Renal cell carcinoma in New Zealand: a national survival study.

OBJECTIVE: To determine clinical and pathologic prognostic factors for renal cell carcinoma (RCC) using cases reported to a population-based cancer registry. METHODS: All cases of RCC reported to the New Zealand Cancer Registry between 1976 and 1986 were retrieved and data analyzed to determine parameters of prognostic importance. RESULTS: In eleven years, 1,308 cases of RCC (66.7% males and 33.3% females) were reported to the New Zealand Cancer Registry. The age-standardized incidence rate was 3.78 per 10(5) person-years and showed no significant trend over the period of the study. There was a significant difference in the age at presentation between the largest racial groups (Maori 52.2 years; non-Maori 63.2 years), which is accounted for by increased predisposing risk factors among Maori. The five-year actuarial survival rate was 42.4 percent with 63 percent of patients reported dead in follow-up to December 1990. In the series, patient gender (female > male), tumor laterality (right > left), stage (intrarenal > localized > disseminated), grade (1 > 2 > 3 > 4), and treatment modality (surgery > nonsurgery) were found to be significant prognostic factors, although only tumor stage and treatment modality were of independent significance. Tumor laterality was of prognostic significance for Stage II (localized) surgically treated tumors only. CONCLUSIONS: The results of the study emphasize the paramount importance of tumor stage as a prognostic parameter for RCC. The prognostic significance of laterality for localized, surgically treated tumors suggests that radical nephrectomy is less likely to result in tumor clearance for left-sided RCC than for tumors on the right side.

Giant sclerosing leiomyoma of bladder presenting as chronic renal failure.

The clinical and pathologic features of a case of giant sclerosing leiomyoma of the bladder in a male Polynesian patient are reported. The presenting complication of chronic renal failure due to tumor envelopment of both ureters and consequent bilateral renal obstruction appears to be unique in the literature.

Analysis of the prevalence of voiding symptoms in Maori, Pacific Island, and Caucasian New Zealand men.

OBJECTIVES: Data from a community-based sample of 515 men were used to assess the prevalence and presentation of voiding symptoms in Caucasian, Maori, and Pacific Island men in the city of Porirua, New Zealand. METHODS: A random sample, stratified by age groups of 10 years, was obtained for men 40 years and older. Two hundred men were entered into each 10-year age stratum. Frequency of symptoms and quality of life were measured using the International Prostate Symptom Score (IPSS) questionnaire. Bothersomeness of symptoms was assessed using questions from the American Urological Association symptom bother index. Data were analyzed according to age and ethnic group with differences between groups measured by analysis of variance. RESULTS: Symptom score was found to increase with increasing age of subjects, with men in the 40 to 49 years age group recording a mean score (+/- SE) of 2.9 +/- 0.3, increasing to a mean score of 4.8 +/- 0.4 for men aged 50 to 59 years, 7.4 +/- 0.9 for men aged 60 to 69 years, and 7.4 +/- 0.9 for men in the 70 year and older age group. Significant symptoms, represented by a symptom score of 8 or greater, were found in 12.9% of men aged 40 to 49 years, 22.3% of men aged 50 to 59 years, 33.7% of men aged 60 to 69 years, and 33.3% in the 70 year and older age group. No difference was demonstrated in the prevalence of symptoms between Caucasian, Maori, and Pacific Island men. CONCLUSIONS: Despite having a similar prevalence of voiding symptoms to Caucasian men, few Maori or Pacific Island men seek help for their urinary symptoms. The level of understanding of the underlying disease process is poor for men of all ethnic backgrounds and emphasizes the important need for greater public awareness and education with respect to prostate disease.

Testicular germ cell tumor with pineal metastases.

A patient with a mixed testicular germ cell tumor (choriocarcinoma, teratocarcinoma and embryonal carcinoma) that had metastasized to the lungs, cerebrum, and pineal gland is presented. The metastases had resulted in localized neurological signs and initially, on clinical grounds, a primary intracranial lesion could not be excluded. The occurrence of tumor metastases to the pineal gland is discussed and the literature is reviewed.

Sarcomatoid carcinoma of the prostate: progression from adenocarcinoma is associated with p53 over-expression.

