Morbidity and mortality of local failure after definitive therapy for prostate cancer.

We reviewed our experience with morbidity and mortality associated with clinical local failure after definitive therapy for adenocarcinoma of the prostate by interstitial 125iodine implantation, external beam radiation therapy or radical prostatectomy. Morbid complications included unilateral ureteral obstruction; bladder obstruction and/or incontinence requiring treatment by transurethral resection, or placement of a urethral or suprapubic catheter; hematuria requiring intervention for clot evacuation or fulguration, and perineal and/or pelvic pain. Lethal complications included bilateral ureteral obstruction or bowel obstruction.

Half-body irradiation for treatment of widely metastatic adenocarcinoma of the prostate.

A total of 31 patients with prostatic adenocarcinoma received a total of 35 half-body irradiation treatments; 13 treatments of 600 to 800 cGy. to the upper half and 22 treatments of 400 to 1,000 cGy. to the lower half of the body.

Flow cytometric study comparing paired bladder washing and voided urine for bladder cancer detection.

Paired bladder washings and voided urines from bladder cancer patients were compared as sources of exfoliated cells for detection of bladder carcinoma by flow cytometry (FCM). Bladder specimens fixed in 25% ethanol within sixty minutes of collection were found to be superior to unfixed bladder specimens. The percentage of specimens with good DNA resolution was greater for bladder washings (67% unfixed, 90% fixed) than voided urines (41% unfixed, 66% fixed).

Cytogenetic analysis of four primary prostatic cultures.

Primary cell cultures were established from tissue specimens obtained from patients undergoing transurethral resection of the prostate. Cytogenetic analysis of these cultures revealed a normal male chromosomal complement from one and a 45,X karyotype from another patient with benign prostatic hyperplasia. In addition, a normal male chromosomal complement was observed from a moderately differentiated prostatic carcinoma, and a grossly abnormal karyotype was observed from a poorly differentiated adenocarcinoma of the prostate.

Mortality in prostatic carcinoma.

One hundred forty-seven patients definitively irradiated for biopsy-proved adenocarcinoma of the prostate from December, 1975, to March, 1979, have either died after a median survival of forty-five months or have been followed up for a minimum of seven years. Seventy-six patients (52%) are currently alive, 62 of them with no evidence of disease. Seventy-one patients (48%) have died, 28 without disease.

Ex situ study of the effectiveness of enucleation in patients with renal cell carcinoma.

We wished to identify the efficacy of enucleation (excavation) in the treatment of renal cell carcinoma. Surgical specimens from 26 patients with polar or peripheral lesions, 50 per cent of which were found incidentally by computerized tomography scan, were considered amenable to this form of treatment and were studied by ex situ enucleation after standard radical nephrectomy. Eleven patients were determined to have unsuccessful enucleation after histopathological study demonstrated capsular invasion, vascular invasion, residual tumor in the bed or multicentric tumors.

Epithelioid sarcoma of the penis.

A case of epithelioid sarcoma of the penis is reported with a review of the current treatment modalities. A new method of reconstructing the penis involved with malignancy is presented. Pertinent literature is cited.

Radical prostatectomy. Patterns of local failure and survival in 67 patients.

Sixty-seven patients with localized carcinoma of the prostate were treated by radical prostatectomy unaided by adjunctive hormonal therapy. Seven patients (10%) have been lost to follow-up, and 13 patients (19%) have died of other causes without evidence of prostate cancer. The crude or direct survival free of disease for traced patients with clinical Stage B1 nodules (11) and clinical B2 lesions (20) followed for at least fifteen years is 36 per cent and 25 per cent, respectively; the crude or direct survival free of disease for pathologic B (29) and C (12) tumors followed for fifteen years is 31 per cent and 8 per cent, respectively.

Superficial transitional cell carcinoma of the bladder associated with mucosal involvement of the prostatic urethra: results of treatment with intravesical bacillus Calmette-Guerin.

Intravesical Pasteur strain bacillus Calmette-Guerin was used to treat 8 patients with mucosal transitional cell carcinoma of the prostatic urethra associated with superficial transitional cell carcinoma of the bladder. Complete initial response in the prostatic urethra was obtained in 7 of the 8 patients. Two patients had progression of disease during intravesical bacillus Calmette-Guerin therapy (1 in the prostate and 1 in the bladder) and they received further surgical therapy.

The effect of TURP on prognosis in prostatic carcinoma.

