Jüngst, Dieter

Karl, Hans Josef

Lazik, E.

Tauber, R.

English

Open Access LMU

PRELIMINARY COMMUNICATION URINARY CHOLESTEROL IN FOLLOW-UP OF PATIENTS WITH UROLOGIC CARCINOMAS OR BENIGN PROSTATIC HYPER~LASIA D. JUNGST, M.D. R. TAUBER, M.D. E. LAZIK, M.D. H, J. KARL, M.D. From the Divisions of Medicine II and Urology, Klinikum Grosshadern, University of Munich, F.R. Germany ABSTRACT - Urinary cholesterol was determined in follow-up in 2 patients with prostatic adeno~, 3 patients with prostat~e car~no~, 3 patients with ~ar~*~o~ of bladdt~, and 4 patients with carcinoma of kidney. A12 patients revealed marked urinary cholesterol hyperexcretion prior to surgery. Except for-1 patient with prostatic carcinoma, excretion of urinary cholesterol normalized at least six weeks after resection. In 1 remarkable case a localized recurrence of a ~ansurethra~ly resec- ted bladd~ tumor was asso~ated with a marked increase of urinary cho~est~ol excretion six weeks prior to cystoscopy. The results point to a possible future value of this method in monitoring patients with bladder tumors, although additional studies are necessary. Hy-perexcretion of urinary cholesterol in car- cinomas of prostate, kidney, and bladder has been described recently even in early clinical stages of these diseases.1-5 However, the diag- nostic value of this parameter seemed to be di- minished by the fact that elevated concen- trations of urinary cholesterol have been ob- served in other, nonmalignant diseases of the kidney and urinary tract obstruction, especially prostatic adenoma with residual urine.3*5 Nevertheless, serial determinations of urinary cholesterol could be useful in the monitoring of the clinical course which might be of practical value especially in patients with carcinoma of the bladder. Material and Methods Total urinary cholesterol was analyzed in Z-ml. aliquots of twenty-four-hour urine with a gas-liquid chromatographic assay using 4androstenedione as internal standard and peak-height ratio technique for quantitation. This method has been described in detail previ- ously. 3 The preliminary study included a total of 12 patients, 10 males and 2 females, with an age range of from fifty-three to seventy-six years. The diagnosis of cancer or benign prostatic hyperplasia was proved histopathologically after resection. Only patients with marked urinary cholesterol hyperexcretion prior to surgery were selected for the study. Results Prostatic adenoma Serial determinations of urinary cholesterol were performed in 2 patients with prostatic adenoma and residual urine. A marked eleva- tion of urinary cholesterol (normal range 0.3 to 3.0 mg.l.24 hours, 2 SD) was measured in both cases prior to transurethral resection. After an interval of two to four weeks, urinary choles- terol excretion had normalized and remained in the normal range during the total follow-up time (Fig. 1A). These findings were associated with normalized urinary flow. IJROLOGY / TIJLY 1981 / VOLUME XVIII. NUMBER 1 65 l5 T u) I TUR # A I 2 3 L 5MO;THS7 8 9 10 MONTHS 15T C MONTHS FIGURE 1. Urinary cholesterol in follow-up of (A) 2 patients with prostatic adenoma and residual urine prior to transurethral resection; (B) 3 patients with prostatic carcinoma; (C) 3 patients with carcinoma of bladder; (0) 4 patients with carcinoma of kidney. Prostatic carcinoma Three patients with prostatic carcinoma could be monitored by urinary cholesterol determina- tions. In 2 patients increments of urinary cholesterol excretion was observed up to six weeks after resection which normalized in 1 pa- tient and remained in the other patient, most likely due to persistent obstruction of the uri- nary tract. A drop of urinary cholesterol was ob- served in the third patient four weeks after re- section which remained normal until the end of the follow-up (Fig. 1B). Carcinoma of bladder Urinary cholesterol was measured in 3 pa- tients with carcinoma of the bladder. All cases showed normal urinary cholesterol excretion within four