Erectile Dysfunction is a Transient Complication of Prostate Biopsy: A Systematic Review and Meta-Analysis.

PURPOSE: Because the association between erectile dysfunction and prostate biopsy is variable in the available literature, we sought to perform a systematic review and meta-analysis of sexual dysfunction in males within 6 months of prostate biopsy. MATERIALS AND METHODS: We conducted a systematic literature search in 4 databases: MEDLINE® (via PubMed®), Embase® (via Ovid®), Web of Science™ and the Cochrane Library. We included studies focused on sexual dysfunction in men of all age groups undergoing transrectal or transperineal prostate biopsy for suspicion of prostate cancer. We included studies with International Index of Erectile Function 5 scores pre-biopsy and post-biopsy at 1, 3 or 6 months. We performed an effect size meta-analysis comparing patient baseline International Index of Erectile Function 5 (IIEF-5) scores with post-biopsy IIEF-5 scores. RESULTS: We identified 9 studies that met our inclusion criteria, of which 6 examined transrectal prostate biopsy, 2 examined transperineal prostate biopsy and 1 examined both. At 1 month after biopsy, the mean IIEF-5 score decreased by approximately 2.2 points as determined by the effect size (-0.43, p=0.002). However, at 3 and 6 months after biopsy, there was no difference compared to baseline (effect size=-0.08, p=0.52 and effect size=-0.11, p=0.18, respectively). An exploratory subgroup analysis examining transrectal prostate biopsy at 3 months showed a statistically significantly lower mean IIEF-5 score compared to baseline (p=0.047), corresponding to an approximately 1.25-point decrease in IIEF-5. CONCLUSIONS: Prostate biopsy does cause a mild, transient decrease in average IIEF-5 scores at 1-month post-biopsy. However, this resolves at 3 months on average, and average IIEF-5 remains at baseline at 6 months post-biopsy.

RCT on gentian violet versus a hydrogel dressing for radiotherapy-induced moist skin desquamation.

OBJECTIVE: Radiotherapy-induced moist desquamation is a significant problem but there is a paucity of randomised data on which to base treatment decisions. The current prospective randomised trial compared gentian violet (GV) to a hydrogel dressing in this context. METHOD: Thirty patients undergoing radiotherapy to the head and neck region or breast who had developed moist desquamation in the radiotherapy field were randomised to treatment with 0.5% aqueous gentian violet (GV) (n=16) or a hydrogel dressing (n=14). The area of desquamation was regularly measured until healing or withdrawal from the study. RESULTS: The likelihood of healing with the hydrogel was greater than GV with a hazard ratio for healing of 7.95 (95% CI 2.20-28.68; p=0.002). The median time to healing for hydrogel was 12 days but had not been reached for GV by 30 days. Over the first 14 days the median'area under curve' of moist desquamation for GV was 82.6 cm2 (range 31.8-320.7 cm2) and that for hydrogel 20.0 cm2 (range 3.8-301.0 cm2) (difference significant at p=0.003). Ten of 16 patients treated with GV withdrew from the study (due to stinging in five and failure to heal in five) compared with two of the 14 treated with hydrogel (difference significant at p=0.021). CONCLUSION: Hydrogel dressings are more likely to heal radiotherapy-induced moist desquamation and are better tolerated than GV.

Radiotherapy for T1 glottic carcinoma: impact of anterior commissure involvement.

The clinical notes of all new patients with T(1) squamous cell carcinoma of the glottis seen in one head and neck cancer unit between 1989 and 1996 were reviewed. Fifty-three patients were treated with radical radiotherapy and of these 42 (79.2 per cent) had no loco-regional recurrence, after a median follow-up of seven years. Eleven (20.8 per cent) developed local recurrence and were treated with salvage surgery. Fourteen of the 53 (26.4 per cent) tumours involved the anterior commissure and eight of these 14 (57.1 per cent) developed recurrence, whereas only three of the 19 (15.8 per cent) tumours arising from the anterior half of the fold but not involving the anterior commissure had recurrence. None of the remaining tumours recurred. This difference is statistically significant (p<0.001). Anterior commissure involvement is a predictor of poor response to radiotherapy. This may be the result of understaging as none of the cases had computed tomography (CT) scans performed. Technical radiotherapy factors may also be important, although in all cases of anterior commissure involvement steps were taken to ensure adequate radiation dose to this region.

