[Prognostic factors in stage D2 prostate cancer: results of univariate and multivariate analyses].

To evaluate prognostic factors in stage D2 prostate cancer, 235 patients who had been treated with endocrine therapy were investigated. With univariate analysis, performance status, hemoglobin concentration, serum alkaline phosphatase, LDH, histological grade, extent of disease (EOD), and response of tumor markers at 3 months were shown to be significant prognostic factors. To compare these 7 factors, multivariate analyses was performed in 196 cases. Cox proportional hazard model demonstrated that LDH, followed by response of tumor markers at 3 months, histological grade, and EOD were significant for predicting prognosis. We concluded that the patients whose serum LDH was above the normal range and/or whose tumor markers were not or had not been normalized 3 months after the onset of endocrine therapy were in the high risk group, and should be given more aggressive treatment.

[Recurrence of upper urinary tract calculi].

Treatment of upper urinary tract stones has changed greatly. The recurrence of calculi after the discharge was studied in the 634 patients with urolithiasis admitted to our department during the 9 years up to the end of 1984. The recurrence rate in the 325 cases followed for more than 3 months after the disappearance of the original stones, was 15.6% after 2 years, 27.6% after 5 year and 51.4% after 8 years. In recurrent stone formers, the rate of recurrence thereafter was greater than that of primary stone formers. The growth of calculi was rapid in the renal stone former concomitant with urinary tract infection together with a past history of renal surgery. In relation to the composition of the stone, uric acid calculi tended to recur more often than calculi composed of other substances. In view of recurrence, pyelolithotomy is preferred to renal parenchymal incision.

[Two cases of synchronous bilateral renal tumors].

Case 1: A 56-year-old man visited us complaining of gross hematuria. Because of his refusal to undergo a surgical operation, we performed embolization and chemotherapy, which were ineffective and he died of cancerous cachexia. Case 2: A 59-year-old female with microscopic hematuria was referred to our clinic. Left partial nephrectomy and right radical nephrectomy were done in a two-stage operation at a 3 month interval. She is now well without sign of recurrence at 9 months after the last operation.

[gamma-Seminoprotein in serum of prostatic cancer].

From August, 1981 to May, 1984, we measured gamma-seminoprotein in the serum of 51 untreated patients with prostatic cancer in the Chiba University Hospital. Prostatic acid phosphatase (radioimmunoassay) in serum was also measured in these patients. We also measured gamma-seminoprotein and prostatic acid phosphatase in serum of patients under control by hormonal treatment and of reactivated patients. In untreated stage B and stage C cases, positive rate of gamma-seminoprotein in serum was larger than that of prostatic acid phosphatase. Therefore the measurement of gamma-seminoprotein in serum is considered to be useful in the diagnosis of early prostatic cancer. Four weeks after hormonal treatment, gamma-seminoprotein in the serum of 74% of the patients returned to the normal level. The positive rate of gamma-seminoprotein in the serum of reactivated patients is significantly larger than that of the patients under control by hormonal therapy.

[Prostatic acid phosphatase by enzymeimmunoassay].

We measured prostatic acid phosphatase levels by enzymeimmunoassay (PAP-EIA). Intraassay reproducibility of PAP-EIA was markedly good. In thirty normal males, PAP-EIA levels ranged from 0.24 ng/ml to 3.3 ng/ml, mean and S.D. being 0.94 ng/ml, 0.50 ng/ml, respectively. We made the upper limit of PAP-EIA for the normal range, 1.94 ng/ml (Mean + 2 S.D.). O 40 patients with untreated prostatic cancer, 34 patients (85%) gave positive results (1/3 33% of stage A, 3/4 75% B, 10/11 90% C, 20/22 90% D). One out of 12 patients with BPH, and one out of 11 with prostatitis gave positive results. The false positive rate was 9%. PAP levels of 324 samples from 111 patients with prostatic cancer were measured by EIA and radioimmunoassay (RIA). A significant correlation was noted between EIA and RIA (r = 0.997 p less than 0.001).

[Tumor marker in urology].

Tumor marker for tumors in urology has been widely used to testicular and prostatic tumors. A part of testicular tumor produces alpha-fetoprotein (AFP) and HCG, thus these markers can not be used for early detection of disease. However, they are very useful in typing testicular tumor, and in monitoring a course of disease which produces them. beta-HCG seems to be more specific than HCG. In case of prostatic cancer, prostatic acid phosphatase (PAP) assayed immunochemically is sensitive and specific marker. Prostate antigen seems to be another excellent marker for this tumor, and this is well correlated with PAP. In reactivated case, tissue polypeptide antigen was elevated, suggesting use of this marker.