Comparative persistence and adherence to overactive bladder medications in patients with and without diabetes.

AIMS: This retrospective administrative claims-based study evaluated comparative persistence and adherence to overactive bladder (OAB) medications in US patients with and without diabetes. METHODS: Patients ≥ 18 years who initiated OAB medications between 1 January 2005 and 30 June 2008 were analysed from the Truven Health MarketScan Commercial and Medicare Supplemental databases. A 12-month baseline period prior to OAB medication initiation was used to classify patients into diabetes and non-diabetes cohorts, and measure demographic and clinical characteristics. Patients in each cohort were directly matched 1 : 1 based on index year, age, gender and geographic region. Multiple logistic regression was used to compare cohorts on outcomes of ≥ 80% adherence to OAB medications and refilling a second OAB medication prescription. Cox's proportional hazards model compared time to non-persistence with OAB medications between both cohorts. RESULTS: In total, 36,560 patients were included in each cohort. Compared with the non-diabetes cohort, the diabetes cohort had 21.5% higher odds of ≥ 80% adherence to OAB medications, 16.6% higher odds of filling a second OAB medication prescription and 10.3% lower hazard of non-persistence with OAB medications during a 12-month evaluation period. CONCLUSIONS: Patients with diabetes were more persistent and adherent to OAB medications and had higher odds of filling a second medication prescription than patients without diabetes. Further research is needed to identify factors responsible for these findings.

Diagnostic accuracy of extended biopsies for the staging of microfocal prostate cancers in autopsy specimen.

Clinically insignificant prostate cancers may be predicted when biopsies show a microfocal cancer (MiFC). However, at least one-third of MiFC are underestimated by biopsies. The aim of this study was to evaluate the staging accuracy of different biopsy regimen showing a MiFC. We performed 18 biopsy cores on 164 autopsy prostates. Six cores were taken from the mid-peripheral zone (MPZ), 6 from the lateral PZ (LPZ) and 6 from the central zone (CZ). We tested seven different biopsy regimens by distinguishing the MPZ, LPZ or CZ biopsies either separately or associated with each other. Of the cancers detected by biopsies, we selected those showing a MiFC and compared our findings with whole mount analysis. The positive predictive value of a MiFC referred to how often, when needle biopsies showed a MiFC, there was a clinically insignificant cancer on whole mount prostate analysis. We found that the positive predictive value of a MiFC on 6 or 12 biopsy cores was similar irrespective of biopsy location (P approximately 1). On MPZ, MPZ plus LPZ and all 18 biopsies, it was 40, 70 and 87%, respectively (P<0.1). Tumor volume of cancers showing a MiFC on MPZ biopsies was significantly higher than those showing a MiFC on MPZ plus LPZ, or all 18 biopsies (P<0.05). These results show that performing additional cores in case of MiFC on sextant biopsies may help differentiating significant from insignificant cancers.

Targeting epitopes in prostate-specific membrane antigen for antibody therapy of prostate cancer.

Prostate-specific membrane antigen (PSMA) is a target for immunotherapy of prostate cancer. It has been shown that antibodies against PSMA inhibited the in vivo growth of LNCaP tumor. In the present study, monoclonal antibodies against four epitopes in PSMA were raised. MAb 24.4E6 (IgG1), specific for the epitope (residues 638-657) in PSMA, significantly reduced the growth rate of established LNCaP tumor in SCID mice. Mouse IgG was detected in the tumor of mice treated with 24.4E6, but not with an unrelated MAb. These results suggest that this epitope may be the main target in PSMA for antibody therapy of prostate cancer.

Heterocyclic amines and genotype of N-acetyltransferases as risk factors for prostate cancer.

