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M M Lieber

Publications and source records attributed to M M Lieber.

At least 55 records · Page 3Linked to original sources

Environmentally responsive mutator systems: toward a unifying perspective.

Biology has long sought a unifying principle. The behaviour of genetically controlled mutator processes adaptively responsive to stress may reflect such a principle. Related mutators exist in diverse organisms from bacteria to mammals. Such systems have evolved from one another and have defined the very evolution of organisms. Many of these mutator systems can determine in a developmental manner a ultramutability or hypermutability throughout the genome. Though the genetic control of high levels of mutability can reflect molecular features, such mutagenic processes reflect a deeper parameter involving forces and their configurations. These configurations must generate stable or uniform configurations from unstable ones throughout the genome and organism. Directed mutation becomes a generative process attuned to non-uniform forces of local niches and to the more uniform forces of a universal niche. The manner of mutagenic, attuned response depends on the level of genomic and transgenomic organization. This is reflected in hierarchies of evolution. Directed mutation is a feature of a universal, generative ordering process, and this feature is marked by a universal dimensionless constant. It is the dynamic consequence of such directed generation which ultimately confers adaptation through dynamic completion. This suggests an underlying, unitary, and necessary dynamics connecting ultramutability systems in all organisms and would serve, in complementation with a molecular approach, to elicit new and productive research avenues. One outcome would be the illustration of a unifying principle governing biological and physical phenomena.

Adaptation, Physiological↗

Secular changes in radical prostatectomy utilization rates in Olmsted County, Minnesota 1980 to 1995.

PURPOSE: We estimated the changes in utilization of radical prostatectomy for treatment of prostate cancer and describe the clinical characteristics of men undergoing radical prostatectomy in a population based setting. MATERIALS AND METHODS: The Rochester Epidemiology Project was used to identify all Olmsted County residents who underwent radical prostatectomy from 1980 to 1995. The community medical records of these men were reviewed to determine the clinical and pathological stage and grade at biopsy and following surgery. RESULTS: From 1980 to 1995, 311 radical prostatectomies were performed on Olmsted County men. From 1980 to 1987 prostatectomy rates ranged from 6.3 to 31.0/100,000 men but rates increased dramatically to 53.6/100,000 in 1988 and 106.2/100,000 in 1992. The rate after 1992 decreased to 53.0/100,000 and then increased slightly to 80.4/100,000. There was a shift to younger age in more recent times (mean patient age 65.4 years in 1980 to 1986 and 62.4 in 1993 to 1995, p = 0.02), a nonsignificant (p = 0.10) trend toward lower pathological stage in recent years (42% stage pT2 in 1980 to 1986 versus 55% in 1993 to 1995) and a significant decrease in the proportion of cases of disease up staged following surgery (53% in 1980 to 1986 versus 37% in 1993 to 1995, p = 0.03). There was no significant trend in pathological grade with time (63% Mayo grade I or II in 1980 to 1986 versus 52% in 1993 to 1995, p = 0.30). CONCLUSIONS: These findings demonstrate an increase in radical prostatectomy rates that coincided with increases in prostate cancer incidence. There was a decrease in population prostatectomy rates in 1993 which was followed by modest increases to levels lower than the peak in 1992. However, the clinical characteristics of patients during this period did not change dramatically, suggesting that in a population based setting the selection factors for patients undergoing surgical treatment may not have changed.

Adult↗

Association between cigarette smoking and prostatism in a Japanese community.

