Ovarian-type papillary serous cystadenocarcinoma of the testis.
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Cystadenocarcinoma, Papillary↗
Biomedical subjects
J N Nacey
Publications and source records attributed to J N Nacey.
Analysis of the prevalence of voiding symptoms in Maori, Pacific Island, and Caucasian New Zealand men.
OBJECTIVES: Data from a community-based sample of 515 men were used to assess the prevalence and presentation of voiding symptoms in Caucasian, Maori, and Pacific Island men in the city of Porirua, New Zealand. METHODS: A random sample, stratified by age groups of 10 years, was obtained for men 40 years and older. Two hundred men were entered into each 10-year age stratum. Frequency of symptoms and quality of life were measured using the International Prostate Symptom Score (IPSS) questionnaire. Bothersomeness of symptoms was assessed using questions from the American Urological Association symptom bother index. Data were analyzed according to age and ethnic group with differences between groups measured by analysis of variance. RESULTS: Symptom score was found to increase with increasing age of subjects, with men in the 40 to 49 years age group recording a mean score (+/- SE) of 2.9 +/- 0.3, increasing to a mean score of 4.8 +/- 0.4 for men aged 50 to 59 years, 7.4 +/- 0.9 for men aged 60 to 69 years, and 7.4 +/- 0.9 for men in the 70 year and older age group. Significant symptoms, represented by a symptom score of 8 or greater, were found in 12.9% of men aged 40 to 49 years, 22.3% of men aged 50 to 59 years, 33.7% of men aged 60 to 69 years, and 33.3% in the 70 year and older age group. No difference was demonstrated in the prevalence of symptoms between Caucasian, Maori, and Pacific Island men. CONCLUSIONS: Despite having a similar prevalence of voiding symptoms to Caucasian men, few Maori or Pacific Island men seek help for their urinary symptoms. The level of understanding of the underlying disease process is poor for men of all ethnic backgrounds and emphasizes the important need for greater public awareness and education with respect to prostate disease.
Adult↗
The effect of finasteride on prostate volume, urinary flow rate and symptom score in men with benign prostatic hyperplasia.
This study was designed to determine the efficacy of the 5 alpha-reductase inhibitor finasteride (Proscar, MK-906) in men with reduced urinary flow rates and symptoms of urinary outflow obstruction secondary to benign prostatic hyperplasia. Forty-five men were randomized to one of three groups receiving either placebo, 1 mg/day or 5 mg/day finasteride for the first 12 months of the study period. At the end of this period all men received 5 mg/day finasteride for a further 2 years. Efficacy was determined by measurement of prostate volume, maximum urinary flow rate, and symptom score using a modified Boyarsky assessment. Prostate volume reduced by 20 and 27%, respectively, for those on 1 and 5 mg after the first year. At 3 years the volume had reduced by 43%. This reduction in prostate volume was associated with an improvement in maximum urinary flow rate by 50% (1 mg), and 35% (5 mg) at 1 year, and 36% at 3 years. The total, obstructive and non-obstructive symptom scores decreased (improved) for patients on 1 and 5 mg finasteride, with the total score reducing by 33% from baseline at year 3. The results demonstrate that finasteride causes a modest but significant clinical improvement in men with urinary outflow obstruction secondary to benign prostatic hyperplasia.
Aged↗
Occupational risk for renal cell carcinoma. A case-control study based on the New Zealand Cancer Registry.
OBJECTIVE: To evaluate occupational risk factors for renal cell carcinoma. SUBJECTS AND METHODS: A case control design was employed using data reported to the New Zealand Cancer Registry from 1978 to 1986 inclusive. The occupational risk for renal cell carcinoma was derived by comparison with the occupation of cases of non-urinary tract malignancy reported to the Registry over the same period. RESULTS: An active occupational code was derived for 86.2% of all cases and 98.9% (710) of male cases. In a series of case-control studies for selected occupational groups, adjusting for patient age and smoking history, a significantly increased relative risk for the development of renal cell carcinoma among firefighters (RR 4.89, 95% CI 2.47-8.93) and painters (RR 1.79, 95% CI 1.31-3.44) was demonstrated. CONCLUSION: The data suggest that both firefighters and painters may be at an increased risk of developing renal cell carcinoma, which is likely to be of significance as both occupational groups are frequently exposed to known carcinogens.
Adult↗
Prognostic assessment of renal cell carcinoma.
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Carcinoma, Renal Cell↗
Renal cell carcinoma in New Zealand: a national survival study.
