Flow cytometric assay of pinocytosis: correlation with membrane ruffling and metastatic potential in the Dunning R-3327 rat prostatic adenocarcinoma model

Membrane ruffling has been associated with neoplastic transformation, Harvey ras expression, and metastatic capability. In the Dunning R-3327 rat prostatic adenocarcinoma model, membrane ruffling graded visually upon live cultured cells filmed by time-lapse video-microscopy has distinguished sublines of high and low metastatic potential. Fluid-phase pinocytosis is a constitutive, noninducible internalization of medium by cell membrane. Fluid phase pinocytosis may be measured flow cytometrically by cellular uptake of fluorescein-labelled medium constituents. The optimum conditions for a flow cytometric assay of pinocytosis were determined using AT-2 subline that has an intermediate degree of membrane ruffling. The optimum dextran concentration was selected from the midpoint of the linear portion of the dose-response (0.01-10.00 mg/ml) curve, whereas the optimum incubation time was determined from a time-course (1-405 min.) curve study. Cultured cells from 6 Dunning sublines incubated with 1.0 mg/ml of fluorescein-labelled dextran for 90 min were washed, fixed, and the fluorescence of 10,000 cells studied by flow cytometry. For each subline, dextran fluorescence was measured in four independent experiments. Pinocytosis failed to distinguish sublines of high (AT-3 63.5 +/- standard error 4.1 mean channel number, MAT-LyLu 63.2 +/- 6.3, MAT-Lu 64.3 +/- 5.6) and low (G 33.5 +/- 1.2, AT-1 63.5 +/- 4.1, AT-2 58.4 +/- 3.6) (rank p = 0.38) metastatic potential but correlated strongly with visually graded membrane ruffling (r = 0.95, p = 0.003). Pinocytosis assayed by flow cytometry reflects membrane ruffling observed visually and thus flow cytometric assays may facilitate study of membrane activity.

Genetic risk and carcinogen exposure: a common inherited defect of the carcinogen-metabolism gene glutathione S-transferase M1 (GSTM1) that increases susceptibility to bladder cancer

BACKGROUND

Numerous studies have associated bladder cancer with exposure to carcinogens present in tobacco smoke and other environmental or occupational exposures. Approximately 50% of all humans inherit two deleted copies of the GSTM1 gene which encodes for the carcinogen-detoxification enzyme glutathione S-transferase M1. Recent findings suggest that the GSTM1 gene may modulate the internal dose of environmental carcinogens and thereby affect the risk of developing bladder cancer.

PURPOSE

We investigated whether the absence of the GSTM1 gene affects bladder cancer risk and whether there are racial differences in GSTM1 genotype frequency.

METHODS

Using a polymerase chain reaction (PCR)-based method, we examined the frequency of the homozygous deleted genotype (GSTM1 0/0) in 229 patients with transitional cell carcinoma of the bladder and 211 control subjects who were enrolled from the Urology Clinics at Duke University Medical Center and the University of North Carolina Hospitals. Control subjects were urology clinic patients who primarily presented with benign prostatic hypertrophy or impotence, who had no history of any cancer other than nonmelanoma skin cancer, and who were frequency matched to case patients on race, sex, and age (10-year age intervals). In order to explore racial differences in GSTM1 gene frequency, genotype was also determined in a community-based sample of 466 paid, healthy, unrelated volunteers from Durham and Chapel Hill, N.C. The presence or absence of the GSTM1 gene locus was determined by using a differential PCR, a semiquantitative technique in which multiple genes are coamplified.

