History Of Prostate Carcinoma Research Articles

Neuroendocrine differentiation in the setting of prostatic carcinoma: contemporary assessment of a consecutive series.

Clinicopathologic characterisation of a contemporary series of neuroendocrine (NE) differentiation in the setting of prostatic carcinoma (PCa) was examined. We reviewed institutional databases for in-house cases with a history of PCa and histopathologic evidence of NE differentiation during the disease course. In all, 79 cases were identified: 32 primary and 47 metastases. Metastatic lesions were in liver (n = 15), lymph node (n = 9), bone (n = 6), lung (n = 3), brain (n = 1), and other sites (n = 13). In all, 63 of 76 (82%) cases with NE differentiation and available history were posttherapy: six postradiation therapy (RT), 24 post- androgen-deprivation therapy (ADT), and 33 post-RT + ADT. Morphologic assessment (n = 79): (i) 23 pure small-cell/high-grade NE carcinoma (HGNEC): 20/23 metastatic; (ii) 10 combined high-grade PCa and small-cell/HGNEC: 9/10 primary; (iii) 15 PCa with diffuse NE immunohistochemistry (IHC) marker positivity/differentiation, associated with nested to sheet-like growth of cells with abundant cytoplasm and prominent nucleoli, yet diffuse positivity for at least one prostatic and one NE IHC marker: all metastatic; (iv) 11 PCa with patchy NE differentiation, displaying more than single-cell positivity for NE IHC: five primary / six metastatic; (v) nine PCa with focal NE marker positive cells: four primary / five metastatic; (vi) 11 PCa with 'Paneth cell-like' change: all primary. In this contemporary series, the majority of NE differentiation in the setting of PCa was seen posttherapy. We highlight the tendencies of small-cell/HGNEC and PCa with diffuse NE differentiation by IHC to occur in metastatic settings, while morphologically combined high-grade PCa + small-cell/HGNEC and 'Paneth cell-like' change occur in primary disease.

68Ga-PSMA-11 PET/CT in patients with occult biochemical recurrence of prostate carcinoma and negative 18F-Choline PET/CT. Preliminary assessment of its clinical use

ObjectiveTo assess the clinical usefulness of 68Ga-PSMA PET/CT studies in patients with occult biochemical recurrence of prostate carcinoma, with negative or inconclusive radiologic and 18 F-Choline PET/CT imaging studies. Material and methodsRetrospective descriptive study. The first 14 patients with a history of prostate carcinoma, treated with curative intent and presenting suspicion of biochemical recurrence with low PSA values (<3 ng/mL) were selected. Imaging studies, prostate ultrasound, pelvic CT and/or MRI were negative, and all of them had a negative or inconclusive 18F-Choline PET/CT.All patients were referred to 68 Ga-PSMA-11 PET/CT. Protocol: Dose 2.2 M Bq/kg. 20 mg furosemide at start. PET/CT images from skull base to proximal third of thighs at 60 min, and late images at 3 h if needed. ResultsThe 68 Ga-PSMA-11 PET/CT was able to localize the occult biochemical recurrence in 9 of the 14 patients (64.2%), and it affected the therapeutic attitude in all of them.Four patients (28.5%) obtained a negative or inconclusive 68 Ga-PSMA-11 PET/CT and continued under vigilant approach with PSA controls and imaging studies according to the clinical guidelines. These patients had the lowest PSA values (less than 1 ng/mL).One of the 68 Ga-PSMA-11 PET/CT studies was inconclusive, reporting the presence of a doubtful right iliac adenopathy. Conclusion68 Ga-PSMA-11 PET/CT allows an early diagnosis, with low PSA values, of occult biochemical recurrence of prostate carcinoma, even in patients with negative 18 F-Choline PET/CT.