Pancolitis associated with docetaxel: a rare cause of megacolon.

The toxic effects of chemotherapy have been noted to cause a range of acute necrotizing colonic inflammatory disorders but until recently these have not been associated with docetaxel chemotherapy. Here we report a case of pancolitis presenting as megacolon following the administration of docetaxel for recurrent breast cancer.

Determination of radiosensitivity in established and primary squamous cell carcinoma cultures using the micronucleus assay.

In this study, the cytokinesis-block micronucleus assay (CBMN) was used to measure radiosensitivity in three established cell lines (SCC-61, V175 and V134) and 10 primary cell cultures of squamous cell carcinoma (SCC) of the head and neck. Assessment involved optimisation of the assay to determine cytochalasin-B (CB) concentration and sampling time postirradiation. A much closer correlation between dose-response data measured in the clonogenic and micronucleus assays was found when the micronucleus assay was performed under standardised conditions for each cell line (2 micrograms/ml CB: 48 h postirradiation) instead of predetermined optimised assay conditions. This indicates that, for these SCC cell lines, the CBMN assay may be able to predict in vitro radiosensitivity. To be of clinical use in predicting radiosensitivity, the CBMN assay also needs to be evaluated with primary cell cultures. In this study, no relationship between micronucleus frequency at 2 or 6 Gy and patient clinical outcome 12 months following surgery and radiotherapy was seen. Similarly, no association between patient outcome and tumour stage, nodal stage and histology was observed. These CBMN assay data from the primary cell cultures are presently inconclusive as a measure of patient tumour radiosensitivity.

Determination of radiation-induced damage in lymphocytes using the micronucleus and microgel electrophoresis 'Comet' assays.

DNA damage assays may be useful as rapid predictors of normal tissue radiosensitivity in clinical samples. We measured in vitro radiation-induced (2 Gy) damage to lymphocytes from cancer patients and normal healthy donors using both the micronucleus and microgel electrophoresis (Comet) assays simultaneously. For damage assessment, there was a good correlation (P < 0.001) between the mean comet lengths and the fraction of cells with comets. There was no correlation with initial damage, determined as the proportion of cells within a sample that formed comets, in comparison with the mean frequency of micronuclei per binucleate cell. However, there appeared to be an association between the determination of repair proficiency in the Comet assay and the mean frequency of micronuclei per binucleate cell in lymphocytes from cancer patients.

Primary rectal non-Hodgkin's lymphoma treated with radical radiotherapy.

A male patient with localized low grade stage IEA rectal non-Hodgkin's lymphoma is presented. The treatment of choice suggested by the literature is surgical excision, which, in this patient, would have resulted in abdominoperineal resection. He was successfully treated with radical radiotherapy and is well with no evidence of disease 4 years after treatment. A brief review of the literature on the clinical features, pathology and treatment of this condition is presented.

Hypertrichosis lanuginosa acquisita following cytotoxic chemotherapy.

Hypertrichosis lanuginosa acquisita (HLA) refers to abnormal and excessive growth of fine downy hair. It is a rare condition which has been reported in association with both malignancy and certain drug therapy. We report three cases occurring after administration of cytotoxic chemotherapy for cancer. A possible relationship is discussed and previous literature reviewed.

Pions--the potential for therapeutic gain in locally advanced prostate cancer: dose escalation and toxicity studies.