RESULTS

Overall, the GSTM1 0/0 genotype conferred a 70% increased risk of bladder cancer (odds ratio [OR] = 1.7; 95% confidence interval [CI] = 1.2-2.5; P = .004). Absence of the GSTM1 gene encoding the glutathione S-transferase M1 enzyme significantly increased risk to persons with exposure to the carcinogens in tobacco smoke (OR = 1.8; 95% CI = 1.2-3.0; P = .01) but poses little increased risk to persons without such exposure. Persons with smoking exposure of more than 50 pack-years who had the GSTM1 0/0 genotype had a sixfold greater risk relative to persons in the lowest risk group (i.e., nonsmokers who were GSTM1 +/+ or +/0). In the pooled clinic control and community sample groups (677 individuals), the GSTM1 0/0 genotype occurred less frequently among Blacks (35%) than among Whites (49%, P < .001).

CONCLUSIONS

These findings support a protective role for the GSTM1 gene in bladder cancer. From these findings, it is estimated that 25% of all bladder cancer may be attributable to the at-risk GSTM1 0/0 genotype.

Immunohistochemistry of the androgen receptor in human benign and malignant prostate tissue

The role of the androgen receptor in the development and progression of prostatic carcinoma has not been defined. The development of androgen receptor antibodies has provided new opportunities for direct immunohistochemical analysis. We compared the androgen receptor staining characteristics of fresh human prostatic carcinoma with benign prostatic hyperplasia (BPH) using an avidin-biotin complex method. Cancer and BPH obtained from the same radical retropubic prostatectomy specimen in 10 prostate cancer patients (68.5 +/- 7.3 years old standard deviation) and BPH from 10 noncancer patients (71.5 +/- 7.7 years old) were incubated with AR52, a rabbit polyclonal antibody against a synthetic androgen receptor peptide. Nuclei within each section were graded for intensity of androgen receptor staining (0-absent, 1-weak, 2-moderate or 3-strong) and the percentage (0 to 100%) of nuclei sampled staining at each of these intensity levels was determined. A total intensity score (0 to 300) was the summation of the products of each intensity score (0 to 3) and their corresponding percentages. Cancer sections (166 +/- 69) stained less intensely and more heterogeneously than BPH in cancer patients (246 +/- 41, Student's t test p < 0.05) and noncancer patients (225 +/- 39, p < 0.05). The decreased intensity and greater heterogeneity of androgen receptor staining in cancer tissue may implicate a quantitative or functional difference in androgen receptor between prostatic carcinoma and BPH.

In vitro high resolution 1H-spectroscopy of the human prostate: benign prostatic hyperplasia, normal peripheral zone and adenocarcinoma

1H-spectra at 360 MHz from perchloric extracts of 35 human prostate specimens were obtained. First, we sought to define what peaks can be assigned in vitro, and thus, potentially seen in vivo. Second, we sought to try to discriminate between adenocarcinoma, normal peripheral zone and benign prostatic hyperplasia using spectral fingerprints. Thirteen samples of adenocarcinoma, 11 samples of benign prostatic hyperplasia, and 11 samples of normal contralateral peripheral zone were analyzed by obtaining a ratio from the maximum area of each major peak and the area of an added standard (3-trimethyl-silyl-propionic acid). There was a significantly larger benign prostate hyperplasia citrate standardized peak area when compared to the adenocarcinoma citrate standardized peak area for each patient (P < 0.05). However, the citrate standardized peak areas from the normal peripheral zones were not significantly different from those found in the adenocarcinomas. Four out of 13 cases of stromal hyperplasia had similarly low levels of citrate as their respective gland's adenocarcinoma. We also found a sharp peak at 2.05 ppm that was seen in 4 out of 13 adenocarcinoma samples and in only 1 out of 13 of the benign prostate hypertrophy samples which has tentatively been assigned to N-acetyl neuraminic acid. Further studies are required to assess whether low citrate levels alone can serve to exclusively diagnose adenocarcinoma of the prostate.