68Ga-PSMA-11 PET/TC en la recidiva bioquímica oculta del carcinoma de próstata, con 18F-Colina PET/TC negativa. Valoración preliminar de su uso clínico

ObjectiveTo assess the clinical usefulness of 68Ga-PSMA PET/CT studies in patients with occult biochemical recurrence of prostate carcinoma, with negative or inconclusive radiologic and 18F-Choline PET/CT imaging studies. Material and methodsRetrospective observational and diagnostic accuracy. The first 14 patients with a history of prostate carcinoma, treated with curative intent and presenting suspicion of biochemical recurrence with low PSA values (< 3 ng/ml) were selected. Imaging studies, prostate ultrasound, pelvic CT and/or MRI were negative, and all of them had a negative or inconclusive 18F-Choline PET/CT.All patients were referred to 68Ga-PSMA-11 PET/CT. Protocol: Dose 2.2 MBq/kg. 20 mg furosemide at start. PET/CT images from skull base to proximal third of thighs at 60 min, and late images at 3 hours if needed. ResultsThe 68Ga-PSMA-11 PET/CT was able to localize the occult biochemical recurrence in 9 of the 14 patients (64.2%), and it affected the therapeutic attitude in all of them.Four patients (28.5%) obtained a negative or inconclusive 68Ga-PSMA-11 PET/CT and continued under vigilant approach with PSA controls and imaging studies according to the clinical guidelines. These patients had the lowest PSA values (less than 1 ng/ml).One of the 68Ga-PSMA-11 PET/CT studies was inconclusive, reporting the presence of a doubtful right iliac adenopathy. Conclusión68Ga-PSMA-11 PET/CT allows an early diagnosis, with low PSA values, of occult biochemical recurrence of prostate carcinoma, even in patients with negative 18F-Choline PET/CT.

Reflex PCA3 messenger ribonucleic acid testing: validation of postbiopsy urine samples and correlation with prostate biopsy findings in ∼2000 patients.

To validate post-transrectal ultrasonography (TRUS) prostate biopsy (bx) urine samples for PCA3 messenger ribonucleic acid testing, including correlation of PCA3 score with concurrent bx findings. From July 2008 to July 2010, 2015 patients had urine collected immediately after a TRUS-guided prostate bx. Excluded were men with history of prostate carcinoma (CaP), <6 or ≥24 bx cores, and/or prostate-specific antigen (PSA) level ≥50 ng/mL, resulting in 1909 included men. PCA3 and PSA messenger ribonucleic acid were quantitated using transcription-mediated amplification. A PCA3 score of ≥35 was considered positive. Mean and median ages were 66 years. Mean and median PSA levels were 6.7 and 5.1 ng/mL, respectively. Bxs were benign in 970 (50.8%), CaP in 726 (38%), high-grade prostatic intraepithelial neoplasia (HGPIN) in 124 (6.5%), and atypical in 89 (4.7%). PCA3 test was informative in 1887 (98.8%) patients. Means ± standard deviations (median) of PCA3 scores for benign, HGPIN, atypical, and CaP were 22.3 ± 27.9 (12.8), 37.6 ± 43.2 (24.1), 35.7 ± 36.2 (25.7), and 46.9 ± 48.1 (31.6; P <.05 benign vs CaP, benign vs HGPIN and atypical, HGPIN and atypical vs CaP). Sensitivity and specificity of PCA3 for CaP were 46.3% and 78.7%, respectively. CaP risk increased with progressively higher PCA3 score ranges from 14.8% for PCA3 <5 to 66.7% for PCA3 >100. Area under the curve (AUC) for the PCA3 receiver operating characteristics was not significantly different in men without prior bx (AUC = 0.716) compared with men with at least 1 prior nonpositive bx (AUC = 0.702). Post-TRUS bx urine is a valid sample for PCA3 testing. Patients with a negative bx and a positive PCA3 test may have a higher likelihood of unsampled CaP.

HOXB13 is a sensitive and specific marker of prostate cells, useful in distinguishing between carcinomas of prostatic and urothelial origin

The origin of a primary or metastatic carcinoma in the pelvic area is sometimes difficult to establish, in particular the distinction between those originating in the bladder and the prostate. A candidate marker is the HOXB13 gene, essential for prostate development. Some studies have shown expression of HOXB13 protein by immunohistochemistry in the nuclear compartment of benign prostate luminal epithelium and prostate carcinoma. Forty-two cases of biopsies and resection specimens of the prostate and urinary bladder, metastatic lymph nodes, and pelvic masses were retrieved from our databases. In all cases, doubt persisted regarding prostatic versus urothelial origin. All cases were stained for CK7, p63, p504s, PSA, CK20, and HOXB13. Chromogranin A, CD56, and synaptophysin were used when neuroendocrine differentiation was suspected. HOXB13 staining was negative or only weakly positive in all carcinomas of urothelial origin. Three of four carcinomas with neuroendocrine differentiation did not express HOXB13. The fourth carcinoma, in a patient with a history of prostate carcinoma, was positive. In two cases with a synchronous prostatic and urothelial carcinoma, HOXB13 was exclusively expressed in the prostatic carcinoma. Our results demonstrate that HOXB13 expression identifies prostatic origin of a carcinoma with good sensitivity (89 %) and very good specificity (100 %). HOXB13 is a specific and sensitive marker for prostate cells and a valuable diagnostic tool, especially when poorly differentiated or neuroendocrine tumors are encountered. These results justify testing of HOXB13 as a prostate-specific carcinoma marker in larger cohorts for a more thorough evaluation of its sensitivity and specificity.

