Long-term results of patients with clinical stage C prostate cancer treated by phototherapy and early orchiectomy. A retrospective analysis of 169 cases.

BACKGROUND: To evaluate the value of radiotherapy and immediate hormonal therapy in the treatment of stage C prostate cancer. PATIENTS AND METHOD: From 1977 to 1986, 169 patients with clinically stage C prostate cancer underwent irradiation with curative intent following early orchiectomy. Sixty-four patients had a transurethral resection, 22 patients a prostatectomy and 83 patients had only a biopsy. In 38 patients a grade Ia/b tumor was found, in 78 patients a grade IIa/b tumor and in 43 patients a grade IIIa/b tumor using the German grade of malignancy. Treatment fields included the prostate, the seminal vesicles and the locoregional lymphatics. Until 1979 the dose was 60 Gy for the tumor encompassing isodose and from then on 65 Gy with a single dose of 2 Gy. RESULTS: With a median follow-up of 98 months, the overall survival rate for 8 and 10 years was 51% and 37% and the cause specific survival rate was 84% and 77%, respectively. Thirty-two patients (19%) developed distant metastases. Patients with local tumor control (n = 148) had a significantly better overall survival rate of 45% for 10 years compared to patients with clinical local progression of disease (n = 21) of 22% (p < 0.05). Multivariate analysis showed the grade of malignancy and local control as independent factors for overall survival and cause-specific survival (p < 0.05). Twenty-three patients (14%) had at least one late side effect for the rectum or the bladder, in almost all cases grade I or II. Five patients (3%) showed severe late side effects RTOG grade III (n = 2) or IV (n = 3). One patient had a colostomy, in 2 patients a severe haemorrhagic cystitis was seen. CONCLUSIONS: Radiotherapy with photons and early orchiectomy for patients with stage C prostate cancer achieves high local control rates and a 30% to 40% 10-year survival rate with a low incidence of late side effects. The value of the radiotherapy of the locoregional lymphatics remains controversial.

[Obstructive uropathy after kidney transplantation. Experiences with endourologic incision of ureteral stenoses]. / Die obstruktive Uropathie nach Nierentransplantation. Erfahrungen mit der endourologischen Schlitzung von Ureterstenosen.

Between 1985 und March 1991 we have managed 8 upper urinary tract obstructions in kidney transplants using an endourological approach. After a graft rejection was excluded an obstruction was initially diagnosed by nephrosonography and further confirmed by IVP or antegrade pyelography. To investigate the urodynamic relevance of the stenosis, all patients underwent preoperative diuretic isotope renography. In all cases a percutaneous pyelostomy was done to preserve renal function. 7 of these 8 patients demonstrated a stenosis of the ureter, while in one case, the obstruction was caused by a coagulum in the renal pelvis. Incision of the stricture then was performed with a flexible knife antegrade or retrograde and stented for 4-6 weeks. In 6 out of 7 cases with a proven stenosis of the ureter, the cold knife incision lead to a successful outcome, while in one patient, the kidney had to be removed due to uncontrolled bleeding 12 days after successful percutaneous incision. Our results indicate, that the cold-knife-technique for the management of upper urinary tract obstructions in kidney transplants is a promising, fast and in most of the cases effective method. Due to its minimalinvasive character and excellent results, this approach is able to replace open reintervention in most cases.

[Vasovasostomy after vasectomy. The surgical results 1986-1989]. / Vasovasostomie nach Vasektomie. Operationsergebnisse 1986-1989.

The frequency of vasovasostomy has increased dramatically in recent years. A significant percentage of men who have previously undergone vasectomy are now seeking restoration of their fertility. The most common reason for requesting a reversal is remarriage. There were 90 bilateral vasovasostomies performed in 90 patients between 1986 and 1989. The procedure was done according to the technique described by Howards, in a single layer with 7 x 0 prolene and under fourfold magnification. The success rate was 87% for presence of spermatozoa in the ejaculate, 48% for pregnancy. The fertility rate decreases slowly with increasing interval between vasectomy and reanastomosis. These results are statistically significant. In cases of good anatomical and andrological conditions, the chance of restoration of fertility is good. The experience of the urologist is often more important than the details of the technique.

