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Objectives: To test the accuracy of the 2001 Partin Tables in African American men who underwent radical prostatectomy at multiple centers throughout the United States., Methods: We compiled a large multiethnic cohort of men (n = 3748) treated with radical prostatectomy at multiple sites, including all of the sites of the Department of Veterans Affairs-based Shared Equal Access Regional Cancer Hospital (SEARCH) database (n = 1524), Wayne State University (n = 1305), the University of Texas Health Science Center (n = 522), and the Henry Ford Hospital (n = 397). We evaluated the accuracy of the 2001 Partin Tables using area under the receiver operator characteristic curve (AUC) separately among African American and white men., Results: African American men (n = 1188, 32%), despite being more likely to have clinical Stage T1c disease (56% versus 47%, chi-square P <0.001), had higher preoperative PSA values (9.1 versus 7.7 ng/mL, rank-sum P <0.001) and were more likely to have higher-grade disease on diagnostic biopsy (chi-square P = 0.005). Despite these differences in baseline clinical characteristics, the 2001 Partin Tables performed equally well in both racial groups. Specifically, there were no differences in the AUC for African American and white men for predicting organ-confined disease (AUC 0.73 versus 0.72; P = 0.56), extraprostatic extension (AUC 0.62 versus 0.62; P = 0.99), or seminal vesicle invasion (AUC 0.77 versus 0.79; P = 0.53)., Conclusions: These data lend further support to the idea that although baseline differences between the races existed that may underlie an overall more aggressive disease among African American men, for the individual patient, race is not valuable for prognostication.

Objectives: To evaluate the efficacy and safety of neoadjuvant docetaxel and estramustine in patients with high-risk, newly diagnosed, prostate cancer., Methods: Eligible patients had prostate cancer with one or more of the following criteria: clinical Stage T2b or greater, prostate-specific antigen (PSA) of 15 ng/mL or greater, and/or Gleason score of 8 to 10. Chemotherapy consisted of docetaxel (70 mg/m(2)) on day 1 and estramustine (280 mg three times daily) on days 1 to 3 every 21 days for three to six courses. This was followed by local therapy, as deemed appropriate., Results: Twenty-one patients with a median age of 60 years, median PSA level of 16.1 ng/mL (range 2.4 to 175), and median baseline testosterone of 3.4 ng/mL were enrolled. Seven patients met one of the inclusion criteria, 10 met two, and 4 met three. The Gleason score was 8 or greater in 14 patients. A median of five cycles of chemotherapy was delivered. The most frequent high-grade toxicities were grade 3 (8 patients) and 4 (1 patient) neutropenia and deep venous thrombosis (grade 3 in 2 patients) before institution of low-dose warfarin. All patients responded as determined by protocol-defined criteria. Ten patients underwent radical prostatectomy, with negative surgical margins in 7 patients, and 11 received radiotherapy with negative preradiotherapy biopsies in 2., Conclusions: Induction docetaxel and estramustine is well tolerated and feasible in patients with newly diagnosed, high-risk prostate cancer. This combination is active; however, its efficacy relative to hormonal therapy will require a controlled randomized trial.

Objectives: Age-adjusted mortality rates (per 100,000) for men with prostate cancer from 1991 through 1997 reported by the Surveillance, Epidemiology, and End Results national registry have consistently demonstrated that African-American men (AAM) have twice the death rate of white men (WM). However, there has been considerable controversy as to how this relates to progression-free survival among these men. In an attempt to address this controversy of localized prostate cancer, we report on a multivariable analysis of survival data of a large number of AAM and WM who underwent radical prostatectomy., Methods: The study cohort was composed of 791 men whose only prostate cancer treatment was radical prostatectomy performed between July 1990 and December 1999. The variables analyzed were age, preoperative prostate-specific antigen level, pathologic grade and stage, and race/ethnicity. Pathologic examination of all specimens was performed in a uniform manner according to an established protocol. Multivariable analysis based on Cox's proportional hazards regression model was performed to assess whether a significant difference in progression-free survival time between AAM and WM persisted after controlling for the main effects of other prognostic factors., Results: The study cohort consisted of 229 AAM and 562 WM. Our results indicated that all variables, except age, had highly significant effects on progression-free survival, even in the presence of other predictors., Conclusions: The effects of age, preoperative serum prostate-specific antigen level, and pathologic grade and stage did not account for the racial disparity in progression-free survival among men diagnosed with clinically localized prostate cancer and treated with radical prostatectomy.

