Biomedical subjects

H Borchers

Publications and source records attributed to H Borchers.

At least 19 recordsLinked to original sources

PubMed2003

[Potency-sparing radical perineal prostatectomy].

We evaluated the results of a unilateral nerve-sparing radical perineal prostatectomy in a prospective study. Thirty patients with histologically confirmed unilateral prostate cancer and adequate erectile function preoperatively underwent a nerve-sparing procedure. The criteria were a PSA of <10 ng/ml, prostate volume of <60 ml, and a Gleason score <7. In 29 patients the procedure was technically feasible. In one patient significant damage to the neurovascular bundle was seen at the end of the procedure. Bilateral tumors were present in 18 patients on final pathology. Positive surgical margins were observed in five patients (pT2: 2/20; pT3: 3/10). After a follow-up of 3-12 months, 15 of 29 patients (51%) reported some erectile function without additional medication. Of 14 patients, 2 had enough rigidity for penetration within 3 months.The short-term results after unilateral nerve-sparing perineal prostatectomy are encouraging. Since the neurovascular bundle can be exposed very well, interposition of sural nerve should be considered.

Adenocarcinoma↗

PubMed2001

Multi-slice CT urography after diuretic injection: initial results.

PURPOSE: To investigate the feasibility of CT urography (CTU) using a multi-slice (MS) scanner and to find out whether a low-dose diuretic injection is advantageous for the opacification of the urinary tract. METHODS: MS-CTU was performed in 21 patients with urologic diseases. In 5/21 patients, 250 ml of physiologic saline Solution were injected. In 16/21 patients, 10 mg of furosemide were injected 3-5 min before contrast material administration. A 4 x 2.5 mm collimation with a pitch of 1.25 and a tube current of 100-150 mA were used. Scan time was 12-16 sec. 3 mm thin axial images with an overlap of 67% were reconstructed. Multiplanar maximum intensity projection (MIP) images were postprocessed to obtain urographic views. Bone structures were eliminated using the volume-of-interest method. RESULTS: Furosemide-enhanced MS-CTU achieved either near complete or complete opacification in 30/32 (94%) ureters and in 32/32 (100%) pelvicaliceal systems up to a serum creatinine of 150 mumol/l. In our series, only one CTU scan per patient was needed to obtain a diagnostic urogram after 10 min of contrast material injection. Ureteral compression was not necessary. When physiologic saline solution was used instead of furosemide, the radiopacity inside the enhanced pelvicalices was 4-5 times higher and more inhomogeneous. Diuretic-enhanced MS-CTU was more accurate in the depiction of pelvicaliceal details. In combination with furosemide, calculi were well identified inside the opacified urine and were safely differentiated from phleboliths. Postprocessing times of up to 20 minutes were problematic as were contrast-enhanced superimposing bowel loops on MIP images. CONCLUSION: Preliminary results demonstrate a good feasibility of furosemide-enhanced MS-CTU for obtaining detailed visualization of the entire upper urinary tract.

Adult↗

PubMed2001

Perioperative morbidity of the extended radical perineal prostatectomy.

PURPOSE: Perioperative morbidity is an essential indicator for the quality of an operative technique. This fact is especially important in radical prostatectomy since different treatment modalities may provide similar outcome in terms of local tumor control. MATERIALS AND METHODS: The conventional type of radical perineal prostatectomy is associated with a significant percentage of positive surgical margins and was therefore substituted by a modified extended radical perineal prostatectomy at our institution. This procedure which includes partial resection of the dorsal vein complex and extrafascial resection of the seminal vesicals was performed in 200 patients with clinical T1 to T3 prostate cancer. The medical records were retrospectively reviewed for perioperative morbidity. RESULTS: There was no perioperative mortality and only 7% of the patients experienced postoperative complications. Blood substitution was indicated in 14% of the patients and could be reduced to 4% in the last 50 patients. The reintervention rate was 2.5% including 3 patients in whom a rectocutaneous fistula had to be repaired. The suction drainage was removed in 92% patients within 5 days. The indwelling catheter stayed in place for less than 14 days in 89% of all patients and was removed as early as after 2-7 days in 92% of the last 50 patients. Anastomotic strictures were observed in 8 (5%) of 160 patients followed for more than 6 months. 87.4% of patients were considered continent after at least 6 months follow-up. However, pad use was reported in 33.6%. CONCLUSION: The extended type of radical perineal prostatectomy provides excellent results in terms of perioperative morbidity, although a significant learning curve can be noted, which is indicated by blood substitution and duration of necessary catheter drainage. Since the rate of positive surgical margins in pT3 tumors is low (21%) and iatrogenic positive margins in pT2 tumors are avoided, this type of prostatectomy should be performed in case a potency sparing procedure is not indicated.

