Current problems of prostate cancer.

Metastatic prostate cancer is primarily treated by endocrine manipulation. Complete androgen blockade with analogue of luteinizing hormone releasing hormone (LHRH) or surgical castration and antiandrogens seem to have no advantage over the LHRH analogues or surgical castration alone. The progression to a hormone-refractory state is still a challenging issue for urologists because of the lack of standard therapy.

[Acute conditions after kidney transplantation in patients with autosomal dominant polycystic kidney disease]. / Naliehavé situácie po transplantácii oblicky u pacientov s autozomálne dominantnou polycystózou obliciek.

There is a high risk of severe complications after kidney transplantation. In patients with autosomal dominant polycystic kidney disease (AD-PKD) the incidence of complications like ischaemic cardiac disease, acute myocardial infarction, pulmonary embolism, perforation of colonic diverticulosis is especially higher. The authors want to indicate another specific complication, rupture of the cyst of own polycystic kidney with retroperitoneal haemorrhage. Within the group of 658 patients who underwent kidney transplantation between January 1981 and January 2000 there were 54 (8.2%) patients with AD-PKD. Four patients with severe retroperitoneal haemorrhage due to rupture of the cyst of own polycystic kidney we present in a short case reports. All cases were fatal. Expect morphologic and functional follow up of the graft it is necessary to follow up polycystic kidney and indicate urgent nephrectomy in the case of any change.

[Use of RT-PCR in the detection of circulating micrometastases]. / Vyuzitie metódy RT-PCR pri detekcii cirkulujúcich mikrometastáz.

During assessment of the progression of several types of carcinomas, such as cancer of the breast, lungs, prostate or urinary bladder world-wide the presence of circulating cells (micrometastases) in the circulation is followed up. These methods are gradually introduced also in Slovakia. First we tried in the Institute of Medical Biology and Genetics Medical Faculty Comenius University in collaboration with the Urological Clinic of Dérers the Faculty Hospital with policlinic to apply this method in carcinoma of the prostate (CaP). We detected the presence of epithelial prostate cells in the peripheral blood stream of patients with advanced prostate cancer where before secondaries were not detected.

[Laparoscopic fenestration of lymphoceles after kidney transplantation]. / Laparoskopická fenestrácia lymfokély po transplantácii oblicky.

Lymphocele is a relatively frequent complication after kidney transplantation, which impair the passage of urine from the kidney, cause emptying of bladder lymphoedemas of the lower limbs, etc. Percutaneous drainage of lymphocele is associated with a risk of infection and a high percentage of recurrence. Until recently, standard surgical treatment of this complication was open fenestration of the lymphocele into the peritoneal cavity. In their paper, the authors describe their first experience with laparoscopic fenestration of the lymphocele. From May 1998 till April 1999 the authors performed laparoscopic fenestration in 5 patients. In four patients the intervention was successful, in one female patient recurrence of lymphocele was observed, which was later resolved by an open operation. In none of the patients early or late surgical complications occurred, the use of analgetics during the postoperative period was minimal, the length of hospitalisation ranged from 2 to 4 days. The authors consider the discussed method a suitable alternative for treating lymphocele after renal transplantation thanks to its minimal invasivity. It involves practically no load of the sick patients after kidney transplantation.

Cyclin-dependent kinase inhibitor P27(KIP1) is expressed preferentially in early stages of urothelial carcinoma.

OBJECTIVES: To evaluate the expression of p27(KIP1) and p21(CIP1) and the prognostic values of both markers in urothelial carcinoma. The expression of the cyclin-dependent kinase inhibitor p27(KIP1) characterizes early-stage and well-differentiated carcinomas of the colon, breast, and prostate and is associated with an improved prognosis. In urothelial carcinoma, its expression has not been as well investigated. Another cyclin-dependent kinase inhibitor, p21(CIP1), is expressed in early-stage bladder tumors, but published data on its prognostic value are contradictory. METHODS: Expression of p27(KIP1) and p21(CIP1) was analyzed by immunohistochemistry in 114 urothelial carcinoma specimens from 77 patients. The Ki67 index was determined as an indicator of cell proliferation. The expression of the markers was correlated with tumor recurrence and progression during an average follow-up period of 3.9 years. RESULTS: Expression of p27(KIP1) was significantly more frequent in superficial than in muscle-invasive tumors (chi-square test, P = 0.012; Fisher's exact test, P = 0.014). Although similar overall, the expression pattern of p21(CIP1) did not match on a tumor-by-tumor basis. No correlation was seen with the Ki67 index. Patients with tumors displaying strong positive staining for p27(KIP1) or p21(CIP1) had fewer recurrences and progression events, but the difference was not statistically significant. Instead, a Ki67 index of less than 10% was significantly (P = 0.0335) related to a lack of recurrence. CONCLUSIONS: Neither p27(KIP1) nor p21(CIP1) appear to be good predictors of tumor progression in urothelial carcinoma, even though their expression is strongly decreased in muscle-invasive tumors.