The marked discrepancy between the prevalence of preclinical prostate cancer and the incidence of clinically manifest disease indicates a long latency phase and significant heterogeneity in the progression potential of early neoplastic lesions. There are a variety of histologic changes within prostatic epithelium that have been termed atypical or dysplastic. The 2 most widely studied of these lesions are prostatic intraepithelial neoplasia (PIN) and atypical adenomatous hyperplasia (AAH). Although associations between AAH and adenocarcinoma are spurious, those linking high-grade PIN (HGPIN) to cancer are far more established. There is a significantly increased risk for patients with isolated HGPIN to have prostate cancer confirmed on subsequent biopsy, suggesting that HGPIN is a marker for prostate carcinoma in addition to its potential role as a premalignant lesion. Autopsy studies reveal that HGPIN is found in association with cancer in 63% to 94% of malignant and 25% to 43% of benign prostates. Data on age and race reveal that African American men develop more extensive HGPIN at a younger age than white men. A wide spectrum of molecular/genetic abnormalities appears to be common to both HGPIN and prostate cancer. Data loss of 8p, 10q, 16q, 18q, and gain of 7q31, 8q, multiple copies of the c-myc genes, along with changes in chromatin texture, telomerase activity, cell cycle status, and proliferative indices collectively suggest that HGPIN is intermediate between benign epithelium and prostatic carcinoma with respect to these markers. These data indicate that HGPIN is important in neoplastic progression, and may present an appropriate target/marker for chemoprevention.

Objectives: Gleason score 7, in different proportions of grades 3 and 4, is the score most frequently assigned to prostate cancer in our radical prostatectomy specimens (RPSs). We correlated the major grade component of score 7 tumors with clinicopathologic parameters and disease-free survival., Methods: All Gleason score 7 RPSs were classified as having a major grade of 3 or 4 carcinoma. The two groups were compared according to patient age, race, serum prostate-specific antigen (PSA) level, clinical and pathologic stage, tumor volume, and biochemical recurrence., Results: Of the 534 patients analyzed, 356 and 178 had major grade 3 or 4 tumors, respectively. Compared with patients with 3+4 tumors, those with 4+3 had significantly more advanced clinical and pathologic stages, larger tumor volume, higher preoperative PSA levels, and older age and a higher proportion were African American (P <0.05 for all above parameters). With a mean follow-up of 34.6 months, patients with 3+4 tumors experienced lower rates of PSA recurrence than did those with 4+3 tumors (P = 0.0021). Furthermore, for the subset of patients with organ-confined disease, multivariable analysis that included race, age, clinical stage, preoperative PSA level, tumor volume, and major grade component found only the latter to be a significant predictor of recurrence, with patients who had major grade 4 component tumors experiencing a higher incidence of PSA recurrence than those with major grade 3 tumors (P = 0.012)., Conclusions: The major grade 4 component in Gleason score 7 carcinoma indicates a higher likelihood of biochemical recurrence, particularly for the increasing proportion of patients with organ-confined disease after radical prostatectomy.

Objectives: Although the rate of positive surgical margins is higher in African-American men (AAM) than in white men (WM), the impact of this difference on survival is not clear. Furthermore, it is unknown whether there are racial differences in the distribution of the positive surgical margins after radical retropubic prostatectomy (RRP). We investigated the differences between AAM and WM in terms of the site and multifocality of the positive surgical margins and their effect on disease-free survival (DFS) following RRP., Methods: Between January 1991 and December 1995, 493 patients (288 WM and 205 AAM) were treated with RRP as monotherapy. Positive surgical margins were observed in 179 patients (86 WM and 93 AAM). Patients were divided in two groups: group 1 = WM and group 2 = AAM. The incidence and location of the positive surgical margins and their correlation with DFS were determined and compared., Results: Overall, AAM had a higher rate of positive surgical margins than WM (48% versus 33%, respectively, P = 0.001). There was no significant difference in the frequency of multifocality of the positive margins (P = 0.4). Positive surgical margins were located significantly more often at the base in AAM (P = 0.015); however, the location of the positive surgical margins did not impact on DFS between groups. In those with multifocal positive surgical margins, AAM had a worse DFS compared with WM (P = 0.03)., Conclusions: Race is an independent prognostic factor for DFS in patients with positive surgical margins. There were no differences in DFS between WM and AAM based on the margin location. In WM, prognostic factors for DFS in those with positive surgical margins were preoperative serum prostate-specific antigen, Gleason score, and pathologic stage. Conversely, in AAM none of these parameters were significant predictors of failure.