A variety of carcinogenic heterocyclic amines are produced during the cooking of meat at high temperatures. These carcinogens are metabolized by N-acetyltransferases (NAT), which are polymorphic in the population. This study examined associations between prostate cancer (PCa) and the consumption of different kinds of meat, heterocyclic amine intake and NAT genotypes. PCa patients and controls were recruited in the Syracuse, NY area. Levels of meat and heterocyclic amine intakes were determined from validated surveys and NAT genotypes were determined by the sequences of PCR-amplified DNA from buccal swabs. A total of 152 cases and 161 controls were eligible for analysis. There was an association between PCa and history of PCa in the first-degree blood relatives (OR = 4.59, 95% CI 2.21-9.70), and family history of bladder cancer (P < 0.02). However, there was no association with the history of other cancers. There was no association between PCa and either 2-amino-3,8-dimethylimidazo[4,5-f]quinoxaline (MeIQx), 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP) intake, or NAT1 and NAT2 genotypes. However, there was a trend of association with MeIQx and with rapid NAT2 and NAT1*10 in combination with PhIP. A new NAT1 allele with a frequency of one out of 544 chromosomes was found in the Caucasian subjects.

Antitumor effect on murine renal cell carcinoma by autologous tumor vaccines genetically modified with granulocyte-macrophage colony-stimulating factor and interleukin-6 cells.

The authors evaluted the efficacy of vaccination with murine renal cell carcinoma (Renca) secreting the granulocyte-macrophage colony-stimulating factor (GM-CSF) gene and interleukin-6 (IL-6) gene for the treatment of Renca tumor. Murine GM-CSF and murine IL-6 genes were introduced and expressed in Renca cells (Renca-GM-CSF and Renca-IL-6). For a prevaccination study, wild-type Renca cells were injected subcutaneously into Balb/c mice that had been vaccinated three times with inactivated wild-type Renca, Renca-GM-CSF, Renca-IL-6, or a mixture of Renca-GM-CSF and Renca-IL-6 cells 7, 14, and 21 days before this tumor inoculation. For vaccination experiments, Renca tumor-bearing (8 to 10 mm) mice were injected subcutaneously weekly for 3 weeks with inactivated wild-type Renca cells, or either one or a combination of Renca-GM-CSF and Renca-IL-6. A nonvaccinated control was included in all experiments. The animals were monitored for survival and tumor development for 8 weeks. Mice inoculated with wild-type Renca alone died from the tumor within 35 days. Renca-IL-6 grew slower than wild-type Renca (p < 0.05). No tumor was produced by Renca-GM-CSF. Prevaccination with the combination of Renca-GM-CSF and Renca-IL-6 prevented subsequently inoculated wild-type Renca from forming tumors, and prevaccination with either one of them, compared with prevaccination with wild-type Renca, retarded tumor growth and prolonged survival time. Tumor-bearing mice vaccinated with wild-type Renca died within 42 days. Vaccination with Renca-GM-CSF or Renca-IL-6 alone prolonged the survival time, but only Renca-GM-CSF drastically reduced the tumor size. Vaccination with the combination of them achieved complete remission. Neither of the cytokine-secreting cells enhanced the expression of MHC class I or II molecules. Autologous tumor cell vaccine secreting GM-CSF is effective in preventing and treating established tumors. Its efficacy is enhanced by the cosecretion of IL-6.

Murine animal model.

Experimental animal models are available for the development of new treatment. Murine animal models have particular advantages for comparative study to evaluate the efficacy and safety of different treatment modalities because many mice can be treated at the same time with easy handling. Among several experimental models, murine renal carcinoma (Renca), which arises spontaneously in Balb/c mice, is the most frequently used for the assessment of chemotherapy, immunotherapy, and radiotherapy. Renca cells readily establish tumors in isogenic mice, producing histologically proven adenocarcinoma with a predictable growth rate to mimic the clinical situation for orthotopic growth and metastasis in a reasonable time frame. Because of its poor immunogenicity and its responsiveness to immunotherapy, the number of studies using cytokine gene-modified tumor vaccines-such as interferon-alpha or interleukin-2-in the Renca system is growing. Therefore, Renca experiments greatly contribute to the analysis of the mechanisms of antitumor immune response. In this chapter, we describe several experimental systems using this Renca model.

Epidemiology and molecular biology of early prostatic neoplasia.

This paper provides our institutional data with respect to the prevalence of early neoplastic changes within the prostate gland and the age and race distribution of the patients. The changes examined were prostatic intraepithelial neoplasia (PIN) and preclinical (latent) cancers. The literature on the prevalence of these early lesions among different geographic and ethnic groups is summarized, and an abbreviated review of the more common molecular alterations reported at this early phase of prostatic neoplasia is offered.

