[Diagnosis of prostate capsular invasion by pelvic magnetic resonance imaging and serum level of prostate specific antigen].

Transrectal ultrasonography (TRUS), computed tomography (CT), and magnetic resonance imaging (MRI) are employed to diagnose the clinical stage of prostate cancer. However, several cases are diagnosed as pathological stage pT3 after total prostatectomy. We investigated the accuracy of the evaluation of pathologic capsular penetration by preoperative pelvic MRI and preoperative serum PSA level and capsular penetration. The diagnostic accuracy of capsular penetration by MRI was 63.3%. On the other hand, the diagnostic accuracy of capsular penetration by preoperative PSA was 89.7% when its cut off value was 17 ng/ml. We conclude that preoperative serum PSA level could be more useful to diagnose accurately stage of prostate cancer than pelvic MRI.

[Clinical outcome and analysis of radical prostatectomy in clinical stage B and C prostate cancer].

Between 1989 and 1999, 40 patients treated with radical prostatectomy for clinical stage B and C prostate cancer were analyzed. Prostate-specific antigen (PSA) failure after radical prostatectomy occurred in four patients, and one of them died of clinical recurrence of prostate cancer. Cause-specific survival at 5 years was 91.7% and PSA failure-free rate at 5 years was 76.8%. Staging accuracy of CT and MRI image was not satisfactory. In 41.7% patients, extracapsular extension can not be determined. Preoperative serum PSA levels of pathologically organ-confined disease (OCD) patients were significantly lower than those of pathologically non-OCD patients. Further analysis indicated that preoperative serum PSA levels of greater than 20.1 ng/ml are useful predictors for pathologically non-OCD.

[Study of free to total prostate specific antigen ratio in the detection of patients with prostate cancer].

BACKGROUND: We investigated the clinical usefulness of free to total serum prostate specific antigen (PSA) ratio (F/T ratio) in order to improve the specificity of total PSA measurement for detecting prostate cancer. METHOD: In this study 129 patients with total PSA level 4-20 ng/ml underwent transrectal ultrasound guided sextant biopsy. Serum samples were assessed for total PSA, free PSA and the F/T ratio calculated. All patients were pathologically diagnosed as benign prostatic hyperplasia or prostate cancer. RESULTS: Of 129 patients 21 had prostate carcinoma (PCa) and 108 had benign prostatic hyperplasia (BPH) from the results of prostate biopsies. The mean of total PSA were not significantly different between men with PCa and with BPH. The mean of free PSA for PCa was significantly lower than that for BPH (p = 0.043). Furthermore, the mean of F/T ratio was significantly different between PCa and BPH group (p = 0.0014). The F/T ratio had a higher specificity than total PSA at all levels of sensitivity in detecting prostate cancers. Sensitivity, specificity and accuracy for cancer detection at a cut off 0.12 was 90.4%, 51.8% and 58.1%, respectively. Also, free PSA was as useful as F/T ratio for cancer detection when analyzed in receiver operating characteristic curves analysis. When determined the cut off number of free PSA at 0.78 ng/ml, the sensitivity, specificity and accuracy for cancer detection were 61.9%, 66.7% and 65.9%, respectively. CONCLUSION: This study indicated that the F/T ratio and free PSA could improve the specificity without impairing the sensitivity for detecting PCa in patients with 4-20 ng/ml of total PSA.

Prognostic significance of p53 protein overexpression in transitional cell carcinoma of the renal pelvis and ureter.

Fifty-three patients with invasive transitional cell carcinoma of the renal pelvis and ureter were studied for p53 protein overexpression by immunohistochemistry. Overexpression of p53 protein was observed in 19 patients (35.8%). There was a significant correlation between overexpression of p53 protein and histologic grade (p < 0.01). However, there was no correlation found between p53 immunoreactivity and pathologic stage. By univariate survival analysis, a significant difference in cumulative survival was observed between stage pT2 and stage pT3 or pT4 tumors (p < 0.05). The difference in survival between patients with p53-positive and negative tumors did not reach statistical significance (0.05 < p < 0.01). Multivariate analysis revealed that pathologic stage had an independent prognostic value (p < 0.05). The independent prognostic value of p53 protein overexpression did not quite reach statistical significance (p = 0.07). p53 protein nuclear overexpression appears to be a relatively weak prognostic indicator for patients with invasive transitional cell carcinoma of the renal pelvis and ureter.

[Bellini duct carcinoma of kidney with invasive growth pattern: a case report].

We report a case of Bellini duct carcinoma of the left kidney with invasive growth pattern. A 39-year-old man was admitted to our hospital with the chief complaint of gross hematuria. Ultrasonography showed left renal swelling but normal reniform configuration of the kidney was maintained. Computed tomography demonstrated a low density tumor infiltrating into the renal cortex and with tumor extension into the renal vein. Renal angiography revealed a hypovascular tumor. We suspected a left renal cell carcinoma with tumor extension into the left renal vein, and performed radical nephrectomy. Macroscopically, the resected kidney had a normal outer contour. The tumor with infiltrative growth pattern existed in renal medulla. Histopathologic examination revealed a papillary adenocarcinoma originated in Bellini duct (pT3bN2M0). The patient underwent systemic chemotherapy (M-VAC). This case showed invasive growth pattern, which were different from the usual renal cell carcinoma and Bellini duct carcinoma.

[Retrospective study of 107 patients with hematospermia].

