Clinical and pathologic tumor characteristics of prostate cancer as a function of the number of biopsy cores: a retrospective study.

Objectives: Many men with negative prostate biopsies and persistently elevated serum total prostate-specific antigen (tPSA) values will have cancer detected on a repeated biopsy. An important issue is whether the cancer would have been detected on the initial biopsy had more biopsy samples been obtained. The objective of our study was to retrospectively characterize the clinical and pathologic tumor features associated with men who underwent sextant core biopsies compared with men who needed more than six core biopsies during one or more biopsy sessions to detect prostate cancer.

Predicting the pathology results of radical prostatectomy from preoperative information: a validation study.

Background: There are now over 13 published models for predicting the outcomes of radical prostatectomy using preoperative information. Because their ability to predict the pathology of the prostatectomy is key in deciding who benefits the most from this surgery, it is important to know how well these models work for new data.

Methods: The patients in this study were 100 men diagnosed with prostate carcinoma in the prostate specific antigen (PSA)-based screening program at Washington University Medical Center.

Minimal carcinoma in prostate needle biopsy specimens: diagnostic features and radical prostatectomy follow-up.

Prostate cancer screening and early detection efforts have resulted in the identification of smaller volume carcinomas of the prostate. We evaluated the diagnostic features of minimal (< 1 mm) carcinoma in sextant needle biopsy specimens of the prostate and in follow-up analyzed the features of the corresponding carcinomas in the whole gland. We reviewed specimens from 50 consecutive patients who had minimal carcinoma in needle biopsy tissue and who had undergone radical prostatectomy.

Percentage of free serum prostate-specific antigen as a predictor of pathologic features of prostate cancer in a screening population.

Objectives: Measurement of the percentage of free prostate-specific antigen (%FPSA) in serum can improve the specificity of prostate cancer screening. We evaluated the ability of %FPSA to predict pathologic features of screen-detected clinically localized prostate cancer.

Methods: We evaluated the correlation between %FPSA in serum before cancer diagnosis and the pathologic features of the cancers detected in 108 men with clinically localized prostate cancer who were treated with radical prostatectomy and for whom complete embedding of the radical prostatectomy specimen was performed.

A clinical-care pathway for decreasing hospital stay after radical prostatectomy.

Objectives: To evaluate the use of a clinical-care pathway that decreased the stay in hospital after radical retropubic prostatectomy from 3 to 2 days, assessing the costs and quality of care.

Patients And Methods: Forty-four consecutive men who underwent radical retropubic prostatectomy were evaluated prospectively. The first 22 men were hospitalized under the standard 3-day clinical-care pathway in use at our institution.

Comparison of percent free prostate-specific antigen levels in men with benign prostatic hyperplasia treated with finasteride, terazosin, or watchful waiting.

Objectives: Finasteride is known to lower total serum prostate-specific antigen (PSA) levels by approximately 50%. Terazosin is thought to have little or no effect on serum PSA concentration. The objective of our study was to determine the effect of finasteride and terazosin on serum total and serum free PSA levels and the ratio of free to total PSA.

The significance of intraluminal crystalloids in benign prostatic glands on needle biopsy.

Based on data from autopsy, radical prostatectomy, and cystoprostatectomy specimens, it has been suggested that the finding of intraluminal crystalloids in benign glands on needle biopsy may indicate a concurrent carcinoma; therefore, repeat biopsy is recommended. We studied data from 56 consecutive needle biopsies from the Johns Hopkins Hospital and Dianon Systems in which the diagnosis of intraluminal crystalloids in benign glands was rendered and follow-up data were subsequently obtained. Cases in which crystalloids were present in glands suspicious for cancer, in glands of high-grade prostatic intraepithelial neoplasia, or in adenosis were excluded from the study.

Prostate-specific antigen as a screening test for prostate cancer. The United States experience.

Serum PSA-based early detection for prostate cancer has been studied fairly extensively for the past several years. It appears that we can state fairly categorically what the relative performances of total serum PSA, DRE, and TRUS are in detecting early-stage prostate cancer; that initial screening is effective in detecting histologically significant and pathologically organ-confined prostate cancer; that annual, serial, repetitive screening, at least over a 4- to 5-year horizon, does not overdetect prostate cancer, and that the results of early detection will improve as our ability to use certain PSA transformations such as PSA density, PSA slope, age-specific PSA adjustment, and knowledge of free versus total serum PSA is better characterized. These advances in our ability to diagnose early-stage prostate cancer likely will be coupled with an increased ability to predict the behavior, curability, and significance of individual tumors.

Sonographic prediction of viability in testicular torsion: preliminary observations.

This study was performed to determine if sonography can assist in predicting testicular viability in the setting of testicular torsion. Sixteen patients with sonographically diagnosed and surgically proved testicular torsion were studied. The preoperative sonograms were reviewed retrospectively to determine testicular echogenicity and homogeneity, testicular size and vascularity, scrotal skin thickness and vascularity, and the presence or absence of a hydrocele.

Repeat biopsy strategy in men with isolated prostatic intraepithelial neoplasia on prostate needle biopsy.

Purpose: Isolated high grade prostatic intraepithelial neoplasia on needle biopsy of the prostate is a strong predictor of malignancy on repeat biopsy. However, the optimal repeat biopsy technique for these patients has not been defined.

Materials And Methods: We reviewed the records of 66 men in whom isolated prostatic intraepithelial neoplasia was found on needle biopsy of the prostate.

Prostate specific antigen density versus prostate specific antigen slope as predictors of prostate cancer in men with initially negative prostatic biopsies.

Purpose: We determined if prostate specific antigen (PSA) density and PSA slope alone or in combination could be used to predict which men with persistently elevated serum PSA and prior negative prostate biopsies will have prostate cancer on repeat evaluation.