Aged↗

PubMed2001

Radical prostatectomy in patients with previous groin hernia repair using synthetic nonabsorbable mesh.

OBJECTIVE: Identification of patients in whom the perineal route is the optimal approach to perform radical prostatectomy. MATERIAL AND METHODS: During 1992-1999, 376 patients with prostate cancer underwent radical perineal prostatectomy. Four patients were identified in whom the perineal approach was indicated because of previous bilateral groin hernia repair using synthetic meshes. In addition, 1 patient underwent perineal prostatectomy elsewhere for similar reasons. RESULTS: The perineal approach offered an uneventful surgical solution for an adequate and straightforward radical perineal prostatectomy without complications and without biochemical recurrence during the follow-up. CONCLUSION: Radical perineal prostatectomy is suggested to be the optimal approach in patients with previous bilateral groin hernia repair using synthetic, nonabsorbable meshes.

Hernia, Inguinal↗

PubMed2000

[Expanded, radical perineal prostatectomy].

One hundred and twenty-five consecutive patients with prostate cancer underwent an extended, radical perineal prostatectomy according to the technique described by VE Weldon. This technique was modified by an initial complete mobilization of the posterior aspect of the prostate and seminal vesicles from the rectum and pelvic wall, incision of the endopelvic fascia, and partial resection of the dorsal vein complex after suture ligature. The perioperative morbidity was low. An operative revision was necessary in four (3.2%) patients because of arterial bleeding from a drainage channel (n = 1), wound infection (n = 2), and rectocutaneous fistula (n = 1). The in-dwelling catheter was removed on day 4-8 in 104 (83%) patients. Positive surgical margins were diagnosed in 22 (17.6%) patients only. These patients had pT3 (n = 17) and pT4 (n = 5) tumors with a Gleason score > or = 7 (n = 17) mostly; extensive, multifocal capsular penetration (n = 18); seminal vesicle invasion (n = 11); and lymph node metastases (n = 4). The unifocal positive margins were localized at the apex (n = 3), dorsolateral (n = 6) aspect, and bladder neck (n = 4). In nine patients, multifocal positive surgical margins were noted. The risk for a positive surgical margin depends on the serum PSA level, Gleason score, and tumor volume. In case potency preservation is not considered, the extended, radical perineal prostatectomy with the above mentioned modifications should be considered to guarantee a low rate of surgical margins.

Aged↗

PubMed2000

[Reverse transcriptase polymerase chain reaction and immunocytochemistry of bone marrow aspiration specimen and peripheral blood for detection of microdisseminated prostatic carcinoma. A comparative analysis].

Reverse transcriptase-polymerase chain reaction (RT-PCR) assay for prostate-specific antigen and immunocytochemistry for cytokeratin-18 (CK-18) are tests for the detection of microdisseminated carcinoma of the prostate. Bone marrow aspirates and peripheral venous blood from 50 patients with clinically organ-confined prostate cancer were examined. The rate of positive results was independent of the pT stage, serum PSA, and previous antiandrogen treatment. RT-PCR and immunocytochemistry have to be tested under standardized conditions in prospective trials, and the results have to be compared to the serum PSA follow-up.

Aged↗

PubMed1999

Does positron emission tomography using 18-fluoro-2-deoxyglucose improve clinical staging of testicular cancer?--Results of a study in 50 patients.

