[Prostate biopsy: Procedure in the clinical routine]. / Prostatabiopsie : Durchführung im klinischen Alltag.

Over the last decade there has been a 25% decrease in the mortality rates for prostate cancer. The reasons for this significant decrease are most likely associated with the application of urological screening tests. The main tools for early detection are currently increased public awareness of the disease, prostate-specific antigen (PSA) tests and transrectal ultrasound (TRUS) guided topographically assignable biopsy sampling. Together with the histopathological results these features provide essential information for risk stratification, diagnostics and therapy decisions. The evolution of prostate biopsy techniques as well as the use of PSA testing has led to an increased identification of asymptomatic men, where further clarification is necessary. Significant efforts and increased clinical research focus on determining the appropriate indications for a prostate biopsy and the optimal technique to achieve better detection rates. The most widely used imaging modality for the prostate is TRUS; however, there are no clearly defined standards for the clinical approach for each individual biopsy procedure, dealing with continuous technical optimization and in particular the developments in imaging. In this review the current principles, techniques, new approaches and instrumentation of prostate biopsy imaging control are presented within the framework of the structured educational approach.

[High dosage brachytherapy and external irradiation of localized prostate carcinoma--results at the Kiel University Clinic]. / High-dose-rate Brachytherapie und externe Bestrahlung beim lokalisierten Prostatakarzinom--Ergebnisse der Kieler Universitätsklinik.

To evaluate a new therapy protocol for local dose escalation by high dose rate (HDR) brachytherapy for survival, morbidity and prognostic variables in men with localized prostate cancer. The prospectively recorded files of 189 men aged in median 69 years with a mean follow-up of 6 years (12-143 months) receiving curatively intended combined high dose rate (HDR) 192-iridium-brachytherapy (BT) and external beam radiation (EBR) for locally confined prostate cancer were analyzed. Mean age was 68.2 (range 44-84 years). Hundred and twenty-seven patients had T1-2 tumors, and 62 patients had T3-tumors. The total planned dose applied by external beam radiation was 50 Gy in the pelvis, and 40 Gy in the prostate by in-field-dose modification. The HDR-brachytherapy was delivered in two fractions. The dose per fraction amounted 15 Gy. Mean survival was 6 years (range 12-143 months), 76.7% of the patients survived and 86.3% were disease-free. The biochemical non-evidence of disease rate (BNED) was 78%. Univariate survival analysis revealed that low stage (T1-2), low grade (G1-2), normal PSA status after radiation therapy, and no adjuvant hormonal treatment were associated with long survival. However, the stratification for adjuvant hormonal treatment was not according to random. In multivariate analyses PSA status was an independent prognostic factor. The six year results confirm that local dose escalation by HDR-brachytherapy and external beam radiation is curative in men with locally confined prostate cancer. The results are especially in high risk patients encouraging.

Prostate preservation by combined external beam and HDR brachytherapy in nodal negative prostate cancer.

PURPOSE: The combined external beam- and high-dose rate brachytherapy (HDR-BT) of localized prostate cancer was introduced at Kiel University in 1986. The aim of this intermediate analysis was to judge the Kiel method of localized prostate cancer radiation treatment after ten years experience. PATIENTS AND METHODS: In the past ten years 174 patients with histological proven localized prostate cancer were subjected to combined tele-/HDR-brachytherapy. Local staging in all of the cases by transrectal ultrasound, nodal staging in the majority of the cases by CT or MRI. Average age of the patients was 68.2 years (44-84). According to AJCC/UICC staging T1B, T2, T3 was found in 2, 113 and 59 cases, respectively. Highly differentiated tumors (G1) were found in 27, moderately differentiated (G2) in 87, poorly differentiated (G3) in 60 cases. The mean follow-up was 47.1 months with the median of 51.7 months. Total prescribed dose 50 Gy on the small pelvis and 70 Gy on the prostate capsule due to the integration of two, 15 Gy each, HDR-brachytherapy fractions in 6 weeks. RESULTS: Ten patients died of prostate cancer and 18 of intercurrent diseases resulting in a 5 years overall survival rate of 83% and tumor specific survival rate of 94%. Twenty-one patients showed a clinical progression, of these 14 systemic, 5 local and 2 both systemic and local. Additional 16 patients had PSA elevation only. The 5-years biochemical and/or clinical progression-free survival in the cohort was 79% and 73% for the T3 tumors. Side effects were 27 cases of proctitis/colitis and 20 cases of dysuria/cystitis. CONCLUSION: The integrated HDR-BT combined with external beam radiation treatment is a method with excellent tumor control rates at five years superior to those of external beam treatment alone or external beam combined with iodine-125 implants. This form of radiotherapy would appear to be particularly well-suited to treatment of advanced localized (T3) tumors.

