Impact of preoperative antiandrogen medication and nerve-sparing surgery on the outcome of radical prostatectomy.

OBJECTIVES: Radical prostatectomy in antiandrogen-medicated patients, as well as nerve-sparing surgery, has increased within recent years. We investigated the impact of antiandrogen medication on loss of blood and of nerve-sparing surgery on continence and potency. METHODS: A total of 401 men who underwent radical prostatectomy between January 1995 and September 1999 at our clinic were asked about antiandrogenic medication prior to radical prostatectomy and about daily life activities, overall satisfaction, voiding ability, and sexual activities. Consumption of erythrocyte concentrates and cryoprecipitated plasma was taken from the records. RESULTS: The average follow-up was 36 months. Seventy-two percent (n = 289) of our patients replied. Sixty-seven men (23%) who replied to our questionnaire had received antiandrogen medication prior to radical prostatectomy. In 53 (18%) of the men, the nerve-sparing technique was used. In antiandrogen-medicated patients, we observed a significantly elevated consumption of erythrocyte concentrates (antiandrogen-medicated 0.93, not antiandrogen-medicated 0.44; P = 0.013) and of cryoprecipitated plasma (antiandrogen-medicated 0.39, not antiandrogen-medicated 0.08; P = 0.010). Patients who underwent the nerve-sparing technique reported better results in daily life activities, general health status, International Prostate Symptom Score (IPSS), and continence. CONCLUSION: Our results point to a higher quality of life in patients who had undergone nerve-sparing surgery.

[Occupational and non-occupational risk factors in bladder cancer patients in an industrialized area located in former East-Germany]. / Berufliche und ausserberufliche Risikofaktoren für das Harnblasenkarzinom in einem ehemaligen Industriegebiet der neuen Bundesländer.

PURPOSE: Several occupational carcinogens are metabolized by polymorphic enzymes. The distribution of the polymorphic enzymes N-acetyltransferase 2 (NAT2; substrates: aromatic amines), glutathione S-transferase M1 (GSTM1; substrates: e. g., reactive metabolites of polycyclic aromatic hydrocarbons), and glutathione S-transferase T1 (GSTT1; substrates: small molecules with 1 - 2 carbon atoms) were investigated. MATERIAL AND METHODS: At the urological department in Lutherstadt Wittenberg, 136 patients with a histologically proven transitional cell cancer of the urinary bladder were investigated for all occupations performed for more than 6 months. Several occupational and non-occupational risk factors were asked. The genotypes of NAT2, GSTM1, and GSTT1 were determined from leucocyte DNA by PCR. RESULTS: Compared to the general population in Middle Europe, the percentage of GSTT1 negative persons (22.1 %) was ordinary; the percentage of slow acetylators (59.6 %) was in the upper normal range, while the percentage of GSTM1 negative persons (58.8 %) was elevated in the entire group. Shifts in the distribution of the genotypes were observed in subgroups who had been exposed to asbestos (6/6 GSTM1 negative, 5/6 slow acetylators), rubber manufacturing (8/10 GSTM1 negative), and chlorinated solvents (9/15 GSTM1 negative). CONCLUSIONS: The overrepresentation of GSTM1 negative bladder cancer patients also in this industrialized area and more pronounced in several occupationally exposed subgroups points to an impact of the GSTM1 negative genotype in bladder carcinogenesis.

[Quality of life following radical prostatectomy]. / Lebensqualität nach radikaler Prostatektomie.

PURPOSE: To investigate quality of life in prostate cancer patients after radical retropubic prostatectomy. MATERIALS AND METHODS: 401 men who underwent radical prostatectomy between January 1995 and September 1999 at our clinic were asked for information concerning daily life activities, overall satisfaction, voiding ability and sexual activity in standardized questionnaire. RESULTS: The average follow-up was 36 months, 72 % (n = 289) of our patients replied. In 53 (18%) of the men who replied to our questionnaire, the nerve-sparing technique had been used. At the time our patients were questioned, 202 (70%) did not use any pads, and 211 (73%) were satisfied or very satisfied with the outcome. Of these patients 98% would undergo a radical prostatectomy again. 13% (n = 37) of our patients reported limited satisfaction, 14% (n = 41) were not satisfied with their postoperative status. However, 69% of this latter group would nevertheless decide to have a radical prostatectomy again. Of the patients who underwent the nerve-sparing technique, 68% (n = 36) reported sufficient erections for sexual intercourse, four of them under medication with sildenafil. Patients who underwent the nerve-sparing technique reported better results in daily life activities, general health status, IPSS-score and continence. While age at the time of radical prostatectomy did not influence life quality, we found substantial correlation with the postoperative tumor stage. CONCLUSIONS: Our results underline the importance of early prostate cancer detection, not only regarding a lower recurrence rate, but also because of a better postoperative quality of life.