Sclerosing lipogranulomatosis: a case report of scrotal injection of automobile transmission fluid and literature review of subcutaneous injection of oils

For nearly a century, physicians and laypersons have attempted to repair, reconstruct, and embellish the human body in numerous ways by injecting various oils beneath the skin. Soon after Gersuny's first reported subcutaneous injection of oil, the local and systemic complications became apparent. Despite this, the practice of oil injections continues. "Medical grade" silicone injection was investigated in the 1960s to 1980s with varied success and complications. While few physicians practice oil injection therapy, some laypersons continue to subject themselves or their clients to the risk of the disfiguring complications of sclerosing lipogranulomata. Accidental high-pressure injection injury of liquids, so-called grease gun injuries, continues to provide a therapeutic challenge for the hand surgeon. Our case of a man who injected automobile transmission fluid into his scrotum illustrates the classical course and proper management of sclerosing lipogranulomata. A subcutaneous inflammatory and fibrosing reaction occurred with regional lymphadenopathy. The need for complete excision of all involved tissue to treat the condition successfully is illustrated. This case also illustrates the tendency of patients to conceal from their doctors the history of self-injection of foreign bodies. In cases of self-injection, psychological counseling might certainly be appropriate.

Comparison of nuclear shape in aspirated and histologic specimens of prostatic carcinoma

Nuclear shape analysis of histologic sections of operative specimens has separated patients with clinically localized prostatic carcinoma with good and poor prognoses. In order to become more useful clinically, nuclear shape should be evaluable preoperatively but is distorted by core biopsy. We used nuclear morphometry to compare histologic and cytologic specimens obtained from 20 patients who underwent radical prostatectomy for clinically localized prostatic carcinoma. Neoplastic nuclei from cytologic aspirates prepared by the Papanicolaou and Diff-Quik techniques and standard histologic sections stained with hematoxylin and eosin were digitized. Air-dried nuclei of the Diff-Quik preparation had a nuclear area of 104.2 microns 2 +/- 28.2 SD. These nuclei were nearly twice as large (paired t test, P < .001) as in the Papanicolaou (55.6 +/- 13.0 microns 2) and histologic (55.8 +/- 12.7 microns 2) preparations. However, nuclear shape was not affected. Nuclear roundness factor (deviation from circularity) and boundary curvature were similar (paired t tests, P > .05). All nuclear shape descriptors of cytologic smears fell within intraobserver variations of measurements in histologic sections. Nuclear shape is not altered in Papanicolaou- and Diff-Quik-stained cytologic specimens and should be tested for preoperative assessment of outcome in clinically localized prostatic carcinoma.

Cancer cell motility-inhibitory protein in the Dunning adenocarcinoma model

Cell motility has been associated with metastatic ability in the Dunning R3327 rat prostatic adenocarcinoma model. Cancer cell motility promoters but not inhibitors have been described by many investigators. Serum-containing and serum-free media conditioned by the nonmotile, nonmetastatic G Dunning subline inhibited the motility of the highly motile, highly metastatic MAT-LyLu subline. Motility inhibition by the G subline-conditioned serum-free media was lost upon heating to 100 degrees C and by treatment with trypsin. The motility inhibitory protein(s) had a molecular weight exceeding 50,000 as determined by diafiltration. G subline-conditioned RPMI 1640 contained several proteins with molecular weights of between approximately 53,000 and 116,000 when analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. One of these bands may represent the first inhibitor of cancer cell motility identified.

Prediction of metastatic potential of aspirated cells from the Dunning R-3327 prostatic adenocarcinoma model

