[Hospitalization rate in relation to severe complications of transrectal prostate biopsy: About 2715 patients biopsied]

MAIN OBJECTIVE

To identify hospitalizations directly related to a complication occurring within 30 days following a transrectal prostate biopsy (PBP).

SECONDARY OBJECTIVES

Overall hospitalization rates, mortality rates, potential predisposing factors for complications.

PATIENTS AND METHODS

Single-center study including all patients who underwent PBP between January 2005 and January 2012. Any hospitalization occurring within 30 days of the PBP for urgent motive was considered potentially attributable to biopsy. We identified the reason for hospitalization with direct complications (urinary infection or fever, rectal bleeding, bladder caillotage, retention) and indirect (underlying comorbidities decompensation) of the biopsy. The contributing factors were anticoagulant or antiplatelet treatment well as waning immunity factors (corticosteroid therapy, HIV, chemotherapy or immunodulateur).

RESULTS

Among 2715 men who underwent PBP, there were 120 (4.4%) hospitalizations including 28 (1.03%) caused by the biopsy. Twenty-five (0.92%) were related to a direct complication of biopsy: 14 (56%) for urinary tract infection or fever including 1 hospitalization in intensive care, 5 (20%) for rectal bleeding which required several transfusions 1, 10 (40%) urinary retention and 3 (0.11%) for an indirect complication (2 coronary syndromes and 1 respiratory failure). Several direct complications were associated in 3 cases. Only two hospitalizations associated with rectal bleeding were taking an antiplatelet or anticoagulant. There was no association between hospitalization for urinary tract infections and a decreased immune status. The first death observed in our study occurred at D31 of pulmonary embolism (advanced metastatic patient with bladder cancer). Twenty (60.6%) patients urgently hospitalized did not have prostate cancer.

CONCLUSIONS

Within this large sample of patients the overall rate of hospitalization due to the realization of a PBP was 1%. It has not been found predictive of complications leading to hospitalization.

LEVEL OF EVIDENCE

4.

Nephron sparing surgery for De Novo kidney graft tumor: results from a multicenter national study

Nephron sparing surgery (NSS) results in the transplanted population remain unknown because they are only presented in small series or case reports. Our objective was to study renal sparing surgery for kidney graft renal cell carcinomas (RCC) in a multicenter cohort. Data were collected from 32 French transplantation centers. Cases of renal graft de novo tumors treated as RCC since the beginning of their transplantation activity were included. Seventy-nine allograft kidney de novo tumors were diagnosed. Forty-three patients (54.4%) underwent renal sparing surgery. Mean age of grafted kidneys at the time of diagnosis was 47.5 years old (26.1-72.6). The mean time between transplantation and tumor diagnosis was 142.6 months (12.2-300). Fifteen tumors were clear cell carcinomas (34.9%), and 25 (58.1%) were papillary carcinomas. Respectively, 10 (24.4%), 24 (58.3%) and 8 (19.5%) tumors were Fuhrman grade 1, 2 and 3. Nine patients had postoperative complications (20.9%) including four requiring surgery (Clavien IIIb). At the last follow-up, 41 patients had a functional kidney graft, without dialysis and no long-term complications. NSS is safe and appropriate for all small tumors of transplanted kidneys with good long-term functional and oncological outcomes, which prevent patients from returning to dialysis.

Does hormone therapy modify the position of the gold markers in the prostate during irradiation? A daily evaluation with kV-images

PURPOSE

Gold markers are frequently used for a better daily repositioning of the prostate before irradiation. The purpose of this work was to analyze if the combination of an androgen deprivation with the external irradiation could modify the position of the gold markers in the prostate.

PATIENTS AND METHODS

Ten patients have been treated for a prostate cancer, using three implanted gold markers. The variations of the intermarker distances in the prostate were measured and collected on daily OBI(®) kilovoltage images acquired at 0° and 90°. Five patients had a 6-month androgen deprivation started before the external irradiation (H group) and five did not (NH group).

RESULTS

A total number of 1062 distances were calculated. No distance variation greater than 3.7mm was seen between two markers, in any of the two groups. The median standard deviations of the daily intermarker distance differences were 0.7mm (range 0.3-1.2mm) for the H group and 0.6mm (range 0.2-1.2mm) for the NH group. The intermarker distances variations were noted as greater than -2mm, between -2mm and 2mm and greater than 2mm in 16.4, 83.4 and 0.2% for the H group and 1.3, 98.5 and 0.2% for the NH group, respectively.

