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This study examined Alzheimer's disease (AD) knowledge and its predictors among Korean Americans (KAs).Convenience sampling was used to recruit KAs in the Greater Washington metropolitan area. A total of 268 KAs participated in the study and completed a cross-sectional survey in 2014. Using the Alzheimer's Disease Knowledge Scale (ADKS), overall and domain knowledge was assessed. Multiple regression analyses were conducted for overall and domain knowledge with predictors including exposure to AD, social engagement, sources and frequency of health-related information, stigmatic beliefs (pity, antipathy, and social distance), English proficiency, and education.KAs reported a 59% accuracy in the overall AD knowledge. At the domain level, KAs were most knowledgeable about assessment and diagnosis and least knowledgeable about caregiving. Our regression analyses showed that having a college degree or higher is associated with a greater overall AD knowledge. Three domain models of life impact, risk factors, and caregiving turned out to be significant: Having a college degree or higher is a predictor of greater knowledge in all three domains. Having more pity stigmatic beliefs is related to greater knowledge in both life impact and caregiving domains while having less pity stigmatic beliefs is associated with more risk factor knowledge; having less social distance stigmatic beliefs is associated with greater life impact knowledge; and having less antipathy stigmatic beliefs is related to better caregiving knowledge.Our findings revealed areas of misconceptions and knowledge gaps in KAs which need to be addressed in educational interventions. Different knowledge status across the domains demonstrates a multi-dimensional nature of AD knowledge. Multivariate findings confirmed the robust role of education in overall and domain AD knowledge. The effect of different AD stigmatic beliefs on certain AD knowledge domains suggests ways of how stigma change can be efficient for the purpose of increasing AD domain knowledge in KAs.

Background and objectives Advance care planning (ACP) is crucial for quality end-of-life care for patients with Alzheimer's disease. However, limited evidence is available about ACP among ethnic minorities, particularly in the context of Alzheimer's disease. The purpose of this study was to examine intention to discuss ACP for a family member with Alzheimer's disease among Korean Americans. Guided by the theory of planned behavior and prior research, we examined the relationships between acculturation, attitudes, subjective norms, perceived control, and intention to discuss ACP for a family member with Alzheimer's disease. Research design and methods Path analyses were conducted on a cross-sectional convenience sample of 261 Korean Americans. Age, gender, education, and knowledge about Alzheimer's disease and ACP were included as covariates. Results Our descriptive findings showed positive attitudes, strong subjective norms, and a high level of perceived control toward ACP discussion among the participants. The path analyses revealed that attitudes and subjective norms were positively related to intention for ACP discussion. Perceived control was not related to intention for ACP discussion. Among the covariates, greater knowledge about Alzheimer's disease was the only factor shown to be associated with the intention for ACP discussion. Discussion and implications To promote ACP among this population, educational interventions designed to address positives attitudes and subjective norms toward ACP are suggested.

summary Purpose: The purpose of this study was to investigate the anger expression types in nurses and to analyze the differences between the anger expression types and interpersonal problems. Methods: The data were collected from 149 nurses working in general hospitals with 300 beds or more in Seoul or Gyeonggi province, Korea. For anger expression type, the anger expression scale from the Korean State-Trait Anger Expression Inventory was used. For interpersonal problems, the short form of the Korean Inventory of Interpersonal Problems Circumplex Scales was used. Data were analyzed using descriptive statistics, cluster analysis, multivariate analysis of variance, and Duncan's multiple comparisons test. Results: Three anger expression types in nurses were found: low-anger expression, anger-in, and angerin/control type. From the results of multivariate analysis of variance, there were significant differences between anger expression types and interpersonal problems (Wilks lambda F ¼ 3.52, p < .001). Additionally, anger-in/control type was found to have the most difficulty with interpersonal problems by Duncan's post hoc test (p < .050). Conclusions: Based on this research, the development of an anger expression intervention program for nurses is recommended to establish the means of expressing the suppressed emotions, which would help the nurses experience less interpersonal problems.