[NAG (N-acetyl-beta-D-glucosaminidase)--a sensitive marker for disorders of kidney function]. / NAG--Ein sensitiver Marker für Nierenfunktionsstörungen.

In a clinical study we tested the use of the lysosomal enzyme NAG as a parameter of kidney function. Following prospective randomization, we examined NAG excretion during cisplatin treatment with/without nephroprotection, after intravenous urography with ionic/non-ionic contrast media, during lower/upper urinary tract infections and before/after extracorporeal shockwave lithotripsy for intrarenal calculi (first-generation equipment used). Measurements were performed in 3-h urine specimens and in urine collected over 24 h, using a simple method of analysis. A correlation between NAG leakage and functional disorder of the renal tubular cells seemed likely on the basis of additional clinical and experimental data. Increases, in some cases dramatic, in NAG excretion were observed after the administration of cisplatin and ionic contrast media, in acute pyelonephritis, and after extracorporeal shockwave lithotripsy. However, the increase in NAG excretion was less impressive during cisplatin therapy when nephroprotective amino acids were infused, and in the urography group when non-ionic contrast media were used. Infections of the lower urinary tract did not increase NAG excretion. The results indicate that NAG is a sensitive marker of occult renal dysfunction, which can be checked by non-invasive techniques and can be used in a clinic setting to detect functional disorders of the kidney.

Ultrasound examination of bladder and prostate.

Transabdominal (suprapubic) sonography of the bladder and prostate is not limited to special indications but should be considered an integrated part of the urologic sonographic evaluation of the genitourinary tract. Information about many pathological conditions (e.g. residual urine, stone, tumor, diverticulum, enlarged prostate) is obtained without delay, without need of instrumentation or exposure to X-rays. Transurethral sonography has proven useful in the differentiation of superficial bladder tumors from deep infiltrating ones. Transvaginal or transrectal examination of the bladder neck has developed into a new modality for urodynamic examination. More than any other diagnostic modality, transrectal ultrasound of the prostate has become a valuable tool for the more correct detection and staging of prostatic carcinoma.

[Decapeptyl (D-Trp6-LH-RH) in the therapy of prostatic cancer with reference to the intramuscular administration of a depot preparation]. / Decapeptyl (D-Trp6-LH-RH) zur Therapie von Prostatakarzinomen unter Berücksichtigung eines intramuskulär applizierbaren Depotpräparates.

Thirteen patients with untreated prostate cancer were treated initially with subcutaneous 0.5 mg D-Trp6-LH-RH daily for the first week, 0.1 mg daily for the next three weeks and thereafter with intramuscular depot preparations of 3.2 mg every three weeks. Serum testosterone was suppressed to castration levels. Serum LH, FSH and prolactin were reduced, serum cortisol did not change. 10/13 patients showed remissions, as shown by transrectal prostate volumetry, cytological regression grading, serum phosphatases and clinical status. 3/13 tumors showing progression were undifferentiated and androgen-resistant. The investigated compound seems to be effective in selecting androgen sensitive tumors and may be a possible alternative to orchiectomy.