OBJECTIVE: To determine clinical and pathologic prognostic factors for renal cell carcinoma (RCC) using cases reported to a population-based cancer registry. METHODS: All cases of RCC reported to the New Zealand Cancer Registry between 1976 and 1986 were retrieved and data analyzed to determine parameters of prognostic importance. RESULTS: In eleven years, 1,308 cases of RCC (66.7% males and 33.3% females) were reported to the New Zealand Cancer Registry. The age-standardized incidence rate was 3.78 per 10(5) person-years and showed no significant trend over the period of the study. There was a significant difference in the age at presentation between the largest racial groups (Maori 52.2 years; non-Maori 63.2 years), which is accounted for by increased predisposing risk factors among Maori. The five-year actuarial survival rate was 42.4 percent with 63 percent of patients reported dead in follow-up to December 1990. In the series, patient gender (female > male), tumor laterality (right > left), stage (intrarenal > localized > disseminated), grade (1 > 2 > 3 > 4), and treatment modality (surgery > nonsurgery) were found to be significant prognostic factors, although only tumor stage and treatment modality were of independent significance. Tumor laterality was of prognostic significance for Stage II (localized) surgically treated tumors only. CONCLUSIONS: The results of the study emphasize the paramount importance of tumor stage as a prognostic parameter for RCC. The prognostic significance of laterality for localized, surgically treated tumors suggests that radical nephrectomy is less likely to result in tumor clearance for left-sided RCC than for tumors on the right side.
Actuarial Analysis↗
Assessment of proliferative activity in Wilms' tumour.
The proliferative activity in 26 cases of Wilms' tumour was studied by enumeration of silver-staining nucleolar organizer regions (AgNORs) and proliferating cell nuclear antigen (PCNA) staining of the blastemal, epithelial and stromal components of the tumours. The PCNA and AgNOR scores derived from the blastemal (PCNA range 18.9-81.4%, AgNOR range 2.11-4.95) and epithelial (PCNA range 24.1-74.2%, AgNOR range 2.47-4.41) components of the tumours were significantly higher than those of the stromal component (PCNA range 3.4-64.7%, AgNOR range 2.20-4.26). Ten of the patients had died with recurrent or metastatic tumour (mean survival 29 months) while the remaining 16 were disease free (mean follow-up 95 months) at the time of the study. The prognostic significance of PCNA and AgNOR for Wilms' tumour was evaluated by dividing the tumours into groups exhibiting low (PCNA < or = 40 or AgNOR < or = 4) or high (PCNA > 40 or AgNOR > 4) proliferative activity. There was a significant difference in the survival of the two groups for tumours treated with preoperative chemotherapy (PCNA, P = 0.049; AgNOR, P = 0.02), while no significant difference was observed from tumours resected prior to the administration of chemotherapy. The results of this study suggest that assessment of proliferation activity in postchemotherapy Wilm's tumours may be a useful indicator of prognosis.
Cell Division↗
Familial cystic nephroma and pleuropulmonary blastoma.
BACKGROUND: Cystic nephroma (CN) and pleuropulmonary blastoma (PPB) are rare tumors without any previously recognized familial association. METHODS: Two cases of CN and one case of PPB in three siblings are reported. RESULTS: A 27-month-old girl and a 31-month-old boy underwent nephrectomy for CN and are free of disease in the contralateral kidney 16 and 14 years later, respectively. Their 28-month-old sister underwent pleuropneumonectomy with postoperative chemotherapy for PPB and died of recurrent disease 9 months later. CONCLUSION: To the knowledge of the authors, these cases represent the first reported familial occurrence of CN and the second of CN and PPB among siblings. The inheritance of a germline mutation predisposing to the development of these tumors is postulated.
Child, Preschool↗
Proliferating cell nuclear antigen (PCNA) expression as a prognostic indicator for renal cell carcinoma: comparison with tumour grade, mitotic index, and silver-staining nucleolar organizer region numbers.
Proliferating cell nuclear antigen (PCNA) expression in renal cell carcinoma (RCC) was determined by immunohistochemical staining using the PC10 clone. PCNA indices ranged from 2.4 to 53.1 per cent with mean indices of 12.6, 19.0, and 31.6 per cent for grades 1 to 3 RCC and 31.9 per cent for sarcomatoid RCC. There was a significant difference between the indices of grades 1 and 3 and grades 2 and 3 tumours and between grades 1 and 2 RCC and sarcomatoid RCC. AgNOR scores and mitotic indices were determined for each tumour and comparison of PCNA indices with mean AgNOR scores and mitotic indices showed only a weak correlation (PCNA/AgNOR r = 0.406, PCNA/mitotic index r = 0.315). Tumours were divided according to PCNA index (< or = 18 per cent and > 18 per cent) and there was a significant difference in survival between the two groups, for all cases, and for each of the Robson stages. Multivariate analysis using Cox's proportional hazard model showed PCNA index, tumour stage, and mean AgNOR score to be independent predictors of survival, while tumour grade and mitotic index were found to be dependent variables.
Antigens, Neoplasm↗
The efficacy of serum prostate specific antigen as a tumour marker in prostatic carcinoma: a comparison with serum acid phosphatase.
