Outcome for surgically staged localized prostate cancer treated with external beam radiation therapy.

PURPOSE: A retrospective analysis was performed on patients with surgically staged localized prostate cancer treated with external beam radiation therapy for 10-year overall, cause specific and disease-free survivals based on lack of clinical recurrence and 2 separate prostate specific antigen criteria for cure. MATERIALS AND METHODS: We analyzed 145 patients who received external beam radiation therapy after a negative staging pelvic lymphadenectomy for prostate cancer. Followup data were available for 129 patients (90%). Disease was stage A in 29 patients (22.5%), stage B in 64 (49.6%), stage B2/C in 2 (17%) and stage C in 14 (10.9%). Average potential followup from date of diagnosis was 11.5 years (minimum 7.2). Of the patients 87 potentially can be followed for longer than 10 years. Disease-free survival was based on a normal digital rectal examination, lack of symptoms suspicious for metastasis and application of 2 separate prostate specific antigen criteria of 4 ng./ml. or less (group 1), or 1.5 ng./ml. or less (group 2). Survival was analyzed with the Kaplan-Meier actuarial method. RESULTS: Actuarial overall survival at 10 and 15 years was 63.7 and 49.6, respectively, and cause specific survival was 84.2 and 80%, respectively. Disease-free survival was 54.5 and 32.4%, respectively, for group 1, and 42.3 and 9.6%, respectively, for group 2. CONCLUSIONS: The improved patient selection inherent in surgical staging before definitive external beam radiation therapy provides for improved overall and cause specific survival over that of patients without surgical staging. Biochemical disease-free survival also appears to be improved.

Malignant cytological washings from radical prostatectomy specimens: a possible mechanism for local recurrence of prostate cancer following surgical treatment of organ confined disease.

PURPOSE: Local recurrence of prostate cancer following complete and successful resection of organ confined disease has been variably reported in men. We hypothesized that observed secretions from the cut distal urethra during radical prostatectomy may contain malignant prostatic epithelial cells and contribute to this problem. MATERIALS AND METHODS: A prospective study was done of prostate cytology specimens from 50 consecutive men with clinically organ confined adenocarcinoma of the prostate undergoing radical retropubic or radical perineal prostatectomy. Direct cytological evaluation by 1 examiner was used to identify malignant or benign cells in these washings. RESULTS: Of 33 radical perineal and 17 radical retropubic prostatectomy specimens organ confinement was confirmed in 58%. Malignant prostatic epithelial cells were observed in 24% of all cytology specimens. Of cytological washings from prostates with pathologically confirmed organ confined cancers 17% showed malignant cells. While perineural invasion was noted in a majority of tumors with positive washings, only Gleason grade was a statistically significant predictor of recurrence (p = 0.009). Surgical approach did not alter the rate of positive cytology. CONCLUSIONS: Malignant prostatic epithelial cells can be identified in the prostatic washings from men with pathologically organ confined prostate cancer. Surgical approach did not change the cytological findings. Gleason grade is a statistically significant predictor of cytological malignancy. These cells may represent a mechanism of failure following successful radical prostatectomy.

Nephrogenic adenoma in a bladder diverticulum.

Nephrogenic adenoma is a rare proliferative response of urothelium to chronic irritation or infection. It has been reported to occur in various locations in the urinary tract, including the renal pelvis, ureter, bladder and urethra, and within an ileal conduit. We report our experience with this lesion occurring in a bladder diverticulum.

Focal xanthogranulomatous pyelonephritis associated with renal cell carcinoma.

A case of focal xanthogranulomatous pyelonephritis (XGP) with an associated renal cell carcinoma is presented. The tumor was discovered incidentally during a general surgical procedure. Subsequent evaluation showed a 3 cm mass in the lower pole of an otherwise normal kidney with no evidence of calculus or infection. Radical nephrectomy revealed classic findings of focal XGP with coexistent clear cell carcinoma. The literature describing the rare association between these conditions is reviewed.

Renal cell carcinoma with solitary metachronous contralateral adrenal metastasis. Experience with 2 cases and review of the literature.

We report on 2 cases of renal cell carcinoma with solitary metachronous contralateral adrenal metastasis occurring up to four years after radical nephrectomy. Both patients were treated with adrenalectomy and steroid replacement. One patient died with distant metastases twenty-eight months after adrenalectomy and the other is alive with no evidence of disease four years postoperatively. Such a presentation of hypernephroma is rare, with only 1 such case having been found in the literature.

Polyarteritis nodosa masquerading as a primary testicular neoplasm: a case report and review of the literature.

We report a case of polyarteritis nodosa presenting as a mass in the testis mimicking a neoplasm. The diagnosis was confirmed by radical orchiectomy. This is an unusual presentation of this systemic disease. We discuss the physical findings, ultrasonographic features and pathological findings, as well as review the literature for previous similar cases.

Mechanical failure of OmniPhase penile prosthesis.

We report a case of mechanical failure due to cable breakage in both cylinders of an OmniPhase penile prosthesis. The failure occurred six weeks after implantation and was manifested by inability to activate the device. X-ray films showed cable fracture at the point of insertion into the activator mechanism bilaterally. This failure appears to be an isolated episode, and the prosthesis has been successfully replaced with a similar device.

Ipsilateral ureteroureterostomy and pyeloureterostomy: a review of 15 years of experience with 25 patients.

We reviewed our 15-year experience with pyeloureterostomy and ureteroureterostomy in 25 children with ureteral duplication. Pyeloureterostomy was performed in 5 patients, including 4 with reflux and 1 with upper pole obstruction. The results were good in 4 and in 1 patient postoperative anastomotic obstruction developed. Ipsilateral ureteroureterostomy was performed in 20 patients, including 8 with reflux into 1 or both ipsilateral ureters, 7 with obstructed ectopic upper pole ureters without ureterocele, 4 with ectopic ureteroceles and 1 with incomplete ureteral duplication and obstruction of the common distal ureteral segment. At followup, which ranged from 3 months to 6 years, 17 patients had good postoperative results as demonstrated by improved upper tract drainage and absence of reflux. Of 6 patients who underwent simultaneous ipsilateral ureteral reimplantation at the time of ureteroureterostomy postoperative reflux was noted in 1, necessitating a second procedure. Ureteral stumps were left in 13 patients. Postoperative urinary infection occurred in only 3 of these patients, all as single episodes and 2 associated with persistent contralateral reflux. Significant luminal disparity at the time of ureteroureterostomy was noted in 18 patients and did not adversely affect results.