DNA damage phenotype and prostate cancer risk

The capacity of an individual to process DNA damage is considered a crucial factor in carcinogenesis. The comet assay is a phenotypic measure of the combined effects of sensitivity to a mutagen exposure and repair capacity. In this paper, we evaluate the association of the DNA repair kinetics, as measured by the comet assay, with prostate cancer risk. In a pilot study of 55 men with prostate cancer, 53 men without the disease, and 71 men free of cancer at biopsy, we investigated the association of DNA damage with prostate cancer risk at early (0-15 min) and later (15-45 min) stages following gamma-radiation exposure. Although residual damage within 45 min was the same for all groups (65% of DNA in comet tail disappeared), prostate cancer cases had a slower first phase (38% vs. 41%) and faster second phase (27% vs. 22%) of the repair response compared to controls. When subjects were categorized into quartiles, according to efficiency of repairing DNA damage, high repair-efficiency within the first 15 min after exposure was not associated with prostate cancer risk while higher at the 15-45 min period was associated with increased risk (OR for highest-to-lowest quartiles=3.24, 95% CI=0.98-10.66, p-trend=0.04). Despite limited sample size, our data suggest that DNA repair kinetics marginally differ between prostate cancer cases and controls. This small difference could be associated with differential responses to DNA damage among susceptible individuals.

Investigating the distribution of prostate cancer using three-dimensional computer simulation

The objective of this work was to investigate the distribution of prostate cancer using three-dimensional (3-D) computer simulation. Two hundred and eighty-one 3-D computer prostate models were constructed from radical prostatectomy specimens. An algorithm was developed which divided each model into 24 symmetrical regions, and it then detected the presence of tumor within an individual region. The distribution rate of prostate cancer was assessed within each region of all 281 prostate models, and the difference between the rates was statistically analyzed using Mantel-Haenszel methodology. There was a statistically significant higher distribution rate of cancer in the posterior half (57.2%) compared to the anterior half ( 40.5%; P=0.001). The base regions (36.8%) had a statistically significant lower distribution rate than either the mid regions (56.3%; P=0.001) or the apical regions (53.5%; P=0.001). The mid regions did have a statistically significant higher distribution rate compared to the apical regions (P=0.032). There was no statistically significant difference between the distribution rate on the left half (48.5%) compared to that on the right half (49.2%; P=0.494). The spatial distribution of prostate cancer can be analyzed using 3-D computer prostate models. The results illustrate that prostate cancer is least commonly located in the anterior half and base regions of the prostate. Through an analysis of the spatial distribution of prostate cancer, we believe that new optimal biopsy strategies and techniques can be developed.

Therapeutic strategies for localized prostate cancer

Prostate-specific antigen determinations for prostate cancer screening have led to a dramatic increase in the number of men who are diagnosed with organ-confined and therefore potentially curable prostate cancer. Advances in predicting outcomes with artificial neural networks may help to recommend one therapy over another. Less invasive forms of treatment, such as high-intensity focused ultrasound, may ultimately give patients additional options for treatment. Furthermore, attempts to better define the role of both neoadjuvant hormonal therapy and chemotherapy may give higher-risk patients better outcomes than with current treatments. These advances as well as continued research will likely lead to a day when more and more men with organ-confined disease will be cured.

Limitations of reduced-field irradiated volume and technique in conventional radiation therapy of prostate cancer: implications for conformal 3-D treatment

In order to define technical limitations of conventional external beam irradiation for clinically localized prostate cancer, we evaluated the impact of several reduced-field treatment factors, such as reduced-field (RF) irradiated volume, RF technique, photon energy of treatment, and dose on survival endpoints and local control in a retrospective series. Several survival endpoints, such as disease-specific survival, freedom from relapse survival, biochemical no-evidence of disease (bNED) survival, and local control were associated with several treatment variables using univariate and multivariate analyses in 329 patients. Reduced-field technique appeared to predict survival outcome, with patients treated by bilateral 120 degrees arcs faring less well than those treated by full 360 degrees rotational fields. The irradiated volume of the reduced-field was also significantly associated with survival outcome, with patients treated with smaller volumes faring less well. Local failure rates also appeared increased, although not statistically, in patients treated with smaller RF sizes. In an attempt to explain these detected deficiencies, dose-volume histograms for prostate coverage were created for a small sample of patients. The deficiencies related to small reduced-field volume appeared to be largely attributable to poor dosimetric coverage of the prostate. These results underscore the limitations of conventional external beam treatment for prostate carcinoma when conventional techniques are employed, particularly if small reduced fields are used, and further supports the development of improved treatment techniques, such as conformal irradiation, as alternatives.