PIP: Vasectomy was performed in 500,000 men in the US in 1974, and 33 million couples chose this method of contraception worldwide according to a 1984 study. In 1987 there were about 25,000 vasectomies performed in West Germany. Subsequent desire to have a child necessitates vasovasostomy in numerous instances. Between 1986 and 1989, in a prospective study, a total of 90 men with average age of 39 years whose vasectomy had been performed at the average age of 32.1 years underwent bilateral vasovasostomies (VVST). The Howards method of anastomosis was used with prolene thread under fourfold magnification along with a spermiogram and a test of passability of the sperm duct. 64 patients were given a follow-up examination. The passability of anastomosis or spermatozoa in the ejaculate amounted to 87%. A postoperative spermiogram showed oligospermia in 84% (54 of 64) and a normal sperm count in only 2 cases. There were 8 cases of azoospermia owing to the closing of the anastomosis. A total of 31 pregnancies (48% rate) resulted in partners. The decrease of the pregnancy rate was statistically significant as the interval between vasectomy and VVST rose. Refertilization within 5 years after vasectomy produced a 63% pregnancy rate which was significantly higher than the 30% rate within 10 years. Beyond 10 years only an 8% pregnancy rate could be expected. The intraoperative sperm motility was not a good predictor of the expected pregnancy rate, as motility of sperm was found in only 38% and lack of motility in 55%. Laser VVST has been increasingly used, but its suitability has not been evaluated yet. The possible cause of the high rate of oligospermia is the resection during vasectomy of a nerve that controls sperm transport of the vas deferens. Thorough postoperative andrological and gynecological examination is needed for accurate assessment of the success or failure of the operation.

Transplantation of human benign hyperplastic prostate tissue into nude mice: first results of systemic therapy.

Xenografts of human benign hyperplastic prostate tissue (BPH) have been established as a model for the investigation of the etiology of BPH. In this paper it is our aim to answer the question of whether this model is useful for the established therapy of the disease. Additionally we try to evaluate the value of a commonly used plant extract for the therapy of BPH. Is there any influence of the extract from Sabal serrulatum on the BPH tissue in our model? Human BPH tissue from 2 patients was transplanted into athymic nude mice and treated with three different regimens. Animals of group I did not receive any treatment and served as control, in groups II and III the tissue was stimulated by application of silicone tubes containing crystalline 5 alpha-dihydrotestosterone and estradiol. Animals of group II additionally were treated orally with the lipophilic extract of S. serrulatum (contained in Prostagutt N), which is commonly used for the treatment of BPH clinically. Significant inhibition of tissue growth was observed in group III when compared to group II. In group I (control) atrophy of the graft was observed as expected. However, histologically no differences were visible between groups II and III. Our experiment shows a significant growth-inhibiting effect of the plant extract for human BPH tissue in our model (p less than 0.05). We conclude that the nude mouse model can be useful for the evaluation of systemic therapy modalities of human BPH and that the plant extract may have a certain value for clinical treatment, which is not only due to subjective criteria.

[Pheochromocytoma of the urinary bladder. Diagnosis and therapy based on a case report]. / Das Phäochromozytom der Harnblase. Diagnostik und Therapie anhand eines Fallberichts.

Micturition difficulties associated with unstable hypertension, tachycardia and profuse sweating could be a sign of pheochromocytoma of the urinary bladder. Of all pheochromocytomas, 10-36% are located extradrenally, in which case they are also referred to as paragangliomas, and 1-3% are found in the urinary bladder. The case history of a 44-year-old female patient with typical symptoms is described. Diagnosis required not only CT, NMR, excretory urography and MIBG scintigraphy, but also hormonal analyses. Histology reveals malignancy in up to 20%; it is thought that focal invasions of tumor into vessels and destruction of connective tissue might be pathognomonic. A precise history and careful diagnosis are necessary before a pheochromocytoma of the bladder can be disclosed and treated.

[Long-term results in the treatment of metastasizing kidney carcinoma using recombinant alpha-2 or gamma interferon]. / Langzeitergebnisse der Behandlung des metastasierten Nierenkarzinoms mit rekombinantem Alpha-2- oder Gamma-Interferon.

To evaluate whether response to alpha-2- or gamma-interferon in metastatic renal cell carcinoma is associated with a prolonged survival, we studied a total of 65 patients being treated in two phase-II- or phase-III-trials between 1984 and 1986 with one of these interferons. After a median follow-up of 3 years for the alpha-interferon-treated patients and of more than 4 years for gamma-interferon-therapy, respectively, there is a significantly increased duration of survival for patients showing an objective response or stabilisation of the disease due to either therapy compared to those with continuing progression. Therapy with alpha-interferon leading to objective remissions in 26% or with gamma-interferon with an objective response rate of 36% therefore is beneficial for responding patients and can be performed with moderate side effects on an out-patient basis.

Monoclonal antibody to the prostate specific antigen.

Somatic cell hybrids were made from mouse myeloma cells and spleen cells derived from BALB/c mice immunized with homogenized epithelial fractions of BPH. The screening by immunoperoxidase staining on human prostate and non-prostate tissue resulted in one monoclonal antibody identifying a prostate specific antigen. Upon SDS-PAGE and Western blot this antigen exhibited a single band at the position of 34 kDa molecular weight. The immunoreactivity of the prostate antigen was found to be localized exclusively in the epithelial lining of ducts and secretions of normal prostate, BPH and prostate cancer. Anti-p34 antibody reacted with an antigenic determinant on the PSA molecule cancer. Anti-p34 antibody reacted with an antigenic determinant on the PSA molecule and inhibited the binding of Anti-PSA antibody to PSA by about 80 to 90% in the RIA.