A retrospective study on 107 men with hematospermia between 1986 and 1993 is reported. The age of the patients ranged from 16 to 73 years (mean 45.6 years). Sixty five patients (60.7%) were asymptomatic except for hematospermia. Hematospermia disappeared within one month in 43% of all the patients, and in 61% of those under 40 years of age. Thirty four patients had urological diseases; 15 patients had chronic prostatitis, 10 benign prostatic hyperplasia, 3 prostatic calculi, 1 genital tuberculosis, 1 prostate cancer, and 4 other diseases. Hematospermia was ascribed to hypertension in another 5 patients. However, the cause of hematospermia was not apparent in 79% of the patients under 40. We recommend a routine physical examination to detect infectious or inflammatory lesions, in younger patients with transient hematospermia whereas a through urological screening for more serious urogenital diseases, and measurement of blood pressure in older patients especially those with persistent hematospermia.

Predictive value of argyrophilic nucleolar-organizer-region-associated proteins in bladder cancer, using cell-imprint preparations.

The predictive value of quantifying argyrophilic nucleolar-organizer-region-associated proteins (Ag-NOR) in routinely processed paraffin-embedded tissue sections of bladder cancer remains controversial. The purpose of this study was to determine whether cell-imprint preparations facilitate a more accurate determination of the mean number of Ag-NOR per cell (Ag-NOR score). The utility of using the Ag-NOR scores of cell-imprint preparations as a prognostic indicator in patients with bladder cancer was explored. We evaluated 90 patients with newly diagnosed bladder cancer using cell-imprint preparations to determine Ag-NOR score. The score significantly correlated with known prognostic factors associated with this tumor, including histological grade (P < 0.001), pathological stage (P < 0.01), and papillary structure (P < 0.001). Furthermore, the Ag-NOR score appeared to be an independent predictor of intravesical tumor recurrence of superficial bladder cancer (P < 0.05). These results suggest that the Ag-NOR score determined in a cell imprint preparation may serve as a useful prognostic indicator in bladder cancer.

AgNOR staining of cell imprint preparations of human bladder cancer.

OBJECTIVE: To determine the clinical usefulness of argyrophilic nuclear organizer region (AgNOR) staining as applied to cell imprint preparations in bladder cancer. STUDY DESIGN: The study group consisted of 59 bladder cancers (13 grade 1, 24 grade 2 and 22 grade 3). The staining time, quality of staining, relationship of AgNOR counts to tumor grade and interobserver variations in AgNOR counts were compared in cell imprint preparations and paraffin-embedded tissue sections. Interobserver variation was compared by calculating the coefficients of variation (CVs) and correlation coefficients between two independent observers. RESULTS: Following an optimal staining time of 30 minutes, the AgNOR dots of cell imprint preparations were highly distinct. In contrast, the optimal staining time was variable, and the AgNOR dots often were observed to aggregate in paraffin-embedded tissue sections. The mean AgNOR count was significantly higher in imprint preparations. AgNOR counts from the imprint preparations showed a stronger relationship to tumor grade. The CVs of AgNOR scores in the cell imprints was significantly smaller, and the correlation coefficient was significantly greater. CONCLUSION: AgNOR staining of cell imprint preparations is a more objective method than paraffin-embedded tissue sections in human bladder cancer.

[Extirpation of total urinary tract as a final treatment for asynchronous multicentric urothelial cancer: a case report].

A 48-year-old male patient underwent transurethral resection (TUR) for solitary bladder tumor in January 1985. Pathological finding of the specimen was non-invasive transitional cell carcinoma (TCC) G2 > G1. Following the operation, prophylactic intravesical instillation of antitumor agents, intrapelvic irradiation, and hyperthermia were done for the recurrences. In June 1987, left renal pelvic tumor revealed, and nephroureterectomy was performed. Histological examination of renal pelvic tumor showed TCC G1. Five months later, multiple bladder tumors and right renal pelvic tumor were detected. A total cystectomy, partial nephrectomy and nephrostomy were performed in February and March 1988. Pathology of the bladder and right kidney were TCC G3. One month after these operations, tumors recurred in the rest of the right kidney. Complete remission was achieved after systemic chemotherapy with methotrexate, vinblastine, doxorubicin and cisplatin (M-VAC). In January 1992, right renal pelvic tumor recurred again. After two cycles of M-VAC therapy, the rest of the right kidney was extirpated. Postoperative hemodialysis has been uneventful. He has lived without tumor recurrence for three years after the introduction of hemodialysis.

[Treatment of scrotal hydrocele using fibrin adhesive].

For the purpose of adhesion of the tunica vaginalis in scrotal hydrocele, we used fibrin adhesive, Bolheal. Between September 1993 and December 1994, 13 patients with scrotal hydrocele received occlusion therapies using Bolhead. The therapy was effective in 1 of the 6 patients (17%) administered 2.4 mg of fibrinogen and 750 units of thrombin into the vaginal cavity after aspiration of fluids, and in 5 of the 7 patients (71%) administered 240 mg of fibrinogen and 7.5 units of thrombin. Therefore, fibrin adhesive may be useful in the treatment of scrotal hydrocele.

Nucleolar organizer regions: a new prognostic factor for upper tract urothelial cancer.

PURPOSE: The prognostic significance of argyrophilic staining in the nucleolar organizer regions was studied in 63 patients with primary urothelial tumors of the renal pelvis and ureter. MATERIALS AND METHODS: Silver staining of paraffin embedded sections was performed using a 1-step technique. RESULTS: The prognosis for patients with a mean number of argyrophilic nucleolar organizer region proteins per nucleus (argyrophilic nucleolar organizer region score) of 8 or greater was significantly worse than that for patients with a score of less than 8 (P <0.001). CONCLUSIONS: Argyrophilic nucleolar organizer region score is a new prognostic factor in primary urothelial tumors of the renal pelvis and ureter, and it is particularly useful for patients with invasive tumors.