Despite the rapid growth of the older ethnic minority population, knowledge about dementia care for this population is limited. This study examined the experience of dementia caregiving among Korean Americans. We conducted four focus groups with 23 family caregivers of older Korean Americans with dementia symptoms and identified eight themes: (a) struggling and overwhelmed; (b) keeping the cultural roles and responsibility; (c) doing it by themselves; (d) family as a source of stress; (e) limited knowledge and misconceptions; (f) learning as they go; (g) undiagnosed dementia and misunderstandings about medical care; and (h) barriers to use of services and need for culturally responsive services. The findings underscore that Korean Americans need dementia caregiver programs that are linguistically and culturally responsive.

The present study examined the knowledge of Alzheimer's disease and correlates of the disease knowledge among Vietnamese Americans. Cross-sectional survey interviews were conducted with 95 middle-aged and older Vietnamese Americans. Vietnamese Americans showed limited knowledge about Alzheimer's disease. Normalization of Alzheimer's disease in old age was prevalent. They lacked knowledge about treatment and cure of Alzheimer's disease. Those who reside longer in the U.S. and are more exposed to Alzheimer's disease are likely to have higher levels of Alzheimer's disease knowledge. Our study identified current Alzheimer's disease knowledge level and status, and areas of misconceptions and knowledge gaps among Vietnamese Americans, calling for urgent needs for educational outreach to improve knowledge about Alzheimer's disease among Vietnamese Americans. Information about who can be more or less knowledgeable about Alzheimer's disease can be used to strategize and tailor outreach efforts for different segments of the Vietnamese American population.

One of the critical issues in addressing financial abuse in Korea is the absence of an appropriate definition voiced by the elderly. This study is designed to explore how Korean elders define financial abuse in given social and cultural contexts. Face-to-face, in-depth interviews were conducted with 124 elders, aged 60 to 79, residing in Korea. The results of qualitative data analysis using grounded theory revealed that a vast majorty of Korean elderly respondents defined financial abuse as lack of provision of financial support to elder parents, and a small portion of respondents defined it as financial exploitation by adult children. The definition of financial abuse reflects cultural beliefs based on filial piety about financial expectations within the parent–child relationship. Education on financial abuse for both elders and their adult children and establishment of income support programs are urgently needed efforts to increase the financial well-being of elderly Koreans.

Purpose Early detection of Alzheimer's disease (AD) ensures that affected individuals and their caregivers can make appropriate plans for health care needs, yet many ethnic minorities delay seeking care for AD until the disease has progressed. This study examined attitudes toward care-seeking for AD among Korean Americans (KAs) and identified factors affecting their attitudes. Methods A cross-sectional survey was used to collect data from 234 KA adults. We conducted hierarchical regression analyses to examine the effects of sociocultural background (age, gender, education, cultural orientation), AD knowledge and exposure to AD, and beliefs about AD (stigma of pity, shame, and public avoidance) and AD care (subjective norm) on KAs' attitudes toward seeking AD care from primary care physicians (PCPs) and AD specialists. We also tested whether knowledge of AD moderated the impact of beliefs about AD and AD care on KAs' attitudes toward seeking AD care. Results For both PCPs and AD specialists, the subjective norm had the strongest effect on KAs' attitudes toward care seeking (β = 0.557 for PCPs, β = 0.360 for specialists). Effects of stigma beliefs disappeared in the presence of the subjective norm. AD knowledge moderated the impact of the subjective norm on the attitudes toward both PCPs (β = -1.653) and specialists (β = -1.742). Implications The significance of the subjective norm in KAs' attitudes toward AD care-seeking underscores the importance of public education, and our study suggests that increasing AD knowledge could facilitate a change in public attitudes toward seeking AD care.

This focus group study explored experience of Korean American personal care aides caring for older Korean Americans with dementia symptoms. Personal care aides described dementia caregiving as challenging, demanding and stressful, yet they cared for their clients with love and affection, particularly with jeong (i.e., a Korean cultural concept of love, affection, sympathy, and bondage). They learned about dementia mostly through their caregiving experience and expressed their need and strong desire to learn more about dementia. They felt for family struggle and observed family conflict and filial obligation. They advocated the value of personal care aides’ involvement in dementia care. This study revealed a pressing need for dementia training for personal care aides and called for an outreach effort to recruit and train direct care workers with potential of providing culturally competent care for traditionally underserved ethnic minorities.