CONCLUSION

The distance variations remained less than 4mm in both groups and for all the measurements. In the NH group, the variation of the distance between two markers remained below 2mm in 98.5%. In the H group, the presence of a reduction of distance above 2mm in 16.4% of measurements could indicate the shrinkage of the prostate volume.

De novo kidney graft tumors: results from a multicentric retrospective national study

De novo tumors in renal allografts are rare and their prevalence is underestimated. We therefore analyzed renal cell carcinomas arising in renal allografts through a retrospective French renal transplant cohort. We performed a retrospective, multicentric survey by sending questionnaires to all French kidney transplantation centers. All graft tumors diagnosed after transplantation were considered as de novo tumors. Thirty-two centers participated in this study. Seventy-nine tumors were identified among 41 806 recipients (Incidence 0.19%). Patients were 54 men and 25 women with a mean age of 47 years old at the time of diagnosis. Mean tumor size was 27.8 mm. Seventy-four (93.6%), 53 (67%) and 44 tumors (55.6%) were organ confined (T1-2), low grade (G1-2) and papillary carcinomas, respectively. Four patients died of renal cell carcinomas (5%). The mean time lapse between transplantation and RCC diagnosis was 131.7 months. Thirty-five patients underwent conservative surgery by partial nephrectomy (n = 35, 44.3%) or radiofrequency (n = 5; 6.3%). The estimated 5 years cancer specific survival rate was 94%. Most of these tumors were small and incidental. Most tumors were papillary carcinoma, low stage and low grade carcinomas. Conservative treatment has been preferred each time it was feasible in order to avoid a return to dialysis.

[A survey from the French Urology Association about sick leave prescriptions by 145 surgeons]

OBJECTIVES

To describe and evaluate prescriptions of sick leave by urology surgeons for different kinds of interventions.

METHODS

Between January and April 2006, a web-based survey was completed by urology surgeons on a voluntary basis. The analyzed data pertained to personal characteristics of the surgeons, mean duration of sick leave for 15 interventions and the type of job of the patient (strenuous or not). Analyses were performed with software SAS™ version 9.2. Descriptive analyses were performed and Kruskal-Wallis test was used to search for statistically significant differences between variables (p<0,05).

RESULTS

One hundred and forty-eight surgeons were involved and 145 answers could be analyzed. Mean age of the surgeons was 46,3±9,4years. Urology surgeons were in the public sector (n=73/140; 52%), in private practice (n=43/140; 31%) or both (n=24/140; 17%). Kruskal-Wallis test showed that all patients who had a job considered as strenuous had significantly longer sick leave prescriptions. Younger surgeons (under 40) used to prescribe shorter sick leaves than their older counterparts.

CONCLUSION

Sick leave prescriptions of the urology surgeons were globally homogeneous in this survey. Only a few interventions were the occasion of discordant prescriptions depending upon the age or practice (public/private) of the surgeons. Several hypotheses could be further explored as regard the source of variation in sick leave prescriptions. These results are usable for those stakeholders who are interested in continuous medical education and evaluation.

[Male stress urinary incontinence by InVance bone anchored sub-urethral sling: Predictive factors of treatment failure: Multicentric study by the CTMH-AFU]

AIM

To define predictive factors of treatment failure in a multicentric study for the treatment of stress male urinary incontinence by InVance (American Medical System, USA) bone anchored sub-urethral sling.

METHOD

Cases treated by InVance between January 2005 and December 2007 in four French academic centers were collected.

RESULTS

Eighty-four patients were evaluated. Mean age was 68 years old. With a mean follow-up of 20 months, 38 patients (45%) were dry, 22 (26%) were improved, and 24 (29%) suffered treatment failure. In univariate analysis, three parameters were significantly associated with treatment failure, including severe urinary incontinence (P=0.005), urodynamic instability (P=0.043), and incontinence due to a bitherapy including external radiotherapy (P=0.031). If zero or one versus two or three risk factors were present, treatment failure rate was 25 and 67%, respectively (P=0.013). In multivariate analysis, bitherapy including radiotherapy was the sole independent treatment failure risk factor (P=0.017).

CONCLUSION

Two patient groups were defined, allowing to determine preoperatively good candidates and bad candidates for stress urinary incontinence treatment by InVance sling.

