[Selected aspects of diagnosis and treatment of prostatic cancer]. / Wybrane aspekty diagnostyki i terapii raka stercza.

Prostatic cancer is one of the most frequent malignant tumours in men. The chronic course of the disease and the opportunity of selecting of one of many available treatment methods make possible adjustment of the management to the individual problems of the patient. This leads, however, to various difficulties connected with the selection of optimal management in various clinical situations. The purpose of the paper was presentation of selected problems in the diagnosis and treatment of prostatic cancer in the light of own clinical experience, in the first place.

CA-50 serum level in patients with prostate cancer.

CA-50 antigen is considered to be a generalized carcinoma-associated antigen. CA-50 serum levels were measured by solid phase radioimmunoassay using a specific monoclonal antibody. Sera of 49 patients with prostatic cancer of different clinical stages, 43 patients suffering from BPH, and 28 healthy males were tested. Positive test results were observed in 57.1% of patients with prostate cancer values ranging from 42.9% in stage A to 66.7% in stage D. Increased CA-50 levels were found in 11.6% of patients with BPH.

Angiomorphology of the human renal clear cell carcinoma. A light and scanning electron microscopic study.

The vascular system of human renal clear cell carcinoma was studied using light microscopy of silicon rubber-injected specimens and scanning electron microscopy of conventionally prepared tissue and vascular corrosion casts. The system was found to exhibit the following features: (1) a well developed superficial vascular coat showing different pattern on the anterior and on the posterior side of the tumour, (2) an internal vascular network composed of altered and displaced preexisting vessels, numerous newly formed ones and those recruited from adjacent structures, (3) quantitative prevalence of dilated veins and distended capillaries, (4) a remarkable proliferative reaction of stellate veins, (5) characteristic features of the intratumour vasculature in the form of avascular nodules surrounded by basket-like capillary plexuses and separated by well vascularized "septa", (6) a relatively less dense vascularization of central tumour areas, frequently exhibiting necrotic foci, and the highest density of vessels in areas close to the superficial vascular coat, and (7) morphological evidence for a continuous remodelling of the tumour vasculature. The observed patterns of the vascular system seem to provide a pathway for further tumour expansion.

Serum tissue polypeptide antigen (TPA) and prostatic acid phosphatase (PAP) in patients with prostatic cancer.

Concurrent measurements of serum TPA and PAP concentrations by double antibody radioimmunoassays were done in 49 patients with prostatic cancer in different clinical stages. The reference group comprised patients suffering from BPH. Positive TPA was found in 32.7% of cancer patients, the lowest percentage in stage A (11.1%) and the highest in stage D (55.6%). The additional value as a diagnostic aid of the TPA test was revealed on the basis of examination of the selected group of patients with not increased PAP. Positive TPA was found in 16.7% of patients: none in stage A, 22.2% in stage B, and 33.3% in stage D. Prostatic cancer remains the most common malignancy of the genitourinary tract. The improvement in the results of treatment involves not only a modernization of treatment modalities but also the introduction of laboratory tests which give the most ample information on the stage of tumour development and improve possibilities to control tumour therapy. Besides the refinement of the determination procedures of specific prostatic markers, prostatic acid phosphatase (PAP), through radio- and enzyme-immunological methods, there is a search for additional markers which might be helpful in diagnosis and follow-up of treatment.

The concentration of zinc in relation to fundamental elements in the diseased human prostate.

Studies of the composition of prostatic tissue revealed significant decreases not only of the zinc but also of the potassium concentration, in the cancerous tissue, whereas the nitrogen, phosphorus and magnesium concentrations were within normal limits. The composition of hyperplastic prostatic tissue was similar to the normal except for a tendency towards decreased nitrogen concentration.

Serum proteins in patients with benign prostatic hyperplasia.

Studies of serum protein patterns done in a group of 42 patients with benign prostatic hyperplasia (PBH) revealed the following: (1) prior to the operation significant hypalbuminaemia and increase of alpha 2-, beta- and gamma-globulins, IgG, IgA, IgM and CRP levels; (2) 12 days after operation a marked decrease of albumin concentration, increase of alpha 2-globulin and a sharp rise of CRP; (3) after 1 year a decrease of hypalbuminaemia and increase of alpha 2- and beta-globulins and CRP; in contrast to that, there was further increase of gamma-globulin concentration expressed also in the IgG, IgA and IgM levels.

Evaluation of five tumor markers (AFP, CEA, hCG, hPL and SP1) in monitoring therapy and follow-up of patients with testicular germ cell tumors.

61 patients with seminoma and 113 with nonseminomatous germ cell tumors of the testis were treated according to the histology, stage of disease, and serum levels of tumor markers (CEA, AFP, hCG, hPL and SP1). 33 were stage I, 63 stage II, and 78 stage III patients. Most patients with seminoma, mature teratoma, immature teratoma, and 'pure type' embryonal carcinoma, as well as the latter three types with seminomatous admixture, had normal serum levels of the markers. Sometimes, slightly elevated levels of hCG suggested the presence of metastases. But, serial measurements of the markers were seldom useful in monitoring therapy. The 5-year tumor-free survival rates were favorable: 100% for stage I and II disease; and 57 or 44% for, respectively, stage III seminoma or the other tumors amounting to 10% of the nonseminomatous group. The role of the five markers was significant in patients with teratoma with malignant transformation, choriocarcinoma, endodermal sinus tumor (EST), and embryonal carcinoma or teratocarcinoma with an admixture of EST or choriocarcinoma or both. Elevation of a marker was a grave prognostic sign. The 5-year survival rates were 100, 16, and 4% for stages I, II and III disease, respectively. An elevated level of one or more of the markers assayed was always useful for monitoring therapy. Decreasing level indicated regression. However, return of an elevated level to normal did not indicate eradication of all tumor and called for diagnosis by imaging modalities. Constantly elevated or increasing marker levels during treatment indicated resistance to therapy. An increasing level from any nadir during remission indicated recurrence. Elevated levels of any of the five markers tested were as important as imaging modalities, and often more sensitive.

Operative blood loss during common urological operations.

The knowledge of mean blood loss during common urological procedures may be of some help for the surgeon in the appraisal of the magnitude of bleeding and planning blood transfusion. In 9 types of common urological operations (160 patients) the operative blood loss was determined. Results were mathematically evaluated.

90-kilobar diamond-anvil high-pressure cell for use on an automatic diffractometer.

A gasketed diamond-anvil high-pressure cell is described which can be used on a four-circle automatic diffractometer to collect x-ray intensity data from single-crystal samples subjected to truly hydrostatic pressures of over 90 kilobars. The force generating system exerts only forces normal to the diamond faces to obtain maximum reliability. A unique design allows exceptionally large open areas for maximum x-ray access and is particularly well suited for highly absorbing materials, as the x rays are not transmitted through the sample. Studies on ruby show that high-pressure crystal structure determinations may be done rapidly, reliably, and routinely with this system.

Millin's retropubic prostatectomy. A clinical study.

On the basis of two series of retropubic Millin's prostatectomies (426 operations) the value of this method of approach is evaluated. The retropubic procedure seems to offer the best chance for a smooth postoperative course when an open operation is needed.