Is low-grade prostatic intraepithelial neoplasia a risk factor for cancer?

INTRODUCTION: High-grade prostatic intraepithelial neoplasia (HGPIN) is generally accepted to be a precursor lesion of prostate cancer. The likely outcome of isolated low-grade PIN (LGPIN) lesions in prostate biopsies remains unclear. A follow-up study of 106 patients with LGPIN- and HGPIN lesions was performed. MATERIALS AND METHODS: In a 2-y period, 207 men were diagnosed with isolated PIN on standard systematic sextant biopsy of the prostate. In total, 104 patients had LGPIN and 103 had HGPIN. No patients had ever received androgen deprivation therapy, chemotherapy or radiation therapy. In all, 106 patients who underwent repeat second or third sextant biopsies were analysed in the study; 30% of these patients received a selenium-vitamin E supplement for at least 6 months. RESULTS: In total, 43 had LGPIN and 63 HGPIN on the first biopsy. The mean age was 63.5 y (range 46-77) in the LGPIN group and 64.9 y in the HGPIN group. The mean total PSA was 6.96 ng/ml (range 0.59-34.13) in the LGPIN group and 8.44 ng/ml (range 0.59-35.3) in the HGPIN group. In the LGPIN group, 30% of the patients had cancer in at least one of the repeat biopsy cores. In the HGPIN group, 27% had cancer in at least one of the repeat biopsy cores. The mean total PSA of patients who had cancer in repeat biopsies with LGPIN was 7.84 ng/ml (range 2.92-34.13). The mean total PSA of the patients who had cancer in repeat biopsy in the HGPIN was 6.73 ng/ml (range 0.56-25). There was no significant difference in PSA and pathological stage between those patients who did and those who did not receive selenium-vitamin E supplements. CONCLUSIONS: These data are intriguing since the risk of finding prostate carcinoma on repeat sextant biopsy in the LGPIN group is 30%. This is higher than commonly reported. The importance of recognising and re-biopsying HGPIN was confirmed. If chemoprevention could be shown to be effective, it might be beneficial not only in HGPIN but also in LGPIN. The possible activity of chemopreventive agents and their combination with iso-flavonoids needs further investigation.

Long-term results following operation for diabetic foot problems: arterial disease confers a poor prognosis.

OBJECTIVES: to describe the long-term outcome of local amputations and debridements of diabetic feet, with special reference to the presence or absence of arterial disease. MATERIALS AND METHODS: a consecutive series of 75 diabetic patients having local foot surgery during 1987-92 was reviewed in 1998. A total of 136 operations had been done on 92 limbs, of which 52 (60%) had evidence of arterial disease. Survivors were interrogated in 1998, with follow-up intervals of 69-120 (median 92) months after their index operations. RESULTS: complete healing occurred in 48% feet, and 36% limbs required major amputation, after 1 day-7 years (median 24 days). Major amputation was more common in limbs with arterial disease (52% vs. 18%) -p;<0.001. At follow-up 20 (27%) patients were alive (five lost to long-term follow-up) - five of 44 (11%) arteriopaths, and 15 of 26 (58%) of those without arterial disease (p<0.001). No patient who had arterial reconstruction at the outset survived to follow-up. Among the survivors, 78% feet had remained healed, with no recurrent ulceration. CONCLUSIONS: among diabetics requiring local foot surgery, the presence of arterial disease confers a poor long-term prognosis for both life and limb. Those with neuropathy alone tend to do well with good foot care.