Angiotensin II type 1 receptor gene polymorphism and mitral valve prolapse syndrome.

BACKGROUND: Mitral valve prolapse syndrome (MVPS), a term applied to patients who have a variety of symptoms, has been associated with autonomic or neuroendocrine dysfunction. Recent evidence suggests that effects of angiotensin II mediated by the angiotensin II type 1 (AT(1)) receptor are involved in modulation of cardiovascular autonomic control in human beings. Association of a genetic polymorphism (A-C(1166)) of the AT(1) gene with abnormal vasomotion and low blood pressure related to autonomic control has been reported recently. Because the role of this genetic variant in MVPS has not been studied, we performed a case-control study of the A-C(1166) variant in a group of 76 white subjects with MVPS. METHODS AND RESULTS: All patients were genotyped by use of a mismatch polymerase chain reaction/Afl II restriction fragment length polymorphism analysis. Frequency of the C(1166) allele was 0.4 in patients with MVPS and 0.26 in control patients. The difference in genotype (chi square = 6.5; P <.05) and allele (chi square = 5.9; P =.02) frequencies between the groups was significant. The odds ratio in favor of carrying the C allele was 4 times greater for patients with MVP than for control patients (95% confidence interval 1.4 to 12.1). CONCLUSIONS: The current results indicate that the A-C(1166) polymorphism of the angiotensin II type 1 receptor gene is associated with MVPS in the white population.

Validity of a non-invasive determination of the isovolumetric bladder pressure during voiding in men with LUTS.

Invasive pressure flow analysis is the gold standard for discriminating between hypocontractile bladder muscle function and infravesical obstruction in male patients with lower urinary tract symptoms. Here a non-invasive method to determine the isovolumetric bladder pressure to judge contractility is presented. This is based on interruption of urine flow by sudden occlusion of a specially fixed condom catheter. The pressure inside the condom is recorded and used to estimate the isovolumetric bladder pressure. Combined with, for example, home uroflowmetry, this non-invasive method may overcome some of the disadvantages (e.g., invasiveness, cost) of the conventional pressure flow test. To determine the isovolumetric bladder pressure reliably with this non-invasive method, two constraints have to be met. First, the bladder neck and urethra have to remain open after occlusion of the condom catheter. This was tested combining the non-invasive test with radiography in five patients. Second, a steady state has to be reached, i.e., the flow in the urethra, due to the elastic properties of the biological and the condom systems, should come to a stop when the bladder pressure and the condom pressure equilibrate. This was investigated by comparing the non-invasively recorded condom pressure with the simultaneously invasively recorded intravesical pressure in 52 patients. In these patients, three different methods of condom fixation were evaluated. The results show that the bladder neck and urethra remain open during the test. However, a steady state is often not reached. In more than 80% of the cases with the best condom fixation, the bladder pressure has not stabilized, although the condom pressure reached a plateau. Therefore, this method of sudden occlusion is not yet clinically applicable for determining the isovolumetric bladder pressure. Neurourol. Urodynam. 18:477-486, 1999.

The incidence of tumours in renal transplant recipients with long-term immunosuppressive therapy.

