ABH-antigenicity of transitional cell carcinoma of the urinary bladder in patients subjected to topical chemoprophylaxis

Topical chemoprophylaxis with adriamycin was administered to 49 patients with UICC-stages pTA and PT1 (pathological stage 0 and A) of transitional cell carcinoma of the urinary bladder. Tumor specimens obtained prior to initiation of the instillation protocol were evaluated with regard to ABH-antigenicity. ABH-antigens were present in tumors of 19 patients and none of these developed muscle-infiltrating recurrences during or after intravesical chemoprophylaxis. The primary lesions of 30 patients were deleted of antigens; only 5 (16%) developed a progressive recurrence. Compared to a historical control group this is thought to be a true reduction of invasive tumor recurrences in ABH-negative…

Palliativtherapie des Prostatakarzinoms mit dem LHRH-Analog Decapeptyl-Depot: Beeinflussung der Phosphatasekonzentration durch den Testosteronspiegel

Decapeptyl ist das dritte derzeit rezeptierbare LHRH-Analogon zur pharmakologischen Kastration beim fortgeschrittenen Prostatakarzinom. Es ist ein synthetisches Decapeptid wie das naturliche Hormon LHRH, lediglich an der 6. Aminosaure-Position ist Glycin durch D-Tryptophan ersetzt.

Histophotometry: a new method for automated histological examination of solid tissue samples demonstrated on bladder cancer.

The purpose of this study was to demonstrate the ability of a new method to discriminate between benign and malignant tissue. Tissue samples from three patients with bladder tumours and one patient with bladder diverticula have been examined by histophotometry. This method, based on the correlation of nuclear volume and nucleic acid contents per cell uses thick formalin fixed samples. The results are obtained by measurements averaging more than one hundred thousand cells per sample. By this histophotometric examination a clear differentiation between malignant and benign tissue could be achieved. It was also possible to determine the degree of malignancy and to differentiate between infiltr…

Immunotherapy of Metastasizing Renal Cell Carcinoma

119 patients with stage-IV renal cell carcinoma were treated using immunotherapy with autologous tumor vaccine. The immunization was carried out at monthly intervals, the patients were restaged every

Tumor Volume, CT Scan, Lymphography, Sonography, Intravenous Pyelography, and Tumor Markers in Testis Tumors

Correlation of tumor volume to tumor stage in 134 patients with nonseminomatous testicular tumors, which were classified according to the TNM system, revealed similar tumor load for N0 and N1 patients. CT scans (n = 92), lymphangiography (n = 47), intravenous pyelography (IVP) (n = 134), sonography (n = 118) and serial tumor markers (n = 82) were evaluated for sensitivity, specificity and accuracy, both separately and in different combinations. The best individual results were obtained by lymphangiography (sensitivity 0.77, specificity 0.73, accuracy 0.75) and CT scan (sensitivity 0.52, specificity 0.91, accuracy 0.70). In combination CT scan and lymphangiography were the most valuable diag…

Treatment of advanced prostatic cancer with parenteral cyproterone acetate: a phase III randomised trial.

Summary— Forty-two patients with previously untreated T3/4 N1-4 MO/1 prostatic adenocarcinoma were treated with either cyproterone acetate (n=21; 300 mg intramuscularly per week) or oestradiol undecylate (n=21; 100 mg intramuscularly per month) after extensive staging which included open skeletal biopsy and pelvic lymphadenectomy in some cases. Subjective and objective parameters as well as signs of drug toxicity were recorded regularly. Evaluation after 6 months showed cyproterone acetate to be more effective in the following respects: (1) the significantly different castration effect as judged by plasma testosterone, (2) the objective voiding pattern and tumour response, with regression o…

Mainz Pouch for Augmentation Bladder Substitution or Continent Urinary Diversion

Testosterone metabolism in patients with advanced carcinoma of the prostate: a comparative in vivo study of the effects of oestrogen and antiprolactin.

