A study on staging bone scans in newly diagnosed prostate cancer.

OBJECTIVE: This study aimed to evaluate the role of bone scan as a staging investigation in newly diagnosed untreated prostate cancers. MATERIALS AND METHODS: Bone scan results in patients with newly diagnosed prostate cancer were reviewed and correlated with clinical stage, prostate-specific antigen (PSA) and Gleason scores from the biopsy specimen. RESULTS: In all, 124 patients fulfilled inclusion criteria with an age range of 51-94 (mean 72.3) years. Pre-biopsy PSA ranged from 2.2 to 5,864 with a median of 21.1 ng/ml. Clinical stage was T0-T1c 14.5%, T2a 41.9%, T2b 17.7%, T3 16.9%, and T4 9%. A Gleason score of 7 was found in 31%. Four patients' samples were not suitable for Gleason scoring. Twenty patients (16.1%) had a positive bone scan with a mean age of 79.4 years (median 83). Two patients with PSA<20 ng/ml were positive. Of the 44 scans performed in the patients with PSA

The benefits of radical prostatectomy beyond cancer control in symptomatic men with prostate cancer.

OBJECTIVE: To evaluate lower urinary tract symptoms (LUTS) and the symptom-associated quality of life (QoL) after radical prostatectomy. PATIENTS AND METHODS: We carried out a prospective study (January 1999 to March 2001) of 50 consecutive men initially assessed in the nurse-led prostate assessment clinic for their LUTS and subsequently diagnosed to have localized prostate cancer. They had a radical retropubic prostatectomy and were assessed before, 3 and 6 months after surgery with a self-administered International Prostate Symptom Score (IPSS) and QoL questionnaires, and measurements of urinary flow rate and postvoid residual urinary (PVR) volumes. Finally, each patient completed a self-administered continence questionnaire at 6 weeks, 3 and 6 months after surgery. RESULTS: In men with moderate to severe LUTS before surgery there were significant improvements in total IPSS, symptom-associated QoL, mean peak flow rate and PVR (P < 0.05). However, in eight men with mild LUTS, although there was a 33% improvement in the total symptom score, it was not statistically significant. Thirty-eight patients reported complete continence, nine had infrequent stress leaks only on heavy physical activity, and the remaining three used < 2 pads/day for protection before heavy physical activity at 3 months after surgery. CONCLUSIONS: Radical prostatectomy provides major benefits to men with LUTS besides cancer control. These data are important in counselling patients about the treatment options, especially in view of the current enthusiasm for brachytherapy and conformal radiotherapy, which may worsen LUTS.

Renal artery embolization for benign obstructive uropathy.

PURPOSE: We demonstrate safety of renal artery embolization as an alternative to nephrectomy in symptomatic patients with obstructed, poorly functioning kidneys who are unfit for surgery. MATERIALS AND METHODS: We performed renal artery embolization in 2 medically unfit patients with benign obstructive uropathy and poorly functioning kidneys. The affected kidney was initially drained with a nephrostomy tube and the kidney was then selectively embolized using absorbable gelatin sponge particles and Gianturco coils. The nephrostomy tube was removed before hospital discharge. RESULTS: Urine production by the affected kidney ceased and symptoms resolved. CONCLUSIONS: Renal artery embolization with antegrade drainage is a safe alternative to surgery in unfit symptomatic patients with benign obstructive uropathy and poorly functioning kidneys.

Pediatric medulloblastoma: radiation treatment technique and patterns of failure.

PURPOSE: In this study factors are analyzed that may potentially influence the site of failure in pediatric medulloblastoma. Patient-related, disease-related, and treatment-related variables are analyzed with a special focus on radiotherapy time-dose and technical factors. METHODS AND MATERIALS: Eighty-six children and adolescents with a diagnosis of medulloblastoma were treated in Switzerland during the period 1972-1991. Postoperative megavoltage radiotherapy was delivered to all patients. Simulation and portal films of the whole-brain irradiation (WBI) fields were retrospectively reviewed in 77 patients. The distance from the field margin to the cribiform plate and to the floor of the temporal fossa was carefully assessed and correlated with supratentorial failure-free survival. In 19 children the spine was treated with high-energy electron beams, the remainder with megavoltage photons. Simulation and port films of the posterior fossa fields were also reviewed in 72 patients. The field size and the field limits were evaluated and correlated with posterior fossa failure-free survival. RESULTS: In 36 patients (47%) the WBI margins were judged to miss the inferior portion of the frontal and temporal lobes. Twelve patients failed in the supratentorial region and 9 of these patients belonged to the group of 36 children in whom the inferior portion of the brain had been underdosed. On multivariate analysis only field correctness was retained as being significantly correlated with supratentorial failure-free survival (p = 0.049). Neither the total dose to the spinal theca nor the treatment technique (electron vs. photon beams) were significantly correlated with outcome. Posterior fossa failure-free survival was not influenced by total dose, overall treatment time, field size, or field margin correctness. Overall survival was not influenced by any of the radiotherapy-related technical factors. CONCLUSION: A correlation between WBI field correctness and supratentorial failure-free survival was observed. Treatment protocols should be considered that limit supratentorial irradiation mainly to subsites at highest risk of relapse. Optimized conformal therapy or proton beam therapy may help to reach this goal. Treating the spine with electron beams was not deletereous. A significant correlation between local control and other technical factors was not observed, including those relating to posterior fossa treatment. The use of small conformal tumor bed boost fields may be prefered to the larger posterior fossa fields usually considered as the standard treatment approach.

Suppression of methionine sulfoximine seizures by intranigral gamma-vinyl GABA injection.

Studies were undertaken to determine whether enhancement of GABAergic transmission within the substantia nigra could inhibit seizures caused by the novel, long latency convulsant, L-methionine, sulfoximine (MSO; 200 mg/kg i.p.). Bilateral injections of gamma-vinyl GABA (10 micrograms/side) into several brain sites resulted in varying degrees of protection against MSO-induced seizures. However, significant protection was afforded only when gamma-vinyl GABA was infused into the nigra. The protective effect was reduced when injections were made at sites 2 mm dorsal to the nigra, and was further diminished when the drug was injected into the striatum. These results further support the hypothesis that elevation of cerebral GABA levels is protective against a range of experimentally induced seizures, particularly when the substantia nigra is the target of such manipulations.