Biomedical subjects

P Hammerer

Publications and source records attributed to P Hammerer.

At least 55 records · Page 3Linked to original sources

PubMed1996

Urethral closure pressure changes with age in men.

PURPOSE: The natural history of external urethral sphincter function in elderly men is unknown. MATERIALS AND METHODS: In 257 men 45 to 88 years old external sphincter function changes with aging were analyzed by urodynamic studies, including functional urethral length, maximal urethral pressure, sphincter length and maximum urethral pressure during voluntary contraction. RESULTS: Mean functional urethral length was 51.9 mm. and there was no statistical decrease with age. However, sphincter length decreased with age from 24.3 to 14.8 mm., maximal urethral pressure from 88.7 to 55 cm. water and maximal urethral pressure during voluntary contraction from 221.4 to 166.3 cm. water. CONCLUSIONS: Sphincter function according to urethral pressure profile decreases with patient age.

Aged↗

PubMed1995

[Status of PSA determination for early detection of prostate carcinoma].

Prostate Specific Antigen (PSA) appears to be useful in the early detection of prostate cancer when used in conjunction with digital rectal examination (DRE) and transrectal ultrasonography (TRUS). Recent studies suggest that the addition of PSA to the routine digital rectal examination leads to detection of prostate cancer at an earlier stage than when digital rectal examination is used alone. In patients with elevated PSA or abnormal DRE prostate biopsies are recommended. However, the routine use of PSA to detect early prostate cancer is limited due to the PSA elevation in patients with prostatic hyperplasia. Possibilities to distinguish BPH from prostate cancer among men who have minimal PSA elevation (4.0 to 10.0 ng/ml) are the use of PSA velocity, PSA density, age adjusted PSA, and analysis of free and complexed PSA. Screening programs for prostate cancer will increase the percentage of localized prostate cancer, which can be cured by radical prostatectomy.

Adult↗

PubMed1995

[Preoperative assessment of tumor aggressiveness in localized prostatic carcinoma].

In 106 consecutive patients with localized prostate cancer digital rectal examination (DRE), preoperative prostate-specific antigen (PSA) determination and results of systematic sextant biopsies (TRUS 6Bx) of the prostate were analyzed for their value in the estimation of the aggressivity of tumors. In all patients with negative pelvic lymph nodes radical retropubic prostatectomy was performed. Tumor aggressiveness was defined as capsular penetration (pT2 versus pT3) or positive surgical margins in patients with pT3 tumors. Neither DRE nor preoperative PSA level was helpful in predicting capsular penetration or positive surgical margins. However, the number of positive core biopsies and the identification of Gleason 4 or 5 tumors within positive biopsy specimens correlated with capsular penetration and positive surgical margins. These results can be used to create a score, based on DRE, PSA, TRUS 6Bx, and Gleason 4 or 5, that might be helpful in predicting tumour aggressivity in patients with localized prostate cancer.

Adult↗

PubMed1995

[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↗

PubMed1995

[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.

Aged↗

PubMed1994

Frequency and distribution of numerical chromosomal aberrations in prostatic cancer.

Prostatic cancer frequently shows striking morphological heterogeneity and multifocal growth. To better understand the relationship between chromosomal changes and pathological characteristics, 31 routinely processed radical prostatectomy specimens were studied for the presence of numerical chromosomal aberrations by in situ hybridization with centromeric nucleic acid probes specific for chromosomes 7, 10, 17, X, and Y. In 24 of the cases preoperative core biopsy specimens were available and were examined with the probe for the X chromosome. In eight of the prostatectomy specimens chromosome numbers consistent with a normal male karyotype were found. Three cases, besides diploid chromosome numbers, showed a focal doubling of hybridization signals, consistent with tetraploidy. The other 20 cases displayed numerical chromosomal aberrations to a various degree. In this group the appearance of numerical chromosomal aberrations often showed considerable local heterogeneity, generally coinciding with morphological dedifferentiation, and was significantly correlated with tumor stage (P = .0004) as well as primary (P = .0068), worst (P = .0002), and combined (P < .0001) Gleason grades, total tumor volume (P = .0448), and the volume of tumor with Gleason grades 4 or 5 (P < .0001). In four of the 24 core biopsy specimens no residual tumor tissue was left for cytogenetic examination. In the remaining 20 biopsy specimens the presence or absence of numerical changes matched the result obtained on the corresponding prostatectomy specimen. We conclude that in prostatic cancer the presence of numerical chromosomal aberrations is associated with advanced disease. Especially in low differentiated tumors local heterogeneity in 2 chromosome numbers can be very marked. It is possible to forecast the presence or absence of numerical chromosomal changes on preoperative core biopsy specimens.

Adenocarcinoma↗

PubMed1994

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.