In the light of the high incidence of cardiovascular side effects with oestrogen therapy in patients with prostatic cancer, other medications altering androgen metabolism are under investigation. The influence of the anti-prolactin bromocriptine (CB154) on plasma kinetics of testosterone and on endogenous hormones was studied and compared with the effect of ethinyl oestradiol in 25 patients with prostatic carcinoma. Bromocriptine significantly suppressed both prolactin and testosterone, inhibited the transfer of androgen from the inner pool into the deep compartment and favoured its degradation. Ethinyl oestradiol decreased testosterone, LH and FSH, and prolonged the biological half-life of…

Urachal Signet-ring Cell Carcinoma, A Rare Variant of Vesical Adenocarcinoma: Incidence And Pathologicalcriteria

Abstract Of 715 cases of vesical tumors reviewed 18 adenocarcinomas were selected for further study, 5 of which fulfilled all criteria of urachal origin. Herein is reported 1 rare case of such a carcinoma of the signet-ring cell type and the morphological criteria of this variant are discussed briefly. After undergoing radical cystectomy and ureterosigmoidostomy the patient has been free of recurrent tumor or metastasis for 6 years.

Extracorporeal Perfusion of the Tumor Bearing Human Kidney Using Tumor-Specific Monoclonal Antibodies: A Therapeutic Model

The use of monoclonal antibodies for tumor specific in vitro diagnosis is well established. With the possibility of producing tumor specific monoclonal antibodies, not only the in vitro application but also the in vivo use for tumor imaging is of great interest (Bander 1984; Mitchell and Oettgen 1982; Moon et al. 1983; Ritz et al. 1981). Methodology for radiolabelling of immunoglobulines is a well established and simple biochemical procedure thus making these antibodies ideal for immuno-szintigraphy (Greenwood et al. 1963; Hunter and Greenwood 1962; Mach et al. 1981; Scheinberg et al. 1982; Solter et al. 1982). Using alpha- or beta-emitting isotopes the therapeutic use of antibodies as tumo…

Therapie des metastasierten Prostatakarzinoms — 1 Jahr nach Würzburg

An mittlerweile mehr als 150 Patienten mit bisher unbehandeltem Prostatakarzinom konnten wir in den vergangenen 6 Jahren den Kastrationseffekt von pernasal appliziertem Buserelin belegen [1, 2]. Partielle oder komplette Remissionen (objektiviert nach den Kriterien der National Prostatic Cancer Treatment Group oder der EORTC) liegen nach 6 Monaten je nach zugrunde gelegten Ansprechkriterien bei gut 50%, die Progressionsrate bei etwa 20%. Diese Daten konnten mittlerweile von anderen Autoren auch mit anderen LHRH-Analoga als Monotherapie reproduziert werden.

100 cases of Mainz pouch: continuing experience and evolution.

The surgical technique for creation of the Mainz pouch uses 10 to 15 cm. of cecum and ascending colon and 2 ileal loops of the same length for construction of a urinary reservoir. Initial applications of the Mainz pouch were for bladder augmentation after subtotal cystectomy and for continent urinary diversion. Current indications have been extended to complete bladder substitution after radical cystoprostatectomy with anastomosis of the pouch to the membranous urethra. For cosmetic reasons the umbilicus is used as a stomal site for continent urinary diversion, and the technique of intussuscepting the continence nipple has been modified accordingly. A total of 100 patients underwent a Mainz…

Studies on the Intravesical Action of Topically Administered G 3 H-Doxorubicin Hydrochloride in Men: Plasma Uptake and Tumor Penetration

AbstractDoxorubicin hydrochloride has been used for the treatment and prevention of recurrences of transitional cell carcinoma. Ideal indications for the drug and side effects have not been determined. In this regard the penetration of the drug into the bladder wall and the urothelium as a urinary blood barrier is of interest. Using a tritium label we have investigated tumor penetration and transmucosal plasma uptake of doxorubicin hydrochloride after intravesical application in 7 patients with stage A bladder tumors. Of the 7 patients 5 were free of tumor following transurethral resection and 2 had recurrent disease. The patients free of tumor received 40mg. doxorubicin hydrochloride per 3…

Serum prolactin and tumors of the prostate: unchanged basal levels and lack of correlation to serum testosterone