Although individual susceptibility to burnout within a similar structural context is well-documented in other helping professions, little is known about the relationship between personal attributes and burnout in social work. Furthermore, despite a large number of entering MSW students with prior work experience, there is a paucity of research documenting the burnout phenomenon among them. By using a sample of MSW students with prior work experience (N=60), the current study examined the effect of personal attributes on burnout (i.e., overidentification tendency, trait anxiety, and emotional contagion). Findings imply that burnout depends on personal attributes, rooted in cognitive role-taking levels, and that emotional contagion has a significant role in burnout. Implications for social work education and practice are discussed.

This review begins by highlighting the fact that dementia is truly a global problem at this time, with incidence and prevalence rates rising rapidly in most parts of the world and only expected to increase. Along with this comes the growing demand for programs and services targeted to support both the person with dementia and his or her family caregivers. Around the globe such programs are being developed, evaluated, and put into practice, with government funding and needed infrastructures to support them. However, the many pressing needs of family caregivers for services to reduce their burden and improve quality of life for themselves and their relative far outstrip available programs—even in highly developed countries such as the United States, United Kingdom, and Australia. This is even more so the case in less developed countries and regions such as China, India, Africa, and South and Central America. We conducted an extensive search of existing databases and publications related to this topic, and i...

To understand the future demand for community services use in dementia care, this study examined attitudes toward community services use in potential dementia situations among 209 Korean Americans, using a self-administered questionnaire in Korean. Findings revealed that, contrary to expectations about filial/family responsibility in Asian culture, Korean Americans showed favorable attitudes toward using community services in dementia caregiving. Multivariate analysis showed that those who rate their health poorer, and have more social network and greater awareness of community services, are more likely to be favorable toward using community services. The study provides practitioners and providers with an understanding about intentions to utilize services in dementia care and suggests ways to prepare for future service demands in the Korean American community.

Filial obligation, described as culturally-defined rights and duties that prescribe how family members are expected to care for and provide support to each other, is an important variable that influences older immigrants' preferences for living and care arrangements. This exploratory study examined variables associated with expectations of filial obligation among middle-aged and older, Asian Indian, first generation immigrants and explored the relationship between variations in expectations of filial obligation and expressed preferences for future living arrangements. Data were collected through telephone surveys of 226 English-speaking immigrants in Atlanta, GA. Although no significant relationships were observed between filial obligation expectations and length of residence in the U.S., respondents indicated a variety of preferred future living arrangements. Contrary to current living arrangement patterns found among older immigrants, very few respondents preferred to move in with their children. The most popular preference was to "move closer to children," followed by "moving to a retirement community" with the majority preferring a retirement community geared to Asian Indians. Other preferences included "not moving" and "returning to India." Variations in expectations of filial obligation, length of residence in the U.S., and self-rated health were significantly associated with these preferences. Implications are discussed for building capacity within ethnic communities to address living arrangement preferences and their repercussions for caregiving in ethnic families and in communities.

To better understand conceptualizations of dementia, this study explored causal attributions of dementia among 209 Korean Americans, using a self-administered questionnaire in Korean. Findings show that Korean Americans endorsed various causal attributions. Factor analysis yielded 3 dimensions of their attributions including psychological, physical/environmental, and cognitive/social. Bivariate analyses showed that younger age and higher education were related to more physical/environmental attributions, and younger age was related to more cognitive/social attributions. The study provides an understanding of causal attributions of dementia that practitioners need to understand to provide culturally competent practice and highlights a need to customize public education messages by specific ethnic groups.

Traditional and nontraditional export agriculture expansion dramatically changed the social and economic landscapes in the global south. An examination of one aspect of south-south international migration, Nicaraguan migrant economic integration into Costa Rica's export agriculture sector, reveals how production systems in the traditional and nontraditional agricultural sectors shape migrant social networks in distinct ways in the global south and its significance for both migrant workers and the agricultural sectors they work in. The rapid expansion of nontraditional export agriculture - the essence of agricultural development in Costa Rica - depends on the traditional crop production structure of coffee farms. The experiences of Nicaraguan migrant workers and their social ties to each other in nontraditional export agriculture and the coffee farms in Costa Rica demonstrate how different production structures call for distinct fragile and conflicted social networks ties between migrants. The economic integration of migrant workers relies on opportunistic and weak ties that are both gendered and contradictory.