Carcinogenicity of the N-hydroxy derivative of 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine, 2-amino-3, 8-dimethyl-imidazo[4,5-f]quinoxaline and 3, 2'-dimethyl-4-aminobiphenyl in the rat.

Heterocyclic amines and carcinogenic aromatic amines are similarly metabolically activated suggesting that they may have similar organ specificity. Three day-old male ACI/seg rats were injected, i.p., twice a week for 10 weeks with 50 micromol/kg of N-hydroxy-3, 2'-dimethyl-4-aminobiphenyl (N-OH-DMABP; Group II), N-OH-2-amino-3, 8-dimethylimidazo[4,5-f]quinoxaline (N-OH-MeIQx; Group III) or N-OH-2-amino-1-methyl-6-phenylimidaza-[4,5-b]pyridine (N-OH-PhIP; Group IV). Animals in control group (Group I) were similarly injected with solvent alone. The animals were sacrificed at age 68 weeks, and 31, 30, 27 and 31 rats from Groups I, II, III and IV, respectively, were evaluated. Colon carcinomas were found in 0, 15 (P<0.001), 2 and 4 (P<0.06), and bladder transitional cell tumors in zero, two, two and four (P<0.06), in Group I, II, III and IV, respectively. The incidence of atypical hyperplasia of ventral prostate in Groups III and IV, and of anterior prostate and seminal vesicle in all treated groups was also significantly greater (P<0.05). These results suggest that N-OH-PhIP and N-OH-MeIQx may be potential carcinogens for the prostate. Since bladder tumor is rare in ACI rats, N-OH-PhIP may also be a potential carcinogen for the bladder.

Inhibition of lung metastases of murine renal cell carcinoma by the combination of radiation and interferon-alpha-producing tumor cell vaccine.

We have previously demonstrated in a murine lung metastasis model that local sublethal radiation of tumors can synergistically enhance their sensitivity to immunotherapy with either systemic high-dose interleukin-2 (IL-2) or vaccination with autologous tumor cells expressing IL-2, interferon (IFN)-gamma and granulocyte-macrophage colony-stimulating factor (GM-CSF). Host antitumor activity was mediated in large part by natural killer cells, which can be activated by IFN-alpha. In the present study, we used this lung metastasis model to investigate the efficacy of combined therapy with local tumor radiation and vaccination with IFN-alpha-secreting tumor cells (Renca/IFN-alpha). The in vitro and in vivo growth rates of Renca/IFN-alpha cells were significantly reduced relative to normal controls. Subcutaneous vaccination with Renca/IFN-alpha or selective X-irradiation of the left lung (300 rad) reduced the number of lung tumors by 40% and 27%, respectively. The combination of lung irradiation plus vaccination reduced the number of lung metastases by 60%, and the net tumor volume by 95%. The reductions in tumor volume in both irradiated and non-irradiated lungs were comparable. These results indicate that host antitumor response to subcutaneous vaccination with Renca/IFN-alpha was systemic, and was significantly enhanced by radiation of tumor-bearing lungs. A regimen based on enhancement of IFN-alpha immunotherapy by local tumor radiation may be useful in the treatment of metastatic renal cell carcinoma.

Immunotherapy for lung metastases of murine renal cell carcinoma: synergy between radiation and cytokine-producing tumor vaccines.

