Expanded 99mTc-methylene diphosphonate (MDP) bone scan.

Patients with prostatic cancer frequently require evaluation of bony metastases as well as renal function. 99mTc-methylene diphosphonate, a commonly used bone-imaging agent, is about 60 per cent localized in the bony skeleton and about 40 per cent excreted by the kidneys. Immediate imaging after intravenous injection of the isotope may yield high-quality radionuclide nephrourograms, which provide excellent visual and graphic displays of renal anatomy and excretory function.

Lysis of osteoblastic lesions in prostatic cancer: a sign of progression.

Osteoblastic metastases from prostatic cancer often increase in density after successful endocrine treatment. Regrowth of malignancy, at the time of relapse, may cause osteolytic changes in previously stable sclerotic lesions. Four illustrative case reports are presented.

The flare phenomenon on radionuclide bone scan in metastatic prostate cancer.

The radionuclide bone scan 3 months after the initiation of treatment for advanced cancer of the prostate occasionally shows apparent progression of individual lesions despite clinical improvement. To determine the incidence and clinical significance of this so-called flare phenomenon, serial bone scans were reviewed in 33 patients with carcinoma of the prostate and bony metastases, who were receiving endocrine treatment for the first time. A flare reaction was seen in two (6%) of 33 bone scans obtained 3 months after initiation of treatment.

Immunohistochemical identification of prostatic acid phosphatase and prostate specific antigen in female periurethral glands.

Periurethral glands were found in 7 of 10 female urethras harvested at autopsy. In all 7 cases, immunoperoxidase staining showed the presence of prostatic acid phosphatase in glandular acini. By similar techniques, prostate specific antigen was demonstrated in acini of 4 of 7 urethras with periurethral glands.

Detection of ureteral obstruction on radionuclide bone scans.

The kidneys are nearly always visible on a routine radionuclide bone scan. To assess the reliability of the bone scan in detecting ureteral obstruction, 220 bone scans and excretory urograms were compared in 53 patients followed serially for prostatic cancer. There were 15 kidneys obstructed on excretory urograms.

Successful treatment of interstitial cystitis with sodium pentosanpolysulfate.

The surface of the bladder is lined by a layer of sulfonated glycosaminoglycans, of which the nonspecific anti-adherence effect is reproduced by synthetic sulfonated glycosaminoglycans. This mucous layer appears to be the most important line of defense between the transitional cells and all harmful substances in the urine. Many disease states may be associated with a deficiency in the anti-adherence activity of the glycosaminoglycan layer and may benefit from treatment with synthetic glycosaminoglycans.

Endocrine treatment of prostatic cancer.

Data are drawn from the pertinent literature supporting diethylstilbestrol for initial endocrine treatment of advanced prostatic cancer. When diethylstilbestrol is given in a dosage of 2 mg daily, the risk of cardiovascular complications is low. Bilateral orchiectomy is reserved for high-risk patients or those intolerant of estrogen.

Traumatic dislocation of the testes.

A case of bilateral inguinal dislocation of the testes in a motorcycle accident is reported and its pathogenesis is described. The injury probably results from the gasoline tank striking the perineum and the scrotum in the midline, causing upward and outward displacement of the testes and forcible herniation of the gonads through the coverings of the spermatic cord. If efforts at closed reduction are unsuccessful, management requires surgical exploration and orchiopexy.

Whither pelvic lymphadenectomy in prostatic cancer?

In the last decade pelvic lymphadenectomy has gained in popularity as a staging maneuver designed to improve the selection of patients with localized prostatic cancer for curative treatment, by uncovering lymph node metastases. The presence of tumor in the regional nodes portends substantial risk for the later appearance of distant metastases. With rare exceptions, lymphadenectomy is widely regarded as a staging procedure without therapeutic benefits.

The value of nuclear bone imaging in advanced prostatic cancer.

The nuclear bone scan is a highly sensitive means of detecting skeletal metastasis in patients with prostatic cancer. Serial bone imaging provides an accurate method to follow the response of osseous metastases to treatment and to detect relapsing disease in the skeleton. In selected instances the nuclear bone scan can provide information about vertebral metastases that can be important for planning palliative treatment of pain.

Antibacterial activity of bladder surface mucin duplicated in the rabbit bladder by exogenous glycosaminoglycan (sodium pentosanpolysulfate).

Previous data from our laboratory suggest that the transitional epithelium of the urinary bladder secretes and binds to its surface a glycosaminoglycan. The presence of this substance at the bladder surface markedly reduces the ability of microorganisms to adhere to the mucosa. Furthermore, this glycosaminoglycan can be removed (with acid) and replaced by intravesical instillation of a synthetic sulfonated glycosaminoglycan (heparin), whose presence is as effective as that of the natural glycosaminoglycan in reducing adherence.

The role of radiography, computed tomography and bone scanning in prostatic cancer.

This report reviews the roles of conventional radiography, computerized axial tomography, and nuclear bone scanning in the diagnosis, staging, follow-up, and management of prostatic cancer. Computed tomography (CT) offers great promise for the better definition of the extent of the primary tumor of prostatic cancer. It contributes positively to the planning of radiation therapy portals in the treatment of localized disease.

Thrombocytopenia during diethylstilbestrol diphosphate (stilphostrol) infusion for carcinoma of the prostate.

Transient thrombocytopenia was noted to occur in ten of 13 patients with advanced carcinoma of the prostate undergoing intravenous diethylstilbestrol diphosphate therapy. This was not associated with abnormalities of the initial platelet count or other parameters of the hemogram. There was no evidence of disseminated intravascular coagulation in these patients.

Osteoblastic response to successful treatment of metastatic cancer of the prostate.

Increasing sclerosis of bone in patients with prostatic cancer most commonly is associated with disease progression. In a study of serial radiographs in a group of 18 patients who experienced objective clinical remission after treatment of metastatic cancer of the prostate, eight (44%) showed an osteoblastic response as part of their healing reaction to successful therapy. The importance of a blastic response as a possible sign of clinical improvement is emphasized.

Bone pain in metastatic cancer of prostate.

The characteristics of bone pain in metastatic cancer of the prostate were studied in 23 patients. The pain may be continuous or intermittent, show diurnal variations, and be migratory. The effects of activity, rest, and alcohol vary in different individuals.

Diagnostic fine needle aspiration of soft tissue metastases from cancer of the prostate.

Pathologic confirmation of soft tissue metastases is necessary for staging and followup of patients with cancer of the prostate. Fine needle aspiration with cytologic evaluation is recommended over other biopsy procedures because it is safe, accurate and applicable to deep and superficial lesions. Small metastases, such as lymph nodes or skin nodules, remain in situ as useful markers to follow the course of the disease and response to treatment.

The angiographic evaluation of renal pelvic carcinoma.

The angiographic findings are described in 6 cases of renal pelvic carcinoma. An angiographic finding which has not hitherto been emphasised is a diminished branching of arteries in the kidney segment related to the pelvi-calyceal tumour--the "pruned-tree" appearance. This is generally associated with a deficiency of the nephrogram in the same segment.