Effect of a nutritional supplement containing vitamin E, selenium, vitamin c and coenzyme Q10 on serum PSA in patients with hormonally untreated carcinoma of the prostate: a randomised placebo-controlled study.

OBJECTIVE: To assess the effect of a nutritional supplement containing vitamin E, selenium, vitamin C and coenzyme Q10 on changes in serum levels of PSA in patients with hormonally untreated carcinoma of the prostate and rising serum PSA levels. METHODS: Eighty patients were randomised to receive a daily supplement with either vitamin E, selenium, vitamin C, coenzyme Q10 (intervention group) or placebo over 21 weeks. Serum levels of PSA were assessed at baseline (-2, -1, 0 weeks) and after 6, 13, 19, 20 and 21 weeks. Mean changes in log serum level of PSA, testosterone, dihydrotestosterone, luteinizing hormone and sex hormone binding globulin over 21 weeks between the verum and the placebo group were compared by analysis of covariance. RESULTS: Seventy patients completed the study (36 verum; 34 placebo). Compliance was >90% in all patients. In the intervention group, plasma levels of vitamin E, selenium and coenzyme Q10 increased significantly over the 21 weeks study period. No significant differences in serum levels of PSA, testosterone, dihydrotestosterone, luteinizing hormone or sex hormone binding globulin (p>0.2) were observed between the intervention and control group. CONCLUSION: Our results indicate that supplementation of a combination of vitamin E, selenium, vitamin C and coenzyme-Q10 does not affect serum level of PSA or hormone levels in patients with hormonally untreated carcinoma of the prostate.

Bicalutamide (Casodex) 150 mg as immediate therapy in patients with localized or locally advanced prostate cancer significantly reduces the risk of disease progression.

OBJECTIVES: To investigate the efficacy and tolerability of bicalutamide (Casodex) as immediate therapy, either alone or as adjuvant to treatment of curative intent, in patients with localized or locally advanced (T1b-T4, any nodal status, M0) prostate cancer. METHODS: This was a multicenter, prospective, randomized, double-blind, placebo-controlled trial in Europe, South Africa, Australia, and Mexico and is part of the Casodex Early Prostate Cancer program. RESULTS: A total of 3603 men were randomized to receive bicalutamide (n = 1798) or placebo (n = 1805). The patient demographics were well balanced between the two groups. Prior therapy of curative intent had been given to 64% of the patients (prostatectomy [44%], radiotherapy [18%], and prostatectomy and radiotherapy [2%]) and 36% had been monitored with watchful waiting. After a median follow-up of 2.6 years and a median exposure to the study drug of 2.2 years, a significant 43% reduction in the risk of objective progression was observed for the bicalutamide group compared with the placebo group (hazard ratio 0.57, 95% confidence interval 0.48 to 0.69, P << 0.0001). The time to prostate-specific antigen doubling was significantly delayed for the bicalutamide group compared with the placebo group (hazard ratio 0.37, 95% confidence interval 0.32 to 0.43, P << 0.001). The survival data were immature, with 7.2% overall mortality. The most frequently reported adverse events with bicalutamide were gynecomastia alone (17.4%), breast pain alone (17.6%), and gynecomastia with breast pain (47.5%). CONCLUSIONS: Bicalutamide 150 mg daily as immediate therapy, alone or as adjuvant to treatment of curative intent, significantly reduced the risk of disease progression in patients with localized or locally advanced prostate cancer. Longer follow-up is underway to assess any benefit in overall survival.

A conservative treatment of phimosis in boys.

OBJECTIVE: The aim of this study was to evaluate the efficacy of topical applications of clobetasol propionate cream in the treatment of phimosis in boys and a comparison of the results presented with an overview of the current studies. METHODS: In a prospective study, 94 boys (mean age 5.5 years) were treated with topical applications of 0.05% clobetasol propionate cream twice daily. The prepuce was treated for 1 month, with an attempt at prepuce retraction after 14 days. The boys were evaluated after 1 month of treatment and every 3 months during follow-up. RESULTS: Of the 94 boys, 91 were available for follow-up, of whom 42 boys (46.1%) achieved complete retraction of the prepuce, 24 (26.4%) had only preputial adhesions and 4 (4.4%) had partial retraction. Twenty-one boys (23.1%) had no response. The treatment was continued in 13 boys with good results eventually. Seven boys (7.7%) had recurrence after a mean follow-up of 4.3 months (range 2-7). No side effects were noted. Circumcision was necessary in 24 of the 91 boys (26.4%). The mean follow-up was 11.0 months (range 3-18). CONCLUSIONS: Local application of clobetasol propionate cream is a simple, safe and effective treatment for phimosis in boys and avoids circumcision and its associated risks. It should be offered first instead of circumcision.

