[Relationship of neuroendocrine differentiation to biological behavior of prostate cancer].

OBJECTIVE: To investigate the relationship between neuroendocrine differentiation (NED) in prostate cancer and hormone refractory prostate cancer. METHODS: Fifty-five prostate cancer specimens were obtained from 55 patients following intermittent androgen blockade during operation of transurethral resection of prostate. Monoclonal antibody immunohistochemistry was used to detect the expression of chromogranin A (CgA), a specific marker of neuroendocrine cell in the specimens. Follow-up was conducted for 25 (5 - 85) months. Serum prostate specific antigen (PSA), bone scan, chest X-ray, and computerized tomography were performed regularly during follow-up. RESULTS: Twenty-six of the 55 specimens (47.3%) were positive in CaG, and 23 of the 35 tumors with the Gleason score >or= 7 was 66%, significantly higher than those of the lower-grade tumors (all P < 0.01). Most of the high-grade tumors showed small cluster pattern, and most of the low-grade tumors showed solitary scattered pattern. The numbers of NED cells in the stage III and IV tumors were 67% and 71.4% respectively, both significantly higher than that of the stage II tumors (25%, both P < 0.05), There was no correlation between the NE positive cell rate and preoperative PSA value (P > 0.05). Thirty cases progressed to a hormone-independent status within 18 (5 - 79) months (Group A), and the rest 25 cases remained not progressing within 31 (17 - 85) months (Group B). The NED rate of Group A was significantly higher than that of Group B (P < 0.05). Univariate analysis showed that NE positivity, Gleason >or= 7, stage IV, and bone metastasis were influential factors of clinical progression. Multivariate COX regression analysis showed that NED and pre-operational PSA value were independent prognostic factors of bone metastasis. CONCLUSION: NED is associated with poor prognosis and hormone refractory prostate cancer in patients with androgen deprivation therapy.

[Etiology, diagnosis and management of spontaneous per renal hemorrhage].

OBJECTIVE: To investigate the etiology, diagnosis, and management of spontaneous perirenal hemorrhage (SPH). METHODS: The clinical data of 35 patients, 10 males and 12 females, aged 35.9 (12-77), with the diagnosis of SPH, without history of trauma, anticoagulant use, dialysis, and renal transplantation, were analyzed. RESULTS: The underlying disease of SPH included angiomyolipoma (18 cases), renal cell carcinoma (7 cases), kidney cyst (2 cases), renal artery aneurysm (3 cases), rupture of renal artery aneurysm accompanied with pregnancy (2 cases), renal pheochromocytoma (3 cases 2 of which accompanied with pregnancy), congenital stricture of pelvic ureter junction (1 case), and liver cancer (1 case). The most common underlying diseases were nephrogenic (96%) with angiomyolipoma ranking first (54%) followed by renal cell carcinoma (21%). The underlying diseases were diagnosed correctly in 23 cases (69%). CT helped in diagnosis of 34 cases. Surgery was performed on most of the cases. CONCLUSION: The most common causes of SPH is renal neoplasms more than 50% of which are benign. Renal artery aneurysm and pheochromocytoma tend to rupture during pregnancy. CT is the first method of choice in diagnosis.

Insulin resistance in patients with advanced prostate cancer undergoing intermittent or continuous androgen blockade.

BACKGROUND AND OBJECTIVE: Androgen blockade is the principle strategy in the treatment of advanced prostate cancer. Impaired glucose tolerance often occurs in those patients after androgen blockade. This study was to investigate the correlation of insulin resistance to intermittent androgen blockade (IAB) or continuous androgen blockade, which is also named surgical castration, in patients with advanced prostate cancer. METHODS: A total of 139 patients with advanced prostate cancer were classified into four groups according to the body mass index (BMI) and the treatment method. Group A consisted of 30 patients receiving surgical castration with BMI >or= 24 kg/m(2), group B consisted of 32 patients treated with IAB with BMI >or= kg/m(2), group C consisted of 37 patients undergoing surgical castration with BMI < 24 kg/m(2), group D consisted of 40 patients treated by IAB with BMI < 24 kg/m(2). Fasting plasma glucose (FPG) and fasting serum level of insulin (FINS) were assessed before treatment, six months and 12 months after treatment, respectively. Insulin resistance index (IRI) was also calculated. RESULTS: Six months after treatment, FINS and IRI were all increased in the four groups compared with those before treatment; FINS and IRI were significantly higher in groups B and D than in A and C (FINS: t(A:B)=7.7516, p < 0.01, t(C:D)=4.8078, p < 0.01; IRI: t(A:B) =7.3671, p < 0.01, t(C:D)=5.1005, p < 0.01). Twelve months after treatment, which was the intermittent period of the IAB method, FINS returned to the pretreatment level in group D (q=2.5255, p > 0.05), and dramatically decreased in group B compared to the value six months after treatment (q = 9.0942, p < 0.01); in contrast, FINS and IRI remained unchanged in groups A and C. CONCLUSIONS: Androgen blockade promotes insulin resistance in patients with advanced prostate cancer. Insulin resistance gradually disappears during the intermittent period of IAB.

[Intravesical instillation of pirarubicin (THP) together with polyvinylpyrrolidone (PVP) in the prevention of postoperative recurrence of superficial bladder cancer].

BACKGROUND & OBJECTIVE: Superficial bladder transitional cell carcinoma is aggressive and tends to recurrence after operation. In order to prevent the relapse of bladder neoplasms,this study was designed to explore the effect of intravesical instillation of pirarubicin (THP) together with polyvinylpyrrolidone (PVP) on patients with superficial bladder cancer who had undergone surgical operation. METHODS: A total of 34 cases were enrolled from October 1999 to May 2002. After one week of operation, pirarubicin (20 mg) dissolved in 10 ml normal saline plus 20 ml PVP was instilled into bladder, and was retained for 60 minutes. In the following 7 weeks, intravesical instillation of pirarubicin was administered once a week. Subsequently it was done bi-monthly, finally once a month for 6 months. RESULTS: Follow-up was performed for 5-26 months (mean:17.2 months). Among the 34 cases, recurrence was found in 2 cases (5.8%),bladder irritation in 6 cases (17.6%) and hematuria in 4 cases (11.7%) as well. CONCLUSION: Intravesical instillation of THP/PVP is effective for prevention of postoperative recurrence of superficial bladder cancer with fewer side effects. Further study is needed for wide use in such way.