weeks after transurethral resection. In 1 patient hyperexcretion of urinary choles- terol occurred three months after surgery which was due to a localized recurrence of the bladder tumor (Fig. 1C). Carcinoma of kidney Four patients with carcinoma of the kidney revealed slightly or marked elevations of urinary cholesterol prior to resection which normalized in all six weeks after surgery (Fig. 1D). Comment Increased concentrations of urinary choles- terol are usually associated with diseases of the kidney or the urogenital system and have been 66 UROLOGY / JULY 1981 / VOLUME XVIII, NUMBER 1 demonstrated even in early clinical stages of urologic carcinomas. l-l* In the present prelimi- nary study serial determinations for up to eight months were performed in 12 selected patients with hyperexcretion of urinary cholesterol prior to surgery. Except for 1 patient with prostatic carcinoma, all revealed normal excretion of uri- nary cholesterol at least six weeks after resec- tion. In 5 cases increments of urinary choles- terol persisted for a short time after surgery which was most likely due to urothelial lesions. In 1 remarkable case a localized recurrence of a transurethrally resected bladder tumor was associated with a marked increase of urinary cholesterol excretion six weeks prior to cystos- copy. In 2 other patients with carcinoma of the bladder urinary cholesterol levels remained normal after transurethral resection; there was no cystoscopic evidence of tumor recurrence. These results point to a possible future value of this method in monitoring patients with blad- der tumors in combination with established diagnostic procedures especially cytology. In view of this it has to be mentioned that the diagnostic sensitivity of the urinary cholesterol method is independent of the tumor grade and only slightly influenced by the tumor stagee3” However, additional studies in more patients are necessary to determine if urinary cholesterol measurements have a place in the monitoring of urologic diseases especially carcinomas of the bladder. Division of Medicine II Klinikum Grosshadern Marchioninistr. 15 8 Miinchen 70, F.R. Germany (DR. JiiNGST) References 1. Acevedo HF, et al: Urinary cholesterol V. Its excretion in men with testicular and prostatic neoplasms, Cancer 32: 1% (1973). 2. Belis JA, and Cenedella RJ: Urinary nonesterified choles- terol excretion in adenocarcinoma of the prostate, ibid. 43: 1840 (1979). 3. Jiingst D, et al: Urinary cholesterol excretion in men with benign prostatic hyperplasia and carcinoma of the prostate, ihid. 43: 361 (1979). 4. Jiingst D, et al: Comparative evaluation of nonesterified and total urinary cholesterol in papilloma and carcinoma of the hlad- der, ibid. 43: 2186 (1979). 5. Pickel A: Die Bedeutung des Urincholesterins in der Diag- nostik van Tumoren der Nieren, der ableitenden Harnwege und der Prostata. Thesis, LMU-Miinchen (1979). 6. Acevedo HF, et al: Urinary cholesterol IV. Its excretion in women with neoplasms of the genital system, Obstet. Gynecol. 37: 425 (1971). 7. Acevedo HF, et al: Urinary cholesterol VII. The significance of the excretion of nonesterified cholesterol in patients with uterine carcinomas, Cancer 36: 1459 (1975). 8. Bruger M, and Ehrlich SB: Cholesterol content of the urine in patients with cancer, Arch. Intern. Med. 72: 108 (1943). 9. Burchell MM, Earle JHO, and Maclagan NF: Urinary cholesterol in cancer: urinary cholesterol excretion in cancer Da- tients and control subjects, Br. J. Cancer 3: 42 (1949). - 10. Burchell MM. and Maclaean NF: Chemical state of urinarv cholesterol and methods of estization, ihid. 3: 52 (1949). ’ 11. Chu TM, Shukla SK, Mittelman A, and Murphy GP: Com- parative evaluation of serum acid phosphatase, urinary cholesterol and androgens in diagnosis of prostatic cancer, Uroloev 6: 291 (1975). -- .’ - ~I, 12. Sobotka H, Bloch E, and Rosenbloom AB: Urinary choles- terol in cancer II, Am. J. Cancer 38: 253 (1940). UROLOGY i JULY 1981 / VOLUME XVIII, NUMBER 1 67 

