Commentary: the role of cytologic analysis of voided urine in the work-up of asymptomatic microhematuria

Microscopic hematuria is a common finding in patients presenting to both primary care doctors as well as urologists. Sources of microscopic hematuria include infection, stones, inflammatory disorders as well as cancer of the genitourinary tract, particularly urothelial cancer. A primary focus in the urologic workup of hematuria is to rule out cancer. This is done using radiographic studies as well as procedures such as cystoscopy and bladder biopsy. As the authors state in their article titled "The utility of serial urinary cytology in the initial evaluation of the patient with microscopic hematuria", cytologic analysis of voided urine, though attractive due to its noninvasive nature, has been found to have the neither the sensitivity, cost-effectiveness, nor the ease of administration necessary to replace more invasive diagnostics in the evaluation of microscopic hematuria

Cytogenetic monoclonality in multifocal uroepithelial carcinomas: evidence of intraluminal tumour seeding

Twenty-one multifocal urinary tract transitional cell carcinomas, mostly bladder tumours, from a total of six patients were processed for cytogenetic analysis after short-term culturing of the tumour cells. Karyotypically related, often identical, cytogenetically complex clones were found in all informative tumours from each case, including the recurrent tumours. Rearrangement of chromosome 9, leading to loss of material from the short and/or the long arm, was seen in all cases, indicating that this is an early, pathogenetically important event in transitional cell carcinogenesis. The presence of related clones with great karyotypic similarity in anatomically distinct tumours from the same bladder indicates that multifocal uroepithelial tumours have a monoclonal origin and arise via intraluminal seeding of viable cancer cells shed from the original tumour. Later lesions may develop also from cells shed from the so called second primary tumours. The relatively complex karyotypes seen in all lesions from most cases argue that the seeding of tumour cells is a late event that succeeds the acquisition by them of multiple secondary genetic abnormalities. © 1999 Cancer Research Campaig

Prognostic factors in prostate cancer

Prognostic factors in organ confined prostate cancer will reflect survival after surgical radical prostatectomy. Gleason score, tumour volume, surgical margins and Ki-67 index have the most significant prognosticators. Also the origins from the transitional zone, p53 status in cancer tissue, stage, and aneuploidy have shown prognostic significance. Progression-associated features include Gleason score, stage, and capsular invasion, but PSA is also highly significant. Progression can also be predicted with biological markers (E-cadherin, microvessel density, and aneuploidy) with high level of significance. Other prognostic features of clinical or PSA-associated progression include age, IGF-1, p27, and Ki-67. In patients who were treated with radiotherapy the survival was potentially predictable with age, race and p53, but available research on other markers is limited. The most significant published survival-associated prognosticators of prostate cancer with extension outside prostate are microvessel density and total blood PSA. However, survival can potentially be predicted by other markers like androgen receptor, and Ki-67-positive cell fraction. In advanced prostate cancer nuclear morphometry and Gleason score are the most highly significant progression-associated prognosticators. In conclusion, Gleason score, capsular invasion, blood PSA, stage, and aneuploidy are the best markers of progression in organ confined disease. Other biological markers are less important. In advanced disease Gleason score and nuclear morphometry can be used as predictors of progression. Compound prognostic factors based on combinations of single prognosticators, or on gene expression profiles (tested by DNA arrays) are promising, but clinically relevant data is still lacking

A comprehensive overview of radioguided surgery using gamma detection probe technology

The concept of radioguided surgery, which was first developed some 60 years ago, involves the use of a radiation detection probe system for the intraoperative detection of radionuclides. The use of gamma detection probe technology in radioguided surgery has tremendously expanded and has evolved into what is now considered an established discipline within the practice of surgery, revolutionizing the surgical management of many malignancies, including breast cancer, melanoma, and colorectal cancer, as well as the surgical management of parathyroid disease. The impact of radioguided surgery on the surgical management of cancer patients includes providing vital and real-time information to the surgeon regarding the location and extent of disease, as well as regarding the assessment of surgical resection margins. Additionally, it has allowed the surgeon to minimize the surgical invasiveness of many diagnostic and therapeutic procedures, while still maintaining maximum benefit to the cancer patient. In the current review, we have attempted to comprehensively evaluate the history, technical aspects, and clinical applications of radioguided surgery using gamma detection probe technology

Radical Prostatectoiviy 1972-1957 Single Institutional Experience: Comparison of Standard Radical Prostatectomy and Nerve-Sparing Technique

During the period of time from 1972 to 1987 a total of 104 radical prostatectomieswere performed at the Ohio State University. From 1972 to 1985, standard radical retropubic nerve-sparing prostatectomy was done in 60 patients and from 1986 to June 30, 1987, radical retropubic nerve-sparing prostatectomy was carried out in 44 patients. Transcrectal ultrasound evaluation was available only for three quarters of the patients in the latter group. In the early part of the series, standard prostatectomy revealed 51 percent of the patients to have organ-confined disease and in the latter series 75 percent had organ-confined disease. In the earlier study only a retrospective analysis of the pathology reports was available, and in the latter study prospective evaluation was available with regard to pre- and postoperative staging, erectile function, blood loss and replacement, PSA data, and clincial and pathologic staging. It appears the radical nerve-sparing prostatectomy has several advantages including decreased blood loss, increased reservation of erectile function in 70 percent of the patients who were potent preoperatively, and a more accurate assessment of clinical stage prior to surgery through the use of transrectal ultrasonography

Localized Staging of Prostate Carcinoma: Comparison of Transrectal Ultrasound and Magnetic Resonance Imaging

To evaluate the usefulness of two new imaging modalities in the clinical staging of prostate cancer the following study was done. Twelve patients with biopsy-proved carcinoma of the prostate were evaluated preoperatively with magnetic resonance imaging (MRI) of the pelvis and transrectal ultrasound of the prostate. The main parameters evaluated were the ability of these two modalities to accurately predict capsular penetration and seminal vesicle involvement in these 12 patients: 10 went on to pelvic lymph node dissections, and 8 had radical retropubic prostatectomies. Thus the preoperative studies could be compared to the pathologic results. Based on our results we believe transrectal ultrasonography is more accurate in the assessment of seminal vesicle involvement and comparable to MRI in determining capsular penetration. Because of the lower cost of ultrasound we believe it to be both an economical and accurate way to preoperatively stage prostate carcinoma