We investigated the combination therapy of local radiation of lung metastasis and vaccination with autologous tumor cells that produced interleukin (IL)-2, interferon-gamma (IFN-gamma), and granulocyte-macrophage colony-stimulating factor (GM-CSF) using the mouse Renca pulmonary metastasis model. Wild-type Renca (W/Renca) were transfected with pEF-BOS vector incorporating cDNAs for IL-2, IFN-gamma, or GM-CSF to express these cytokines. W/Renca, IL-2-producing Renca (Renca/IL-2), and IFN-gamma-producing Renca (Renca/IFN-gamma) produced subcutaneous tumor at the injection site in eight of eight, one of eight, and two of eight mice, respectively. No tumors were found in the GM-CSF-producing Renca (Renca/GM-CSF) group (zero of eight). Renca/IFN-gamma produced subcutaneous (s.c.) tumors in all Balb/c nude mice, but Renca/IL-2 and Renca/GM-CSF did not. To test the elicitation of antitumor activity, Balb/c mice were injected intravenously with 1 x 10(5) W/Renca on day 0, vaccinated, s.c., with 1 x 10(6) cells each of 5,000 rad preirradiated Renca/IL-2, Renca/IFN-gamma, and Renca/GM-CSF or 3 x 10(6) cells of preirradiated W/Renca on days 1, 7, and 14, and radiated with 300 rad to both lungs on day 5. The animals were killed on day 21 and tumor nodules in the lungs were enumerated. Neither local irradiation alone nor the combination of lung radiation and multiple vaccination with irradiated W/Renca significantly reduced the number of lung tumors. In contrast, the combination of lung radiation and the multiple vaccinations with cytokine-producing Renca cells significantly reduced the number of lung tumors. This regimen was more effective than the multiple vaccinations with cytokine-producing Renca cells alone. These studies demonstrate the efficacy of vaccination with autologous tumor cells expressing these cytokines and sensitization of the tumor target with radiation.

N-Acetyltransferase expression and DNA binding of N-hydroxyheterocyclic amines in human prostate epithelium.

Intact prostate epithelial cells prepared from benign prostatic hypertrophy tissues from two patients were incubated for 2 h with N-hydroxy derivatives of 2-amino-1-methyl-6-phenylimidazo[4, 5-b]pyridine (N-OH-PhIP) or 2-amino-3,8-dimethylimidazo[4, 5-f]quinoxaline (N-OH-MeIQx). (32)P-post-labeling analysis detected PhIP and MeIQx adducts in the DNA of these cells but not in the untreated control. Adduct levels were approximately 100 times greater in N-OH-PhIP- than in N-OH-MeIQx-treated cells. Repair synthesis of DNA was observed in cells, prepared from two additional patients, treated for 24 h with these carcinogens and was greater for N-OH-PhIP than for N-OH-MeIQx. PhIP, MeIQx and their nitro derivatives did not produce repair synthesis of DNA in this system. The difference in the activity of N-OH-PhIP and N-OH-MeIQx may be due to their stability, since N-OH-MeIQx decomposed rapidly in neutral solution. Transcripts of NAT1 and NAT2 were detected by an in situ hybridization method in prostate epithelial cells, but were absent from stromal tissues. These results suggest that PhIP may be a potential carcinogen for human prostate, since cooked meats, which contain this heterocyclic amine, have been associated with human prostate cancer.

Cisplatin, methotrexate and bleomycin for the treatment of carcinoma of the penis: a Southwest Oncology Group study.

PURPOSE: We ascertained whether combined cisplatin, methotrexate and bleomycin have efficacy for treating locally advanced or metastatic carcinoma of the penis, and evaluate the toxicity resulting from this regimen. MATERIALS AND METHODS: Patients had biopsy proved locally advanced or metastatic epidermoid carcinoma of the penis. Chemotherapy consisted of 75 mg./m.2 cisplatin infused intravenously on day 1, 25 mg./m.2 intravenous bolus of methotrexate on days 1 and 8, and 10 unit per m.2 intravenous bolus of bleomycin on days 1 and 8 with a cycle length of 21 days. Our study was performed as a standard phase II evaluation with 2 stages of accrual. RESULTS: Enrolled in this study were 45 patients, including 40 who were evaluable for a response. There were 5 complete and 8 partial responses for a 32.5% response rate. Five treatment related deaths occurred and 6 of the 36 remaining patients evaluable for toxicity had 1 or more life threatening toxic episodes. CONCLUSIONS: A regimen of cisplatin, methotrexate and bleomycin appears to have promising results. However, toxicity was prodigious, and an emphasis of future research should be to decrease toxicity.

Prostatic intraepithelial neoplasia and apoptosis in benign prostatic hyperplasia before and after the Chernobyl accident in Ukraine.

