Natural and clinical course of renal cell carcinoma--better prospect for the patients.

The many improvements in diagnostic and therapeutic tools over the last half-century have changed the prospects for patients with renal cell carcinoma (RCC). Higher survival rates and less morbidity have been achieved. The disease is, however, still unpredictable and represents many unsolved problems. In this paper we focus on determinants of the natural and clinical course of RCC and the changes in regard to this over the last decades.

Nephrectomy - indications, complications and postoperative mortality in 646 consecutive patients.

OBJECTIVE: To gain information about the indications for and complications of conventional nephrectomy, also to create standards for future evaluation of nephrectomies performed by minimal invasive techniques. METHODS: We present a historical 20 years' series of 646 consecutive nephrectomies performed in the period of 1978-1997. Malignant disease led to the operation in 437 cases, of which 98 were urothelial tumors in the renal pelvis or ureter. 209 kidneys were removed due to benign conditions. The incidence of nephrectomy for benign conditions has declined from 75 in the first 5-year period to 32 in the last. RESULTS AND DISCUSSION: Postoperative complications occurred in 100 patients (15.5%). Nephrectomy for malignant disease had a significantly higher rate of complications than operations for benign conditions (p<0.001), especially hemorrhagic complications and pneumonias were more frequent. There were no differences as a result of the operative approach. Reoperation was carried out in 3.0% of the cases. Overall mortality rate (<30 days) was 3.1%.

[Treatment of benign prostatic hyperplasia with Proscar (finasteride). Results of a 10-year Scandinavian study]. / Behandling av benign prostatahyperplasi med Proscar (finasterid). Resultater av en toårig skandinavisk undersøkelse.

707 patients with moderate prostatic hyperplasia were recruited to a two-year Scandinavian multicenter study. The study was randomized, prospective and double-blind. Half of the patients were treated with finasteride (5 mg daily) and the controls were given placebo. The patients were monitored with regard to symptoms, urinary flow rate and prostate volume. In addition, various laboratory examinations were performed. A statistically significant difference was found between the groups with regard to symptom improvement and increase in urinary flow rate in favour of finasteride. Finasteride reduced prostate volume and stopped further growth, leading to a difference of 30% in prostate volume between the two groups after two years of treatment. Thus, finasteride was able to stop the continuous growth of the prostate in the elderly male. The proportion of patients with adverse clinical experiences was similar in both treatment groups. However, the finasteride-treated group contained more patients with sexual dysfunction. We conclude that finasteride is an alternative to vigilant waiting for patients with moderate symptoms of benign prostatic hyperplasia.

[Finanseride in symtomatic benign prostatic hyeprtrophy. A 2-year placebo-controlled study]. / Finasterid ved symptomgivende benign prostatahypertrofi. Et toårs placebokontrolleret studie. Skandinaviske BPH-Studiegruppe.

The efficacy and safety of treatment with finasteride 5 mg daily for 24 months was assessed in this multicentre double blind placebo-controlled study including 707 patients with moderately symptomatic benign prostatic hyperplasia. Efficacy parameters were changes in voiding- and bladder storage symptoms assessed by a validated symptom score, changes in maximum urinary flow rate and changes in the prostate volume. In the finasteride patients, symptom score improved during the whole study with a significant difference between active treatment and placebo after 24 months (p < 0.01). Maximum flow rate increased in finasteride treated patients resulting in a difference between these and the placebo treated patients of 1.8 ml/s after 24 months (p < 0.01). Prostate volume was reduced by 19% in the finasteride treated patients versus an increase of 12% in the placebo treated patient group (p < 0.01). Finasteride was well tolerated. Patients receiving placebo progressed in symptoms after 16 months. Finasteride can halt the natural progression of moderately symptomatic BPH over a 24 month period.

[Can finasteride reverse the progress of benign prostatic hyperplasia? A two-year placebo-controlled study.].