A new temporary catheter (ContiCath) for the treatment of temporary, reversible, postoperative urinary retention

OBJECTIVES

To describe the initial experience of a newly designed temporary urethral catheter, ContiCath, as an aid in the management of postoperative or temporary outflow obstruction. In patients with normal detrusor and sphincter function, this catheter allows volitional voiding while maintaining an open prostatic urethra.

METHODS

In a pilot study, 64 nonconsecutive patients with postoperative or temporary urinary retention, at eight clinical trial sites, were enrolled for the placement of this temporary catheter. Three patients did not have the catheter placed because of placement failure because of either a large median lobe or a urethral stricture. The remaining 61 patients were divided into three groups: those with non-neuropathic causes of retention and retention for 1 week or less (37 patients), those with non-neuropathic causes of retention and retention for longer than 1 week (19 patients), and those with neuropathic causes of retention and retention for longer than 1 week (5 patients). The ContiCath is placed in the office setting, in the same fashion as a Foley catheter. A blue prolene tether extends from the bulbar urethra to the meatus to assist in the removal of the device. Patients were then reassessed at 3 hours, and at 7, 14, 21, and 28 days, at which point the device was removed.

RESULTS

In patients with a neuropathic cause for their retention (5 patients) and those with non-neuropathic causes of retention and retention for longer than 1 week (19 patients), only 3 patients were able to void after the catheter was placed. Of the 37 patients with a non-neuropathic cause and retention 1 week or less, controlled voiding was seen in 33 patients (89%). Controlled voiding was defined as the patient's volitional ability to initiate and stop his urinary stream. There were no complications with catheter placement; however, 8 patients (24.2%) had minor adverse experiences of frequency/urgency (n = 3), incontinence (n = 3), migration of the catheter (n = 1), and pain (n = 1).

CONCLUSIONS

ContiCath offers an alternative to an indwelling Foley catheter in men with temporary bladder outlet obstruction and urinary retention.

Transurethral microwave thermotherapy

OBJECTIVES AND METHODS

The present status of transurethral microwave thermotherapy (TUMT) in the low (LE) and high energy (HE) version is given as an overview.

RESULTS

With LE software, approximately 75% of patients will note significant improvement with 65% reduction in symptom scores and a 35-40% improvement in peak flow rate. Sham studies have shown statistically significant improvement in treated patients compared to sham. Randomized studies between TUMT and TURP show similar improvements in symptom scores with TURP producing higher flow rates, as expected. Long-term studies have been reported to 5 years showing durability, although 10-20% of patients subsequently undergo TURP. The clinical efficacy of HE-TUMT 2.5 has been documented in recently completed studies. Approximately 37% of patients develop cavitation with HE-TUMT. The symptomatic improvement is similar between low and high energy while the flow rates with high energy improve by approximately 65%. Pressure flow studies have documented relief of obstruction in most of those patients who had obstruction prior to treatment. The morbidity of HE-TUMT in terms of retrograde ejaculation and posttreatment retention is higher compared to the LE version.

CONCLUSIONS

TUMT is a 1-hour out-patient, local anesthetic procedure, minimally invasive treatment option for benign prostatic hyperplasia that encompasses microwave radiative heating and water conductive cooling. TUMT has been proven both safe and efficacious for relieving benign prostatic hyperplasia symptoms in several large-scale controlled studies. The existence of low and high energy versions offers the opportunity to select patients according to obstruction grade.

The radiographic diagnosis of pelvic lipomatosis

We describe a patient who initially presented with asymptomatic hydronephrosis. He underwent extensive radiologic evaluation which led to the diagnosis of pelvic lipomatosis. The possible etiology, workup, and treatment options of this unusual entity are discussed.

Renal angiosarcoma: a rare primary genitourinary malignancy

Sarcomatous lesions of the kidney comprise less than 2% of all primary renal malignancies. Angiosarcomas are an exquisitely infrequent histologic type in this setting and are associated with a universally poor prognosis. We report the eighth known case of primary renal angiosarcoma and review the available literature on this rare entity.

Treatment of female urethral carcinoma in medically inoperable patients using external beam irradiation and high dose rate intracavitary brachytherapy

PURPOSE

We developed and present our experience with high dose rate brachytherapy for treatment of carcinoma of the urethra in medically inoperable women.

MATERIALS AND METHODS

Since 1991, 4 women with localized urethral cancer, medically unable to undergo resection or interstitial implantation, were treated with external beam and high dose rate intracavitary implantation rather than external beam irradiation alone. The fractionated implants were delivered with a high dose rate remote afterloader using a shielded vaginal applicator and modified urethral catheter. The urethral catheter was inserted through the lumen of a 20F Foley tube to improve depth dose. Homogeneous dose distribution was achieved and customized to the individual patient.

