Imaging in BPH patients

Benign prostatic hyperplasia is one of the most common pathological processes to afflict men. Strikingly, there is a large variety of methods of evaluation and therapeutic strategies for BPH in various countries. Before adequate treatment is possible, the process of benign adenomatous hyperplasia has to be distinguished from malignant or inflammatory prostatic disease. Furthermore, secondary alterations of the bladder and upper urinary tract have to be evaluated. A wide range of imaging techniques of the lower and upper urinary tract have evolved over the years. The specific benefits and restrictions of each of them are discussed. Finally, the recent developments and possibilities of computer-aided tissue characterisation and volume determination are outlined. The development of imaging techniques for BPH has just begun...

Phase I/II study of recombinant interferon alpha and gamma in advanced progressive renal-cell carcinoma

In vitro studies have documented the synergistic antiviral and antiproliferative activity of recombinant interferon alpha (rIFN alpha) and rIFN gamma. Furthermore, rIFN gamma is a strong immunomodulator with optimal effects at a relative low dose (0.1 mg/m2). On the basis of these observations, we began a phase I/II study with the combination of rIFN gamma at 100 micrograms/m2 (2 x 10(6) IU/m2) and rIFN alpha 2c 6 micrograms/m2 (2 x 10(6) IU/m2), injected twice a week subcutaneously. In cases of stable or progressive disease we increased the dose of rIFN alpha 2c every 2 weeks by 6 micrograms/m2 until the maximum tolerated dose was reached. A total of 32 patients with proven progressive renal-cell carcinoma were included. Of the 31 eligible patients, 21 were male and 10 female, their average age was 57.2 years (range 35-72), 28 had had nephrectomy, their median Karnofsky performance status was 90% (70%-100%), and their tumors were localized predominantly to visceral tissue. In 2, response was complete and in 6 it was partial, for a response rate of 25%. The disease had stabilized in 5 patients and progressed in 16. The median duration of partial response was 14 months (8-16 months); of 2 cases of complete response, 1 persists (23+ months), and the other suffered a relapse after 22 months. The median time to response was 24 weeks (18-24 weeks). The maximum tolerated dose of rIFN alpha was 30 micrograms/m2 (range of 6-36 micrograms/m2). Side-effects included those known to be associated with interferon treatment. One patient developed septicemia during a period with grade 4 leukopenia. Our study permits no conclusion regarding the additional value of rIFN gamma.

Ketoconazole high dose in management of hormonally pretreated patients with progressive metastatic prostate cancer. Dutch South-Eastern Urological Cooperative Group

Ketoconazole high dose (H.D.) effectively reduces the testosterone production in both adrenals and testes. Its use in the management of (metastatic) prostate cancer has been advocated. Even in relapsing patients, after previous hormonal therapy, ketoconazole H.D. could be of value. Twenty-eight relapsing patients, of whom 15 were evaluable at three months, have been treated with ketoconazole H.D. As could be expected, objective response was seen in only a small number of patients followed up till nine months. Subjective improvement, however, was noticed in the majority of symptomatic patients. The side effects and toxicity of the therapy remain a major limitation for the use of ketoconazole, be it as first line treatment or as therapy for relapsing patients.

BCG (RIVM) versus mitomycin intravesical therapy in superficial bladder cancer. First results of randomized prospective trial

This study presents the preliminary results of a randomized prospective two-arm study in which bacillus Calmette-Guérin (BCG) RIVM, a Dutch BCG preparation, is compared with mitomycin C (MMC) in patients with primary or recurrent superficial bladder tumors, including carcinoma in situ (CIS). Therapeutic regimens were as follows: after complete transurethral resection of all visible tumors, BCG RIVM (1 x 10(9) bacilli in 50 mL saline) was instilled once a week for six consecutive weeks, and mitomycin C (30 mg in 50 mL saline) was administered once a week for one month (weeks 1 to 4) and thereafter once a month for a total of six months. Reported are the incidence of side effects in 165 patients and the recurrence rate of tumors in 308 patients after a follow-up period of twelve months. Drug-induced, or chemical cystitis was observed in 13 (16.7%) of 78 BCG-treated patients and in 12 (13.8%) of 87 MMC-treated patients. In the same groups bacterial cystitis occurred in 17 (21.8%) patients and in 16 (18.4%) patients, respectively. In the BCG-treated group (N = 148), 44 (29.8%) had recurrent tumors, while in the MMC-treated group (N = 160), 40 (25.0%) had a recurrence. The recurrence rate for BCG-treated patients was 0.33; the recurrence rate for MMC-treated patients was 0.29 (P = 0.560, not significant). These preliminary data demonstrated no statistically significant difference between the two arms with regard to toxicity and recurrence of tumors.

Alpha and gamma interferon in the treatment of advanced renal cell carcinoma

Thirty-two patients with proven progressive metastatic renal cell carcinoma were treated with the combination of 0.1 mg/m2 (2 X 10(6) IU/m2) r-interferon (r-IFN)-gamma and 6 micrograms/m2 (2 X 10(6) IU/m2) r-IFN-alpha. In case of progressive disease (PD) or stable disease (SD), after 8 weeks, the dose of r-IFN-alpha was escalated by 6 micrograms/m2 every 2 weeks until the maximum tolerable dose was reached, while r-IFN-gamma was maintained at the low dose. The rationale for this study is provided by the dose-related efficacy of IFN-alpha as a monotherapy, the potent immunostimulatory activity of IFN-gamma, and the alleged synergistic effect of the combination. Fourteen patients are evaluable for 8 weeks of low-dose combination treatment (7 X SD, 5 X PD, 2 X early progression), while so far 6 of 24 patients (25%) who started dose escalation of IFN-alpha have reached a partial response. These data indicate better efficacy with higher doses of IFN-alpha. Because of the infrequent administration and the relative low doses, compared to other trials, the treatment regimen was well tolerated. Although preliminary results are promising, definite efficacy remains to be proven.