Epididymal Sparing Bilateral Orchidectomy with Epididymoplasty for Advanced Cancer Prostate: Our Experience in Rural Setup

Rise in incidence and variable natural history of prostatic carcinoma, presents a challenge to professionals involved in its management. Cases that come for evaluation and treatment in developing countries like ours are elderly and usually present in the late stages of the disease. Perhaps the best option remain at this stage is palliative in the form of channel TURP to improve the urine flow and suppress the cancer growth by androgen deprivation treatment (ADT). Further improvement of quality of life is achieved by supportive measures like good nutrition, vitamins and calcium supplementation to prevent demineralisation of bones and analgesic for pain relief. Bilateral Orchidectomy remains the most effective and permanent solution for ADT as it brings down serum testosterone level very rapidly to castration level of 20%. Epididymis functions only as the carrier of sperms and help in maturation during the passage. In no way it is involved in spermatogenesis or production of testosterone. Epididymal sparing bilateral orchidectomy with epididymoplasty achieves androgen deprivation to that of castration level. Left over epididymal bubbins in the scrotal sacs maintains the shape of scrotum and gives the patient a feel of scrotal sac not being empty.

2313 PROSTATE BIOPSY GUIDED WITH TISSUE ELASTICITY IMAGING - NOVEL APPROACH TO IMPROVE PROSTATE CANCER DETECTION

You have accessJournal of UrologyImaging/Radiology: Uroradiology1 Apr 20112313 PROSTATE BIOPSY GUIDED WITH TISSUE ELASTICITY IMAGING - NOVEL APPROACH TO IMPROVE PROSTATE CANCER DETECTION Masahiro Sumura, Chiaki Kobara, Keita Inoue, Naoko Arichi, Yozo Mitsui, Takeo Hiraoka, Koji Wake, Satoshi Honda, Hiroaki Yasumoto, Hiroaki Shiina, and Mikio Igawa Masahiro SumuraMasahiro Sumura Izumo, Shimane, Japan More articles by this author , Chiaki KobaraChiaki Kobara Izumo, Shimane, Japan More articles by this author , Keita InoueKeita Inoue Izumo, Shimane, Japan More articles by this author , Naoko ArichiNaoko Arichi Izumo, Shimane, Japan More articles by this author , Yozo MitsuiYozo Mitsui Izumo, Shimane, Japan More articles by this author , Takeo HiraokaTakeo Hiraoka Izumo, Shimane, Japan More articles by this author , Koji WakeKoji Wake Izumo, Shimane, Japan More articles by this author , Satoshi HondaSatoshi Honda Izumo, Shimane, Japan More articles by this author , Hiroaki YasumotoHiroaki Yasumoto Izumo, Shimane, Japan More articles by this author , Hiroaki ShiinaHiroaki Shiina Izumo, Shimane, Japan More articles by this author , and Mikio IgawaMikio Igawa Izumo, Shimane, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2559AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Real-time tissue elastography is a recently developed novel approach for revealing prostate cancer based on tissue elasticity. In cancer tissues, tissue elasticity elevation is considered to sensitively reflect the condition of the lesion before morphological changes can be detected by ultrasonography, as the lesion may or may not possess echogenic properties to make it ultrasonically detectable. It is expected that elastography will provide new and clinically useful information different from that obtained by usual ultrasound examination. In the present study, we investigated whether objective analysis of prostate tissue elasticity using real-time tissue elastography (RTE) is more useful to detect localized prostate cancer (PC) than a conventional approach with a PC-detection screening program. METHODS This study included 208 patients (38–93 years old, median 72 years) with PSA levels ranging from 0.8-1113.8 ng/ml (median 6.0 ng/ml) who underwent a prostate biopsy procedure, because of a palpable abnormality in digital rectal examination (DRE), elevated serum PSA level, and/or abnormal gray-scale transrectal ultrasonographic (TRUS) findings. All patients underwent TRUS, power Doppler ultrasonography (PDUS), and RTE examinations prior to the prostate biopsy, and none had a known history of prostate carcinoma. To evaluate the utility of RTE, gray-scale, PDUS, and RTE findings recorded prior to the biopsy by a single urologist were used to compare between among those modalities and the biopsy findings. Three analysis strategies were used; a conventional 8-site biopsy-based approach, a targeted biopsy-based approach, and a patient-based approach. RESULTS Prostate cancer was detected in 89 of 208 patients (42.4%). The sensitivity, specificity, and positive predictive value (PPV) of RTE were 88.8%, 96.8%, and 86.2%, respectively, while its negative predictive value (NPV) was 97.4%. All results related to the diagnostic probability of PC detection were higher for RTE than for PDUS or TRUS. Using multivariate analysis with PSA density and prostate volume as variables, PSA density and DRE contributed only weakly to PC detection in the 207 patients with PSA levels below 120 ng/ml, whereas a positive finding by RTE was the variable most significantly associated with PC detection. CONCLUSIONS RTE is simple and noninvasive, and can compensate for the functional limitations of TRUS and PDUS. In addition, it was shown to be effective for early identification of clinically significant cancer with high Gleason score. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e927 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Masahiro Sumura Izumo, Shimane, Japan More articles by this author Chiaki Kobara Izumo, Shimane, Japan More articles by this author Keita Inoue Izumo, Shimane, Japan More articles by this author Naoko Arichi Izumo, Shimane, Japan More articles by this author Yozo Mitsui Izumo, Shimane, Japan More articles by this author Takeo Hiraoka Izumo, Shimane, Japan More articles by this author Koji Wake Izumo, Shimane, Japan More articles by this author Satoshi Honda Izumo, Shimane, Japan More articles by this author Hiroaki Yasumoto Izumo, Shimane, Japan More articles by this author Hiroaki Shiina Izumo, Shimane, Japan More articles by this author Mikio Igawa Izumo, Shimane, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Multi-resistant Escherichia coli sepsis following transrectal ultrasound-guided prostate biopsy