Pathological grading systems have failed to assess accurately the prognosis of patients with prostatic carcinoma. A visual grading system of cancer cell motility has described successfully the metastatic potential of sublines of the Dunning R-3327 rat prostatic adenocarcinoma model maintained in vitro and in vivo. Clinical application of this technique would be facilitated if it could be performed upon aspirated cells. We compared the motility of cells obtained by biopsy and fine needle aspiration from in vivo Dunning tumors and determined if the motility of aspirated cells could predict metastatic potential. Specimens from the same tumor were obtained by fine needle aspiration and incisional biopsy from three sublines of low (less than 10%) and three sublines of high (greater than 90%) metastatic potential. Membrane ruffling, pseudopodal extension and cellular translation of 100 cells were graded using time-lapse videomicroscopy. Cells obtained by biopsy and aspiration had similar average (analysis of variance, p greater than 0.7) and variation (coefficient of variation, aspirated = 18.6%, biopsy = 17.7%) of motility. Aspirated cells from three low metastatic sublines (membrane ruffling 5.20 +/- SEM 0.41, pseudopodal extension 4.10 +/- 0.57 and cellular translation 3.07 +/- 0.45) were distinguished from cells of three high metastatic sublines (membrane ruffling 7.10 +/- 0.15, pseudopodal extension 6.93 +/- 0.22 and cellular translation 5.47 +/- 0.25). Cellular translation, the best discriminator, correctly classified the metastatic potential of the subline of origin in 82% of 60 individual cells. A grading system based upon the motility of aspirated cancer cells should be studied in human prostatic carcinoma.

Prediction of metastatic potential by cancer cell motility in the Dunning R-3327 prostatic adenocarcinoma in vivo model

Many grading systems for prostatic carcinoma exist; however, none allows pathologists to predict accurately the prognosis of individual patients. The Dunning R-3327 prostatic adenocarcinoma model consist of sublines of known metastatic potential which were indistinguishable until recently. A visual grading system of cancer cell motility distinguished the metastatic potentials of Dunning sublines maintained in vitro and was validated prospectively. We used this grading system to assess the metastatic potential of cells harvested directly from in vivo Dunning tumors. We graded the motility of cells from three Dunning sublines of low (less than 10%) (G, AT1, AT2) and three sublines of high (greater than 90%) AT3, (MAT-LyLu, PAT2) metastatic potential. Cells obtained from primary tumors were studied by time lapse videomicroscopy after passages 1, 3 and 5 in vivo and in vitro. Membrane ruffling, pseudopodal extension and cellular translation were graded 0-10. Serial analysis of mean and heterogeneity (coefficient of variation) of membrane ruffling, pseudopodal extension and cellular translation demonstrated that subline motility grades were assessed adequately by a sample of 10 cells. Motility did not depend upon whether cells were maintained in vitro or in vivo; however, motility increased with successive passages in four of six sublines. In 60 cells harvested directly from the fifth in vivo passage, three sublines of low metastatic potential were distinguished from three sublines of high metastatic potential (Student's t test, p less than 0.01). Individual cells from the sublines were identified correctly as high or low metastatic in 83, 78 and 70% of cases by membrane ruffling, pseudopodal extension and cellular translation respectively, and logistic regression analysis failed to improve classification accuracy. A visual grading system of cancer cell motility described the metastatic potential of in vivo neoplasms in the Dunning model and may warrant testing in human prostatic cancer.

Prediction of prognosis in untreated stage A2 prostatic carcinoma

Carcinoma is found unexpectedly in approximately 10% or more of the 400,000 prostatectomies performed annually in the United States. Patients with Stage A2 carcinoma die of their disease in only 35% of the cases. To alter the course of disease in these patients, 65% of Stage A2 patients may be treated unnecessarily by radical prostatectomy, radiation therapy, or hormonal therapy. An accurate method to predict the outcome of patients with Stage A2 carcinoma is needed. Histologic sections from 18 patients with Stage A2 prostatic carcinoma followed without further treatment until progression, or followed without progression, were evaluated by several investigators who did not have knowledge of patient outcomes and who employed standard pathologic grading systems as well as morphometric, cytophotometric, flow cytometric, and immunohistochemical techniques. Outcome was predicted correctly by random sampled absolute (17 of 18 cases) and relative (16 of 18) nuclear roundness factor (NRF), tumor volume expressed as percent of specimen (13 of 16), primary (13 of 18), secondary (14 of 18), sum (15 of 18), and worse (14 of 18) Gleason grades and prostate-specific antigen immunohistochemical findings (13 of 18) that produced statistically significant separation of the two groups. Significant separation was not obtained with Mostofi's pattern, nuclear, sum, and worse grades, Johns Hopkins' grade, absolute tumor volume, nuclear DNA content measured by image cytophotometric study of Feulgen-stained histologic sections and flow cytometric study of propidium iodide-labeled suspensions of nuclei obtained from paraffin blocks, nonrandom sampled NRF of worse and most prevalent neoplastic areas, and prostatic acid phosphatase and peanut agglutinin immunohistochemical study. NRF measured by a random technique best predicted outcome in these patients with A2 prostatic carcinoma and should be evaluated prospectively as a means for selecting patients who require therapy.

