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Biomedical subjects

M P Wirth

Publications and source records attributed to M P Wirth.

At least 73 records · Page 4Linked to original sources
PubMed1998

[Screening in prostate carcinoma].

With an increasing incidence, prostate cancer has become the most common cancer in males in the USA. In Germany, 20,000 new cases of prostate cancer were detected in 1995. Only organ confined prostate cancer is curable. Therefore the main intention of screening is an increasing detection rate of clinically significant tumors in time. Cancer specific mortality and morbidity should be decreased by screening. Whether screening can actually achieve this has to be proven in prospective randomized trials, which have only been started recently. Therefore, valid results cannot be expected before the year 2007. Different trials revealed the combination of digital rectal examination and the measurement of prostate specific antigen to be the most useful tools in screening at present. In conclusion, at present, the recommendation is an urological examination once a year in men from 45-50 (depending on risk) to 70-75 years of age--if the patient agrees to the possible diagnostic and therapeutic consequences.

Adult↗
PubMed1997

The antiandrogen withdrawal syndrome.

In 1989 the unanticipated agonist effect of antiandrogens on LNCaP prostate cancer cells was detected. A "flutamide withdrawal syndrome" was first described by Kelly and Scher [15], who reported a decrease in serum prostate-specific antigen (PSA) levels after the removal of flutamide from the treatment regimen. In the last few years the paradoxical response to antiandrogens has also been reported for bicalutamide, chlormadinone acetate and others. Therefore the name of the syndrome has changed to "antiandrogen withdrawal syndrome." Several reasons such as mutations in the androgen receptor or a direct stimulatory effect of the antiandrogen for this effect have been discussed, but the exact molecular mechanism remains unclear. However, in patients with hormonally relapsed prostate cancer, a trial of "withdrawal therapy" is required prior to the initiation of toxic therapies.

Androgen Antagonists↗
PubMed1997

[Significance of 5-alpha-reductase inhibitors in therapy of benign prostatic hyperplasia with mild to modern symptoms].

Medical therapy in the treatment of symptomatic benign prostatic hyperplasia has changed very much during the last few years. Finasteride is a 5-alpha-reductase inhibitor, which inhibits the predominant intraprostatic isoenzyme II of 5-alpha-reductase and therefore DHT, which is-among other factors-essential for the physiological growth of the prostate. However, it also has an important influence on developing BPH. It was shown in several studies that finasteride can increase urinary flow rates, decrease the prostate volume, and improve the symptom score and PSA value. The objective improvement in urinary flow rates was only moderate, but better results were obtained in the improvement of patient symptoms. Large multicenter studies will be conducted to see if the efficacy of treatment can be improved by combination therapy with alpha-1-blockers.

3-Oxo-5-alpha-Steroid 4-Dehydrogenase↗
PubMed1996

Clinical significance of the determination of noncomplexed prostate-specific antigen as a marker for prostate carcinoma.

OBJECTIVES: The aim of this study was to investigate whether a significant difference consists between patients with and without prostate carcinoma (CaP) regarding the ratio of prostate-specific antigen (PSA) in complex with major proteinase inhibitors to noncomplexed (free) PSA (FPSA). METHODS: We analyzed the sera of 29 patients with untreated CaP, 34 patients with benign prostatic hyperplasia (BPH), and 33 men with no symptoms of prostate disease for the amount of FPSA and total PSA (TPSA) with the Immulite chemiluminescent enzyme immunometric assay. RESULTS: FPSA was found only as a minor fraction in all sera tested. Calculation of the percentage of FPSA from TPSA revealed a significant difference between patients with CaP (median, 9.55%) versus patients with BPH (median, 17.07%; P = 0.00001) or versus healthy men (median, 16.11%; P = 0.0006). Considering only patients with PSA values less than 10 ng/mL, the difference between patients with CaP versus patients with BPH remained significant (P = 0.026). The specificity for differentiation between CaP and BPH at a sensitivity level of 89% for the combined evaluation of the proportion of FPSA and TPSA increased from 30% (TPSA considered alone) to 61%. The cutoff level for TPSA was determined at 4 ng/mL and for the proportion of FPSA at 21.1%. CONCLUSIONS: These data indicate that the differentiation between CaP and BPH can be considerably improved by measuring both FPSA and TPSA and calculating the ratio of the one to the other.

Aged↗
PubMed1995

Prognostic significance of capsular invasion and capsular penetration in patients with clinically localized prostate cancer undergoing radical prostatectomy.

