Prostate cancer detection rate of transrectal ultrasonography, digital rectal examination, and prostate-specific antigen: results of a five-year study of 6- versus 12-core transperineal prostate biopsy.

AIM: The purpose of the present comparative work was the processing and assessment of data collected in a five-year period of urological practice with more than 1.500 transperineal, ultrasound-guided, prostatic biopsies performed. Our aim was to identify advantages and limitations of 6 and 12-core protocols, by extending the evaluation not only to cancer detection rate but also to the other histological findings. METHODS: A total of 1.151 patients were included in the study. Two subgroups were identified: 836 patients who had undergone a 6-core biopsy from 2001 to 2004, and 315 patients who had undergone a 12-core biopsy from 2005 to 2006. RESULTS: Cancer detection rate was 291/836 (34.8%) in group 1 (6-core biopsy), and 148/315 (47%) in group 2 (12-core biopsy) (P<0.0001). The total number of histological diagnoses other than cancer was 162/836 in group 1 (19.4%) and 103/315 (32.7%) in group 2 (P<0.0001). CONCLUSION: In prostate biopsy, a higher number of cores seems to definitely improve its diagnostic value by dramatically decreasing the number of negative findings. The 12-core technique is particularly effective in case of prostate-specific antigen (PSA) values ranging between 4.1 and 10 ng/mL combined with a free-to-total PSA ratio below 16%, in case of negative digital rectal examination and when serum prostate-specific antigen levels are lower than 4 ng/mL. On the other hand, in the case of abnormal digital rectal examination, especially when combined with high prostate-specific antigen levels and/or changes detected at transrectal ultrasound, the 6-core technique can be considered a reasonable strategy.

Use of local hyperthermia as prophylaxis of fibrosis and modification in penile length following radical retropubic prostatectomy.

OBJECTIVE: The aim of the study was to evaluate the effectiveness of local hyperthermia in reducing possible penile shortening following radical retropubic prostatectomy. PATIENTS AND METHODS: The study population comprised 40 patients, aged 52-74 years, submitted to radical retropubic prostatectomy. Patients were divided into two groups of 20. In Group A, patients were submitted to local hyperthermia 3 weeks after surgery, three times a week, with treatment lasting 30 min. Patients received a total of 10 applications, which reached a local temperature of 39-40 degrees C. A second cycle was repeated after 1 month. In Group B, patients were submitted only to post-operative follow-up once a month. Penile length was measured in all patients both before and 3 months after surgery in the 'stretching phase' from the pubo-penile junction to the tip of the glans. RESULTS: In Group A patients (hyperthermia treatment), no variation in penile length was observed in 16 cases (80%), while the reduction ranged from 0.5-1.5 cm in four cases (20%). In Group B, 12 patients (60%) showed a reduction in penile length ranging from 0.5-2.5 cm, while penile length remained unchanged in eight patients (40%). CONCLUSIONS: Results of this study demonstrate a mild but statistically relevant reduction in penile shortening following low-grade, externally delivered penile hyperthermia, thus confirming the efficacy of this approach in preventing penile shortening caused by post-ischaemic fibrosis.

Role of hyperthermia in the treatment of Peyronie's disease: a preliminary study.

OBJECTIVE: Previous experience in the treatment of plaque with hyperthermia in orthopaedics led the authors to investigate the effectiveness of this approach in patients with Peyronie's disease. PATIENTS AND METHODS: The study population comprised 60 patients (aged 36-76 years) with advanced Peyronie's disease. Patients were divided into two groups (A and B), with 30 in each. Group A patients underwent local hyperthermia treatment, with 30-min treatment sessions twice a week for 5 weeks. Patients received a total of 10 applications, which reached a local temperature of 39-40 degrees C. A second cycle was repeated after a 1-month interval for a total of 20 treatment sessions. Group B patients were treated with intra-plaque infiltrations using 10 mg verapamil; they received one infiltration once a week for 3 months. Differences between the two groups, as well as between variables (before and after treatment), were analysed using Student t-test and Fisher test. RESULTS: Hyperthermia significantly reduced plaque size and penile curvature and led to an increase in mean scores of erectile function (EF) domain, while verapamil had no such effects. Haemodynamic parameters were not significantly modified in either group. Hyperthermia caused significantly fewer side effects than verapamil infiltrations and was significantly more effective in preventing disease progression. There were no significant differences between the two groups in terms of pain reduction during erection. CONCLUSIONS: Results of this study stress the efficacy of hyperthermia in the treatment of advanced Peyronie's disease.

Role of 5-aminolevulinic acid in the diagnosis and treatment of superficial bladder cancer: improvement in diagnostic sensitivity.

