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M K Brawer

Publications and source records attributed to M K Brawer.

At least 127 records · Page 7Linked to original sources
PubMed1991

Phenotypic relationships of prostatic intraepithelial neoplasia to invasive prostatic carcinoma.

Thirty-one snap-frozen human prostate specimens containing examples of benign hyperplasia, prostatic intraepithelial neoplasia (PIN), and invasive carcinoma were analyzed using a panel of 24 antibodies and one lectin. Twenty-seven additional routinely processed radical prostatectomy specimens were studied using selected probes known to work on formalin-fixed paraffin-embedded material. Three probes, anticytokeratin KA4, anti-vimentin V9, and the lectin from Ulex europaeus (UEA-1), demonstrated phenotypic similarities between PIN and invasive carcinoma. Whereas the luminal cells of normal or hyperplastic prostatic epithelium are minimally reactive with KA4 (4%) or UEA-1 (0%) and strongly reactive with anti-vimentin (91%), both the PIN and invasive carcinoma are reactive with KA4 (89% and 93%, respectively) and UEA-1 (96% and 93%, respectively) and minimally reactive with anti-vimentin (15% and 0%, respectively). The increased KA4 staining was shown to be in part due to detection of cytokeratin 19, by using cytokeratin-19-specific antibodies, 4.62 and LP2K. The reasons for the increased expression of this cytokeratin and the decreased expression of vimentin are unclear but seem to indicate a phenotypic relationship between the PIN lesions and invasive carcinoma.

Carcinoma↗
PubMed1990

Laboratory studies for the detection of carcinoma of the prostate.

Acid phosphatase and prostate-specific antigen are extremely useful markers for the management of patients with prostatic carcinoma. Prostatic acid phosphatase, because of its relatively low sensitivity and specificity, as well as analyte instability and diurnal variability, is unsuitable for prostate cancer screening. Improved performance characteristics, stability, the lesser diurnal variation, and the association of elevated prostate-specific antigen with prostatic intraepithelial neoplasia make prostate-specific antigen possibly a better candidate for early detection of this common malignancy. Further investigations in this area are clearly indicated before we can recommend screening with prostate-specific antigen.

Acid Phosphatase↗
PubMed1990

Update: prostate cancer.

Prostate cancer represents a major health-care issue for older men. Recent technical advances in imaging, serum markers, and treatment hold great promise. Further insight into the natural history and biologic potential of this ubiquitous neoplasm is necessary before we can make rational decisions about early detection and newer treatment approaches.

Adenocarcinoma↗
PubMed1989

Keratin immunoreactivity as an aid to the diagnosis of persistent adenocarcinoma in irradiated human prostates.

Postirradiation prostatic biopsy is believed by many to be the best measure of radiation effectiveness in prostatic cancer. Therapeutic irradiation may induce prostatic glandular atypia, which in its severe form can be confused with persistent adenocarcinoma on prostatic biopsies. In the current study, 37 postirradiation prostate biopsy specimens were evaluated by immunohistochemistry using a specific monoclonal anticytokeratin antibody (KA1) that reacts with the basal cells of normal or hyperplastic glands, but is nonreactive with the lumenal cells or with prostatic carcinoma cells. Persistent carcinoma was observed in 19 cases in which antibody staining was absent. The noncarcinomatous glands retained reactivity, but this reactivity appeared in a new and previously undescribed pattern. The irradiated lesion was characterized by cellular pleomorphisism, with enlargement of nuclei and loss of polarity. The immunoreactivity was seen in the enlarged basal cells and was seen to focally extend to involve the lumenal cell layer. In five of 37 cases, glands were seen that were so atypical on the routinely stained sections that a distinction from cancer could not be made. These same glands in the adjacent section reacted with KA1 in each case allowing us to conclude that the changes were benign. We conclude that the interpretation of postirradiation prostatic biopsy specimens may be aided by immunohistochemistry with this anticytokeratin antibody.

Adenocarcinoma↗
PubMed1989

Prostate-specific antigen in management of prostatic carcinoma.