BACKGROUND: The purpose of this study was to examine the association between cigarette smoking and prostatism among Japanese men. METHODS: Male residents of Shimamaki-mura, Japan, aged 40-79 years old (n = 286), completed a self-administered questionnaire that included the international prostate symptom score (IPSS). A detailed cigarette smoking history was also obtained. All men had a transrectal ultrasonographic estimate of prostatic volume and a peak urinary flow rate measurement. RESULTS: Current cigarette smoking was inversely associated with an impaired peak urinary flow rate (< 15 mL/sec) (odd ratio [OR] = 0.39, 95% confidence interval [CI] = 0.18, 0.84), and with moderate to severe symptoms (IPSS > 7) (OR = 0.84, 95% CI = 0.48, 1.49), but was not significantly associated with prostatic volume. Smokers of 1 to 1.4 packs a day were less likely and smokers of less than a pack a day or 1.5 or more packs a day were more likely to have moderate to severe symptoms and a greater prostatic volume. CONCLUSION: These findings suggest that cigarette smoking may have a protective effect on prostatism at certain smoking intensities, but no effect or a deleterious effect at other intensities.

Adult↗

Detection of c-myc oncogene amplification and chromosomal anomalies in metastatic prostatic carcinoma by fluorescence in situ hybridization.

The role of c-myc in prostatic carcinogenesis is poorly understood. The pathogenetic relationship between high-grade prostatic intraepithelial neoplasia (PIN), prostatic carcinoma, and metastases is not well-defined. We used fluorescence in situ hybridization (FISH) with a region-specific probe for c-myc (band 8q24) and chromosome enumeration probes for chromosomes 7, 8, 10, 12, and Y to evaluate genetic changes in matched PIN (48 foci), localized prostatic carcinoma (71 foci), and lymph node metastases (23 foci) in 25 totally embedded whole-mount stage D1 (T2-3 N1-3 M0) radical prostatectomy and pelvic lymphadenectomy specimens. The c-myc protein expression in these lesions was evaluated by immunohistochemistry. Foci with extra copies of c-myc could be divided into three groups: (a) those with simple gain of a whole chromosome 8 (no increase in c-myc copy number relative to the chromosome 8 centromere), which was identified in 42, 25, and 46% of foci of PIN, carcinoma, and metastases, respectively; (b) those with an intermediate increase in c-myc copy number relative to the chromosome 8 centromere, which was found in 8, 11, and 25% of foci of PIN, carcinoma, and metastases, respectively; and (c) those with substantial amplification of c-myc (large increases in c-myc copy number relative to the chromosome 8 centromere), which was detected in 0, 8, and 21% of foci of PIN, carcinoma, and metastases, respectively. Substantial amplification of c-myc was strongly correlated with increasing cancer nuclear grade and immunohistochemical evidence of c-myc protein overexpression. Numeric chromosomal anomalies were found in 67, 68, and 96% of foci of PIN, carcinoma, and metastases, respectively. The most frequent anomaly in PIN and carcinoma was a gain of chromosome 8, and the presence of this anomaly strongly correlated with Gleason score. Carcinoma foci usually contained more FISH anomalies than paired PIN foci, but three prostates contained one or more PIN foci with more anomalies than carcinoma. Thirteen primary tumor foci exhibited intratumor genetic heterogeneity by FISH. One or more foci of the primary tumor usually shared FISH anomalies with the matched metastases. Our FISH results indicate that: (a) gain of chromosome 8 and amplification of c-myc are potential markers of prostate carcinoma progression; (b) PIN is likely a precursor of carcinoma; (c) intraglandular and intratumoral genetic heterogeneity is relatively common; and (d) usually a single focus of cancer gives rise to metastases.

Aged↗

Natural history of prostatism: risk factors for acute urinary retention.

