The diagnosis and detection of urogenital cancers

Urologic cancer

Cancer prevention and risk reduction in patients with carcinomas of the urinary tract are most easily identified by smoking cessation. Recent assessments of patients with bladder carcinomas show a high percentage of active smokers. Urologic surgeons and those dealing with cancers of the genitourinary tract should recognize such an important factor. In other lifestyle guidelines, the American Cancer Society suggests that those who significantly reduce the fat content of their diet with weight reduction will generally reduce risk factors in a number of cancers, including prostate cancer. Many new diagnostic tests have been introduced since the 1980 conference. Transrectal ultrasonography as a preoperative staging technique has been received with some enthusiasm. Currently, a national program for the testing of the detection of prostate cancer by ultrasound compared with other physical examinations and marker antigens, such as prostate antigen, is underway. The evaluation of renal masses continues to be improved by the use of ultrasonography and computed tomography (CT) scanning. Currently, magnetic resonance imaging (MRI) techniques are believed to have added some improved assessment for particularly large tumors and the question of their vascular extension. Occasionally observed lesions of the adrenal gland without hormonal expression in patients continue to be noticed during evaluations for frequently unrelated diagnoses. The management of such lesions less than 3.5 cm in diameter is believed to be conservative based on their size. Preoperative staging of the bladder has improved with transurethral ultrasonography use and the follow-up with patients has developed more frequently with the widely available urinary cytology. Fine needle aspiration of the prostate gland, lymph nodes, and other urinary tumor masses is increasing in diagnostic use. Flow cytometry has been applied to all lesions of the urinary tract and continues to be a field of clinical investigation. The field of biologic markers in diagnosis, detection, and follow-up evaluation of patients with carcinomas of the urinary tract is a most interesting and progressive one. Currently, the most widely accepted new innovation is the prostate antigen, which was developed by members of the National Prostatic Cancer Project between 1975 and 1986. Other markers offer potential added value in more accurate and earlier diagnosis and detection and correlation with prognostic factors concerning individual groups of patients. Progress in the detection, diagnosis, and management of genitourinary cancer is being achieved, and prevention, although perhaps simplistic in design, can be more readily applied.

Diagnostic techniques in prostatic cancer

At present no single test is effective in detecting prostatic carcinoma, although some newer tests show promise. Several investigators are working to increase the specificity and sensitivity of various radioimmunoassays for prostatic cancer detection, but to date this research has not been rewarding. Careful rectal examination and close attention to the patient's symptoms may still be the only keys to diagnosis. Patients in their 50s and 60s with acute onset of symptoms have a relatively high incidence of prostatic carcinoma. These patients should have a rectal examination and aspiration biopsy cytology of any suspicious areas found on examination. Possibly these patients should have aspiration biopsy cytology even in the absence of suspicious findings to screen for disease before it becomes an obvious clinical entity. This is perhaps the best approach to prostatic cancer, ie, attack at a time in which there are fewer cells and a greater chance of cure.

A study of multiple biological markers in twins

Genetic and environmental influences on the phenotypic expressions of several biological markers were studied in 18 monozygous (MZ) and 8 dizygous (DZ) twin pairs. Zygosity was determined using ABO, Rh, and HLA. The biomarkers studied included: T & B lymphocytes, suppressor and helper T lymphocytes (T gamma, T mu), T cell (PHA) mitogen activation (MA), serum immunoglobulins (IgA, IgM, and IgG), plasma carcinoembryonic antigen (CEA), aryl-hydrocarbon hydroxylase (AHH) and sister chromatid exchange (SCE) in lymphocytes. Temporal variation of markers over a 6-month period was not significant. The mean absolute differences between levels from first and second blood draws were less than one standard deviation. Variability associated with age was not significant. Females had higher levels of T lymphocytes than males. A gender related association was observed for the IgM immunoglobulin test: females had a higher mean level of IgM. Smoking was found to influence the levels of SCE, T helper lymphocytes and mitogen activation. The variability of these biomarkers within and between twin pairs was quantified. Immunoglobulin levels, particularly that of IgM, showed statistically greater similarity within MZ twins than within DZ twins. Several other markers suggested heritability.