Combination therapy-permanent interstitial brachytherapy and external beam radiotherapy for patients with localized prostate cancer.

BACKGROUND: Combination of permanent interstitial brachytherapy based on radioactive iodine with external beam radiotherapy is an alternative to other treatment modalities, such as radical prostatectomy or external beam radiotherapy alone in patients with intermediate-risk localized prostate cancer. In this article we report our experience with this combination modality. METHODS: Among patients who were treated in our institute with brachytherapy, there were 64 patients who received combination therapy for the above indication. Combination therapy enables administration of 110 Gy as brachytherapy and thereafter 45 Gy as external beam radiation. All patients received adjuvant androgen deprivation therapy for 6 months. The prospective follow-up was done with the aid of validated evaluation instruments (questionnaires). RESULTS: Combination therapy was administered without additional urinary (IPSS-based) or sexual (IIEF-based) side effects above those with brachytherapy alone. No severe perianal and lower intestinal tract side effects were observed. Short-to-moderate-term results based on serum PSA levels are encouraging, and are not inferior to what is accepted by the literature for other radical therapies. CONCLUSION: Combination of permanent interstitial brachytherapy and external beam radiotherapy in the appropriate patients does not cause any additional morbidity, and its biochemical results justify its application. This modality should be offered as an accepted and good alternative to other radical treatment options, to men with prostate cancer with moderate risk factors.

Effect of oral administration of high-dose nitric oxide donor L-arginine in men with organic erectile dysfunction: results of a double-blind, randomized, placebo-controlled study.

OBJECTIVES: To determine, in a prospective randomized, double-blind placebo-controlled study, the effect of 6 weeks of high-dose (5 g/day) orally administered nitric oxide (NO) donor L-arginine on men with organic erectile dysfunction (ED). PATIENTS AND METHODS: The study included 50 men with confirmed organic ED who were randomized after a 2-week placebo run-in period to receive L-arginine or placebo. A detailed medical and sexual history, O'Leary's questionnaire, a specially designed sexual function questionnaire and a sexual activity diary were obtained for each patient. All participants underwent a complete physical examination including an assessment of bulbocavernosus reflex and penile haemodynamics. Plasma and urine nitrite and nitrate (designated NOx), both stable metabolites of nitric oxide, were determined at the end of the placebo run-in period, and after 3 and 6 weeks. RESULTS: Nine of 29 (31%) patients taking L-arginine and two of 17 controls reported a significant subjective improvement in sexual function. All objective variables assessed remained unchanged. All nine patients treated with L-arginine and who had subjectively improved sexual performance had had an initially low urinary NOx, and this level had doubled at the end of the study. CONCLUSIONS: Oral administration of L-arginine in high doses seems to cause significant subjective improvement in sexual function in men with organic ED only if they have decreased NOx excretion or production. The haemodynamics of the corpus cavernosum were not affected by oral L-arginine at the dosage used.

Hyperthermia as a treatment modality in benign prostatic hyperplasia.

OBJECTIVE: To review the current status of hyperthermia (heating the prostate up to 45 degrees C) as a treatment modality for benign prostatic hyperplasia (BPH). METHODS: Hyperthermia versus thermotherapy is defined, the techniques and equipment are presented, and the current English literature regarding safety and efficacy is reviewed. RESULTS: Both transrectal and transurethral heat applications are very safe procedures. Most studies evaluating the efficacy have been nonrandomized and uncontrolled. The 50-70 percent symptom improvement rate should be compared with the natural history of the disease and the considerable placebo effect. The few controlled studies produced contradictory results. CONCLUSIONS: At the present time, hyperthermia has not been shown, in scientifically well-designed studies, to be a treatment modality with measurable and durable outcome in BPH.

Decreased bone density in elderly men treated with the gonadotropin-releasing hormone agonist decapeptyl (D-Trp6-GnRH).

