[Prostate-specific antigen (PSA)].
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Aged↗
Biomedical subjects
H Huland
Publications and source records attributed to H Huland.
[Value of determining prostate-specific antigen for early detection or prostatic carcinoma].
The use of prostate-specific-antigen in the early detection of prostatic carcinoma combined with digital-rectal examination results in a 2-3 times increase in prostatic carcinoma detection rate. 2/3 of PSA detected prostatic carcinoma are organ confined vs 40% of those which are detected by digital-rectal examination. 15-35% of all operated localized prostatic carcinoma have a normal PSA. A biopsy is indicated in men with a life expectancy of more than 10 years when the PSA value is above 10 ng/ml and/or digital-rectal examination is suspicious. This concerns only 2% of all men at the age older than 50 years. In 90% of all men older than 50 years the PSA is normal as well as the digital-rectal examination. In 4% of these the result of PSA and digital-rectal examination is false negative that means 4% have prostatic carcinoma. However, repeated digital-rectal examination and PSA determination on a yearly basis detects most of these overlooked prostatic carcinoma which still are organ confined in about 90% of the cases. In men with a minimal elevated PSA-value of 4-10 ng/ml, 25% will have a prostatic carcinoma regardless of the finding on digital-rectal examination. The indication to do a biopsy can be specified by the use of age specific PSA cut-off-levels and most likely in future by determining the free PSA vs the complex-bound PSA. Controversy exists about the usefulness of PSA-density and PSA-velocity.
Aged↗
[Perioperative and postoperative complications of pelvic lymphadenectomy and radical prostatectomy in 320 consecutive patients].
To examine the intra- and postoperative morbidity of radical retropubic prostatectomy we analyzed the first 320 consecutive patients with clinical stages T1b, T2a-c and negative lymph nodes by frozen section. Patient age varied from 42 to 75 years (mean 63.5 years). In 74.7% the estimated blood loss was less than 1500 ml. With a preoperative autologous blood collection program the intraoperative blood requirement for homologous blood units was only 15%. Intraoperative complications included rectal injuries with vesical rectal fistulas in 2.5% and ureteral injuries in 1.6%. Within the perioperative period the mortality rate was 0.9%. At 12 months after surgery 199 of 218 men (90.9%) were continent, 5.1% had minimal urinary incontinence, and only 4.6% had urinary incontinence grade III. Postoperatively, PSA (prostate-specific antigen) decreased to < 0.5% in 90.4% of the patients after radical prostatectomy. At 12 months after operation PSA was < 0.5 ng/ml in 83.4%. We conclude that radical retropubic prostatectomy is a safe procedure for the curative treatment of localized prostate cancer.
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[Individualized therapy with alpha-interferon in metastatic renal cell carcinoma].
Thirty-two patients with metastatic renal cell carcinoma were treated as outpatients with individually dosed interferon alpha (IFN alpha). The individual maximum dose was based on the side effects. In 7 patients the course of the disease was influenced: 1 attained complete remission, 3 patients, partial remission and 3, stable disease. The outcome of therapy was not dose-dependent. Patients with lung metastases were more sensitive to IFN alpha than the others. Up to 20% of patients responded to the therapy.
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[Treatment of rectal injuries with vesicorectal fistulization in radical prostatectomy].
In the literature many different ways are described of treating rectal injured during radical prostatectomy. Therefore, following this procedure we evaluated our patients with rectal injuries. Rectal injury occurred in 16 of 299 patients with radical prostatectomy for treatment of localized prostate cancer. Seven developed a vesicorectal fistula, 4 of whom needed no further surgical intervention. Only 3 (1%) had to undergo an additional operation.
Follow-Up Studies↗
Inhaled interleukin-2 in combination with low-dose systemic interleukin-2 and interferon alpha in patients with pulmonary metastatic renal-cell carcinoma: effectiveness and toxicity of mainly local treatment.