[Imaging of normal, hyperplastic and inflammatory prostate gland]

According to Mc Neal, the prostate gland is characterized by three major glandular compartments: the transition zone, the central zone and the peripheral zone. This zonal anatomy can be identified with endorectal sonography and with MRI. With the later, both endorectal or external surface coils can be used. Internal structure of seminal vesicles and vas deferens is better analyzed with MRI than with sonography. Relationship between these elements is important to know, as well as areas of weakness of the prostatic capsule, mainly in the evaluation of cancer extraprostatic extension. Sonography plays a major role in diagnosis, pre-therapeutic evaluation and follow-up of patients with benign prostatic hyperplasia. The role of imaging in inflammatory disorders is more questionable.

p53 immunodetection of liquid-based processed urinary samples helps to identify bladder tumours with a higher risk of progression

p53 could help identify bladder tumour cases with a risk of progression from superficial to invasive disease. Semiautomatic, liquid-based cytology (LBC) techniques offer an opportunity to standardise molecular techniques. The aim of our study was to investigate whether LBC could improve p53 immunolabelling, and to assess whether urinary p53 could have a prognostic value. Immunoreactivity for p53 was studied in 198 urine samples after treatment with the Cytyc Thinprep® processor. After antigen retrieval, cells were labelled with a monoclonal antibody that recognises both wild-type and mutant form of the p53 protein (Clone DO-7, Dako), 1/1000. Positivity for p53 was assessed in 17.2% of the cases. High-grade (G3) tumours were positive in 74.1% of the cases. Comparatively, low-grade (G1–2) urothelial carcinomas were positive in 23.5% of the cases. During a median follow-up period of 26 months, recurrence was observed in 52.9% of the cases with p53 overexpression, and in only 10.9% of negative cases (P<0.001). The progression rate was 35.3% of p53-positive cases vs 5.5% of p53-negative cases (P<0.001). Progression-free survival was significantly shorter in patients with p53 accumulation (P=0.007). In a multivariate analysis stratified on grade and stage, p53 was an independent predictor of overall survival (P=0.042). The results show that using Thinprep® LBC, p53 immunolabelling of voided urothelial cells allows most high-grade tumours to be detected and may help identify cases with a higher risk of recurrence and progression.

Preservation of prostate during radical cystectomy: Evaluation of prevalence of prostate cancer associated with bladder cancer

OBJECTIVES

To estimate the frequency and characteristics of prostatic lesions discovered incidentally in radical cystoprostatectomy specimens and to determine whether any factors would allow for the detection of prostate cancer preoperatively.

METHODS

A total of 100 radical cystoprostatectomy specimens with orthotopic bladder reconstruction were performed for malignant bladder disease between 1990 and 2000. The mean patient age at surgery was 62 +/- 8 years (range 32 to 75). Digital rectal examination and prostate-specific antigen (PSA) assay were done routinely before surgery. During the 10-year study period, the same pathologist examined the prostatic tissues from radical cystoprostatectomy specimens using McNeal's technique on fine slices every 2.5 mm.

RESULTS

The overall incidence of prostate cancer discovered incidentally in radical cystoprostatectomy specimens was 51%, of which 29% were microcancers (volume less than 0.5 cm3) and 22% were significantly larger (volume 0.5 cm3 or more). The mean Gleason score was 6. Of the tumors, 24% could be considered "clinically nonsignificant" (less than 0.5 cm3 and Gleason score less than 7). The mean preoperative PSA level was 4.13 +/- 1.36 ng/mL. Of 66 patients with a PSA level of less than 4 ng/mL (mean PSA 1.5 +/- 0.8) and a normal digital rectal examination before surgery, 50% had prostate cancer, of which 69% were microcancers.

CONCLUSIONS

The prevalence of prostate cancer (51%) in our series is among the highest in published reports. Furthermore, our results stress that currently no factors are available to enable the detection of "clinically significant" prostate cancer preoperatively.

Temporary urethral stenting after high-energy transurethral microwave thermotherapy of the prostate

The objective of this study was to assess the use of temporary stenting of the prostatic urethra for the prevention of acute urinary retention after high-energy transurethral microwave thermotherapy (TUMT) of the prostate. Stenting was performed immediately after high-energy microwave therapy. Two stents were used at two sites; at one site a silicone transurethral prostatic bridge was used in 42 patients, and at the second site a self-reinforced polyglycolic acid (SR-PGA) biodegradable spiral was used in 16 patients. Patients were scheduled for TUMT for symptomatic benign prostatic hyperplasia. Preoperative investigations included determination of a symptom score, measurement of the peak flow rate, and determination of the voided volume. The patients were treated using the Prostatron TUMT system. The software used provided a maximal power output of 70 W. After 1 week as well as 1, 3, 6, and 12 months the measurements were repeated and the effect of the stents was assessed. The symptom score, peak flow rate, and voided volume showed a significant improvement. Improvement was observed at first visit and sustained during the follow-up. Prophylaxis of acute urinary retention after TUMT can easily be managed by temporary stenting of the prostatic urethra. Temporary stenting can be routinely proposed after high-energy TUMT of the prostate.