AIMS: To assess the efficacy of serum prostate specific antigen (PSA) in the diagnosis of prostatic cancer. To compare this tumour marker with serum acid phosphatase (ACP) in order to define the more effective diagnostic test. METHODS: Serum samples from 349 patients attending a urology department were assayed for PSA and ACP. Histological assessment of prostatic biopsy samples was used as the standard by which the diagnostic effectiveness of the tumour markers was determined. RESULTS: Mean serum PSA results from patients with prostatic carcinoma (159 (SEM 35) ng/mL) were significantly different to those from patients with benign prostatic hyperplasia (4.0 (0.53) ng/mL). As there was considerable overlap of results, test sensitivities and specificities were calculated for various decision points. The sensitivity and specificity of PSA at a level of 10 ng/mL were 61.2% and 93.0% respectively, while for ACP at a level of 0.8 U/L they were 47.6% and 89.9%. The areas beneath receiver-operator curves (0.81 for PSA and 0.72 for ACP) indicated that PSA gives better diagnostic information than ACP. For a stated incidence of cancer, posttest probabilities following a given PSA result have been calculated. CONCLUSIONS: PSA is a more effective serum marker for prostatic carcinoma than ACP. We present a table so that for similar patient groups posttest probabilities for prostatic cancer can be assessed for a given serum PSA level.
Acid Phosphatase↗
Wilms' tumour in New Zealand 1960-1986.
Between 1960 and 1986, 177 cases of Wilms' tumour were reported to the New Zealand National Cancer Registry. There was an equal sex distribution and 93.2% of patients were in the paediatric age group with a mean age of 3.4 years. The mean symptom interval was 2.0 months and the majority of patients presented with localised disease, although the incidence of advanced disease was greater than that reported from other series. The 5-year survival rate for all cases was 52.5%. Data were divided into patients presenting before and after the publication of the first National Wilms' Tumour Study (NWTS) in the United States in 1976. In patients presenting after 1976 the diagnosis was based on histology in 100%, compared to 58.6% in patients before 1977. Treatment was considered curative in a greater proportion of the post-1976 group. Treatment modalities reflected the recommendations of the NWTS and the 5-year survival rate of this group was 78.3%, this being similar to that reported from the NWTS. Multivariate analysis showed patient age, symptom interval, tumour stage and treatment (pre- and post-NWTS) to be independent predictors of survival.
Adolescent↗
Giant cystic nephroma in an adult. Case report.
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Adult↗
Variation in AgNOR scores for renal cell carcinoma.
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Carcinoma, Renal Cell↗
The value of early diagnosis in the treatment of patients with testicular cancer.
A study of 79 patients treated at Wellington Hospital for testicular cancer showed that those presenting with a short history (time from tumour recognition to surgery) had no better prognosis than those with a longer history (chi 2 = 1.857, p = 0.173). Tumour size was significantly related to this time interval such that those patients with a short history were more likely to have smaller tumours (rp = 0.651, p = 0.001). The data suggests that testicular tumours are currently being recognised too late in their development to allow any improvement in survival to be gained from reducing the interval from recognition to treatment. However, earlier recognition of the tumour by the patient may allow diagnosis and treatment in an earlier stage. The advantages of diagnosis in early stage disease are substantial and the need for a public education programme involving testicular self examination to allow early diagnosis is discussed.
Adult↗
Nucleolar organizer regions and prognosis in renal cell carcinoma.
The prognostic significance of nucleolar organizer regions (NORs) in renal cell carcinoma (RCC) was evaluated. NORs were quantified in a series of 182 cases of RCC using the silver-colloid method. The cases were staged according to Robson's method (48 stage I, 26 stage II, 33 stage III, 75 stage IV) and mean NOR numbers for each tumour were correlated with survival over a 5-year period. Localized tumours (stages I and II) with low NOR numbers had an almost 100 per cent 5-year survival. Those patients with clinical evidence of metastases at presentation showed a high mortality, although those with low numbers of NORs had a significantly increased disease-free interval. Statistical analysis using the log rank test indicated NORs to be a significant predictor of survival over the whole series (P = 0.0001) and within each of Robson's stages (P = 0.0008 stage I, P = 0.0154 stage II, P = 0.0009 stage III, P = 0.0001 stage IV). Analysis of data using Cox's proportional hazard model showed mean NOR numbers to be independent of stage as a predictor of survival.
Carcinoma, Renal Cell↗
Giant sclerosing leiomyoma of bladder presenting as chronic renal failure.
The clinical and pathologic features of a case of giant sclerosing leiomyoma of the bladder in a male Polynesian patient are reported. The presenting complication of chronic renal failure due to tumor envelopment of both ureters and consequent bilateral renal obstruction appears to be unique in the literature.
Adult↗