One hundred thirty patients with an observed follow-up of more than 10 years after radical prostatectomy were restaged with regard to local extent of the tumor in relation to the prostate capsule. Of 112 patients with surgically staged negative pelvic lymph nodes, 62 had a tumor-free prostate capsule, 24 had capsular invasion without penetration, and 26 had tumors extending through the capsule of the prostate. Observed overall and disease-free 10-year-survival rates were 79% and 69.4%, respectively, in patients with absence of capsular involvement and 70.8% and 66.7%, respectively, in patients with capsular invasion alone. In patients with capsular penetration, however, the survival rates significantly decreased to 57.7% (P = 0.018) and to 38.5 (P = 0.017), respectively. The overall progression rate was found to be significantly higher in patients with tumors extending through the prostatic capsule (46.2%), as compared to those with absence of capsular involvement (21%; P = 0.014) as well as to those with capsular invasion alone without penetration (25%; P = 0.034). Thus, in contrast to capsular invasion alone, capsular penetration means a poor prognostic indicator, which accounts for a reduced survival expectancy and a higher progression rate following radical prostatectomy. Therefore, tumors with capsular invasion and those with capsular penetration should not be grouped together in the same tumor stage as done in the 1987 edition of the TNM tumor classification system.

Adult↗
PubMed1995

Primary non-Hodgkin's lymphoma of the male urethra. A case report and review of the literature.

Approximately 15-25% of malignant non-Hodgkin's lymphomas (NHLs) are primarily extranodal and only 2.7% of these are located in the genitourinary tract. Only a few particular cases of primary manifestation of NHL in the urethra have been described, most of them in female patients, whereas a secondary involvement occurs more frequently. In the present case a high-grade malignant NHL of the B-cell type was located in the urethra of a 29-year-old male patient. No other manifestations of NHL could be found. After surgical removal of the urethral neoplasm the patient was treated with combined chemotherapy (6 cycles of the CHOP scheme). Thereafter, reconstruction of the urethra by the island flap method of Duckett was carried out. Two years after diagnosis the patient is alive and in complete remission with good functional and cosmetic results of surgery and a normal sexual life.

Adult↗
PubMed1995

Survival and quality of life of patients with stage D1 (T1-3 pN1-2 M0) prostate cancer. Radical prostatectomy plus androgen deprivation versus androgen deprivation alone.

A series of 139 patients with histologically proven stage D1 (T1-3 pN1-2 M0) prostate cancer was reviewed in order to determine the influence of radical surgery in addition to hormonal treatment on long-term outcome with respect to survival and quality of life. In all 139 patients a pelvic lymphadenectomy was performed. In 87 patients, lymphadenectomy was followed by androgen deprivation alone (group 1). Fifty-two patients underwent additional radical prostatectomy (group 2). The actuarial 10-year nonprogression rates were 14.6% in group 1 and 35.8% in group 2, respectively (p = 0.0016). The overall and disease-specific 10-year survival rates were found to be 29.7 and 32.1%, respectively, for group 1 and 50.8 and 70.7%, respectively, for group 2. Local progression as the main parameter influencing quality of life occurred in 60 of the 87 patients (69%) not subjected to radical prostatectomy. Transurethral resection of the prostate was required in 29 of these patients. In contrast, following radical prostatectomy, only 4 of the 52 patients (8%) had local progression and only 1 patient (2%) needed a dilatation of the vesicourethral anastomosis for relief of infravesical obstruction. Thus, radical prostatectomy plus androgen deprivation for patients with stage D1 prostate cancer appeared to be superior to androgen deprivation alone with respect to survival expectancy and quality of life. Prospective randomized trials, however, have to be undertaken to verify these results.

Biopsy↗
PubMed1995

[The value of prostate-specific antigen in therapy follow-up of prostatic carcinoma].

The prostate specific antigen (PSA) has gained great importance for the diagnosis and the treatment of prostate carcinoma since its isolation from prostate tissue in 1979. PSA is produced and secreted almost only by the prostatic tissue. After radical prostatectomy PSA changes from a tissue specific marker to a tumor specific parameter. At least 30 days after radical prostatectomy the PSA serum level should decline nondetectable values. A high incidence for a local recurrence, distant metastases, or a incomplete resection of the prostate is a still present PSA serum value. After a radiation or androgen deprivation therapy the PSA value is a prognostic marker. A good prognosis can be expected if the PSA level decreases after androgen deprivation therapy to values below 4 ng/ml. In contrast to that increasing PSA levels indicate a local or distant recurrence. Progression of the tumor without an increase of PSA values is possible but rare. It could be shown in several studies, that the determination of PSA values is sufficient for routine treatment control and that other methods could therefore be omitted.