PURPOSE: We determined the occurrence of and risk factors for acute urinary retention in the community setting. MATERIALS AND METHODS: A cohort of 2,115 men 40 to 79 years old was randomly selected from an enumeration of the Olmsted County, Minnesota population (55% response rate). Participants completed a previously validated baseline questionnaire that assessed symptom severity, and voided into a portable urometer to measure peak urinary flow rates. A 25% random subsample underwent transrectal sonographic imaging of the prostate to determine prostate volume. Followup was performed through a retrospective review of community medical records to determine the occurrence of acute urinary retention in the subsequent 4 years. RESULTS: During the 8,344 person-years of followup 57 men had a first episode of acute urinary retention (incidence 6.8/1,000 person-years, 95% confidence interval [CI] 5.2, 8.9). Among men with no to mild symptoms (American Urological Association symptom index score 7 or less) the incidence of acute urinary retention increased from 2.6/1,000 person-years among men 40 to 49 years old to 9.3/1,000 person-years among men 70 to 79 years old. By contrast, rates increased from 3.0/1,000 person-years for men 40 to 49 years old to 34.7/1,000 person-years among men 70 to 79 years old among men with moderate to severe symptoms (American Urological Association symptom index score greater than 7). Men with depressed peak urinary flow rate (less than 12 ml. per second) were at 4 times the risk of acute urinary retention compared with men with urinary flow rates greater than 12 ml. per second (95% CI 2.3, 6.6). Men with an enlarged prostate (greater than 30 ml.) experienced a 3-fold increase in risk (95% CI 1.0, 9.0, p = 0.04). CONCLUSIONS: Lower urinary tract symptoms, depressed peak urinary flow rates, enlarged prostates and older age are associated with an increased risk of acute urinary retention in community dwelling men. These findings may help to identify men at increased risk of acute urinary retention in whom closer evaluation may be warranted.

Acute Disease↗

Natural history of prostatism: impaired health states in men with lower urinary tract symptoms.

PURPOSE: Lower urinary tract symptoms are reported to have a significant impact on quality of life. However, the impact on specific aspects of health status is not clear. We evaluated the association between lower urinary tract symptoms, and physical and mental aspects of health using community based data from a cross-sectional component of a prospective cohort study. MATERIALS AND METHODS: A total of 2,133 men 41 to 84 years old who were randomly selected from the Olmsted County, Minnesota population completed the 36-item health status questionnaire and a previously validated questionnaire assessing urinary symptoms. Eight domains, measured on a scale of 0 to 100, were used to assess general health status. Men were classified as having an impaired health status if they scored less than 75 points on the scale. Symptom severity (none, mild, moderate or severe) was measured from responses to the urinary symptom questionnaire. RESULTS: The results demonstrated a cross-sectional decrease in mean health status scores for all 8 domains across levels of increasing urinary symptom severity. The strongest associations between health status scores and urinary symptoms (severe versus none) were observed for role limitation due to physical problems (odds ratio 15.7, 95% confidence interval 6.6 to 37.0), energy/fatigue (odds ratio 9.2, 95% confidence interval 4.7 to 18.1), role limitation due to emotional problems (odds ratio 8.7, 95% confidence interval 4.1 to 18.2) and general perception of health (odds ratio 7.2, 95% confidence interval 3.8 to 13.4). For these 4 dimensions men with mild urinary symptoms were also significantly more likely to have an impaired health status. Adjustment for age and co-morbidity did not alter the results. CONCLUSIONS: These findings suggest that urinary symptoms have a multidimensional association with physical and mental aspects of health. Although lower urinary tract symptoms may be the cause of an impaired health status, men with impaired health conditions may be more sensitive to prevalent urinary symptoms and more likely to report them. While the casual nature of this association has not been ascertained, these results may help to identify appropriate health dimensions to assess in patients with lower urinary tract symptoms.

Adult↗

Correlation between prostate size estimated by digital rectal examination and measured by transrectal ultrasound.