Squamous cell carcinoma of suprapubic cystostomy tract without bladder involvement.

This report describes a third case of squamous cell carcinoma of the suprapubic cystostomy tract. The first case reported in 1993 concerned a squamous cell carcinoma arising adjacent to the suprapubic cystostomy site and extending anteriorly to the abdominal wall in a 80-year-old man, 5 years after suprapubic urinary diversion for urethral stricture. A second case published in 1995 described a 50-year-old paraplegic man (T11-T12 spinal cord injury) in whom a suprapubic cystostomy tract squamous cell carcinoma developed after 25 years of urinary diversion. The tumour involved the cystostomy tract primarily with extension into the bladder but did not penetrate the bladder wall muscle. Our patient is in fact the second one to have a suprapubic cystostomy tract squamous carcinoma not involving the bladder.

Indiana pouch in female patients with spinal cord injury.

OBJECTIVE: We assessed the results of a continent urinary diversion (Indiana pouch) in seven women with severe neurogenic urinary incontinence. PATIENTS AND METHODS: There were seven patients (mean follow-up 28 months), in five of whom a complete Indiana pouch was created. In two the bladder was augmented with the Indiana pouch, the bladder neck was closed and an umbilical stoma was created. In three cases the appendix served as outlet whereas in the other patients a continent catheterisable stoma was created by means of a tapered terminal ileum. RESULTS: All the patients were dry (the stoma was continent) and could catheterise themselves while sitting in a wheelchair. There was one complication (bleeding) immediately postoperatively that needed reintervention. The late complications were acceptable: in one patient a stone had to be removed from the pouch and there was a stenosis of the stoma in two others. There was no hyperchloraemic acidosis. CONCLUSION: The Indiana pouch is a safe and effective method for neurogenic incontinence when all available pharmacological treatments and clean intermittent catheterisation have failed. It has little impact on the body image, and the independence and social reintegration of the woman is improved.

Metastasis of gastric carcinoma to the ureter.

Metastasis of gastric carcinoma to the ureter is very rare. In most published cases, the diagnosis is only made at postmortem examination or when gross metastasis is present. This report presents a case in which the metastasis occluded the ureteral lumen from inside, and the diagnosis was made by histopathologic examination of a biopsy specimen taken during ureteroscopy.

Oral desmopressin as a new treatment modality for primary nocturnal enuresis in adolescents and adults: a double-blind, randomized, multicenter study. Dutch Enuresis Study Group.

PURPOSE: We evaluated the efficacy and safety of 2 oral doses of desmopressin compared to 20 micrograms. nasal spray and baseline values in the treatment of primary nocturnal enuresis. MATERIALS AND METHODS: A multicenter study was done comparing oral dosages (200 and 400 micrograms.) of desmopressin (4-week, randomized, double-blind phase followed by 12 weeks of open label treatment with 400 micrograms.) to 20 micrograms. nasal spray in 66 adults and adolescents 12 to 45 years old with primary nocturnal enuresis. RESULTS: No significant differences were found between the 2 doses of desmopressin tablets or between the tablets and 20 micrograms. nasal spray during the double-blind phase. However, patients who initially received 200 micrograms. desmopressin tablets experienced fewer wet nights after they completed 12 weeks of open label treatment when the dose was escalated to 400 micrograms. tablets. Those who received 400 micrograms. tablets initially maintained response during this phase. Desmopressin tablets were well tolerated at both dose levels: 96% of patients and 94% of physicians rated the tolerability as excellent. CONCLUSIONS: Desmopressin tablets are an effective and safe alternative for treatment of nocturnal enuresis.

Coagulation and fibrinolysis activation markers in prostatic carcinoma patients.