Biomarkers, Tumor↗
PubMed1994

DNA-ploidy, G2M-fractions and prognosis of stages B and C prostate carcinoma.

Paraffin embedded tissue of 49 stage C and 27 stage B prostate adenocarcinomas was investigated by flow cytometry. All patients were treated by radical prostatectomy with pelvic lymphadenectomy and followed up for 5-10 years. The tumour was separated from the benign tissue to increase the proportion of tumour cells. Ten stage C and seven stage B carcinomas had to be excluded because of poor fixation. Six of the 39 (15%) stage C and 1/20 (5%) stage B carcinomas were aneuploid. Cell cycle analysis was done with correction for sliced nuclei and background subtraction. The threshold between carcinomas with low and with increased ("tetraploid") G2M-fraction was determined by comparing carcinomas with and without tumour progression. Sixty-seven percent of the patients with non-euploid stage C carcinomas and 11% of those with euploid carcinomas suffered from tumour progression (P < 0.01). The respective values for the stage B carcinomas were 67% and 6% (P < 0.01). These results demonstrate the strong prognostic impact of DNA-ploidy and G2M-fractions for each individual patient.

Adult↗
PubMed1994

[Treatment of advanced renal cell carcinoma with subcutaneous administration of interleukin 2 and interferon-alpha].

Twenty-three patients with advanced renal cell carcinoma were treated with subcutaneous injections of interleukin-2 (IL-2) and interferon-alpha (IFN-alpha). IFN-alpha (5-10(6) U/m2) was injected on day 1 of the 1st week of a treatment cycle of 6 weeks and high doses of IL-2 (20.10(6) IU/m2) on days 3, 4 and 5. In the 2nd and 3rd week IFN-alpha (dose as above) and low doses of IL-2 (5.10(6) IU/m2) were injected on days 1, 3 and 5. The treatment from the 4th to the 6th week corresponded to that of the 1st to 3rd week. In cases of remission or stable disease the treatment schedule was repeated as a rule once or twice. In 12 of the 23 cases nephrectomy had been carried out previously. Complete remission lasting 4 + months and partial remission lasting 2 months were achieved in two patients with lung and skeletal metastases. A stable state of the disease lasting 1-7 + months was observed in 11 cases. Ten patients showed progression of the disease after the first treatment cycle. Thus, the overall objective response rate was 9%. The side effects were only slight and corresponded to WHO toxicity grade I (n = 8) and grade II (n = 15). In two cases the first treatment cycle could not be finished.

Adult↗
PubMed1993

Extracorporeal shock wave lithotripsy in patients with renal malformations.

Twenty-four consecutive patients with malformed kidneys (21 horseshoe kidneys, 2 crossed ectopic and 1 pelvic kidney) underwent extracorporeal shock wave lithotripsy (ESWL) for nephrolithiasis between 1984 and 1990. No serious complications occurred either during or after treatment. Urinary obstruction was accompanied by fever in 3 patients and by renal colic in 4. Auxiliary measures were required in only 2 cases. Patients with renal anomalies remained in hospital longer than patients with normal kidneys. Fifteen patients were free of stones 3 months after ESWL and 16 after 1 year. Six patients required further ESWL less than 1 year after their first treatment as a result of stone recurrence or regrowth. ESWL is a safe and successful non-invasive procedure for the treatment of nephrolithiasis in patients with malformed kidneys. However, the higher frequency of stone recurrence and regrowth means that these patients must undergo careful monitoring.

Adult↗
PubMed1993

Immunotherapy for metastatic renal cell carcinoma.

Immunotherapy with autologous tumor cells, tumor cell vaccines, and immune RNA did not become established in the treatment of renal cell carcinoma, as the response rates were low, and in some investigations, no response at all could be detected. In the past, cytokines such as interferons, IL-2, and TNF have been tested on a large scale in the treatment of advanced renal cell carcinoma. However, the rates of objective remission (partial and complete) are disappointing, only rarely exceeding 20%. Up to now, longer survival could not be demonstrated in patients with advanced renal cell carcinoma after treatment with cytokines. The combination of IFN-alpha and IL-2 by subcutaneous administration appears to provide results similar to those of other treatment modalities with lower morbidity. However, because generally accepted treatment schedules for cytokine therapy do not exist, and because the patients who would profit most from treatment with cytokines cannot be exactly defined, the administration of these agents is indicated at present only in the context of prospective clinical trials.

