Local recurrence after radical prostatectomy: correlation of US features with prostatic fossa biopsy findings.

PURPOSE: To evaluate the diagnostic accuracy of transrectal ultrasonography (US) in the detection of local recurrence following radical prostatectomy. MATERIALS AND METHODS: Ninety-nine patients with biochemical recurrence after radical prostatectomy were evaluated at transrectal US and prostatic fossa biopsy. Location of suspected recurrence at transrectal US and clinical features, such as prostate-specific antigen levels and digital rectal examination findings, were correlated with biopsy results. RESULTS: Forty-one (41%) of 99 cases of local recurrence were detected. The percentage of sites of lesions identified at transrectal US and corresponding positive biopsy rates were as follows: the urethrovesical anastomotic area, 56% and 61%; bladder neck, 26% and 54%; retrovesical space, 4% and 100%; and more than one site, 14% and 71%. By comparing transrectal US and digital rectal examination, the sensitivities were 76% and 44% (P =.007), while specificities were 67% and 91% (P =.004), respectively. An increased positive biopsy rate with increasing prostate-specific antigen levels was noted (P =.04). CONCLUSION: Transrectal US is more sensitive but less specific than digital rectal examination in the detection of local recurrence. Biopsy findings in more than half of the suspected lesions at the urethrovesical anastomotic area and bladder neck were positive. Lesions in the retrovesical space, although less frequently encountered, had a high likelihood of representing cancer recurrence.

Characteristics of normal prostate vascular anatomy as displayed by power Doppler.

BACKGROUND: To define the vascular anatomy of the normal prostate as depicted by power Doppler and to provide baseline data for evaluation of this modality in the diagnosis and management of prostatic disease. METHODS: The vascular anatomy of 40 subjects was studied. Power Doppler images were correlated with corresponding gray-scale images. Doppler spectral waveform measurements were obtained for the vessels identified. RESULTS: Separate branches of the capsular vessels were visualized clearly, distributed radially in the peripheral and central zones and converging toward the center of the gland. Urethral vessels were visualized in the transition zone coursing from bladder neck to verumontanum. The neurovascular bundles were identified posterolaterally along the length of the gland. No significant difference between the resistive indexes of the urethral and capsular vessels was identified (P = 0.595), although there was a significant difference between the resistive index of the neurovascular bundles and that the prostatic vessels (P < 0.001). CONCLUSIONS: The vascular anatomy of the normal prostate as displayed by power Doppler demonstrates a reproducible and symmetric flow pattern. Power Doppler is highly sensitive in depicting blood flow, the number, course, and continuity of vessels more readily than other imaging modalities, such as color Doppler. These data should allow comparison of the vascular anatomy of the normal prostate with that of the prostate with diseases such as prostate cancer and benign prostatic hyperplasia.

The prognostic value of DNA ploidy in small renal cell carcinoma.

The objective was to study the prognostic value of Deoxyribonucleic Acid (DNA) ploidy status in small renal cell carcinomas (RCC). The nuclear DNA content of renal cell carcinoma tissues from patients who underwent radical or partial nephrectomy has been analyzed by flow cytometry. The results of the DNA ploidy have been correlated to the size of tumors and disease progression. Of the 50 patients with RCC studied, 8 (16%) progressed. Tumors with non-diploid DNA patterns were found in 24 (48%) of the 50 patients and in 4 of the 8 patients who progressed. Overall the median tumor size in our series was 50 mm. A tumor diameter of 50 mm or less was measured in 26 patients (group I) and above 50 mm in 24 (group II). Non-diploid DNA patterns were found in 11 (42.3%) and 13 (54.2%) patients in groups I and II, respectively. This difference between the groups was not significant. Only one patient in group I (3.8%) developed metastatic disease and died 72 months after the operation. In group II, 7 patients (29.2%) presented tumor progression and 5 died of metastatic disease. The survival probability in group I was 95% at 5 and 8 years (95% CI 70% to 99%) and for group II 94% at 5 years (95% CI 67%-99%) and 67% at 8 years (95% CI 39%-83%). DNA ploidy is an inaccurate predictor of tumor behavior in patients with RCC, even in small tumors. Tumor size is a more significant predictor of outcome.