Nontraditional agricultural exports (NTAE) expansion and liberalized agricultural policies have changed the shape and structure of rural economies in the global South. This study focuses on how the change related to NTAE production determines where and how migrant women work in the agricultural industry. While a number of studies demonstrate an increase in labor demand and women’s participation in nontraditional agricultural export production and postharvest processing, there is a dearth of literature examining the relationship between international migration and export agriculture. This study uses the case of Nicaraguan migrant women working in pineapple and cassava postharvesting industries in north central Costa Rica to examine the relationship between international migration and NTAE production—more specifically, how legal status and gender shape work options and work structure for women. In‐depth interviews, surveys, and participant observation inform the study. Findings show that internatio...

Despite a growing interest in end-of-life care, there is a dearth of research about advance care planning (ACP) among ethnic minorities. The purpose of this study was to examine intention of ACP among Korean Americans. Two specific objectives were: 1) to identify factors affecting intention of ACP and 2) test the Theory of Reasoned Action (TRA) in explaining intention of ACP. The TRA explains that subjective norms, attitudes toward behavior, and perceived behavioral control predict intentions and behaviors. Specifically, using a culturally expanded TRA model, direct effects of acculturation on attitudes, norms and perceived control; and direct effects of attitudes, norms, and perceived control on intention of ACP were hypothesized. Data was drawn from a cross-sectional survey with 226 Korean Americans. Multivariate regression analysis revealed that greater knowledge about Alzheimer’s and more positive attitudes and stronger subjective norms were associated with greater intention of ACP. The initial path model of a culturally expanded TRA model yielded a poor model fit. However, a revised path model produced an excellent model fit. In the revised model, direct effects of perceived control on attitudes and norms, and direct effects of attitudes and norms on intention were found. Perceived control had only an indirect effect on intention through attitudes and norms. Reluctance to seek medical assistance often found in Korean Americans may explain the direct effect of perceived control on attitudes and norms regarding ACP. The finding of the revised model suggests the importance of culturally sensitive approach to promote ACP among this population.

The purpose of the study is (1) to compare the effects of factors on self-rated health (SRH) among older non-Hispanic Whites (NHW), Hispanic, and Asian Californians and (2) to provide estimated influence size of each factor on SRH. This study analyzed secondary data drawn from the 2005 California Health Interview Survey. Binary logit regressions were used to analyze data with the Jackknife replication sampling weights. Significant differences were found in SRH among the three groups. Hispanics and Asians reported poorer health than NHW. Socioeconomic status, acculturation, and health access significantly accounted for an association between ethnicity and SRH. However, the magnitudes of their effects on SRH varied across the groups and by the factors examined. This study discusses and concludes with some recommendations on the opportunities presented by the Affordable Care Act and Healthy People 2020.

What's known on the subject? and what does the study add?: As most urologist known, obesity significantly lowers serum PSA levels. So there is some concern about delayed diagnosis of prostate cancer in obese men. In the present study, we found that the accuracy level of PSA for detecting prostate cancer was not significantly different between different obesity levels. A well-designed study adjusting for several factors, e.g. diet, exercise, medication and comorbidity, which may possibly compensate for the associated effects on PSA levels, is needed for confirmation of the present findings.To investigate prostate-specific antigen (PSA) accuracy in detecting prostate cancer according to body mass index (BMI) in Asian men with a PSA level of30 ng/mL using contemporary multicore (≥ 12) prostate biopsy.We reviewed the records of 3471 patients, whose initial PSA levels were30 ng/mL, who underwent multicore (≥ 12) transrectal ultrasound-guided prostate biopsy between January 2004 and May 2011. BMI was categorised as performed previously for the Asian population:23, 23-24.9, 25-29.9, and ≥ 30 kg/m(2) . PSA accuracy for detecting prostate cancer in each BMI group was assessed based on the receiver operating characteristics-derived area under the curve.The mean age and median PSA level were inversely associated with BMI; the median PSA level in each BMI category was 7.84, 7.75, 7.33 and 5.79 ng/mL, respectively (P0.001). In all, prostate cancer was detected from biopsy in 1102 (31.7%) patients. The PSA accuracy for predicting prostate cancer in all patients was estimated to be 0.607, and PSA accuracies in each BMI category were 0.638, 0.572, 0.613 and 0.544, respectively; there was no significant difference among the groups in terms of PSA accuracy.The accuracy of PSA in predicting prostate cancer did not change regardless of BMI category in Asian men. However, as patients with higher BMIs had lower PSA levels than those with lower BMIs, it can therefore be suggested that the PSA threshold should be lower in obese men to discriminate between prostate cancer and benign conditions in the real clinical situation.

