The ratio of free to total prostate specific antigen: an advantageous addition in the differential diagnosis of benign hyperplasia and cancer of the prostate?

UNLABELLED: This study examined the clinical relevance of the determination of free PSA (f-PSA) in addition to total PSA (t-PSA). PATIENTS AND METHODS: Both total PSA- and free PSA-values of frozen sera obtained pretherapeutically from 80 patients with carcinoma (PC) and 171 patients with benign hyperplasia of the prostate (BPH) were analysed by means of PSA IRMA and FREE PSA IRMA (IMMUNOCORP/IBL). RESULTS: At 95% specificity (true negative test results), a cut-off value of 16.8 [micrograms/L] was obtained for total PSA (9 patients with BPH [5%] were above this value). For this cut-off value we calculated a sensitivity (true positive test results) of 41%. Using the same criteria for the ratio Q = f-PSA:t-PSA a cut-off of 0.083 was found again at a specificity of 95%. In a second step only patients with total PSA values below the cut-off level of 16.8 [micrograms/L]) were considered. Of these patients 11 of 160 with BPH (missing values = 1) and 13 of 33 with PC (missing values = 2) were below the above mentioned ratio (Q = 0.083). Considering both steps (total PSA and Q) 46 patients with PC were detected correctly and 20 patients with BPH would have been biopsied unnecessarily (positive biopsy rate: 70%). CONCLUSION: High total PSA levels are a very good indicator for the presence of prostate cancer. There is still concern to improve the differentiation between the diagnosis between BPH and PC, when an intermediate or low value (< or = 95% specificity) is observed. The determination of Q is only useful in this range and might be helpful for the clinician's decision to apply or avoid biopsy.

[Drug therapy of benign prostatic hyperplasia]. / Medikamentöse Therapie der benignen Prostatahyperplasie.

BPH patients with Vahlensieck stage II or III disease are suitable for drug treatment. The points of attack are reduction of testosterone, conversion of testosterone to dihydrotestosterone, conversion of testosterone to estrogen using GnRH analogues, antiandrogens and alpha reductase inhibitors or aromatose inhibitors. Furthermore a reduction in obstruction is achieved through the use of phytopharmaceuticals containing 5-lipoxygenase and cyclooxygenase inhibitors. At present, Curcurbitae pepo seeds, Urtica dioica root, Pollinis siccae extract and Sabal serrulata seed extract are approved for the treatment of prostatic diseases in Germany. The use of alpha-1-sympathicolytic treatment may reduce muscular tone in the prostate. Combination of the various modes of action may also offer an effective form of treatment.

Comparison of CYFRA 21-1, TPA and TPS in lung cancer, urinary bladder cancer and benign diseases.

Recently CYFRA 21-1, a new tumor marker measuring a fragment of cytokeratin 19, was introduced and proved to be suitable for therapy monitoring and follow-up of non-small cell lung carcinomas (NSCLC), in particular squamous cell carcinomas. Besides CYFRA 21-1 there are two other tumor markers, tissue polypeptide antigen (TPA) and tissue polypeptide-specific antigen (TPS), which also measure various cytokeratins in serum. In a retrospective study we investigated the clinical significance of these three cytokeratin markers in lung cancer and in carcinoma of the urinary bladder. For this purpose we investigated the sera of 50 healthy persons, 273 patients with various benign diseases, 218 patients with histologically proven lung cancer and 88 patients with carcinoma of the urinary bladder. In a first step the specificity was established for the different reference groups and the cutoff values were fixed at a specificity of 95%. In lung cancer the single and combined sensitivities were calculated versus benign lung diseases (n = 58) as reference group. With single determinations CYFRA 21-1 proved to have the highest sensitivity in lung cancer in general (61%), in non-small cell lung carcinomas (64%), in squamous cell carcinomas (79%), in adenocarcinomas (54%) and in large cell carcinomas (65%). In small cell lung carcinomas (SCLC) NSE was confirmed to be the marker of choice (55%). With combined determinations a clear increase in sensitivity could only be reached in large cell carcinomas (CYFRA 21-1 + TPA: 77%) and in small cell carcinomas (CYFRA 21-1 + NSE: 62%).(ABSTRACT TRUNCATED AT 250 WORDS)

[BCG vs interferon A for prevention of recurrence of superficial bladder cancer. A prospective randomized study]. / BCG vs. Interferon A zur Rezidivprophylaxe beim oberflächlichen Harnblasenkarzinom. Eine prospektiv randomisierte Studie.