Prediction of response to salvage radiation therapy in patients with prostate cancer recurrence after radical prostatectomy.

PURPOSE: To identify factors predictive of local recurrence as defined by a complete response to salvage radiation therapy in patients whose disease recurs after radical prostatectomy. PATIENTS AND METHODS: Ninety-five patients with recurrence after radical prostatectomy who were evaluated by prostatic fossa biopsies, and a subset of 49 of these patients treated with radiation for control of presumed or biopsy-proven local recurrence, were studied. RESULTS: Biopsies were positive in 40 (42%) of the 95 biopsied patients. Multivariate analysis revealed that prebiopsy prostate-specific antigen (PSA) level, postrecurrence PSA doubling time, and positive digital rectal examination (DRE) of the prostatic fossa were all statistically significant predictors of a positive biopsy. For the 49 patients subsequently treated with salvage radiation therapy, the overall actuarial 3- and 5-year PSA relapse-free probabilities were 43% and 24%, respectively. Univariate analysis showed no differences in the PSA relapse-free probabilities associated with any pathologic features of the radical prostatectomy specimen, biopsy confirmation of local recurrence, or DRE of the prostatic fossa. In multivariate analysis, controlling for all other variables, preradiation PSA and postrecurrence PSA doubling time measured before radiation were the only statistically significant predictors of outcome. CONCLUSION: DRE of the prostatic fossa, prebiopsy PSA, and postrecurrence PSA doubling time predict which patients will have biopsy-proven local recurrence. However, response to salvage radiation therapy is associated with postrecurrence PSA doubling time and with preradiation PSA level only. DRE of the prostatic fossa and biopsy confirmation of local recurrence are not associated with salvage radiation outcome.

Detection of metastatic prostate cancer using a splice variant-specific reverse transcriptase-polymerase chain reaction assay for human glandular kallikrein.

We developed a highly sensitive splice variant-specific reverse transcriptase-PCR (RT-PCR) assay for human glandular kallikrein (hK2) mRNA and tested its ability to detect metastatic disease in men with clinically localized prostate cancer. An RT-PCR assay using primers spanning intron IV and including a significant portion of the 3' untranslated region of the hKLK2 gene, with maximum nonhomology to both hK1 and hK3, was developed. The limit of detection of the assay was five copies of hK2 cDNA and one LNCaP cell in 10(9) lymphoblasts. RT-PCR-hK2 was performed on preoperative peripheral blood specimens from 228 consecutive radical prostatectomy patients as well as 7 metastatic prostate cancer patients and 14 healthy men without prostate cancer. This new RT-PCR-hK2 assay amplifies two distinct fragments. The larger fragment (hK2-U) is approximately 680 bp in length and corresponds to the amplified product of a previously reported splice variant in the splice donor site of intron IV in the hKLK2 gene. The smaller fragment (hK2-L) is approximately 643 bp in length and corresponds to the amplified product of the native hK2 mRNA. Whereas the RT-PCR-hK2-L assay was positive in 71% of our patients with metastatic prostate cancer, 14% of healthy control men also tested positive. By univariate (P = 0.028) and multivariate (P = 0.0269) analysis, which controlled for preoperative PSA, clinical stage, and biopsy Gleason score, RT-PCR-hK2-L status added prognostic information to the prediction of lymph node-positive disease. We have developed a new RT-PCR assay which demonstrates a high sensitivity for detecting hK2 mRNA. Preoperative RT-PCR-hK2-L status helps predict pathological lymph node positivity in patients with clinically localized prostate cancer.

Diagnosis and management of incidental ureterocele during the treatment of clinically localized prostate cancer.

