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Titles/descriptions of selected newsworthy abstracts to be presented during American Urological Association annual meeting

American Urological Association

Kidney-preserving tumor resection in renal cell carcinoma (RCC) with fluorescence photodetection by 5-aminolevulinic acid (ALA). Preclinical and preliminary clinical results
No. 26 (Gralf Popken)
Poster presentation on Saturday, April 29; 1 -- 3 p.m.; Rooms 360/361 W

Giving 5-aminolevulinic acid (ALA) before surgery caused kidney tumors to become fluorescent, making it possible to identify the outer borders of the tumors in humans and in mice. These investigators gave oral and intravenous ALA to mice transplanted with human renal cell carcinoma, then removed the tumors and found that they were fluorescent. In 35 humans undergoing partial nephrectomy for renal cell carcinoma, ALA given by mouth 4 hours before surgery caused good fluorescence of the cancer during surgery in 31 patients and no fluorescence in 4 with a benign growth. There was also no photodynamic reaction in normal tissue. The patients had no side effects and no local recurrence at a followup of 18 + 12 months. These findings indicate that photodynamic detection of renal cell carcinoma using ALA can help to show the amount of tissue that should be removed during kidney-preserving surgery.

Phase 2 clinical trial of a vaginal mucosal vaccine for recurrent urinary tract infections in women
No. 52 (Walter J. Hopkins)
Poster presentation on Saturday, April 29; 1 -- 3 p.m.; Rooms 364/365 W

Recurrent urinary tract infections (RUTIs) in susceptible women are a significant clinical problem because of the increasing number of bacteria that are resistant to antibiotics. In an attempt to develop an alternative to long-term antibiotic prophylaxis, these researchers immunized women with 3 weekly doses of a vaginal mucosal vaccine suppository of killed uropathogenic bacteria. Compared to those on placebo, immunized women had 12 weeks without RUTIs. In their current study, the researchers gave additional doses of the vaccine in an attempt to extend the disease-free period. Thirty-six women with a history of RUTIs were taken off prophylactics and randomly assigned to receive a placebo, primary immunization with a vaginal suppository vaccine but without boosters and primary immunization with the suppository plus 3 boosters. The initial immunization was done by giving 3 suppositories at weekly intervals with 3 booster immunizations given at 1-month intervals starting 1 month after the third primary dose. Adverse affects and RUTIs were documented for 5 months. There were no significant adverse affects over the study period. The patients who received the 6 vaccine doses were infection-free for a significantly longer time. At the end of the study period, more than 50% of the women who received boosters had not had an RUTI , while 80% of those on placebo were diagnosed with an RUTI. These 2 independent, placebo-controlled studies of vaginal mucosal immunization for RUTIs show that this method is safe and effective, and appears to be helpful for long-term prophylaxis.

Brachytherapy, radical prostatectomy, and external beam radiation for prostate cancer are associated with different long-term effects on health-related quality of life
No. 67 (John T. Wei)
Podium presentation on Saturday, April 29; 3:30 -- 5:30 p.m.; Rooms 304/305 E

These investigators compared long-term health-related quality of life (HRQOL) in consecutive men who underwent brachytherapy, radical prostatectomy or external beam radiation, and in age-matched controls. Study participants completed the RAND 36-Item Health Survey (SF-36), FACT-P, AUA Symptom Score (AUA-SS) and UCLA Prostate Cancer Index with expanded urinary, bowel, sexual and hormonal function, and bother items. A total of 1,002 of the 1,406 subjects completed the survey, and the response rate was similar in all 3 therapy groups and controls. The test-retest reliability coefficients compared favorably to the observed and expected coefficients of the FACT-P, SF-36 and AUA-SS for the expanded prostate-related function and bother items. However, the expanded prostate-related function domains identified certain adverse treatment-specific HRQOL effects that were not identified by the SF-36 or FACT-P. Compared to controls, patients had significantly worse urinary and sexual functioning after prostatectomy; significantly worse bowel, sexual and hormonal function after radiation; and significantly worse urinary, bowel, sexual and hormonal function after brachytherapy. In addition, the FACT-P and AUA-SS identified uniquely adverse function after brachytherapy. This comprehensive composite questionnaire detects age-independent, adverse HRQOL differences between controls and each of 3 prostate cancer therapy cohorts.

Adenocarcinoma of the prostate: An expensive way to die
No. 256 (Natania Y. Piper)
Poster presentation on Sunday, April 30; 10 a.m. -- 12 p.m.; Rooms 264/365 W

Because the costs of terminal care for men with metastatic prostate cancer are less well known than the costs of radical prostatectomy and radiation therapy for localized disease, these investigators retrospectively reviewed the charts of 32 men who died of prostate cancer at 5 military centers from 1995 to 1997. They examined the duration of metastatic disease, the number of days hospitalized during the last year of life, palliative procedures, radiation therapy, chemotherapy and the need for transfusions. Costs were assigned to these interventions according to the codes and billing schedules used at civilian hospitals in the San Antonio, Texas area. The mean overall cost of hospitalization, all studies, outpatient urologist visits, palliative procedures and hormonal therapy was $24,660 for terminal care, compared to $12,250 for radical prostatectomy and $13,823 for 3- dimensional conformal radiotherapy. These researchers believe that their study underestimated the costs of metastatic disease because they could not determine the additional costs of hospice and skilled nursing care, outpatient medication, equipment, transportation, loss of work by the patient or spouse and other factors. Since 113 American men die of metastatic prostate cancer each day, the national cost is a minimum of $1 billion annually.