Objectives: To determine whether outcome differences between African-American men (AAM) and white men with prostate cancer (PCa) will still be present if we control for stage in a large cohort of men. It is well established that AAM have a worse outcome from PCa than white men., Methods: We examined 848 consecutive patients who underwent radical prostatectomy at Wayne State University, Karmanos Cancer Institute, between 1991 and 1995. The mean follow-up was 34 months (range 1.5 to 75). We included men with Gleason score 7 (4 + 3) with those men with Gleason score 8 to 10 for racial/ethnic comparisons., Results: AAM and white men diagnosed with organ-confined PCa demonstrated similar prostate-specific antigen (PSA) levels, Gleason grade, and biochemical recurrence. However, AAM diagnosed with non-organ-confined disease demonstrated higher PSA levels and a higher incidence of recurrence than did white men with non-organ-confined disease. There was a trend toward AAM having a greater proportion of high-grade lesions than white men when PCa was not organ confined. The evidence suggests that the difference in recurrence among AAM versus white men is based on pretreatment PSA, grade, extracapsular extension, and positive surgical margins. Seminal vesicle invasion predicted a worse prognosis equally for both AAM and white men., Conclusions: A difference in biochemical recurrence was not detected between AAM and white men with organ-confined PCa after radical prostatectomy. PSA was higher in AAM than in white men with pathologically locally advanced PCa, and the biochemical recurrence was greater. AAM had a greater percentage of high Gleason grade lesions compared with white men, and this difference approached statistical significance. We hypothesize that AAM have a more rapid growth rate of PCa, which may be responsible for these clinical findings. Further investigations of the biology of PCa are needed to understand these findings.

Objectives: One of the concerns regarding the widespread use of serum prostate-specific antigen (PSA) as a screening tool for prostate cancer is the possibility that it may detect latent or clinically insignificant cancers. One indicator of clinical importance is thought to be histologic grade, with clinically unimportant cancers more likely to be well differentiated and clinically important tumors more likely to be moderately or poorly differentiated., Methods: Data from the metropolitan Detroit population-based Surveillance, Epidemiology, and End Results Program were examined to determine trends in prostate cancer histologic grading before and after the introduction of PSA screening., Results: From 1989 through 1996, the most recent year for which data are available, a dramatic increase in the incidence of prostate cancer occurred in the Detroit area, corresponding to the routine use of PSA as a screening test for prostate cancer. Local stage cancer demonstrated the largest increase in incidence. The incidence of moderately differentiated cancers also rose substantially during the same period; the incidence of poorly differentiated tumors remained about the same, and the incidence of well differentiated tumors decreased. Coincident with the increasing proportion of moderately differentiated cancers was a significant increase in the proportion of prostate biopsies performed (P = 0.001)., Conclusions: These population-based data add important evidence that prostate cancers identified with PSA are more likely to be moderately than well differentiated. Additionally, if the definition of clinical significance depends on histopathologic grade, this finding could further be interpreted as evidence that PSA is more likely to detect clinically significant prostate cancer.