RESULTS

All high dose rate brachytherapy treatments were given at the clinic without use of sedation or anesthesia. Treatment was well tolerated, and all patients maintained voluntary urinary function and local control at 12 to 55 months after therapy. Chronic morbidity due to urethral, bladder, vaginal or rectal injury, including urethral stenosis, necrosis or fistula, was not noted. Isodose distributions were compared among this technique, interstitial implantation and external beam radiotherapy alone.

CONCLUSIONS

Although we prefer interstitial implantation as the boost technique for women with urethral cancer, high dose rate brachytherapy is a reasonable option for medically inoperable patients. This outpatient treatment is well tolerated, preserves voluntary urinary function and enhances quality of life.

Management of locally advanced prostate cancer

The staging and treatment of prostate cancer are complex, particularly in patients with clinical disease that has advanced locally beyond the confines of the gland. Management choices are made more difficult by a paucity of quality randomized and controlled studies. Staging has traditionally relied on digital rectal examination, which is now being augmented by improved noninvasive radiologic studies. Radiation is the most common form of treatment today, and newer techniques are being examined and compared to external-beam therapy. Surgical intervention as monotherapy has failed to show a survival advantage. Current approaches treatment appear to be evolving toward combination therapies, potentially incorporating hormonal manipulation. Patients with locally advanced disease should be encouraged to enter prospective clinical trials.

Transurethral microwave thermotherapy for management of benign prostatic hyperplasia: results of the United States Prostatron Cooperative Study

The primary objective of the study was to determine the safety and efficacy of transurethral microwave thermotherapy for the treatment of symptomatic benign prostatic hyperplasia. From March to August 1991, 150 patients were entered into a multi-site study and treated with transurethral microwave thermotherapy under a Food and Drug Administration approved protocol. Only patients with symmetrical trilobar or bilobar prostatic hypertrophy, peak flow rate of less than 15 cc per second (on 2 voided volumes of 150 cc or greater) and a total Madsen symptom score of more than 8 were treated. Transurethral microwave thermotherapy was performed with a 20F catheter and 1,296 MHz. microwave antenna for 60 minutes. The mean power achieved for this single session was 32.1 watts, with a mean power at maximum urethral temperature of 41.1 watts. Mean urethral temperature was 44.3C and the mean rectal temperature was 42.2C. The rectal and urethral temperatures were continuously monitored. Mean peak urinary flow rates, Madsen symptom score, post-void residual volume and improvement in motivating symptom to seek treatment were measured at 6 weeks, and 3, 6 and 12 months. Mean peak urinary flow rates improved 33% at 12 months (p < 0.0001). Overall, the mean Madsen symptom score improved 61% (p < 0.0001). The obstructive score and the irritative score improved 67% and 43%, respectively. Of 17 patients 12 (71%) reported improvement in weak stream when that was the motivating symptom to seek treatment. Of 28 men 18 (64%) reported improvement in nocturia, while 11 of 30 (37%) reported improvement in daytime frequency and 12 of 17 (71%) reported improvement in urgency. There was no statistically significant difference in post-void residual volume at 12 months from baseline. The treatment was well tolerated by all patients, and side effects were considered mild and transitory. Our study demonstrates the safety, effectiveness, patient tolerability and durability of transurethral microwave thermotherapy.

Treatment of advanced prostate cancer

Many patients with prostate cancer present with advanced disease (stage C or D). For these patients, treatment is palliative and is aimed at reducing serum testosterone levels. Since the growth of prostate cancer is testosterone-dependent (approximately 95% of testosterone is produced by the testes, with the remainder coming from the adrenals), hormonal manipulation has been the mainstay of palliative treatment. Bilateral orchiectomy has been the traditional approach, but most patients prefer equally effective drug therapies that include the administration of estrogens, luteinizing hormone-releasing hormone (LHRH) agonists, and anti-androgens.

Chemotaxis and chemokinesis of human prostate tumor cell lines in response to human prostate stromal cell secretory proteins containing a nerve growth factor-like protein

