Complete embedding and close step-sectioning of radical prostatectomy specimens both increase detection of extra-prostatic extension, and correlate with increased disease-free survival by stage of prostate cancer patients

The objectives of this work were to evaluate the efficacy of controlled close step-sectioned and whole-mounted radical prostatectomy specimen processing in prediction of clinical outcome as compared to the traditional processing techniques. Two-hundred and forty nine radical prostatectomy (RP) specimens were whole-mounted and close step-sectioned at caliper-measured 2.2-2.3 mm intervals. A group of 682 radical prostatectomy specimens were partially sampled as control. The RPs were performed during 1993-1999 with a mean follow-up of 29.3 months, pretreatment PSA of 0.1-40, and biopsy Gleason sums of 5-8. Disease-free survival based on biochemical or clinical recurrence and secondary intervention were computed using a Kaplan-Meier analysis. There were no significant differences in age at diagnosis, age at surgery, PSA at diagnosis, or biopsy Gleason between the two groups (P<0.05). Compared with the non-close step-sectioned group, the close step-sectioned group showed higher detection rates of extra-prostatic extension (215 (34.1%) vs, 128 (55.4%), P<0.01), and seminal vesicle invasion (50 (7.6%) vs 35 (14.7%), P<0.01). The close step-sectioned group correlated with greater 3-y disease-free survival in organ-confined (P<0.01) and specimen-confined (P<0.01) cases, over the non-uniform group. The close step-sectioned group showed significantly higher disease-free survival for cases with seminal vesicle invasion (P=0.046). No significant difference in disease-free survival was found for the positive margin group (P=0.39) between the close step-sectioned and non-uniform groups. The close step-sectioned technique correlates with increased disease-free survival rates for organ and specimen confined cases, possibly due to higher detection rates of extra-prostatic extension and seminal vesicle invasion. Close step-sectioning provides better assurance of organ-confined disease, resulting in enhanced prediction of outcome by pathological (TNM) stage.

Simple release of pubovaginal sling

Overcorrection of bladder stress urinary incontinence is an infrequent result of a commonly performed procedure, the pubovaginal sling operation. Obstructive voiding symptoms and frank urinary retention may persist until the sling is partially or completely released. Transection of the sling material on either side of the urethra should correct retention while preserving continence. A simple procedure using a Lowsley retractor is described that achieves spontaneous voiding.

Prostate cancer in men age 50 years or younger: a review of the Department of Defense Center for Prostate Disease Research multicenter prostate cancer database

PURPOSE

Prostate cancer in men age 50 years or younger traditionally has accounted for approximately 1% of those diagnosed with prostate cancer. Prior studies of prostate cancer in men of this age led many clinicians to believe that they have a less favorable outcome than older men. Most of these studies were conducted before the advent of prostate specific antigen (PSA) screening programs. We evaluated a surgically treated cohort of men age 50 years or younger to determine whether disease recurred more frequently among them than in those 51 to 69 years old in the PSA era.

MATERIALS AND METHODS

We reviewed the medical records of 477 men who underwent radical prostatectomy between 1988 and 1997. Age, ethnicity, preoperative PSA, clinical and pathological stage, margin and seminal vesicle involvement, and recurrence were compared between 79 men age 50 years or younger (study group) and 398, 51 to 69 years old (comparison group). Disease-free survival rates were compared using Kaplan-Meier and Cox regression techniques.

RESULTS

There were 6 (7.6%) recurrences in the study group (79) and 107 (26.9%) in the comparison group (398). The disease-free survival curves were significantly different (log-rank p = 0.010). Age remained a significant prognostic factor (Wald p = 0.033) in multivariate Cox regression analyses that controlled for race, clinical and pathological stage, and pretreatment PSA. Similar results were found when the comparison group was limited to 116 patients 51 to 59 years old (log-rank p = 0.034, Wald p = 0.069).

CONCLUSIONS

These data suggest that patients in the PSA era who underwent radical prostatectomy and were age 50 years or younger have a more favorable disease-free outcome compared to older men.

A new flow cytometric approach to the analysis of DNA and a second parameter

OBJECTIVE

To describe a new method of analyzing flow cytometry data by continuously variable gating (CVG), which is particularly useful for analysis of cellular DNA plus a second parameter, such as the proliferation marker Ki-67.

STUDY DESIGN

CVG was compared with histogram subtraction (HS) using Overton's cumulative subtraction and with boxed gating (BG). Background suppression (thresholding) was used to remove outliers. The comparisons were carried out on a human bladder cancer cell line (T24) in various phases of cell proliferation and on disaggregated cells of fresh specimens of human prostatic and bladder carcinoma. With similar counts in control and test samples, data did not have to be normalized.

RESULTS

In most cases histogram analysis by CVG was similar to that of BG and HS. However, when true positive values showed only a slight shift in fluorescence intensity, HS generated higher values than CVG. When true positive values exhibited strong fluorescence signals, HS could falsely include minor shifts in fluorescence values, and CVG became more accurate. CVG generated a continuous plot of percent positive events that could be superimposed on the DNA histogram, or a DNA histogram of positive events only could be created. This latter method demonstrated the DNA subpopulations containing most of the positive cells and improved discrimination of small subpopulations.

CONCLUSION

The CVG method presents data in unique graphic form from flow cytometry assays of DNA and a second parameter. It is relatively objective and particularly useful in analyzing specimens with multiple DNA populations.

Display and correction of flow cytometry time-dependent fluorescence changes

The resolution of measurements of cellular attributes by flow cytometry, based on differences in labeling by fluorescent markers, may be affected by variations in staining and sample stream flow that can occur during the course of data acquisition. We describe a method of display and correction of time-dependent changes by looking at the list mode data in chronological order.

Hypocellular bladder wash specimens and their clinical significance

Bladder wash flow cytometry specimens containing less than 1,000 cells were defined as hypocellular. Between June 1981 and December 1990, 5,676 bladder wash flow cytometry specimens were collected, of which 142 (2.5%) were deemed hypocellular. Of the 132 evaluable patients with hypocellular specimens 34 (30%) had documented evidence of carcinoma compared to 52% for the entire population. Among the 34 patients 30 had transitional cell carcinoma, of which 12 were carcinoma in situ, 9 stage Ta or T1 and 9 stage T2 or greater. Thus, there was no obvious relationship between stage or grade of carcinoma versus probability of a hypocellular specimen. Differences in irrigation techniques of different urologists in the operating room using general anesthesia versus catheter and cystoscopic irrigation in the outpatient clinic are discussed as possible explanations for the hypocellular specimens.

Anterior urethral valves. A case report

Anterior urethral valves are rare anomalies which cause obstructive uropathy in the lower urinary tract of young men. We discuss our illustrative case and review the English medical literature in order to analyze the clinicopathologic spectrum. We propose a hypothesis of embryology of this lesion and present guidelines for its management.

Percutaneous nephrostomy for treatment of hydronephrosis of pregnancy

Hydronephrosis of pregnancy is a common phenomenon that rarely requires invasive intervention. We describe a young woman with markedly obstructive hydronephrosis of pregnancy causing forniceal extravasation who was treated successfully by percutaneous nephrostomy. The rationale of such intervention and its advantages over retrograde ureteral catheterization or stenting are discussed.

Mature teratoma of the testis metastasizing as mature teratoma

We report an unusual case of mature teratoma of the testis with retroperitoneal metastasis of mature teratoma. Mature teratoma of the testis should be considered a low grade malignant neoplasm.