Intermittent androgen deprivation (IAD) in patients with biochemical failure after radical retropubic prostatectomy (RRP) for clinically localized prostate cancer

We report a study in which our objective was to analyze the clinical response during IAD in patients with biochemical failure after RRP for clinically localized prostate cancer. Between February 1994 and May 1996, 34 patients who exhibited a primary postoperative decrease in PSA to below the detection limit after RRP and then showed PSA progression during follow-up were included as group 1 and 17 patients in whom PSA did not decrease after RRP were included as group 2. Patients were offered IAD when PSA progressed over 0.4 ng/ml in group 1 and over 4.0 ng/ml in group 2. Median follow-up is 184 weeks in group 1 and 206 weeks in group 2. The median time "off" therapy increased from 25% (1st cycle) to 68.7% (5th cycle) of the entire cycle in group 1 and from 33.3% to 58.3% in group 2. Nine out of 12 cases with Gleason score > or =8 failed to respond to IAD and all developed metastatic and/or local failure. No case with Gleason score <7 failed to respond to IAD. Our conclusions suggest that IAD may be effective in patients with biochemical progression after RRP. In our experience, Gleason score seems to be an important variable.

Correlations among prostatic biopsy results, transrectal ultrasound findings and PSA levels in diagnosing prostate adenocarcinoma

OBJECTIVE

The objective of this study was to evaluate transrectal ultrasound (TRUS) findings and prostate-specific antigen (PSA) levels in relation to prostatic biopsy results and to analyze their individual and combined performances in diagnosing prostate adenocarcinoma (PAC).

METHODS

Men (n=143) with PSA levels above 4 ng/ml underwent TRUS and randomized ultrasound-guided prostatic biopsy through the peripheral zone, including additional hypoechoic nodules biopsies, if they were noted on TRUS. Data related to TRUS, biopsy, and PSA level results were then correlated.

RESULTS

A significant correlation between TRUS images suspicious for PAC and a biopsy-confirmed diagnosis of PAC, or between the lack of such images and a negative biopsy result, was not found. However, a significant correlation was found between positive biopsy results and PSA levels greater or equal to 10 ng/ml. The sensitivity of transrectal ultrasound in making a diagnosis of PAC was 63%, whereas its specificity was 73%.

CONCLUSION

We conclude that while the separate performances of these examinations were not effective in diagnosing PAC, the integrated use of these methods was more adequate for making the diagnosis.

Targeting of cancer cells with monoclonal antibodies specific for C3b(i)

PURPOSE

The goal of this research is to determine the feasibility of an immunotherapeutic approach based on the use of monoclonal antibodies (mAb) to target complement activation fragments on opsonized cancer cells.

METHODS

We investigated whether treatment of LNCaP and C4-2 human prostate cancer cell lines with normal human serum would allow for deposition of sufficient amounts of the complement-activation protein C3b and its fragments [collectively referred to as C3b(i)] such that these proteins could serve as cancer-cell-associated antigens for targeting by mAb. Radioimmunoassays, flow cytometry, and magnetic purging with specific immunomagnetic beads were used for the analyses.

RESULTS

In vitro opsonization of human prostate cancer cells with normal human serum resulted in deposition of C3b(i) in sufficient quantity (approx. 100,000 molecules/cell) for the cells to be targeted in a variety of protocols. We found that 51Cr-labeled and C3b(i)-opsonized cancer cells could be specifically purged at high efficiency (95%-99%) using anti-C3b(i) mAb covalently coupled to magnetic beads. Flow-cytometry experiments indicated that most normal white cells were not removed under similar conditions. Opsonization of cancer cells with sera from men with prostate cancer led to lower levels of cell-associated IgM and, subsequently, lower amounts of C3b(i) deposited than in normal subjects. Prototype experiments suggested that this deficiency could be corrected by addition of IgM from normal donor plasma.

CONCLUSION

mAb directed against complement-activation products may provide new opportunities to deliver diagnostic and therapeutic agents selectively to cancer cells and tumor deposits. These opportunities may include ex vivo purging of C3b(i)-opsonized cancer cells prior to autologous bone marrow or stem cell transplantation.

Generation and functional characterisation of dendritic cells from patients with pancreatic carcinoma with special regard to clinical applicability

BACKGROUND

We studied dendritic cell (DC) function in patients affected by pancreatic carcinoma, and the possibility of obtaining DC adequate for immunological treatment modalities.