To investigate the possible role of circulatory levels of prolactin on the development of prostatic tumors, and to gain insight into the prolactin-androgen relationship, serum prolactin and testosterone were determined in 73 patients with newly diagnosed prostatic adenocarcinoma. Controls consisted of 32 patients with benign prostatic hyperplasia before treatment, 19 age-matched controls, and 21 young individuals. Hormones were measured under standardized conditions by highly specific and sensitive radioimmunoassays. There was no difference in prolactin in the elderly men regardless of prostate pathology, but a significant increment was found in young controls. Individual prolactin values d…

The Effects of Chlorotrianisene (Tace) on Kinetics of 3H-testosterone Metabolism in Patients with Carcinoma of the Prostate

Summary— Alterations in the metabolism of testosterone and plasma levels of testosterone, luteinising hormone (LH), follicle stimulating hormone (FSH), prolactin and oestradiol were studied in 6 patients with newly diagnosed prostatic carcinoma before and during treatment with chlorotrianisene at a daily dosage of 48 mg for 14 days. Parameters of plasma kinetics were determined according to the single injection technique and the 2-compartment model, and the plasma hormones by radioimmunoassay. Chlorotrianisene altered neither plasma levels of testosterone, gonadotrophins, prolactin and oestradiol, nor metabolic clearance rate, production rate and other kinetic parameters of testosterone. Th…

Lektine als biologische Marker beim Harnblasenkarzinom

Der Verlust der Blutgruppenantigenitat wird beim Urothelkarzinom der Harnblase als Marker der zellularen Entdifferenzierung angesehen. Daraus last sich vermuten, das wahrend der malignen Transformation Veranderungen in der Glykoproteinzusammensetzung der Zellmembranen stattfinden.

Silicone-Silver Penile Prosthesis: Description, Operative Approach and Results

A silicone penile prosthesis in which silver wires are embedded to allow for voluntary bending of the penis for urination and resting position and for straightening for intercourse is described. The implantation is done via a hemicircular incision on the dorsum of the penis in the sulcus coronarius. Buck's fascia is identified and opened, and the corpora are dilated up to 30F. After the exact length is determined with a special sizer the prosthesis is slipped into each corpus cavernosum. The advantage of this approach is the optimal insertion of the prosthesis distal to the sulcus coronarius, thereby preventing kinking of the glans during intercourse. Our experiences with the implantation i…

Behandlung des fortgeschrittenen Prostatakarzinoms mit dem Gonadotropin-Releasing-Hormon-Analog Buserelin: klinische Ergebnisse

Wie aus der vorangegangenen Veroffentlichung (Wenderoth u. Jacobi 1984) hervorgeht, ist das Gonadotropin-Releasing-Hormon-Analog Buserelin sowohl in subkutaner, als auch in pernasaler Applikation in der Lage, uber eine Down-Regulation der hypophysaren Freisetzung des luteinisierenden Hormons eine Suppression des Serumtestosterons auf Kastrationswerte zu bewirken. Dieser fur die Therapie des Prostatakarzinoms signifikante biologische Effekt tritt, wie Abb. 1 zeigt, mit einer mehr als 95%igen Wahrscheinlichkeit ab dem 28. Behandlungstag auf. Vergleichbare endokrinologische Daten wurden von der Arbeitsgruppe um Nagel (Borgmann et al. 1972) berichtet.

Active immunotherapy of stage IV renal cell cancer using autologous tumor cells

A total of 53 patients with stage IV renal cell carcinoma were treated by vaccination with autologous tumor cells in Candida-antigen after palliative tumor nephrectomy. Follow-up has been up to 9 years. Complete remission within 48 months after nephrectomy was observed in 3 patients, while 6 showed partial remission and 18 are stable with disease. Of 26 patients with rapid progression, 17 died within 1 year after operation. The best response was seen in metastases to the liver and lung. CNS-lesions or bone metastases do not appear to respond to this treatment. We conclude that this mode of therapy is beneficiary to a certain group of patients and should be offered, as no severe side effects…

Alterations of peripheral testosterone metabolism after induced hypoprolactinemia in patients with prostatic carcinoma