In 49 patients with benign prostatic hyperplasia, 24 metastatic prostatic carcinoma patients all under palliative hormonal treatment, 17 untreated prostatic carcinoma patients without metastases and 14 untreated prostatic carcinoma patients with metastases, plasma levels of thrombin-antithrombin III complex, D-dimer and plasmin-alpha2-antiplasmin were determined. The coagulation activation marker thrombin-antithrombin III complex did not show any significant difference between the different patient groups. Of the fibrinolysis markers, D-dimer levels were elevated in both metastatic groups compared to the non-metastatic group and the benign prostatic hyperplasia group. Surprisingly, the levels of the other fibrinolysis marker, plasmin-alpha2-antiplasmin, showed no significant difference. The nature of these findings is discussed and related to other relevant literature. The general conclusion is that fibrinolysis may not play such a prominent role in prostatic carcinoma as described and expected.

Diagnostic value of some biochemical bone markers for the detection of bone metastases in prostate cancer.

Bone metastases in cancer of the prostate are diagnosed routinely by isotope bone scintigraphy and the measurement of alkaline phosphatase in serum and the calcium excretion in urine. The specificity of these examinations is in general not satisfactory. We therefore investigated the diagnostic value of five new markers of bone formation and bone resorption for the detection of the metastatic process. In a group of 43 patients with carcinoma of the prostate the carboxyterminal propeptide, the carboxyterminal cross-linked telopeptide, the aminoterminal cross-linked telopeptide, and the deoxypyridinoline cross-links of type 1 collagen were measured as well as the specific bone alkaline phosphatase isoenzyme. A group of 34 patients with benign prostatic hyperplasia served as a control. A receiver-operating characteristic analysis was performed. It appeared that the sensitivity of carboxyterminal cross-linked telopeptide of type I collagen was the greatest (89%), while the best specificity was obtained for the deoxypyridinoline cross-links assay (92%). The diagnostic values of the new markers were generally comparable with those of alkaline phosphatase although carboxyterminal cross-linked telopeptide of type I collagen yielded better results, but those with carboxyterminal propeptide of type I procollagen were less satisfactory. Calcium excretion in urine had no added value at all.

Inverted papilloma of the ureter with subsequent invasive bladder cancer.

A 63-year old man presented with urinary frequency and urge. An IVU showed a tumour in the lower right ureter. Partial ureterectomy was done with a uretero-ureterostomy. Pathological investigation showed an inverted papilloma. Inverted papilloma of the ureter should always be considered in the differential diagnosis before major surgery is done. There is an association between inverted papilloma and urothelial carcinoma. Our patient developed an invasive bladder tumour 6 years after the operation on the inverted papilloma.

Haematuria: intravenous urography, ultrasound or both?

PURPOSE: To compare the diagnostic value of intravenous urography (IVU), ultrasound (US) and their combination in detecting upper urinary tract malignancies in patients with haematuria. MATERIALS AND METHODS: In a prospective study, 360 consecutive patients who consulted the urologist for haematuria without renal colic were scheduled for IVU and US on the same day. The two procedures were performed by two different radiologists and reported independently. Histology or clinical follow-up of one year served as the gold standard. RESULTS: 63 patients dropped out. Of the remaining 297 patients, 9 (3%) had a malignancy in the upper urinary tract. Sensitivity and specificity with regard to the upper urinary tract pathology were 67% and 91% for IVU and 56% and 94% for US, respectively. For both techniques combined this was 79% and 88%, respectively. CONCLUSION: An acceptable sensitivity for detecting upper urinary tract malignancies is obtained only by combining IVU and US.

Haematological variables in prostatic carcinoma patients.

Routine laboratory tests of the red, white and platelet blood cell systems were performed in 49 patients with benign prostatic hyperplasia (BPH), in 24 hormonally treated patients with metastatic prostatic carcinoma, in 17 patients with untreated prostatic carcinoma without metastases and in 14 patients with untreated metastatic prostatic carcinoma. Significantly lower erythrocyte counts, haemoglobin levels and haematocrit values were found in the hormonally treated cancer group compared to all three other groups. The untreated metastatic cancer group had significantly lower haemoglobin levels and haematocrit values compared to the untreated non-metastatic cancer group. These results indicate that patients with metastases were developing anaemia and that this development was not influenced by palliative hormonal therapy. The results of this study showed that abnormal platelet counts in patients with prostatic carcinoma were rare and that the white blood cell system did not seem to be affected in patients with prostatic carcinoma.

Urethral metastasis from a rectal carcinoma.

A 67-year-old man presented with a tumour of the penis. Endoscopy revealed a bleeding tumour. Histological examination showed an adenocarcinoma; urethral metastasis of rectal carcinoma. As far as we know only 6 previous cases have been described.

