Effects of complete androgen blockade for 12 and 24 weeks on the pathological stage and resection margin status of prostate cancer.

AIMS: To compare the pathological stage and surgical margin status in patients undergoing either immediate radical prostatectomy or 12 and 24 weeks of neoadjuvant hormonal treatment (NHT) in a prospective, randomised study. METHODS: Whole mount sections of 393 radical prostatectomy specimens were evaluated: 128 patients had immediate surgery, 143 were treated for 12 weeks and 122 for 24 weeks with complete androgen blockade. RESULTS: Histopathology revealed organ confined tumours in 40.4% of patients with clinical stage B disease in the immediate surgery group, whereas 12 and 24 weeks of NHT increased the number of organ confined tumours to 54.6% and 64.8%, respectively. Among patients with clinical stage C tumours, pathological staging found organ confined disease in 10.4%, 31.4%, and 61.2% in the immediate surgery, 12 weeks of NHT, and 24 weeks of NHT groups, respectively. Preoperative NHT caused a significant decrease in positive margins both in patients with clinical stage B and C disease. The extent of margin involvement was not influenced by preoperative treatment. CONCLUSIONS: Neoadjuvant androgenic suppression is effective in reducing both the pathological stage and the positive margin rate in patients with stage B and C prostatic cancer undergoing radical surgery. Some beneficial effects are evident in those patients treated for 24 weeks, and it is reasonable to assume that the optimal duration of NHT is longer than three months.

980-nm diode laser treatment for recurrent urethral strictures.

OBJECTIVES: Our experience with laser treatment of urethral strictures with a 980-nm diode laser is reported. METHODS: 45 consecutive patients with relapsing urethral strictures (mean age 65, range 25-85 years) were treated between February 1995 and February 1998. The fibrous and scar tissue was cut and vaporized at the 6 o'clock position with the laser beam. RESULTS: 44/45 patients were available for follow-up at 1 year and 32/43 at 2 years. At 12 months the average peak flow rates of the patients was 18 ml/s, and at the second year assessment it was 15.5 ml/s. Of the patients 21/44 (47.7%) were extremely satisfied (0-1 of the quality-of-life, QoL, assessment index) with the procedure, 14/44 (31.8%) were satisfied (2 of the QoL assessment index), and 9/44 (20.4%) were not satisfied (> or = 3 of the QoL assessment index) due to the low flow rate or the recurrence of the stricture. (The sum of the first two categories is 79.5%.) At the second year assessment the percentage of satisfied patients reached 78%, with 71% of the patients stable without any dilatation. CONCLUSIONS: Usually in recurrent strictures of the urethra open surgery is suggested, but we believe that there is still a place for endoscopy. With the laser we can make an incision at the 6 o'clock position without significant bleeding, very easily opening the urethra. We had 79.5 and 71% good results at the 1- and 2-year assessments (mean peak flow rate of 18 and 15.5 ml/min), respectively. To date, no definitive conclusions can be drawn, but we believe that laser treatment is indicated for recurrent strictures in high risk or elderly patients and in those who demand a minimally invasive procedure.

Effect of complete androgen blockade on pathologic stage and resection margin status of prostate cancer: progress pathology report of the Italian PROSIT study.

OBJECTIVES: To compare the pathologic stage and surgical margin status in patients undergoing either immediate radical prostatectomy or surgery preceded by 3 or 6 months of neoadjuvant hormonal treatment (NHT) in a prospective, randomized study. METHODS: Four hundred thirty-one men with prostate cancer were enrolled in the Italian randomized prospective PROSIT study. The whole-mount sectioning technique was used. By May 1999, the reviewing pathologist had evaluated 303 specimens. One hundred seven patients were untreated before radical prostatectomy was performed, and 114 and 82 patients had been treated for 3 and 6 months, respectively, with complete androgen blockade. RESULTS: Pathologic organ-confined disease was found in 63.1% of patients with clinical Stage B disease treated with 6 months of NHT versus 61.0% after 3 months of NHT and 37.5% after immediate surgery. Among patients with clinical Stage C tumors, pathologic staging found organ-confined disease in 62.5%, 32.1%, and 11.1% of patients after 6 months of NHT, 3 months of NHT, and immediate surgery, respectively. Three months of NHT produced a significant increase in negative margins both in patients with clinical Stage B and C disease, but the addition of another 3 months of treatment did not significantly improve this result. A lower degree of benefit was observed in patients with clinical Stage C tumors. CONCLUSIONS: This study shows that complete androgen blockade before surgery is beneficial in men with clinical Stage B disease. The effects are more pronounced after 6 months of NHT than after 3 months.

Transurethral electrovaporization of the prostate vs. transurethral resection. Results of a multicentric, randomized clinical study on 150 patients.

