Prostate Cancers Detected During 5α-Reductase Inhibitor Use Are Smaller, De-Differentiated, But Confined when Compared To Controls

Rationale: To compare cancers detected during use of 5α-reductase inhibitors (5αRI) with cancers detected in untreated controls stratified for tumor size

Clinical Prostate Cancer

Cryosurgery of the prostate presents as an efficient therapy following failed radiation therapy. We report on a 7-year retrospective analysis evaluating the morbidity and biochemical disease-free survival (bDFS) of this therapy. Between 1993 and 2001, 59 patients who had been previously treated with radiation therapy and had rising serum prostate-specific antigen (PSA) values underwent salvage cryoablation of the prostate for localized, histologically proven, recurrent prostate cancer. Serial serum PSA testing was performed, and biopsies were taken at 6, 12, and 24 months, and again at 5 years, and any time the PSA rose above 0.5 ng/mL. Patients were stratified along clinical parameters. The combined postsalvage bDFS rate using a PSA cutoff of 0.5 ng/mL was 59% and 69% with a 1.0 ng/mL PSA cutoff. Using a PSA threshold of 0.5 ng/mL as evidence of biochemical recurrence, 61%, 62%, and 50% of patients with < 4 ng/mL, 4-10 ng/mL, and > 10 ng/mL PSA, respectively, remain biochemically relapse free at 7 years. A threshold of 1.0 ng/mL yielded a disease-free status of 78%, 74%, and 46%, respectively. Patient biopsies showed no evidence of residual or recurrent disease. Improved survival rates and no known latent complications indicate cryosurgery is a promising form of treatment for radiation-resistant prostate cancer. This 7-year analysis shows a promising validation of cryosurgery as an efficacious treatment modality for locally confined T1-T3 prostate cancer following primary radiation therapy failure. Abstrac

A clever technique for placement of a urinary catheter over a wire

Objective: The objective was to present a straightforward, step-by-step reproducible technique for placement of a guide-wire into any type of urethral catheter, thereby offering a means of access similar to that of a council-tip in a situation that may require a different type of catheter guided over a wire. Materials and Methods: Using a shielded intravenous catheter inserted into the eyelet of a urinary catheter and through the distal tip, a "counsel-tip" can be created in any size or type of catheter. Once transurethral bladder access has been achieved with a hydrophilic guide-wire, this technique will allow unrestricted use of catheters placed over a wire facilitating guided catheterization. Results: Urethral catheters of different types and sizes are easily advanced into the bladder with wire-guidance; catheterization is improved in the setting of difficult urethral catheterization (DUC). Cost analysis demonstrates benefit overuse of traditional council-tip catheter. Conclusion: Placing urinary catheters over a wire is standard practice for urologists, however, use of this technique gives the freedom of performing wire-guided catheterization in more situations than a council-tip allows. This technique facilitates successful transurethral catheterization over wire in the setting of DUC for all catheter types and styles aiding in urologic management of patients at a cost benefit to the health care system

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

Prostate Cancers Detected During 5α-Reductase Inhibitor Use Are Smaller, De-Differentiated, But Confined when Compared To Controls

<p><b>Rationale:</b> To compare cancers detected during use of 5&#945;-reductase inhibitors (5&#945;RI) with cancers detected in untreated controls stratified for tumor size.</p><p><b>Methods:</b> Prostate biopsies were performed on 235 consecutive patients &#8220;for cause&#8221; (elevated or rising PSA, positive digital rectal examination, or focal hypoechoic lesion). Fifty patients were excluded for a prior diagnosis of cancer, leaving 185 as the study group (5&#945;RI=41, control=144). Patients in the 5&#945;RI group had been treated for a mean of 3.5 years. Cancer was ultimately diagnosed in 114/185 patients.</p><p><b>Results:</b> Cancer was diagnosed in 31/41 (76%) of patients treated with 5&#945;RI and 83/144 (58%) of the control group (p=0.04). Control tumors were larger (14.3 mm) than those in 5&#945;RI treated patients (9.4 mm, p=0.0007). No differences in mean PSA or PSA kinetics were detected between groups. For tumors less than 1.0 cm, the proportion of high grade cancers (Gleason 7-10 and Gleason 4+3-10) was higher in 5&#945;RI subjects than in controls (p&#60;0.05). Fewer 5&#945;RI patients had proven extracapsular extension than controls, but this difference did not reach statistical significance (p=0.13). Normal DNA ploidy was more likely to be diagnosed in the 5&#945;RI group versus controls, but this difference was not statistically significant (81% vs. 65%, p=0.14).</p><p><b>Conclusions:</b> Cancers diagnosed in patients presenting &#8220;for cause&#8221; treated with 5&#945;RI drugs are more likely to be de-differentiated compared to controls. However, these tumors are also smaller and less likely to have extracapsular extension and abnormal DNA ploidy than controls.</p

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