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Purpose: High grade prostatic intraepithelial neoplasia (HGPIN) and atypical small acinar proliferation (ASAP) in the sextant biopsy had been associated with a high risk of prostate cancer. We determined whether the extended biopsy schemes used in the contemporary era have altered the prognostic value of these lesions at repeat biopsies., Materials and Methods: From 1998 to 2003, 105 of 1,188 men had at least 1 repeat extended biopsy due to the presence of HGPIN (33 men) or ASAP (72 men) in a previous extended biopsy. Median biopsy interval for HGPIN and ASAP was 15 and 10 weeks (p <0.05), respectively. Differences in cancer detection rates were analyzed using the Pearson chi-square test., Results: In the HGPIN group only 1 of 22 (4.5%) men had cancer on 1st repeat biopsy and 0 of 11 men had cancer on 2nd repeat biopsy. In men with ASAP 19 of 53 (36%, p <0.005) had cancer on 1st repeat biopsy, and 3 of 19 (16%) had cancer on 2nd repeat biopsy. Cancer was confined to a single core in 16 of 22 (73%) men. Median Gleason score was 6. Patient age, digital rectal examination status, prostate specific antigen, free prostate specific antigen, number of cores and biopsy interval were not independent predictors of cancer in men with ASAP., Conclusions: HGPIN found in the contemporary extended biopsy does not warrant repeat biopsy. ASAP continues to be associated with a high risk of cancer and requires at least 1 repeat biopsy using the extended biopsy scheme.

Purpose: We developed a neural network to identify patients with bladder cancer more effectively than hematuria and cytology. The algorithm is based on combined urine levels of nuclear matrix protein-22, monocyte chemoattractant protein-1 and urinary intercellular adhesion molecule-1., Materials and Methods: A randomized double-blinded study of voided urine from 253 patients undergoing outpatient cystoscopy was performed. Of the patients 27 had bladder cancer on biopsy and 5 had muscle invasion. Urine tumor markers were measured using sandwich-enzyme-linked immunosorbent assay kits. Urine from patients with bladder cancer on cystoscopy was compared to urine from controls with negative cystoscopy results. An algorithm was created with 3 sets of cutoff values modeled to be 100% sensitive for superficial bladder cancer, 100% specific for superficial cancer and 100% specific for muscle invasive cancer, respectively. We compared our model to hematuria and cytology., Results: For the hematuria dipstick test sensitivity, specificity, positive and negative predictive values were 92.6%, 51.8%, 18.7% and 98.2%, respectively. For atypical cytology sensitivity, specificity, positive and negative predictive values were 66.7%, 81%, 29.5% and 95.3%, respectively. For the sensitive model set sensitivity, specificity, positive and negative predictive values were 100%, 75.7%, 32.9% and 100%, respectively. For the specific model set sensitivity, specificity, positive and negative predictive values were 22.2%, 100%, 100% and 91.5%, respectively. For the muscle invasive model set sensitivity, specificity, positive and negative predictive values were 80%, 100%, 100% and 99.6%, respectively. The standard bladder tumor evaluation of 253 patients costs 61,054 US dollars but 36,450 US dollars using our model., Conclusions: Our algorithm is superior to conventional screening tests for bladder cancer. The model identifies patients who require cystoscopy, those with bladder cancer and those with muscle invasive disease. It provides possible savings over current screening methods. The potential loss of other information by not performing cystoscopy was not evaluated in our study.

Purpose: We assessed the staging accuracy of endo-rectal coil magnetic resonance imaging (MRI) in patients with clinically localized prostate cancer., Materials and Methods: In a prospective study 56 consecutive patients underwent endo-rectal coil MRI before scheduled surgery. The ability of MRI to identify tumor involvement of the periprostatic soft tissue, seminal vesicles and pelvic lymph nodes was assessed by comparison with final pathological stage., Results: Specificity of MRI was relatively high (84% for periprostatic soft tissue, 93% for seminal vesicles and 91% for pelvic lymph nodes) and sensitivity was low (22, 23 and 0%, respectively). Accuracy was 64% for identification of periprostatic soft tissue invasion, 77% for seminal vesicle invasion and 86% for pelvic lymph node metastases. Had we excluded from surgery patients with MRI evidence of extraprostatic disease our organ confined disease rate would have improved by 16.6%. However, this improvement would have been obtained at the expense of incorrectly excluding from surgery 21% of our patients with pathologically organ confined disease because of false-positive MRI predictions., Conclusions: Endo-rectal coil MRI is not sufficiently accurate to influence the treatment of patients with clinically localized prostate cancer. Therefore, we advise against routine use of this imaging modality in staging such cases.

Purpose: Zanoterone (100 to 800 mg.) versus placebo was studied in 463 patients with benign prostatic hyperplasia., Materials and Methods: Study end points were maximum urinary flow rate, American Urological Association symptom index, prostate volume, prostate specific antigen and sex steroid concentrations after 6 months of treatment., Results: Mean increases in maximum urinary flow rate were 2 to 3-fold over placebo, although only the 200 mg. group had significant results (1.7 ml. per second, p = 0.026). There were no statistically significant differences between the zanoterone and placebo groups in symptom index or prostate volume. Estradiol and testosterone concentrations, and the incidence of breast pain and gynecomastia increased significantly with zanoterone compared with placebo. Prostate specific antigen levels decreased significantly., Conclusion: Zanoterone did not demonstrate a favorable risk-to-benefit profile for the treatment of benign prostatic hyperplasia.

True carcinosarcoma of the prostate is a rare neoplasm, with only 9 cases well documented by immunocytochemistry and ultrastructural examination. We report a case of an unresectable pelvic tumor studied at autopsy. The primary prostatic neoplasm and pulmonary metastases were composed of well differentiated adenocarcinoma admixed with foci of leiomyosarcoma and osteosarcoma. The sarcomatous components showed reactivity with vimentin and desmin, did not express prostatic acid phosphatase (PAP) and prostate specific antigen (PSA), and contained myofilaments on electron microscopic examination. Positive staining of the carcinomatous component for PAP and PSA was noted. These findings confirm the mixed epithelial and mesenchymal components in primary and metastatic sites, and support the diagnosis of true prostatic carcinosarcoma.

Verrucous carcinoma of the bladder unassociated with bilharzial cystitis is an exceedingly rare entity, with only 3 cases reported in the literature. We describe a patient and review the literature concerning verrucous carcinoma.