Can the reverse transcriptase-polymerase chain reaction for prostate specific antigen and prostate specific membrane antigen improve staging and predict biochemical recurrence?

OBJECTIVE: To evaluate the perioperative gene-specific primed nested reverse transcription-polymerase chain reaction (RT-PCR) for prostate-specific antigen (PSA) and prostate-specific membrane antigen (PSMA) for staging patients undergoing radical prostatectomy and predicting biochemical recurrence. PATIENTS AND METHODS: In 80 consecutive patients undergoing radical prostatectomy for prostate cancer, blood samples were drawn before, during and 1 and 7 days after removing the prostate. After buffy coat and mRNA extraction, gene-specific primed nested RT-PCR was performed for PSA, PSMA and glyceraldehyde-3-phosphate dehydrogenase mRNA, and Southern blot analysis of the PCR reaction. RESULTS: The sensitivity of gene-specific RT-PCR to detect tumour cells was comparable with random primed RT-PCR. In the 80 patients the stage distribution was pT1 in two (2.5%), pT2 in 30 (37.5%) and > or = pT3 in 48 (60%); the nodal status was pN0 in 57 (71%), pN1 in 11 (14%) and pN2 in 12 (15%). The gene-specific RT-PCR reaction for PSA and PSMA was positive in no patients with pT1, 11 (37%) with pT2 and 23 (48%) with stage > or = pT3 disease. The result for PSA was positive in 12 (52%) and for PSMA in 11 (48%) of those with positive nodal status. Neither gene-specific RT-PCR for PSA or PSMA was able to predict organ-confined disease (P > 0.5). After a median (range) follow-up of 37 (11-67) months a biochemical recurrence was predicted in 65% of patients by preoperative RT-PCR for both PSA and PSMA, with a sensitivity, specificity, positive and negative predictive value of 58%, 80%, 87% and 47%, respectively; the assay after surgery predicted a recurrence in 73%, with respective values of 68%, 84%, 84% and 57%. CONCLUSIONS: Gene-specific primed nested RT-PCR for PSA and PSMA is a sensitive and simple assay; it might add substantial information for tumour staging in individual patients. RT-PCR before surgery allows the prediction of recurrence in 65% of cases and after surgery in 73%.

Keys to success in orthotopic bladder substitution.

Orthotopic bladder substitution is here to stay. Excellent long term functional results can be obtained. However, careful, restrictive patient selection before surgery, strict attention to some special surgical details during surgery and, probably most important, meticulous postoperative instruction and follow-up of the patient with an orthotopic bladder substitute are mandatory.

[Effect of regular training on total and vital capacity of the lung in 17 to 25-year-old rowers]. / Der Einfluss eines regelmässigen Trainings auf Total- und Vitalkapazität der Lunge bei 17-25jährigen Ruderern.

Lung volumes, FEV1 and airway resistance have been repeatedly measured from age 17 to 26 in a group of 16 rowers. Total capacity, vital capacity and FEV1 are in the upper normal range. Airway resistance is normal. The increase in total and vital capacity from age 17 to 26 has been within the normal limits of other young men in the same age group. Intensive training does not appear to influence total and vital capacity once the final height has been reached. Top Swiss rowers of the years 1981 and 1982 have total and vital capacity values well above the predicted values for men of the same height and age, and also above those measured in top Swiss rowers of the period 1968-1972. The latter finding can be explained by a difference in the selection process.