The purpose of this study is to explore the cultural definitions of financial abuse from the perspective of 124 elderly Korean immigrants and to examine the role of traditional cultural values in their definitions by using a mixed methods approach. The qualitative analysis generated four themes relevant to definition of financial abuse. A binary logistic regression indicated that those with stronger cultural adherence to traditional values had higher odds of providing culture-based definitions of financial abuse. Education is needed for health professionals, social service providers, and adult protective workers to increase their understanding of culture-specific experiences of financial abuse among ethnic minority elders.

This cross-sectional survey study of 146 caregivers of older Korean Americans explored access barriers to and unmet needs for home- and community-based services (HCBS) programs (respite care, adult day care, personal care, home health, housekeeping, and transportation). Most often reported access barriers were lack of awareness and care recipient refusal. Predictors of unmet needs varied depending on the type of service, but included caregiver gender, relationship, education, caregiving duration, Medicaid coverage, English proficiency, caregiver self-efficacy, care recipient functional dependency, cognitive impairment, and caregiving hours. This study highlighted unmet needs for HCBS in Korean American communities, pointing to the pressing need for a collaborative effort to develop plans that modify and expand HCBS programs for older Korean Americans.

Although several studies have reported on the biological effects of ultraviolet (UV) radiation, there have been only a few reports on the changes in epidermal lipids following long-term UV irradiation at suberythemal dose (SED), to which people are usually exposed during their lifetime.To investigate the changes of epidermal lipid properties after long-term UV radiation with SED.Hairless mice were irradiated three times weekly for 15 weeks at an SED of UV (UVB: 20 mJ/cm(2) ; UVA: 14 J/cm(2) ). Every three weeks, transepidermal water loss (TEWL) was measured by a Tewameter. The morphological alterations of stratum corneum (SC) lipid lamellae were examined by electron microscopy (EM). Activities of three key enzymes for mRNA of serine palmitoyl transferase, fatty acid synthase, and HMG CoA reductase were analyzed with real time reverse transcriptase-polymerase chain reaction. We also measured the amount of ceramide, cholesterol sulfate, and free fatty acid in the SC by high-performance thin-layer chromatography with exposed times.The SED UV-irradiated group showed increased TEWL after 12 weeks. Following the irradiation period, EM revealed incomplete and separated lamellae at SC intercellular space. mRNA of three key enzymes was increased until six weeks of UV irradiation and decreased thereafter. However, three major lipid amounts gradually decreased throughout the exposed period, with a notable decrease in ceramide.Long-term UV irradiation even with SED influences skin barrier function and structure with prominent ceramide decrease in SC intercellular lipid.

The literature on the motivations and the impacts of remittances sent by international migrants to their families and communities strongly focus on their economic impacts and the flows of money from the global North to the South. The driving factors for remittance sending, closely embedded in motivations for migration, often overlook the conditions in which remittances are not sent, where households do not prosper, and community development does not happen. This ethnographic study uses the case of Nicaraguan migration to Costa Rica to examine the lives of the families of migrants in the context of rural to rural and South to South migration. The paper examines the intentions and realities of South-South migration through the lens of migrants and their families, and illuminates the other side of migration often invisible in the migrant's home communities and the migration and development literature. The paper also shows the disparity in physical, economic, and emotional distance as it illustrates the unique structural challenges of South-South and especially rural to rural migrants. These structural barriers that create an unbridgeable distance between migrants and their families embody the chasm between the intentions and the realities of migration for individuals on both sides of the border. DOI: 10.5377/encuentro.v42i87.245 Encuentro 2010/ Ano XLII, N° 87, 6-25