A 63-year-old man with a family history of prostate carcinoma underwent a transrectal ultrasoundguided biopsy of the prostate for investigation of a slowly raising prostate-specific antigen 5.0 ng/ml. The patient had recently returned from a 4-week holiday in India, where he experienced an episode of self-limiting diarrhoea. Before biopsy he was given prophylactic norfloxacin 400 mg orally twice daily, started 1 day before biopsy and continued for 1 day post biopsy with 240 mg intravenous (IV) gentamicin given during the procedure. Three days post procedure he was admitted to hospital with fevers and rigors. Gentamicin and ceftriaxone were commenced but he remained febrile. Forty-eight hours later urine culture grew a multi-resistant gram-negative rod, and the patient was started on IV imipenem. Final sensitivities reported Escherichia coli with resistance to amoxicillin, amoxicillin and clavulanic acid, norfloxacin, ciprofloxacin, gentamicin and ceftriaxone, and with sensitivity to meropenem and nitrofurantoin. The fever settled and the patient was discharged on oral nitrofurantoin for a further 2 weeks, making a complete recovery.

Primary Parathyroid Tumors of the Mediastinum

We describe 17 cases (9 women, 8 men; aged 36 to 72 years) of primary parathyroid tumors occurring primarily in the anterior mediastinum. Clinically and radiologically, all patients had an anterior mediastinal tumor. All patients had metabolic disturbances with calcium and phosphorus. Of 17 patients, 13 had clinical primary hyperparathyroidism, 1 had secondary hyperparathyroidism due to polycystic kidney disease, and 1 had a history of prostatic carcinoma and 1 of chronic obstructive pulmonary disease. In 1 patient, the tumor was found at autopsy. Grossly, the tumors varied in size from 2 to 7 cm in greatest dimension. Histologically, 2 tumors showed features of parathyroid carcinoma, and 15 tumors showed more conventional features of parathyroid adenomas. Six tumors were predominantly oncocytic, 6 were composed predominantly of chief cells, and 3 had mixed cellular composition. Immunohistochemical studies for chromogranin, synaptophysin, low-molecular-weight keratin (CAM 5.2), and parathyroid hormone were performed in 10 cases (8 parathyroid adenomas and 2 parathyroid carcinomas). All the tumors examined showed variable positive reaction for those antibodies. The cases highlight the importance of keeping primary parathyroid tumors in the differential diagnosis of anterior mediastinal tumors.