OBJECTIVES: To use 5-aminolevulinic acid (5-ALA) in diagnostic cystoscopy and during transurethral resection of the bladder (TURB) to treat transitional cell carcinoma. The efficacy of this new technique was compared with standard cystoscopy. METHODS: The 5-ALA, instilled in the bladder 2 hours before cystoscopy, makes the pathologic tissue fluorescent when illuminated with blue light (375 to 400 nm). This allows a better recognition of the neoplastic forms for both diagnostic and therapeutic purposes during TURB. This method has been used since May 1997 on 49 patients in whom bladder tumor was diagnosed either immediately or during postchemotherapy follow-up. RESULTS: One hundred seventy-nine biopsies were taken of fluorescent and nonfluorescent areas (3.5 per patient) to check the effectiveness of the new method compared with standard cystoscopy. A good correlation was found between 5-ALA cystoscopy and the histopathologic diagnosis, with a good sensitivity (87%). The 5-ALA cystoscopy allowed the diagnosis of a tumor in 24 patients with negative standard cystoscopic findings. Furthermore, 5-ALA cystoscopy detected 7 cases of carcinoma in situ. Neither local nor systemic (because of endovesical instillation) side effects were noted. CONCLUSIONS: We believe that 5-ALA could be routinely used in the diagnosis of superficial bladder tumors, as it was shown to improve the diagnostic sensitivity for carcinoma in situ and to reduce the risk of recurrence related to missed cancerous lesions or incomplete TURB.

[Multiple prostatic biopsies in the "gray zone" of the specific prostatic antigen]. / La biopsia prostatica multipla nella "zona grigia" dei valori dell'antigene prostatico specifico.

PURPOSE: Aim of our study was to identify cases of undetected prostatic cancer in patients with normal findings at digital examination and transrectal US, and prostate specific antigen (PSA) values ranging 4-10 ng/mL. MATERIAL AND METHODS: Two hundred and ninety patients were submitted to transrectal US and random bilateral prostatic biopsy; 3 samples were collected from each side of the gland using 16-Gauge thru-cut needles. Of the 290 patients who gave fully informed consent, we selected 34 whose age ranged 56 to 76 years (mean: 64). Inclusion criteria were PSA 4-10 ng/mL, PSAD cut-off 0.15, free/total PSA ratio 15-25%, and normal findings at digital examination and transrectal US. PSA velocity was calculated collecting 3 blood samples every 30 days for 2 months. RESULTS: Five of the 34 selected patients (15%) had prostatic cancer, and 2 (6%) Pin (1 Pin 1 and 1 Pin 2). As for the other 27 patients, biopsy demonstrated 4 (12%) cases of prostatitis and 23 (62%) cases of BPH. PSA values increased in all patients with positive histology, versus only 6 (22%) of those with negative histology. PSAD was 0.15 or greater in 3 of 7 prostatic cancer patients. Free/total PSA ratio never exceeded the cut-off value. Gleason score ranged 2 to 4. CONCLUSIONS: Our findings confirm that prostatic biopsy can detect tumors also in areas which appear normal at transrectal US and digital examination, and that PSA rate increases in patients with positive histology. Finally, the actual clinical role of prostatic biopsy relative to all other diagnostic imaging techniques remains to be defined.

Epithelioid sarcoma of the penis. Clinicopathologic study of a tumor with myogenic features and review of the literature concerning this unusual location.

Soft tissue tumors of the penis are uncommon. We report here the clinicopathologic features of a penile epithelioid sarcoma (ES), review the literature concerning this unusual location and focalize our attention on its differentiation. The 34-year-old patient was admitted for abrupt urinary retention due to the growth of a firm and painful plaque on the left side of the shaft, three years previously clinically diagnosed as Peyronie's disease. Magnetic nuclear resonance revealed an infiltrating lesion of both corpora cavernosa. Histology of bioptic fragments showed a nodular malignant spindle and epithelioid cell tumor with focal necrosis and relatively high mitotic rate. Based on the immunohistochemical data (cytokeratin+, vimentin+, EMA+, CD34+, and S100-), the diagnosis of ES was strongly considered. Penectomy was undertaken and the diagnosis confirmed by both light and ultrastructural microscopy. The 22 month follow-up was free of recurrences and metastases. Although not dissimilar from the 10 previously described ES of the penis in terms of natural history and histology, the tumor reported here showed myogenic features as revealed by both immunohistochemistry (immunoreactivity for muscle specific actin) and ultrastructure (intercellular junctions, discontinuous basal lamina, pinocytotic vesicles and thin filaments with intercalated dense bodies). Although previously observed in ES of other sites, this feature has never been established in ES of the penis.

[Radiologic staging after surgical, chemical, and radiation treatment of non-seminomatous tumors of the testis]. / La stadiazione radiologica dopo trattamento chirurgico, chemio e radioterapico dei tumori non seminomatosi del testicolo.