Phase II evaluation of coumarin (1,2-benzopyrone) in metastatic prostatic carcinoma

The unavailability of effective treatment of metastatic hormone refractory prostatic carcinoma warrants trials of new and promising treatments. Coumarin is an investigational new drug that has produced objective tumor regression in some patients with metastatic renal cell carcinoma and malignant melanoma. Coumarin has shown activity against prostatic carcinoma in the Dunning R-3327 rat prostatic adenocarcinoma model. Forty-eight patients with metastatic hormone naive (5 stage D1 and 10 stage D2) or hormone refractory (33 stage D3) prostatic carcinoma of average age 67.6 years (range 46-86) and ECOG performance status of 2 or better were given 3 grams coumarin daily by mouth and evaluated monthly for toxicity and response by rigid criteria in a multicenter trial. Toxicity was limited to asymptomatic SGOT elevations in 3 patients and nausea and vomiting in 4 patients that required cessation of therapy in 2. Eligibility and protocol violations removed 6 additional patients from response evaluation. There were no complete responses. Partial responses (3 of 40 patients, 8%) occurred in 2 patients with bidimentionally measurable disease and 1 patient with disease evaluable by bone scan and elevated prostate specific antigen and prostatic acid phosphatase. The remaining patients progressed after 1 to 12 (average 4.4) months. Coumarin is a relatively nontoxic drug that may warrant further trials in a subset of patients with prostatic carcinoma.

Metastatic potential and substrate dependence of cell motility and attachment in the Dunning R-3327 rat prostatic adenocarcinoma model

Cancer cell motility has been associated with metastatic potential of sublines of the Dunning R-3227 rat prostatic adenocarcinoma model. However, three sublines of high motility lacked the capacity for metastasis. In all previous works, motility has been studied upon plastic and only upon attached cells at least 18 h after gravity plating. We studied two highly motile sublines; MAT-LyLu metastasizes to lungs and lymph nodes whereas PIF-1 metastasizes rarely. We compared the motility and attachment capability of cells from the Dunning model in serum-free media upon plastic, glass, laminin, type IV collagen, fibronectin, and elastin to determine whether study upon more physiological surfaces could better explain the discrepancy in metastatic capability observed in vivo. In the high-motility low-metastatic PIF-1 and high-motility high-metastatic MAT-Lylu sublines, membrane ruffling, pseudopodal extension, and cellular translation upon plastic in serum-free media were reduced (P less than 0.0001) by 33 and 31, 70 and 60, and 77 and 65%, respectively. When returned to serum-containing media, biological characteristics (histology, chromosomal number, growth rate, host survival, and metastatic potential) were unchanged. Motility was affected by substrate (analysis of variance, P less than 0.05); however, no consistent pattern of enhancement or detriment occurred in any substrate across both sublines. When motility was compared between sublines, membrane ruffling and cellular translation were relatively unaffected by substrate, whereas pseudopodal extension was altered significantly by different substrates. However, upon individual substrates, no significant differences in motility existed between the two sublines to resolve the inconsistency of high-motility but low-metastatic potential in the PIF-1 subline. Therefore, we examined cell attachment, since in order for a metastatic cell to be motile upon substrate, it must first attach to it. Percentage of 10(5) cells attached was determined in serum-free media with the use of a cell counter after 1, 2, 4, 8, and 16 h on plastic and plastic coated with laminin, fibronectin, elastin, or type IV collagen. Cell attachment increased with time (P less than 0.05) on all substrates for MAT-LyLu (r = 0.95) and PIF-1 (r = 0.98). Attachment of MAT-LyLu cells was impaired by fibronectin and enhanced by elastin, laminin, and type IV collagen compared to plastic at all time points.(ABSTRACT TRUNCATED AT 400 WORDS)