The migration of three human prostate tumor epithelial cell lines (TSU-pr1, PC-3, DU-145) in response to secreted protein from a human prostate stromal cell line was investigated by using the modified blind-well Boyden chamber assay. Migrated cells were quantified by spectrophotometrically measuring the concentration of crystal violet stain extracted from their nuclei. Cell number was correlated linearly with the concentration of extracted crystal violet stain. All three tumor cell lines showed intrinsic migratory ability in the absence of chemoattractants, such that approximately 1-7% of plated cells migrated across the filter of the Boyden chambers during a 5-h incubation period. Prostate tumor cell migration was significantly enhanced (3-13-fold) in response to stromal cell secretory protein in a dose-dependent manner, whereas bovine serum albumin had no effect on stimulating tumor cell migration. Immunoprecipitation of the stromal cell secreted protein with a nerve growth factor antibody partially and significantly reduced its stimulatory activity for tumor cell migration. A Zigmond-Hirsch matrix assay of tumor cell migration in response to various concentration gradients of stromal cell secreted protein demonstrated both chemotaxis and chemokinesis by all three cell lines. These results are consistent with the stromal cell secretory protein stimulation of chemokinetic tumor cell migration through the capsule of the prostate. Outside of the prostate gland metastasis of tumor cells may occur by chemotaxis to preferential sites containing chemoattractants similar to or related to maintenance factors that can substitute for components of stromal cell secretory protein.

Management of stage C adenocarcinoma of the prostate

A review of numerous clinical series dealing with the treatment of patients with clinical stage C prostate cancer failed to find the treatment or a combination of treatments that is superior to any other. Accurate staging, which was difficult in older studies, and stage migration, which complicates the comparison of recent to older studies, may contribute to this lack of identification. The majority of patients ultimately experience disease progression and are therefore treated with hormonal therapy, the use of which obscures survival data for initial modes of treatment. These observations point to the need for control of randomised clinical trials to identify effective treatments in the future.

Reduced expression of the low affinity nerve growth factor receptor in benign and malignant human prostate tissue and loss of expression in four human metastatic prostate tumor cell lines

In the human prostate, a low affinity (p75) nerve growth factor (NGF) receptor (NGF-R) localizes to the epithelia while a NGF-like protein localizes to the stroma. This NGF-like ligand, derived from prostate stromal cell cultures, has been shown to participate in paracrine mediated growth of a human tumor epithelial cell line (TSU-prl) in vitro. In order to investigate the role of the NGF-R in neoplastic growth we have examined the expression of the NGF-R in normal prostate tissues, benign prostatic hyperplasia tissues, adenocarcinoma tissues, and four metastatic tumor cell lines of the human prostate. In primary epithelial cell cultures of normal human prostate the p75 NGF-R was localized by immunocytochemistry to cytoplasmic vesicles. Furthermore, Western blot analysis of the NGF-R in subcellular fractions of normal prostate tissue identified an M(r) 75,000 immunoreactive protein in the microsomal fraction under nonreducing conditions of sodium dodecyl sulfatepolyacrylamide gel electrophoresis. However, microsomal preparations of five prostatic adenocarcinoma and five benign prostatic hyperplasia specimens showed varying immunoreactivity among samples, all of which expressed less of the p75 NGF-R than the normal tissue. Interestingly, microsomal preparations of the human prostatic epithelial cell lines, TSU-prl, DU-145, PC-3, and LNCaP did not show NGF-R expression by immunoblot analysis. Hence, expression of the p75 NGF-R in normal prostate tissue, partial loss of NGF-R expression in benign and malignant prostate tissue, and complete loss of NGF-R expression in the four metastatic tumor cell lines, suggests an inverse association of p75 NGF-R expression with the neoplastic progression of the human prostate.

Distribution of nerve growth factor-like protein and nerve growth factor receptor in human benign prostatic hyperplasia and prostatic adenocarcinoma

Recent observations from our laboratory have identified a nerve growth factor (NGF)-like protein in conditioned media of stromal cells and neoplastic epithelial cells of the human prostate which mediates paracrine interactive growth of both cell types in vitro. In order to investigate the location of this NGF-like protein in the human prostate in vivo, and whether a nerve growth factor receptor (NGF-R) could be identified, we have carried out immunocytochemical studies on frozen tissue sections of human benign prostatic hyperplasia (BPH), prostatic adenocarcinoma and normal prostatic tissue. The NGF-like protein localized predominantly to the stromal component of BPH, adenocarcinoma and normal (non-cancerous) prostatic tissue. Conversely, the NGF-R localized predominantly to the epithelial cells of these tissues. Renal tissue provided negative controls for both the NGF-like protein and the NGF-R. The testis provided positive controls for both the NGF-like protein and the NGF-R. These results provide corroborative evidence for a NGF-like protein produced by stromal cells which interacts with a NGF-R on the adjacent epithelial cells thereby mediating paracrine interactive growth regulation of the human prostate.