METHODS

Leucocytes were isolated from buffy coats obtained by autotransfusion of six patients undergoing pancreatico-duodenectomy. The leucocytes were cryopreserved and, after thawing, were purified by density gradient and/or plastic adhesion. They were then cultured in vitro in cytokine-enriched medium (granulocyte/macrophage-colony-stimulating factor + interleukin-4) with different sources of serum: 10% fetal calf serum (FCS), 2% autologous human serum or 2% pooled human AB serum.

RESULTS

The DC obtained were identical to those from healthy donors in terms of phenotype, antigen uptake capacity, capacity for antigen presentation and their capacity to mature after exposure to stimuli like CD40L. DC differentiated in human serum demonstrated more mature behaviour than did DC cultured in FCS but, after exposure to CD40L, this difference disappeared. In one patient soluble factors in serum were able to inhibit the capacity of DC to stimulate T cells.

CONCLUSION

It's possible to obtain DC from autotransfusion of patients with pancreatic carcinoma: these cells do not show evident quantitative or qualitative alterations, are able to present soluble antigen even when cultured in the presence of human serum and may be used in immunological tumour treatments.

Behaviour of interleukin-2 serum levels in advanced non-small-cell lung cancer patients: relationship with response to therapy and survival

Interleukin(IL)-2 is a T helper (Th) 1 type cytokine that has been shown to play an important role in antitumour immune responses. In this study, the prognostic significance of serum IL-2 levels was investigated in 60 advanced non-small-cell lung cancer (NSCLC) patients. IL-2 serum levels were determined before chemotherapy, at the end of chemotherapy and during follow-up, using a commercially available enzyme-linked immunoadsorbent assay kit. The results were analysed according to the response to therapy and were used to generate a model predicting overall survival and time to treatment failure. All 60 patients were shown to have higher IL-2 serum levels than controls (P < 0.0001). Stage IV patients had significantly lower IL-2 levels than stage III patients (P < 0.0001), although they were still significantly higher than controls (P < 0.0001). It is interesting that, when patients were divided into responders and non-responders according to the response to therapy, the former were shown to have significantly higher pre-chemotherapy levels than the latter (P < 0.0001). Moreover, a further significant increase in IL-2 serum levels (P = 0.004) and a significant decrease (P < 0.0001) were shown in responders and non-responders, respectively at the end of the therapy. Using univariate and multivariate analyses, both overall survival and time to treatment failure were shown to be affected by the mean pathological levels of IL-2. Furthermore, the prognostic significance of the serum level of IL-2 was confirmed by the stepwise regression analysis. In conclusion, determination of pre-treatment IL-2 serum levels was shown to be of independent prognostic utility in patients with advanced NSCLC; therefore, its possible use for prediction of outcome is proposed.

Increase of anti-inflammatory cytokines in patients with esophageal cancer after perioperative treatment with G-CSF

Granulocyte colony-stimulating factor (G-CSF) has been shown to effectively stimulate granulopoiesis, in both neutropenic and in non-neutropenic patients. Recently, other effects of G-CSF on the immune system have attracted interest in treating non-neutropenic patients with a high risk of severe infection. In this phase II trial, we measured the effects of G-CSF on the serum cytokine levels in patients with esophageal cancer undergoing esophagectomy. Twenty subsequent patients (study group, 19 evaluable) received G-CSF (rhG-CSF, Filgrastim) at standard doses (300 microg or 480 microg) subcutaneously 2 days before and up to 7 days after surgery. G-CSF was well tolerated. Leukocytes increased from 7600/microl at study entry (day -2) to a maximum of 45 100/microl (day 6). In the study patients, we found a highly significant (P<0.001) postoperative increase of G-CSF, IL-1ra, sTNFRp55 and sTNFRp75 as compared with the baseline level. In contrast, IL-8 levels were decreased by a factor of 6.8; there were no changes in the very low TNF-alpha levels. The comparison of the study group with a control group of 21 cancer patients undergoing major surgery who were not treated with G-CSF showed significant differences in the serum levels of G-CSF, sTNFRp55, sTNFRp75, and IL-1ra, respectively. There was no infection in the study group up to 10 days after surgery as compared with 29.9% in a historical control group (P=0.008). Thus, the induction of anti-inflammatory cytokines and the downregulation of pro-inflammatory cytokines by G-CSF might be a promising adjuvant treatment of infectious complications in patients undergoing esophagectomy.