To investigate the efficacy of simplified (two- or three-tiered) Fuhrman grading systems as prognostic indicators in clear-cell renal cell carcinoma (RCC).By reviewing records, various clinicopathological factors were assessed in 431 patients who received surgical management for clear-cell RCC. A conventional four-tiered Fuhrman grading system was compared with a modified two-tiered grading system (Fuhrman grades I and II were combined as one class, and grades III and IV as another) and also with a three-tiered grading system (only grades I and II were combined). Efficacies of grading systems were assessed via univariate analyses and multivariate models for prediction of cancer-specific survival.In univariate analysis, the four-tiered and three-tiered grading systems showed similar accuracies (76.5 vs 76.2%, P =0.614) for predicting cancer-specific survival, which were greater than that of the two-tiered system (72.5%; both P0.05). Of the three grading systems, only the three-tiered system was an independent predictor of cancer-specific survival in multivariate analysis (P = 0.046). When receiver operating characteristic-derived areas under the curve (AUCs) of multivariate models for predicting cancer-specific survivals were assessed, AUCs for models including the three-tiered Fuhrman grading system and the conventional four-tiered Fuhrman grading system were the same (95.3%), followed by that of a model incorporating the two-tiered grading system (95.1%).A modified, three-tiered Fuhrman grading system can be considered an appropriate option in the application of a nuclear grading system to the prognostication of clear-cell RCC in both univariate analysis and multivariate model setting.

To investigate the rate of pathologically confirmed unfavourable prostate cancers among Korean men who fulfilled the contemporary Epstein criteria for clinically insignificant prostate cancer.This was a retrospective study of 131 Korean men who underwent radical prostatectomy (RP) for clinically insignificant prostate cancer as defined by contemporary Epstein criteria. We assessed the percentage of unfavourable prostate cancer (pathological Gleason sumor = 7 and/or extraprostatic extension [EPE]) among these men and tried to identify useful predictors for such unfavourable tumour profiles using uni- and multivariate analyses.Among 131 men with clinically insignificant prostate cancer, 40 (30.5%) had pathological Gleasonor = 7 tumours after RP. Of these 40 men, four (3.1%) also had EPE on examination of RP specimen. All those who did not have Gleason score upgrading after RP had organ-confined disease from examination of RP specimen. Overall, 40 (30.5%) of the 131 men who fulfilled the contemporary Epstein criteria for clinically insignificant prostate cancer before RP had pathologically unfavourable disease. Among our patients, no significant preoperative predictor of pathologically unfavourable disease was identified using uni- and multivariate analyses.Our results showed that a significant proportion of contemporary Korean patients who meet all the conditions of the contemporary Epstein criteria for prediction of clinically insignificant prostate cancer might actually harbour prostate cancer with unfavourable pathological features. Such findings should be considered when treatment options are contemplated based upon the Epstein criteria among Asian patients.

Objective The present study examined knowledge of Alzheimer's disease (AD) and factors related to the disease knowledge among Korean American immigrants. Methods Two-hundred and nine middle-aged and older Korean American immigrants completed a self-administered questionnaire. Results Korean American immigrants had strong stigma about AD and interpreted the disease as a form of insanity. They considered memory loss and AD as a part of the aging process. They seriously lacked knowledge about the treatment, diagnosis and cause of AD. Those who were less acculturated and less exposed to AD were likely to have poorer AD knowledge. Conclusions There is a need to expand AD education efforts among Korean American immigrants because the views of stigmatization and normalization of AD combined with certain Asian cultural norms can be barriers to early recognition and intervention. Our study suggests knowledge areas of concentration in AD education and a segment of the population that AD education should target. Further research on symptom knowledge by the disease stages and causal beliefs is needed to better understand the existing views about AD in Korean American immigrants. Copyright © 2009 John Wiley & Sons, Ltd.

Despite a growing need for geriatric social workers, there is a question as to whether MSW graduates who are gerontologically prepared actually enter the workforce to serve older adults. By tracking MSW graduates who had special training in aging, this study aims to explore their job search and career experience. Findings show that most graduates located aging-related jobs 4 months postgraduation and remained committed to the field 1 to 2 years later. The majority were working in direct service provision in clinical settings. Their salaries compare favorably with those of generic social workers. Implications for geriatric social work education are discussed.