Long-term recurrence of primary amyloidosis of the bladder

An 84-year-old man presented to our department with a recurrence of a primary amyloidosis of the bladder 14 years after the first diagnosis. Follow-up had been stopped 5 years after the first procedure because no cystoscopic anomalies were noted. General evaluation confirmed the diagnosis of primary amyloidosis. The lesions were endoscopically resected. At the 3-year follow-up, the patient was free of symptoms and had remained cystoscopically free of disease. However, stable amyloidosis deposits have always been noted on the computed tomography scans. This case emphasizes the necessity of a longer follow-up, including computed tomography of the pelvis, during the 10 to 15 years after the first occurrence of the disease.

[Deferred adjustment of the tension of tension-free vaginal tape (TVT) after surgical repair of stress urinary incontinence in women]

INTRODUCTION

Urinary retention is a frequent complication of repair of female urinary incontinence treated by tension-free vaginal tape (TVT). The authors report a modification of the original technique designed to decrease the risk of postoperative dysuria and retention.

MATERIAL AND METHODS

One hundred and twenty four patients with pure stress urinary incontinence were treated by TVT. In 74 patients (group 1), the TVT was placed according to the original Swedish technique. In 50 patients (group 2), no tension was applied to the suprapubic extremities of the TVT during the operation, but they were preserved and buried in an antiseptic dressing. On the day after the operation, traction was applied to the suprapubic TVT in the case of persistent incontinence. The immediate postoperative results and the results at 3 months, in terms of continence and urethral obstruction, were compared.

RESULTS

Perfect continence was obtained in 84 +/- 6.5% and 94 +/- 4.2% of patients in groups 1 and 2, respectively (p = 0.08). Acute urinary retention (15% vs 2%, p < 0.03) and post-voiding residual urine > 50 cc (38% vs 10% on D1 and 14% vs 2% at 3 months) were more frequent in group 1. At 3 months, the reduction in maximum and mean flow rate was lower in group 2 (p < 0.03). In group 2, deferred traction of the TVT was necessary in 20% of cases, without causing any major infectious complications or pain.

CONCLUSION

Deferred traction of TVT appears to decrease the rate of dysuria and urinary retention following repair of female urinary incontinence by tension-free vaginal tape (TVT). This technical modification does not affect the results on continence, which appears to be at least as satisfactory. This technical variant appears to be associated with a low morbidity.

[Intravesical BCG-therapy: comparison of side effects of Connaught (Toronto) and Pasteur (Paris) strains]

INTRODUCTION

Urologists have felt that the adverse effects of intravesical BCG-therapy have been more serious and more frequent since the use of the Connaught strain. The objective of this retrospective study was to compare the toxicity of this new strain with that previously used in France (Pasteur strain).

MATERIAL AND METHODS

After endoscopic resection, 89 patients with stage Ta grade 1-2 recurrent or T1 grade 3 and/or CIS bladder tumour were treated with 6 instillations of 150 mg of BCG Pasteur from 1992 to 1996 (50 patients: group 1) or 81 mg of BCG Connaught from January 1997 to December 1998 (39 patients: group 2). Adverse effects were classified as minor, lasting less than 48 hours (bladder irritation syndrome and/or macroscopic haematuria and/or fever less than 38 degrees C), moderate (requiring symptomatic treatment, reduction of the dose or an increased interval between instillations), and major (contraindication to continuation of treatment).

RESULTS

74% of patients in group 1 presented at least one adverse effect versus 77% in group 2. The reasons for permanent discontinuation of BCG-therapy in groups 1 and 2, respectively, were as follows: malaise during instillation (1 vs 0), bladder irritation syndrome not controlled by symptomatic treatment (4 vs 5) and epididymitis (0 vs 1). Pulmonary tuberculosis was diagnosed in one patient from group 2, one year after the last instillation. The frequency and severity of adverse effects were not statistically different between the two groups. The number of patients discontinuing BCG-therapy because of severe complications was also not statistically different between the two groups.