Recombinant granulocyte colony-stimulating factor induces production of human neutrophil peptides in lung cancer patients with neutropenia

Human neutrophil peptides (HNPs) 1, 2 and 3 are antimicrobial peptides localized in the azurophil granules of neutrophils. We investigated the effects of recombinant human granulocyte colony-stimulating factor (rhG-CSF) on the biosynthesis of HNPs 1-3 using a sensitive radioimmunoassay and Northern blot analysis. Seven patients with lung cancer were first treated with various anticancer agents for 3 days (days 1-3) followed by treatment with rhG-CSF (2 microgram/kg weight/day) for 7 days (days 8-14). Chemotherapy caused neutropenia but the neutrophil count increased biphasically between days 8 and 14. Chemotherapy did not change the baseline plasma concentration of HNPs 1-3 (74.1+/-2.1 pmol/ml) but the concentration increased from day 12, 5 days after commencement of rhG-CSF therapy, to reach a peak value of 430.8+/-57.0 pmol/ml on day 15, 1 day after the last administration of rhG-CSF. Baseline HNPs 1-3 content per neutrophil was 0.59+/-0.02 fmol, decreased to 0.30+/-0.07 fmol on day 9, then increased to 0.78+/-0.07 fmol on day 15. Analyses of peripheral blood neutrophils by Northern blot and reverse-phase high-performance liquid chromatography showed that the amounts of HNPs 1-3 mRNA and precursors of HNPs 1-3 markedly increased in response to rhG-CSF. Our results indicate that recombinant hG-CSF does not only increase neutrophil count but stimulates HNPs 1-3 biosynthesis in neutrophils, thus enhancing the host defense system of compromised hosts with neutropenia.

[Usefulness of PSA-complex in the diagnosis of prostatic carcinoma]

OBJECTIVE

Since its discovery as a marker for prostate cancer, there have been many attempts to enhance the diagnostic efficacy of the prostate specific antigen (PSA). Among these are the studies that analyze the behavior of different forms of serum PSA bound to different antiproteases, such as alpha-1-antichymotrypsin, which forms the complexed PSA (PSA-c). This study analyzed the utility of PSA-c to enhance specificity without altering sensitivity in comparison to total PSA (PSA-t).

METHODS

From September 1998 to March 1999, blood samples were obtained from 96 patients that had undergone a prostate biopsy due to a suspicion of prostate cancer. PSA-c, PSA-t (Technicon Immunol system, Bayer) and PSA-c/PSA-t ratio were analyzed in these patients.

RESULTS

ROC curves were plotted and the optimal cutoffs were found for which the specificity was higher for PSA-c (44.6% [CI 95%, 32-57]) versus PSA-t (35.4% [CI 95%, 25-49]) and the PSA-c/PSA-t ratio (38.5% [CI 95%, 27-51]) while maintaining a similar sensitivity index (90%). PSA-c showed similar results for other values of sensitivity.

CONCLUSIONS

PSA-c was found to improve specificity in comparison to PSA-t and PSA-c/PSA-t ratio. PSA-c determination could avoid unnecessary biopsies without altering sensitivity; i.e., the same number of prostate cancers will be detected.

Prospective trial of the herbal supplement PC-SPES in patients with progressive prostate cancer

PURPOSE

PC-SPES is an herbal supplement for which there are anecdotal reports of anti-prostate cancer activity. This phase II study was undertaken to assess the efficacy and toxicity of PC-SPES in prostate cancer patients.

PATIENTS AND METHODS

Thirty-three patients with androgen-dependent prostate cancer (ADPCa) and 37 patients with androgen-independent prostate cancer (AIPCa) were treated with PC-SPES at a dose of nine capsules daily. Clinical outcome was assessed with serial serum prostate-specific androgen (PSA) level measurement and imaging studies.

RESULTS

One hundred percent of ADPCa patients experienced a PSA decline of >/= 80%, with a median duration of 57+ weeks. No patient has developed PSA progression. Thirty-one patients (97%) had declines of testosterone to the anorchid range. Two ADPCa patients had positive bone scans; both improved. One patient with a bladder mass measurable on computed tomography scan experienced disappearance of this mass. Nineteen (54%) of 35 AIPCa patients had a PSA decline of >/= 50%, including eight (50%) of 16 patients who had received prior ketoconazole therapy. Median time to PSA progression was 16 weeks (range, 2 to 69+ weeks). Of 25 patients with positive bone scans, two had improvement, seven had stable disease, 11 had progressive disease, and five did not have a repeat bone scan because of PSA progression. Severe toxicities included thromboembolic events (n = 3) and allergic reactions (n = 3). Other frequent toxicities included gynecomastia/gynecodynia, leg cramps, and grade 1 or 2 diarrhea.