Primary Parathyroid Tumors of the Mediastinum

We describe 17 cases (9 women, 8 men; aged 36 to 72 years) of primary parathyroid tumors occurring primarily in the anterior mediastinum. Clinically and radiologically, all patients had an anterior mediastinal tumor. All patients had metabolic disturbances with calcium and phosphorus. Of 17 patients, 13 had clinical primary hyperparathyroidism, 1 had secondary hyperparathyroidism due to polycystic kidney disease, and 1 had a history of prostatic carcinoma and 1 of chronic obstructive pulmonary disease. In 1 patient, the tumor was found at autopsy. Grossly, the tumors varied in size from 2 to 7 cm in greatest dimension. Histologically, 2 tumors showed features of parathyroid carcinoma, and 15 tumors showed more conventional features of parathyroid adenomas. Six tumors were predominantly oncocytic, 6 were composed predominantly of chief cells, and 3 had mixed cellular composition. Immunohistochemical studies for chromogranin, synaptophysin, low-molecular-weight keratin (CAM 5.2), and parathyroid hormone were performed in 10 cases (8 parathyroid adenomas and 2 parathyroid carcinomas). All the tumors examined showed variable positive reaction for those antibodies. The cases highlight the importance of keeping primary parathyroid tumors in the differential diagnosis of anterior mediastinal tumors.

Type I hereditary punctate keratoderma

A 75-year-old man with a history of prostatic carcinoma and atypical fibroxanthoma reports a long-standing history of 1-2 mm depressed, hyperkeratotic papules on the palms. His mother suffered a similar condition. Histologically, the papules demonstrated hyperkeratosis, without columns of parakeratosis. A diagnosis of type I hereditary punctate keratoderma (Buschke-Fisher-Brauer disease) was made. This condition, which is classified as one of the three hereditary forms of punctate palmoplantar keratoderma, is an autosomal-dominant condition with variable penetrance. It is characterized clinically by multiple, tiny, punctate keratoses of the palms and soles. Affected individuals appear to be at increased risk of developing malignant conditions.

Concomitant bilateral herpes zoster opthalmicus

A 75-year-old man presented with general weakness and nausea for 3 weeks. He had a history of prostate carcinoma, stage III, hormone refractory with metastasis to the bones, for which he underwent radical prostatectomy and was treated with antiandrogens, luteinising-hormone-releasing-hormone agonist, and systemic chemotherapy. Other problems included anaemia of chronic disease, gastrooesophageal reflux, and osteoarthritis. He received recombinent erythropoetin weekly. Vital signs were stable on presentation and clinical examination was unremarkable.

The natural history of prostate carcinoma based on a Danish population treated with no intent to cure

The natural history of prostate carcinoma based on a Danish population treated with no intent to cure

False-Positive Radionuclide Venography Caused by Distended Urinary Bladder

A 60-year-old man with a history of prostatic carcinoma presented with left lower extremity swelling. A massively distended urinary bladder produced a false-positive radionuclide venogram.

Endobronchial metastasis from prostatic cancer in patient with renal cell carcinoma

A patient was seen with a right upper lobe endobronchial mass initially thought to be bronchogenic carcinoma. There was a history of prostatic carcinoma, and subsequent investigation demonstrated a hypernephroma. Thoracotomy and special studies proved the endobronchial metastasis to be prostatic in origin, a rare cause of endobronchial metastasis.

The Sign of Leser-Trélat

<h3>To the Editor.—</h3> The sign of Leser-Trélat, ie, the development of multiple pruritic seborrheic keratoses, either preceding or concurrent with the development of internal carcinomas, is a sign which has not been totally accepted by the dermatologic community.¹Recently we saw a patient with a history of prostatic carcinoma who subsequently developed multiple seborrheic keratoses that were essentially asymptomatic. <h3>Report of a Case.—</h3> A 64-year-old man was seen in August 1974 with a chief complaint of "black moles of the back." He acknowledged the presence of this type of lesion for several years but sought medical attention at this time because of a sudden increase in their number during the preceding months. There was no history of pruritus. Medical history showed adenocarcinoma of the prostate first treated by transurethral resection in the spring of 1973. He was treated chemotherapeutically for recurrence of his genitourinary disorder in August 1974. Physical examination