OBJECTIVES: To correlate prostate size estimates performed by single or multiple examiners through digital rectal examination (DRE) with volume measured by transrectal ultrasound (TRUS) and to propose measures for predicting prostate volume using DRE estimates in clinical settings. METHODS: Data from four sources were analyzed: (1) the Olmsted County community study of 397 patients examined by a single urology nurse, with TRUS measurements done by multiple examiners; (2) a community study in Stirling, Scotland, involving 480 patients with DRE and TRUS performed by one urologist; (3) baseline data from the Veterans Affairs Cooperative Study No. 359 in 1222 patients with DRE and TRUS measurements by multiple personnel at 31 centers; and (4) a clinical series of 100 men with DRE and TRUS by a single urologist. RESULTS: DRE estimates and TRUS volumes were significantly correlated (r = 0.4 to 0.9), but prostate size was underestimated by 25% to 55% for men with a prostate volume over 40 mL, depending on the study, with greater variability for studies involving multiple examiners. In one study that assessed prostate dimensions by DRE, posterior surface area (SA) correlated with overall TRUS volume (r = 0.4). According to receiver operating characteristic curves, SA showed a 70% and 76% chance of correctly identifying men with prostate volume greater than 30 or 40 mL, respectively; those with larger prostates were best distinguished by SA greater than 7 cm2 (sensitivity greater than 0.74, specificity greater than 0.50). CONCLUSIONS: DRE underestimates prostate size, particularly if TRUS volume is greater than 30 mL. However, DRE estimates may help identify prostates likely to be larger than certain cutpoints by TRUS. Posterior SA may be useful as a preliminary assessment when prostate size is an important predictor of therapeutic response.

Aged↗

Primary testicular seminoma: prognostic significance of nuclear DNA ploidy pattern.

OBJECTIVE: To evaluate the impact of nuclear DNA content on outcome of patients with testicular seminoma. METHODS: Formalin-fixed paraffin-embedded blocks taken from 111 patients with primary testicular seminoma were studied by flow cytometry for nuclear DNA content. The results of ploidy status were correlated with histopathologic features, tumor progression and patients' survival. RESULTS: 48% of the tumors were DNA diploid and 52% were DNA aneuploid. None of the patients with DNA diploid seminoma had an advanced stage seminoma at the time of diagnosis. Progression after therapy or cancer-related death occurred only in patients who had DNA aneuploid testicular tumors. CONCLUSIONS: Nuclear DNA ploidy pattern provides important prognostic information for patients with testicular seminoma.

Adult↗

Chromosomal anomalies in stage D1 prostate adenocarcinoma primary tumors and lymph node metastases detected by fluorescence in situ hybridization.

PURPOSE: We determined if characteristic chromosomal anomalies exist within the primary tumors and lymph node metastases in patients with stage D1 prostate cancer, and compared the patterns of chromosomal alterations between primary tumors and nodal metastases. MATERIALS AND METHODS: Fluorescence in situ hybridization analysis using peri-centromeric probes for chromosomes 6, 7, 8, 17, X and Y was performed on 5 mu. sections from paraffin embedded tissue blocks obtained from 23 consecutive patients who underwent radical prostatectomy and bilateral pelvic lymphadenectomy in 1990 for stage D1 prostate cancer. RESULTS: The dominant focus of primary tumor was compared to matched nodal metastases in 12 cases. Five of 12 primary tumor foci (41.7%) had similar chromosomal gains and the same fluorescence in situ hybridization ploidy result as the corresponding nodal metastases. Chromosomes 7 and X (73.2% of cases) were most frequently gained in the primary tumors, and chromosomes X and Y (81.2% of cases) were most frequently gained in the metastases. No primary tumor or metastasis demonstrated chromosomal loss. Three of 19 primary tumors (15.7%) were diploid, while 16 of 19 (84.3%) were nondiploid. Chromosomal aneusomy was inversely correlated with increasing Gleason summary score. CONCLUSIONS: These data indicate that the dominant primary tumor foci may not give rise to nodal metastases, gains of chromosomes 7, X and Y may be associated with metastatic behavior, and patients with stage D1 disease have a greater rate of aneuploidy than those with lower stage cancer.

Adenocarcinoma↗

Age-related differences in internal prostatic architecture on transrectal ultrasonography: results of a community based survey in Japan.

PURPOSE: We determined age-related differences in prostate internal architecture and prostate volume by transrectal ultrasonography in Japanese men 40 to 79 years old. MATERIALS AND METHODS: The 287 study participants were categorized by transition zone disease: group 1-not visible (normal prostate), group 2-visible, borders unclear (diffusely enlarged hyperplasia) and group 3-visible, border clear (nodularly enlarged hyperplasia). RESULTS: Group 1 comprised 40% of men 50 to 79 years old and showed slightly decreased median prostate volume with age. Prostate volume and its variance increased with age in group 3 but differed little across age in group 2. CONCLUSIONS: In a community sample the prostatic internal architecture relationship with age and prostate volume suggested differing growth patterns.