CONCLUSION

PC-SPES seems to have activity in the treatment of both ADPCa and AIPCa and has acceptable toxicity. Further study is required to determine whether its effects exceed those expected with estrogen therapy.

Disseminated intravascular coagulation in a lung cancer patient after acute myocardial infarction

A 70-year-old man with adenocarcinoma of the lung suffered from an attack of acute myocardial infarction during hospitalization. Eleven days after the heart attack, clinically obvious disseminated intravascular coagulation (DIC) occurred. The intravascular coagulation abnormalities progressed and eventually the patient died. We suspect that both lung adenocarcinoma and the insult of myocardial infarction may have contributed to the development of DIC in this patient.

Changes in serum and tissue zinc levels in sex hormone-induced prostatic carcinogenesis in the noble rat

We investigated the changes in serum and tissue zinc levels in the Noble rat prostate gland under different pathological conditions induced by the administration of a combination of testosterone and 17beta-estradiol. The results showed that there were significant differences in serum zinc values between normal and hormone-treated rats with prostatic hyperplasia, dysplasia and prostatic carcinoma (p < 0.05), although there was no significant difference among rats with different forms of prostatic lesions (i.e. hyperplasia, dysplasia and prostatic adenocarcinoma). There was also a difference in zinc content between the lateral prostate (LP), ventral prostate (VP) and dorsal prostate (DP) in normal rats. The zinc levels of LP were several times greater than those of either VP or DP (p < 0.01). There was also a great difference in zinc levels between the normal and the hyperplastic/dysplastic and carcinomatous LP and VP (p < 0. 05). The levels of zinc in both LP and VP were increased in hyperplasia/dysplasia and carcinoma. On the other hand, the zinc levels of LP were much higher than those of VP in hyperplasia/dysplasia and carcinoma (p < 0.01), which may be correlated with the incidence of prostate cancers in these lobes (i. e. higher in LP and much lower in VP). In contrast, in DP, the levels of zinc were not affected, which may be correlated with the very low incidence of carcinoma in this lobe. Our data suggest that the difference in zinc levels among these lobes reflect the heterogeneity in zinc content in various lobes of the rat prostate. The growth and development of prostatic lesions in LP and VP may be positively correlated with the significant increase in tissue zinc levels in these lobes. On the other hand, the lack of response of DP to carcinogenesis may be due to its relatively stable low zinc levels. It is suggested that tissue zinc content may be used as a marker for prostatic lesions, including hyperplasia, dysplasia and carcinoma, while serum zinc levels may be a useful indicator for abnormal prostatic growth.

Clinical value of tumor markers for early detection of recurrence in patients with cervical adenocarcinoma and adenosquamous carcinoma

OBJECTIVE

The clinical value of tumor markers for early detection of recurrence was investigated in 32 patients with cervical adenocarcinoma or adenosquamous carcinoma who had recurrent tumors.

METHODS

Serum levels of CA 125, CA 19-9, carcinoembryonic antigen (CEA), and squamous cell carcinoma antigen (SCC), in addition to clinical status at the time of recurrence were investigated.

RESULTS

Among the 32 patients, 26 had no symptoms at the time of recurrence. In 20 patients, elevated serum levels of tumor markers were the first sign of recurrence. In 21 patients with recurrent adenocarcinoma, the positive rates were 14% (CA 125), 62% (CA 19-9), 29% (CEA), and 5% (SCC). There were 71% of cases positive for CA 19-9 and/or CEA. In 11 patients with recurrent adenosquamous carcinoma, the corresponding positive rates were 37% (CA 125), 46% (CA 19-9), 64% (CEA), and 55% (SCC), with 100% positive for CA 19-9, CEA, and/or SCC.

CONCLUSIONS

The combination of CA 19-9 and CEA is probably the most promising for detection of recurrent cervical adenocarcinoma. For adenosquamous carcinoma, the additional use of SCC is recommended.