In 1979, Wang and associates isolated prostate-specific antigen (PSA). Only recently, however, has the clinical importance of this new tumor marker been recognized. It is now widely accepted that PSA represents a significantly more effective tumor marker than prostatic acid phosphatase (PAP). This article will review the chemistry associated with PSA, the application of PSA in immunohistochemistry, salient features of the two clinically available assays, factors that affect the circulating level of PSA, and the usefulness of PSA in the staging, monitoring, and screening of patients with prostatic carcinoma.

Acid Phosphatase↗
PubMed1989

Prostatic intraepithelial neoplasia: a lesion that may be confused with cancer on prostatic ultrasound.

Most prostatic adenocarcinomas reveal a hypoechoic peripheral zone lesion on transrectal ultrasonography. Numerous benign processes can have similar transrectal ultrasound findings. We report 8 cases of transrectal ultrasound-guided prostatic biopsies of peripheral zone hypoechoic lesions that demonstrated prostatic intraepithelial neoplasia, a presumed premalignant lesion. Immunohistochemistry using an antibody directed against cytokeratins 5 and 14 was performed to exclude carcinoma. Of the men 2 had invasive carcinoma on repeat biopsy and 1 had carcinoma diagnosed on subsequent transurethral resection. Patients with prostatic intraepithelial neoplasia on biopsy of hypoechoic peripheral zone lesions merit careful monitoring.

Adenocarcinoma↗
PubMed1989

Papaverine-induced fibrosis of the corpus cavernosum.

Intracorporeal papaverine self-injection is a new therapy for erectile dysfunction. Although reports of side effects are few, complications, such as priapism and fibrosis, have been described. We report a case of papaverine-induced obliteration of the corpus cavernosum with resulting inability to place a penile prosthesis.

Erectile Dysfunction↗
PubMed1989

Serum prostate-specific antigen and prostate pathology in men having simple prostatectomy.

Prostate-specific antigen (PSA) is a sensitive and specific serum marker for monitoring disease activity in men with prostatic carcinoma. Despite reports of elevation of levels of this analyte in men with benign prostatic hyperplasia, no information is available correlating the serum levels with the actual prostatic abnormalities in men having prostatectomy for presumed benign disease. In the present investigation, the authors compared preoperative serum PSA levels with prostate disease in 81 men with bladder outlet obstruction. Five pathologic groups were found: incidental high-grade carcinoma (n = 3), low-grade carcinoma (n = 11), acute inflammation (n = 16) with or without chronic inflammation, Prostatic intraepithelial neoplasia (PIN) (n = 25), and benign hyperplasia (n = 26). Serum PSA levels were significantly elevated in both low- and high-grade carcinoma, acute inflammation, and PIN when compared with the patients with benign hyperplasia with and without chronic inflammation. Within the four groups with elevated levels, use of PSA levels could separate only the high-grade cancer patients who were subsequently shown to have metastatic disease. Only one patient with simple hyperplasia had PSA levels in the abnormal range.

Adenocarcinoma↗
PubMed1989

The relationship of basement membrane to histologic grade of human prostatic carcinoma.

The presence or absence of basement membrane (BM) was examined in normal and neoplastic adult prostatic tissue as well as prostate cell lines using immunohistochemistry and electron microscopy. Immunohistochemical studies using antibodies directed against laminin and type IV collagen were done on 55 samples of human prostate representing various grades of prostate carcinoma. The percentage of glandular structures surrounded by BM was determined. Benign prostates (n = 15) had BM around 99% of the acini. Gleason Grade II adenocarcinoma (n = 9) had 65%, Grade III (n = 5) had 23%, Grade IV (n = 12) had 15%, and Grade V (n = 7) had 0% BM around glandular structures, respectively. None of the metastases (n = 7) had visible BM. By transmission electron microscopy, 32 prostates were examined for the glandular profile of BM. One hundred percent of the acini in the benign prostates (n = 17) had BM. Of the low grade carcinomas, Gleason I and II (n = 4), 44% of the acini had BM, and of the high grade carcinomas, Gleason IV and V (n = 7), 34% had BM. None of the metastases (n = 4) had BM by electron microscopy. We conclude that, in prostatic carcinoma, there is a progressive loss of BM with decreasing differentiation, and that in prostate carcinoma metastases there is a complete loss of epithelial BM.

