A trial of combination chemotherapy followed by hormonal therapy for previously untreated metastatic carcinoma of the prostate.

We administered combination chemotherapy with cyclophosphamide, doxorubicin, and cisplatin to 25 previously untreated patients with metastatic prostate cancer in order to assess the efficacy of chemotherapy before any hormonal manipulation. Hormonal therapy was administered only after progression of disease to chemotherapy. All 25 patients were followed until time of death and all were able to receive hormonal therapy. We did not find substantially improved response rates when combination chemotherapy was applied before endocrine treatment since the 33% objective response rate to chemotherapy was only minimally higher than the response in our patients who had failed hormonal therapy and then received identical or similar chemotherapy. Furthermore, the introduction of intensive combination chemotherapy before hormonal therapy in our study did not result in any striking improvement in overall survival compared with patients who received initial hormonal therapy in many other studies. Responses to chemotherapy were not attributable to suppression of serum testosterone since all 12 patients with partial response (PR) or stable disease (SD) and four of seven patients with no response (NR) had normal testosterone levels at the time of response assessment. The initial use of chemotherapy did not adversely affect the expected high percentage of objective responses (68%) to subsequent hormonal manipulation. The frequency, duration, and quality of responses to hormonal therapy exceeded the responses to chemotherapy. The disappointing responses to chemotherapy reflect the very modest efficacy of even aggressively delivered cytotoxic agents.

Immunoperoxidase staining of acid phosphatase in human prostatic tissue.

The introduction of immunoperoxidase and the indirect immunoperoxidase technique made important contributions in histopathologic diagnosis of prostatic cancer. This staining can be performed on formalin-fixed paraffin-embedded tissue which is usually available. We have used this histopathologic staining technique in 56 patients. The tissues include primary and metastatic prostatic cancer tissue in addition to normal renal pelvis and bladder tissue from other patients. Our data indicate that acid phosphatase can be localized in prostatic cells but not in transitional cells. Therefore, immunohistochemical staining of prostatic acid phosphatase seems most useful to identify metastatic prostate adenocarcinoma or primary tumor and to differentiate them from intraductal prostatic transitional carcinoma or other transitional cell carcinomas.

Misconceptions about posterior approach for renoureteral surgery.

Misconceptions about the posterior approach for renal and ureteral surgery are dispelled. A review of the pertinent lumbar anatomy and a few fine points of technique are emphasized. The advantages of easy access to the kidney, minimal postoperative pain, and absence of the occurrence of postoperative hernia warrant more frequent use of this procedure.

The role of coronary thrombosis in myocardial infarction: further evidence shown by intracoronary thrombolysis with streptokinase.

Myocardial infarction is usually caused by a thrombus occurring on a significant coronary lesion. A 60-year-old male was admitted with an acute evolving anterior myocardial infarction. Three hours after the beginning of chest pain, the electrocardiogram showed ST-segment elevation in the anterior and lateral leads which persisted despite intravenous nitroglycerin (100 mcg/min). One hour later, an angiogram showed complete obstruction at the origin of the left anterior descending artery (LAD). After intracoronary streptokinase (250,000 units) the LAD opened and a 90% obstruction was seen at its origin. However, an anterior myocardial infarction occurred. One month later, an angiogram showed a slight irregularity at the origin of the LAD. Thus, this case demonstrates that 1) a myocardial infarction may occur with a near normal coronary artery, and 2) a thrombus may occur at the site of a slight coronary irregularity.

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Cancer serum index: a useful nonspecific test as a parameter in multimodality screening and assessment of patients with cancer of the prostate.

A satisfactory, simple test for screening and monitoring of patients with prostatic cancer is still being sought. We suggest the use of a nonspecific test in combination with other tests. The ratio of two serum proteins (alpha 1 acid glycoprotein [AGP] and prealbumin [PAB]), may be useful markers for a cancer serum index (CSI). By separating serum components by gradient polyacrylamide gel electrophoresis, staining and quantitating these proteins by scanning densitometry, and dividing the area of AGP by that of PAB, indices can be obtained. In a test of sera from 450 patients with prostatic cancer, other urologic problems, and normal controls, CSIs of 360 sera presently decoded were found to be: (Formula: see text). The CSI should prove highly valuable when used in combination with selected prostatic cancer tests.