Vol. 153,1361, May 1995 Printed in U S A

This Month in Urology

MOLECULAR STAGING IN PERIPHERAL BLOOD OF PROSTATE CANCER Molecular staging in peripheral blood of prostatic cancer using reverse transcriptase polymerase chain reaction

assays showed that prostate specific antigen (PSA) primers were highly sensitive and more accurate than prostate specific membrane antigen. Cama et a1 (page 1373) from New York, New York found that all noncancer patients had negative results. Of 20 metastatic prostate cancer patients 16 (80%) had positive polymerase chain reaction assays for PSA, while only 10 (50%) had positive assays for prostate specific membrane antigen,

REPEAT PROSTATE NEEDLE BIOPSY Ellis and Brawer (page 1496) from Seattle, Washington performed repeat prostate biopsies in 100 patients

without an initial diagnosis of cancer for indications of atypia, prostatic intraepithelial neoplasia, increasing PSA level or positive digital rectal examination. Cancer was detected on repeat biopsy in 4 of 17 men (29.4%) with atypia, 5 of 5 with grade I1 or I11 prostatic intraepithelial neoplasia and 0 of 9 with grade I prostatic intraepithelial neoplasia. Cancer was detected on the second biopsy in 10 of 69 cases (14.5%) without atypia or prostatic intraepithelial neoplasia.

PROSTATE SPECIFIC ANTIGEN FOLLOWING RADIOTHERAPY FOR PROSTATE CANCER

Approximately a third of prostate cancer patients treated with radiation therapy who are considered recur- rence-free by standard clinical criteria at 10 years have elevated PSA levels and are at risk for later clinical failure. Rosenzweig et a1 (page 1561) from New Haven, Connecticut found that 48% of patients with stages A and B disease were clinically free of recurrence, while only 33% had PSA levels less than 4.0 ng./ml. Of the stage C cancer patients 33% were clinically free of disease versus 22% with normal PSA levels.

HORMONAL THERAPY VERSUS DEFERRED TREATlMENT FOR PROSTATE CANCER Lundgren et a1 (page 1580) from Lund, Sweden found a higher mortality rate at 10 years due to prostatic

cancer in the deferred treatment group compared to 2 immediate treatment groups of patients. There was no difference in interval to metastasis among the groups. The probability of dying of prostatic cancer at 10 years was 26%.

THE STUDER POUCH The Studer pouch was found by Rogers and Scardino (page 1432) from Houston, Texas to provide a satisfactory

bladder substitute in 20 men who underwent radical cystoprostatectomy for bladder cancer. Four patients had low vitamin B12 levels, 1 had hyperchloremia and 18 had diurnal continence but 9 had enuresis.

SODIUM NITROPRUSSIDE VERSUS PROSTAGLANDIN E l Martinez-Pifiero et a1 (page 1487) from Madrid, Spain found intracavernous injection of prostaglandin El to

be superior to intracavernous administration of sodium nitropmsside. Sodium nitropmsside did cause less pain, was less expensive and allowed for detumescence after orgasm.

PROGNOSIS AFTER STAGHORN CALCULUS MANAGEMENT Teichman et a1 (page 1403) from Minneapolis, Minnesota found renal deterioration in 28% of staghorn stone

Patients. Renal deterioration was associated with no therapy, solitary kidneys, hypertension, recurrent stones, complete versus partial staghorn calculi, patients with versus without diversion and patients with a neurogenic bladder.

LAPAROSCOPIC PARTIAL NEPHRECTOMY Successful laparoscopic partial nephrectomy is reported by Winfield et al (page 1409) from Iowa City, Iowa in

4 of 6 patients. Laparoscopic techniques were associated with less blood loss and less morbidity but a 2-hour longer operating time.

BOOK REVIEW On page 1754 Resnick from Cleveland, Ohio reviews the book entitled Urogenital Ultrasound-A Text Atlas,

J. Y. Gillenwater Editor

by Cochlin et al.

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