Two instances of simultaneous diagnosis of prostate cancer and ureterocele were recently identified. In one patient an ectopic ureterocele in a duplex system with an obstructed upper pole was unroofed at the time of radical prostatectomy. Surgical excision of the ureterocele wall provided decompression of the obstructed system. In a second patient, bilateral intravesical ureteroceles associated with normal renal units were left untreated. Complications were not associated with the untreated ureteroceles. On rare occasions a ureterocele may be discovered incidentally during the evaluation of patients with prostate cancer. When radical prostatectomy is planned, treatment of the ureteroceles should be determined by the ureterocele's size, anatomic configuration, and location and by the degree of obstruction of the affected renal unit. Surgical excision of the ureterocele at the time of radical prostatectomy may be the best approach for patients requiring treatment.

NMR in porous materials.

Nuclear magnetic resonance (NMR) was used to determine the pore size distribution of hardened Portland cement pastes. The method is based on the well-known freezing point depression of water when confined inside the pore matrix of a material. It is demonstrated how this technique can be applied in cementitious materials to probe the microstructure of the main hydration product: the cement gel.

Evaluation of sufentanil as a supplement to anaesthesia in lengthy spinal surgery.

The efficacy of sufentanil citrate as a supplement to anaesthesia was studied in 31 patients undergoing lengthy spinal surgery (mean duration 150 min). Anaesthesia was induced with 1 microgram/kg sufentanil (bolus) and 2 mg/kg thiopental, followed by 1.5 mg/kg succinylcholine to facilitate intubation, all given intravenously; after intubation, administration of N2O:O2 (70:30) was started. Further doses of sufentanil (10-25 micrograms) were given, on average 2.3 times, depending on the length of the operation, systolic blood pressure, pulse rate and other autonomous signs; the mean total amount of sufentanil administered was 126.3 micrograms. Our findings showed that sufentanil provided good cardiovascular stability and rapid recovery. More specifically mean arterial blood pressure and heart rate were significantly reduced 1 min after intubation (P < or = 0.001). Thereafter mean arterial blood pressure increased, returning to preanaesthesia values and remaining constant while heart rate remained constant throughout the operation at values similar to the value immediately after induction of anaesthesia. Recovery was rapid, awakening time was 6 min or less in 50% of patients and 10 min or less in 90% of patients, while the corresponding values for response time were 8 and 12 min, for extubation time, 9 and 13 min, and for orientation time, 15 and 19 min. Two patients experienced nausea and vomiting and one patient mild chest-wall rigidity. Finally, respiratory depression was not observed in any of the patients.

Successful treatment of intracerebral hydatid cysts with albendazole: case report and review of the literature.

Experience with the use of the drug albendazole in the management of cerebral hydatid disease is limited. We report a 33-year-old woman who was harboring multiple cerebral hydatid cysts and who was treated successfully with albendazole. No other treatment was used. The efficacy and the few reversible side effects of the drug are discussed, and the literature is reviewed.

Pattern of CSF glucose concentration after induced hyperglycaemia in patients with acute meningitis and evidence of cerebrospinal canal obstruction.

The pattern of glucose CSF concentration after induced hyperglycaemia was studied in 14 patients suffering from acute meningitis and 10 having meningism, as judged by normal CSF. Four out of the first group of patients had symptoms and signs likely to be due to cerebrospinal canal obstruction after the acute phase of the disease was over. When the patterns of CSF glucose concentration of the two groups were compared it was noted that patients suffering from acute meningitis showed generally a quicker and more profound rise of glucose levels after induced hyperglycaemia than patients with meningism. In four cases CSF glucose levels showed a partial or complete failure to rise, despite adequate increase of blood glucose concentration. Subsequent investigation revealed permanent obstruction of the cerebrospinal canal in three of the cases. The usefulness of serial CSF glucose estimations after induced hyperglycaemia as an early screening test for cases with possible obstruction is discussed.