In 12 patients with advanced prostatic carcinoma the effect of bromocriptine-induced hypoprolactinemia on the peripheral androgen metabolism was investigated after 3H-testosterone injection under conditions that each individual served as his own control. After a 5-day significant prolactin suppression, the elimination of 3H-label 1 h after testosterone injection was about 45% and equal to pre-bromocriptine values. The recovery of dihydrotestosterone separated by silica gel T.L.C., however, was significantly augmented, resulting in a marked decrease of the testosterone/dihydrotestosterone ratio from 12.2 to 6.3. This induced 5alpha-reductase activity after prolactin suppression is in accorda…

Adriamycin Permeability of the Rat Bladder under Different Conditions

Abstract Fifty female Sprague-Dawley rats were treated with 1.4 or 2.4 mg. adriamycin intravesically. Radioimmunological measurement of serum concentrations were performed up to 3 hours post-instillation in normal bladder mucosa, cystitis, and after electrocoagulation, under different filling conditions, as well as with the use of a detergent (Tween 80). The serum concentrations achieved were markedly higher after electrocoagulation or cystitis; altogether they reached only 1/6,000 of the instilled concentration. These studies on the rat bladder suggest that perioperative instillation of adriamycin to prevent recurrence is not contraindicated shortly before or after transurethral resection …

Bromocriptine and Prostatic Carcinoma: Plasma Kinetics, production and Tissue Uptake of3H-Testosterone in Vivo

The influence of the anti-prolactin bromocriptine on plasma kinetics, production rate and tissue uptake of testosterone was investigated in 15 patients with newly diagnosed stages C and D prostatic carcinoma. Bromocriptine was given for 5 days in a daily dose of 15 mg. orally. The studies were performed with the single injection technique using the 2-compartment model. Plasma testosterone, serum prolactin, and luteinizing and follicle-stimulating hormones were determined initially. Blood samples were drawn up to 5 hours after the injection of 3H-testosterone. For tissue studies a transrectal needle biopsy was done 3 hours post-injection. Bromocriptine suppressed prolactin and the endogenous…

Die intravesikale Rezidiv-Chemoprophylaxe des oberflächlichen Harnblasentumors

Das oberflachliche Harnblasenkarzinom stellt eine Domane der transurethralen Resektion dar. Das maligne Potential dieser Tumoren ist vergleichsweise niedrig und die betroffenen Patienten leiden oft infolge ihres fortgeschrittenen Alters an zusatzlichen internistischen Grunderkrankungen, die im Vordergrund stehen (1). Andererseits nimmt die karzinombedingte Todesrate in Abhangigkeit vom Infiltrationsstadium und der zellularen Entdifferenzierung deutlich zu. So sinkt die 3-Jahresuberlebensrate von Patienten mit Harnblasenkarzinomen des Stadiums T1–3 mit zunehmender histologischer Entdifferenzierung. Sie betragt bei G1-Tumoren noch 76% und sinkt auf 32% bei G3-Tumoren. Ebenso nimmt die Todesra…

Gradientenanalyse klinisch-chemischer Parameter und Tumormarker in der Verlaufskontrolle des Prostatakarzinoms nach pharmakologischer Kastration

Unsere Analyse basiert auf ca. 6000 Laboruntersuchungen im Rahmen einer engmaschigen Langzeituberwachung von 22 Patienten mit fortgeschrittenem Prostatakarzinom, behandelt durch pharmakologische Kastration mit dem LHRH-Analogon Decapeptyl-Depot.

Extracorporeal shock wave lithotripsy (ESWL): alternatives and adjuvant procedures

Within a short time, extensive statistics on ESWL have documented its efficiency in the treatment of most renal and ureteral stones. Approximately 20% of all stone patients, however, require additional or other forms of therapy, such as URS, PNL, or surgery. Up to now, the differential indications for these procedures have not been completely established. A crucial factor for successful application of ESWL is stone volume and localization. Large stones with a central stone mass may be successfully treated by combining ESWL and PNL, while surgery is still preferred in those with a peripheral stone mass.

Skelett- und Lebermetastasierung bei Harnblasen- und Hodenmalignomen: Szintigraphie als primäre Stagingmethode?

