Evaluation of cellular immunity following bacillus Calmette-Guérin therapy in patients with superficial bladder cancer.

Despite its marked effectiveness in the prevention of tumor recurrences, a great deal of information on the mode of action of Bacillus Calmette-Guérin (BCG) as an antitumor therapy modality is still lacking. In this prospective study, by performing lymphocyte subset analysis and quantitative assessment of delayed hypersensitivity skin reactions before transurethral resection of the detected tumor and 3-6 months after intravesical BCG administration in 23 patients with superficial bladder carcinoma, we tried to demonstrate the immunostimulatory effect of BCG therapy. We had 4 recurrences at 6 months' follow-up. Evaluation of lymphocyte subset analysis readings in our group revealed a statistically significant difference (p < 0.05) in CD4+/CD8+ ratio between baseline values and that obtained following BCG administration at 3 and 6 months. However, there was no statistically significant increase of this value in 4 patients who had tumor recurrences. Evaluation of delayed hypersensitivity skin test score results revealed a statistically significant increase in the whole group at 3 months of follow-up (p < 0.05) but the same evaluation at 6 months of follow-up showed no statistically significant difference with respect to this evaluation. Again, no statistically significant difference was found in 4 patients who had tumor recurrences. These results support the idea that BCG-associated antitumor activity is an immune-mediated reaction and the assessment of T-lymphocyte subsets together with quantitative evaluation of delayed hypersensitivity skin reactions would give us a definite idea about the immunotherapeutic effects of BCG in such patients.

Prostate-specific antigen density: the role in benign prostate hyperplasia, prostate intraepithelial neoplasm, organ-confined prostate carcinoma and advanced prostate carcinoma.

To determine the relative role of prostate-specific antigen density (PSAD) in the early detection of prostate cancer and to assess the hypothesis that PSAD offers significant advantages over prostate-specific antigen (PSA) alone in the evaluation of patients with benign (BPH), pre-malignant (PIN) and malignant prostatic diseases, we studied retrospectively 149 patients who were evaluated with either prostatic biopsies or by surgical means. Mean PSAD was calculated to be 0.1 for BPH patients; 0.09 for PIN-1 patients; 0.1 for PIN-2 patients; 0.51 for organ-confined prostatic carcinoma (CaP) patients and 1.7 for advanced CaP patients. Although we could not be able to differentiate BPH from PIN-1 and PIN-2 by using PSAD alone (p > 0.05), there were statistically significant differences between BPH versus localized CaP, PIN-2 versus localized CaP and localized CaP versus advanced CaP (p < 0.05). In conclusion we suggest that the information provided by PSAD is superior to absolute PSA values in the differentiation between BPH and CaP but PSAD was not able to add more information on differentiating BPH from pre-malignant conditions.