The use of body mass index to predict pathological stage in patients with clinically localized prostate cancer.

BACKGROUND: To investigate whether body mass index (BMI) is an independent risk factor for nonorgan-confined disease in patients with clinically localized prostate cancer. PATIENTS AND METHODS: Overall, 735 patients undergoing radical prostatectomy formed the study cohort. Pathological and clinical factors with special emphasis to BMI were used to determine a model for the prediction of nonorgan-confined disease. RESULTS: 359 patients had pathologically nonorgan-confined prostate cancer. These patients showed a significantly higher BMI than those with organ-confined disease (26.7 vs. 26.2; p = 0.0012). In multivariate analysis, age (p = 0.049), prostate-specific antigen (PSA) (p < 0.001), clinical stage (p < 0.001), prostatectomy grade (p < 0.001), and BMI (p = 0.004) were independent risk factors for nonorgan-confined disease. In patients with a serum PSA between 10.1 and 20 ng/ml only prostatectomy grade (p < 0.001) and BMI (p = 0.005) remained independent predictors. CONCLUSION: Patients with nonorgan-confined disease showed a significantly higher BMI than those with organ-confined stages. Moreover, BMI was an independent predictor for nonorganconfined prostate cancer. This knowledge might be helpful in patient counseling to choose between various options for the treatment of clinically localized prostate cancer.

The impact of cigarette smoking on human semen parameters and hormones.

BACKGROUND: In this prospective study, semen parameters and hormone concentrations of infertile smokers were compared with infertile non- and ex-smokers. We also determined how many men with idiopathic infertility would stop smoking in an attempt to improve their fertility. METHODS: 1104 men (517 non-smokers, 109 ex-smokers and 478 smokers) with infertility for at least 1 year were evaluated. Evaluation included medical history, physical examination, hormone analysis and two semen analyses. Prior to the second semen analysis, smokers were urged to quit smoking. RESULTS: Smokers were significantly younger (P < 0.001), had significantly more round cells in their ejaculates (P = 0.003), and the percentage of ejaculates with > 1 x 10(6)/ml leukocytes was higher in smokers (P < 0.001). Increased free and total serum testosterone (P < 0.001) and decreased prolactin levels (P < 0.001) were found in smokers. No differences were found between non-smokers and ex-smokers. Only 23.1% of the smokers versus 46% non-smokers (P < 0.001) returned for a second semen analysis, 14 of whom reduced and 15 of whom quit smoking completely. Testosterone levels were significantly lower in those who were able to stop or reduce smoking (P < 0.001). CONCLUSIONS: Smoking does not affect conventional semen parameters, but significantly increases round cells and leukocytes. Only a few idiopathic infertile smokers were able to quit smoking.

Alterations in gap junction protein expression in human benign prostatic hyperplasia and prostate cancer.

PURPOSE: Gap junctions composed of connexin proteins have an essential role in intercellular communication and differentiation. Dysregulation of connexin expression is believed to have a role in carcinogenesis. The human prostate has been reported to express connexin 32 and 43. However, the expression pattern in prostate cancer is controversial, while to our knowledge connexin expression has not been reported in benign prostatic hyperplasia (BPH). To understand the potential involvement in prostate disease connexin 32 and 43 expression was evaluated in a series of normal prostate, BPH and prostate cancer specimens that were surgically removed due to bladder outlet obstruction. MATERIALS AND METHODS: Frozen sections of 23 normal, 43 BPH and 40 cancer involved prostates were evaluated for the presence, staining intensity and pattern of connexin 32 and 43 by immunocytochemical testing. RESULTS: In all specimens examined connexin 43 stain was punctate along the borders of the basal epithelial cells, whereas connexin 32 immunolocalized to luminal epithelial cells. In normal prostate connexin 43 and 32 were present in 87% and 65% of specimens, respectively, at low to moderate stain intensity. Importantly none of the normal samples were negative foreach connexin. In BPH specimens there was a marked increase in the incidence and intensity of connexin 43 and 32 immunostaining within epithelial cells. In addition, 23% of BPH samples showed strong connexin 43 expression in stromal cells. In contrast, connexin was decreased in prostate cancer specimens, of which 65% and 38% were negative for connexin 43 and 32, respectively, and 28% were negative for each type. In poorly differentiated tumors connexin 43 and 32 were present in only 10% and 40% of tumors, respectively, at low immunostaining intensity. CONCLUSIONS: In normal human prostate basal cells communicate via connexin 43 gap junctions, whereas luminal cells communicate via connexin 32 gap junctions. In BPH gap junctional intercellular communication is increased in epithelial and stromal cells, which may have a role in BPH pathogenesis. In prostate cancer gap junctional intercellular communication is decreased, is as indicated by decreased expression of connexin 43 and 32 with severe loss in poorly differentiated prostate cancer. These alterations in connexin expression may have a role in dedifferentiation and tumor progression.

