An inherited NBN mutation is associated with poor prognosis prostate cancer

BACKGROUND

To establish the contribution of eight founder alleles in three DNA damage repair genes (BRCA1, CHEK2 and NBS1) to prostate cancer in Poland, and to measure the impact of these variants on survival among patients.

METHODS

Three thousand seven hundred fifty men with prostate cancer and 3956 cancer-free controls were genotyped for three founder alleles in BRCA1 (5382insC, 4153delA, C61G), four alleles in CHEK2 (1100delC, IVS2+1G>A, del5395, I157T), and one allele in NBS1 (657del5).

RESULTS

The NBS1 mutation was detected in 53 of 3750 unselected cases compared with 23 of 3956 (0.6%) controls (odds ratio (OR)=2.5; P=0.0003). A CHEK2 mutation was seen in 383 (10.2%) unselected cases and in 228 (5.8%) controls (OR=1.9; P<0.0001). Mutation of BRCA1 (three mutations combined) was not associated with the risk of prostate cancer (OR=0.9; P=0.8). In a subgroup analysis, the 4153delA mutation was associated with early-onset (age ≤ 60 years) prostate cancer (OR=20.3, P=0.004). The mean follow-up was 54 months. Mortality was significantly worse for carriers of a NBS1 mutation than for non-carriers (HR=1.85; P=0.008). The 5-year survival for men with an NBS1 mutation was 49%, compared with 72% for mutation-negative cases.

CONCLUSION

A mutation in NBS1 predisposes to aggressive prostate cancer. These data are relevant to the prospect of adapting personalised medicine to prostate cancer prevention and treatment.

A large germline deletion in the Chek2 kinase gene is associated with an increased risk of prostate cancer

BACKGROUND

Germline mutations in the Chek2 kinase gene (CHEK2) have been associated with a range of cancer types. Recently, a large deletion of exons 9 and 10 of CHEK2 was identified in several unrelated patients with breast cancer of Czech or Slovak origin. The geographical and ethnic extent of this founder allele has not yet been determined.

PARTICIPANTS AND METHODS

We assayed for the presence of this deletion, and of three other CHEK2 founder mutations, in 1864 patients with prostate cancer and 5496 controls from Poland.

RESULTS

The deletion was detected in 24 of 5496 (0.4%) controls from the general population, and is the most common CHEK2 truncating founder allele in Polish patients. The deletion was identified in 15 of 1864 (0.8%) men with unselected prostate cancer (OR 1.9; 95% CI 0.97 to 3.5; p = 0.09) and in 4 of 249 men with familial prostate cancer (OR 3.7; 95% CI 1.3 to 10.8; p = 0.03). These ORs were similar to those associated with the other truncating mutations (IVS2+1G-->A, 1100delC).

CONCLUSION

A large deletion of exons 9 and 10 of CHEK2 confers an increased risk of prostate cancer in Polish men. The del5395 founder deletion might be present in other Slavic populations, including Ukraine, Belarus, Russia, Baltic and Balkan countries. It will be of interest to see to what extent this deletion is responsible for the burden of prostate cancer in other populations.

The coexistence of cystic nephroma and renal cortical adenoma

Cystic nephroma is rare, but its coexistence with renal cortical adenoma is unique and has never been reported previously. We present a unique case of simultaneous occurrence of cystic nephroma and renal cortical adenoma in 47-year-old man. Both tumours were situated in the lower pole of the right kidney and were clinically asymptomatic.

[Fibrohistiocytic sarcoma of the kidney (borderline malignancy)]

We described a case of 45 year old woman with left kidney tumour. In the pathological examination it appeared asa very seldom neoplasm--fibriohistiocytoma sarcomatosum. This lesion was accidentally diagnosed in ultrasound evaluation due to myomatous uterus observation in gynaecological hospital. There were no signs or symptoms of kidney tumour disease.