[Use of electronic data processing at a urologic polyclinic--a program packet for recording and evaluating data of specialized consultations]. / Einsatz der EDV in einer Urologischen Poliklinik--ein Programmpaket zur Datenerfassung und Auswertung von Spezialsprechstuden.

A software package was developed for computerized recording and processing of clinical data in a urological out-patient clinic. In a pilot study this program proved to be useful for the rapid evaluation of all important clinical and laboratory results of patients with renal cell carcinoma, and its use also accelerated the preparation of medical reports. The experience gained in this initial project shows that the application of this newly developed concept of data processing can easily be extended to routine out-patient followup in other special areas within the field of oncology.

Effect of cyproterone acetate in comparison to flutamide on the ventral prostate of adult male castrated Copenhagen-Fisher rats and on Dunning R-3327 H tumors.

In this investigation the effect of CPA was tested in comparison to FL after the procedure of double blinding on the ventral prostate of 70 adult male castrated Copenhagen-Fisher rats and on the Dunning R-3327 H tumor. Total androgen blockade by castration plus CPA or by castration plus FL induced significant decrease in prostate weight compared to the androgen deprivation by castration alone. No significant difference between CPA and FL was observed. Furthermore it was impossible to exaggerate this effect with higher doses of CPA of FL. The Dunning R-3327 H tumor did not become palpable 60 days after inoculation of the tumor cells indicating that androgen deprivation by total androgen blockade by castration plus CPA or plus FL did not exhibit any proliferative activity on the hormone-sensitive Dunning R-3327 H tumor cells.

[Papaverine-induced priapism. Experiences with a new urologic emergency]. / Der papaverin-induzierte Priapismus. Erfahrungen mit einem neuen urologischen Notfall.

Ten patients with priapism after self-administered intracavernous papaverine injection for erectile impotence had to be treated as emergencies between September 1985 and February 1988. In half the patients it was possible to achieve penile detumescence by puncture of the corpora cavernosa, injection of 2-5 mg metaraminol or both, but failed in the remainder, requiring the intracavernous injection of 10-30 mg metaraminol in 500 ml physiological saline. Surgical treatment was necessary in one case. Papaverine-induced priapism constitutes a urological emergency which, because of the danger of hypertensive crises, demands treatment in hospital.

Monoclonal antibody that defines the prostate specific antigen.

A monoclonal antibody to a protein with a single band in the 30-kD region was obtained from fusion of Balb/C mouse spleen cells immunized with epithelial fractions of BPH, with the myeloma cell line P3 x 63 Ag8 6.5.3 by standard procedures. This antigen was characterized in immunobinding studies with various cellular and target antigens and in immunoperoxidase staining.

Recombinant interferon gamma in the treatment of metastatic renal cell carcinoma. Results of a phase II trial.

A clinical Phase II study was performed to evaluate the efficacy and safety of treatment with interferon gamma in patients with metastatic renal cell carcinoma. Patients received interferon gamma by two different regimens: 1. 100 micrograms/m2 3x/week i.v. over 4 h every other week--low dose. 2. 500 micrograms/m2 5x/week i.v. over 24 h every other week--high dose--for non-responders to regimen 1. The response rate, duration of response, survival and toxicity in the two regimens were evaluated. Treatment with interferon gamma resulted in an overall response rate of 31%, with a duration of response ranging between 2 and 44+ months. Patients responding objectively to interferon gamma or showing stable disease survived significantly longer than non-responders (p = 0.0056).

Determination of androgen, progestin and estrogen receptors with two different assays in renal cell carcinoma.

Twenty-one renal cell carcinomas were analyzed for the presence of androgen progestin and estrogen receptors by agar gel electrophoresis and a dextran-coated charcoal assay. An androgen receptor could be demonstrated in 3 tumors, a progestin or estrogen receptor was not detectable. It was therefore concluded that renal cell carcinoma is generally not a hormone-dependent tumor, and a hormonal treatment of metastatic renal cell carcinoma as first-line therapy does not seem to be justified.

[Pyelonephritic scar formation]. / Pyelonephritische Narbenbildung.

Pyelonephritic scars almost never develop after urinary tract infections alone, but require in addition certain risk factors. The most important risk factors are: vesicoureteral reflux, intrarenal reflux, obstructive uropathy, and nephrolithiasis. Most of the pyelonephritic scars develop in early childhood, where we find the combination of vesicoureteral reflux, intrarenal reflux, and urinary tract infections. Urinary tract infections alone almost never result in pyelonephritic scars. After the age of 3 years the risk to develop pyelonephritic scars is not more than 10% in those with the combination of urinary tract infections and vesicoureteral reflux. In this age group the risk to develop pyelonephritic scars is not altered by antireflux operation.