Objectives: To determine whether lymph node size is a surrogate marker for lymph node metastasis., Methods: We reviewed 980 patients who underwent radical retropubic prostatectomy with bilateral pelvic lymph node dissection for clinically localized prostate cancer, of whom 63 had lymph node metastases. A comparable group of patients with prostate cancer undergoing radical prostatectomy who did not have lymph node involvement was identified using the following parameters: serum prostate-specific antigen level, clinical and pathologic stage, and pre- and postoperative Gleason score. The axial and longitudinal dimensions of the nodes from patients with and without metastases were analyzed to assess the significance of lymph node size in predicting the presence of metastases. All patients had negative preoperative computed tomography (CT) and bone scans. Of the 63 patients with lymph node metastases, 48 had tissue available for measuring the dimensions of the lymph nodes., Results: A total of 76 metastatic and 92 negative lymph nodes were identified from the patients with and without metastatic nodes, respectively. The mean nodal longitudinal size was 1.65 cm (range 0.2 to 6.5) and 3.50 cm (range 0.5 to 9) for positive and negative nodes, respectively (P = 0.0001). The mean axial nodal size was 0.8 cm (range 0.2 to 3.2) and 1.0 cm (range 0.2 to 2.2) for positive and negative lymph nodes, respectively. In 56 metastatic nodes (74%), the axial size was less than 1 cm and in 20 (26%) less than 5 mm., Conclusions: Lymph node size should not be used as a surrogate for the presence of lymph node metastases. Although no patient had enlarged lymph nodes by CT scan criteria (greater than 1.5 cm), 6 (8%) of 48 and 19 (12%) of 48 patients with and without lymph node metastases, respectively, had nodes with an axial dimension greater than 1.5 cm.

Objectives: To evaluate pathologic characteristics and biochemical survival rate differences between patients with Gleason score 6 or less, 7, and 8 or more prostate cancer., Methods: A total of 652 patients who underwent a radical prostatectomy for clinically localized prostate cancer between March 1991 and December 1995 were selected for this study. Patients who underwent neoadjuvant or adjuvant hormonal therapy or radiotherapy were excluded. Clinical and pathologic data were obtained from our prostate cancer data base. Serum prostate-specific antigen (PSA) level, pathologic stage, and disease-free survival (DFS) were analyzed between the three Gleason score groups., Results: The overall mean pretreatment serum PSA level was 12.9 ng/mL, being 8.4, 13.4, and 23 ng/mL for Gleason score 6 or less, 7, and 8 or more prostate cancers, respectively (P = 0.0001). Of patients with specimen Gleason score 6 or less, 7, and 8 or more, pathologic organ-confined disease was present in 69.4%, 43.1 %, and 9.2%, respectively (P = 0.001). Extraprostatic extension was present in 30.6%, 56.9%, and 90.8% (P = 0.0001); positive surgical margins, considered independently from the other pathologic findings, were present in 31 %, 47.6%, and 67.8% of patients with Gleason score 6 or less, 7, and 8 or more, respectively (P = 0.0001). DFS was 34.5% for patients with Gleason score 8 or more, 75% for Gleason score 7, and 91.2% for Gleason score 6 or less prostate cancers, at a median follow-up of 34.2 months (P = 0.0001). On multivariable analysis, after adjusting for serum PSA level (10 or less or more than 10 ng/mL) and pathologic stage, Gleason score (6 or less, 7, 8 or more) remained a statistically significant predictor of DFS (P = 0.0001)., Conclusions: Patients with Gleason score 7 prostate cancer should be considered a specific prognostic category. We believe that this distinction is critical to obtain more reliable results from prostate cancer analyses about prognosis of patients treated with curative intent.

Objectives: To evaluate the correlation between race and lymph node metastasis for prostate cancer by analyzing which preoperative parameters may predict lymph node status in both races., Methods: We analyzed a group of patients (552 American white men [AWM] and 423 African-American men [AAM]) who underwent radical prostatectomy plus modified pelvic lymphadenectomy between January 1991 and June 1997. Patients who received neoadjuvant radiation or hormone therapy were excluded. Univariate and multivariate analyses were performed to determine the influence of race on lymph node positivity, as well as to correlate the preoperative parameters (serum prostate-specific antigen [PSA], biopsy Gleason score, and clinical stage) with lymph node metastasis for each race separately., Results: The AAM presented with significantly higher preoperative Gleason scores and PSA levels than AWM. However, comparing lymph node status by race, the difference of positivity (41 AWM [7.4% and 22 AAM [5.2%]) was not statistically significant (P = 0.16). The percentage of positive nodes was similar in both races for each subset of PSA, Gleason score, and clinical stage. Despite the statistical significance of the three preoperative parameters in univariate analysis, in multivariate analysis only PSA and Gleason score were independent predictors of positive lymph nodes., Conclusions: There is no influence of race on lymph node metastasis, despite AAM presenting with higher preoperative Gleason scores and PSA levels. In multivariate analysis, preoperative Gleason score and PSA were independent factors for positive nodes regardless of race.