OBJECTIVES: To compare positron emission tomography (PET) using 18-fluoro-2-deoxyglucose (FDG) with conventional clinical staging in unselected patients with germ cell cancer. METHODS: Fifty patients underwent PET scans of the abdomen (n = 50) and chest (n = 41 ) after the initial diagnosis. PET images were evaluated qualitatively and quantitatively using standardized uptake values (SUVs). The results were compared with computed tomography (CT) results and tumor markers (human chorionic gonadotropin, alpha-fetoprotein, and lactate dehydrogenase). Retroperitoneal lymphadenectomy in 12 patients and clinical staging, including follow-up data in all patients, were taken as a reference standard. RESULTS: PET detected metastases in 13 (87%) of 15 patients and excluded metastases in 33 (94%) of 35 patients. A sensitivity of 73% and a specificity of 94% were obtained using CT. The respective values for tumor marker determination were 67% and 100%. Retroperitoneal metastases were detected in 2 patients by PET only and in 1 patient by CT only. In the latter patient, surgery of a residual mass after chemotherapy revealed a well-differentiated teratoma. False-negative findings with PET and CT occurred in 2 patients with retroperitoneal metastases approximately 10 mm in size. False-positive findings were due to sarcoidosis or to muscular activity of the neck. Quantitative FDG uptake was very heterogeneous, with an SUV ranging from 1.8 to 17.3. CONCLUSIONS: FDG PET has the potential to improve clinical staging of testicular cancer. However, PET, as well as CT, is limited in the detection of small retroperitoneal lymph node metastases.

Adult↗

PubMed1999

Detection of prostate-specific antigen immunoreactivity in amniotic fluid.

OBJECTIVE: To examine whether prostate-specific antigen (PSA) is present in amniotic fluid, whether the amniotic fluid PSA concentration changes with gestational age, and whether there is an association between amniotic fluid PSA and fetal sex. METHODS: The PSA concentration was measured in the amniotic fluid of 48 pregnant women. Thirty-four samples were obtained during routine amniotic fluid analyses performed during gestational weeks 16-18, whereas 14 samples were obtained during cesarean section performed after gestational week 36. RESULTS: PSA was detected in all amniotic fluid samples. The median amniotic fluid PSA was 0.193 ng/ml during gestational weeks 16-18 and 0.39 ng/ml after gestational week 36 (p = 0.1). Furthermore, no significant association was seen between amniotic fluid PSA and fetal sex. The median amniotic fluid PSA level was 0.233 ng/ml for the 21 boys and 0.222 ng/ml for the 27 girls investigated (p = 0.72). CONCLUSIONS: These results confirm recent literature reports that PSA may serve as a growth regulator during normal fetal development. However, further studies are necessary to elucidate the exact role of PSA during fetal development.

Amniotic Fluid↗

PubMed1998

Very frequent p53 mutations in metastatic prostate carcinoma and in matched primary tumors.

BACKGROUND: The frequency of mutant p53 in bone marrow metastases of patients with carcinoma of the prostate (CaP) and in matched sets of metastatic and primary lesions from the same patients was investigated. The data were examined in relation to prior treatment with androgen ablation (AA) therapy and were compared with the frequency of mutant p53 reported for primary CaP. METHODS: Seventeen patients with M1b (bone metastasis: TNM Stage IV) CaP had either unilateral or bilateral bone marrow biopsies taken for these studies. Specimens were divided and the outer one-third examined histologically to confirm the presence of CaP cells. Immunohistochemical (IHC) staining for accumulated p53 protein was performed by an antibody cocktail technique. RNA was extracted from the remaining portion of the biopsy, and p53 transcripts were amplified by reverse transcriptase-polymerase chain reaction (RT-PCR) and screened for base sequence changes in the exon 4-11 region using nonisotopic single-strand conformation polymorphism (SSCP) analysis and direct DNA sequencing. RESULTS: Ten of 17 metastases (59%) demonstrated accumulation of p53. Six of 7 (86%) of the p53 IHC positive bone marrow samples contained RT-PCR-SSCP abnormalities, as did 2 of 3 IHC negative samples. Overall, 12 of 17 metastases (71%) contained mutant p53. Four of 7 biopsies (57%) retrieved prior to AA contained mutant p53, whereas 8 of 10 post-AA biopsies (80%) contained mutant p53. One patient showed identical SSCP abnormalities in right and left iliac crest metastases after therapy, and in this patient DNA sequencing demonstrated a missense mutation at codon 126 (TAC --> GGC, Tyr --> Gly). Archival primary cancers from seven patients were retrieved. All seven were IHC positive for p53 accumulation. CONCLUSIONS: p53 mutations are associated with increased metastatic potential of CaP. Abnormalities are found at approximately twice the frequency in metastases than in unselected samples of primary CaP, whereas in matched specimens there is a high rate of consonance. Mutant p53 may contribute to systemic therapy resistance, due to increased association with post-AA CaP specimens.