OBJECTIVE: To study if placebo-induced improvement in men with symptomatic benign prostatic hyperplasia (BPH) is maintained over two years, and to study the efficacy and safety from intervention with finasteride 5 mg for 24 months. METHODS: This was a multicenter, double-blind, placeba-controlled study involving 707 patients with moderate symptoms of BPH enrolled at 59 centers in five Scandinavian countries. Following enrollment and a four-week single-blind placebo run-in period, patients were randomized to receive finasteride 5 mg once daily or placebo for 24 months. Urinary symptoms, urinary flow rate, prostate volume, postvoiding residual urinary volume, and serum concentrations of prostate-specific antigen together with laboratory safety parameters were measured at entry and at months 12 and 24. Interim physical and laboratory examinations were performed when indicated clinically. RESULTS: In finasteride-treated patients the total symptom score improved throughout the study, with a significant difference between the two groups at 24 months (p<0.01) whereas in placebo-treated patients, there was an initial improvement in the symptom score but no change from baseline at 24 months. The maximum urinary flow rate decreased in the placebo group, but improved in the finasteride group, resulting in a between-group difference of 1.8 mL/s at 24 months (p<0.01). The mean change in prostate volume was +12% in the placebo group versus -19% in the finasteride-treated group (p%lt;0.01). Finasteride was generally well tolerated throughout the two-year study period. CONCLUSIONS: The efficacy of therapy with finasteride 5 mg in improving both symptoms and maximum urinary flow rate and reducing prostate volume has been shown to be maintained during 24 months while patients receiving placebo experienced a return to baseline or deterioration of these parameters during the study. These results demonstrate that finasteride can reverse the natural progression of BPH.

Can finasteride reverse the progress of benign prostatic hyperplasia? A two-year placebo-controlled study. The Scandinavian BPH Study Group.

OBJECTIVES: To study if placebo-induced improvement in men with symptomatic benign prostatic hyperplasia (BPH) is maintained over 2 years, and to study the efficacy and safety from intervention with finasteride 5 mg for 24 months. METHODS: This was a multicenter, double-blind, placebo-controlled study involving 707 patients with moderate symptoms of BPH enrolled at 59 centers in five Scandinavian countries. Following enrollment and a 4-week single-blind placebo run-in period, patients were randomized to receive finasteride 5 mg once daily or placebo for 24 months. Urinary symptoms, urinary flow rate, prostate volume, postvoiding residual urinary volume, and serum concentrations of prostate-specific antigen together with laboratory safety parameters were measured at entry and at months 12 and 24. Interim physical and laboratory examinations were performed when indicated clinically. RESULTS: In finasteride-treated patients the total symptom score improved throughout the study, with a significant difference between the two groups at 24 months (P < or = 0.01), whereas in placebo-treated patients, there was an initial improvement in the symptom score but no change from baseline at 24 months. The maximum urinary flow rate decreased in the placebo group, but improved in the finasteride group, resulting in a between-group difference of 1.8 mL/s at 24 months (P < or = 0.01). The mean change in prostate volume was +12% in the placebo group versus -19% in the finasteride-treated group (P < 0.01). Finasteride was generally well tolerated throughout the 2-year study period. CONCLUSIONS: The efficacy of therapy with finasteride 5 mg in improving both symptoms and maximum urinary flow rate and reducing prostate volume has been shown to be maintained during 24 months while patients receiving placebo experienced a return to baseline or deterioration of these parameters during the study. These results demonstrate that finasteride can reverse the natural progression of BPH.

Scandinavian clinical study of finasteride in the treatment of benign prostatic hyperplasia.

The effects of finasteride, a potent 5 alpha-reductase inhibitor, were assessed in patients with benign prostatic hyperplasia. Patients were treated with finasteride or placebo for 24 weeks in a double-blind multicenter study followed by a 12-month open-extension period. After 24 weeks, finasteride-treated patients, when compared to placebo-treated patients, showed a significant reduction in prostate volume (22.5% median decrease) and prostate significant antigen (32.4% median decrease), a significant increase in maximum urinary flow (1.6 ml/s mean increase from baseline) and a significant improvement in their obstructive symptom scores (two-point decrease from baseline). Finasteride was well tolerated, and the improvements in prostate volume, maximum urinary flow rate and obstructive symptom scores observed in the controlled study were maintained throughout the extension study.

[Laser in urology]. / Laser i urologien.

The Neodymium YAG-laser is particularly suited for endoscopic urologic surgery because the YAG-laser light can be conducted in flexible fibers. Superficial bladder tumours can be treated under local anaesthesia in the outpatient department. The frequency of local recurrences is low, significantly lower than after electroresection or electrocoagulation. Selected cases of T2-muscle invasive bladder tumours can be cured with laser coagulation applied subsequently to transurethral resection. Combined treatment with electroresection and laser coagulation of localized prostatic cancer is a promising method which compares favourably with results obtained by other treatment modalities. Tumours in the upper urinary tract can be laser-treated through ureteroscopes or nephroscopes, but the treatment should be limited to low stage, low grade tumours. Laser is the treatment of choice for intraurethral condylomatas. Laser treatment of pencil carcinoma gives excellent cosmetic and functional results and few local recurrences. Laser lithotripsy is a new technique for treatment of ureteric stones and photodynamic laser therapy is a promising technique for treatment of carcinoma in situ in the bladder epithelium. However, neither of these techniques are available for clinical use in Norway as yet.

