Prospective use of free PSA to avoid repeat prostate biopsies in men with elevated total PSA.

Background: Prostate-specific antigen (PSA) is a most valuable tool for the early detection of prostate cancer; however, it has a high false-positive rate as presently used in prostate cancer screening programs. Patients with persistent PSA elevations, normal digital rectal examinations, and multiple negative biopsies present a clinical dilemma. We prospectively evaluated whether free PSA improves the specificity of PSA and can be useful as a clinical guide to avoid repeat prostate biopsies in a group of such patients.

Recombinant adenovirus vector expressing wild-type p53 is a potent inhibitor of prostate cancer cell proliferation.

Objectives: A recombinant adenovirus vector (AdWTp53) expressing wild-type p53 was evaluated for its cell growth inhibitory effects on metastatic human prostate cancer cells.

Methods: Human prostate cancer cells LNCaP, DU145, PC3, 1LN, and DUPro-1 were infected with AdWTp53 vector and expression of exogenous p53 in these cells was analyzed by immunoprecipitation and western blot assays. The cell growth inhibitory effects of AdWTp53 were determined by counting cell number on a hemocytometer or by crystal violet staining of cells after infection with AdWTp53.

p53 nuclear protein expression is an independent prognostic marker in clinically localized prostate cancer patients undergoing radical prostatectomy.

Immunohistochemical (IHC) staining for p53 protein nuclear expression was evaluated in archival paraffin-embedded radical prostatectomy specimens from 139 patients with clinically localized prostate cancer followed up from 1 to 8 (mean, 4) years. Elevated nuclear p53 protein expression was detected in 85 (61%) of 139 patients, being heterogeneous and focal in the majority of specimens. Only four specimens displayed homogeneous nuclear accumulation of p53 protein.

Prostate-specific antigen values at the time of prostate cancer diagnosis in African-American men.

Objective: To determine if African-American men with newly diagnosed prostate cancer (PC) have higher pretreatment serum prostate-specific antigen (PSA) values after adjustment for clinical stage, age, and tumor grade, and to determine if any difference detected is related to tumor volume difference.

Design: Consecutive case series of newly diagnosed PC patients between January 1990 and September 1994 and cohort analytic study of PC patients treated by radical prostatectomy (RP) and who had whole-mount pathologic tumor volume assessment between May 1993 December 1994.

Setting: Tertiary care military medical center.

Proper staging techniques in testicular cancer patients.

Testicular cancer has become a highly curable neoplasm, and research efforts in the 1990s are focusing on ways to improve staging and treatment so as to limit cost and morbidity. Our group has performed a number of recent studies that help to answer a number of important clinical questions. First, do we need to order computed tomography of the chest (CCT) to stage all newly diagnosed patients? Second, how accurate is contemporary era abdominal CT to stage the retroperitoneum in low-stage nonseminoma patients, and are there techniques that may improve accuracy? Third, can histological primary tumor factors be useful to predict stage in low-stage nonseminoma patients? In a study of 201 testicular cancer patients [117 (58%) NSGCT, 84 (42%) seminoma] who had both CCT and chest X-ray (CXR) in initial staging, CXR alone was found to be sufficient initial chest staging in all seminoma patients and in NSGCT patients who had a negative abdominal (CTA).

Increased p53 protein does not correlate to p53 gene mutations in microdissected human testicular germ cell tumors.

Purpose: To determine if primary testicular germ cell tumors that overexpress p53 tumor suppressor gene protein have p53 gene mutations.

Materials And Methods: We examined 30 primary testicular tissues from 26 patients representing two groups. Group one consisted of eleven cases (6 nonseminomatous germ cell tumors and 5 seminomas) in which tissue samples for DNA analysis were microdissected from paraffin block regions with elevated immunohistochemical staining for p53 protein.

Alteration of the tumor suppressor gene p53 in a high fraction of hormone refractory prostate cancer.

Purpose: We studied the role of p53 tumor suppressor gene alteration in prostate cancer progression by demonstrating a difference in abnormal p53 findings between early and hormone refractory disease.

