Incidence of Prostate Cancer in Sicily: Results of a Multicenter Case-Findings Protocol

OBJECTIVE

To establish the incidence of prostate cancer (PCa) in Sicily in patients who entered an early detection protocol.

METHODS

From February 2002 to February 2004, 16,298 subjects aged 40-75 entered the protocol. Patients with suspicious DRE, PSA>10 ng/ml, PSA<or=2.5 ng/ml, from 2.6 to 4 ng/ml or from 4.1 to 10 ng/ml with F/T PSA of <or=15%, <or=20% and <or=25% respectively underwent needle biopsy according to an extensive protocol.

RESULTS

3266 patients were eligible for biopsy; PSA was <or=4 in 12.7% and <or=10 ng/ml in 63.9% of patients. A PCa was found in 1171 cases (36.9%) with a relationship between PCa incidence and PSA and age respectively (chi2-test, p<0.0001); 51.8% of patients with PCa had a PSA<10 and 8.8% a PSA<4 ng/ml; 49% were clinically staged as T1c. The estimated odds ratios for each age group showed increased risk for PCa in the fourth decade with PSA between 2.6 and 4 ng/ml (12.5 times higher) and in the fifth decade with PSA between 4.1 and 10 ng/ml (6.2 times higher).

CONCLUSIONS

Age and serum PSA levels are the major risk factors for PCa. On their basis it is possible to modulate the most suitable timing for early diagnosis in individual patients.

Osservational Study on Early Diagnosis of Prostate Carcinoma in Sicily and Calabria

The diagnosis of prostate carcinoma has been monitored in Sicily and Calabria for one year.

Material e Methods

Twenty-seven urological centres of Sicily and Calabria joined the study. Detailed informations about age, familiarity, PSA, Gleason score and TNM stage at diagnosis were centralized between november 2001 and november 2002.

Results

721 patients have been recruited. The median age was 73 years. More than 80% of the patients were older than 65 years. Median PSA was 14 ng/ml. The clinical stage at diagnosis was T1c in 33% of patients and 67% had an organ confined prostate cancer (T1-T2). Familiarity was detected in 8% of cases. Age and PSA at diagnosis in these patients were similar to those of the remaining population. However, only 18% of them had a T1 tumor, emphasizing the delay in diagnosis in these patients. Although only 10% of the patients shows at diagnosis a metastatic tumor, 29% only are fit for radical prostatectomy in according to age, PSA and stage.

Terapia della calcolosi delle vie urinarie: Ancora tema controverso? Interrogativi

The authors report some cases of urinary calculosis mistakenly treated in monotherapy with ESWL. They indicate the limits of this technique as well as the necessity of starting auxiliary and/or alternative methods. In the authors’ opinion the indispensable preliminary parameter is the careful evaluation of the functional possibilities of the involved area, also taking into account that if anatomical function is partially or totally compromised, traditional surgery undoubtedly still plays a leading role.

Coinvolgimento urologico in corso di ascessi retroperitoneali: A proposito di 3 osservazioni

Abscesses in the retroperitoneal space should be suspected in patients with abdominal pain, high temperature and weakness. They should be diagnosed early and treated by adequate surgical drainage associated with a well-aimed antibiotic therapy.

Voluminose masse addominali: Diagnosi differenziale e soluzione chirurgica adottata

Masses involving the abdominal organs present the problem of differential diagnosis and the symptomatology can be extremely varied in relation to their manifestation. The authors report their experience in a few cases, showing that the histopathological examination often plays an important role in leading to a correct diagnosis.

p53 expression in human renal cell carcinoma: an immunohistochemical study and a literature outline of the cytogenetic characterization

In this study both the incidence and pattern of p53 over-expression in various histological subtypes of a series of 36 cases of renal cell Grawitz carcinoma, partially studied in a previous paper, were analyzed. This series consisted of these histologic subtypes: clear cell non papillary (18 cases), clear cell papillary (2 cases), granular cell (5 cases), mixed (clear and granular cell) (9 cases) and spindle cell (2 cases). At present, our aim was, firstly, to see which were the best technical conditions for detection of p53 in the available paraffin-embedded tumor specimens, using several antibodies, specific for various epitopes; secondly, to investigate if some relation might exist between this expression and the histological features of these tumors. Twenty-five per cent (9/36 cases) resulted p53 immunoreactive, the highest percentage being represented in the papillary clear and granular cell carcinomas; low expression was detected in 11 cases (30%) and no reactivity in 16 cases (44%). Neither technical or dilution modifications proved to transform these latter results; however, detection was maximal using the CM-1 polyclonal rabbit antiserum. Thus, in RCC, expression of p53, analyzed in the light of the cytogenetic characterization through a literature review, resulted at low frequency. This finding means that mutation of the p53 gene are not frequent in the neoplastic transformation in RCC. Nevertheless, in spite of the small number of cases and of the short follow-up period of this study, detection of p53 positivity in tumors with either high grade and stage or high proliferative activity could suggest that p53 mutations lead to tumors of a more aggressive type.(ABSTRACT TRUNCATED AT 250 WORDS)

Renal cell (Grawitz) carcinoma: an immunohistochemical study in correlation with nuclear grade, histological pattern and proliferative activity of tumor cells

Since morphological features of renal cell carcinomas may not always predict their clinical behaviour, other biological parameters are more and more searched for, as prognostic indicators. Among those, the Authors evaluate the cytokeratin-vimentin intermediate-sized filaments co-expression in a series of 32 renal carcinomas and analyze this feature in correlation with both traditional criteria and proliferative activity of tumor cells, studied by means of the proliferation cellular nuclear antigen (PCNA) expression as well as of the nucleolar organizer regions (NORs) count, within tumor cells. From this study, nuclear grade stands out as the best parameter which, furthermore, shows a significant relationship with the cytokeratin-vimentin co-expression and the mean NORs count in tumor cell populations. Further investigations about relationships between these parameters and survival of the patients, who, at present, are almost all alive, will be performed afterwards.