Massive haemorrhage presenting as a complication after percutaneous nephrolithotomy (PCNL)

Authors describe and discuss cases of massive haemorrhage after percutaneous nephrolithotomy. In 10 (0.3%) of 3080 patients who underwent PCNL massive haemorrhage from renal fistula drain or urinary bladder was observed. Renal arteriography was performed in this group of patients which revealed arteriovenous fistulae in 4 patients and aneurysms of renal artery branches in 2. In 4 patients arteriography did not reveal haemorrhage. In one patient nephrectomy was necessary to stop the haemorrhage.

Abnormal function of renal tubules in patients with simple renal cysts

The present study aimed to assess the function of proximal and distal tubules in patients with simple renal cysts. Thirty-one patients with simple renal cysts and 10 healthy subjects were examined. Based on the cyst fluid/plasma sodium ratio, 25 cysts were found to be of proximal origin and 6 of undetermined origin. In all patients cyst fluid and plasma concentrations of beta-2-microglobulin (beta-2-MG), sodium, potassium, calcium, phosphorus and total protein were assessed. Urinary excretions of sodium, potassium, calcium, phosphorus, beta-2-MG and Tamm-Horsfall protein (THP) were also estimated. Fractional excretion of beta-2-MG was calculated. The concentrations of beta-2-MG in fluid obtained from cysts of proximal origin were significantly higher than in fluid from cysts of undetermined origin (2.26 +/- 0 36 vs. 0.65 +/- 0.13 mg/l, p = 0.0004). Concentrations of THP (6.85 +/- 1.21 vs. 3.14 +/- 1.06 micrograms/ml, p < 0.05), and potassium (4.39 +/- 0.07 vs. 3.13 +/- 0.44 mmol/l, p < 0.05) were also higher in fluid from proximal cysts than in fluid from cysts of undetermined origin. Plasma beta-2-MG concentration was significantly higher in patients with proximal and undetermined cysts than in the control group (4.35 +/- 0.34 and 4.11 +/- 0.74 vs. 1.89 +/- 0.1 mg/l, p < 0.001). Urinary beta-2-MG excretion was also significantly higher in both groups of patients than in healthy subjects (474.8 +/- 165.9 and 346 +/- 94 vs. 100.2 +/- 19.6 micrograms/24 h, p < 0.05). Urinary THP excretion was significantly higher in patients with proximal cysts than in healthy subjects (31.0 +/- 5.1 vs. 16.3 +/- 2.5 mg/24 h, p < 0.05). From the results obtained in this study it seems that patients with simple renal cysts of proximal origin are characterized by abnormal tubular handling of beta-2-MG, and calcium and THP excretion. Thus, in patients with proximal cysts presence of a latent renal tubulopathy seems to be likely.

Blood loss during transurethral prostatic resection with continuous bladder irrigation

A total of 120 men with benign prostatic hypertrophy were assigned randomly into three groups. Transurethral prostatic resections were performed in all patients. In Group I the operation was performed with continuous flow bladder irrigation, in Group II with suprapubic flow irrigation (without suction pump) and in Group III without continuous flow irrigation. Blood loss was determined by a colorimetric method. There were no statistically significant changes in blood loss between the groups of patients.

IGFBP-3 and IGFBP-5 association with endothelial cells: role of C-terminal heparin binding domain

IGFBP-3 and IGFBP-5, but not the other 4 IGF binding proteins, specifically bound to endothelial cell (EC) monolayers. Charged compounds, such as heparin and heparan sulfate, competed for this binding. Of the 6 IGFBPs, IGFBP-3 and IGFBP-5 had the greatest heparin affinity. Peptides of 18 amino acids were synthesized, corresponding to a common basic region of IGFBP-3 (P3), IGFBP-5 and IGFBP-6 (P6) which contained a heparin binding sequence. P3 and P6 inhibited IGFBP-3 and -5 binding to endothelial cell monolayers and the peptides bound directly to EC extracellular matrix. This suggested that the C-terminal basic segment of IGFBP-3/-5 is important for the association of the binding protein with the EC monolayer.