The prevalence of prostatic intraepithelial neoplasia (PIN) in men who underwent surgery for benign prostatic hyperplasia (BPH) before and after the Chernobyl nuclear accident was studied. BPH samples were obtained by adenomectomy from 45 patients operated in 1984 before the accident (Group I), and 47 patients from the low contaminated Kiev City (Group II) and 76 from high contaminated area (Group III) operated between 1996 and 1998. Their BPH samples were examined histologically and immunohistochemically. The incidences of prostatic intraepithelial neoplasia (PIN) and high grade PIN (HGPIN) were 15.5 and 11.1% in Group I, 29.8 and 14.9% in Grpoup II, and 35. 5 and 19.7% in Group III. The difference between the incidences of PIN in Group I and III is significant (p<0.02). There was increased apoptosis in areas of PIN in Group II and III as compared to Group I (p<0.001). Since apoptosis has been shown to be associated with ionizing radiation and it is now found to be associated with PIN in patients diagnosed after the Chernobyl nuclear accident, this suggests that long-term low dose internal ionizing radiation potentially may cause prostate cancer.

Epithelial proliferation and expression of the aromatic amine activation enzyme N-acetyltransferase in the prostate of postnatal rat.

Male ACI/seg rats of different postnatal ages were injected, i.p., with 150 mg/kg bromodeoxyuridine one hour before being sacrificed. The incorporation of this compound into the DNA of prostate epithelium was detected immunohistochemically. The labeling indices in prostate epithelium were 16.8, 26.5 and 13.7%, in 3, 11 and 17 days old rats, respectively. It decreased gradually thereafter to 1.8% in 60 days old rats. The mRNA of N-acetyltransferase 1 was detected by a non-isotopic in situ hybridization method using a mixture of specific digoxigenin-11-dUTP-labeled oligodeoxynucleotide probes. The mRNA of N-acetyltransferase 1 was detected during the entire postnatal period. It was not detected in the stromal or endothelial cells. The coincidence of N-acetyltransferase expression in actively proliferating prostate epithelial cells during the postnatal period suggest that the prostate tissue may be particularly sensitive during this period to the carcinogenesis by aromatic and heterocyclic amines.

Expression of p53 and pRb in bladder and prostate cancers of patients having both cancers.

Evidence has been presented that tumor suppressor genes p53 and Rb play a crucial role in the development of both human prostate and bladder cancer. Patients with either cancer are at an increased risk for developing the other malignancy as compared to the general population. The purpose of the present study was to investigate whether there is abnormal expression of these two suppressor proteins in both the bladder and prostate cancers of the same patient. The expression of p53 and pRb in bladder and prostate cancer specimens obtained from 15 patients having both cancers was studied using immunohistochemical staining with antibodies against these proteins. The expression of p53 and pRb in both bladder and prostate cancers of the same patient was congruent in 8 of 15 cases (53%) for p53 and 9 of 15 cases (60%) for pRb. The significance of these findings warrants further investigations.

Pathology of premalignant lesions and carcinoma of the prostate in African-American men.

The objective of this study was to summarize data describing the morphological characteristics of the spectrum of prostatic neoplasia in African-American men and compare them to their equivalents in Caucasian men. Studies that have emphasized the documentation of pathological features of prostate cancer or its putative precursors in African Americans are reviewed and are contrasted with comparable data concerning Caucasians. The author's experience is also presented. There is significant overlap between the pathological features of prostate cancer in African Americans and Caucasians in their clinical associations. The main pathological parameter reported with consistency to differ between the two groups is the observation that African-American patients present with a more advanced stage of the disease compared with Caucasian patients. Reports on differences in the grade and volume of the disease are less consistent. Comparative data on "preclinical," autopsy-type cancers and those concerning premalignant lesions indicate a similar prevalence of autopsy cancers between the two races while the prevalence and extent of high-grade prostatic intraepithelial neoplasia is higher in African-American men compared with Caucasian men. The difference is more evident in younger individuals. In conclusion, there are indications that African-American men with clinically localized prostate cancer tend to have a more advanced pathological stage at the time of radical prostatectomy compared with Caucasian men. Our data also indicate a higher prevalence of a putative precursor for clinically evident prostate cancer, high-grade prostatic intraepithelial neoplasia in African-American men. The earlier onset and extensiveness of this lesion may contribute to the higher incidence of clinically evident prostate cancer in African Americans.