Comparison of the digital rectal examination, endorectal ultrasound, and body coil magnetic resonance imaging in the staging of adenocarcinoma of the prostate

A series of 25 patients with biopsy proven adenocarcinoma of the prostate underwent preoperative staging evaluation with a digital rectal examination, endorectal ultrasound, and body coil magnetic resonance imaging (MRI) before their radical retropubic prostatectomy. The sensitivity and specificity of the digital rectal examination for the detection of extracapsular disease were 17 and 100%, respectively. The sensitivity and specificity of endorectal ultrasound for the detection of extracapsular disease were 35 and 89%, respectively. The sensitivity and specificity of body coil MRI for the detection of extracapsular disease by adenocarcinoma of the prostate were 47 and 63%, respectively. Microscopic disease of the capsule and seminal vesicles was the principle reason for understaging by both imaging modalities. This small series suggests that both imaging modalities are marginally more sensitive, albeit less specific, for extracapsular disease of the prostate than the digital rectal examination, with ultrasound having a slight edge in specificity and MRI having a slight edge in sensitivity.

Preoperative prediction of pathological tumor volume and stage in clinically localized prostate cancer: comparison of digital rectal examination, transrectal ultrasonography and magnetic resonance imaging

Accurate preoperative staging is important for proper selection of patients for radical retropubic prostatectomy. Preoperative staging by digital rectal examination, transrectal ultrasound, magnetic resonance imaging (MRI), Gleason grade and prostate specific antigen was compared to pathological stage for 25 patients who underwent radical retropubic prostatectomy. The predictive value for tumor confinement was 36% by rectal examination, 37% by ultrasound and 30% by MRI. The predictive value for extracapsular disease was 100% by rectal examination, 83% by ultrasound and 66% by MRI. Preoperative determinations of tumor volume by any modality did not correlate with pathological tumor volume. Digital rectal examination, ultrasound and MRI clinically understage the disease in most patients but they may be reliable to predict extracapsular disease.

The decoy catheter

A decoy catheter can prevent traumatic indwelling catheter removal in patients with altered mental status who require temporary bladder drainage. We illustrate the technique in a demented patient who underwent transurethral prostatectomy.

Nuclear shape analysis for assessment of prognosis in renal cell carcinoma

Clinically localized renal cell carcinoma is cured by radical nephrectomy in 47% [stage T3a (II)] to 65% [stage T1, T2 (I)] of the patients. Local recurrence and metastatic disease probably result from undetectable microscopic metastases present at operation. Chemotherapy and immunotherapy may improve cure rates if administered adjuvantly. The outcome of individual patients who share surgical stage cannot be predicted reliably by tumor histology, pathological and/or nuclear deoxyribonucleic acid analysis. Two groups of 10 patients with clinically localized renal cell carcinoma were similar by sex distribution (5 men and 5 women), surgical stage (stages T1 in 1, T2 in 6 and T3a in 3 patients) and age (54.3 +/- 15.2 standard deviation versus 55.8 +/- 8.7 years). Group 1 had no recurrences with a minimum followup of 5 years and a mean followup of 10 years. Group 2 died of metastatic renal cell carcinoma after a mean of 5 years. All neoplastic areas of each paraffin-embedded operative specimen were randomly sampled and the nuclear perimeter of 150 cancerous cells was digitized. There were 25 shape descriptors calculated for each nucleus. All shape descriptors for each patient were described by 19 statistical tests. Nuclear perimeter and area as well as mean nuclear roundness factor failed to separate the 2 groups. Range median quartiles of ellipticities by Fourier analysis, coefficients of variation of chain code minimums and relative means of largest 10 convexity values produced greatest separation (Mann-Whitney-Wilcoxon test p less than 0.001, and variance normalized difference 3.21, 3.29 and 2.83, respectively). These descriptors normalized and summed provided near perfect separation (Mann-Whitney-Wilcoxon test p less than 0.001 and variance normalized difference 3.59). We developed a quantitative nuclear morphometric analysis system that permitted the correct assignment of outcome in 19 of 20 patients. Accurate prediction of prognosis in patients with clinically localized renal cell carcinoma by nuclear shape analysis may allow for selection of patients for adjuvant therapy who have clinically undetectable metastatic disease.