CONCLUSION

This study did not reveal any difference of toxicity between Connaught and Pasteur strain in intravesical BCG-therapy of superficial bladder tumours.

[Inverted papilloma of the pyelo-ureteral junction, current literature data]

The authors report the fourth case of inverted papilloma of the ureteropelvic junction since the first description of this lesion in 1963 by Potts and Hirst. In view of the rarity of this lesion and its unusual presentation, they conducted an exhaustive review of the literature concerning inverted papillomas of the upper urinary tract. This proliferative lesion of the urothelium can precede, accompany or follow superficial or invasive urothelial tumours. Rigorous treatment and surveillance are therefore justified to detect an associated tumour. The controversy concerning the benign nature of inverted papilloma has still not been clarified.

Motorised resection device for transurethral resection of the prostate: a laboratory evaluation

Transurethral resection of the prostate is the most common method of relieving urinary outflow obstruction secondary to prostatic enlargement. However, this procedure can be responsible for various complications, including irrigant-fluid absorption and blood loss, both of which are strongly dependent on operation duration time. To reduce the latter, a new resection device has been designed for transurethral prostatectomy. The device basically consists of a rotating cutting loop controlled externally, with three degrees of freedom, to fit the adenoma shape. Its performance is assessed in vitro by drilling conical and semi-ellipsoidal cavities in agar gel models. The mean difference between the calculated and obtained cavity volumes is 3% (SD = 0.9%). The volume cutting rate, found to be independent of the type of cavity drilled, is equal to 2.9 +/- 0.3 cm3 min-1. The advantages of this motorised resection device prototype are reduction in operation duration and accuracy of the resected volume. In vivo resection of a 20 cm3 adenoma in less than 15 min can be expected.

[Prognostic factors of survival in infiltrating urothelial bladder carcinoma. A retrospective study of 158 patients treated by radical cystectomy]

The clinical files of 158 patients who were treated by radical cystectomy for infiltrating bladder carcinoma were retrospectively reviewed to define prognostic factors. PATIENTS AND METHODS.--All patients had a radical cystectomy with bilateral pelvic lymph node dissection for an infiltrating operable bladder urothelial tumor. Each tumor was classified according the pTNM staging system and were analysed for the presence of vascular invasion, carcinoma in situ and tumor grade. Twenty-three patients (14.5%) had an irradiation. Sixty-seven patients (42%) received chemotherapy (neoadjuvant in 31, adjuvant in 30, both in 6). RESULTS.--The median overall survival of the whole group was 19 months. The 5 years disease free survival (DFS) and overall survival (OS) were 44% and 31%, respectively. In the univariate analysis, the factors with significant prognostic value were: pT stage and the tumor size for OS, age and lymph node involvement for DFS, presence of carcinoma in situ (CIS) and tumor size for local recurrence free survival (LRFS) and sex and lymph node involvement for metastatic free survival (MFS). The following variables attained significant prognostic value in the multivariate analysis: pT stage and an interaction between lymph node involvement and vascular invasion for OS, pT stage and presence of CIS for LRFS, pT stage for MFS. CONCLUSION.--The pT stage, lymph node involvement and vascular invasion are the most important prognostic factors of survival in infiltrating bladder cancer.

Responders and nonresponders to transurethral microwave thermotherapy: a multicenter retrospective analysis

PURPOSE

We attempted to identify any parameter that could possibly lead to a successful treatment outcome after transurethral microwave thermotherapy.

MATERIALS AND METHODS

Clinical parameters and treatment profiles of 292 patients were analyzed in a retrospective multicenter manner. Responder and nonresponder groups were identified according to a given definition.

RESULTS

No statistically significant differences in baseline characteristics were found. Responders showed a 76% symptomatic improvement rate compared to 27% in nonresponders, and an 82% improvement rate in peak flow compared to a 5% decrease in nonresponders. Responders also showed a significantly greater increase in posttreatment PSA level and a significantly greater amount of energy released during treatment.

CONCLUSIONS

No baseline clinical parameter is capable of predicting treatment outcome.

Flow and image cytometric DNA measurements in fine needle aspiration samples of prostatic neoplasms

OBJECTIVE

To compare the DNA content measured by flow cytometry (FCM) and image analysis (IA) from prostatic fine needle aspiration (FNA) samples.