Materials And Methods: The study included p53 immunohistochemistry of 26 archival transurethral resection specimens from patients with radiation recurrent and hormone refractory disease, 27 untreated primary tumors and 8 untreated metastatic lesions. p53 mutation analysis of tumor deoxyribonucleic acid (DNA) from microdissected specimens was done by cold single strand conformational polymorphism and DNA sequencing.

Neural network analysis of quantitative histological factors to predict pathological stage in clinical stage I nonseminomatous testicular cancer.

A great deal of controversy exists in staging clinical stage I (CSI) nonseminomatous testicular germ cell tumors (NSGCT) because of the difficulty of distinguishing true stage I patients from those with occult retroperitoneal or distant metastases. The goal of this study was to quantitate primary tumor histologic factors and to apply these in a neural network computer analysis to determine if more accurate staging could be achieved. All available primary tumor histological slides from 93 CSI NSGCT patients were analyzed for vascular invasion (VI), lymphatic invasion (LI), tunical invasion (TI) and quantitative determination of percentage of the primary tumor composed of embryonal carcinoma (%EMB), yolk sac carcinoma (%YS), teratoma (%TER) and seminoma (%SEM).

Controversies in the treatment of prostate cancer with maximal androgen deprivation.

The concept of maximal androgen deprivation (MAD) has become the accepted therapy for metastatic prostate cancer. MAD is also under investigation as neoadjuvant therapy prior to radical prostatectomy and radiation therapy. Innovative new approaches, such as intermittent androgen deprivation and new combination therapies, will emerge over the next decade.

Comparative studies of prostate cancers among United States, Chinese, and Japanese patients: characterization of histopathology, tumor angiogenesis, neuroendocrine factors, and p53 protein accumulations.

Although interracial differences of prostate cancer progression are well recognized, their underlying molecular and cellular mechanisms remain obscure. We compared the histopathologic, immunohistochemical, and molecular characteristics of unselected prostate cancer tissues obtained from U.S.

Recurrent metatarsal stress fractures in a college football lineman.

Stress fractures are common overuse injuries of bone attributed to repetitive trauma, training errors, and/or structural abnormalities. A 21-year-old, 252-lb football lineman participating in spring conditioning drills complained of right foot pain following a plantar flexion, inversion injury that occurred while cutting. Pain was concentrated over the dorsum of the foot in both weight bearing and at rest.

Evaluation of cathepsin D and epidermal growth factor receptor in prostate carcinoma.

Differential reactivity for cathepsin D (cath-D) and epidermal growth factor receptor (EGFR) was compared in 102 archival cases of human primary prostatic carcinoma and nine prostate carcinoma metastases by immunohistochemical techniques using commercially available antibodies (Ciba-Corning, Triton Diagnostics Division, Alameda, CA). Western immunoblotting confirmed that the anti-cath-D and anti-EGFR antibodies recognized the appropriate-sized proteins in extracts of human prostatic carcinoma cell lines. For immunohistochemical analysis, the primary prostate carcinomas ranged from Gleason's combined scores of 2 to 9.

Thymic hyperplasia in newly diagnosed testicular germ cell tumors.

Thymic hyperplasia has been reported as a rebound phenomenon in children and young people, most commonly following chemotherapy for cancer. Although thymic hyperplasia has been documented in testis cancer patients after chemotherapy, to our knowledge it has not previously been reported in newly diagnosed cases before systemic therapy. A retrospective review of 362 testicular germ cell tumor patients treated at a single tertiary care center between January 1, 1980 and August 1, 1993 was performed, with special review of 221 who underwent computerized tomography staging of the chest.

Retroperitoneal imaging with third and fourth generation computed axial tomography in clinical stage I nonseminomatous germ cell tumors.

Objectives: To examine the accuracy rate of abdominal staging using third and fourth generation computed tomography (CT) scanning in clinical Stage I testicular nonseminoma patients.

Methods: Between January 1985 and August 1993, 57 patients presented to our center with clinical Stage I testicular nonseminoma. Retroperitoneal computed tomographic staging studies were interpreted to be normal preoperatively in the entire group.

