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Our study supports cryosurgery of the prostate as safe and effective treatment in patients in whom radiation therapy fails. Using the CRYOCare machine resulted in a marked decrease in complications.

Whether prostate cancer recurrence can be predicted by microvessel density (MVD) measurements is controversial. One reason for the lack of agreement may be the differing antibodies used to determine MVD. We evaluated MVD using 2 different antibodies against endothelial cells, CD31 and CD34, on 102 patients who underwent radical prostatectomy without adjuvant hormonal therapy. The tumors from these cases were identified, and areas with the highest Gleason pattern were immunostained. Average MVD determined by CD31 (MVD/CD31) staining was significantly lower than that obtained by MVD/CD34 staining (60.1 vs 80.3). By using Kaplan-Meier analysis, prostate-specific antigen (PSA) recurrence was correlated with MVD/CD31 and MVD/CD34. MVD/CD34 and MVD/CD31 were associated strongly with PSA recurrence on a univariate level. However, only MVD/CD34 was an independent predictor of PSA failure. Therefore, some of the confusion about MVD value as a prognostic indicator may be due to the antibodies used.

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Objective To evaluate the incidence of renal and seminal mutations (eight of 13 vs three of 10). Semen variables (pH<7.2, fructose <1 g/L and ejaculate volume vesicle (SV) abnormalities, and the presence or absence of CFTR gene mutations, in a cohort of patients <2 mL) did not diCerentiate patients with or without anomalies of the kidney, SV or with mutations, except referred for congenital bilateral absence of the vas deferens (CBAVD).in patients with a pH<7.2 for which renal anomalies were less frequent (two of 25 vs six of 16, P<0.05) Patients and method Forty-one patients with CBAVD, confirmed by surgical exploration, were evaluated by and mutations more frequent (19 of 25 vs five of 12, P<0.01). ultrasonography for renal and SV anomalies. Semen variables (pH, fructose level and ejaculate volume),Conclusion Renal anomalies associated with CBAVD should be considered as supporting maldevelopment sweat chloride levels and mutations of the 3, 4, 7, 9, 10, 11, 13, 14b, 17b, 19, 20 and 21 exons of the as a cause, but analysis of CFTR mutations in these cases should not be omitted. Unlike anomalies of the CFTR gene were determined. Result In eight patients with renal anomalies there were SV, a low ejaculate volume or low fructose level, a semen pH of <7.2 is the only nonspecific variable in no detectable mutations of CFTR, compared with 23 in the 33 patients with no renal anomalies (P<0.02).patients with CFTR mutations. Keywords Cystic fibrosis, azoospermia, kidney, seminal SV anomalies were not related to the presence or absence of mutations (11 of 23 vs 11 of 18), or in vesicle, malformations compound heterozygote patients carrying two (CFTR) responsible for cystic fibrosis were discovered,

Objective To determine the complication rates and biochemical recurrence after cryoablation of the prostate, using an argon gas-based system, in patients with localized prostate cancer. Patients and methods Between October 1997 and June 1999, 35 patients underwent cryoablation of the prostate (19 after radiation therapy failure and 16 as a primary treatment for localized prostate cancer). All patients had biopsy-con®rmed prostate cancer with no seminal vesicle invasion, negative bone scans and a negative lymph node dissection. Patients received 3 months of combined hormonal therapy before cryosurgery. One surgeon performed all the procedures. Biochemical recurrence was de®ned by an increase in prostate speci®c antigen (PSA) of ¢0.2 ng/ mL above the PSA nadir. Results The complications were rectal pain (26%), urinary infection (3%), scrotal oedema (12%), haematuria (6%) and incontinence (6%). Complication rates were higher in those patients who failed after radiation therapy than in those who did not receive radiation (incontinence 11% vs 0%, rectal pain 37% vs 12%) but the difference was not statistically signi®cant. Twenty-two patients (63%) had an undetectable serum PSA nadir (<0.1 ng/mL) after cryotherapy and 30 (84%) patients had a PSA value of <1.0 ng/mL. After a mean follow-up of 8.3 months (range 0.2±18), nine patients had biochemical recurrence. The biochemical recurrence-free survival (BRFS) was 70% at 9 months. Patients who had an undetectable PSA nadir had a statistically higher BRSF at 9 months than did patients who had a detectable PSA nadir (89% vs 55%, respectively, P = 0.03). Similarly, patients with a preoperative serum PSA level of <10 ng/mL had a statistically higher BRFS than patients who had a PSA level of >10 ng/mL (86% vs 42% at 9 months, P<0.001). Conclusion A PSA level before cryotherapy of <10 ng/ mL and an undetectable PSA nadir after cryotherapy were associated with the highest BRFS. Cryoablation of the prostate, with low morbidity, seems to be a viable option in managing patients by salvage therapy after radiation therapy and for the primary treatment of clinically localized prostate cancer.

The authors thank Christine M. Lohse from the Division of Biostatistics, Mayo Clinic (Rochester, MN) for her excellent and kind collaboration with martingale residuals analysis. Receiving this kind of collaboration was a great honor for all the authors.

We validated the independent prognostic value of the new Grade Groups on biopsy and RP specimen from European PCa men. However, it does not improve the accuracies of prognostic models by a clinically significant margin. Nevertheless, this new classification may help physicians and patients estimate disease aggressiveness with a user-friendly, clinically relevant and reproducible method.