Aged↗

PubMed1994

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↗

PubMed1994

[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↗

PubMed1993

Numerical chromosomal aberrations in prostate cancer: correlation with morphology and cell kinetics.

Eleven routinely processed radical prostatectomy specimens were studied for the presence of numerical chromosomal aberrations by means of in situ hybridization with nucleic acid probes specific for chromosomes 7, 10, 17, X, and Y. Cytogenetic information was correlated with morphology, tumour stage and volume as well as with cell kinetics, the latter being assessed by immunohistochemistry with antibodies raised against the proliferative cell nuclear antigen (PCNA) and against a formalin-resistant epitope of the Ki-67 antigen, MIB 1. In 5 of 11 cases, numerical aberrations of at least one chromosome were found. The cases with normal chromosome numbers were those with the smallest volumes of Gleason grade 4 and/or 5 tumour (mean 0.5 cm3) and represented tumours restricted to the prostate. Tumours with aberrations in the number of detected chromosomes showed advanced stages and large volumes of high-grade tumour (mean 12.5 cm3). All 4 tumours with positive surgical margins were recruited from a group with marked local heterogeneity in chromosome numbers. Immunostaining with MIB 1 and PCNA was most intense in areas of high-grade tumour and was positively correlated with the emergence of chromosomal aberrations. The data suggest that the appearance of numerical chromosomal aberrations in prostate cancer coincides with aggressive tumour behaviour and could be used as an additional prognostic marker.

Aged↗

PubMed1993

[Significance of numerical chromosome aberrations in prostate cancer].

Thirty-one routinely processed radical prostatectomy specimens were examined for the presence of numerical chromosomal aberrations by in situ hybridization with centromeric nucleic acid probes specific for chromosomes 7, 10, 17, X, and Y. In eight of the prostatectomy specimens, chromosome numbers consistent with a normal male karyotype were found. Three cases, in addition to diploid chromosome numbers, showed a focal doubling of hybridization signals, consistent with tetraploidy. The other 20 cases displayed more or less marked numerical chromosomal aberrations. In this group, the appearance of numerical chromosomal aberrations often showed considerable local heterogeneity and was significantly correlated with tumor stage, Gleason grades, and tumor volume. We conclude that in prostatic cancer the presence of numerical chromosomal aberrations is associated with advanced disease. Especially in low differentiated tumors local heterogeneity in chromosome numbers can be very marked.

Chromosome Aberrations↗

PubMed1992

Prostate cancer in nonurological patients with normal prostates on digital rectal examination.

Random systematic ultrasonographically guided transrectal core biopsies of the prostate were performed in 73 patients with pulmonary malignancies to exclude prostate cancer as a primary malignant neoplasm. Of the patients 41 had normal prostates as judged by digital rectal examination, 27 had firm prostates and 5 had clinical stage B nodules. Hypoechoic areas were seen on transrectal ultrasonography in 14 of the 41 patients (34%) with normal prostates. Biopsy of the hypoechoic areas in this subgroup detected only 1 grade II prostate cancer. In another patient with normal transrectal ultrasound grade I cancer was detected by mapping of the prostate with 6 systematic ultrasonographically guided transrectal core biopsies. Of the remaining 39 patients with normal prostates transrectal ultrasound detected no hypoechoic defect in 26, a specificity for the detection of prostate cancer of 67%. Multiple core biopsies revealed prostate cancer in 15 of the 32 cases of palpably abnormal prostates, including 12 that were hypoechoic. Prostate cancer is a rare histopathological finding in men with normal prostates on rectal examination. Transrectal ultrasound detected only 1 of 2 low volume prostate cancers in our study group. Thus, ultrasound seems to have little use in patients with prostates that appear normal on digital examination, and its specificity is low.

Aged↗

PubMed1992

Digital rectal examination, imaging, and systematic-sextant biopsy in identifying operable lymph node-negative prostatic carcinoma.

The value of digital rectal examination, computerized tomography, magnetic resonance imaging, prostate-specific antigen, transrectal ultrasonography, and systematic-sextant biopsy in the identification of lymph node-positive patients before radical prostatectomy was analyzed in 103 men who had pelvic lymph node dissection, CT had a sensitivity of only 7% and a specificity of 96% in detecting lymph nodes, whereas magnetic resonance imaging had a sensitivity of 50% and a specificity of 100%. To evaluate the use of tumor volume in predicting lymph node metastasis, we counted the number of positive core biopsies and compared the results with the incidence of positive lymph nodes. If fewer than 5 positive core biopsies were considered negative for predicting lymph node metastasis, the sensitivity would be 67% (12 of 18), and the specificity 94% (50 of 53). To investigate tumor volume more precisely, we measured the extent of tumor volume in every biopsy as a percentage of the total biopsy core and added the percentage for the 6 biopsies. The lowest score was 10% (10% prostatic cancer in 1 of 6 cores), the highest score 580% (4 cores with 100% each and 2 with 90% each). The score was analyzed for sensitivity and specificity in predicting lymph node metastasis. If a score of 280% was used as a cutoff point, the sensitivity was 71% (10 of 14) and the specificity 91% (52 of 57). When we include the grading system by multiplying the percentage of tumor volume with tumor grade, the difference between the lymph node-positive state and lymph node-negative state becomes even more readily apparent.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1991

[The diagnosis of prostatic carcinoma].