Histological and histochemical changes in the colon mucosa after ureterosigmoidostomy or colonic conduit

A study was made of 22 patients previously subjected to urinary diversion, 12 with ureterosigmoidostomy and 10 with colon conduit. The histological and histochemical examination of biopsies of intestinal mucosa near to and far from the ureteral orifices showed transformations with considerable inflammatory infiltration, variations in the composition of the acid mucins with a prevalence of sialomucins, lengthening and branching of the glandular crypts, and sometimes dysplasias of the epithelium. These structural modifications are typical of transitional mucosa. Transitional mucosa might reflect an aspecific reaction of the intestinal mucosa or alternatively it might signify a precancerous condition. Its presence in intestinal diversions suggests the advisability of careful follow-up in all patients subjected to this operation.

Testosterone metabolism in benign prostatic hypertrophy: in vivo studies of gestonorone caproate and cyproterone acetate

18 patients with obstructive benign prostatic hypertrophy were studied. A 5-day treatment with gestonorone caproate (200 mg daily and 200 mg on alternate days) and cyproterone acetate (300 mg daily) suppressed the plasma LH and serum LH levels. Subsequently, H3-testosterone was injected intravenously and its elimination from plasma and uptake and metabolism in the BPH tissue studied. The elimination of total radioactivity and H3-testosterone from plasma was not altered after the 3 treatment regimens as compared to the control group. The uptake of total radioactivity into BPH tissue and its intraprostatic metabolism particularly to dihydrotestosterone was significantly suppressed in the patients with daily injections of gestonorone. Cyproterone acetate and gestonorone caproate on alternate days did not cause this effect.

[Retrograde renal phlebography with balloon occlusion of the renal artery. Technique and scope of a new method (author's transl)]

A new method of retrograde phlebography of the kidney is described; it is carried out by using a balloon catheter in the renal artery for occluding the circulation. The procedure has been carried out in 13 patients without complication. Early experience has provided very good results in the diagnosis of malignant renal tumours; invasion into the venous system can be demonstrated radiologically. In particular, in cases of carcinoma of the renal pelvis, this method represents a significant improvement of the hitherto unsatisfactory angiographic techniques.

[Short time in-situ preservation of the ischemic kidney by a simple initial hypothermic perfusion with various cold solutions. An animal experimental study]

In unilateral nephrectomized beagle dogs the remaining kidney was subjected to 2 hrs of ischemia in situ. The ischemic organ was cooled to 22--23 degrees C by initial hypothermic perfusion over a 5-F catheter introduced into the renal artery via the carotid artery. It was then left in the open abdominal wound without any further attempts of cooling. Three perfusates were used: an isoosmolar Dextran solution (Eisenberger), a hyperosmolar, "intracellular" electrolyte solution (Sacks), and a hyperosmolar, "extracellular" electrolyte solution. There was a mean postoperative increase in serum creatinine levels of 0.6 mg-%. By the 3rd p.o. day at latest the serum creatinine was again within normal limits. The inulin and PAH clearances on the 7th and 14th p.o. day showed no significant differences to preoperative determinations. No definite advantage or disadvantage was noted among the three perfusates. All control dogs whose kidneys were made ischemic for 2 hrs without perfusion died due to acute tubular necrosis. Apparently the homogenous cooling and flushing by the initial perfusion is of more importance for good preservation in this situation than the composition of the perfusate.

A systematic study of testosterone metabolism in benign prostatic hypertrophy (BPH): in vitro results

An in vitro system for testing steroids which might be effective in treating benign prostatic hypertrophy (BPH) has been developed based upon the transformation of H-3-testosterone into the 5-alpha-reduction products dihydrotestosterone and 3-alpha-androstanediol. In scrutinizing the influence of the amount of BPH-tissue, time, and pH, 300 mg of tissue incubated for 2 h at the physiological pH of 7.4 were used in the standard experiment. -The H-3-testosterone concentration was varied from 0.17-100 times 10-8 M. Plotting the resulting 5-alpha-reduction products as a function of testosterone concentration a hyperbolic pattern of enzyme kinetics ensued. Performing a double reciprocal plot of 4 experiments with double determination of each value regression lines could be computed. Those two regression lines most different in their slopes were considered "normal" limits. The rate of H-3-testosterone metabolism could not be enhanced after the endogenous testosterone content within the prostate glands had been used up by means of a preincubation. Scrutinizing the effect of heparin, a weak non-specific enzyme inhibitor, no suppression of the appearance of 5-alpha-reduction products was found. Damaging the BPH-cells, however, by repetitive freezing and thawing lead to an almost complete inhibition of H-3-testosterone turnover.