Value of intravesical sonography in tumor classification of bladder carcinoma.

The possibility of a T classification for bladder carcinoma by intravesical sonography was investigated in a 3-year field study (1982-1985) at the Urological Clinic, Bonn University. In a total of 571 patients with histologically verified bladder cancer, the sonographic classification was compared with the histological T category. There was an agreement of 70.1%. While the infiltration of superficial tumors (above all of large tumors) was frequently overestimated (28.7%), understaging predominated in invasive carcinomas (20.9%). The overall precision of conventional staging techniques was 67%. Ultrasonography showed a marked superiority, above all in infiltrative papillary tumors of low diameter (precision 76% compared to 12% with the conventional T classification). The sensitivity of the method with regard to the detection of tumor infiltration (90%) was also markedly higher than that of earlier techniques (66%). Particularly helpful in the evaluation of more deeply infiltrating tumors, intravesical sonography constitutes a major extension of the diagnostic spectrum for T classification of bladder carcinoma.

[Comparative study on clinical effectiveness of mecillinam and pivmecillinam versus ampicillin in acute urinary infections (author's transl)]. / Vergleich klinischer Wirksamkeit von Mecillinam und Pivmecillinam gegenüber Ampicillin bei Harnwegsinfekten.

30 outpatients suffering from acute urinary infections underwent oral treatment with pivaloyloxymethyl-(2S,5R,6R)-6-(perhydroazepin-1-ylmethylenamino)penicillinate (pivmecillinam) (n = 15) or ampicillin (n = 15) in a first study. In a second study 6-beta-(hexahydro-1H-azepin-1-yl)-methylenamino penicillanic acid (mecillinam) (n = 16) or ampicillin (n = 14) were applied i.v. to 30 patients with pretreated urinary infections. The tolerance of the drugs proved to be comparatively good in both studies. The clinical and antibacterial effectiveness were equally good in the first study. However, in the second study the effectiveness of mecillinam However, in the second study the effectiveness of mecillinam seemed to be comparatively inferior.

Conservation surgery of renal carcinoma: the EIRSS experience.

Seventy-two patients with renal carcinoma (RC) in a solitary kidney or bilateral synchronous tumours underwent parenchyma-sparing excision of their neoplasms. This was performed in situ in 51 and extracorporeally in 21 kidneys, with a complication rate respectively of 17 and 43%. The 5-year survival rates were 78% for unilateral disease, 48% for bilateral synchronous and 38% for bilateral asynchronous disease. Survival correlated with P category, grade and diameter of the tumour. Vascular invasion and spindle cells indicated a poor prognosis; the position of the tumour, oncocytic elements, calcification, lymphocytic infiltration or the predominance of clear cell or granular cells did not influence survival.

[Complications following ureteroneocystostomy without antireflux technique in the adult (author's transl)]. / Komplikationen nach direkter Ureterocystoneostomie (UCN) beim Erwachsenen.

65 adult patients subjected to direct uretero-vesical implantation without the use of a recognized antirefluxing technique were followed up to 9 years. Good results could be achieved in 90.8%, whereas failures were mainly due to radiation damage and malignant tumors. A postoperative stenosis was observed five times. Reflux was demonstrable in 7 cases, of which, however, only one was of pathologic significance.

Contribution of long chain fatty acids to the energy supply of the rat kidney cortex.

Tubular fragments from rat kidney cortex were isolated by collagenase and suspended in an incubation medium containing a combination of several renal substrates. Substrate concentrations were in the physiological range. O2 uptake, total CO2 production, and the 14CO2 production from U-14C-labeled palmitate and oleate were measured. During the first minutes of incubation the CO2 production from palmitate and oleate was 10.5% or 6.3%, respectively, of the total CO3 produced. The RQ was 0.897. A subsequent decrease of the total CO2 production at a constant uptake of oxygen indicated a rising contribution of fatty acids to the fuel of respiration. The renal preference for substrates other than longchain fatty acids is discussed.