). Accordingly, the aim of the present study was to measure a plasmatic level of von Willebrand factor antigen (vWF) in patients with bladder carcinoma and compare this level of vWF with relationship to the staging of the disease.

Selenium level in benign and cancerous prostate

The dietary microelement selenium (Se) has been proposed as a potential chemopreventive agent for prostate cancer. This element is present in various amounts in all tissues. Little information is available on Se level in patients with prostate gland disorders. The levels of Se in prostatic gland of patients with prostate cancer, benign prostate hyperplasia, and healthy controls were examined. The Se level for benign prostate hyperplasia (156±30.6 ng/g) was the same as in the control group (157±26.0 ng/g), but in the gland of prostate cancer patients (182±34.1 ng/g wet weight), the Se level was significantly (p<0.01) higher than in both healthy controls and benign prostate hyperplasia. Thus, the Se level in human healthy controls is lower than in kidney and liver but higher compared with other tissues.

Significance of atypical small acinar proliferation and extensive high-grade prostatic intraepithelial neoplasm in clinical practice

Introduction Prostate cancer (PCa) is one of the most commonly diagnosed neoplasms in elderly men. The precancerous lesion of PCa is considered a high-grade prostate intraepithelial neoplasm (HG-PIN), while atypical small acinar proliferation (ASAP) is commonly considered as an under-diagnosed cancer. The aim of the study was to establish the impact of ASAP and extensive HG-PIN on pre-biopsy prostate-specific antigen (PSA) levels and the risk of cancer development in subsequent biopseis. Material and methods The 1,010 men suspected for PCa were included in the study based on elevated PSA, and/or positive rectal examination. Transrectal ultrasound (TRUS) guided 10 core biopsy was performed. In those with extensive HG-PIN or ASAP on the first biopsy, and/or elevated PSA value, a second biopsy was performed. Results In the second biopsy, PCa was diagnosed in 6 of 19 patients (31.57%) with extensive HG-PIN, in four of 40 (10%) with BPH, and in 4 of 18 (22.22%) with ASAP. There was a statistically significant difference between the values of PSA in the group of patients with ASAP in comparison to those with benign prostate hyperplasia (BPH) (p = 0.005) as well as in patients with HG-PIN in comparison to BPH (p = 0.02). Conclusions A precancerous lesion diagnosed upon biopsy causes a statistically significant increase in the values of PSA in relation to BPH, as well as in the case of ASAP and extensive HG-PIN. The estimate of risk of PCa diagnosis in patients with ASAP and those with extensive HG-PIN in the first biopsy is comparable, which is why there are no reasons for different treatment of patients with the above-mentioned diagnoses. Both should be subjected to urgent second biopsy in around the 4-6 weeks following the initial biopsy.

Inflammatory changes in biopsy specimens from patients with suspected prostate cancer.

Introduction Prostate cancer (PCa) is one of the most commonly diagnosed cancers in elderly men, and accounts for 30% of all newly diagnosed cases of cancer. The development of the ‘clinically insignificant’ prostate cancer into its invasive form is still unclear, and it is believed that chronic inflammation may play its role, as proposed by De Marzo in 1999. However, there is no clear opinion on the subject of existence of dependencies between changes of the inflammatory type and PCa. Material and methods The study involved 1,010 men, suspected of prostate cancer development by positive digital rectal examination (DRE) and/or elevated PSA value. The 10 cores, TRUS guided biopsy was performed. In those with ASAP, HG–PIN or inflammation the second biopsy was proposed. Results In the first biopsy PCa was diagnosed in 336 patients (33.27%). ASAP was found in 58 (5.74%), HG–PIN in 82 (8.11%), and the coexistence of both was found in 19 (1.88%). Chronic prostatitis was diagnosed in 101 (10%) men. Of those who underwent second biopsy, PCa was diagnosed in six of 19 patients (31.57%) who were diagnosed with HG–PIN in the first biopsy, in four of 40 (10%) with BPH in the first biopsy, in four of 18 (22.22%) with ASAP or LG–PIN together with ASAP, and in two out of five (40%) with the coexistence of ASAP and HG–PIN. Malignancy was not confirmed in any of the patients in whom the diagnosis of BPH, HG–PIN, or ASAP was accompanied by chronic prostatitis. Conclusions Chronic prostatitis does not significantly increase the value of PSA in patients with benign changes (BPH). The presence of prostatitis in the first biopsy did not predict cancer in subsequent biopsy, because the second biopsy did not reveal prostate cancer in any of the patients in whom prostatitis was diagnosed in the first biopsy.

The relationship of cancer stem cells in urological cancers

Numerous studies are ongoing to identify and isolate cancer stem cells from cancers of genito-urinary tracts. Better understanding of their role in prostate, urothelial and kidney cancer origin, growth and progression opens new pathways in development of more effective treatment methods. However there are still many issues before advances in this field can be introduced for clinical application. This review addresses current achievements in cancer stem cells research in uro-oncology.