INTRODUCTION: The incidence of cancers after renal transplantation is significantly higher than in population that have not undergone transplantation. It is increased by a long-term survival of functional graft requiring long-term immunosuppressive therapy. MATERIAL AND METHODS: Since 1972, 620 renal transplantations have been performed for different causes of end stage renal disease. The authors report a group of 18 renal transplant patients (2.9%) who had cancer. Patients with malignancies are reviewed according to their age, sex, type of immunosuppression, interval between transplantation and the diagnosis of cancer, method of treatment and survival. RESULTS: All patients received cadaver kidneys, and secondary transplantation was performed in two patients. Five patients received conventional immunosuppression--azathioprine with prednisone, another 13 patients received cyclosporine with prednisone and/or azathioprine. In 13 males and 5 females (mean age 46.1 years) the malignant disease developed about 62.4 months after renal transplantation. Six patients had epithelial skin cancers (four of them had squamous cell carcinomas and two basal cell carcinomas). Two patients had breast cancer, colorectal carcinoma, renal cell carcinoma and bladder cancer, respectively, one patient had gastric cancer, thyroid carcinoma, carcinoma of tonsilla, and monocytic leukaemia with blastic transformation, respectively. The average survival of patients with malignancies was 20.3 months. Of 17 patients with cancer, 13 underwent surgical treatment, four patients with advanced disease received radiotherapy, hormonal treatment or only symptomatic therapy. In one patient the malignant disease was only discovered at autopsy. Five patients died of progressive malignant disease, four of intercurrent disease. Nine (50%) patients are alive, with no evidence of disease (NED), 31.9 months in average following the diagnosis of malignancy. Three patients returned to dialysis treatment, other 6 patients live with well functioning graft. CONCLUSIONS: In patients surviving long time after kidney transplantation the possibility of development of malignant disease should be considered. Preventive evaluation should guarantee early detection of cancer. Appropriate treatment, without cessation of immunosuppressive therapy, is indicated with the intention to prolong the patients' life with a functional graft and without dialysis treatment.

[Will determination of prostate specific antigen density improve the diagnosis of prostatic carcinoma?]. / Pomôze sledovanie hustoty prostatického specifického antigénu zlepsit' diagnostiku karcinómu prostaty?

Prostate specific antigen (PSA) serum levels in patients with prostate carcinoma and with benign prostate hyperplasia overlap. In order to improve the positive predictive value of PSA in the diagnosis of prostate carcinoma the authors recommend to evaluate the PSA levels in relation to the prostate volume, the so-called density of the prostate specific antigen (PSAD). The correlation of PSA and PSAD with results of bioptic examination revealed that PSAD does not increase the capacity of PSA to predict the presence of prostate carcinoma and does not reduce the number of prostate biopsies. All patients with PSA levels higher than 4 ng/ml and/or a pathological finding on digital rectal examination need a bioptic examination of the prostate.

[Prostate-specific antigen in patients with benign prostatic hyperplasia]. / Prostatický specifický antigén u pacientov s benígnou prostatickou hyperpláziou.

The authors examined 119 patients with the histological finding of benign prostatic hyperplasia (BPH). Before the planned operation of the prostate (transurethral resection or open prostatectomy) the authors examined in all patients the level of the prostate specific antigen (PSA) and the prostate volume by sonography. Of 119 patients 70 (58.8%) had elevated serum levels of PSA and in 35 (29.4%) the PSA level was higher than 10 ng/ml. The authors demonstrated a highly significant (p < 0.0001) linear relationship of the PSA serum level and volume of prostate in patients with BPH. Based on the results of simple regression analysis they elaborate an equation for the prostate volume: PSA ng/ml = (3.26 + 0.12 x volume of prostate (ml) +/- 8.44). By adding the value of the standard deviation of PSA the authors created an interval in which are most of the patients with BPH. The authors recommend supplementary examinations (transrectal sonography and biopsy of the prostate) in patients where there is a disproportion between the PSA level and the prostate volume.

[Revascularization of the penis]. / Revaskularizácia penisu.

Revascularization of the penis is indicated in those patients in whom peripheral arterial occlusion of the internal pudendal artery alone or in combination with the venous incompetence of the penis, was detected to be the cause of erectile dysfunction. The authors present the results of penile revascularization in 12 patients impotent after crushing pelvic fracture associated with urethral rupture. Revascularization of the dorsal artery of the penis by the inferior epigastric artery was used as the method of surgical treatment. Satisfactory functional results were achieved in 58% of patients. In other 8 patients with combined arteriogenic and venogenic impotence, arterialization of the venous system of the penis was utilized. In 6 patients the method of "triple" anastomosis of the inferior epigastric artery, dorsal artery of the penis, and penile deep dorsal vein was used. In 2 cases the deep dorsal vein of the penis was arterialized by the inferior epigastric artery. The cumulative success rate of venous arterialization of the penis was 62.5%. (Fig. 5, Ref. 15.)