Both the incidence of, and the mortality due to, prostate cancer in the USA are higher in African-American men than in Caucasian men. This is particularly true in men less than 60 years of age. Our findings indicate that both the prevalence and the extensiveness of high-grade prostatic intraepithelial neoplasia (PIN) are higher in African-American men compared to Caucasians and that this discrepancy starts as early as the third decade of life. In an autopsy series comprising 650 men, extensive high-grade PIN with diffuse involvement of the prostate gland was evident in 25 (7%) of 364 African-American men less than 50 years of age compared to 4 (2%) of 208 Caucasian men in the same age group (p = 0.002). In a series of more than 1,200 men undergoing radical prostatectomy for clinically localized prostate cancer, extensive high-grade PIN was significantly and consistently higher in the African-American cohort than the Caucasian cohort. The difference was more evident in younger patients and those with smaller, organ-confined tumors. In a subset of 216 men (71 African-Americans and 138 Caucasians) with clinical stage T1C prostate cancer, extensive high-grade PIN was identified in 33% and 12% of the two groups respectively (p = 0.001). Moreover, in patients with organ-confined disease, both Gleason score and the extensiveness of high-grade PIN were significant predictors of biochemical recurrence. Our findings suggest an important role for high-grade PIN in the development of clinically significant, potentially aggressive prostate cancer in African-American men. In this epidemiologically identifiable high-risk group, there is a potential opportunity for chemoprevention strategies in younger men with high-grade PIN.

Objectives: To determine preradiation and preoperative clinical staging and postoperative pathologic factors that can predict disease-free survival in patients undergoing salvage surgery for radio-recurrent prostate cancer., Methods: A retrospective review was performed on 40 patients who underwent salvage surgery for radio-recurrent prostate cancer. Preradiation and preoperative clinical staging factors, as well as pathologic stage were analyzed as predictors of disease-free survival. Biochemical failure was defined as a persistent serum prostate-specific antigen (PSA) elevation greater than 0.4 ng/mL., Results: As a group, salvage surgery provided excellent clinical disease control in 35 of 40 patients (87.5%). Overall, 18 of 38 (47.4%) patients analyzed had no evidence of biochemical progression. Preradiation clinical stage and pathologically organ-confined disease were statistically significant predictors of disease-free survival (P = 0.03 and P = 0.02, respectively). Seminal vesicle invasion and positive lymph nodes were the worst pathologic prognostic factors. Preoperative clinical T1c disease approached statistical significance in predicting pathologically organ-confined disease and disease-free survival (P = 0.08 and P = 0.07, respectively)., Conclusions: Ideal candidates for salvage surgery should have preradiation and preoperative clinically organ-confined disease. All patients with pathologically organ-confined disease following salvage prostatectomy were disease free at a mean follow-up of 36.1 months. Salvage surgery, although technically feasible, should not be widely advocated as an effective curative treatment in patients with locally advanced disease at the time of diagnosis.

Objectives: To evaluate risk factors for urethral involvement in female patients undergoing cystectomy for bladder cancer and to define potential candidates for orthotopic continent urinary diversion., Methods: From 1990 to 1996, 43 female patients underwent cystectomy for primary bladder malignancy. Bladder mapping studies were performed with special attention to tumor location, multifocality, pathologic stage and grade, presence of carcinoma in situ (CIS), and the relationship of these factors to urethral involvement., Results: Of the 43 patients evaluated, 7 (16.3%) had urethral involvement by tumor. Two patterns of urethral invasion were identified: 5 patients had tumors in the vascular or lymphatic channels of the periurethral tissue, and 2 had tumors in the mucosa or submucosa. Three of the 12 patients with tumors located at the trigone and 4 of the 26 with CIS of the bladder had tumor in the urethra. Three of the 5 patients with vaginal involvement had tumor in the urethra. Only vaginal involvement was significantly associated with urethral involvement (P = 0.02)., Conclusions: Vaginal involvement was the only preoperative factor that was associated with presence of tumor in the urethra. Five patients with urethral involvement had submucosal tumors without concomitant CIS of the urethra. Before the performance of orthotopic urinary diversions, intraoperative full-thickness bladder neck biopsies are needed to accurately evaluate the female urethra.