BACKGROUND: The pathogenesis of sarcomatoid metaplasia of prostatic adenocarcinoma is uncertain. The histologic features of sarcomatoid carcinoma arising in two patients with previously irradiated prostatic adenocarcinoma are reported and the relationship between prostatic adenocarcinoma and subsequent sarcomatoid carcinoma is investigated by immunohistochemical detection of epithelial and soft tissue tumor markers, and p53 protein. METHODS AND RESULTS: Two patients, aged 72 and 67 years, underwent localized radiotherapy for prostatic adenocarcinoma and re-presented with sarcomatoid carcinoma 41 months and 60 months later, respectively. In both cases the tumor consisted of anaplastic spindle cells with occasional osteoclast-like giant cells. The initial tumors showed immunohistochemical staining typical of prostatic adenocarcinoma with absence of expression of p53 protein. The subsequent sarcomatoid carcinomas were positive for vimentin and negative for epithelial cell markers. In both cases serial biopsies showed a temporal increase in tumor expression of p53 protein. CONCLUSIONS: The development of sarcomatoid carcinoma in prostatic adenocarcinoma is associated with progressive accumulation of p53. This is suggestive of increasing clonal dominance of dedifferentiated tumor cells carrying p53 mutations.

Renal cell carcinoma. II. Histological indicators of prognosis.

Tissue obtained from 102 renal tumours presenting over a 21-year period was reviewed in an attempt to identify histological features of prognostic importance. Statistical analysis showed the grade of nuclear pleomorphism to have a significant bearing on survival. Application of the proportional hazard model, and using the grade of nuclear pleomorphism as a baseline index, showed mitotic rate, pseudocapsule thickness and the presence of sarcomatoid tumour cells to have an independent association with survival. The presence of tumour cells with granular cytoplasm was correlated with outcome; however, this parameter was not independent of grade of nuclear pleomorphism. Tumour pattern, intensity of lymphocytic infiltrate, degree of fibrosis, necrosis and hemorrhage, and amount of haemosiderin and dystrophic calcification were found to have no association with survival.

Renal cell carcinoma: I. Clinical indicators of prognosis.

A retrospective analysis was carried out on 162 patients presenting to Wellington Hospital with renal cell carcinoma between 1958 and 1978, to evaluate factors that may influence prognosis. Following radical nephrectomy the five year survival was 70% for stages 1 and 2, 53% for stage 3A and 13% for stages 3B and 3C. No patient with distant metastases survived this period. Those with renal vein or caval involvement had a significantly worse prognosis than those with stage 1 or 2 disease, and a significantly better survival than those with nodal spread. Once the tumour stage had been assigned as a baseline the influence of clinical, haematological and biochemical variables on the prognosis was analysed using a proportional hazard model. The only factor showing a significant independent association with survival was the presentation of the renal cancer as an incidental finding (p less than 0.01). The presence of anaemia or a low peripheral lymphocyte count may be independently associated with survival (p = 0.02, 0.08 respectively). Weight loss, symptoms length, the ESR, abnormality of liver function and tumour size, although associated when considered alone, do not have an independent association and therefore offer little added prognostic information. The age and sex of the patient were not related to survival.

The value of early diagnosis in the treatment of patients with testicular cancer.

A study of 79 patients treated at Wellington Hospital for testicular cancer showed that those presenting with a short history (time from tumour recognition to surgery) had no better prognosis than those with a longer history (chi 2 = 1.857, p = 0.173). Tumour size was significantly related to this time interval such that those patients with a short history were more likely to have smaller tumours (rp = 0.651, p = 0.001). The data suggests that testicular tumours are currently being recognised too late in their development to allow any improvement in survival to be gained from reducing the interval from recognition to treatment. However, earlier recognition of the tumour by the patient may allow diagnosis and treatment in an earlier stage. The advantages of diagnosis in early stage disease are substantial and the need for a public education programme involving testicular self examination to allow early diagnosis is discussed.

The efficacy of serum prostate specific antigen as a tumour marker in prostatic carcinoma: a comparison with serum acid phosphatase.

AIMS: To assess the efficacy of serum prostate specific antigen (PSA) in the diagnosis of prostatic cancer. To compare this tumour marker with serum acid phosphatase (ACP) in order to define the more effective diagnostic test. METHODS: Serum samples from 349 patients attending a urology department were assayed for PSA and ACP. Histological assessment of prostatic biopsy samples was used as the standard by which the diagnostic effectiveness of the tumour markers was determined. RESULTS: Mean serum PSA results from patients with prostatic carcinoma (159 (SEM 35) ng/mL) were significantly different to those from patients with benign prostatic hyperplasia (4.0 (0.53) ng/mL). As there was considerable overlap of results, test sensitivities and specificities were calculated for various decision points. The sensitivity and specificity of PSA at a level of 10 ng/mL were 61.2% and 93.0% respectively, while for ACP at a level of 0.8 U/L they were 47.6% and 89.9%. The areas beneath receiver-operator curves (0.81 for PSA and 0.72 for ACP) indicated that PSA gives better diagnostic information than ACP. For a stated incidence of cancer, posttest probabilities following a given PSA result have been calculated. CONCLUSIONS: PSA is a more effective serum marker for prostatic carcinoma than ACP. We present a table so that for similar patient groups posttest probabilities for prostatic cancer can be assessed for a given serum PSA level.

