The release of free prostate specific antigen into the circulation during transurethral resection of the prostate: kinetics and interaction with serum protease inhibitors.

OBJECTIVE: To determine the nature and extent of the release of prostate specific antigen (PSA) and its interaction with its plasma protein-derived inhibitors after transurethral resection of the prostate (TURP). MATERIALS AND METHODS: Twenty-three consecutive patients undergoing routine TURP for benign prostatic hyperplasia had blood samples taken pre-operatively and then post-operatively at 8-hourly intervals for 24 h. Further samples were obtained at 48 and 72 h post-operatively. Serum free and total PSA were determined by immunofluorometric assay. The major plasma protein inhibitors for PSA were also determined by immunoassay. RESULTS: The mean free and total PSA fractions increased significantly post-operatively with levels greatest immediately after surgery. There was also a gradual increase in the complexed PSA fraction, reaching a peak at 48 h. The concentration of the major serum inhibitors of PSA (alpha-1-antichymotrypsin and alpha-2-macroglobulin) also declined immediately after surgery. CONCLUSION: Increases of serum total PSA in patients after TURP are caused by increases in the free PSA fraction. The exponential decline in free PSA concentrations is consistent with the complexing of PSA with its protease inhibitors present in the plasma. The formation of this complex suggests that the free PSA released into the circulation at the time of TURP is the enzymatically active form.

Malignant mesothelioma of the tunica vaginalis.

Malignant mesothelioma is a rare, often aggressive tumor of the tunica vaginalis. We report 2 cases and review the literature concerning current management strategies. It appears that, although adjuvant chemotherapy and radiotherapy have little value, local and nodal recurrence may be successfully treated by local excision.

A review of testicular intratubular germ cell neoplasia in infertile men.

A group of 2,739 infertile men whose testes were biopsied during the investigation of infertility in the period from January 1955 to December 1992 have been reviewed. Unilateral intratubular germ cell neoplasia was seen in the testicular biopsies of 16 patients and was always associated with testicular atrophy (Johnsen score lower than 4). Germ cell tumors of the testis occurred in 50% of untreated patients within 6 years and the longest period of tumor-free follow-up was 10 years. A retrospective study was performed to evaluate the incidence of tumors in a subset of 1,639 infertile men biopsied between 1955 and 1982. Three of the patients, without intratubular germ cell neoplasia on the biopsy, were found to have developed a germ cell tumor. The incidence and management of intratubular germ cell neoplasia in infertile men is discussed.