Die Inzidenz von Skelett- oder Lebermetastasen bei Harnblasen- und Hodenmalignomen, also bei Tumoren, fur welche Skelett und Leber nicht als Metastasierungspradilektionsorgane gelten, wird in der Literatur sehr uneinheitlich angegeben. Je nach Patientenselektion, Intensitat der Stadienabklarung, Metastasenabklarung im Rahmen der Primardiagnostik, im Therapieverlauf oder aber Metastasennachweis erst bei der Autopsie, schwanken die Angaben fur das Blasenkarzinom bezuglich der Skelettmetastasie-rung zwischen 0,9% und 64%, bezuglich der Le-bermetastasierung zwischen 3% und 51%. Fur das Hodenkarzinom werden ebenfalls extreme Schwankungsbreiten von 0,3%–18% bzw. 9%–75% angegeben.

The mainz-pouch (mixed augmentation ileum 'n zecum) for bladder augmentation and continent diversion

The ideal urinary reservoir constructed from bowel material should be a low-pressure system with a high capacity, capable of preventing upper tract deterioration resulting from ureteral obstruction or reflux. It should achieve reliable control of continence and assure easy emptying of the reservoir. In the Mainz-pouch, the combination of cecum and ileum, the latter of which is able to absorb pressure waves created by the cecum, produces a low-pressure system with a high capacity immediately postoperatively. By incorporating large bowel in our pouch, ureteral implantation can be done using a simple and reliable standard antireflux technique with a submucosal tunnel. The Mainz-pouch has been …

Gonadotropin-releasing hormone analogues for palliation of carcinoma of the prostate

Since the introduction of contrasexual treatment as the basic concept of palliation of prostatic carcinoma in the 1940's, orchiectomy, estrogens, and, in recent years, antiandrogens have become generally accepted treatment forms. Three facts: 1) estrogen treatment being at best palliative and at worst dangerous; 2) surgical castration having psychological impacts, at least in the younger age group; and 3) both being probably ineffective from the beginning, have led us to investigate an alternative of minimal toxicity and possible reversibility in the initial treatment of advanced prostatic carcinoma. 12 patients with far advanced carcinoma of the prostate were treated with the gonadotropin …

Experience with palliative percutaneous nephrostomy in bladder cancer patients

Minimal percutaneous nephrostomy as a palliative urinary diversion was performed in 50 patients with advanced bladder cancer disease. The average survival time was 6.6 months, with 38% of the patients alive after 6 months. Although 88% of the patients died within one year, 2 (5%) are still alive after more than 2 years. Each case of palliative diversion is an individual one, with many different factors influencing the decision. Prolonging life cannot be an indication for diversion. Percutaneous nephrostomy in combination with other percutaneous techniques provides the urologist with excellent therapeutic tools to avoid surgery in such emergency situations as uremia or local tumor symptoms. …

Prognostic parameters of renal cell carcinoma.

The Mainz Pouch (Mixed Augmentation Ileum and Cecum) for Bladder Augmentation and Continent Diversion

The ideal urinary reservoir constructed from bowel material should be a low-pressure system with a high capacity, capable of preventing upper tract deterioration resulting from ureteral obstruction or reflux. It should achieve reliable control of continence and assure easy emptying of the reservoir. In the Mainz-pouch, the combination of cecum and ileum, the latter of which is able to absorb pressure waves created by the cecum, produces a low-pressure system with a high capacity immediately postoperatively. By incorporating large bowel in our pouch, ureteral implantation can be done using a simple and reliable standard antireflux technique with a submucosal tunnel. The Mainz-pouch has been …

Hat die pelvine Lymphadenektomie im Rahmen der radikalen Zystektomie eine therapeutische Bedeutung?

Bei mehr als 270 Zystektomien seit 1968 stellt die pelvine Lymphadenektomie seit 1973 einen integralen Bestandteil der radikalen Zystektomie an unserer Klinik dar. Wir beginnen die Lymphadenektomie mit der Dissektion der iliacalen Lymphknoten, nach cranial bis zur Aortenbifurkation. Sie wird zwischen V.iliaca und Muskulus psoas fortgesetzt, wo die sakrale Lymphknotengruppe entlang des proximalen Anteils des N. obturatorius ausgeraumt wird. Dem Verlauf dieses Nervs folgend, schliest sich die Ausraumung der Fossa obturatoria an, welche die Lymphadenektomie beendet.