A total of 78 patients with superficial bladder carcinoma were prospectively randomized to two groups following complete transurethral resection (TUR). Each received 12 intravesical instillations of 10(7) units interferon A or 120 mg BCG Connaught for 1 year starting 6 weeks post-TUR. After a mean observation period of 24 (13-31) months in the BCG and 25 (6-32) months in the IFN group 5/32 (15.6%) recurrences in the BCG versus 21/35 (60%) in the IFN group were observed (P = 0.0003). In the IFN group 18.4% of the patients had dysuria and 2.6% fever; in the BCG group 35% had fever, 60% cystitis, 1 patient granulomatous epididimoorchitis and 1 patient pneumonitis with granulomatous prostatitis. With our instillation regimen interferon A had few side effects but also no prophylactic effect, whereas BCG had tolerable-seldom severe--side effects and was very effective in preventing recurrences. Perhaps IFN should be given earlier after TUR and in a higher dosage.

[Bilateral ureteral obstruction by granuloma formation in chronic granulomatosis]. / Bilaterale Ureterobstruktion durch Granulombildung bei chronischer Granulomatose.

A 24-year-old patient with chronic granulomatous disease had bilateral hydronephrosis resulting from ureteral granuloma formation. He was treated with high-dose steroids, antibiotics and percutaneous nephrostomy. The etiology, incidence, clinical findings and treatment of chronic granulomatous disease are discussed.

Placebo-controlled study of terazosin in the treatment of benign prostatic hyperplasia with 2-year follow-up.

This randomised, placebo-controlled, double-blind study was performed to evaluate the efficacy and safety of once-a-day terazosin (10 mg/d) in ambulatory patients (n = 57) with benign prostatic hyperplasia (BPH). After a 4-week placebo lead-in and a 24-week treatment period with terazosin (with both phases being single-blind), 30 patients who responded to terazosin were randomly assigned to either the terazosin or placebo treatment group for 12 weeks. During the single-blind treatment period, the peak urine flow rate increased 54% from a baseline average of 7.76 ml/s to 11.92 ml/s after terazosin administration; the mean flow rate increased 55% from a baseline of 4.90 ml/s to 7.59 ml/s; and the residual volume decreased 56% from 93.1 ml to 40.7 ml. The mean obstructive symptom score, irritative symptom score and physician global assessment score improved by 68%, 34% and 27%, respectively. All these changes were significant when compared with baseline values. During the double-blind period, the improvement in all the variables was sustained in the terazosin group but not in the placebo group. Peak and mean urinary flow rates, and physician assessment showed significant differences at the end of the double-blind period. Adverse events occurred only during the single-blind period. The most frequently experienced events were headache (n = 6), asthenia (n = 3) and hypotension (n = 3). A follow-up study that initially included 12 patients showed no significant loss of improvement in symptoms and no change in urodynamic parameters with the 5 mg terazosin dose at 1 year. At 2 years, the 9 remaining patients showed sustained improvement and no signs of tachyphylaxis.

Efficacy of once-a-day terazosin in benign prostatic hyperplasia: a randomized, double-blind placebo-controlled clinical trial.

This randomized, placebo-controlled, double-blind study was performed to evaluate the efficacy and safety of once-a-day terazosin (10 mg/day) in ambulatory patients (n = 57) with benign prostatic hyperplasia (BPH). After a 4-week placebo lead-in and a 24-week treatment period with terazosin (both single-blind), 30 patients who responded to terazosin were randomly assigned to either the terazosin or placebo treatment group for 12 weeks. During the single-blind treatment period, the peak urine flow rate increased 54% from a baseline average of 7.76 ml/sec to 11.92 ml/sec after terazosin; the mean flow rate increased 55% from a baseline of 4.90 ml/sec to 7.59 ml/sec; and the residual volume decreased 56% from 93.1 ml to 40.7 ml. The mean obstructive symptom score, irritative symptom score and physician's global assessment score improved by 68%, 34% and 27%, respectively. All these changes were significant (P less than 0.05) when compared to baseline values. During the double-blind period, the improvement in all the variables was sustained in the terazosin group but not in the placebo group. Peak and mean urinary flow rates, and physician's global assessment showed significant (P less than or equal to 0.05) differences at the end of the double-blind period. Adverse events occurred only during the single-blind period. The most frequent were headache (n = 6), asthenia (n = 3), and hypotension (n = 3). In summary, terazosin administered once-a-day improved the obstructive and irritative symptoms of BPH, urine flow rates and residual volume. Terazosin was well tolerated.