Objectives: Several investigators have reported that African-American men with clinically localized prostate cancer have poorer survival than do white men. In addition, prostate cancer in African-American men is commonly diagnosed at a more advanced stage of disease. Is race or ethnicity predictive of outcome of clinically localized prostate cancer? It has been reported that the presence of positive surgical margins significantly influences time to progression independently of other prognostic factors. Therefore, we have elected to conduct a multivariate analysis of clinical factors including race as potential predictors of positive surgical margin outcome., Methods: We studied 369 consecutive men (120 African-American and 249 white) who had radical prostatectomies at a single institution. Comparisons by race of Gleason score, stage, presence of positive surgical margins, and mean preoperative prostate-specific antigen (PSA) level were carried out., Results: Our data demonstrate that African-American men have more pathologically locally advanced prostate cancer than do white American men: 69% among blacks compared with 57% among whites. However, the difference in rate of positive surgical margins between blacks and whites is statistically significant: 58% among blacks versus 40% among whites (P = 0.002). Four factors were predictive of positive surgical margins: preoperative PSA level, race, clinical stage, and Gleason score., Conclusions: We have demonstrated that race is an independent predictor of positive surgical margins among patients with clinically localized prostate cancer and should be included in treatment decisions. In addition, the risk of positive surgical margins increases noticeably when PSA is greater than 10 ng/mL.

In spite of the slow progression rates common to most prostate cancers, it is well recognized that a subset of patients will experience a more aggressive course with many losing their lives to this malignancy. As the number of patients diagnosed with prostate cancer continues to increase, there is a growing pressure to refine and supplement the three most important prognostic parameters for this disease (tumor pathologic stage, its histologic differentiation (Gleason score) and the level of prostate specific antigen). While this review emphasizes the value of these factors in stratifying patients into risk groups, it also explores the prognostic significance of additional commonly used and evolving non-traditional markers (DNA ploidy, proliferation, tumor angiogenesis, and the status of tumor suppressor genes).

Objective: To asses the role of expression of resistance phenotypes in treatment failure in patients with invasive transitional cell carcinoma of the urinary bladder, since P-glycoprotein and glutathione S-transferase pi (GST) expression are implicated in resistance to various chemotherapy agents in different tumors., Methods: Tumor samples from P-glycoprotein and GST-pi were analyzed by immunohistochemistry., Results: P-glycoprotein and GST-pi were found in 35.7 and 42.9% of the samples, respectively. In 21.4% of the samples there was simultaneous expression of both proteins. No significant impact on prediction of tumor behavior was evident on statistical analysis by any one of the protein expressions., Conclusion: Drug resistance in transitional cell carcinoma may be through different mechanisms. Although the small sample size of this study precludes firm conclusions, the assessment of P-glycoprotein or GST-pi expression appears to be of little value as a predictor of response to chemotherapy in this group of tumors.

Aims: To study the prevalence, extent and evolution of high-grade prostatic intraepithelial neoplasia (HGPIN) in African-American and Caucasian men of a wide age range in order to help clarify the role this lesion may play in the racial differences of prostate cancer., Methods: The lesion was documented in step-sectioned, entirely submitted prostates of two study populations: 525 autopsied men who died of trauma and 1,000 patients who had retropubic radical prostatectomy for clinically localized carcinoma of the prostate., Results: We found that HGPIN starts in young individuals and increases progressively with advancing age in both races but is more prevalent in African-Americans. Additionally, the more extensive form of HGPIN with multifocal or diffuse involvement of the gland appears at a younger age in African-Americans., Conclusions: Microscopic foci of HGPIN can be documented in males in the 3rd and 4th decades with the lesion becoming more extensive in older men. The finding that HGPIN is both more prevalent and its more diffuse form appears earlier in African-Americans, indicates a potentially important role for this lesion in the race-related discrepancies associated with this disease.

