PEP has an equal anticancer efficacy to CAD and does not increase cardiovascular mortality. Final evaluation of cardiovascular morbidity is awaiting further analysis and follow-up. PEP is considerably cheaper than CAD.

PEP has an anticancer efficacy equal to CAD and does not increase cardiovascular mortality in metastasized patients, but carries a significant risk of non-fatal cardiovascular events, which should be balanced against the skeletal complications in the CAD group. It is feasible to use Estradurin in the primary or secondary endocrine treatment of metastasized patients without prominent cardiac risk factors and especially those with osteoporosis.

Approximately 15% of men with hormone naïve metastatic prostate cancer primarily fail to respond to androgen deprivation treatment (ADT). The reason why the response to ADT differs in this subgroup of men with prostate cancer remains unclear. The aim of this study was to describe the characteristics of these men and to thereby define predictors of early ADT failure in prostate cancer patients with bone metastases. The study was based on 915 men from the prospective randomized multicenter trial (no. 5) conducted by the Scandinavian Prostate Cancer Group comparing parenteral estrogen with total androgen blockade. Early ADT failure was defined as death from metastatic prostate cancer within 12 months after the start of ADT. Multivariate logistic regression models were applied to identify clinical predictors of early ADT failure. Ninety‐four (10.3%) men were primarily nonresponders to ADT. Independent predictors of early ADT failure were poor Eastern Cooperative Oncology Group performance status (PS), analgesic consumption, low hemoglobin, and high Soloway score (extent of disease observed on the scan), in where patients with poor PS and/or high analgesic consumption had a threefold risk of early ADT failure. Not significantly factors related to early ADT failure were age, treatment, cardiovascular comorbidity, T category, grade of malignancy, serum estrogen level, and SHBG at enrolment. We analyzed characteristics of a subgroup of patients who primarily failed to respond to ADT. Four independent clinical predictors of early ADT failure could be defined, and men exhibiting these features should be considered for an alternative treatment.

No abstract

Tranexamic acid is a potent antifibrinolytic drug frequently used in the treatment of haematuria and a number of other haemorrhagic conditions. Since it is eliminated mainly in the urine, the drug accumulates in patients with uraemia. The excretion of tranexamic acid in patients with renal failure has been investigated and dosage recommendations are given for tranexamic acid therapy in cases of renal failure.

No abstract

Endocrine treatment of prostate cancer can be performed under several different regimes. They all have side effects which in different ways influence quality of life and the patient's general health. This paper is a survey of the most important early side effects of the different modes of endocrine treatment, their etiology, and possible ways to avoid or treat them. Prostate Supplement 10:32–37, 2000. © 2000 Wiley‐Liss, Inc.

Of all cancers affecting the penis >95% are squamous cell carcinoma (SCC). The disease is rare, representing only 1% of male cancers, and incidence rates vary across the world. The highest rates are found in Africa and South America and the lowest rates in Israel. Penile intraepithelial neoplasia (PIN) is considered to be a precursor of SCC but only a small proportion (estimated rate 5-15%) of cases of PIN will develop into invasive SCC. The evolution from low-grade PIN to invasive cancer may take as much as 15-20 years.Research into the etiology of cervical cancer has pointed to the role of oncogenic HPV-types, mainly HPV 16. The etiological significance of these oncogenic HPV types has also been established in SCC of the penis: in %50% of cases of SCC of the penis, HPV-DNA is detected (again mainly from HPV 16). Depending on the grade of differentiation of the PIN lesion, 70-100% of cases of PIN will show the presence of HPV-DNA. However, only oncogenic HPV types (16/18) have the ability to transform infected tissue into SCC. HPV types 6/11 lead mainly to the formation of benign warts. Some explanations can be given for the discrepancy between the high incidence of HPV-DNA in highgrade PIN lesions and the much lower incidence in SCC of the penis. Firstly, the sensitivity of the various tests for demonstrating HPV-DNA differs. Secondly, progression to SCC may occur concomitantly with disappearance of HPV. A third reason could be that an HPV-negative precursor lesion has not yet been recognized. Other risk factors associated with SCC are phimosis, recurrent balanoposthitis, lichen sclerosus et atroficus (LSA), smoking, PUVA treatment and HIV infection (see Dillner et al, p. 189).HPV infection is a sexually transmitted disease with a very high rate of acquisition. The infection is characterized by a high rate of spontaneous clearance (!70%). The prevalence of HPV DNA in healthy men is estimated to be 5%, with a peak of 8-11% occurring between 16 and 35 years of age.In almost 60% of male partners of women with cervical intraepithelial neoplasia (CIN), the presence of HPV (mostly the high-risk type HPV 16) has been shown. The etiological role of HPV is supposed to act through binding of the viral oncogene products E6 and E7 to the gene products of the tumor suppressor genes p53 and pRb.HPV infection elicits serum antibody response against HPV capsid. The antibody response is highly HPV type-specific. Because of its stability over time, even after clearance of the infection, this provides a useful marker of cumulative HPV exposure. Seropositivity is strongly correlated with the lifetime number of sexual partners (see Dillner et al, p. 194).The clinical presentation of HPV lesions is paradoxical. Most lesions, and in particular those induced by oncogenic HPV, tend to remain asymptomatic, while symptomatic lesions are mostly caused by lowrisk HPV and are usually self-limiting. Clinical entities histologically identified as PIN III are Bowen's disease, erythroplasia of Qeyrat and bowenoid papulosis.The role of inflammat...