Evaluation of inflammatory cytokines in malignant and benign pleural effusions

We measured the levels of inflammatory cytokines interleukin-1alpha (IL-1alpha), interleukin-1beta (IL-1beta), interleukin-2 (IL-2), interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor-alpha (TNF-alpha) in pleural effusions and serum in 65 consecutive patients: 32 with malignant pleural effusion (MPE) (group A), and 33 with inflammatory benign pleural effusion (BPE) (group B). Serum levels of 15 healthy individuals served as control. Concentrations of IL-1alpha were higher in serum compared to pleural fluid in both groups (47.1+/-33.9 vs. 25.9+/-1.7 fmol/ml, p<0.001, in group A; and 39.9+/-30.9 vs. 25.4+/-16.3 fmol/ml, p<0.02, in group B). Similarly, concentrations of IL-1beta and IL-2 were significantly higher in serum compared to pleural fluid in both groups. In contrast, IL-6, IL-8 and TNF-alpha were found at high concentration in MPE in comparison to serum IL-6: 171.8+/-60.4 vs. 7. 2+/-7 fmol/ml (p<0.001), IL-8: 1175.15+/-2385.6 vs. 285.2+/-187.2 pg/ml (p<0.05), TNF-alpha: 204.9+/-82.9 vs. 79.4+/-31.9 fmol/ml (p<0. 001). Similarly, pleural concentrations of IL-6, IL-8 and TNF-alpha were higher in BPE patients in comparison to serum IL-6: 124.3+/-56. 2 vs. 8.6+/-6.4 fmol/ml (p<0.001) IL-8: 2109.2+/-4121.5 vs. 291. 6+/-197.9 pg/ml (p<0.02), TNF-alpha: 183.8+/-28.2 vs. 86.2+/-23.9 fmol/ml (p<0.001). These data suggest that IL-6, IL-8 and TNF-alpha might be secreted locally at the site of active disease both in benign and malignant pleural effusions.

Pretreatment plasma TGF beta 1 levels are prognostic for survival but not morbidity following radiation therapy of carcinoma of the cervix

PURPOSE

To determine whether pretreatment plasma-transforming growth factor beta 1 (TGF beta 1) levels are prognostic for tumor control and late morbidity following radiation therapy in carcinoma of the cervix.

METHODS AND MATERIALS

The study was comprised of 79 patients undergoing radiotherapy with curative intent for Stage I-III carcinoma of the cervix. TGF beta 1 levels were analyzed using ELISA. Late morbidity was measured using the Franco-Italian glossary. Data were available for the pretreatment levels of circulating tumor markers that represent disease burden, and for peripheral blood lymphocyte radiosensitivity measured as SF2.

RESULTS

Pretreatment TGF beta 1 levels were a significant prognostic factor for survival and local control. There were weak significant correlations of TGF beta 1 levels with disease stage and the levels of circulating tumor markers (CA125, TPA). There was a weak significant correlation between TGF beta 1 levels and normal cell radiosensitivity (lymphocyte SF2). There was no relationship between TGF beta 1 levels and grade of morbidity and pretreatment TGF beta 1 levels were not a significant prognostic factor for the probability of developing late morbidity.

CONCLUSION

In carcinoma of the cervix, pretreatment TGF beta 1 levels reflect tumor burden and are a significant prognostic factor for survival. Despite an underlying weak relationship of TGF beta 1 levels with intrinsic normal cell radiosensitivity, pretreatment levels are not prognostic for the probability of developing late complications. This finding does not rule out the possible usefulness of measurements toward the end of treatment once tumor burden has been reduced.

Predictive factors for tumor response to chemotherapy in patients with pancreatic cancer

BACKGROUND/AIMS

Systemic chemotherapy for pancreatic adenocarcinoma, at present, has been of limited value in clinical practice and only a small portion of patients obtains meaningful palliation.

METHODOLOGY

We retrospectively examined 96 patients with metastatic pancreatic adenocarcinoma undergoing systemic chemotherapy to determine factors predictive of tumor response. None of the patients had received any prior anti-cancer treatment except for pancreatectomy.

RESULTS

Of these 96 patients, 5 patients (5.2%) showed partial response but none showed complete response. There was no responder with a performance status of 2 or 3, serum albumin level less than 3.5 g/dL, serum total bilirubin level equal to or more than 2.0 mg/dL, or peritoneal dissemination. Response rates tended to be higher in the subgroups of female patients, those with serum albumin level > or = 3.5 g/dL and those with serum carcinoembryonic antigen level < 10 ng/mL, although there were no significant differences.