STUDY DESIGN

A total of 48 samples were studied. FCM was performed on propidium iodide-stained nuclei according to the Vindelov method, and image analysis was performed on Feulgen-stained slides. Positive FNA results were grade (1-3) and compared with Gleason grades.

RESULTS

Aneuploidy was closely related to positive FNA results (P < .01). DNA histograms were found to be aneuploid in all grade 3 carcinomas (n = 13) by IA and in 11 cases (84.6%) by FCM. Grade 2 carcinomas (n = 9) were found to be aneuploid with both methods. In grade 1 carcinomas (n = 10), 2 cases exhibited IA aneuploid profiles, whereas all FCM cases were diploid. Aneuploid profiles were more often associated with high Gleason scores than were diploid ones (P < .01). Among the 16 patients with negative FNA results, two cases had tetraploid DNA profiles related to contaminating seminal vesicle cells. The difference in DNA measurements reached 10.4% but was not statistically significant.

CONCLUSION

These findings show that the two methods, as applied to prostatic FNA samples, give comparable results and that seminal vesicle cells may be responsible for false tetraploid profiles.

Bracken fern-induced bladder tumors in guinea pigs. A model for human neoplasia

We have induced tumors by feeding guinea pigs with a diet containing 25 or 30% dried bracken fern for 100 or 150 days. A high incidence of bladder tumors was obtained. All but one animal had preneoplastic or neoplastic lesions after 4 months; after one year, 24 or 25 exposed animals had carcinoma. Bladder tumors obtained were essentially pure transitional cell carcinomas, although 4 cases (7% of the exposed animals and 10% of the 39 transitional cell carcinoma observed) showed areas of focal squamous metaplasia. Immunohistological detection of cytokeratins 10, 13, and 18 confirmed the transitional nature of these tumors. Tumor development can be followed by ultrasonography and cytology. Bladder tumors arose through several steps. Dysplasia and preneoplastic hyperplasia were seen after 4 months and papillary carcinomas appeared after 6 months, whereas muscle-invasive carcinomas required 1 year. Thus this model reproduces the full spectrum of preneoplastic and neoplastic bladder lesions observed in humans. Interestingly, when tumors were induced in older guinea pigs, none of them progressed to a muscle-invasive stage. This phenomenon should provide the opportunity to study the molecular mechanisms associated with these two different growth patterns, a major issue in understanding human bladder tumor progression.

Clinical value of fine-needle aspiration cytology and biopsy in the evaluation of male infertility. A comparative study of 48 infertile patients

OBJECTIVE

To evaluate whether fine-needle aspiration cytology of the testis can be considered as a diagnostic parameter in the evaluation of male infertility.

PATIENTS AND METHODS

We studied 30 oligospermic and 18 azoospermic patients using 63 fine-needle aspiration samples and 57 biopsy samples obtained surgically (10 cases) or with a spring-loaded biopsy device (47 cases). Cytologic evaluation of spermatogenesis was performed by studying longitudinal segments of seminiferous tubules and cytocentrifuged dissociated cells.

RESULTS

Comparison between fine-needle aspiration and the biopsy methods gave concordant results in 72.2% of cases. Discordant findings were recorded in 10 cases (27.8%). In eight cases, significant maturation into spermatozoa was recognized in samples obtained by fine-needle aspiration only, whereas moderate to severe hypospermatogenesis or germ cell aplasia were demonstrated in samples obtained by the spring-loaded biopsy device or by open surgical biopsy. Germ cell aplasia was recognized in samples obtained by both methods in 75.0% of cases. Insufficient specimens were obtained by fine-needle aspiration and the spring-loaded biopsy device in 15.9% and 12.3% of cases, respectively, whereas all surgical biopsy specimens were of good quality. Four bleeding episodes and one case of epididymitis were observed after use of the spring-loaded biopsy device, but no complication was related to either surgical biopsy or fine-needle aspiration.

CONCLUSION

The findings show that fine-needle aspiration cytology could represent a more reliable means of identifying significant numbers of the most mature germ cells.

[Diagnosis and evaluation of spread of prostate cancer]

In more than 50% of the cases, the diagnosis of prostate cancer is made at the time of extra-prostatic or distant disease involving poor prognosis for cure. Small tumours for which curative treatment is possible are asymptomatic. Thus, useful early diagnosis of prostatic cancer is based on digital rectal examination and PSA concentration. PSA levels are also indicative of tumour volume. Thus, determining dissemination becomes significant only in the case of elevated PSA, indicating a large tumour.