Localized prostate carcinoma treated with TUR and neodymium-YAG laser irradiation.

Neodymium-YAG laser irradiation subsequent to extended transurethral resection has been practised in our department since 1981 as an alternative treatment for patients with localized prostate carcinoma. The treatment is performed endoscopically in two separate steps. The procedure is simple and complications are few. One hundred and twenty-four patients have been treated and followed up for more than 6 months. One hundred and ten patients are evaluated as disease free survivors and the overall actuarial disease free survival rate is 88% at 4-9 years of follow-up. The initial promising results persist and the results from other clinics confirm the method to be a fair alternative or patients with localized prostate carcinoma.

[Does preoperative urethral catheter increase the risk of complications in transurethral prostate resection?]. / Oker preoperativt urethrakateter komplikasjonsrisikoen ved transurethral prostatareseksjon?

In a material consisting of 243 patients treated with transurethral prostate resection 76 had preoperatively been drained for urine by indwelling urethral catheter. Delayed recovery or increased risk for complications due to the resection could not be demonstrated in this group compared to 167 patients without use of preoperative catheter. Peroperative antibiotic prophylaxis is to recommend in patients operated upon directly after catheter drainage.

Neodymium-YAG laser irradiation of stage T2 muscle-invasive bladder cancer. Long-term results.

The study group consisted of 15 patients with solitary stage T2 bladder tumours treated with transurethral resection (TUR) and subsequent neodymium-YAG laser irradiation. Ten patients are alive without evidence of cancer 56 to 78 months (mean 67) after treatment; 1 died of cardiovascular disease 2 years after treatment and autopsy revealed no cancer. In 4 patients the treatment failed and cystectomy or external beam radiation was carried out. The long-term results indicate the combination of TUR and laser irradiation to be beneficial in the management of T2 tumours in selected cases.

Possibilities of laser in the treatment of urinary bladder cancer.

Clinical use of laser in the treatment of urinary bladder tumours has been practiced since 1976. Today, the method is widely accepted as a simple and effective method for destroying superficial bladder tumours. In selected cases of muscle invasive tumours of stage T-2 beneficial long term results are reported. Locally advanced tumours of stage T-3 or T-4 are beyond the possibility of cure by the laser.

Neodymium-YAG laser in the treatment of localized prostate cancer.

The combination of transurethral resection and subsequent Neodymium-YAG laser irradiation has been practiced for radical treatment of localized prostate cancer since 1981. One hundred and eighteen patients have been treated and the observation time ranges 6-98 months. The treatment is performed endoscopically in two separate steps. The procedure is simple and complications are few. One hundred and four patients are evaluated as disease-free survivors. The overall actuarial disease-free survival rate is 88% in the 4-8 year period. The results compare satisfactorily with results obtained by other methods. Recently published results from other clinics confirm the laser to be promising in the treatment of localized prostate cancer.

[Intravesical BCG vaccine in bladder cancer]. / Intravesikal BCG-vaksine ved blaerecancer.

We present a preliminary report on intravesical BCG instillation in four patients. The indications are prevention of new superficial tumors and treatment of carsinoma in situ. 120 mg Connaught BCG-vaccine in 50 cc saline is instillated weekly for a total of six treatments. Follow-up was performed every three months and included cystoscopy and urine cytology. The prophylactic effect is encouraging, even in patients who have previously not responded to intravesical chemotherapy. There were no serious complications and the common side effects of fever and dysuria did not delay or interrupt treatment.

A contribution to the special discussion on YAG laser irradiation of superficial bladder cancer.

In a randomized prospective study on YAG-laser irradiation versus TUR in the treatment of superficial bladder tumors 38% of the patients in the TUR group had local tumor recurrence in treated area within two years compared to non in the laser group. There was no difference between the groups in regard to new occurrence of tumors in remote areas. The rationale of these results are discussed and a plea is made for specification between true recurrences in treated area and new occurrence of tumors in remote areas when evaluating patients treated with laser.

Neodymium-YAG laser in the treatment of localized prostatic cancer.

Transurethral resection with subsequent Neodymium-YAG laser irradiation is introduced as a method for radical treatment of localized prostatic cancer. 101 patients are treated and follow up ranges 6-81 months. 90 patients are evaluated as disease-free survivors. The actuarial disease-free survival rates are 98% on one year, 90% on 2 years, 88% on 3 years and 86% in the 4-7 year period. Six patients developed distant metastases and 5 patients had local tumor recurrence. The treatment procedure is simple and without serious complications.