Adult↗

Relationship between DNA ploidy and functional estrogen receptors in operable prostate cancer.

OBJECTIVE: To evaluate the relationship between the nuclear DNA content and the tissue estrogen receptor (ER) level in patients with operable adenocarcinoma of the prostate. METHOD: Surgical specimens taken from 73 patients with clinically localized prostate cancer were studied. Tumor DNA ploidy pattern as measured by flow cytometry was correlated with the level of functional ER using the nuclear biopsy assay. RESULTS: Forty-five percent of the tumors were DNA diploid, and 55% had an abnormal ploidy pattern (DNA tetraploid or DNA aneuploid). The ER level ranged from 0 to 6,475 fmol/mg DNA (mean 839 fmol/mg DNA). Twenty-two percent had no functional receptors. Marked association was noted between ER and nuclear DNA content. Seventy-five percent of the tumors with no ER had abnormal ploidy patterns. The mean receptor level for DNA diploid prostate cancer was 1,034 fmol/mg DNA versus 661 fmol/mg DNA for DNA nondiploid tumors (p < 0.008). An inverse correlation was found between ER values and histologic grade or pathologic stage. High-grade and high-stage tumors had lower levels of ER compared to low-grade and early-stage carcinomas. CONCLUSION: Our results demonstrate an association between ER values and variables that predict prognosis in prostate cancer. It is possible that this parameter may be helpful in identification of prognostic groups in patients with prostate cancer.

Adenocarcinoma↗

Predictive properties of serum-prostate-specific antigen testing in a community-based setting.

BACKGROUND: Most studies that have described the sensitivity and specificity of prostate-specific antigen (PSA) as a screening test have been conducted in urology practice settings or in media-based screening programs. The control patients from these settings may have a higher prevalence of urologic disorders that increase serum PSA levels than that of the general population in which screening efforts might take place, leading to biased estimates of sensitivity and specificity. OBJECTIVE: To determine the sensitivity and specificity of serum PSA levels for the early detection of prostate cancer in a population-based setting. PATIENTS AND METHODS: This population-based case-control study was conducted in Olmsted County, Minnesota, where the Rochester Epidemiology Project could identify all incident cases of prostate cancer through passive surveillance of medical care provided to local residents. Case patients were all 177 men (age range, 50-79 years) who were newly diagnosed as having prostate cancer from 1990 through 1992 and had a prediagnostic serum PSA determination (90% of all incident cases). Control patients were randomly selected from the Olmsted County population and had undergone a clinical examination to exclude prostate cancer. RESULTS: The median (25th and 75th percentiles) of serum PSA levels was 9.4 ng/mL (5.4 and 18.6 ng/mL, respectively) for case patients and 1.2 ng/mL (0.7 and 2.1 ng/mL, respectively) for control patients (P < .001). When sensitivity was plotted against 1-specificity, the area under the receiver operating characteristic curve was 0.94 (SE, 0.01). The predictive power declined somewhat with age, with areas under the curve of 0.96, 0.94, and 0.90 for men in their 50s, 60s, and 70s, respectively. When cases were restricted to the 155 men with clinically localized disease, the area under the curve was essentially unchanged (0.94; SE, 0.01) and still much greater than the estimates of 0.75 that were reported from urology practice- and media-based settings. CONCLUSIONS: In a community-based setting, serum PSA levels provide better discrimination between men with and without clinically localized prostate cancer than has been observed in studies that were conducted in urologic practices. These results suggest that previous decision analyses may have underestimated the predictive value of PSA for the detection of prostate cancer in a primary care or community-wide screening program.

Age Factors↗

Adverse effects of medications on urinary symptoms and flow rate: a community-based study.