Prediction of locoregional extension and metastatic disease in prostate cancer: a review.

Despite efforts to enhance the accuracy of prediction of extraprostatic disease, approximately 40% of the men undergoing radical prostatectomy are found at surgery to have non-organ-confined cancer. Predictive algorithms based on multivariate regression analysis and neural networks are widely available and are superior to our standard empirical methods of clinical staging. These algorithms have been validated in diverse and well-characterized patient groups. For enhancement of the predictive value, data input must be standardized and improved input variables must be incorporated. In addition to the three "classic" staging parameters, i.e., pretreatment prostate-specific antigen (PSA), biopsy pathology, and digital rectal examination, new variables now show promise in predicting disease extent and may be integrated in future predictive models. This review focuses on our present methods for prediction of locoregional spread and distant metastases in men with clinically localized prostate cancer.

[Occupational risk factors for bladder carcinoma. A case control study]. / Berufliche Risikofaktoren des Harnblasenkarzinoms. Eine Fallkontrollstudie.

Aim of this case-control study, performed on 412 male bladder cancer cases and 414 controls with benign prostatic hyperplasia in a former area of coal, iron and steel industries in Germany, was to identify occupations with an increased bladder cancer risk. In bladder cancer cases, smokers were overrepresented (58.3%) compared to controls (35.2%). The percentage of patients who had stopped smoking for at least 10 years did not differ in cases (10.2%) and controls (9.7%). Significantly elevated smoking-adjusted bladder cancer odds ratios (MH) were observed in painters and lacquers (MH 2.24, 95% CI 1.07-5.13), chemistry-related occupations (MH 2.44, 95% CI 1.05-5.67), coke plant workers (MH 2.89, 95% CI 1.16-7.16) and hard coal miners (MH 2.33, 95% CI 1.52-3.58). Significantly decreased smoking-adjusted bladder cancer odds ratios (MH) were observed in businessmen (MH 0.64, 95% CI 0.45-0.92) and office personnel (MH 0.58, 95% CI 0.41-0.81). In these two groups a relevant exposure to occupational bladder carcinogens is not likely.

Artificial neural networks in urology: Update 2000.

Artificial neural networks (ANNs) are widely available and have been demonstrated to be superior to standard empirical methods of detecting, staging and monitoring prostate cancer. These algorithms have been statistically validated in diverse, well-characterized patient groups and are now being evaluated for clinical use worldwide. New variables based on demographic data, tissue and serum markers show promise for improving our ability to predict disease extent and outcome and may be integrated in future ANN models. This review focuses on recently developed neural networks for detecting, staging and monitoring prostate cancer.

Urothelial cancer of the bladder in an area of former coal, iron, and steel industries in Germany: a case-control study.