A comparison of nuclear morphometry and Gleason grade as a predictor of prognosis in stage A2 prostate cancer: a critical analysis

The natural history of stage A2 prostate cancer is unknown. Previous studies from this institution have shown that, without treatment, a third of the men with clinically localized stage A2 prostatic adenocarcinoma will have disease progression within 4 years. Presently, most patients who present with stage A2 prostate cancer receive surgical or radiation therapy. The degree of differentiation of the tumor (Gleason score) presently is used to predict the prognosis among patients with clinically localized prostate cancer. The Gleason score does well to predict the prognosis for patients with scores of 2 to 4 and 8 to 10. Unfortunately, the majority of patients fall within the range of Gleason scores of 5 to 7. Better methods are needed to predict which patients diagnosed with stage A2 prostate cancer have a high probability of disease progression. Several studies have reported that morphometrically determined nuclear shape descriptors provided accurate separation of these patients that was superior to Gleason grading methods. To evaluate critically the usefulness of nuclear morphometry for prediction of prognosis we developed a system. The Hopkins Morphometry System, that calculated and compared 15 different shape descriptors that were analyzed by 17 different statistical tests. We tested this system on 18 untreated patients with stage A2 prostate cancer with an average followup of 10.5 years (range 5 to 18 years). For each patient 17 statistical analyses of the 15 shape descriptors (255 total) were evaluated and 50 analyses (50 of 255, 19.6%), including average nuclear roundness factor, provided significant separation (p less than 0.01) of the patients on the basis of outcome, whereas the Gleason score (p equals 0.076) did not. The best separation (p less than 0.01) was provided by the lower quartile analysis of the ellipticity shape descriptor.

Topical oxybutynin chloride for relaxation of dysfunctional bladders

Eleven patients with persistent urge incontinence and frequent side effects on oral anticholinergic agents were treated with oxybutynin chloride administered intravesically. Five mg. tablets were dissolved in saline, and the solution was instilled twice daily and retained for 30 minutes. One patient was unable to retain the medication because of severe detrusor hyperreflexia and was eliminated from the study. The remaining 10 patients all reported subjective improvement following treatment and all became totally continent. No side effects were observed. In these 10 patients mean bladder capacity increased from 224 to 360 ml. (p less than 0.01) and mean maximum filling pressure decreased from 33 to 24 cm. water (p equals 0.17). Two additional patients with continent ileocecal urinary diversions were treated with topical oxybutynin chloride instilled directly into the intestinal reservoir. Both patients reported improved comfort with filling and 1 demonstrated a decrease in uninhibited contractions. These encouraging results suggest that treatment with topical oxybutynin chloride is an effective alternative in patients with voiding dysfunction who either are unresponsive to or have intolerable side effects on oral medications.