Phase II trial of sequential radiation and interleukin 2 in the treatment of patients with metastatic renal cell carcinoma.

We have previously demonstrated that local tumor irradiation effectively enhanced the therapeutic effect of interleukin 2 (IL-2) therapy in an experimental murine renal adenocarcinoma model. Based on these preclinical studies, we have designed and initiated a Phase II trial of irradiation combined with IL-2 for the treatment of metastatic renal cell carcinoma. Patients received 800 cGy to the primary or metastatic lesions on days 1 and 15 followed by IL-2 (600,000 IU/kg i.v.) every 8 h on days 4-8 and 18-22. Sixteen patients were entered; all completed treatment and are therefore evaluable for toxicity and response. Two partial remissions were seen for a response rate of 12.5% (95% confidence interval, 0-28.7). There was no increase in toxicity over that which is anticipated from IL-2 alone. The antitumor activity seen in this trial is consistent with what would be expected from high-dose IL-2 alone.

Cirsoid arteriovenous malformation of kidney presenting as a mass suggestive of malignancy.

This paper reports a rare case of cirsoid renal arteriovenous malformation (AVM) that showed radiological characteristics of a renal malignancy. Using only conventional procedures such as computerized tomography, the present case was misdiagnosed as a solid tumor mass and therefore radical nephrectomy was indicated. Angiographic analysis is expected to improve the accuracy of diagnosis of AVM, thus reducing the need to resort to invasive techniques.

Clinicopathologic and interphase cytogenetic analysis of papillary (chromophilic) renal cell carcinoma.

Trisomy 7 and 17 with deletion of Y is typical of papillary renal cell adenoma (PRCA), and additional alterations occur in the putative genetic progression toward papillary renal cell carcinoma (PRCC). Our study correlated aneuploidy with clinicopathologic features in PRCCs. We used fluorescence in situ hybridization to assess copy number for chromosomes 7, 8, 10, 12, 16, 17, and Y in 16 PRCCs and surrounding benign tubular parenchyma from 15 patients by use of alpha satellite (centromere) probes on deparaffinized tissue sections. We then compared the pattern of monosomy/nullisomy or trisomy/polysomy/hemidisomy to clinicopathologic parameters. Nine tumors (58% Group 1) showed the numeric aberrations typical of PRCAs and PRCCs, with gains of 7 and 17 and loss of Y. We also identified four trisomies of 12 and 16 and one of 8 in Group 1. The remaining seven cases (Group 2) were cytogenetically atypical. Two displayed borderline loss of chromosome 7, although trisomy 17 was present in both. Five had trisomy 7, but none exhibited chromosome 17 alterations, and two exhibited a gain of Y. Neoplasms in Group 2 were less often multicentric than were Group 1 tumors, and they contained foamy macrophage infiltrates less often. One chromophilic carcinoma with abundant clear cells and another with oncocytic features exhibited Group 2 chromosomal profiles. One patient (nuclear grade 4) died from disease, and 14 had no evidence of carcinoma at the last follow-up. We concluded that PRCCs represent a histologically and genotypically heterogeneous group of tumors. If PRCAs consistently exhibit +7, +17, and -Y, it is uncertain whether PRCCs always evolve directly from such lesions. The presence of genotypic heterogeneity might reflect histologic variants of PRCCs, which overlap with other types of RCC. PRCC is generally an indolent neoplasm, despite a high frequency of chromosomal aneuploidy.

Epidemiology of prostate cancer.

Malignant transformation of the prostate and progression of carcinoma appear to be the consequence of a complex series of initiation and promotional events under genetic and environmental influences. Increased incidence of the condition may be the result of improved detection, greater awareness of the condition, and possibly an increased life expectancy accompanied by a decrease in competing causes of death rather than a true increase in the prevalence of the disease. The marked racial and geographic differences are probably multifactorial, with genetic, environmental, and possibly social influences affecting progression of the disease. Among several risk factors, evidence for the familial inheritance of some prostate cancers is compelling. Dietary influences, hormonal milieu, and the role of environmental carcinogens are currently under intense investigation. As further risk factors are identified, it will become increasingly important to identify individuals at increased risk for the disease. These men should undergo regular evaluation with state-of-the-art methods.