The effect of pH on the in vitro colony forming ability of transitional cell carcinoma cells treated with various chemotherapeutic agents: implications for in vivo therapy

Extracellular pH may affect the sensitivity of cancer cells to chemotherapy agents. In an attempt to maximize the conditions for chemotherapy treatment of transitional cell carcinoma we tested the effect of pH on sensitivity of MGH-U3 transitional cell carcinoma cell line to thiotepa, doxorubicin, and mitomycin c in vitro. The toxicity of each agent tested varied with pH. There was no variation in cell growth in response to pH alone. The cytotoxic activity of thiotepa was markedly enhanced when cells were treated with a diluent pH of 5.5. Significant differences were also observed after treatment with doxorubicin and mitomycin c with a diluent pH of 7.0. This in vitro assay may be useful for clinical application of pH modulation during intravesical chemotherapy.

Density dependent polarized secretion of a prostatic epithelial cell line

The polarized secretions (apical/basal) of newly synthesized total protein and proteases from prostatic epithelial sheets of PA-III cells grown in dual compartment chambers were investigated at various cell densities and culture conditions. PA-III cells grown in a serum free defined medium (SFDM) form morphologically polarized monolayers of epithelial cells. These cells secreted their 35S-methionine labeled total protein in a predominantly apical direction (apical/basal ratio, 4-8 fold), with a lesser proportion of protein secreted apically at lower cell densities of the PA-III cell monolayer. PA-III cells grown in 5% fetal calf serum (FCS) are morphologically squamous, comparable to the anaplastic phenotype, and exhibited an inversion of polarized total protein secretion (apical/basal ratio, 0.4-0.9 fold), with an increased proportion of total protein secreted in a basal direction at lower cell densities. Since the culture of PA-III cells in FCS may approximate the anaplastic phenotype we investigated the polarized secretion of proteases from these cells at various cell densities, and compared them with the secretory pattern of protease secretion from polarized PA-III cells cultured in SFDM. At lower cell densities of the PA-III cells grown in FCS the polarity of protease secretion was inverted such that metalloproteinases, tissue type plasminogen activator, and a 72 kD gelatinase were secreted in a predominantly basal direction, as well as urokinase and a gelatinase of 26 kD that were secreted more or less equally into the apical and basal compartments of the chambers. On the other hand, for cultures of PA-III cells grown in SFDM the aforementioned proteases exhibited predominantly an apically directed polarity of secretion. These results suggest that the anaplastic phenotype characterized by a loss of polarized structure may also be characterized by a functional loss or inversion of polarized secretion. The consequences of such a loss or inversion of polarized secretion would be to increase the localized concentrations of proteases along the basal domain of cells thereby facilitating degradation of the basement membrane and interstitial tissue in vivo.

Primary leiomyosarcoma of adrenal gland. Case report with immunohistochemical and ultrastructural study

A primary leiomyosarcoma of the right adrenal gland is reported in a 49-year-old male who presented with progressive flank pain. This is the second case in the English language literature and the first to have documentation of malignant behavior. The tumor measured 11 cm in diameter and showed marked necrosis with prominent mitotic activity (average 15 per 10 high-power fields). Smooth muscle differentiation was apparent ultrastructurally and confirmed by positive immunostaining for muscle-specific and alpha-smooth muscle actin. Bony metastases developed; following palliative treatment with radiation and chemotherapy, the patient is alive with tumor 9 months later. Origin from smooth muscle associated with the central adrenal vein or its tributaries is proposed.

Regulation of growth by a nerve growth factor-like protein which modulates paracrine interactions between a neoplastic epithelial cell line and stromal cells of the human prostate

Nerve growth factor-like substance(s) were identified in both conditioned media of a human prostatic tumor epithelial cell line (TSU-pr1) and a human prostatic stromal cell line (HPS) by Western blot analysis and bioassay of neurite outgrowth of PC12 cells. Nerve growth factor-beta (NGF) immunofluorescence was also localized to secretory vesicles in the cytoplasm of both the TSU-pr1 and HPS cells. Western blot of the TSU-pr1 and HPS cell-secreted protein identified an Mr 65,000 major protein which immunoreacted with murine NGF antibody. NGF Western blot of HPS cell-secreted protein also identified an Mr 42,000 minor band under reduced and nonreduced conditions and an Mr 61,000 minor band under reduced conditions. The secreted protein from the TSU-pr1 cells (50 micrograms/ml) and HPS (50 micrograms/ml), as well as murine NGF (50 ng/ml) or human recombinant NGF (50 ng/ml), stimulated neurite outgrowth from PC12 cells. This neurite outgrowth activity was partially inhibited by treatment with NGF antibody. Neither the serum containing growth medium nor bovine serum albumin (50 micrograms/ml) stimulated neurite outgrowth. The NGF-like secretory protein appeared to play a role in the paracrine regulation of prostatic growth between TSU-pr1 cells and HPS cells. The relative growth of TSU-pr1 cells, as indicated by [3H]thymidine incorporation, in response to HPS secretory protein was stimulated 2.8-fold in a dose-dependent manner. In the converse interaction, the relative growth of HPS cells in response to TSU-pr1 secretory protein was stimulated 1.8-fold in a dose-dependent manner. Immunoneutralization of TSU-pr1 and HPS secretory protein was performed with antibody against NGF, acidic fibroblast growth factor, and basic fibroblast growth factor. Removal of the NGF-like protein from the maximal stimulatory dose of TSU-pr1 secretory protein (100 micrograms/ml) with NGF antibody reduced HPS proliferation to 52% of maximal levels, and immunoneutralization of the NGF-like protein in the maximal stimulatory dose of HPS secretory protein (20 micrograms/ml) also reduced TSU-pr1 proliferation to 16% of maximal levels. Addition of normal rabbit serum or prior immunoprecipitation of either TSU-pr1 or HPS secretory protein with antibody against acidic fibroblast growth factor and basic fibroblast growth factor did not inhibit the proliferation of either cell type. These results suggest that TSU-pr1 tumor cells and HPS cells secrete NGF-like protein(s) which modulate their paracrine interactive growth in vitro.