We describe here a mainly topical interleukin-2 (IL-2) application in pulmonary metastatic renal-cell carcinoma: a high-dose long-term inhalation of IL-2 (90% of IL-2 dose) and low-dose systemic subcutaneous IL-2 (10% of IL-2 dose) and systemic subcutaneous interferon alpha (IFN alpha). The effectiveness of this treatment is remarkable. No pulmonary metastases progressed during treatment. One complete response, 8 partial responses, and 6 cases of stable disease were achieved in the lungs of the 15 patients. In addition, 3 of 7 patients had partial responses and 1 of 7 had stabilization of non-pulmonary metastases. Overall response according to WHO criteria was 1 complete response, 6 partial responses, 2 mixed responses, 5 stable diseases and 1 progressive disease. Toxicity was low. Only WHO grade I toxicity occurred, except for a single grade II event (bronchospasm). This allowed long-term ambulatory treatment (1-23 months) inclusion of high-risk patients, and inclusion of patients with advanced disease. The expected mean survival of patients was 9.9 months, the actual mean survival is now 19.1 months, and 11 of 15 patients are still alive. Quality of life during treatment was good. Inhalation of IL-2 serves as a clinical model for high effectiveness and low toxicity of long-term local IL-2 application. We conclude that mainly local treatment might be the key to successful nontoxic use of IL-2 in cancer patients.
Administration, Inhalation↗
Immunohistochemical detection of p53 protein in human prostatic cancer.
Tissue sections from 73 radical-prostatectomy specimens were studied immunohistochemically for the presence of p53 protein. In seven specimens numerous tumor cells showed a strong nuclear immunostaining. An additional 27 revealed a more discrete and focal accumulation of p53 protein. Comparison of the pathologic characteristics of the p53-negative and -positive groups showed that the presence of p53 protein closely correlated with more advanced tumor stages (p < 0.00001), with higher primary (p = 0.0004), combined (p < 0.0001) and worst (p < 0.0001) Gleason grades, and with larger total (p = 0.0001) and high-grade (p < 0.0001) tumor volumes. No staining was found in areas of benign hyperplasia or in well-differentiated tumor zones. Our results suggest that the accumulation of p53 protein to immunohistochemically detectable concentrations is not a feature of low-grade cancer. This finding implies that abnormal p53 accumulation might be involved in the process of prostatic cancer progression.
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Endo-urological cold-knife incision for ureteral stenosis after renal transplantation.
Cold-knife incision of stenoses in the transplant ureter was performed in 11 patients with upper urinary tract obstruction in renal transplants. The operations were complicated by bleeding in 2 patients and the graft had to be removed in 1 of them. The stenoses could be treated successfully in 10 of the 11 patients (91%) and the mean serum creatinine concentration decreased significantly from 3.4 to 1.8 mg./dl. After a mean of 26 months only 1 obstruction recurred, so the long-term success rate was 82%. Because of the favorable long-term results and the low incidence of complications, we recommend endo-urological cold-knife incision of ureteral stenosis as the first-line treatment for upper urinary tract obstruction in renal transplants.
Adult↗
Systematic sextant biopsies in 651 patients referred for prostate evaluation.
In 651 patients mapping of the prostate by 6 systematic sextant ultrasonography guided biopsies was performed without major side effects using the automatic biopsy gun. The histological findings provided data on patients with normal and abnormal prostates as determined by digital rectal examination. Only 3 of 72 nonurological patients (4%) with normal prostate specific antigen (PSA) levels of less than 4 ng./ml. had prostate cancer. Of the 259 patients with a firm prostate on digital rectal examination 105 (41%) had prostate cancer. For those with a PSA level of less than 4 and 4 ng./ml. or greater the positive biopsy rates were 13% and 58%, respectively. Of 56 patients with clinical stage B or C disease and a PSA level of less than 4 ng./ml. 20 (36%) had prostate cancer, compared to 155 of 187 (83%) with a PSA level of 4 ng./ml. or greater. Transrectal ultrasound was not helpful in screening for prostate cancer due to the low positive biopsy rate for hypoechoic lesions. However, among 175 patients with clinical stage B or C disease transrectal ultrasound identified 157 (90%) with prostate cancer.
Adult↗
Systematic biopsies and digital rectal examination to identify the nerve-sparing side for radical prostatectomy without risk of positive margin in patients with clinical stage T2, N0 prostatic carcinoma.