The relationship between urinary symptoms and medication use was investigated in a community-based cross-sectional study involving a random sample of 2115 men 40-79 years of age in Olmsted County, Minnesota. The American Urological Association Symptom Index (AUASI) was generated from a validated self-administered questionnaire. Medication use was assessed by in-person interviews. While 1087 men reported daily medication use, only 136 reported daily use of medications known to affect urinary function adversely, including antidepressants (42), antihistamines (23), and bronchodilators (43). Age-adjusted AUASI scores were higher in men reporting daily use of antidepressants, and the association persisted after additionally adjusting for the Depression and Anxiety subscales of the General Psychological Well-Being Scale (adjusted mean difference, 2.1; 95% confidence interval (CI), 0.5-3.6; p = 0.008). The adjusted AUASI was also higher among men who took antihistamines daily (adjusted mean difference, 2.3; 95% CI, 0.3-4.3; p = 0.03). Lower age-adjusted urinary flow rates occurred with antidepressants, but not with antihistamines or bronchodilators. Clinicians evaluating men for causes of voiding dysfunction in accordance with the Agency for Health Care Policy and Research practice guideline for the diagnosis and management of benign prostatic hyperplasia should be aware that daily use of antidepressants or antihistamines may be associated with AUASI scores that are two to three points higher than in men not taking these medications.

Adult↗

Renal oncocytoma: magnetic resonance imaging characteristics.

PURPOSE: We investigated the magnetic resonance imaging (MRI) appearance of renal oncocytomas. MATERIALS AND METHODS: Between 1985 and 1993, 11 patients at our institution underwent MRI of the kidneys and were subsequently diagnosed with renal oncocytoma. Patient charts and MRI were reviewed. RESULTS: Of 11 T1-weighted images 8 showed a mass with decreased signal intensity compared to renal cortex and 3 of 6 T2-weighted images revealed masses with increased intensity. In addition, 5 tumors were surrounded by a well defined capsule, 3 demonstrated a central stellate architecture and 1 contained an area of central decreased signal, all of which corresponded pathologically to scar. These MRI findings differ somewhat from those of renal cell carcinoma, which typically show intermediate to high signal intensity compared to renal cortex on T1 and T2-weighted pulse sequences and usually contain evidence of either hemorrhage or necrosis. CONCLUSIONS: A low intensity homogeneous mass on T1-weighted images, which appears as increased intensity on T2-weighted images, the presence of a capsule, central scar or stellate pattern and the absence of either hemorrhage or necrosis suggest oncocytoma. It is in the evaluation of patients with a solitary kidney, poor renal function, advanced age or a small easily resectable renal mass when MRI may help diagnose an oncocytoma and, thus, allow renal sparing surgery. The optimal MRI to evaluate renal masses should include T1-weighted spin echo images and without gadolinium, T2-weighted images and gradient recalled echo images.

Adenoma, Oxyphilic↗

Natural history of prostatism: longitudinal changes in voiding symptoms in community dwelling men.

PURPOSE: We report the results of 3 contacts during 42 months of The Olmsted County Study of Urinary Symptoms and Health Status Among Men, a longitudinal cohort study of men 40 to 79 years old that was initiated in 1990 to describe changes in lower urinary tract symptom severity. MATERIALS AND METHODS: At baseline and followup, men completed questionnaires that elicited urinary symptom severity with questions nearly identical to those of the American Urological Association symptom index: RESULTS: Overall, there was an average increase in American Urological Association symptom index of approximately 0.18 (95% confidence interval 0.13 to 0.24) points per year of followup. The average annual symptom score slope and variability in slope increased with patient age at baseline from a mean of 0.05 +/- 1.06 (standard deviation) per year among men in the forties to 0.44 +/- 1.35 per year for men in the sixties, and decreased to 0.14 +/- 1.42 per year for men in the seventies. The age-related changes in symptom severity mirror previous estimates of prostatic growth from autopsy prevalence studies. CONCLUSIONS: These results demonstrate a slow but measurable progression in urinary symptom severity among community dwelling men for 42 months of followup.