Penile cancer: curable with early detection

When this malignancy is recognized and treated early, cure rates are high. No one approach to the treatment of penile cancer is acceptable to all surgeons, however. Diagnosis and treatment guidelines are reviewed.

Paracrine stimulation of polarized secretion from monolayers of a neoplastic prostatic epithelial cell line by prostatic stromal cell proteins

The paracrine influence of prostatic stromal cell proteins on a neoplastic prostate cell line (PA-III) was investigated. We have utilized an in vitro experimental model whereby confluent epithelial sheets of PA-III cells are grown on Matrigel-coated filters in bicameral chambers (Millicell-HA). Confluence of the epithelial sheet was confirmed morphologically by electrical resistance measurements and by impedence of [3H]inulin permeability across paracellular channels. Stromal cells were isolated from the ventral prostate of 50-day-old rats by isopyknic Percoll centrifugation. Purity (92%) of the isolated stromal cells was confirmed by indirect immunofluorescence of vimentin intermediate filaments. Prostatic epithelial cells were negative for vimentin immunofluorescence. Prostatic stromal cell secretory proteins with molecular weights greater than 10,000 were placed in the basal reservoir of the bicameral chambers underneath the confluent epithelial sheets of PA-III in a manner that mimics the relationship between stroma and epithelia in vivo. After 24 h incubation the stromal cell proteins increased the [35S]methionine-labeled protein secretion from the epithelial sheet of cells. Trypsinization of the stromal cell secretory proteins eliminated the stimulatory effect on epithelial protein secretion. In addition, conditioned media from Swiss 3T3 fibroblasts, A431 cells, or bovine serum albumin did not stimulate epithelial protein secretion. Two-dimensional gel electrophoresis of the [35S]methionine-labeled epithelial protein secretion showed that the stromal cell proteins induced the secretion of a novel peptide (SE-1) from the basal domain of the epithelial sheet of cells within the first hour of metabolic labeling. These results indicate that stromal cell secretory proteins contain a stimulatory protein that can induce overall protein secretion as well as the vectorial secretion of a novel peptide from the basal domain of PA-III epithelial cells. These results are consistent with a paracrine interaction between epithelial and stromal cells in the regulation of prostatic secretion.

Priapism: current concepts

The treatment options for the management of the patient with priapism have changed markedly within the past several years. When possible, the underlying cause of the priapism should be identified. Therapy should be guided by the results of aspiration of the blood-filled corpora cavernosa of the erect penis. Early intervention through pharmacologic manipulation or surgical shunting should not be delayed while trying conservative measures.

Prognostic significance of DNA ploidy in carcinoma of prostate

Flow cytometry was used to measure the DNA content in archived paraffin-embedded human prostatic cancer tissue for 69 patients with known outcomes that presented between 1975 and 1982. Of these, 51 patients had clinically localized lesions and were surgically staged prior to radical prostatectomy, while 18 patients presented with advanced Stage D2 disease. Thirty-six of 37 (97.3%) pathologic Stage B lesions were diploid. In contrast, the majority (72.2%) of patients with metastatic disease had aneuploid tumors. The average Gleason grade for aneuploid tumors was 8.2 +/- 1.98 versus 5.5 +/- 1.89 for diploid tumors (p less than 0.01). For 51 patients with clinically localized tumors, 13.9 percent of diploid tumors with a low Gleason sum (2 to 6) had extracapsular spread of tumor or regional lymph node involvement compared with 83.3 percent of aneuploid tumors with high Gleason scores (7 to 10). The addition of DNA ploidy to degree of glandular differentiation may enhance the prognostic evaluation of prostatic tumors and eventually improve our ability to select patients who are likely to benefit from radical prostatectomy.