OBJECTIVES: Systematic biopsies and digital rectal examination were used to identify the nerve-sparing side for radical prostatectomy without risk of positive margin in patients with clinical Stage T2, N0 prostatic carcinoma. METHODS: We studied specimens from 73 consecutive radical prostatectomies by the 3 mm step-section technique for clinical Stage T2a, T2b (n = 57), and T2c (n = 16) tumors to see whether digital rectal examination or the use of 6 systematic biopsies could identify the side where nerve-sparing could be used without risk of positive margin. RESULTS: In 39 of the 57 (68%) patients with clinical Stage T2a, T2b 3 contralateral biopsies were negative. Only in these 39 patients was unilateral nerve-sparing done on the biopsy-negative side. None of these 39 specimens had a positive margin at this nerve-sparing side. The other 18 (32%) of the 57 patients with clinical T2a, T2b tumors had positive biopsies on the contralateral side of the palpable tumor; no nerve-sparing was done in this group. Of the 18 specimens, only 5 (28%) had full capsular penetration on the contralateral side in the area of the nerve bundle and thus the potential risk of positive margins if contralateral nerve-sparing would have been done. That could mean that 13 patients of these 18 (23% of the whole group of the 57 patients with T2a, T2b lesions) were unnecessarily excluded from the unilateral contralateral nerve-sparing. CONCLUSIONS: We conclude that unilateral contralateral nerve-sparing can be done safely in patients with T2a, T2b lesions without risk of positive margins when three biopsies on the contralateral side are negative. We calculate that by such strict selection criteria for unilateral contralateral nerve-sparing technique only one of five patients with clinical unilateral tumors will be excluded unnecessarily from the nerve-sparing technique.
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[MR tomography in prostatic carcinoma: comparison of conventional and endorectal MRT].
In a prospective study an attempt was made to determine the value of conventional MRI (354 patients) and MRI using the endorectal surface coil (ESC) (36 patients) in the preoperative staging of prostatic carcinoma. Local preoperative staging with conventional MRI was correct in 83.9% and 88.9% with ESC-MRI. Compared to conventional MRI, ESC-MRI was better in the delineation of the prostatic capsule and early detection of infiltration into the neurovascular bundle. Lymph node staging with MRI showed a sensitivity of 54.4% in detecting pelvic lymph node metastasis. MRI is as limited as CT in assessing pelvic lymph node metastasis.
Evaluation Studies as Topic↗
[Long-term results of intravesical prevention of recurrence with mitomycin C and adriamycin in patients with superficial bladder cancer].
In a prospective multicenter study, four protocols for administration of mitomycin C and Adriamycin by intravesical installation were evaluated for effectiveness in the prevention of recurrent tumours in patients whose superficial bladder tumours (TA and T1) had been removed by transurethral resection. The 3-year and short-term installation protocols were compared with each other and each with a combination of the two. Evaluation after a mean follow up of 62.5 months was possible in 333 patients: the overall recurrence rate was 20.7% and the overall progression rate, 9.3%. No statistically significant differences were found in frequency of tumour recurrence among three mitomycin regimens and an Adriamycin regimen, regardless of the risk groups. However, frequency of recurrence per time unit was much lower in the treatment group with short-term intensive (weekly) mitomycin instillation, which was due mainly to prevention of late recurrence.
Administration, Intravesical↗
[Morphologic results of 106 consecutive radical prostatectomy specimen of patients with clinical stage B1-B3 (T2a-c) and histologically negative lymph nodes in the fossa obturatoria].
The morphologic results recorded in 106 consecutive radical prostatectomy specimens from patients with clinical stage B1-B3 (T2a-c) are presented. All specimens had inked margins and were subjected to morphometric work-up using a 3-mm step section technique. In only 39 (37%) was the tumour confined to a single organ (pT2); 67 (63%) were stage pT3; 40 (37.7%) had only capsular penetration; and 27 (25.4%) had seminal vesicle invasion. In 33 (31.1%) the surgical margin was positive. None of those with pathological stage pT2 had a positive margin. Of the 40 patients with pathological stage pT3a+b, 19 (47.5%) had a positive margin. Of the 27 patients with seminal vesicle invasion (pT3c), 14 (51.8%) had a positive margin. Specimens with only unilateral seminal vesicle invasion or none at all had positive surgical margins in only 25% and 24% of cases, in contrast to those with bilateral seminal vesicle invasion, in which the rate for positive margins was 73%. The mean tumour volume was 8.1 cm3 (0.12-50.13 cm3). There were 9 (8.4%) tumours with a volume < 0.5% cm3 while 62 specimens contained > 0.5 cm3 Gleason 4 and Gleason 5 tumours. Our analysis shows a good correlation of the positive margin rate with tumour volume and especially with volume of the high-grade tumor.