Fine-needle core and aspiration biopsy. A new method for diagnosis of prostatic carcinoma

Fine-needle aspiration of the prostate has failed to gain widespread acceptance among pathologists more familiar with histologic sections. The authors aspirated 27 freshly excised radical prostatectomy specimens with needles of varying caliber and type and found a 22-gauge Turner needle (Cook Incorporated, Bloomington, IN) which obtained large tissue fragments suitable for cell block preparation as well as high quality cytologic specimens. Thirty men with prostate nodules each had 14-gauge transperineal core biopsy and fine-needle aspiration. In 20 cases, cytologic smears and cell blocks and core biopsies agreed on a diagnosis: 12 benign and eight carcinoma. Of seven cases that were atypical by cytologic smears, five were benign on cell block and core; one was benign on cell block and carcinoma on core; and one was carcinoma on cell block and core. Three cases with scant specimens and diagnoses of carcinoma by cytologic smears were benign on cell blocks and cores: one contained seminal vesicle on review; one had repeat benign biopsies; and one had three microscopic foci of low-grade carcinoma in his radical prostatectomy specimen. This fine-needle aspiration technique provides histologic sections which are especially useful to those gaining experience with cytologic specimens of the prostate. Cases with discordant diagnoses on cell block and cytologic preparations warrant further evaluation.

Fourier analysis of cell motility: correlation of motility with metastatic potential

We report the development of a computerized, mathematical system for quantitating the various types of cell motility. This Fourier analysis method simultaneously quantifies for individual cells (i) temporal changes in cell shape represented by cell ruffling, undulation, and pseudopodal extension, (ii) cell translation, and (iii) average cell size and shape. This spatial-temporal Fourier analysis was tested on a series of well-characterized animal tumor cell lines of rat prostatic cancer to study in a quantitative manner the correlation of cell motility with increasing in vivo metastatic potential. Fourier motility coefficients measuring pseudopodal extension correlated best with metastatic potential in the cell lines studied. This study demonstrated that Fourier analysis provides quantitative measurement of cell motility that may be applied to the study of biological processes. This analysis should aid in the study of the motility of individual cells in various areas of cellular and tumor biology.

Metastatic potential prediction by a visual grading system of cell motility: prospective validation in the Dunning R-3327 prostatic adenocarcinoma model

A method for accurate prediction of prognosis in individual patients with prostatic carcinoma does not exist. The limitations of pathological grading systems may result from the failure of standard pathological examination of fixed dead tissue to accurately assess the biological and metastatic behavior of live tumor cells. Many of the sublines of the Dunning R-3327 rat prostatic adenocarcinoma are histologically similar yet differ in metastatic potential. Cells from the Dunning model were grown in culture and filmed by time-lapse videomicroscopy. These cells exhibited characteristic membrane ruffling, pseudopodal extension, and cellular translation that could be graded with 80% reproducibility. Individual cells from sublines with high metastatic potential were separated from cells from sublines of low metastatic potential in 96% of cases. We have applied our cell motility grading system to prospectively classify the metastatic potential of neoplastic cells. The mean motility grades of sublines of high and low metastatic potential differed significantly (Mann-Whitney-Wilcoxon, P less than 0.0005). Among seven sublines in which the grading system was developed, individual cells were correctly classified as high or low metastatic in 71% of cases by ruffling or pseudopodal extension, 73% of cases by translation, and 75% of cases by motility index, an average of the three parameters of motility. Among four newly tested sublines, cells from a low metastatic and high metastatic sublines were perfectly classified. Cells from two other low metastatic sublines were misclassified. When all 88 cells from the 11 sublines were classified, high metastatic cells were detected with 94% sensitivity and 50% specificity. The predictive value of a determination of low metastatic was 93%, whereas the predictive value of an assignment of high metastatic was 52%. The ability to detect and accurately classify most highly metastatic cells while rarely erring in a classification of low metastatic potential suggests that a grading system of cancer cell motility should be evaluated in human prostatic carcinoma. The motility of live prostatic carcinoma cells may predict patient prognosis better than standard pathological grading systems.