Of 553 patients definitively irradiated for biopsy proven prostatic adenocarcinoma from January 1976 to March 1986, 287 patients with a minimum follow-up of 4 years were studied. One hundred sixty-two patients had transurethral prostatic resection (TURP); one hundred twenty-five patients did not. When subdivided by stage and histologic grade, those patients with poorly differentiated tumors who underwent TURP had a noticeably higher, but not statistically different, incidence of bony metastasis as compared to those who did not have TURP.

Effect of local tumor control on distant metastasis and survival in prostatic adenocarcinoma.

Of 495 patients definitively irradiated for prostatic carcinoma, 286 with a minimum follow-up of thirty-six months were studied. While tumor histology appeared to predict prognosis, the poorly differentiated tumors showing the highest incidence of distant metastasis and the lowest survival, local tumor control was an important factor within the poorly differentiated group. Of those with local recurrence, distant metastases developed in 68 per cent compared with 37 per cent of those with no local disease (p = 0.

Mortality associated with feeding catheter jejunostomy after radical cystectomy.

Twenty-five patients undergoing cystectomy and diversion for transitional cell carcinoma of the bladder and 8 patients having major surgery for renal and testes neoplasms and trauma have received needle jejunostomy placement at the time of surgery. One patient died secondary to vascular collapse. Postmortem examination revealed necrosis of the entire small bowel except the conduit segment.

Upper tract urothelial malignancy after cyclophosphamide therapy: a case report and literature review.

We report an unusual case of simultaneous transitional cell carcinoma of the renal pelvis and distal ureter without transitional cell carcinoma of the bladder occurring after chronic cyclophosphamide therapy for nonHodgkin's lymphoma. Other upper tract neoplasms after cyclophosphamide are reviewed.

Prostate biopsy after definitive treatment by interstitial 125iodine implant or external beam radiation therapy.

The response to definitive radiation therapy of localized carcinoma of the prostate by 125iodine implantation or external beam radiotherapy was monitored by examining specimens from biopsies performed after treatment. We analyzed 126 biopsy specimens obtained 18 months or more after treatment: 71 were obtained from 109 patients treated by 125iodine and 55 from 197 patients treated by external beam radiotherapy. Thereafter, the disease status of these patients was examined at minimum 3-year intervals.

Müllerian duct cysts: conservative management.

Three cases of the unusual entity, müllerian duct cyst, are presented. Each was managed differently, demonstrating that with appropriate patient selection either aspiration alone, aspiration and instillation of a sclerosing agent, or transurethral resection of bladder base to establish communication and cyst drainage are successful.

Characteristics of spinal cord compression in adenocarcinoma of prostate.

Of 611 patients with biopsy-proved adenocarcinoma of the prostate, spinal cord compression developed in 41 (6.7%) at a median interval of twenty-four months after primary diagnosis. Spinal cord involvement most often occurred in the thoracic area, with 95 per cent of patients showing radiographic evidence of osseous vertebral metastasis at the level of cord compression.

Renal metastases from carcinoma of the lung.

Five cases of clinically manifest solitary and bilateral renal lesions metastatic from the lung are presented. These cases are unusual in that renal metastases are usually silent lesions discovered at autopsy. Review of the autopsy data from this hospital identified renal metastases in 19% of patients who died from carcinoma of the lung.

The effect of prior transurethral resection of the prostate on post radiation urethral strictures and bladder neck contractures.

Patients treated for prostate cancer from 1975-1982 were reviewed to assess if pre-irradiation transurethral resection of the prostate (TURP) predisposed to the formation of post treatment urethral strictures or bladder neck contractures. A total of 368 patients were treated with external beam irradiation delivered by a linear accelerator or 125I interstitial implants. Of the 253 patients treated by external beam, 138 patients had a history of at least one TURP before treatment.

Intestinal strictures complicating preoperative radiation therapy followed by radical cystectomy.

Between January 1975 and January 1981, 100 patients with invasive bladder cancer were evaluated for therapy. Of these patients 51 were selected for treatment with preoperative radiation therapy followed by radical cystectomy. Of 36 patients who actually completed the integrated therapy 4 (11 per cent) had clinical intestinal strictures.

Paraganglioma of urinary bladder in patient with neurofibromatosis.

Pheochromocytoma in patients with von Recklinghausen's neurofibromatosis is a well-known association. However, extra-adrenal pheochromocytoma with this association is rare. Herein we report a case of urinary bladder paraganglioma in a patient with neurofibromatosis.