Can gemcitabine instillation ablate solitary low-risk non-muscle-invasive bladder cancer? Results of a phase II marker lesion study.

PURPOSE: The purpose of this phase II study was to evaluate whether low-risk non-muscle-invasive bladder cancer can be ablated with intravesical gemcitabine in a marker lesion study. PATIENTS AND METHODS: The study had a Simon II-stage design. Thirteen patients were to be recruited for stage I. In the event of ≥4 responses, another 30 patients were to be recruited. Patients were given gemcitabine 2,000 mg intravesically once per week for 6 weeks and the response was assessed with endoscopic, histological, and urine cytological findings. RESULTS: Fourteen patients evaluated for efficacy completed the study; complete responses were achieved by 2 patients (14.3%), both of these patients had lesions of <1 cm. Eleven patients (78.6%) were non-responders and 1 patient (7.1%) had progressive disease. Since the response rate in stage I was below the minimal pre-defined limit, the study was stopped. CONCLUSIONS: This study shows that intravesical gemcitabine does not merit further study in this patient population. A tumor size of >1 cm may be a critical factor in accounting for the low response rate.

Reverse transcriptase-PCR analysis of apoptosis-regulating gene expression in human benign prostatic hyperplasia.

BACKGROUND: To determine whether an imbalanced interaction between proapototic and antiapoptotic signals may account for the loss of the normal cell growth control in benign prostatic hyperplasia (BPH), the expression of some apoptosis-regulating genes (bcl-2, bax, c-myc, fas) was investigated. PATIENTS AND METHODS: BPH specimens were obtained from 20 patients who underwent trans-urethral resection of the prostate (TURP) or adenomectomy. Gene expression was studied by reverse transcriptase-polymerase chain reaction (RT-PCR) and its correlation with age and serum PSA level was also investigated. RESULTS: Genes were found to be differentially expressed in BPH tissues. In particular, the antiapoptotic gene bcl-2, which was found in 18/20 samples, gave the weakest signal (p < 0.05 - p < 0.001, Wilcoxon's signed rank test), whereas the cell cycle regulator c-myc was detected in all the specimens and was the most highly expressed (p < 0.001). A positive relationship between the expression of bcl-2 and that of the two proapoptotic genes bax and fas was observed (p < 0.05, Spearman's rank correlation test), as well as between c-myc and fas levels (p < 0.005). Moreover, bax expression positively correlated with age and PSA (p < 0.02), which have also been shown to directly correlate (p < 0.01). CONCLUSION: The higher expression of the oncogene c-myc suggests the activation of mitogenic signals within hyperplastic prostate tissue which a relatively high expression of the proapoptotic genes bax and fas fails to counterbalance.

Prostate cancer: preliminary results of a case finding campaign.

OBJECTIVES: The objective of this study was to evaluate the feasibility of applying a case finding programme for prostate carcinoma based on a questionnaire which was sent by post to the male population of a Northern Italian region. METHODS: In November 2000 a questionnaire containing prostate related questions was sent to all men aged 55 or older residing in the area served by our hospital. Information provided by the answers was included in a specific data base. Subjects considered at risk for prostate carcinoma were invited for clinical consultation and prostate biopsy when appropriate. RESULTS: 41,627 questionnaires were sent and 7,732 were completed and returned. 960 subjects (12.4%) were considered at risk. Presently, 816 patients have been examined and 116 were biopsied. Thirty-six cases of prostate cancer were found (4.4%). DISCUSSION: The value of mass screening programmes for prostate carcinoma is still under debate and mature data from controlled screening trials must be obtained before definitive conclusions can be drawn. In the meanwhile, considering the growing public awareness, it may be advisable to activate programmes asking for information through questionnaires about prostate disease in order to find cases of undetected prostate cancer.