AIM OF THE STUDY: To evaluate clinical, urodynamic efficacy and safety of TURP and TVP in patients with symptoms due to obstructive benign prostatic hypertrophy with a prospective multicentric randomized study. MATERIALS AND METHODS: 150 patients with BPH, urodynamically obstructed, were randomized to receive TURP or TVP. At the end of the recruitment phase, 80 patients underwent TURP and 70 patients underwent TVP. Patients were clinically evaluated by the I-PSS score at months 0, 1, 3, 6 and 12. Preoperative evaluation included complete blood routine examination, PSA, transrectal ultrasound and pressure/flow studies. Pressure/flow studies were also performed after 3 months. RESULTS: There was no statistical difference between groups in any of the preoperative parameters. All patients were considered urodynamically obstructed at preoperative pressure studies. As for catheter days and hospitalization days, statistical differences between TVP and TURP were found; catheter days were 2.71 days (SE 0.12) in the TURP group vs. 1.9 (SE 0.24) in the TVP group (p < 0.000). Hospitalization was 4.7 days (SE 0.22) after TURP and 3.9 days (SE 0.24) after TVP (p < 0.000). Mean preoperative I-PSS score was 18.84 and 18.19 in the TVP and TURP groups, respectively. At 3, 6 and 12 months, IPSS was 5.52 and 5.50, 3.77 and 4.94, 3.52 and 4.04 for TURP and TVP, respectively. Mean preoperative peak flow rate (PFR) was 8.78 and 7.26 ml/s for TURP and TVP, respectively; after 3, 6 and 12 months, PFR was 19.21 and 18.8, 20.77 and 20.13, 20.30 and 20.31 ml/s, respectively. After 3 months, 6 patients in the TURP group (7.5%) and 7 patients in the TVP group (10%) were borderline obstructed. 1 patient in the TVP group (1.4%) was still obstructed and underwent TURP. As for complications, 4 patients (5.7%) in the TVP group had stress urinary incontinence after 12 months vs. 1 (1.25%) in the TURP group. DISCUSSION: The present study clearly demonstrates that TVP is as effective as TURP in relieving urinary obstruction due to BPH, it offers some advantages in terms of catheterization and hospital stay, but at the price of a higher incidence of postoperative urine incontinence. Technical improvements might solve this problem in the future, perhaps combining TVP with TURP of the apical tissue.

Comparison of LH-RH analogue 1-month depot and 3-month depot by their hormone levels and pharmacokinetic profile in patients with advanced prostate cancer.

In an open, randomized phase II pharmacokinetic study conducted in Germany and Italy, a total of 42 patients with advanced or metastatic prostate cancer (PCa) were treated for 9 months with the luteinizing hormone-releasing hormone analogue (LH-RH-a) leuprorelin acetate depot in two different formulations. Fifteen patients received the 1-month depot and 27 patients received the newly developed 3-month depot, containing 3.75 mg and 11.25 mg, respectively. In both groups, subcutaneous injections of leuprorelin acetate injected monthly or at 3-month intervals produced a complete down-regulation of the pituitary and led to persistent suppression of testosterone and dihydrotestosterone to the castrate range (< or = 50 ng/dl for testosterone) within the first month of treatment, which thereafter could be maintained over the entire observation period of 9 months. In 10 patients, pretreatment with an antiandrogen for the prevention of clinical flare-up resulted in a slightly more profound and earlier drop in serum testosterone. The 3-month depot showed a higher median peak serum concentration (Cmax) of leuprorelin at 20.8 ng/ml than the 1-month depot at 10.7 ng/ml but, conversely, this did not influence the rise in serum testosterone levels. Cmax occurred at 3 h for the 3-month and at 1 h for the 1-month depot formulation. During the steady state, constant release could be detected, starting on day 3 and day 7 for the 1-month and 3-month depot, respectively. A marked decrease in median prostate-specific antigen levels of 97.8% (1-month depot) and 96.6% (3-month depot) compared with baseline was observed, indicating an objective clinical response for more than 80% of all patients in both arms. Based on European Organization for Research and Treatment of Cancer criteria, the best response in terms of complete/partial remissions and stabilization was comparable in the two arms at 86.7% (1-month depot) and 85.2% (3-month depot). 6.7% in the 1-month group and 3% in the 3-month depot group showed progression of the disease. The most common side effects in both treatment groups were related to hormone deprivation. Both formulations of the potent LH-RH-a leuprorelin acetate were highly effective in the treatment of advanced PCa and led to comparable endocrine and clinical effects.

A paratesticular localization of desmoplastic small cell tumor. A case report.

We report a case of paratesticular desmoplastic small cell tumor. In accord with the literature, the patient was subjected to treatment with combined chemotherapy, but he developed progression of disease and died 13 months later.

Transurethral laser surgery with a conventional modified resectoscope.

A new 1,800-microns side fiber made of pure silica with laser beam deviation of 82 degrees and divergence of 18 degrees was inserted into a modified transurethral resectoscope and used to treat in vitro some prostates removed during radical prostatectomy. Sterilization of prostatic tissue with a depth of penetration of 12 mm was observed after treatment with 20 W for 2 min. Irradiation with 60 W for 1 min produced vaporization and explosion of the tissue and a depth of penetration of 15 mm. The laser resectoscope was then successfully employed for the treatment of 6 cases of benign prostatic hyperplasia (BPH) as well as in high risk patients with bulky bleeding bladder tumors (4 cases) and with transitional carcinoma of the prostate invading the parenchyma (2 cases). 3 patients with small size BPH underwent only laser irradiation. All others were submitted to traditional transurethral resection followed by laser treatment with Nd: YAG using the same instrument. Our laser resectoscope lowers costs since the side fiber is reusable for 4-5 treatments and brings laser treatment nearer to traditional endoscopic treatment, thereby making its application more comfortable for the urologist.