Adenocarcinoma↗
PubMed1989

Massive lymphocele following pelvic lymphadenectomy for staging of prostatic cancer.

Two patients developed massive pelvic lymphoceles within 30 days of retroperitoneal node dissection for staging of prostatic cancer. Excised lymph nodes were negative for metastases. Both patients developed severe bilateral peripheral edema, and one developed pulmonary thromboembolism from intraluminal thrombi in the adjacent, compressed inferior vena cava. Each patient responded to unroofing of the cyst wall with either concomitant external or internal drainage.

Aged↗
PubMed1988

Endobronchial metastases from prostatic carcinoma.

Prostatic carcinoma presenting with pulmonary symptoms is unusual. We describe the case of a 59-year-old man whose disseminated prostate cancer was diagnosed with bronchoscopy. To our knowledge, this represents the second reported case of prostate cancer that manifested with endobronchial symptoms. The importance of this entity and clinical and therapeutic aspects are also discussed.

Adenocarcinoma↗
PubMed1988

The effect of digital rectal examination on serum levels of prostatic-specific antigen.

Serum prostate-specific antigen (PSA) and acid phosphatase (AP) levels were measured before and after digital rectal examination in 26 patients with varying genitourinary complaints. Prostate examination had no effect on the level of these markers. However, AP levels demonstrated greater within-day, intraindividual variance than PSA levels. Digital rectal examination does not appear to be a source of preanalytical error for serum PSA or AP determinations.

Acid Phosphatase↗
PubMed1988

A schema for teaching differential diagnosis.

Eighty-one third-year and early fourth-year medical students were taught a simple schema for generating differential diagnoses. Significant gain in listing correct diagnoses was realized following training.

Clinical Clerkship↗
PubMed1987

Prostatic intra-epithelial neoplasia and early invasion in prostate cancer.

Prostatic intra-epithelial neoplasia (PIN, or intraductal dysplasia) is considered a precursor of invasive carcinoma, characterized by proliferation and anaplasia of cells lining prostatic ducts and acini. The highest grade of PIN, Grade 3, is thought to represent carcinoma in situ. To quantitate the degree of disruption of the basal cell layer in human prostatic ducts and acini as a potential marker of early invasion in PIN, a monoclonal antibody to keratin proteins of 49, 51, 57, and 66 kd which selectively labels the prostatic basal cell layer was used. A total of 1093 acini with PIN were identified in 14 cases with invasive carcinoma. Tumor cells consistently failed to be decorated with this antibody. The frequency of disruption of the basal cell layer increased with increasing grades of PIN, with disruption present in 0.7% of cases of PIN 1, 15% of cases of PIN 2, and 56% of cases of PIN 3. The amount of disruption of the basal cell layer also increased with increasing grades of PIN, with loss of more than one third of the basal layer in 52% of foci of PIN 3 compared with less than 2% in lower grades of PIN. Disruption of the basal layer was more common in acini adjacent to invasive carcinoma than in distant acini. These findings suggest that early invasion in prostate cancer is characterized by disruption of the basal layer, and that invasion occurs commonly in association with foci of high-grade prostatic intra-epithelial neoplasia.

Antibodies, Monoclonal↗
PubMed1987

Prostatic abscess owing to anaerobic bacteria.

Abscess of the prostate is seen infrequently. We report a prostatic abscess owing to anaerobic bacteria in a 46-year-old man with a 10-year history of irritable voiding symptoms. Preoperative computerized tomography confirmed the diagnosis of prostatic abscess, which was treated with transurethral resection and broad-spectrum antibiotics.

Abscess↗