CONCLUSIONS

Patients with a poor performance status, hypoalbuminemia, jaundice, or peritoneal dissemination might be inappropriate candidates for systemic chemotherapy and might be treated with other experimental approaches or supportive care.

[Determining factors in the presence of carcinoma in prostate biopsies]

PURPOSE

Prostate biopsy is the diagnostic method to detect prostate carcinoma. We try to identify the optimal PSA cut-off, biopsy indication and the clinico-pathological characteristics in order to differentiate those patients with negative biopsy in which we should repeat the proceeding.

METHOD

We study 344 biopsies in 292 patients for 16 months. An univariate and multivariate study to identify the influent factors in the existence of prostate cancer in the first biopsy and in the patients with a second one was taken place.

RESULTS

Patients in the first biopsy Univariate study: Out of these variables (PSA, PSA ratio, digital rectal examination and prostate volume) just the PSA has statistical significance. Multivariate study: Only the the PSA is an indepent influence factor. Receiving Operated Curve: The optimal cut-off is 10.5 ng/ml. Patients with a second biopsy Univariate study: None of the variables is related with the existence of prostate cancer. Groups comparison: A comparison between the patients in the first biopsy and the patients with a second biopsy is performance with no statistical differences in the variables already mentioned.

CONCLUSION

The patient with a PSA greater than 4 ng/ml should be perform a prostate biopsy, mostly if his PSA is over 10 ng/ml. In our experience we do not related the need of a second biopsy with any factor in particular, therefore in our opinion and because of the high rate of negative false, all of the patients should be controlled and undergo a second biopsy if any change in PSA or clinics modification takes place.

Preoperative platelet count in pancreas cancer: a prognostic factor?

AIM

To determine whether preoperative platelet count influenced the prognosis for surgical treatment of pancreas cancer.

METHODS

Retrospective study of 144 patients operated on for pancreatic cancer: 49 with adenocarcinoma, operable with curative intent (group A), 86 in whom palliative resection or bypass was done (group B), and 9 in whom exploratory laparotomy was done. Preoperative platelet count was done for all patients. Groups A and B were divided into 2 subgroups (> 200,000 platelets/mm3 and < 200,000 platelets/mm3), and an additional subgroup was established for patients with > 300,000 platelets/mm3. Survival was analyzed in the resulting subgroups.

RESULTS

Among patients who underwent curative resection, statistical analysis revealed significantly better survival (p < 0.05) in patients with a platelet count > 200,000 platelets/mm3 and a very significant difference (p < 0.01) in the 300,000 platelets/mm3 subgroup. No differences were found in the subgroups of patients who underwent palliative surgery.

CONCLUSION

Preoperative platelet count may represent a prognostic factor in patients with pancreatic cancer operated on with curative intent. Our findings justify the need for clinical trials of antiangiogenic therapy.

Is prostate-specific antigen a reliable marker of bone metastasis in patients with newly diagnosed cancer of the prostate?

OBJECTIVE

Staging in patients with newly diagnosed cancer of the prostate has significant ramifications in the management of the disease. At present, measurement of serum prostate-specific antigen (PSA) concentration and radionuclide bone scintigraphy are two important procedures in the metastatic work-up of these patients. We evaluated the efficacy of PSA as a staging marker to discriminate prostate cancer patients with and without bone metastases.

METHODS

In a retrospective study, 359 prostate cancer patients with (n = 40) and without (n = 319) bone metastases were analyzed. In all patients the initial PSA measurement as well as the radionuclide bone scan were evaluated.

RESULTS

Patients without bone metastases demonstrated a median serum PSA concentration of 12 ng/ml, whereas those with bone metastases revealed a median serum PSA concentration of 59 ng/ml, with 7 patients demonstrating a serum PSA concentration of < 10 ng/ml. This resulted in a negative predictive value of 96%. In addition, only 40% of these patients with bone metastases demonstrated a serum PSA concentration of > 100 ng/ml, which resulted in a positive predictive value of 50%.

CONCLUSION

The serum PSA concentration seems only to provide limited information with regard to the presence of bone metastasis in patients with newly diagnosed cancer of the prostate. We therefore question whether a staging radionuclide bone scan may be omitted in patients with a serum PSA value of < 10 ng/ml.

