Pilot study of screening for prostate cancer in general practice.

The success of a screening programme for cancer depends on the sensitivity of the tests used and on the proportion of the target population that comes forward for screening. To assess the value of digital rectal screening and prostate-specific antigen (PSA) measurement as screening measures, the 814 men in a city general practice aged between 55 and 70 were recruited in one of five different ways. Men with a palpably suspicious prostate or a serum PSA greater than 4 ng/ml were referred for transrectal ultrasonography and, if indicated, biopsy. 472 men (58%) were screened; of these 68 underwent transrectal ultrasonography and 29 biopsy. In 7 the biopsy specimen showed carcinoma. Serum PSA was better than digital examination as a screening test--all men with prostate cancer had raised concentrations of serum PSA, whereas only 1 had a palpably abnormal prostate. All 7 had localised disease, and 5 underwent radical prostatectomy. The best methods of patient recruitment were to send an appointment for screening and to "tag" the patient's notes.

Comparison of transrectal ultrasound and magnetic resonance imaging in the staging of prostate cancer.

A group of 32 patients with a histological diagnosis of prostate cancer underwent transrectal ultrasound (TRUS) and magnetic resonance imaging (MRI) to stage the disease. TRUS was more sensitive in the detection of tumour and in the detection of direct extracapsular spread. MRI was more sensitive in the detection of tumour involvement of the seminal vesicles and bladder base. MRI allowed the detection of lymphadenopathy and bone metastases in the lumbosacral spine and pelvis. During MRI the short tau inversion recovery (STIR) sequence was found to be particularly useful for the detection of tumour spread. TRUS and MRI are complementary investigations and for the accurate staging of prostatic malignancy both investigations should be used.

Magnetic resonance imaging of spinal metastases.

Sixty-six patients with spinal metastatic disease secondary to urological malignancy underwent magnetic resonance imaging. Twenty-eight patients had clinical evidence of spinal cord compression. MRI demonstrated metastatic cord compression in 16 cases, a benign cause in two cases, nerve root involvement in five cases. In seven patients MRI demonstrated spinal metastases which were not visible on plain radiographs and isotope bone scans. Nine patients had metastatic deposits involving the cauda equina and in a further 22 patients spinal metastases were an incidental finding during MRI for staging of the primary tumour. MRI is a sensitive method of imaging spinal metastases and provides a non-invasive means of assessing patients with spinal cord compression.

The interaction of phenytoin and carbamazepine with combined oral contraceptive steroids.

Patients taking oral contraceptive steroids (OCS) are known to suffer contraceptive failure while taking anticonvulsants such as phenobarbitone, phenytoin and carbamazepine. We have studied the single dose kinetics of ethinyloestradiol (EE2); 50 micrograms, and levonorgestrel (Ng); 250 micrograms in groups of women before and 8-12 weeks after starting therapy with phenytoin (n = 6) and carbamazepine (n = 4). The area under the plasma concentration-time curve (AUC) was measured over a 24 h period for each steroid and significant reductions were seen with both anticonvulsants. Phenytoin reduced the AUC for EE2 from 806 +/- 50 (mean +/- s.d.) to 411 +/- 132 pg ml-1 h (P less than 0.05) and for Ng from 33.6 +/- 7.8 to 19.5 +/- 3.8 ng ml-1 h (P less than 0.05). Carbamazepine reduced the AUC for EE2 from 1163 +/- 466 to 672 +/- 211 pg ml-1 h (P less than 0.05) and for Ng from 22.9 +/- 9.4 to 13.8 +/- 5.8 ng ml-1 h (P less than 0.05). These changes are compatible with the known enzyme inducing effects of phenytoin and carbamazepine. Patients taking these anticonvulsants will need to be given increased doses of OCS (equivalent to 50-100 micrograms EE2 daily) to achieve adequate contraceptive effects.

Life with urostomy.

The quality of life of urostomy patients was assessed by direct interview. Specific problems, such as urine leakage, were documented and the size, site and quality of the stoma were assessed. The study included 41 patients; 83% noted an improvement in the quality of life since their urinary diversion and 90% were still able to work or continue to perform household duties. Urine leakage was the commonest problem and this was unrelated to the length of the stoma or the build of the patient. More important factors were the correct siting of the stoma and the avoidance of parastomal herniation. All patients emphasised the importance of the stoma therapist.