Materials And Methods: In our PSA-1 data base we identified 327 men 50 years old or older with an initially negative prostate biopsy who had persistent PSA elevation, and compared those who did and did not have prostate cancer on subsequent serial prostatic biopsy.

Results: Of 70 men with a PSA density of 0.

Clinical and pathological features of hereditary prostate cancer.

Purpose: We determined whether the clinical and pathological features of hereditary prostate cancer differ from those of sporadic prostate cancer.

Materials And Methods: We compared the clinical and pathological features of radical prostatectomy specimens from 50 men with and 50 without a family history of prostate cancer who were matched for age and date of surgery.

Results: Median serum prostate specific antigen concentration was not significantly different in the 2 groups.

Prospective characterization of pathological features of prostatic carcinomas detected via serum prostate specific antigen based screening.

Purpose: Many small (less than 0.5 cc), well differentiated, organ-confined prostate carcinomas remain clinically undetected during the life of the patient and are identified only at postmortem examination. Thus, these cancers are often called latent or autopsy cancers.

Familial aspects of prostate cancer: a case control study.

Purpose: We evaluated the importance of positive family history, age at diagnosis and history of vasectomy in predicting the risk for prostate cancer in the brothers of prostate cancer patients.

Materials And Methods: A total of 1,084 men with newly diagnosed prostate cancer responded by interview to a family history survey, which included detailed information on the diagnosis of any cancer in the parents of the proband, diagnosis of prostate cancer in male relatives and age at onset of prostate cancer in the proband. A history of vasectomy was also obtained from the proband.

Prostatic transition zone biopsies in men with previous negative biopsies and persistently elevated serum prostate specific antigen values.

Purpose: In men with persistently elevated serum prostate specific antigen (PSA) concentrations and prostatic biopsies that show no cancer an important question is whether the PSA elevation is caused by undetected cancer in the transition zone of the prostate gland.

Materials And Methods: To evaluate this issue further we examined 166 men age 50 years of older who participated in a PSA based screening trial for prostate cancer. All men had an initially elevated serum PSA concentration of 4.

Morphometric analysis and clinical followup of isolated prostatic intraepithelial neoplasia in needle biopsy of the prostate.

Purpose: We evaluate the significance of grade and extent of isolated prostatic intraepithelial neoplasia in prostate needle biopsies as a predictor of cancer on repeat biopsy.

Materials And Methods: We reviewed our experience with 58 men 50 years or older who had isolated prostatic intraepithelial neoplasia on initial prostate needle biopsy during a prostate specific antigen (PSA) based screening trial for prostate cancer. All 58 men underwent repeat biopsy to follow the initial findings of prostatic intraepithelial neoplasia.

Cryosurgical ablation of the prostate.

A new surgical procedure, cryosurgical ablation of the prostate, offers patients with organ-confined prostate cancer another treatment option. The advantages of this cryosurgical technique are complete ablation of prostatic cancers without radical prostatectomy procedures, less blood loss, decreased hospital stays, reduced health care costs, and minimal associated morbidity. Some possible complications of cryosurgical ablation of the prostate procedures include incontinence, impotence, rectal freezing from inadequate monitoring of the freezing process, urethrocutaneous and urethrorectal fistula formations, and urethral tissue sloughing.

Medical therapy for benign prostatic hyperplasia.

Benign prostatic hyperplasia (BPH) is a common clinical entity in elderly men. We review the epidemiology of BPH and the mechanisms by which it causes bladder outlet obstruction. The currently available medical therapies are examined with respect to mechanism of action, effectiveness, side effects, and cost.

Optimal therapy for the distal ureteral stone: extracorporeal shock wave lithotripsy versus ureteroscopy.

Extracorporeal shock wave lithotripsy (ESWL not equal to) is the optimal therapy for renal calculi less than 2 cm. in diameter and for proximal ureteral calculi. Controversy continues over the initial approach to distal ureteral calculi (that is below the bony pelvis): in situ ESWL versus ureteroscopy.

Development of a mouse model for nonbacterial prostatitis.

Nonbacterial prostatitis is a common clinical entity which is often difficult to diagnose and treat. Little is known with regard to the etiology and pathogenesis of this disease process. To develop an animal model and characterize the immune parameters of nonbacterial prostatitis, we harvested the prostates from SJL, AJ, Balb/c, C57bl/6 and C57bl/6 lpr mice.

Serial prostatic biopsies in men with persistently elevated serum prostate specific antigen values.

The objective of this study was to determine the need for repeat prostatic biopsies in men whose initial biopsy results revealed no evidence of cancer or atypia. We evaluated 1,136 men who underwent 1 or more prostatic biopsies in a longitudinal prostate specific antigen (PSA) based prostate cancer screening study that called for biopsy if the serum PSA level was greater than 4.0 ng.

Transitional cell carcinoma of bladder in children and adolescents.

Transitional cell carcinoma of the bladder is rare in patients under sixteen years of age. A case is described in a ten-year-old boy, and the literature is reviewed. The diagnosis and treatment of this tumor is the same in childhood as in older patients.

Modification of Mitrofanoff principle for continent urinary diversion.

In 1980, Mitrofanoff described a method of achieving continent urinary diversion by surgically closing the bladder neck and creating a continent catheterizable stoma from the appendix, which had been implanted in a non-refluxing manner into the bladder, or from a non-refluxing distal ureter. We describe a modification of the Mitrofanoff procedure for continent urinary diversion in 7 children in whom a standard Mitrofanoff procedure was not possible due to either body habitus or appendiceal anatomy. All 7 patients are continent both day and night.