Administration of GnRH agonist analogs to women may result in a hypoestrogenic state and bone mass reduction. In the present study we examined bone mineral density (BMD) and parameters of mineral metabolism in elderly men with benign prostatic hyperplasia before and during a hypoandrogenic state induced by the long-acting GnRH agonist D-Trp6-LHRH (decapeptyl). Our results showed that decapeptyl treatment caused a significant decrease in serum testosterone concentrations in all patients and resulted in a significant decrease in individual vertebral BMD in 10 of 17 patients. A significant decrease in BMD was observed in 5 patients after 6 months of treatment. Another 5 patients showed a decreased BMD only after 12 months. The mean serum concentrations of osteocalcin, phosphorus, and alkaline phosphatase activity increased after 6-12 months of treatment with decapeptyl. Serum calcium, vitamin D metabolites, and PTH concentrations remained unchanged during treatment. Urinary calcium excretion was slightly, but not significantly, increased after 6 months of treatment. These results demonstrate that long-acting GnRH agonist treatment may cause high turnover accelerated bone loss in some men during the first year of GnRH agonist treatment, as has been previously shown in women.

In vitro study of the effect of hyperthermia on normal bladder cell line and on five different transitional cell carcinoma cell lines.

Intraluminal hyperthermia is potentially useful in the management of superficial bladder cancer. The potential inhibitory effect of hyperthermia on various human bladder cancer cell lines, normal human bladder cells and the murine MBT-2 bladder cancer cell line has been studied in vitro. These cell lines were exposed for one hour to 43 +/- 0.5C and compared to controls. Cell survival was assessed comparing the cell growth curve and colony formation. The human transitional cell carcinoma (TCC) cell lines vary in their sensitivity to heat. MGH-U1 was the most heat sensitive cell line. The human A-1698, CUB-2, UM-UC-3 and the murine MBT-2 lines were heat insensitive. We conclude that the cytocidal effect of hyperthermia in bladder transitional cell carcinoma is variable. Further experiments using the combination of hyperthermia and intravesical anticancer agents are in progress.

Complications in hyperthermia treatment of benign prostatic hyperplasia.

Of 435 patients treated with local hyperthermia to the prostate 27 had 29 complications, for an over-all complication rate of 6.6%. Urinary tract infections (7 cases), hematuria (6), and epididymitis (2) accounted for roughly half of the complications and could be attributed to the insertion of a catheter rather than the treatment itself but this remains to be proved. Most of the complications occurred within the first 3 treatment sessions. Despite the complication, 9 patients continued and completed the treatment course. Mean age of the study group was 73 +/- 8.3 years. Given the age of these patients, high incidence of accompanying diseases and low rate of complications, local hyperthermia should be considered a viable low risk treatment option in patients with benign prostatic hyperplasia.

Local microwave hyperthermia in the treatment of benign prostatic hypertrophy.

Local deep microwave hyperthermia has been introduced recently for the treatment of benign prostatic hypertrophy (BPH). We report the results of treatment in 114 patients divided into 2 groups. The first group included 83 patients with severe obstructive symptoms. Although some improvement was found in the scoring of both subjective and objective parameters, the number of patients benefiting was small, with only 28% showing improvement in both parameters. Approximately 50% reported subjective improvement but in only 25% was this significant. In 42% there was objective evidence of improvement. Prostatic volumes did not change as a result of treatment. The second group comprised 31 patients with indwelling catheters because of acute urinary retention. After treatment, 19 patients (61%) were able to dispense with the catheter. The difficulties of interpreting an open trial of treatment for BPH and assessing its impact on objective parameters and symptomatology are discussed. Our results should be regarded cautiously in view of these reservations.

Primary hypomagnesemia with a probable double magnesium transport defect.

We describe a boy with a neonatally diagnosed primary nonfamilial hypomagnesemia. Oral supplementation of large quantities of magnesium salts was required to maintain low normal serum magnesium levels. Lately, a further increase in the oral supplementation had to be administered in order to avoid seizures. A thorough investigation was conducted. Both an intestinal and urinary magnesium wasting was noticed. The rarity of this simultaneous double transport defect merit its description.