Adult↗
[Urologic complications after kidney transplantation. Experiences in a center with 539 recipients].
A total of 539 renal transplantations were performed at the Department of Urology of the University Hospital of Hamburg between 1984 and 1991. 132 (24.5%) patients developed urological complications (by definition, complications occurring as a result of the operative procedure). In 31 cases the transplants had to be removed secondary to urological complications, and 4 patients died of such complications (mortality 0.7%, lethality 3.0%). Urinary tract infections occurred in 13.2% of all patients during the first postoperative year and were by far the most frequent complication, followed by haematomas, which occurred in 9.6%. The incidence of urinary tract and wound infections was significantly reduced during the 8-year period studied by improving antibiotic prophylaxis and adopting a strategy of early removal of indwelling catheters (P < 0.05). Stenting the ureteroneocystostomy with a double-J stent instead of an external ureteral catheter resulted in a definite decrease in the incidence of ureteral leaks (P < 0.05). Continuous control of operative results and efforts to improve operative and perioperative strategies make it possible to reduce the incidence of urological complications in renal transplantation and thus result in an improved graft function and patient survival.
Adolescent↗
[Multilocular, giant angiomyolipoma of the kidney, adrenal gland and para-aortic lymph nodes. Case report of a 9-year-old boy with tuberous sclerosis].
The symptoms and therapy of a multicentric angiomyolipoma of the kidney, adrenal gland, paraaortic lymph nodes and renal fat tissue in a 9-year-old boy with tuberous sclerosis are reported. Angiomyolipomas are benign mesenchymal tumours that often occur together with tuberous sclerosis. Renal cell carcinoma in an angiomyolipoma is rare. Multicentricity and lymph node involvement is not a sign of malignancy or metastatic disease. Radiological characteristics in CT and plain X-ray may help in the diagnosis. Characteristically, the renal lesions are asymptomatic. Patients with incidental symptom-free angiomyolipoma should be followed. In other patients with pain in the loin, or when a solid tumour cannot be confidently excluded, conservative surgery or nephrectomy should be performed.
Adrenal Gland Neoplasms↗
[Erectile dysfunction and hypogonadism. Is routine endocrine screening necessary?].
Erectile dysfunction is rarely caused by hypogonadism. We distinguish between primary and secondary hypogonadism. Among 70 consecutive men treated for impotence within 1 year in the authors' clinic, the rate of endocrinopathy was 4.3%. The exact role of testosterone in male sexual function is unclear. Testosterone replacement may be helpful only in patients with low serum testosterone and decreased libido. Endocrine screening is necessary in impotent patients with clinical signs of hypogonadism. Patients with decreased libido and no signs of hypogonadism should also be undergo endocrine evaluation. Routine endocrine testing for all patients with erectile dysfunction is expensive and not productive.
Adult↗
[Early complications of radical prostatectomy. Pelvic vein compression caused by wound drainage].
Deep vein thrombosis and thromboembolism is a common complication following urologic pelvic surgery, with incidences up to 80% being reported. We report on a 71-year-old patient with prostate cancer, who showed clinical and radiological signs of pulmonary embolism with no evidence of a deep vein thrombosis 14 days after radical prostatectomy. Phlebography revealed compression of the left external iliac vein by the drainage tube as the potential cause of the pulmonary embolism. The drainage tube was repositioned under CT control. The ultrasound Doppler technique confirmed unimpaired flow in the left external iliac vein after repositioning. Drainage tubes should be positioned far enough medially to avoid compression of the iliac vessels.
Adenocarcinoma↗