Emotional autonomy versus detachment: revisiting the vicissitudes of adolescence and young adulthood

3 studies reexamine Steinberg and Silverberg's construct of "emotional autonomy" (EA) in adolescent and young adult samples. We argue that rather than measuring either autonomy or independence, EA represents emotional detachment from parents. In Study 1, EA is shown to be negatively associated with early adolescents' (n = 148) reported quality of attachment to parents, but not to friends. In Study 2, EA is shown to be positively related to experienced parental rejection but largely unrelated to perceived independence-support in a high school sample (n = 193). In Study 3, EA in young adults (n = 104) is inversely related to measures of family cohesion, parental acceptance, independence support, and self-perceived lovability. Finally, a projective measure of parental nurturance taken by a subsample of subjects (n = 58) was associated negatively with EA but positively with perceived lovability. Discussion concerns the conceptualization of attachment versus detachment, dependence, and autonomy in theories of adolescence.

Daily variability in human serum prostate-specific antigen and prostatic acid phosphatase: a comparative evaluation

The daily variation of serum levels of prostate-specific antigen (PSA) and prostatic acid phosphatase (PAP) was investigated simultaneously in 10 patients with osseous metastatic prostatic cancer, 10 patients with benign prostatic hyperplasia, and 10 volunteers without prostatic disease. Duplicate serum samples were obtained from all patients on the same day at 8 AM, 12 PM, 4 PM, and 8 PM. Statistical analysis (two-factor analysis of variance comparing time period to disease group) of the mean PSA and PAP levels at the four sampling times on all patient groups demonstrated no evidence of circadian rhythmic variation or any other distinct pattern for the observed sample times. Overall, the variability in PSA levels was significantly less than that observed for PAP. There was no significant difference in mean percent variation between patient groups (cancer, benign, and normal prostate glands) for both the PSA and PAP assays. Our data reveal that serum PSA measurements fluctuate unpredictably over the course of a day in patients with and without prostatic disease, but to a lesser extent than that seen for serum PAP values. These findings illustrate the potential inaccuracy of single determinations of serum PAP or PSA levels for monitoring disease recurrence and treatment response in patients with prostate cancer.

Epididymitis--an unusual presentation of colovesical fistula secondary to diverticulitis. Report of a case

A case of colovesical fistula secondary to diverticulitis that had the unusual presentation of epididymitis is presented. The current literature on diverticulitis involving the urinary tract is reviewed.

Renal cell carcinoma: dynamic thin-section CT assessment of vascular invasion and tumor vascularity

Dynamic thin-section computed tomography (CT) was used to evaluate renal cell carcinoma in 80 patients. The lesion was correctly staged with CT in 90% of patients. With use of the dynamic technique, the ipsilateral renal vein was depicted in 99% of patients. Extension of the tumor to the renal vein or the inferior vena cava was correctly detected in 18 of 19 patients. Actual depiction of tumor thrombus was a far more accurate indicator of renal vein invasion than was the identification of isolated renal vein enlargement. Dynamic thin-section CT of the kidney should be considered the routine method for comparison studies with other newer cross-sectional techniques in the evaluation of renal cell carcinoma.

The acute scrotum

Testicular torsion is characterized by the sudden onset of testicular pain associated with abdominal pain, nausea and vomiting. Fever is unusual and urinalysis is often normal. Fever, pyuria, dysuria and urethral discharge are characteristic of epididymitis. Radionuclide scanning and Doppler ultrasound are helpful in establishing the diagnosis. If the diagnosis is uncertain, the patient should be considered to have testicular torsion until it is proved otherwise. Undiagnosed torsion leads to testicular necrosis.

Benign villous polyp with prostatic type epithelium of the penile urethra

We report a case of a benign polyp of the penile urethra composed of prostatic type epithelial tissue. The etiology, pathology, diagnosis and treatment of these uncommon lesions are discussed.

Characterization of secretion pattern of human prostatic acid phosphatase: a reassessment

The daily variation of serum levels of prostatic acid phosphatase (PAP) determined by the Roy enzymatic method was investigated in 10 patients with metastatic prostatic cancer and in 10 patients without prostatic disease. Duplicate serum samples were obtained from all patients on the same day at 8 AM, 12 PM, 4 PM, and 8 PM. Statistical analysis of the mean PAP levels at the four sampling times in both groups of patients demonstrated no evidence of circadian or diurnal rhythmic variation. Prostate cancer patients did show significantly greater variability in daily PAP than patients without prostatic disease, although a distinct pattern of secretion was not observed in either group. These results underscore the potential inaccuracy of the use of single determination of serum PAP as a parameter of response in patients with metastatic prostatic cancer and in the staging of patients with clinically localized prostatic malignancy. Evaluation of trends of PAP levels over time, however, continues to play a major role in the assessment and management of patients with prostatic carcinoma.