[The current status and place of open surgery in treating urolithiasis]. / Suvremennoto sustoianie i miastoto na otvorenata khirurgiia pri lechenieto na urolitiazata.

Within the concept of treatment of urinary calculosis, open surgery still occupies a firm place. At present, however, the indications for open surgical interventions have been considerably narrowed, and only a small group of patients with urinary calculosis are subject of open surgery, which requires experienced operators and special instruments for optimally sparing performance of the operation. Often intraoperative echography makes useless the application of intraoperative hypothermia and intraoperative X-ray diagnosis.

A new method of investigating the efficacy of regional thermotherapy in subcutaneous xenografts of nude mice.

A new method of investigating the efficacy of regional thermotherapy in subcutaneous xenografts of nude mice is reported. The use of high frequency hyperthermia was well tolerated by the sensitive animals and allowed an exact continuous temperature measurement in different tumor regions. The interstitial procedure in this model could be the best approach for later clinical use in urology, e.g. for prostate treatment and is an alternative to the transrectal hyperthermia application.

[Causes, prevention and therapy of complications of lymphadenectomy following tumor nephrectomy]. / Ursachen, Prophylaxe und Therapie von Komplikationen der Lymphadenektomie nach Tumornephrektomie.

In our series of 295 patients who had to undergo a radical nephrectomy. 34% had postoperative wound drainage for longer than 6 days. In 7 patients (2.4%) lymphocele developed, which was cured by percutaneous puncture and drainage in most cases.

[Clinical relevance of radioimmunologic determination of prostate specific antigen in prostate cancer]. / Klinische Relevanz der radioimmunologischen Bestimmung des prostataspezifischen Antigens (PSA) beim Prostatakarzinom.

To recognize progression of an inoperable prostatic cancer we use clinical parameters and the prostate specific phosphatase. The prostate specific antigen (PSA) is a new, sensitive and specific laboratory tumor marker. With 363 specimens of patients without prostatic cancer we defined for the normal range of this serum parameter. In 98 men with histologically proven prostatic cancers we investigated for the clinical relevancy of the serum level of PSA. We believe, that measurement of serum PSA give important information for clinical management of prostatic cancer.

Application of fibrin adhesive in the urinary bladder.

The investigations on rats and pigs showed that the transuretheral haemostasis of the urinary bladder damaged by radiotherapy is possible by means of fibrin adhesion. The spraying procedure has to be carried out by means of a special balloon-catheter in a bladder filled with CO2. During spraying the bladder must be kept constantly free of pressure.

[Differential diagnostic problems of spontaneous rupture of the fornix]. / Differentialdiagnostische Probleme der spontanen Fornixruptur.

By means of two contrary cases of spontaneous peripelvic extravasations in i.v. urogramm is discussed. Anamnese, urological statement and clinical progress have to be seen in narrow connection with roentgenological statement. A sole conservative therapy is not possible in all cases.

[Control of glycolysis in magnesium deficiency: studies on intact red cells and hemolysates]. / Kontrolle der Glykolyse bei magnesiummangel: Untersuchungen an intakten roten Blutzellen und Hämolysaten.

The behaviour of glycolytic flux and glycolytic metabolic concentrations was studied under conditions of magnesium deficiency. The Mg-deficiency was produced in whole animals (rats) by feeding a diet almost completely free of Mg and in hemolysates of men by the addition of a chelating agent. The results show that the decrease of the free Mg-level is diminished by partial destruction of ATP and 2,3-DPG. The analysis of the control strength of the overall flux leads to the conclusion that the decrease of the glycolytic rate is caused by an inhibition of the hexokinase-phosphofructokinase-control system. The decrease of the MgATP-Complex and free Mg++-level explains the diminished phosphorylation of glucose by the hexokinase. The ATP-inhibition of the phosphofructokinase is amplified by a small increase of free ATP-concentration and a simultaneous decrease of the Fru-6P-level. The increase of the PEP-level is caused by the diminished free Mg++ and MgATP-complex and does not demonstrate a larger control strength of the pyruvate kinase.