1/15. Transperineal magnetic resonance image guided prostate biopsy.PURPOSE: We report the findings of a transperineal magnetic resonance image (MRI) guided biopsy of the prostate in a man with increasing prostate specific antigen who was not a candidate for a transrectal ultrasound guided biopsy. MATERIALS AND methods: Using an open configuration 0.5 Tesla MRI scanner and pelvic coil, a random sextant sample was obtained under real time MRI guidance from the peripheral zone of the prostate gland as well as a single core from each MRI defined lesion. The patient had previously undergone proctocolectomy for ulcerative colitis and, therefore, was not a candidate for transrectal ultrasound guided biopsy. Prior attempts to make the diagnosis of prostate cancer using a transurethral approach were unsuccessful. RESULTS: The random sextant samples contained benign prostatic hyperplasia, whereas Gleason grade 3 3 = 6 adenocarcinoma was confirmed in 15% and 25% of the 2 cores obtained from the MRI targeted specimens of 2 defined lesions. The procedure was well tolerated by the patient. CONCLUSIONS: Transperineal MRI guided biopsy is a new technique that may be useful in detecting prostate cancer in men with increasing prostate specific antigen who are not candidates for transrectal ultrasound guided biopsy.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
2/15. Progressing prostate carcinoma.In the Karnell Cancer Center Grand Rounds, we present a patient who underwent radical prostatectomy with bilateral pelvic lymphadenectomy, but had positive margins and subsequently developed local recurrence and then systemic disease. Pathologic and radiologic aspects of his disease are discussed. Therapeutic options at different stages of the disease are examined from the point of view of the urologist, radiation oncologist, and medical oncologist. The surgical portion of the discussion focuses on the selection of initial therapy. Both the selection of surgical candidates and choice of pre- or post-operative therapy in patients can be aided by prognostic tools looking at several variables, including prostate-specific antigen (PSA) level, Gleason score of the tumor, seminal vesicle invasion, extracapsular invasion, and lymph node involvement. Low-risk patients can be treated with monotherapy, such as radical prostatectomy, external beam radiation therapy, prostate brachytherapy, or cryosurgical ablation of the prostate. Higher risk patients may require adjuvant and possibly neoadjuvant therapy in addition. The radiation portion of the discussion focuses on the use of radiation therapy as salvage for relapsing disease. Of particular importance is the point that treating high-risk patients whose PSA levels have started to rise but are less than 1 ng/ml results in a long-term PSA control rate as high as 75%, but that limiting the use of salvage radiation therapy to patients with high PSA levels or biopsy confirmation of local recurrence in the face of a negative bone scan results in biochemical long-term control of less than 40%. In the medical oncology part of the discussion, the major focus is on the use of chemotherapy to treat patients whose disease has become resistant to hormonal therapy. mitoxantrone plus a corticosteroid has been found to offer significant palliation for such patients. Combination therapy with estramustine plus taxanes, other microtubule inhibitors, or other agents such as topoisomerase ii inhibitors, has been found to cause shrinkage of measurable soft tissue disease and diminution of serum PSA levels. The development of effective hormonal and chemotherapeutic drugs for treatment of metastatic disease has led to new interest in adjuvant and neoadjuvant therapy of high-risk patients.- - - - - - - - - - ranking = 0.5keywords = antigen (Clic here for more details about this article) |
3/15. Exaggerated signet-ring cell change in stromal nodule of prostate: a pseudoneoplastic proliferation.A stromal nodule of the prostate was incidentally identified in a simple prostatectomy specimen from a 66-year-old man with benign prostatic hyperplasia. Microscopically, the nodule consisted of short spindly cells with bland nuclear features. Many of the cells in the nodule, however, contained a large, clear cytoplasmic vacuole that displaced and indented the nucleus, generating signet-ring cell morphology. Immunohistochemically, these cells were strongly positive for vimentin and weakly positive for desmin, suggesting a myofibroblastic nature. Further immunostains demonstrated the cells to be negative for cytokeratins and prostate-specific antigen, excluding the possibility of signet-ring cell carcinoma. The cytoplasmic vacuoles also stained negative for mucin production. Electron microscopy revealed no intracytoplasmic lumina. Notably, thermal effect or other signs of cellular injury, frequently associated with signet-ring cell change seen in prostate specimens obtained by transurethral resection and needle biopsy, were not appreciated in this stromal nodule. This case demonstrates that signet-ring cell change may occur in benign, hyperplastic, prostatic stromal cells in the absence of cellular damage.- - - - - - - - - - ranking = 0.5keywords = antigen (Clic here for more details about this article) |
4/15. Paneth cell-like metaplasia of the prostate gland.We report two cases of Paneth cell-like metaplasia of the prostate gland, one in poorly differentiated carcinoma and the second in benign hyperplasia. By light microscopy, the Paneth-like cells were indistinguishable from paneth cells found in the normal small intestine and ultrastructurally showed electron-dense granules typical of paneth cells. Immunohistochemical stains were positive for prostate-specific antigen and prostatic acid phosphatase and negative for lysozyme and alpha 1-antitrypsin. The clinical significance of Paneth cell-like metaplasia is unknown and may represent an example of the multipotential metaplastic capability of actively dividing cells.- - - - - - - - - - ranking = 0.5keywords = antigen (Clic here for more details about this article) |