The aim of this work was to evaluate the clinic usefulness of Computed Tomography (CT) and Magnetic Resonance (RM) in the staging after surgery, radiotherapy and chemotherapy of the nonseminomatous germ cells tumours of the testis. The Authors discussed the CT and MR dimensional criteria for the diagnosis of retroperitoneal metastases of the nonseminomatous germ cells tumours and delineated their CT and MR morphologic appearances in detail. The density of the residual mass on CT was classified as solid, cystic and half-cystic. The retroperitoneal hematoma and lymphocele formed as a complication respectively of orchiectomy and retroperitoneal lymphadenectomy can be misinterpreted to represent metastatic disease on post operative staging CT scans. Early recognition of this complication are crucial if unnecessary treatment is to be avoided. Finally the Authors evaluated, in patients affected from nonseminomatous germ cells tumours of the testis, the possibility to characterize with CT and MR imaging the retroperitoneal mass. The density and character of the residual mass on CT scan did not reliably predict the histology. On the basis of tumor consistency and signal intensity in T1 and T2 weighted images, MR cannot yet warrant any conclusion about the ultimate effect of chemotherapy.

DNA markers in diagnosis of adult dominant polycystic kidney disease.

We report the results of a biological and molecular study carried out on 11 Italian families, with a total of 111 individuals in which adult dominant polycystic kidney disease segregates. A restriction fragment length polymorphism analysis was performed. Two families have shown a genetic heterogeneity even if not phenotypically different from the other ones: they resulted unlinked to 16p markers. A prenatal diagnosis has been performed in a family of the linked type.

[Surgical treatment of unrepairable vesicovaginal fistulas]. / La terapia chirurgica delle fistole vescico-vaginali non riparabili.

The authors discuss different types of urinary diversion as the therapy of unrepairable vesico-vaginal fistulas. They also describe the therapy performed in their experience and underline that, at the moment, rectal bladder is to be considered the best solution.

[A case of epidermoid cyst of the testis]. / Un caso di cisti epidermoide del testicolo.

The epidermoid cyst of the testis represents about 1% of all testicle tumours. The average age of presentation ranges from the second and the fourth decade of life. Its clinical features do not differ from those of a testis malignancy. Preliminary clinical and laboratory findings do not determine the diagnosis. The Authors report a case and review the Literature (about 150 cases up to 1985). Therapeutic strategy is also discussed: orchiectomy or simple removal of the cyst.

Biochemical picture accompanying sclerotic bone metastases of prostatic origin.

This study was carried out to evaluate the metabolic consequences of osteosclerotic skeletal metastases of prostatic origin in a homogeneous group of patients. We found significantly increased mean values of serum alkaline phosphatase activity and significantly reduced mean values of serum phosphate, 24-h urinary calcium, fasting calcium excretion and TmP/GFR in cancer patients with respect to age-matched controls. Mean serum immunoreactive parathyroid hormone (iPTH) levels were raised, with two patients showing increased values of the hormone above our normal limits. Our findings indicate that mild secondary hyperparathyroidism is a feature of these patients. However, it cannot be excluded that both the reduced serum phosphate and TmP/GFR values may be related, at least in some cases, to the effects of the tumour itself on tubular reabsorption of phosphate.

[Effect of antibiotic chemotherapy on urinary N-acetyl-B-D-glucosaminidase activity in patients with chronic pyelonephritis]. / Effetti della terapia chemio-antibiotica sull'attività NAG-urinaria in pazienti affetti da pielonefrite cronica.

The behaviour of N-acetyl-B-D-Glucosaminidase (NAG) was studied in the urine of patients with chronic pyelonephritis under pharmacological treatment for renewed attacks of acute renal inflammation. It was noted that by the end of target chemo-antibiotic treatment all patients presented a reduction in the inflammation and hence the tubular distress. Once treatment was suspended several patients showed an increase tendency in the activity of the enzyme followed by the reappearance of significant bacteriuria and/or leukocyturia. The acute attack of renal inflammation would not have been recognised if the enzymuria technique had been used to monitor the patients.

[Behavior of certain forms of enzymuria in subjects treated with pipemidic acid]. / Considerazioni sul comportamento di alcune enzimurie in soggetti trattati con acido pipemidico.

Three groups of subjects (I with infections of the lower urinary ways; II with chronic pyelonephritis; III healthy controls) were treated with pipemidic acid for 10 consecutive days and the behaviour of their urinary NAG and AAP was studied. It was discovered that the healthy group and the patients with infections of the lower urinary ways showed no significant variations in the urinary activity of the two enzymes following the administration of pipemidic acid. However there was a distinct reduction in both enzymes in patients with chronic pyelonephritis who presented demonstrable bacterial sensitivity to the drug. Apart from the fact that it produces no nephrotoxic effects at least in the doses used and for the treatment period adopted, the drug is therefore considered to reduce renal inflammation that is beneficial to individuals with chronic interstitial nephropathy.