Cytokeratin 8/18 levels in patients with prostate cancer and benign prostatic hyperplasia

OBJECTIVES

Recently, tissue polypeptide-specific antigen (TPS), a cytokeratin 18 marker, was described to be discriminative between cancer of the prostate (CaP) and benign prostatic hyperplasia (BPH). Cyfra 8/18, a marker which recognizes both cytokeratin 8 and 18 fragments, is discussed to improve sensitivity and specificity of TPS. We investigated whether Cyfra 8/18 serum concentration discriminates between patients with clinically localized CaP and BPH.

METHODS

Serum Cyfra 8/18 levels were determined in patients with untreated CaP before radical prostatectomy (pT1-3pNoMo; n = 11) and with histologically confirmed BPH (n = 22). Cyfra 8/18 concentration was correlated to the prostate-specific antigen (PSA) concentration.

RESULTS

Median Cyfra 8/18 level was 0.64 ng/ml in CaP patients and 0.57 ng/ml in BPH patients. This difference is statistically not significant (p = 0.91). Furthermore, no correlation to PSA levels could be established (CaP: r = 0.036; BPH: r = 0.09).

CONCLUSION

In contrast to a recent report we found the Cyfra 8/18 serum concentration to be a nondiscriminative parameter between CaP and BPH.

Serum levels of vascular endothelial growth factor dependent on the stage progression of lung cancer

STUDY OBJECTIVE

In lung cancer, vascular endothelial growth factor (VEGF) is an important cytokine and is correlated with tumor vessel density, malignant pleural effusions, and coagulation-fibrinolysis factors in vitro. We investigated the correlation between serum VEGF level and stage progression in lung cancer to study the predicted value of VEGF level. We also studied whether coagulation-fibrinolysis factors and PaO(2) levels, which are also important factors for the prediction of the clinical course, are correlated with VEGF.

METHODS

Forty-nine patients with lung cancer were investigated prospectively. VEGF levels of sera and malignant effusions, and plasma concentrations of coagulation-fibrinolysis factors were measured by enzyme-linked immunosorbent assay. We measured PaO(2) levels in all patients at rest.

RESULTS

Serum levels of VEGF were increased significantly according to stage progression. Additionally, plasma concentrations of D dimer, thrombin-antithrombin complex (TAT), and tissue plasminogen activator/plasminogen activator inhibitor type I complex were elevated significantly according to stage progression. The serum VEGF level had a significant positive correlation with the TAT and D dimer levels. Serum VEGF levels had a significant negative correlation with PaO(2) levels. The incidence of cerebral vascular disorder was significantly higher in the patients with systemic hypoxemia than in those without (p<0.05). Mean VEGF levels in malignant effusions in eight patients (five with pleural effusions, two with pericardial effusions, and one with both) were extremely high, especially in pericardial effusions ([mean +/- SD] pleural effusions, 531.9+/-285.4 pg/mL; pericardial effusion, 3,071.6+/-81.3 pg/mL).

CONCLUSION

We predict that in lung cancer, VEGF production and the abnormality of the coagulation-fibrinolysis system differ depending on the stage of progression of disease. Serum VEGF levels would be affected by PaO(2) levels in lung cancer.

Pharmacokinetics of gemcitabine and 2',2'-difluorodeoxyuridine in a patient with ascites

Gemcitabine (dFdC) is a prodrug that undergoes metabolism by cytidine deaminase to form an inactive metabolite, 2',2'-difluorodeoxyuridine (dFdU). The pharmacokinetics of dFdC and dFdU have been studied; however, their disposition has never been evaluated in a patient with ascites. A patient with pancreatic cancer and malignant ascites was treated with dFdC 1,500 mg/m2 over 150 minutes weekly for 3 weeks, repeated every 4 weeks. Serial plasma and ascites samples were obtained on weeks 1 and 2 of cycle 2. High-pressure liquid chromatography was used to quantify dFdC and dFdU in plasma and ascites. The systemic dispositions of dFdC and dFdU were similar to those reported in patients without ascites. The concentration of dFdC in ascites approached 1 mg/ml. Ascitic fluid did not serve as a depot for dFdC, and the agent's concentration in ascites approached that at which its phosphorylation is saturated.