Aims: The aim of this report is to review the literature concerning atypical adenomatous hyperplasia (AAH) with specific regard to evidence in support of or refuting its role as a precursor lesion for prostatic adenocarcinoma., Methods: The available literature was collected and critically reviewed. In addition, recently reported (abstract) but as yet unpublished data were included. Particular attention was focused on biological studies., Results: There is considerable morphologic evidence suggesting that AAH is associated with low-grade (Gleason patterns 1 and 2) adenocarcinoma arising in the transition zone. Only limited biologic studies have been performed. There is weak and limited data to indicate that AAH has a proliferation rate higher than hyperplasia but lower than adenocarcinoma. AAH is diploid, as are most examples of low-grade adenocarcinoma. A few markers (blood group antigens, peanut agglutinin) show similar patterns of expression in AAH and adenocarcinoma while others (carbohydrate D-galactose-N-acetyl-D-galactosamine) do not. Recent cytogenetic analyses have detected abnormalities of chromosome 8 in a very small proportion (4-6%) of cases of AAH studied., Conclusions: Presently, the only strong evidence linking AAH to adenocarcinoma is morphologic. The few biologic and molecular/cytogenetic studies performed have not provided convincing evidence to support or refute this possibility. Additional studies are required. Finally, in comparative studies of AAH with adenocarcinoma, the latter should include low-grade transition zone tumors.

Objectives: Prostate cancer is the most frequently diagnosed cancer and the second leading cause of cancer death in males in the United States. The mortality is due mainly to distant metastasis. Therefore, predicting the prognosis of prostate cancer patients is an important clinical problem. Previously, we demonstrated that a 12-lipoxygenase (12-LOX) metabolite of arachidonic acid, 12(S)-hydroxyeicosatetraenoic acid, enhances the invasiveness of prostate cancer cells and that a 12-LOX-selective inhibitor [N-benzyl-N-hydroxy-5-phenylpentanamide] reduces experimental metastasis in animal model systems. In this study, we investigated the potential of 12-LOX as a predictor for the aggressiveness of prostate cancer., Methods: The mRNA expression level of 12-LOX in 122 matching prostate normal and cancerous tissues were measured by quantitative reverse transcription- polymerase chain reaction. Possible association between 12-LOX expression and histologic grade, pathologic and clinical stage, margin positivity, age, and race was analyzed., Results: 12-LOX mRNA levels were elevated in cancer cells and the expression associated with poor differentiation and invasiveness of prostate cancer. Overall, 46 (38%) of 122 evaluable patients showed elevated levels of 12-LOX mRNA in prostate cancer tissues compared with the matching normal tissues. A statistically significantly greater number of cases were found to have an elevated level of 12-LOX among T3, high grade, and surgical margin-positive than T2, intermediate, and low grade, and surgical margin-negative prostatic adenocarcinomas., Conclusions: Our data suggest that elevation of 12-LOX mRNA expression occurs more frequently in advanced stage, high-grade prostate cancer and that 12-LOX may serve as an indicator for progression and prognosis of prostate cancer. This enzyme also may be a novel target for the development of anti-invasive and antimetastatic agents.

Benign testicular masses are recognized with increasing frequency and testis-sparing surgery, based on benign frozen section diagnosis, is practiced more often. However, there is a paucity of information in the medical literature regarding the accuracy of frozen section diagnoses of testicular tumors, and misdiagnoses could have dire consequences. We reviewed thirty frozen section examinations that were performed between 1962 and 1991, a period in which five hundred inguinal orchiectomies were performed. The entire testicle was available for histologic evaluation in 26 cases. Frozen sections correctly identified all of twenty-four malignant and two benign testicular masses. This study demonstrates that frozen section examinations can accurately diagnose testicular cancer.

Von Recklinghausen neurofibromatosis occurs in 1 in 3,000 live births; however, urologic manifestations are rare. There have been over 40 reported cases of neurofibroma of the bladder. Malignant degeneration of subcutaneous neurofibroma occurs in about 5 to 10 percent of patients. We believe we present the second reported case of a malignant peripheral nerve sheath tumor involving the bladder in a patient with this disorder.