Since 1982, 49 patients with locally advanced carcinoma of the prostate have been treated with pion radiotherapy in tolerance and tumor response studies. The relative biological effectiveness (RBE) was confirmed as 1.5 for both acute and late effects, a figure expected on the basis of animal and human studies. The radiation dose has been safely escalated to tolerance, which is estimated to be 37.5 Gy pi in 15 fractions (volume less than 500 cc), and 36 Gy pi in 15 fractions (volume 500-800 cc). Severe acute toxicity occurred in 6% and severe chronic toxicity in 4%, figures comparable to those seen with conventional radiotherapy. The equivalent photon doses are approximately 78 Gy in 39 fractions and 73 Gy in 36 fractions, respectively. That this high dose can be delivered with no increase in toxicity is a reflection of smaller volume radiotherapy achieved by exploiting the dose distribution and biological characteristics of pions. Local response rates of 94% are reported. A Phase III study is now under way.

Detection of pion-induced radioactivity by autoradiography and positron emission tomography.

An autoradiographic technique incorporating a new imaging system was used to detect pion-induced radioactivity in Plexiglass and the results were compared with aluminium activation and PET imaging. The activity distribution in the region of the pion-stopping peak was similar in all three cases. Another large signal in the entrance region due to in-flight interactions [12C(pi-, pi- n) 11C] was detected by autoradiography and by PET but was not reflected in the aluminium activation measurements. This new technique is capable of defining the stopping region in phantoms with a better resolution than PET scanning and is useful as a complementary technique to other methods of pion dosimetry.

Plasmacytoma of the head and neck.

Fourteen cases of plasmacytoma arising in the head and neck are described. Good local tumour control was achieved with minimal surgery and moderate doses of radiation. Subsequent myelomatosis did occur but this was unusual and no more frequent with tumours arising in the maxilla and mandible than at extramedullary sites. It is recommended that all apparently solitary plasma cell tumours of the head and neck are treated by radiotherapy with curative intent and then followed up carefully for life.

Syme amputation. An evaluation of the physical and psychological function in young patients.

Twenty-one patients who had had twenty-three Syme amputations at an average age of four years and eleven months were studied to assess their physical and psychological functional status. Physical evaluation was based on a timed fifty-yard (45.7-meter) dash, Cybex testing of quadriceps and hamstring function, and history of sports participation. Psychological function was based on four psychological tests. Quadriceps power correlated closely with athletic function. Excessive genu valgum caused a noticeable abnormality of gait. Migration of the heel pad did not cause problems with gait. Better psychological function correlated with better orthopaedic function. The level of family stress was the predominant factor that influenced test results relative to behavior, self-concept, and intelligence quotient. As a result of this study, we believe that a Syme amputation in a young patient may be compatible with athletic and psychological function closely approaching that of a non-handicapped child of the same age.

Primitive neuroectodermal tumours of the cerebrum. Pathology and treatment.

Eighteen cases of cerebral tumour composed partly or totally of primitive embryonal cells are reported. These lesions comprise 2.8% of all primary cerebral hemisphere tumours in the histopathology files of The Royal Marsden Hospital between 1971 and 1980 inclusive. Most exhibited some degree of differentiation towards neuronal or glial elements and, as more than one type of differentiation was often present in the same lesion, we agree with others that the term primitive neuroectodermal tumour (PNET) is more appropriate to describe these lesions than terms based on histogenesis. The extent of the primitive component varied, but usually accounted for more than 80% of the tumour. Although the tumours bear some similarities to posterior fossa medulloblastomas, they exhibit important differences in histology, immunohistology, natural history and response to treatment. Nearly all PNETs examined expressed some glial fibrillary acidic (GFAP) both in primitive areas and zones of astrocytic differentiation. GFAP staining may thus be of value in distinguishing PNETs from undifferentiated non-neurogenic tumours. Of 14 patients referred for radiotherapy, the survival rate at 3 years was 29% (4/14) and 5 years 25% (3/12). Patients with tumours in which at least 90% of the tissue was undifferentiated exhibited an extremely poor prognosis with none of 9 patients still alive at 3 years in contrast to 3 of 5 patients (60%) with tumours showing less than 90% undifferentiation. Radical tumour removal, where feasible, followed by irradiation of the whole cerebrospinal axis is recommended. Adjuvant chemotherapy with such agents as CCNU and Vincristine may be of value: the 3 long term survivors in the present series (7-11 years), including one who presented disseminated intracranial disease, received such adjuvant treatment.