Bone Marrow↗

PubMed1998

Is prostate-specific antigen a reliable marker of bone metastasis in patients with newly diagnosed cancer of the prostate?

OBJECTIVE: Staging in patients with newly diagnosed cancer of the prostate has significant ramifications in the management of the disease. At present, measurement of serum prostate-specific antigen (PSA) concentration and radionuclide bone scintigraphy are two important procedures in the metastatic work-up of these patients. We evaluated the efficacy of PSA as a staging marker to discriminate prostate cancer patients with and without bone metastases. METHODS: In a retrospective study, 359 prostate cancer patients with (n = 40) and without (n = 319) bone metastases were analyzed. In all patients the initial PSA measurement as well as the radionuclide bone scan were evaluated. RESULTS: Patients without bone metastases demonstrated a median serum PSA concentration of 12 ng/ml, whereas those with bone metastases revealed a median serum PSA concentration of 59 ng/ml, with 7 patients demonstrating a serum PSA concentration of < 10 ng/ml. This resulted in a negative predictive value of 96%. In addition, only 40% of these patients with bone metastases demonstrated a serum PSA concentration of > 100 ng/ml, which resulted in a positive predictive value of 50%. CONCLUSION: The serum PSA concentration seems only to provide limited information with regard to the presence of bone metastasis in patients with newly diagnosed cancer of the prostate. We therefore question whether a staging radionuclide bone scan may be omitted in patients with a serum PSA value of < 10 ng/ml.

Adenocarcinoma↗

PubMed1998

Cytokeratin 8/18 levels in patients with prostate cancer and benign prostatic hyperplasia.

OBJECTIVES: Recently, tissue polypeptide-specific antigen (TPS), a cytokeratin 18 marker, was described to be discriminative between cancer of the prostate (CaP) and benign prostatic hyperplasia (BPH). Cyfra 8/18, a marker which recognizes both cytokeratin 8 and 18 fragments, is discussed to improve sensitivity and specificity of TPS. We investigated whether Cyfra 8/18 serum concentration discriminates between patients with clinically localized CaP and BPH. METHODS: Serum Cyfra 8/18 levels were determined in patients with untreated CaP before radical prostatectomy (pT1-3pNoMo; n = 11) and with histologically confirmed BPH (n = 22). Cyfra 8/18 concentration was correlated to the prostate-specific antigen (PSA) concentration. RESULTS: Median Cyfra 8/18 level was 0.64 ng/ml in CaP patients and 0.57 ng/ml in BPH patients. This difference is statistically not significant (p = 0.91). Furthermore, no correlation to PSA levels could be established (CaP: r = 0.036; BPH: r = 0.09). CONCLUSION: In contrast to a recent report we found the Cyfra 8/18 serum concentration to be a nondiscriminative parameter between CaP and BPH.

Adenocarcinoma↗

PubMed1998

Efficacy of skeletal alkaline phosphatase and prostate-specific antigen in the diagnosis of bone metastasis in cancer of the prostate.

PURPOSE: To study the efficacy of prostate-specific antigen (PSA) and skeletal alkaline phosphatase (SAP) as staging markers in discriminating patients with cancer of the prostate (CaP) with (M+) and without bone metastases (M0). MATERIAL AND METHODS: 73 patients with untreated CaP entered the study. After staging the patients were divided into 3 groups: group I, patients with CaP and bone metastases (n = 21); group II, patients with locally advanced CaP without bone metastases (n = 26), and group III, patients with clinically localized CaP without bone metastases (n = 26). RESULTS: None of the M0 patients but 71% of the M+ patients exhibited an increased SAP. A corresponding cutoff point of 100 ng/ml for PSA showed that 19% of M0 patients and 71% of the M+ patients exhibited a value of >100 ng/ml. This resulted in a sensitivity and specificity of 71 and 100% of SAP and 71 and 81% for PSA, respectively. CONCLUSION: SAP could become a useful marker in the evaluation of patients with newly diagnosed CaP as it provides additional information concerning the skeletal status of these patients.