[Intrarenal cyst communicating with the kidney calyx, suggesting tuberculous changes]

The authors presented a female patient in whom intrarenal cyst was found communicating with the calyx-pelvic system, suggesting a tuberculous lesion. The attention was paid to the possibility of diagnostic error. The probable pathogenetic mechanism of intrarenal cyst development is described.

[Concentrations of B2-microglobulin and Tamm-Horsfall protein in cyst fluid and urinary excretion of these proteins in patients with simple renal cysts]

The existing classifications of simple renal cysts are based on cyst fluid sodium concentration or cyst fluid/plasma sodium ratio. The present study aimed to assess: 1) the usefulness of cyst fluid concentrations of beta-2-microglobulin (beta-2-MG) as a marker of proximal tubules function and Tamm-Horsfall protein (THP) as a marker of distal tubules function to define the origin of renal cysts (proximal or distal); and 2) the function of proximal and distal tubules in patients with simple renal cysts. 31 patients with simple renal cysts and 10 healthy subjects were examined. Basing on the cyst fluid/plasma sodium ratio, 25 cysts were classified as of proximal origin and 6 as of undetermined origin. In all patients cyst fluid and plasma concentrations of beta-2-MG, erythropoietin, sodium, potassium and total protein were assessed. Urinary excretion of beta-2-MG and THP was also estimated and fractional excretion of beta-2-MG was calculated. The concentration of beta-2-MG in fluid obtained from cysts of proximal origin were significantly higher than in fluid from cysts of undetermined origin (2.26 +/- 0.36 vs. 0.65 +/- 0.13 mg/l, p = 0.0004). Concentrations of THP (6.85 +/- 1.21 vs. 3.14 +/- 1.06 micrograms/ml, p < 0.05), erythropoietin (500.6 +/- 176.8 vs. 42.0 +/- 17.7 mU/ml, p < 0.05) and potassium (4.39 +/- 0.07 vs. 3.13 +/- 0.44 mmol/l, p < 0.05) were also higher in fluid from proximal cysts than in fluid from cysts of undetermined origin.(ABSTRACT TRUNCATED AT 250 WORDS)

[Renal trauma]

An analysis is presented of 70 patients treated for renal trauma in the I Department of Urology in Katowice in the years 1974-1989. Renal damage was evaluated according to a three-grade scoring system. Conservative treatment was given to 43 patients (61.4%), including 14 patients with I degree trauma, 12 with II degrees, and 17 with III degrees trauma. Nephrectomy was performed in 17 cases, and 10 sparing operations were carried out--one combined with splenectomy.

[Complications after extracorporeal shock wave lithotripsy (ESWL) and methods of management of such cases]

The authors presented the complications which occurred in patients after extracorporeal shock wave lithotripsy (ESWL), and discussed the methods of management of such patients. It was found that the most common complications were: renal colic, fever, "calculus route", and, less frequently, subcapsular and perirenal haematomas. In most patients conservative treatment was adequate. Some of these patients required admission to hospital and proper specialized management.

Long-term results of treatment of male urethral strictures using direct vision internal urethrotomy

This study presents long-term results of treatment of urethral strictures in 178 men who underwent direct vision cold urethrotomy between January 1, 1979 and December 31, 1984. Satisfactory urodynamic results were achieved in 69.7% of cases.

Evaluation of uroflowmetry in different groups of patients after transurethral resection of prostatic adenoma

One hundred patients after transurethral prostatectomy (TURP) were examined. The patients' age, presence or absence of urinary tract infection, time after TURP, and the size of adenoma were taken into consideration in the assessment of uroflowmetry. It was found that with the passage of time all parameters have improved. Comparison of the results of uroflowmetry performed in patients with large or small adenomas showed that TURP was successful in both groups. Infection was found to affect the volume of the bladder, but it had no significant influence on other uroflowmetry parameters or on residual urine. The age of the operated patients seemed to have no influence on the results of flowmetry after TURP.