Flow cytometry was used to analyze deparaffinized primary renal cell carcinoma specimens from 106 patients to evaluate deoxyribonucleic acid ploidy as a predictor of disease progression and survival. Of these specimens 62 (58%) demonstrated aneuploid stem lines: 30 (48%) of these were tetraploid aneuploid while 32 were nontetraploid aneuploid. Two or more specimens were analyzed from a single primary tumor in 17 patients and heterogeneity of ploidy status was observed in 5 (30%). Specimens of the primary tumor, and regional and/or distant metastases from 11 patients were analyzed; 5 (45%) demonstrated discordance between the ploidy of the primary and the metastatic site. A significant correlation was noted between the presence of aneuploid stem lines and high stage disease (p equals 0.004) but there was no significant correlation between ploidy status and tumor grade. Although there was a significant difference (p equals 0.037) in the incidence of disease progression in patients with diploid tumors (13%) versus those with aneuploid tumors (35%) in the total population, and Kaplan-Meier disease-specific survival curves demonstrated a survival advantage for patients with diploid tumors in the total population, no clear survival advantage was demonstrated for evaluable patients with diploid tumors when controlled for tumor, nodes and metastases stage. In conclusion, the heterogeneity of ploidy status in primary renal cell carcinoma, the high incidence of disease progression in patients with diploid primary tumors and the lack of a clearly demonstrable stage-independent impact of ploidy on prognosis currently would not support widespread clinical application of ploidy status of the primary tumor in the management of individual patients with renal cell carcinoma.

Pathological data from 321 patients who underwent radical prostatectomy or cystoprostatectomy with a diagnosis of prostatic adenocarcinoma were reviewed. Of these specimens 4 (1.2 per cent) demonstrated histopathological findings consistent with prostatic comedocarcinoma. Prostatic acid phosphatase and prostate specific antigen detected by immunoperoxidase technique confirmed the prostatic origin of all comedocarcinomas studied. Flow cytometric analysis of deparaffinized sections from these specimens as well as a total of 40 representative specimens from normal prostate, and low, intermediate and high grade prostatic carcinomas was performed. Frequency of aneuploidy in low, intermediate and high grade prostatic adenocarcinoma was 0, 43 and 75 per cent, respectively. All cases of prostatic comedocarcinoma studied had distinctly aneuploid deoxyribonucleic acid histograms and the mean deoxyribonucleic acid content in comedocarcinoma was the highest of all groups analyzed. The mean time to recurrence in patients with comedocarcinoma was 13 months. Our flow cytometric data suggest that prostatic comedocarcinoma represents a potentially aggressive tumor demonstrating cytogenetic aberration shown to be associated with poor clinical outcome in prostatic adenocarcinoma.

Flow cytometry was used to evaluate 88 deparaffinized radical prostatectomy specimens to compare deoxyribonucleic acid ploidy in prostatic adenocarcinoma as a predictor of disease progression with other well documented predictors of clinical recurrence. Aneuploidy, Gleason grade and seminal vesicle involvement were nonindependent variables, and all correlated to statistical significance with disease recurrence. The incidence of aneuploidy in the total population was 51 of 88 (58 per cent). Aneuploidy was found in 25 of 28 primary tumors (89 per cent) from patients who subsequently had recurrent disease. Aneuploidy was noted in 40 of 59 specimens (68 per cent) exhibiting seminal vesicle involvement, compared to 11 of 29 (38 per cent) without seminal vesicle involvement (p less than 0.01). The probability of an interval free of disease of 60 months was calculated by Kaplan-Meier analysis to be 85 per cent in diploid specimens compared to 9 per cent in aneuploid specimens (p less than 0.001), and 87 per cent in the absence of seminal vesicle involvement compared to 28 per cent in the presence of seminal vesicle involvement (p less than 0.003). The probability of remaining free of disease in patients exhibiting concomitant diploidy and seminal vesicle involvement (17) was 73 per cent compared to 8 per cent in those with aneuploid specimens and seminal vesicle involvement (p less than 0.004). The incidence of recurrence in patients with Gleason sums of 7 or less was 22 per cent compared to 62 per cent in patients with Gleason sums of greater than 7. There was a 29 per cent incidence of recurrence in intermediate grade tumors (Gleason sum 5 to 7) but only 5 per cent of the patients with intermediate grade diploid tumors had recurrent disease. In conclusion, the recognition of a deoxyribonucleic acid aneuploid stem line in a primary prostatic adenocarcinoma is correlated statistically with a greater likelihood of seminal vesicle invasion and subsequent development of recurrent disease. The markedly increased probability of remaining free of disease in diploid patients, even in the presence of seminal vesicle involvement, suggests that routine flow cytometric analysis in prostatic adenocarcinoma would significantly enhance prognostic stratification.