[Leiomyoma of the female urethra]. / Leiomioma de la uretra femenina.

Leiomyoma of the urethra is a small, benign and extremely rare tumor of mesenchymal origin. To date, about thirty cases have been reported in the literature. A case of leiomyoma of the urethral meatus that had been incidentally discovered is described. The anatomopathological aspects are presented and the clinical and therapeutic problems are discussed.

Prognosis of bladder cancer. III. The value of radical cystectomy in the management of invasive bladder cancer.

From January 1979 to June 1982, 141 consecutive patients with bladder transitional cell carcinoma were treated with a single stage lymphadenectomy plus radical cystectomy. The survival rate observed in our patients, based on the TNM classification, was comparable with that reported for other groups employing contemporary surgery. Survivorship for patients with deep invasive tumors was also estimated by breaking down the pT3 stage, and patients with tumor confined to the bladder wall (pT3a) were separately evaluated from those with tumor extended outside (pT3b). The results obtained with this subdivision showed that pT3a patients have almost the same survival rate as pT2 patients. From these results it is concluded that radical cystectomy is a satisfactory curative treatment of bladder cancer confined to the bladder wall, whatever the extension of the muscular involvement. Such considerations suggest that, in order to achieve a more objective analysis of the results after radical cystectomy for invasive bladder cancer, a modification of clinical staging is necessary. Moreover, a simplification of the classification methods should provide a better identification of the elements required to assess the prognosis and to improve treatment planning.

Primary endodermal sinus tumor of the prostate: report of a case.

A 29-year-old man was admitted to the Department of Urology of the University of Padova with a diagnosis of prostatic adenocarcinoma. Cystourethrography showed a prostatic urethral obstruction, and CT scan demonstrated a low pelvic solid mass involving the prostate and the seminal vescicle. A radical prostatectomy was performed, and the prostate was found to be widely infiltrated by a neoplasia formed by tubules, papillary structures, and solid cords of cuboidal or flat elements, each having indistinct borders and scant cytoplasm, in a myxoid or fibrous stroma. "Schiller-Duval-like," PAS-diastase-resistant and alfa-fetoprotein hyaline bodies were present. An endodermal sinus (yolk-sac) tumor was diagnosed. There was infiltration of the periurethral prostatic ducts, prostatic urethra, and seminal vesicles and single lymph node metastasis. Testicular echotomography was negative. In spite of aggressive surgery and chemotherapy, the patient died 10 months after diagnosis. This is the third case in the literature after those presented by Benson and Michel.

Sperm antibodies and infertility in patients with testicular cancer.

The level of antisperm antibodies using the enzyme-linked immunosorbent assay (ELISA) in the serum of 48 patients with testicular cancer before and after therapy is reviewed. This is not a linear study of each patient, but some conclusions can be drawn: In a high percentage of testicular cancer patients serum antisperm antibodies can be detected: 73.3 per cent before orchiectomy and 43.7 per cent overall. The percentage of patients with antibodies decreases with adequate therapy. In patients with advanced disease there is a higher percentage of positivity (50%) for serum antisperm antibodies than in patients with low-stage disease (30%). The higher percentage of antibodies-positive patients among those with infertility patterns could be an important argument that supports the hypothesis that autoimmune pathology can play a role in oligo/azoospermia in testicular cancer patients.

[Locoregional staging of prostatic neoplasms by extemporaneous histological examination of pelvic lymph nodes]. / Stadification loco-régionale des cancers prostatiques par l'examen histologique extemporané des ganglions pelviens.

Pelvic lymphadenectomy prior to radical prostatectomy is essential to detect lymph nodal extension of prostatic cancer. Accuracy obtained by means of frozen section examination of the nodes is particularly favourable. Frozen sections correspond to paraffin sections in 100% of the cases. Authors' experience in 42 consecutive patients candidates to radical prostatic procedure is herein presented.

Water-path echotomography in differential diagnosis of scrotal masses.

Experience with Octoson water-path echotomography in examining 21 testicular masses is reported. Sonographic results were confirmed by surgical and pathologic findings in all cases. We believe this procedure to be of value in differential diagnosis of intrascrotal swellings.

[Scrotum transillumination: method and results (author's transl)]. / Transilluminazione dello scroto: tecnica e diagnostica.

The results obtained from a continuous series of 48 patients have been critically appraised. The report of the diaphanoscopy appeared pathognomonic only in the event of hyper-diaphanous cystic formation and of varicocele. In all other types of pathology the report was aspecific, requiring a knowledge of the clinical picture for its interpretation, and sometimes absent (neoplasia in the initial phase). For these reasons the diaphanoscopy of the scrotum may be considered as part of a clinical examination and not as a complete (self sufficient) experimental examination.