Incidental prostatic adenocarcinomas and putative premalignant lesions in TURP specimens collected before and after the introduction of prostrate-specific antigen screening

BACKGROUND

Since the introduction of prostate-specific antigen (PSA) screening for the detection of prostatic adenocarcinoma (PCA), there has been an increase in the incidence of stage T1c PCA. The purpose of this study was to compare the frequency of incidental PCA found in transurethral resection of prostate (TURP) specimens for a 14-month period during 1989-1990 (before PSA screening was available) with the incidence of PCA for a 32-month period during 1997-1999 (after PSA screening became available).

DESIGN

Consecutive TURP specimens from the 2 time periods were reviewed to identify incidental PCA, prostatic intraepithelial neoplasia (PIN), and atypical adenomatous hyperplasia (AAH). Cases of TURP for palliative treatment of known advanced PCA were excluded from the study. All TURP specimens were fixed in 10% buffered formalin and were processed according to the same protocol.

RESULTS

We reviewed 533 and 449 TURP specimens for the time periods 1989-1990 and 1997-1999, respectively. Comparison of the results for these 2 time periods revealed that the combined prevalence of T1a and T1b PCA decreased over time from 12.9% to 8.0% (P =.06) with the introduction of PSA screening. A new group of T1c PCA was established in the post-PSA screening period of 1997-1999. There were no statistically significant differences in the incidences of T1a PCA, PIN, and AAH in TURP specimens for the 2 time periods.

CONCLUSION

The decreased incidence of T1b PCA in TURP specimens for the 1997-1999 period represents a shift in PCA staging. Some PCAs previously staged as T1b are now staged as T2 carcinomas, as a result of PSA screening and earlier clinical detection. The introduction of PSA screening has had no influence on the incidence of T1a PCA, PIN, or AAH in TURP specimens.

The value of percent free prostate specific antigen, prostate specific antigen density of the whole prostate and of the transition zone in Turkish men

INTRODUCTION

This study was undertaken to evaluate the value of percent free prostate specific antigen (PSA), PSA density of the whole prostate (PSAD) and of the transition zone (TZPSAD) in reducing unnecessary biopsies in Turkish men with serum PSA levels between 2.5 and 20 ng/mL.

MATERIALS AND METHODS

A total of 105 patients referred for early prostate cancer detection or lower urinary tract symptoms participated in the study. All patients had serum total PSA level, PSAD, total prostate volume, and rectal examination, 43 patients had serum free PSA level, and 65 patients had TZPSAD. Using transrectal ultrasound, sextant biopsy and two additional transitional zone biopsies were performed. The value of percent PSA, PSAD, and TZPSAD in reducing unnecessary biopsies was evaluated.

RESULTS

Prostate carcinoma was detected in 25 of 105 patients (23.8%). Overall, areas under the ROC curves for percent free PSA, PSAD, and TZPSAD were 0.553, 0.595, and 0.550, respectively. In patients with a benign rectal examination, the value of percent free PSA slightly increased. On the other hand, in patients with prostate volume smaller than 50 cc, the value of percent free PSA and TZPSAD was encouraging. Areas under the ROC curves for percent free PSA, and TZPSAD were 0.615 and 0.642 respectively.

CONCLUSION

In Turkish men with intermediate serum PSA concentrations, percent free PSA, PSAD, and TZPSAD are poor predictors of biopsy outcome, whereas in the prostate smaller than 50 cc, percent free PSA and TZPSAD provide additional information. This may reflect ethnic differences between this population and those reported in other series.

[High carcinoembryonic antigen level following cancer surgery: another way to detect thyroid medullary carcinoma]

INTRODUCTION

Thyroid medullary carcinoma is usually detected in the presence of an isolated thyroid nodule or in the context of a family disease: familial thyroid medullary carcinoma or multiple endocrine neoplasia type 2A.

EXEGESIS

Here we report a third means of detection: an unexplained rise in carcinoembryonic antigen levels after cancer surgery. In each case, the carcinoembryonic antigen increase led to the assessment of the caicitonin plasma level and to a thyroid echography being performed. Thyroid medullary carcinoma was confirmed in every case after surgery.

CONCLUSION

Even though the association of thyroid follicular carcinoma with familial adenomatous polyposis is common, the association of thyroid medullary carcinoma with breast or colonic carcinoma remains exceptional and probably accidental. Due to the seriousness of the thyroid medullary carcinoma, it is mandatory to look for it in the event of an unexplained rise in the carcinoembryonic antigen level, by assessing the calcitonin plasma level.