Psychological aspect of qualification to implant an artificial urethral sphincter AMS 800

Introduction Implantation of the AMS 800 artificial urethral sphincter is a “gold standard” in the treatment of total urinary incontinence in men. Appropriate qualification of patients to urinary incontinence treatment determines the higher effectiveness of this method. Service of this device requires physical fitness and mental efficiency from a patient. Material and methods The Urological Clinic hospitalized 16 patients, aged from 60 to 80 years, after first qualification for artificial urethral sphincter implantation. Psychological assessment was carried out during anamnesis and medical examination using the MMSE and the GDS. Results Psychological deviations were found in 7 out of 16 examined patients, but finally 2 patients were disqualified because of their cognitive function disorders with elements of low level depressive syndrome (1) and benign cognitive and member function disorders (1). Among the patients who were examined by a psychologist: four of them showed mild (3) and temperate (1) features of depressive syndrome and one patient showed benign cognitive disorder without dementia. However, none of these findings were contraindications to incontinence treatment with an artificial urethral sphincter. Conclusions 1. Mild and temperate features of depression syndrome are not absolute contraindications for a sphincter AMS 800 implantation. These patients need only pharmacological treatment. 2. Cognitive and other memory disorders are contraindications to this method. 3. The qualification to implantation an artificial urethral sphincter should include a psychological assessment, especially in older patients in whom mental disorders are suspected.

Prostate epithelial stem cells are resistant to apoptosis after α1-antagonist treatment. The impact for BPH patients.

Introduction Induction of apoptosis in prostatic epithelial cells by doxazosin, terazosin and prazosin has been well documented. However, the biochemical pathways of doxazosin action is still unclear. Aforementioned drugs should lead to decrease of prostate volume, although this effect was never observed in patients suffering from BPH after treatment with α1-antagonists. Probably, it is connected with cancer stem cells’ resistance on chemotherapeutic agents. The aim of this study was to compare incidence of apoptosis induced by doxazosin in progenitor and differentiated cells isolated from human prostate epithelium. Material and methods For this purpose tissue specimens were obtained from 10 patients suffering from BPH, the primary cultures of prostate epithelium were established and CD133 MicroBeads sorting was prepared. Both, CD133(+)/CD133(-) co-cultures and CD133(+) cells were incubated with different concentration of doxazosin for 12 h. Cell viability and apoptosis was estimated with Annexin V-FITC. Results 12 h incubation of CD133(+)/CD133(-) co-cultures with doxazosin resulted in increase of apoptotic cells, while in CD133(+) cultures no changes were observed. Correlation between apoptotic cell number and doxazosin concentration in CD133(+)/ CD133(-) co-cultures group was high (R = 0.99). Conclusion Doxazosin induced apoptosis in co-cultures of progenitor and differentiated epithelial cells. However, progenitor cells were not susceptible to apoptosis, what can be a reason of treatment failure in BPH patients.

Credibility of a smoking questionnaire based on urine cotinine level for patients with bladder cancer - a preliminary report.

An analysis of the reliability of a questionnaire on smoking in 96 patients with transitional cell carcinoma (TCC) of the bladder. The credibility of the questionnaire was evaluated based on the detection of cotinine, an objective marker of tobacco smoke exposure, in urine. It was confirmed that approximately 18% of smokers did not admit to smoking, did not comply with recommendations to stop smoking, and about 4% of non-smokers were exposed to tobacco smoke unknowingly.

Re: João Silva, Rui Pinto, Tiago Carvallho, et al. Mechanisms of Prostate Atrophy after Glandular Botulinum Neurotoxin Type A Injection: An Experimental Study in the Rat. Eur Urol 2009;56:134-41

We have read an interesting paper on the influence of botulinum neurotoxin type A (BoNTA) on the rat prostate [1]. First, it must be emphasized that stroma predominates within the human prostate, while rat prostate has a huge epithelial compartment, so human and rat prostates are, in fact, not comparable. Second, BoNTA changes expression of growth factors and neurotransmitters within the nerve endings and leads to temporal tissue denervation throughout. BoNTA is used in treatment to decrease muscle tonus and contraction. A new, interesting phenomenon of prostate atrophy following BoNTA injection has been discussed. Several papers were published in this field, including clinical trials [2]. It is hard to believe in promising results of this approach. Our department performed a small trial including six patients suffering from acute urine retention due to benign prostatic hyperplasia (BPH) who were disqualified for transurethral resection of the prostate. Patients were treated with BoNTA injections directly into the prostate. Results were disappointing: Although tissue shrinkage was observed during the first month of observation, after 6 mo, all prostate volumes were similar to the starting point of the experiment. Finally, only one patient, whose prostate was only 38 ml, was able to void with acceptable postvoid residual urine levels [3]. Based on our negative results, an in vitro study was designed. BoNTA influence on human prostate fibroblasts and 3T3 mouse fibroblasts was tested in vitro. It was observed that even a dose as high as 10 U of Botox (Allergan,

Parenteral ambroxol treatment causes xanthine and calcium oxalate stones in rats

Introduction:  Ambroxol (ABX) is known to promote bronchial secretion and is used as an expectorant. This study was undertaken to document the connection between ambroxol parenteral treatment and bladder stones in rats.