Hydroxyproline as a marker for following patients with metastatic prostate cancer

Serial measurements of urinary hydroxyproline excretion were performed in 16 patients with stage D2 prostatic cancer to evaluate its role as a marker for following disease course. Patients were defined as having stable or progressive disease by the criteria of the National Prostatic Cancer Project. For patients with stable disease and those with disease progression excretion of hydroxyproline did not correlate with the clinical course. We did not find that hydroxyproline was a useful marker in the clinical setting to follow patients with prostatic cancer.

Adrenal metastases by renal cell carcinoma. Incidence at nephrectomy

Recently, there have been questions raised as to the results and feasibility of performing renal-sparing procedures for localized renal cell carcinoma. We reviewed the records of 72 patients treated with standard radical nephrectomy to determine the incidence of adrenal involvement and to determine if adrenal lesions were detectable by radiographic methods preoperatively. Four patients had evidence of adrenal involvement for an overall incidence of 5.5 per cent. All had upper pole lesions. Adrenal involvement in each case was apparent at surgery or on preoperative imaging studies. For patients with middle and lower pole localized renal cell carcinoma who have normal findings on preoperative computerized tomography scans, modified radical nephrectomy sparing the adrenal gland may be a surgical alternative to radical nephrectomy.

Computed tomography of adrenal abscess

We present a patient with a progressively enlarging adrenal mass detected by CT which extended to the renal hilum and inferior vena cava. Pathologic evaluation revealed an adrenal abscess containing purulent debris.

Thrombosis of the inferior vena cava by seminoma

We report a case of metastatic seminoma that caused thrombosis and obstruction of the inferior vena cava. The pathogenesis of this rare clinical entity is discussed. The diagnostic studies for detection of vena caval thrombosis and clinical management strategies are reviewed.

Invasion of the inferior vena cava by testicular seminoma: demonstration by computed tomography and venography

Involvement of the inferior vena cava (IVC) by testicular neoplasms is unusual and often clinically unsuspected. We present a patient with testicular seminoma that involved the IVC secondarily and caused multiple pulmonary emboli requiring the placement of a caval filter. The radiographic features of this phenomenon are presented with special emphasis on the computed tomographic (CT) appearance of caval thrombosis and pulmonary embolus. The characteristically low density lymphadenopathy of seminoma may obscure the diagnosis of caval thrombosis on CT. Although the findings are nonspecific, tumor invasion of the IVC should be suspected in all patients with testicular neoplasms who demonstrate caval thrombosis radiographically.

Controversies in the radiologic diagnosis of pelvic malignancies

Although vast differences exist among the many pelvic malignancies, several unifying concepts emerge from this discussion. First, there is a different role for diagnostic imaging for each type of pelvic malignancy. The radiologist should be aware that although the radiographic findings may be similar, the clinical impact varies greatly with a particular tumor. Second, although clinical staging is notoriously inaccurate, nevertheless diagnostic imaging techniques only improve upon but do not replace it because of false-positive and false-negative results. Third, because of the high false-negative rates of most of the modalities in use, negative studies do not in fact rule out the presence of disease. A surgical procedure may still be needed. Finally, several new techniques, including MRI and transrectal or transurethral ultrasound, may improve the accuracy rates. These developments will probably further enliven the controversies surrounding the radiologic evaluation of pelvic malignancies.

Case report: complete response of metastatic transitional cell carcinoma of the bladder with chemotherapy alone

Transitional cell carcinoma of the bladder has remained to date basically a surgical disease with the addition of preoperative radiation therapy to increase survival. Chemotherapy for bladder cancer is administered either in an adjuvant setting or in patients with metastatic disease, most of whom have been treated already with cystectomy and/or radiation. We report a complete response at 54 months in a patient with clinical stage D2 and pathologic stage D1 carcinoma using cisplatin, doxorubicin and cyclophosphamide. The patient was treated with urinary diversion and chemotherapy alone, and no attempt was made to remove the primary lesion.

Malacoplakia of the bladder: a case report of resolution with bethanechol, trimethoprim-sulfamethoxazole and ascorbic acid

Malacoplakia is a granulomatous disease that most frequently involves the urinary tract but also may involve the genital tract, gastrointestinal tract and retroperitoneum. It is believed to be infectious in origin, secondary to a deficiency of intracellular lysosomal digestion, and heretofore considered a chronic problem. We report a case of malacoplakia of the bladder, which was treated successfully with a combination of bethanechol, trimethoprim-sulfamethoxazole and ascorbic acid.