Proliferating cell nuclear antigen expression to predict occult disease in clinical stage I nonseminomatous testicular germ cell tumors.

We analyzed primary tumor tissue from 89 clinical stage I nonseminomatous germ cell testicular tumor patients for proliferating cell nuclear antigen expression and histological features to determine if these elements could distinguish pathological stage I (52 patients) from pathological stage II disease or patients who later had relapse (37). Using a monoclonal antibody (PC10) developed for use in archival tissue, nuclear proliferating cell nuclear antigen expression was immunohistochemically measured for the overall tumor (total proliferating cell nuclear antigen) and for each neoplastic cell type present. In addition, the primary tumor was examined for the presence of vascular invasion and determination of the percentage of tumor composed of embryonal carcinoma.

Clinically detected carcinoma of the prostate treated by radical prostatectomy in a 29-year-old man.

Prostate cancer is rare in young adults and when clinically detected it has been invariably locally or distantly advanced, undifferentiated and exhibiting aggressive behavior. To our knowledge no previous report documents clinically detected and localized disease amenable to curative surgery in a young adult. We report on a 29-year-old man with clinically detected, moderately differentiated adenocarcinoma of the prostate who was treated by nerve sparing radical retropubic prostatectomy.

Efficacy of radiographic chest imaging in patients with testicular cancer.

Objective: To determine the efficacy of computed tomography of the chest (CTC) and plain radiograph (CXR) in the initial staging process of testicular germ cell tumors.

Methods: The medical records of 362 patients with testicular germ cell tumor treated at our center between January 1980 and August 1993 were reviewed with particular attention to initial chest screening studies. Two hundred one patients had both CXR and CTC, 24 CXR alone, and 20 CTC alone during initial staging.

Immunohistochemical expression of P53 tumor suppressor gene protein in adult germ cell testis tumors: clinical correlation in stage I disease.

P53 tumor suppressor gene protein immunostaining was evaluated in the primary tumor of adult testicular germ cell cancer to assess if P53 expression would serve as a clinically useful tumor marker. Representative archival tissues from 152 orchiectomy specimens were studied for P53 immunohistochemistry. Seminoma and nonseminomatous germ cell tumor constituents revealed P53 expression via immunohistochemistry in 90% and 94% of the cases, respectively.

Frequent detection of codon 877 mutation in the androgen receptor gene in advanced prostate cancers.

Prostatic tissue specimens derived from transurethral resections of patients with metastatic prostate cancer were analyzed for genetic alterations in the hormone-binding domain of the androgen receptor (AR) gene. Direct sequencing of the polymerase chain reaction-derived DNAs of 6 of 24 specimens revealed a codon 877 mutation (ACT-->GCT, Thr-->Ala) in the hormone-binding domain of the AR gene. This same AR mutation has been reported previously in a metastatic prostate cancer cell line, LNCaP, where this mutation confers upon the AR an altered ligand-binding specificity which is stimulated by estrogens, progestagens, and antiandrogens.

Testicular cancer in blacks. A multicenter experience.

Background: The rarity of testis tumor in black patients has made the study of a large series difficult. Much of the epidemiologic and clinical information regarding this neoplasm in this population is in dispute, including data on incidence, prognosis, histologic distribution, age and stage at presentation, and side distribution.

Methods: A retrospective review of 66 blacks with testicular tumors from seven military medical centers was performed.

Percentage of embryonal carcinoma and of vascular invasion predicts pathological stage in clinical stage I nonseminomatous testicular cancer.

We analyzed 92 clinical stage I nonseminomatous testicular germ cell tumors for primary tumor histological factors that would distinguish true pathological stage I disease (N = 54) from those patients who harbored occult disease and actually were later found to have pathological stage II disease (N = 38). Primary tumor pathological material was analyzed for vascular invasion, lymphatic invasion, tunical invasion, and quantitative determination of percentage of the primary tumor composed of embryonal carcinoma, yolk sac carcinoma, teratoma, and seminoma. Univariate logistic regression analyses revealed that vascular invasion (P = 0.