and Maclaean NF: Chemical state of urinarv cholesterol and methods of estization,

Cholesterol content of the urine in patients with cancer,

Comparative evaluation of serum acid phosphatase, urinary cholesterol and androgens in diagnosis of prostatic cancer,

Die Bedeutung des Urincholesterins in der Diagnostik van Tumoren der Nieren, der ableitenden Harnwege und der Prostata. Thesis,

et al: Comparative evaluation of nonesterified and total urinary cholesterol in papilloma and carcinoma of the hladder,

et al: Urinary cholesterol excretion in men with benign prostatic hyperplasia and carcinoma of the prostate,

et al: Urinary cholesterol IV. Its excretion in women with neoplasms of the genital system,

et al: Urinary cholesterol V. Its excretion in men with testicular and prostatic neoplasms,

Urinary cholesterol in cancer II,

Urinary cholesterol in cancer: urinary cholesterol excretion in cancer Datients and control subjects,

Urinary cholesterol VII. The significance of the excretion of nonesterified cholesterol in patients with uterine carcinomas,

Urinary nonesterified cholesterol excretion in adenocarcinoma of the prostate,

Urinary cholesterol in follow-up of patients with urologic carcinomas or benign prostatic hyperplasia

Universität München: Elektronischen Publikationen

PRELIMINARY COMMUNICATION 
URINARY CHOLESTEROL IN FOLLOW-UP OF 
PATIENTS WITH UROLOGIC CARCINOMAS 
OR BENIGN PROSTATIC HYPER~LASIA 
D. JUNGST, M.D. 
R. TAUBER, M.D. 
E. LAZIK, M.D. 
H, J. KARL, M.D. 
From the Divisions of Medicine II and Urology, 
Klinikum Grosshadern, University of Munich, F.R. Germany 
ABSTRACT - Urinary cholesterol was determined in follow-up in 2 patients with prostatic 
adeno~, 3 patients with prostat~e car~no~, 3 patients with ~ar~*~o~ of bladdt~, and 4 patients 
with carcinoma of kidney. A12 patients revealed marked urinary cholesterol hyperexcretion prior to 
surgery. Except for-1 patient with prostatic carcinoma, excretion of urinary cholesterol normalized at 
least six weeks after resection. In 1 remarkable case a localized recurrence of a ~ansurethra~ly resec- 
ted bladd~ tumor was asso~ated with a marked increase of urinary cho~est~ol excretion six weeks 
prior to cystoscopy. The results point to a possible future value of this method in monitoring patients 
with bladder tumors, although additional studies are necessary. 
Hy-perexcretion of urinary cholesterol in car- 
cinomas of prostate, kidney, and bladder has 
been described recently even in early clinical 
stages of these diseases.1-5 However, the diag- 
nostic value of this parameter seemed to be di- 
minished by the fact that elevated concen- 
trations of urinary cholesterol have been ob- 
served in other, nonmalignant diseases of the 
kidney and urinary tract obstruction, especially 
prostatic adenoma with residual urine.3*5 
Nevertheless, serial determinations of urinary 
cholesterol could be useful in the monitoring of 
the clinical course which might be of practical 
value especially in patients with carcinoma of 
the bladder. 
Material and Methods 
Total urinary cholesterol was analyzed in 
Z-ml. aliquots of twenty-four-hour urine with a 
gas-liquid chromatographic assay using 
4androstenedione as internal standard and 
peak-height ratio technique for quantitation. 
This method has been described in detail previ- 
ously. 3 
The preliminary study included a total of 12 
patients, 10 males and 2 females, with an age 
range of from fifty-three to seventy-six years. 
The diagnosis of cancer or benign prostatic 
hyperplasia was proved histopathologically after 
resection. Only patients with marked urinary 
cholesterol hyperexcretion prior to surgery were 
selected for the study. 
Results 
Prostatic adenoma 
Serial determinations of urinary cholesterol 
were performed in 2 patients with prostatic 
adenoma and residual urine. A marked eleva- 
tion of urinary cholesterol (normal range 0.3 to 
3.0 mg.l.24 hours, 2 SD) was measured in both 
cases prior to transurethral resection. After an 
interval of two to four weeks, urinary choles- 
terol excretion had normalized and remained in 
the normal range during the total follow-up time 
(Fig. 1A). These findings were associated with 
normalized urinary flow. 
IJROLOGY / TIJLY 1981 / VOLUME XVIII. NUMBER 1 65 
l5 T 
u) 
I TUR 
# 
A I 2 3 L 5MO;THS7 8 9 10 
MONTHS 
15T C 
MONTHS 
FIGURE 1. Urinary cholesterol in follow-up of (A) 2 patients with prostatic adenoma and residual urine prior 
to transurethral resection; (B) 3 patients with prostatic carcinoma; (C) 3 patients with carcinoma of bladder; 
(0) 4 patients with carcinoma of kidney. 
Prostatic carcinoma 
Three patients with prostatic carcinoma could 
be monitored by urinary cholesterol determina- 
tions. In 2 patients increments of urinary 
cholesterol excretion was observed up to six 