5/15. Sustained, substantially increased concentration of prostate-specific antigen in the absence of prostatic malignant disease: an unusual clinical scenario.A 60-year-old man had a persistent, marked increase in the serum concentration of prostate-specific antigen (more than 20 times the upper limit of the reference range) and no identifiable prostatic malignant involvement. To our knowledge, this is the first such case reported in the literature. Possible explanations for this increased value are described, and nonmalignant conditions that can increase serum concentrations of prostate-specific antigen are reviewed.- - - - - - - - - - ranking = 3keywords = antigen (Clic here for more details about this article) |
6/15. Large solitary fibrous tumor of the seminal vesicle.solitary fibrous tumors show a classic morphologic pattern ("patternless pattern") consisting mainly of a proliferation of bland spindle cells with varying amounts of thick, often hyalinized or keloid-like, intercellular collagen bundles. immunohistochemistry shows a strong reactivity for CD34 antigen, vimentin, and, in a variable percentage, bcl-2 antigen. We report the case of a 50-year-old man with a large solitary fibrous tumor located in the pelvic cavity with a rare nonspecific histologic pattern of pseudovascular formations. The patient underwent pelvic exenteration with orthotopic continent urinary diversion and sigmoid-J-pouch bowel reconstruction. No signs of tumor recurrence were noted within 24 months of surgery.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
7/15. Giant multilocular cystadenoma of the prostate: a rare differential diagnosis of benign prostatic hyperplasia.We report a case of giant multilocular cystadenoma of the prostate in a 43-year-old man. This is a rare benign entity of the prostate imitating symptoms of benign prostatic hyperplasia and originates from the prostate with extensive spread into the pelvis. Histologically, prostatic glands and cysts lined by cuboid to columnar epithelial cells with basally located nuclei are characteristic. Immunohistochemical staining is positive for prostate-specific antigen in the epithelial cells. Giant multilocular prostatic cystadenoma should be taken into account in the differential diagnosis in any case of a large cystic mass originating from the prostate.- - - - - - - - - - ranking = 0.5keywords = antigen (Clic here for more details about this article) |
8/15. prostate-specific antigen in prostatic carcinoma.To evaluate the clinical and prognostic value of prostate-specific antigen (PSA) for the detection of tumor and tumor growth after therapy, 520 sera from 246 patients with prostatic carcinoma, 990 sera from patients with BPH, and 1,488 sera from patients with other urological diseases were analyzed. The values ranged from 0.1 to 1,828.9 ng/ml. 51% of all values were about 2.5 ng/ml, and 76.8% of all values about 10 ng/ml. The commercial recommendation for the cutoff values is 2.5 ng/ml (IBL, FRG). In patients with benign prostatic hypertrophy this cutoff means 61% false-positive results, which makes the test highly sensitive but unspecific. In prostatic carcinoma patients this borderline means a false-negative result in 9.75% (24 of 246). By determining the cutoff at 10 ng/ml in our series, a false-negative result appeared in 14.6%. Therefore a plea is made for the 10-ng/ml cutoff. In follow-up studies a marked decline in PSA values after transurethral resection or antiandrogen therapy (orchiectomy/Zoladex/ICI/flutamide, Essex). Generally, the greater the PSA levels the more advanced the stage of disease. These data suggest that PSA may be a useful adjuvant marker for monitoring tumor growth in patients with regionally confined tumor.- - - - - - - - - - ranking = 2.5keywords = antigen (Clic here for more details about this article) |
9/15. The natural-killer-cell-associated HNK-1 (Leu-7) antibody reacts with hypertrophic and malignant prostatic epithelium.While using the natural killer (NK) cell-associated HNK-1 antibody in a panel of hematopoietic cell markers, the authors found that metastatic tumor cells in the bone marrow of a patient with disseminated prostatic carcinoma stained strongly with this antibody using an indirect immunofluorescence technique. More than 50% of cells from the patient's prostate also reacted with HNK-1. Subsequent study of frozen sections of prostate tissue from patients with benign prostatic hypertrophy (BPH) showed that HNK-1 reacted with prostatic epithelium and the contents of the glandular lumina. Two other markers associated with NK cells (OKM1 and OKT3) were not detected on nonneoplastic or neoplastic prostatic epithelial cells using a two-color immunofluorescence technique. Recent reports have shown that the HNK-1 antibody also detects an antigen on cells of neuroectodermal origin. The authors have concluded that HNK-1 also reacts with prognostic epithelium in patients with BPH and may be useful as another marker for metastatic carcinoma of the prostate.- - - - - - - - - - ranking = 0.5keywords = antigen (Clic here for more details about this article) |
10/15. Steroid abuse in athletes, prostatic enlargement and bladder outflow obstruction--is there a relationship?OBJECTIVE: To evaluate the effects of exogenous androgenic-anabolic steroids on the human prostate gland. SUBJECT AND methods: A white male athlete, who was routinely using anabolic steroids, volunteered for the study. He was studied during a 15-week period of steroid self-administration. Both objective and subjective parameters were measured, including: prostatic volume (transrectal ultrasound), digital rectal examination, urine flow rate, serum acid phosphatase and prostate specific antigen, symptom scoring for bladder outflow obstruction and other associated symptoms. RESULTS: During the period of steroid self-administration, prostatic volume increased and urine flow rate decreased. The man also noticed an increase in nocturnal urinary frequency, libido and aggression. CONCLUSION: In this pilot study, the administration of exogenous androgenic-anabolic steroids has been demonstrated to have profound effects on the human prostate gland, including an increase in prostatic volume, reduction in urine flow rate and an alteration in voiding patterns. These findings warrant further investigation.- - - - - - - - - - ranking = 0.5keywords = antigen (Clic here for more details about this article) |
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