Adult↗

PubMed1998

Transforming growth factor-beta1 serum concentration in patients with prostatic cancer and benign prostatic hyperplasia.

OBJECTIVE: To assess serum levels of transforming growth factor-beta1 (TGF-beta1), normally markedly elevated in prostate cancer tissue, in patients with cancer of the prostate, and to correlate these levels with tumour stage and serum prostate specific antigen (PSA) levels. PATIENTS AND METHODS: Serum TFG-beta1 and PSA levels were determined in 32 patients with untreated prostate cancer. Patients were divided into: group 1, 14 patients with pT1-3pN0M0; group 2, four with T1-3pN+M0); and group 3, 14 with T1-4NxM+. Ten patients with histologically confirmed benign prostatic hyperplasia (BPH) served as controls. RESULTS: The median TGF-beta1 levels were no different between patients with cancer or BPH (30.7 ng/mL and 26.9 ng/mL, respectively; P > 0.05). Furthermore, there was no increase in TGF-beta1 concentrations with advancing tumour stage (group 1, 34.1 ng/mL; group 2, 33.0 ng/mL; group 3, 28.3 ng/mL; P > 0.05). There was no correlation with PSA levels (group 1, r= -0.42: group 2, r= -0.43; group 3, r= -0.23; BPH, r=0.38). CONCLUSION: TGF-beta1 levels did not discriminate between patients with BPH and prostate cancer, and there was no increase in TGF-beta1 levels with advancing tumour stage.

Aged↗

PubMed1997

[Improved discrimination between prostatic carcinoma and benign prostatic hyperplasia by determination of free prostate-specific antigen percentage].

We investigated whether the free-to-total prostate-specific antigen (PSA) ration (f-PSA/t-PSA ratio; i.e. percentage of free PSA) represents a better discriminator for the detection of cancer of the prostate (CaP). In a retrospective analysis, the percentage of free PSA was determined in the sera of 35 patients with histologically proven benign prostatic hyperplasia (BPH) and 35 patients with clinically localized CaP. Patients with urolithiasis (n = 33) served as a control group. Serum levels of free PSA and total PSA were determined employing a chemiluminescent enzyme immunoassay. Patients with CaP demonstrated a lower percentage of free PSA (median: 8.7) than patients with BPH (median: 20.0; P < 0.001). Determination of the percentage of free PSA enhances the differentiation between BPH and CaP and may reduce the number of unnecessary biopsies in patients with an elevated PSA. Confirmation of our preliminary results is required.

Aged↗

PubMed1997

Prostate-specific antigen immunoreactivity in spinal fluid.

OBJECTIVES: Prostate-specific antigen (PSA) is no longer believed to be tissue specific for prostate epithelial cells as it has been documented in various human tissues. The physiological role of PSA in this context is currently unknown. Furthermore the distribution of PSA throughout the human body remains to be established. We therefore investigated PSA immunoreactivity in human spinal fluid (SF). METHODS: The PSA concentration was measured in the SF and sera of 34 men and 6 women. The SF was obtained prior to spinal anesthesia and was kept frozen at -20 degrees C until analysis. RESULTS: PSA was detected in the SF of male patients. Median SF PSA was 0.03 ng/ml in the 34 men, whereas SF PSA was below the detection limit in the 6 women. In men we could establish a positive correlation between SF PSA and serum PSA with a correlation coefficient of r = 0.85 (p < 0.001). CONCLUSION: These results confirm recent literature reports indicating that PSA is detectable in various human tissues and fluids.

Adult↗

PubMed1997

Determination of local tumour extension in cases of carcinoma of the prostate.