Percutaneous endoscopic treatment of urothelial tumours of the renal pelvis.

OBJECTIVE: To evaluate the results of percutaneous endoscopic treatment of renal pelvic transitional cell carcinoma (TCC). PATIENTS AND METHODS: Ten patients (median age, 70 years; range 56-86) with a renal pelvic TCC were treated by percutaneous endoscopic resection. Seven had a normal contralateral kidney and were treated electively. RESULTS: Follow-up was from 3 to 77 months. There was one recurrence locally and one recurrence in the bladder. There have been no recurrences in the nephrostomy tract. CONCLUSION: We have shown that percutaneous resection of intrarenal TCC is a possible and safe technique. Further follow-up is needed to confirm its safety.

Vacuum constriction devices in erectile dysfunction: acceptance and effectiveness in patients with impotence of organic or mixed aetiology.

OBJECTIVE: To investigate the value of vacuum constriction devices in the treatment of erectile dysfunction. PATIENTS AND METHODS: A total of 67 patients were treated with vacuum constriction devices. The impotence was of organic origin in 36 men (54%) while in the remaining 31 (46%) it was of mixed aetiology (organic and psychological factors). Forty-seven patients continued to use the device at home for the duration of the practice period. RESULTS: All 67 patients underwent a vacuum test which resulted in nearly half of them achieving an erection sufficient for intercourse. Adequate erections were achieved in 34 of 47 (72%) patients who used the device at home during the practice period. In the group of patients with organic impotence (venous leakage), rigidity was better and the frequency of intercourse higher than in patients with diabetes and in those with neurogenic disorders. CONCLUSION: These findings support further the role for vacuum devices for the treatment of erectile dysfunction in carefully selected patients.

Pitfalls in the differentiation of N-glycosylation variants of prostate-specific antigen using concanavalin A.

We determined the optimal conditions for the separation of N-glycosylation variants of prostate-specific antigen using concanavalin A. Concanavalin A is a lectin that binds to the terminal sugar residues of glycoproteins. We demonstrated that differences in the percentage of prostate-specific antigen bound to concanavalin A-Sepharose in patients with benign prostatic hyperplasia compared with patients with prostatic carcinoma, as described in the literature, arise when insufficient concanavalin A binding sites are added for complete binding of the glycosylation variants of prostate-specific antigen. We observed similar percentages of prostate-specific antigen bound to concanavalin A-Sepharose for benign prostatic hyperplasia (86.3% +/- 7.5, mean +/- SD) and carcinoma patients (81.8% +/- 12.0, mean +/- SD), when sufficient concanavalin A-Sepharose was added to allow optimal binding, and when samples with high prostate-specific antigen concentrations were not pre-diluted before incubation with concanavalin A-Sepharose. We conclude that differentiation of patients with benign prostatic hyperplasia or carcinoma of the prostate on the basis of differences in percentages of prostate-specific antigen bound to concanavalin A-Sepharose, i.e. separation of N-glycosylation variants, is not possible.

Vasovasostomy results in 66 patients related to obstructive intervals and serum agglutinin titres.

In this series we present the results of a retrospective analysis of 66 vasovasostomy procedures performed between 1983 and 1991. Obstructive intervals and serum antisperm antibodies were correlated with pregnancy and patency rates. With obstructive intervals of less than 5 years a patency rate of 100% (31/31) was obtained. Even more than 10 years after reversal, pregnancy occurred in 25% (2/8) of the patients. Preoperative serum antisperm antibodies were correlated with pregnancy rates. Patients with a high agglutinin titre of 1/64 obtained a pregnancy rate of 23% (3/13). Those men who had no circulating antisperm antibodies in their blood had a significantly better chance in obtaining pregnancy (pregnancy rate 80%). In this study we accounted for an overall pregnancy rate of 51.5% (34/66) versus an overall patency rate of 84.8% (56/66). Neither long obstructive intervals nor high antisperm antibody titres should dissuade a surgeon from performing a vasovasostomy procedure.

Secondary signet ring cell tumour of the prostate.

We report a rare case of clinically significant secondary prostatic neoplasm. In a patient with outflow obstruction, a transurethral resection of the prostate revealed a metastasis of a signet ring cell carcinoma of the stomach in the resected prostatic tissue.