Adult↗

Free, complexed, and total serum prostate-specific antigen concentrations and their proportions in predicting stage, grade, and deoxyribonucleic acid ploidy in patients with adenocarcinoma of the prostate.

OBJECTIVES: Nearly half of men with clinically localized prostate cancer are understaged. We evaluated whether knowledge of preoperative free prostate-specific antigen (f-PSA), complexed (c-PSA), and total (t-PSA) concentrations or the ratios thereof (f-PSA/t-PSA, c-PSA/t-PSA, and f-PSA/c-PSA) could improve upon the staging of prostate cancer when compared with standard PSA testing (t-PSA). In addition, we examined their associations with tumor grade and deoxyribonucleic acid (DNA) ploidy. METHODS: Two hundred ninety patients with prostate cancer, 178 (61%) of whom were treated with radical prostatectomy, formed the study group. RESULTS: Although there were significant differences in the f-PSA concentrations with respect to clinical stage, considerable overlap in PSA levels among the clinical substages was observed. Statistically significant differences but weak correlations were observed between the individual f-PSA, c-PSA, and t-PSA concentrations with regard to pathologic stage (organ-confined versus extraprostatic) and grade. No significant relationship, however, was observed with the three ratios. Higher PSA values were not always associated with a pathologic stage of pT3 or greater, and lower levels did not ensure that a tumor was organ-confined. Only a slight association was observed between c-PSA and t-PSA levels and DNA ploidy. No significant relationship was observed between the f-PSA levels as well as the three ratios with regard to DNA ploidy. A statistically significant improvement in predicting pathologic stage was observed when combining knowledge of preoperative t-PSA concentration with the c-PSA/t-PSA ratio. However, the area under the receiver operator characteristic curves was only slightly increased; as such this combination was of limited clinical utility. CONCLUSIONS: Statistically significant but weak correlations were observed between the molecular forms of PSA and stage, grade, and DNA ploidy. The significant overlap in f-PSA and c-PSA values among all stages, grades, and ploidy values precluded any useful predictive information for the individual patient. As such, preoperative knowledge of f-PSA and c-PSA values and the three ratios provided no additional diagnostic information over standard PSA (t-PSA) values alone.

Adenocarcinoma↗

International comparison of the community prevalence of symptoms of prostatism in four countries.

We conducted an international comparison of the prevalence of urinary symptoms of prostatism in 4 countries, using a community-based random sampling of subjects, similar study procedures, and a single definition of cases that was based on a standardized symptom questionnaire. In Scotland 1,994 medically eligible men aged 40-79 years agreed to participate from 3 communities of the Forth Valley. In France, a nation-wide survey was conducted cross-sectionally in a representative sample of 2,011 French men aged 50-84 years. In the USA, the Olmsted County (OC) study recruited an age- and urban/rural-stratified random sample of 2,115 county residents drawn from medically eligible men aged 40-79 years. In Japan, 290 men aged 40-79 years from a fishing village participated in the study. Response rates were 55, 53, 55, and 43% in Scotland, France, OC and Japan, respectively. Urinary symptoms were assessed by the International Prostate Symptom Score (I-PSS), after metrologic validation in English and cross-cultural adaptation of the questionnaire. The prevalence of moderate to severe symptoms (I-PSS > 7) were 14, 18, 38, and 56% in France, Scotland, OC and Japan, respectively. This pattern was consistent within decades of age, and was found for most of the individual urinary symptoms. The proportion of men in Japan reporting very low I-PSS (0 or 1) was approximately 2, 4 and 8 times less frequent, than in OC, Scotland, and France, respectively. Differences in the prevalence of reported urinary symptoms might reflect between-country differences in the true prevalence of benign prostatic hyperplasia. However, cross-cultural differences in the perception and/or willingness to report urinary symptoms may play an important role in the observed differences. Further study will be required to elucidate the underlying causes of the observed differences.

Adult↗