Use of DHEA in a patient with advanced prostate cancer: a case report and review.

Dehydroepiandrosterone (DHEA) is being evaluated in the basic science laboratories as a potential treatment for adenocarcinomas, with some initial promise for success. However DHEA can be metabolically converted to androgenic compounds, possessing unwanted side effects. A patient with advanced prostate cancer with progressive symptomatology was treated with DHEA after other treatment regimens failed. Many of his symptoms improved on DHEA therapy, but his cancer also flared dramatically during treatment. His previous hormonally unresponsive cancer subsequently responded transiently to third-line hormonal therapy with diethylstilbestrol (DES). Adrenal precursor molecules such as DHEA may have significant therapeutic benefits in a number of diseases of the elderly, however their utility may be limited by potential androgenic side effects including endocrine epithelial cell growth. The development of analogue compounds with less conversion to androgenic metabolites should be considered, as molecules such as DHEA are more widely tested and utilized clinically.

The potential for reintroduction of tumor cells during intraoperative blood salvage: reduction of risk with use of the RC-400 leukocyte depletion filter.

OBJECTIVES: Intraoperative autotransfusion of shed blood is widely utilized in surgery. However, several studies have raised concern about the transmission of tumor cells during oncologic procedures. We compared the ability of a leukocyte depletion filter (RC-400; LDF) to a standard red blood cell filter (SBF) to remove tumor cells derived from urologic malignancies. METHODS: Cells were suspended in media and passed through a SBF or a LDF. The filtrate was evaluated for the presence of viable cells utilizing the trypan blue exclusion method as well as cell culture. In a second experiment, cells were suspended in fresh bovine blood and processed through a cell saver apparatus followed by filtration with either a SBF or a LDF. Aliquots were cultured after admixture with blood, after processing, and after filtration. RESULTS: The LDF was able to remove tumor cells completely, as demonstrated by both counting with the trypan blue exclusion test and by cell culture. In contrast, admixture with blood processing through the cell saver apparatus nor a standard red blood cell filter removed these cells. CONCLUSIONS: Tumor cells derived from urologic malignancies are easily removed with a LDF but not with a SBF. Filtration of blood salvaged at the time of uro-oncologic surgery with a LDF but not with a SBF reduces the potential for reinfusion of viable tumor cells.

Adenocarcinoma of the prostate metastatic to the choroid of the eye.

We report an unusual case of bilateral choroidal masses developing in a patient with metastatic prostate cancer. Visual symptoms resolved and ocular mass lesions regressed after initiating total androgen deprivation. The natural history and management of choroidal metastatis originating from prostate cancer is discussed.

Iatrogenic urinary tract infection with Pseudomonas cepacia after transrectal ultrasound guided needle biopsy of the prostate.

In response to an unexplained development of Pseudomonas cepacia cystoprostatitis after transrectal ultrasound guided prostate biopsy, a retrospective review of records and biopsy protocol was performed at our institution. Between June 5, 1990 and January 9, 1991 no documented infections occurred in 272 patients undergoing transrectal ultrasound and prostate biopsy. During the next 6 months, however, 9 of 110 patients (8.2%) presented again with infectious symptomatology after transrectal ultrasound guided needle biopsy of the prostate. Culture of a majority of the specimens (67%) yielded P. cepacia. Two additional asymptomatic patients became colonized with P. cepacia. Environmental investigations revealed the ultrasound transmission gel as the source of the contamination. The proposed mechanism of infection was direct prostate or bladder seeding of contaminated transmission gel used to prepare the ultrasound transducer probe. Infections developed in immunocompetent patients despite adequate antimicrobial prophylaxis most likely secondary to underlying bladder outlet obstruction and significant direct inoculum of organisms. We currently recommend use of individualized sterile packets of transmission gel in addition to appropriate antimicrobial prophylaxis and povidone-iodine cleansing enemas when performing transrectal sonographic guided biopsies of the prostate.

Genitourinary involvement of systemic sarcoidosis confined to testicle.

We report on a patient with systemic sarcoidosis who presented with a lesion of the genitourinary tract confined to the testicle. Clinically evident sarcoidosis of the testicle has been identified in few instances. Several recommendations in evaluating such lesions have been offered. A consensus on treatment is not yet defined. The therapeutic options are presented and the literature is reviewed.

Postoperative urinary retention. Guidelines and an algorithm.

Postoperative urinary retention is a common problem after surgery. Prevention includes obtaining a preoperative history and physical, having the patient void just before surgery, avoiding overhydration, and encouraging micturition soon after surgery. Management requires sterile catheterization, when indicated, to drain the urinary bladder completely. Urine cultures must be done when indwelling catheters are used. Antibiotics may be necessary.

Mature teratoma of the testis metastasizing as mature teratoma.

We report an unusual case of mature teratoma of the testis with retroperitoneal metastasis of mature teratoma. Mature teratoma of the testis should be considered a low grade malignant neoplasm.

Small bowel perforation secondary to metastatic lung carcinoma.

Since 1961, there have been a total of seven patients with small bowel perforation caused by metastatic lung carcinoma reported in the literature. Perforation of the small bowel to metastatic lung carcinoma must be considered when evaluating older patients who have histories of heavy cigarette smoking and signs and symptoms suggestive of pulmonary neoplasia. Primary resection and end-to-end anastomosis of the perforated bowel is the treatment of choice. No patient with small bowel perforation secondary to lung carcinoma has survived more than four months.