Patient self-reporting questionnaire on urological morbidity and bother after radical retropubic prostatectomy.

OBJECTIVES: We assessed the incidence of morbidity and bother on quality-of-life (QL) after radical retropubic prostatectomy for prostate cancer. METHODS: At least 12 months after surgery, self-reporting questionnaires were completed and returned by 368 (77.8%) of 473 eligible patients. Surgery related morbidity was evaluated by adhoc constructed questions. QL was assessed by the European Organization for Research and Treatment of Cancer QL core questionnaire (EORTC QLQ-C30). Multivariate and univariate analysis as well as regression analysis were used to assess the bother factors. RESULTS: Postoperative urinary incontinence significant enough for the patient to use some kind of protection was reported by 27.2%. After surgery, 14.2% of preoperative potent men were able to get and maintain an erection sufficient enough for sexual intercourse without any aid. Overall 10.6% of respondents had undergone surgery for anastomotic stricture and 23.6% reported on adjuvant therapy. Furthermore, 43.2% reported on fear of not being cured from cancer. Postoperative urinary incontinence and fear of not being cured were associated with significant lower global QL scores and turned out as independent predictors for global QL. In contrast, postoperative erectile dysfunction, anastomotic stricture and adjuvant therapy were not independent predictors. In addition, 82.1% would vote for surgery again. CONCLUSION: The majority of the patients would opt for surgical treatment again, although morbidity is common after radical prostatectomy and may impair QL. Particularly urinary incontinence and fear of not being cured are independent predictors for global QL after surgery. Therefore, surgical techniques with a low morbidity are requested as well as some kind of psychological support in order to cope with existential fear.

Findings and clinical course of a localized primitive peripheral neuroectodermal tumor of the kidney.

Primitive neuroectodermal tumor (PNET) is a very aggressive neoplasm, considered to have an unfavorable prognosis, and renal location is extremely rare. We present the findings and clinical course of a patient with localized disease who is free of disease more than 3 years after first presentation. In suspicious cases we recommend to surgically explore renal masses as early as possible.

Is repeated transurethral resection justified in patients with newly diagnosed superficial bladder cancer?

OBJECTIVES: To assess the value of repeated transurethral resection (TUR) in patients with newly diagnosed superficial bladder cancer. METHODS: A second TUR was performed in 110 consecutive patients (24 women and 86 men) with newly diagnosed superficial bladder cancer. The mean age was 66 years (range 30 to 85). A second TUR was performed within 4 to 6 weeks after the initial TUR. After the first TUR, the pathologic stage was pTa in 31 patients (28%), pT1 in 76 (70%), and carcinoma in situ in 3 (2%). The pathologic records of the second TUR were reviewed and compared with the findings of the first operation. RESULTS: Cystoscopy before the second TUR was negative in 79 patients. Of these cases, 14 (17.7%) had cancer histologically. The second TUR was negative in 70 patients (63.6%). Twenty-two (20%) had residual cancer of the same stage, 9 (8.2%) had a lower stage, and 9 (8.2%) had a higher stage. Of 31 patients with Stage pTa and 76 patients with Stage pT1 at the first TUR, 19 (61.3%) and 51 (67.1%) had a negative second TUR, respectively. CONCLUSIONS: We recommend a second TUR for patients with superficial bladder cancer for several reasons. A negative second TUR provides important prognostic information. In addition, removal of residual cancer is achieved early. Finally, patients with pT1 G3 tumors are at high risk of residual, or even invasive, cancer and should be offered definitive therapy as early as possible.