Wilms' tumour: a 30 year experience at Wellington Hospital.

Over the 30 year period from 1958-88, 20 cases of Wilms' tumour have been treated at Wellington Hospital. All eight patients presenting prior to 1976 have died. The 12 patients presenting after 1976 were treated according to the guidelines of the National Wilms' Tumour Study Group and ten of these are alive (mean follow up seven years). Four of the patients received preoperative chemotherapy and this was found to facilitate surgical removal of the tumour. The concept of partial nephrectomy in the management of Wilms' tumour is discussed. Retrospective analysis of this series has shown that this would have been a feasible management option in four of the cases reviewed.

Radical radiotherapy for carcinoma of the prostate: localized and extended field treatment.

From 1972 to 1981, 50 patients who received radical radiotherapy for clinically localized adenocarcinoma of the prostate have been reviewed. Of these 50 patients, 70% showed some degree of reaction to the radiotherapy in the form of minor, transient urinary or bowel symptoms. Significant complications occurred in 20%, the most common of which was proctitis. There was no apparent relation of complication rate to the extent of the radiation field. The overall corrected 5 year survival was 74%.

Foley catheter balloon puncture and the risk of free fragment formation.

The incidence of free fragment formation following balloon puncture or spontaneous bursting was examined in 294 Foley catheters immersed for 48 h in urine. The catheters were divided into 3 groups: 100 were inflated to the manufacturer's recommended volume, 100 to twice the volume and 94 to 3 times the recommended volume. The catheter balloons were punctured by pricking with a hypodermic needle. The overall incidence of free fragment formation was 27.3%. For both types of catheter examined, increasing balloon volume was not associated with an increased risk of free fragment formation following puncture. However, increasing volume was associated with increased free fragment formation when the balloon burst spontaneously. In view of the high risk of free fragment formation, cystoscopy should be performed in all cases of spontaneous catheter balloon rupture or after percutaneous balloon puncture.

Toxicity study of first and second generation hydrogel-coated latex urinary catheters.

The hydrogel-coated urinary catheter is a novel formulation in which the coating hydrogel polymer is claimed to reduce the level of cytotoxicity frequently associated with the use of latex catheters. This study was undertaken to measure cytotoxicity using in vivo techniques. Twelve first generation and 5 second generation hydrogel-coated latex catheters were evaluated in vivo using canine urethras. The results showed all catheters to cause minimal inflammatory changes of the urethral mucosa (toxicity score 0-1.2/6).

Orchiectomy and delayed radiotherapy as treatment for prostatic carcinoma. A 10-year survey.

One hundred and fifty patients with carcinoma of the prostate treated between 1967 and 1982 have been reviewed. Thirty-three patients were treated with stilboestrol alone, 36 by orchiectomy alone and in 81 cases radical radiotherapy was given to the prostate (and in 10 of the 81 cases to the regional and para-aortic lymph nodes) 5 or 6 months after orchiectomy. Although there was no significant difference between the results of those treated by stilboestrol alone and those treated by orchiectomy alone, in those patients receiving orchiectomy and delayed radiotherapy there was a significant improvement in survival. If patients with Stage D disease are excluded, this is a highly significant difference and indeed the survival in these patients does not differ significantly from the expected survival at this age. The 5-year survival rate of Stage D patients treated by this method was 35%.

Catheter-induced urethritis: a comparison between latex and silicone catheters in a prospective clinical trial.

A controlled randomised prospective study has been carried out on 100 male patients to compare the incidence of urethritis following catheterisation with either latex or silicone catheters. All patients underwent elective cardiac surgery and were catheterised for 48 h with antibiotic cover, and were followed up for 6 months post-operatively. Of those with latex catheters 22% developed urethritis, compared with 2% of those in the silicone catheter group. This difference is statistically significant (P less than 0.01). Two of the former patients developed a decreased urinary flow and both had tight anterior urethral strictures.