Thanks to the combination of high-resolution transrectal ultrasound and the "Biopty-Gun", it has now become possible for the first time to obtain multiple punch biopsies of the prostate, painlessly and with few complications. "Mapping" of the prostate by 6 randomized punch biopsies permits an evaluation of the sensitivity and specificity of such screening procedures as digital rectal examination (DRE), prostate-specific antigen (PSA) and transrectal ultrasound (TRUS). In addition, randomized biopsies provide reliable information about prostatic carcinomas with a significant volume. The indications and efficacy of the various diagnostic methods are discussed in detail.

Aged↗

PubMed1991

[The diagnosis of bladder carcinomas by NMR tomography: an improvement with Gd-DTPA?].

85 patients suffering from urinary bladder carcinoma were examined by magnetic resonance imaging in a prospective study. Following precontrast diagnosis, 15 patients were given an intravesicular application of gadolinium-DTPA (Gd-DTPA). Another 35 patients received an intravenous bolus of GD-DTPA. A diagnostic advantage was achieved in only 2 of 15 tumours by using intravesicular contrast application. Compared to the precontrast diagnosis, a 14% improvement from 69% (precontrast) to 83% (contrast medium) was seen with Gd-DTPA applied intravenously in the diagnosis of the tumour stage. The diagnostic gain lies in the improved tumour recognition, the improved demarcation of papillary, non-muscle-infiltrating tumours and in the more definite diagnosis of infiltration into neighbouring organs and the pelvic wall. Demarcation of perivesicular fatty infiltration is rendered more difficult by Gd-DTPA.

Administration, Intravesical↗

PubMed1991

[Endosonography of the prostate].

The role of transrectal prostate ultrasonography (TRUS) for screening and early detection is controversial due to its low sensitivity and specificity. The digital rectal examination (DRE) in combination with PSA still remains useful in screening for prostate cancer. Less than 4% of patients with normal DRE and normal PSA have prostate cancer found on random biopsies. We recommend TRUS for exact determination of prostate volume, in patients with suspicious DRE findings, in combination with the Biopty gun for ultrasound-guided biopsies, and in staging before radical prostatectomy.

Biopsy, Needle↗

PubMed1991

[Diagnosis of localized prostate cancer: screening and preoperative staging].

In 712 patients, mapping of the prostate by six systematic ultrasound-guided core biopsies was performed without major side effects using the "biopyt gun". The histologic findings provided data on patients with normal and those with abnormal prostates on digital rectal examination (DRE). Only 3 of 72 (4%) nonurologic patients with normal prostate-specific antigen (PSA; less than 4 ng/ml) had prostate cancer. In patients with firm prostates on DRE and normal PSA, 13 out of 101 (13%) had prostate cancer. In patients in whom PSA was greater than or equal to 4 ng/ml, 92 of 158 (58%) had prostate cancer. In patients with clinical stage B or C and PSA less than 4 ng/ml, 20/56 (36%) had prostate cancer, compared to 155 of 187 (83%) patients with PSA greater than or equal to 4 ng/ml. Transrectal ultrasound (TRUS) seemed not to be useful in screening for prostate cancer, due to its low specificity of 54%, although in patients with clinical stage B or C TRUS identified 157/175 (90%) patients with prostate cancer. For staging prostate cancer we compared in 103 men with pelvic lymph node dissection the value of digital rectal examination, computerized tomography (CT), magnetic resonance imaging (MRI), PAS, TRUS, and random systematic biopsy for identification of lymph-node-positive patients before radical prostatectomy. CT had a sensitivity of only 7% and a specificity of 96% in detecting lymph nodes, whereas MRI had a sensitivity of 50% and a specificity of 100%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1989

[Anatomy and sonography of the prostate].

According to the data of John McNeal, a three-dimensional model of the prostate is presented; this is based on his serial sections of the prostate in different, carefully selected planes. The urethra is the anatomical reference point. The proximal urethral segment is covered by the transition zone, periurethral tissue and the preprostatic sphincter. The two main glandular regions of the prostate are the central zone and the peripheral zone. Carcinoma arises mainly in the peripheral zone, while benign prostatic hyperplasia (BPH) arises mainly in the transition zone.

Adenocarcinoma↗