No abstract

We have reviewed 500 consecutive prostatectomies with a follow-up period of between 5 and 8 years; 184 surviving patients were sent a questionnaire and patients with residual urinary symptoms were interviewed, examined and a flow rate was performed. The operative mortality rate was 0.5%. Patients who presented with retention of urine had a high mortality rate in the first 3 years after the operation. Thirty-six per cent of surviving patients with chronic retention and 24% of those who underwent elective prostatectomy had residual urinary symptoms at the time of the study. Of patients who were sexually active pre-operatively, 34% felt that the operation was responsible for a deterioration in their sex lives. The incidence of retrograde ejaculation was 93%. It was concluded that prostatectomy is a safe operation with good patient acceptability. Patients with symptoms of prostatism require careful evaluation before prostatectomy and sexually active patients should be warned of the risks of impotence and decreased satisfaction due to retrograde ejaculation.

Summary Thirty-five patients with advanced malignant disease have been treated as outpatients with increasing doses (0.1 -00 mcg) of interleukin 2 (IL2) by once daily self-administered subcutaneous (s.c.) injection, 5 days weekly for 8 weeks followed by a 4 week observation period. Systemic side effects were not experienced by patients at the 3 lower doses. Three patients required dose reduciton from 100 mcg daily because of intolerance (fever, rash, lethargy, nausea and vomiting) and one patient was discontinued because of dyspnoea. We observed immunological effects at the 100 mcg dose (but not at the lower doses). These consisted of (a) a modest sustained lymphocytosis, (b) eosinophilia in six (out of nine) patients and (c) a significant rise in IL2-stimulated peripheral blood lymphocyte activated killer (LAK) cell activity in six (out of nine) patients to a mean of 2.0 times pretreatment levels (P<0.01). Two (out of nine) patients with renal cell carcinoma treated with 100 mcg daily had partial responses of duration 4 and 9 months respectively and a further three had disease stabilisation for at least 3 months. Low dose long-term s.c. IL2 is clinically and immunologically active, and in comparison to other IL2 regimens it has minor toxicity and is easy to administer. These characteristics make low dose s.c. IL2 suitable for study in the adjuvant setting.

Summary Experience of 26 patients with carcinoma of the prostate treated by adrenal suppression with aminoglutethimide is reviewed. 60% of hormone resistant tumours showed some response. A fall in plasma testosterone beyond that achieved by oestrogens was not observed. A high incidence of side‐effects was noted. A limited role for aminoglutethimide in the management of prostatic carcinoma is suggested. Our thanks are due to the Consultant Surgeons, St Peter's Hospitals who referred their cases to us for investigation. We acknowledge with thanks the help of Dr I. F. Sommerville and Mr M. D. Mansfield, Department of Clinical Endocrinology, Chelsea Hospital for Women, who performed testosterone assays. Aminoglutethimide was supplied by Ciba Laboratories Ltd, Horsham, Sussex. This work was supported by a grant from the St Peter's Research Trust.

Summary Transforming growth factor beta-i (TGF-P1) has been proposed as a mediator of tumour growth in a number of tumours and cell lines including prostate, and in a recent study was shown to be up-regulated in the stroma of breast cancer tissue following treatment with the anti-oestrogen tamoxifen. Immunolocalisation of the intracellular form of TGF-P1 confirmed that the source of the stromal TGF-Pf was the peritumoral fibroblasts. We present here the results of a study in which five patients with hormonally unresponsive prostatic carcinoma and seven patients responding to a luteinising hormone-releasing hormone analogue had prostate biopsies taken before and during treatment. These were stained for TGF-P expression prior to treatment and at either relapse or 3 months later respectively. Six of seven clinically responding tumours and three of five relapsed tumours showed up-regulation of extracellular TGF-p1, again primarily in the stroma, with no apparent up-regulation of intracellular TGF-p1, TGF-P2 or TGF-P3. These data illustrate that the epithelial growth inhibitor TGF-P1 can be induced by hormonal manipulation in prostate cancer in vivo, and may continue to be up-regulated even after relapse. This suggests that relapse of hormonally treated prostate cancer may be associated with a failure of the epithelium to respond to stromal TGF-p1.

Urology 47 (1996) 497-504. doi:10.1016/S0090-4295(99)80484-1Received by publisher: 1995-09-26Harvest Date: 2016-01-04 12:21:03DOI: 10.1016/S0090-4295(99)80484-1Page Range: 497-50

No abstract

Aminoglutethimide has been used in combination with hydrocortisone in patients with advanced prostatic cancer with the rationale that it causes a 'medical adrenalectomy'. Both objective and subjective responses have been recorded. We have examined the effect of AG and HC alone and in combination on plasma androgen levels throughout the day in two studies on 11 such patients. Whilst AG combined with HC led to a significant suppression of both testosterone and androstenedione levels, the suppression with HC alone was significantly greater, indicating that any beneficial clinical effects of AG in these patients is not due to its suppression of adrenal androgen secretion.