weeks after resection which normalized in 1 pa- 
tient and remained in the other patient, most 
likely due to persistent obstruction of the uri- 
nary tract. A drop of urinary cholesterol was ob- 
served in the third patient four weeks after re- 
section which remained normal until the end of 
the follow-up (Fig. 1B). 
Carcinoma of bladder 
Urinary cholesterol was measured in 3 pa- 
tients with carcinoma of the bladder. All cases 
showed normal urinary cholesterol excretion 
within four weeks after transurethral resection. 
In 1 patient hyperexcretion of urinary choles- 
terol occurred three months after surgery which 
was due to a localized recurrence of the bladder 
tumor (Fig. 1C). 
Carcinoma of kidney 
Four patients with carcinoma of the kidney 
revealed slightly or marked elevations of urinary 
cholesterol prior to resection which normalized 
in all six weeks after surgery (Fig. 1D). 
Comment 
Increased concentrations of urinary choles- 
terol are usually associated with diseases of the 
kidney or the urogenital system and have been 
66 UROLOGY / JULY 1981 / VOLUME XVIII, NUMBER 1 
demonstrated even in early clinical stages of 
urologic carcinomas. l-l* In the present prelimi- 
nary study serial determinations for up to eight 
months were performed in 12 selected patients 
with hyperexcretion of urinary cholesterol prior 
to surgery. Except for 1 patient with prostatic 
carcinoma, all revealed normal excretion of uri- 
nary cholesterol at least six weeks after resec- 
tion. In 5 cases increments of urinary choles- 
terol persisted for a short time after surgery 
which was most likely due to urothelial lesions. 
In 1 remarkable case a localized recurrence of a 
transurethrally resected bladder tumor was 
associated with a marked increase of urinary 
cholesterol excretion six weeks prior to cystos- 
copy. In 2 other patients with carcinoma of 
the bladder urinary cholesterol levels remained 
normal after transurethral resection; there was 
no cystoscopic evidence of tumor recurrence. 
These results point to a possible future value 
of this method in monitoring patients with blad- 
der tumors in combination with established 
diagnostic procedures especially cytology. In 
view of this it has to be mentioned that the 
diagnostic sensitivity of the urinary cholesterol 
method is independent of the tumor grade and 
only slightly influenced by the tumor stagee3” 
However, additional studies in more patients 
are necessary to determine if urinary cholesterol 
measurements have a place in the monitoring of 
urologic diseases especially carcinomas of the 
bladder. 
Division of Medicine II 
Klinikum Grosshadern 
Marchioninistr. 15 
8 Miinchen 70, F.R. Germany 
(DR. JiiNGST) 
References 
1. Acevedo HF, et al: Urinary cholesterol V. Its excretion in 
men with testicular and prostatic neoplasms, Cancer 32: 1% 
(1973). 
2. Belis JA, and Cenedella RJ: Urinary nonesterified choles- 
terol excretion in adenocarcinoma of the prostate, ibid. 43: 1840 
(1979). 
3. Jiingst D, et al: Urinary cholesterol excretion in men with 
benign prostatic hyperplasia and carcinoma of the prostate, ihid. 
43: 361 (1979). 
4. Jiingst D, et al: Comparative evaluation of nonesterified and 
total urinary cholesterol in papilloma and carcinoma of the hlad- 
der, ibid. 43: 2186 (1979). 
5. Pickel A: Die Bedeutung des Urincholesterins in der Diag- 
nostik van Tumoren der Nieren, der ableitenden Harnwege und 
der Prostata. Thesis, LMU-Miinchen (1979). 
6. Acevedo HF, et al: Urinary cholesterol IV. Its excretion in 
women with neoplasms of the genital system, Obstet. Gynecol. 
37: 425 (1971). 
7. Acevedo HF, et al: Urinary cholesterol VII. The significance 
of the excretion of nonesterified cholesterol in patients with 
uterine carcinomas, Cancer 36: 1459 (1975). 
8. Bruger M, and Ehrlich SB: Cholesterol content of the urine 
in patients with cancer, Arch. Intern. Med. 72: 108 (1943). 
9. Burchell MM, Earle JHO, and Maclagan NF: Urinary 
cholesterol in cancer: urinary cholesterol excretion in cancer Da- 
tients and control subjects, Br. J. Cancer 3: 42 (1949). - 
10. Burchell MM. and Maclaean NF: Chemical state of urinarv 
cholesterol and methods of estization, ihid. 3: 52 (1949). ’ 
11. Chu TM, Shukla SK, Mittelman A, and Murphy GP: Com- 
parative evaluation of serum acid phosphatase, urinary cholesterol 
and androgens in diagnosis of prostatic cancer, Uroloev 6: 291 
(1975). -- .’ - 
~I, 
12. Sobotka H, Bloch E, and Rosenbloom AB: Urinary choles- 
terol in cancer II, Am. J. Cancer 38: 253 (1940). 
UROLOGY i JULY 1981 / VOLUME XVIII, NUMBER 1 67 


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Urinary cholesterol in follow-up of patients with urologic carcinomas or benign prostatic hyperplasia

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