The diagnostic significance of serum creatine kinase-BB isoenzyme in adenocarcinoma of prostate.

The relative diagnostic usefulness of total serum acid phosphatase, tartrate-inhibited fraction of acid phosphatase, immunoreactive prostatic acid phosphatase, and creatine kinase-BB isoenzyme was evaluated in 30 patients with biopsy-proven adenocarcinoma of prostate. The total and tartrate-inhibited acid phosphatase, measured by standard chemical methods, were elevated in 8 patients with stage D disease. The radioimmunoassay (RIA) method confirmed these abnormal values and also indicated the presence of elevated prostatic serum acid phosphatase in 3 additional patients. The electrophoretic fractionation of total serum creatine kinase (CK) into its various isoenzyme components showed the presence of CK-BB isoenzyme in 8 patients. In 5 of these patients with detectable CK-BB isoenzyme, RIA values for prostatic acid phosphatase were also elevated. Histologic studies of the prostatic tissues revealed that the presence of serum CK-BB was invariably associated with poorly differentiated adenocarcinoma of prostate. The results of the present studies indicate that 1) with simultaneous measurements of serum CK-BB and immunoreactive prostatic acid phosphatase laboratory confirmation of prostatic cancer can be obtained in 50 per cent of patients; 2) determination of total and tartrate-inhibited acid phosphatase along with CK-BB and immunoreactive prostatic acid phosphatase does not increase the frequency of correct diagnosis; and 3) the presence of serum CL-BB isoenzyme is suggestive of poorly differentiated adenocarcinoma of prostate.

Vasectomy: benefits and risks.

Bilateral occlusion of the vas deferens, vasectomy, is progressively becoming the method of choice for couples seeking permanent contraception at a younger age, with smaller families. They are apparently well-informed and view the procedure as a natural step. Vasectomy is an inexpensively performed office procedure that causes minimal disruption of routine and has a high degree of community acceptance. The risks of significant hematoma, infection, discomfort and other sequelae are within acceptable limits. Improved techniques will continue to reduce the small failure rate. Antibodies observed in half of the patients have not been linked to systemic disease, although they are a hazard for the one patient in 500 returning for a vasovasostomy. Refinements in microsurgery and availability of artificial insemination enhance vasectomy as the method of choice. Evidently, extending the minimum time of sterility confirmation permits detection of occasional recanalization from technical failures. Adequate screening of the couple's motivation and expectations can prevent the rare psychologic disturbances, the greatest risk with this procedure and a problem associated with all options. For the male, there is no competitive technique at this time. In a world striving for equal rights, where the female still carries the burden of temporary contraception, the simplicity and popularity of vasectomy for permanent contraception add the desired undertones of social equilibrium.