In a case-control study performed in an area of former coal, iron, and steel industries, the professional and lifestyle histories of 412 male urothelial bladder cancer inpatients (cases) and 414 inpatients with benign prostatic hyperplasia (controls) were investigated. Smoking habits were identified as the main confounder for occupational bladder cancer risk. Two hundred and forty (58.3%) of the bladder cancer inpatients and 146 (35.3%) of the inpatients with benign prostatic hyperplasia were smokers. The percentage of ex-smokers in the bladder cancer cases was 10.2%; the percentage of ex-smokers in the controls was 9.7%. Smoking-adjusted Mantel-Haenszel estimates of the odds ratios (OR&infMH;) for bladder cancer were elevated in underground hard-coal miners (OR&infMH; =2. 54, 95% CI =[1.64; 3.93]), chemical workers (OR&infMH; =2.16, 95% CI =[0.87; 5.38]), painters/varnishers (OR&infMH; = 2.42, 95% CI =[1. 05; 5.57]), technicians (OR&infMH; = 1.99, 95% CI =[0.95; 4.16]), and foundry workers (OR&infMH; = 2.22, 95% CI = [0.53; 9.08]). Administrative officers had significantly lower smoking-adjusted odds ratios (OR&infMH; = 0.61, 95% CI = [0.42; 0.88]). Although statistically not significant, the results of the Breslow-Day test of homogeneity of the odds ratios over the strata are compatible with interactions between tobacco smoking and the occupations of underground hard-coal miners (chi(2)&infBD; = 4.91, p=0.07) and chemical workers (chi(2)&infBR; = 3.32, p=0.06).

N-Acetyltransferase 2 (NAT2) and Glutathione S-Transferase µ (GSTM1) in Bladder-cancer Patients in a Highly Industrialized Area.

The study was designed to assess occupational and non-occupational risk factors in patients with urothelial carcinomas in an area of former coal, iron, and steel industries, with special regard to the impacts of polymorphic enzymes involved in the metabolism of aromatic amines (N-acetyltransferase 2, NAT2) and of polycyclic aromatic hydrocarbons (glutathione S-transferase µ, GSTM1). Inpatients with bladder cancer (n = 179) were interviewed for occupations ever engaged in for more than six months, and for bladder cancer risk factors in general. NAT2 was phenotyped by high-pressure liquid chromatography of caffeine metabolites in urine. The NAT2 status was additionally evaluated by genotyping 88 of these patients. Eighty-nine patients were genotyped for GSTM1. Of the 179 bladder-cancer patients, 115 (64%) were slow acetylators. In 70% of the subgroup of 89 patients, GSTM1 was negative, suggesting an impact of polycyclic aromatic hydrocarbons (PAHs) in bladder-cancer carcinogenesis in the general population in this area. Contrary to an ordinary distribution of the acetylator status in underground coal miners (18 slow acetylators out of 32), GSTM1 was negative in 16 of 19 of these coal miners. Five of six coke-oven workers were slow acetylators; GSTM1 was negative in all four genotyped coke-oven workers. Twelve of 17 patients formerly exposed to colorants were slow acetylators. Distributions of NAT2 (59% slow acetylators) and GSTM1 (54% GSTM1 negative) were normal in businessmen and administrative officers among the occupationally non-exposed bladder-cancer patients. The results are consistent with the view that a slow-acetylator status and lack of the GSTM1 gene are individual risk factors for bladder cancer in persons occupationally exposed to aromatic amines and PAHs. Aromatic amines may be connected with induction of bladder cancer in persons who have been in contact with azo dyes and in coke-oven workers. PAHs may also contribute to elevated bladder-cancer risks in coke-oven workers and in underground coal miners.

Glutathione S-transferase GSTM1 and GSTT1 null genotypes as potential risk factors for urothelial cancer of the bladder.

One-hundred-and-thirteen patients with cancer of the urinary bladder (cases) were examined with respect to the frequency of null genotypes of the polymorphic glutathione S-transferases GSTM1 and GSTT1. The allelic background in the German population of the area was evaluated by analysing 170 newborns (controls). The frequency of GSTM1 and GSTT1 null genotypes in this population, using methods based upon internal standard controlled polymerase chain reaction (PCR), was 0.54 and 0.18 respectively. An elevated relative bladder cancer risk of GSTM1 null genotype carriers was indicated by comparison of this background with the data of the bladder cancer cases (OR = 1.81; 95% CI [1.10, 2.98]; p = 0.019). The frequencies of the GSTT1 null genotype in the total group of bladder cancer cases versus controls did not differ statistically. However, a significantly higher relative risk of bladder cancer for the GSTT1 null genotype was detected in the cases-subgroup of non-smokers (OR = 3.84; 95% CI [1.21, 12.23]; p = 0.023). Thus, the GSTT1 null genotype might represent a minor risk factor for human bladder cancer which should be further investigated.