OBJECTIVE: Since most cases of carcinoma of the prostate (CaP) are still diagnosed at a time when the tumour has already spread beyond the prostatic capsula and therefore is incurable, recent impetus has been given to early detection with the chance of curative therapy. METHODS: This paper reviews of the literature concerning the ability of prostate-specific antigen (PSA), digital rectal examination (DRE), transrectal ultrasonography (TRUS), TRUS directed sextant biopsies, computerized tomography (CT) and magnetic resonance imaging (MRI) to determine the pathological stage of clinically organ-confined CaP. RESULTS: The combination of PSA, DRE, TRUS and TRUS directed sextant biopsies yield the best information about the pathological extent of clinically organ-confined CaP. However, while this is true for a cohort of patients, the individual patient may still suffer from locally advanced disease that was unpredictable preoperatively by applying these tests. Positive surgical margins after radical prostatectomy are a logical consequence of advanced disease and therefore will be seen as long as no better clinical staging is available to the urologist and as long as CaP does not get diagnosed earlier in the course of the disease. CONCLUSION: At the present time the determination by PSA, DRE, TRUS and TRUS directed sextant biopsies are the diagnostic procedures of choice for the clinical staging of patients with potentially organ-confined CaP, CT and MRI are unable to markedly enhance the accuracy of clinical staging in this disease.

Biomarkers, Tumor↗

PubMed1996

Free-to-total prostate-specific antigen serum concentrations in patients with prostate cancer and benign prostatic hyperplasia.

OBJECTIVE: To determine whether the proportion of total serum prostate-specific antigen (tPSA) which is unbound or free (free PSA) offers a better discriminant for the detection of patients with prostate cancer (CaP) and those with benign prostatic hyperplasia (BPH) than does serum tPSA alone. PATIENTS AND METHODS: In a retrospective analysis, the proportion of free PSA was determined in the sera of 60 patients with histologically confirmed localized (n = 39; pT1-3NoMo) and metastatic (n = 21; T2-4NxM+) CaP and 45 patients with BPH. Forty patients with urolithiasis served as a control group. Serum levels of free and total PSA were determined using a chemiluminescent enzyme immunoassay. RESULTS: Patients with CaP had a lower percentage of free PSA (localized CaP median 8.8%; metastatic CaP median 7.1%) than patients with BPH (median 19.5%) and those with urolithiasis (median 18.8%: P < 0.001). The percentage of free PSA did not differ significantly between patients with clinically localized and metastatic disease. CONCLUSION: The determination of the proportion of free PSA enhanced the discrimination between BPH and CaP and may reduce the number of unnecessary biopsies in patients with an elevated PSA. The results warrant further investigations in a broader population to improve the clinical use of serum PSA as a tumour marker for discriminating patients with an early, potentially curable CaP from men with BPH.

Aged↗

PubMed1996

Prostate-specific antigen: insufficient discrimination between benign prostatic hyperplasia and organ-confined prostate cancer.

OBJECTIVE: Discrimination of patients with benign prostatic hyperplasia (BPH) from those with cancer of the prostate (CaP) is crucial to the management of these diseases. At present, a number of new treatment modalities for symptomatic BPH, which include various nonsurgical treatment modalities, are being discussed. Prior to treatment, it is important to exclude those patients with CaP. In the present study we examined retrospectively the serum prostatic-specific-antigen (PSA) values in both patient groups in order to determine whether serum PSA identifies those patients harboring organ-confined CaP. PATIENTS AND METHODS: Group 1 consisted of 121 patients with histologically confirmed BPH as determined from pathological analysis of the surgically removed specimens. Group 2 included 69 patients with organ-confined CaP, confirmed pathologically from the analysis of the radical prostatectomy specimens. PSA serum concentration was analyzed in both groups. RESULTS: The median PSA level was 3.96 ng/ml (range: 0.5-31.2 ng/ml) in the BPH group and 7.8 ng/ml (range: 0.7-37.7 ng/ml) in the CaP group. In spite of a statistically significant difference (p = 0.0001), serum PSA values overlapped considerably in both groups. CONCLUSIONS: Serum PSA demonstrated only a limited ability to discriminate between BPH and organ-confined CaP. Therefore some patients with symptomatic BPH undergoing nonsurgical treatment may harbor clinically significant CaP despite "normal' serum PSA values. Furthermore, PSA-based screening may overlook a significant percentage of patients in whom a rectal digital examination would detect CaP.

Aged↗