Antineoplastic Agents↗
PubMed1993

[Value of transrectal ultrasound in determining the T-stage of prostate cancer].

Accurate preoperative staging of prostate adenocarcinoma is especially important before radical prostatectomy. The purpose of this prospective study was to investigate the staging accuracy of transrectal ultrasonography in prostatic adenocarcinoma. The results of the preoperative staging evaluation in 126 patients with endorectal ultrasound were compared with the histopathologic findings after radical prostatectomy. Correct staging by transrectal sonography was possible in 82 of 126 patients (65%). For stage pT3 tumors, sensitivity, specificity and positive predictive value were 69%, 51% and 82% respectively.

Adult↗
PubMed1993

[Results of low dosage cyclic interferon-gamma therapy of metastatic renal cell carcinoma].

A total of 24 patients with metastatic renal cell carcinoma were treated with a low-dose cyclic regimen of interferon-gamma (IFN-gamma). The dosage was 50 micrograms IFN-gamma s.c. per day for 5 days every 4 weeks. In 16 of the 24 patients nephrectomy had preceded this treatment. Another immunotherapy had already been performed in 13 of the 24 cases. No complete remission was achieved in any of the patients, all of whom were evaluable. One patient with pulmonary metastases achieved partial response. Stable disease lasting 2 to 12+ months was seen in 5 cases. Tumour progression was observed in 18 patients. Only slight side-effects were noted. Patient selection could be one reason for the wide range of response rates reported for IFN-gamma treatment in the literature.

Adult↗
PubMed1992

Primary extracorporeal shock wave lithotripsy of staghorn renal calculi.

186 patients with partial and 55 patients with complete renal staghorn calculi were treated with primary extracorporeal shock wave lithotripsy (ESWL) at the Department of Urology, University of Würzburg Medical School. Partial staghorn calculi required an average of 1.4, complete staghorn calculi an average of 2.2 treatment sessions using the Dornier HM 3 lithotriptor. 55% of all patients and 46% of the patients with complete staghorn calculi were rendered stone-free within 1 year after ESWL. Pretreatment urinary tract infections present in 50.6% of all patients could be reduced to 22.5% 1 year after ESWL. The most frequent complications after ESWL were ureteral obstruction caused by 'steinstrasse' (41.4%), fever (38.4%), and renal colics (29.4%). Severe complications needing open operative procedures or blood transfusions did not occur. 50% of all patients underwent auxiliary procedures (e.g. insertion of indwelling ureteral stents: 25.3%, percutaneous nephrostomy: 20.3%, percutaneous nephrolithotripsy: 2.9%). Pretreatment insertion of an indwelling ureteral stent was found to reduce posttreatment complications as well as the need for percutaneous nephrostomy only in patients with partial staghorn calculi. The data presented in this study demonstrate that primary ESWL therapy can be safely and successfully performed in the majority of patients with renal staghorn calculi. In patients requiring complete removal of all stone fragments, a percutaneous lithotripsy can be performed following ESWL.

Adult↗
PubMed1992

Spontaneous thrombosis of the renal vessels. Rare entities to be considered in differential diagnosis of patients presenting with lumbar flank pain and hematuria.

We report 2 cases of spontaneous thrombotic occlusion of the main renal vessels presenting with acute lumbar flank pain and hematuria suspect of nephrolithiasis. Clinical and laboratory signs of blood hypercoagulability, generalized arterial embolism, nephrotic syndrome or glomerulonephritis were absent. Excretory urography, nephrosonography and retrograde ureteropyelography showed no evidence of upper urinary tract calculi or other causes of obstruction. Renal angiography and cavography demonstrated an acute renal vein thrombosis in 1 patient and a thrombotic occlusion of all but one of the segmental renal arteries in the other patient. These 2 cases demonstrate that thrombotic occlusion of the renal artery or renal vein has to be considered in patients who are presenting with lumbar flank pain and hematuria, in whom the excretory urogram shows severe malfunction of one of the kidneys, and stone disease can be excluded. Renal angiography and cavography as well as CT scan should be carried out in these patients. When the disease is diagnosed at an early stage, an intra-arterial thrombolysis can be attempted.

Acute Disease↗