Endocrine and Clinical Evaluation of 107 Patients With Advanced Prostatic Carcinoma Under Long-Term Pernasal Buserelin or Intramuscular Decapeptyl Depot Treatment

Three major assumptions emerged from these clinical and endocrine long-term studies. First, buserelin, given pernasally in the conventional doses, and Decapeptyl microcapsules administered intramuscularly in 5-week intervals are equally effective in terms of their long-term castration effect in previously untreated patients with prostatic carcinoma. However, Decapeptyl causes complete LH and subsequent testosterone down-regulation 1 week earlier than buserelin. Furthermore, this treatment is more convenient, and the compliance is better. Both LHRH analogues are equally well tolerated. Second, in groups of prostate cancer patients with far advanced disease treated with palliative intention, …

Follow-up results of embolization therapy for palliation of incurable bladder carcinoma

Embolization therapy of the renal artery (N=10), hypogastric arteries (N=18) and ureter (N=24) was performed in 41 patients with incurable bladder carcinoma for palliation of gross hematuria and severe dysuria. Careful follow-up of the patients until death gave a mean survival time of 12.3 months after embolization; 6 patients are still alive. The results show that embolization therapy is justified for management of bleeding and dysuric complaints. Ureteral occlusion alone has almost no effect on hematuria. Combined embolization procedures yield better results than occlusion of the vessels or the ureter. Ureteral occlusion with a detachable balloon is superior to embolization with tissue ad…

Coincident vesical transitional cell carcinoma and prostatic carcinoma. Clinical features and treatment.

Summary— Twenty-two patients with vesical urothelial carcinoma associated with prostatic carcinoma were reviewed. They represented 1.5% of the bladder and prostatic tumours treated in our department within a 12-year period from 1968 to 1979. Their management included several treatment policies, based on the separate assessment of each tumour variant. For non-infiltrating bladder tumours, transurethral tumour resection was combined with hormonal treatment, external radiotherapy or resection of the prostate depending on the stage of the prostatic tumour. Radical cystoprostatectomy was performed for two cases of infiltrating bladder tumour with well localised prostatic tumours. A conservative …

Radical Cystectomy - Often Too Late?

From 1967 to 1985, 246 cystectomies for treatment of transitional cell carcinoma of the urinary bladder were performed. Perioperative mortality decreased from 15% in the early years to 0% in 1985. Preoperative radiotherapy was not given. Patients who underwent cystectomy immediately following the diagnosis of invasive bladder carcinoma had a significantly better prognosis than those having cystectomy after recurrence of a transurethrally resected invasive carcinoma in spite of identical G and T criteria. A total of 26 patients who were cystectomized because of tumor recurrence after definitive radiotherapy (salvage cystectomy) represented the group with the worst prognosis: they had a 5-yea…

Therapeutische Alternativen beim fortgeschrittenen Nierentumor

Metastasierte Nieren-Carcinome stellen ein ungelostes therapeutisches Problem dar. Seit uber 20 Jahren werden in die Immuntherapie immer wieder Erwartungen gesetzt, die sich letztlich nicht erfullt haben. Die Liste immunologischer Therapieansatze ist lang und reicht von der BCG-Therapie bis zu den verschiedenen Interferonen. Damit konnten zwar in wenigen Fallen komplette Metastasenregressionen erzielt werden. Ein therapeutischer Durchbruch war es jedoch nicht.

Digital Subtraction Angiography in Staging Renal Cell Carcinoma: Comparison with Computerized Tomography and Hlstopathology

Digital subtraction angiography was compared to computerized tomography and histopathological findings for staging renal cell carcinoma in 24 patients. Injection of contrast material through a 16 gauge angiocatheter into the femoral vein provided digital subtraction cavography, digital subtraction arteriography and excretory urography during 1 investigation. Computerized tomography established the diagnosis in all patients, while digital subtraction angiography showed all angiographic signs of renal cell carcinoma in 14 (58 per cent). T staging was correct on computerized tomography in 18 patients and on digital subtraction angiography in 16. Absence or presence of venous involvement was in…