Decrease in prostate cancer mortality following introduction of prostate specific antigen (PSA) screening in the federal state of Tyrol, Austria
No. 387 (Georg Bartsch)
Poster presentation on Sunday, April 30; 3:30 -- 5:30 p.m.; Rooms 364/365 W

In 1993, a screening program to test prostate specific antigen (PSA) levels was started in Tyrol, Austria. In that year, a third of Tyrolean men aged 45 to 75 were tested, and two- thirds were tested at least once in the first 4 years of the study. The incidence of prostate cancer peaked in the area in 1994 and then declined. Since screening began, lower stages of disease have been found and the number of potentially curable cancers has increased. While the number of 40 to 79-year-old Tyrolean men who died of prostate cancer remained constant from 1970 to 1993, it has now declined, even though the number of other Austrian men who died of prostate cancer has not changed. In fact, in 1997 there was a 32% decrease in prostate cancer deaths in Tyrol, and a 42% decrease in 1998. This study shows that making PSA testing available to men in Tyrol led to the detection of more potentially curable cancers as well as a decrease in the number of men who died of the disease.

Evaluation of current AUA prostate cancer screening
No. 392 (Robert L. Grubb)
Poster presentation on Sunday, April 30; 3:30 -- 5:30 p.m.; Rooms 364/365 W

These researchers report early outcome data on men diagnosed with prostate cancer following the current AUA guidelines that recommend surveillance by annual digital rectal examination (DRE) and prostate specific antigen (PSA) testing beginning at age 50 when there is no preexisting prostate cancer. This study enrolled 10,548 men 50 to 59 years old with a benign DRE and low PSA, of whom 103 were later diagnosed with prostate cancer for a cancer detection rate of 0.98%. At the time of the diagnosis, cancer was stages T1c to T2B in 90% of the men, but 1% had metastatic disease. Radical prostatectomy was done in 83 of the men with prostate cancer, while the rest underwent external beam radiation, brachytherapy with implanted radioactive seeds, hormone therapy, cryotherapy or watchful waiting. Cancer was confined to the prostate in 74% of the men with prostatectomy and in 17% the disease was considered possibly harmless. At 2 to 81 months of followup, 95% of the patients with prostate cancer did not have PSA progression. These researchers found that the current AUA guidelines usually do detect medically important cases of cancer, although 17% are potentially harmless and 1% may rapidly progress. Testing resulted in a favorable short-term outcome after cancer treatment.

A novel prostate specific transcription (PSTF-1) is a urine marker for prostate cancer
No. 443 (Mark E. Stearns)
Poster presentation on Monday, May 1; 7 a.m. -- 4:30 p.m.; 160 W

Identifying specific prostate related genes or protein markers is important for detecting prostate cancer early and targeting therapy because prostate cancer is a heterogeneous disease whose clinical behavior varies. In an attempt to identify possible cancer markers, these researchers performed electrophoretic mobility shift assays (EMSAs) to screen protein extracts from benign and malignant prostate tissue obtained from radical prostatectomy specimens. Ultimately they cloned and sequenced a novel protein, called prostate specific transcription (PSTF-1). DNA and amino acid sequencing confirmed the novel sequence. They also used EMSAs to test voided urine samples from 10 men with prostate cancer and 62 with a benign urological disease. PSTF-1 was detected in the prostate cancer samples but not in prostatic intraepithelial neoplasia, benign prostatic hyperplasia or normal prostate tissue. In addition, PSTF-1 was found in the urine of all 10 men with prostate cancer, indicating that it had 100% sensitivity for prostate cancer. Its specificity was 80%. These data suggest that urinary PSTF-1 is a sensitive marker for prostate cancer, but a larger number of specimens with clinical followup is needed to establish that this prostate cancer-specific protein, which DNA binding assays can identify in the urine of men with prostate cancer, is indeed a clinically useful marker for this disease.

Cavermap™ assisted radical prostatectomy: A multi-institutional evaluation by experienced surgeons
No. 626 (Patrick C. Walsh)
Podium presentation on Monday, May 1; 10 a.m. -- 12 p.m.; Auditorium

The Cavermap™ Surgical Aid is a combined nerve stimulating and erection monitoring device designed to make nerve-sparing prostatectomy easier to perform in men with prostate cancer. In this study, 5 experienced surgeons tested the Cavermap™ during prostatectomy in 52 men with prostate cancer, and evaluated how well it identified the cavernous nerves during surgery and predicted the recovery of sexual function after surgery. During the operation, the surgeons used the Cavermap™ to find out whether they had identified the cavernous nerves properly and left them intact after the prostate was removed. After surgery, 33% of 49 men were potent at 3 months, 66% at 6 months, and 95% at 1 year. Cavermap™ stimulation had 91% sensitivity and 81% specificity for confirming the location of the nerves that these experienced surgeons had first identified. The investigators conclude that using this device to stimulate the nerves during prostate cancer surgery may help in preserving sexual function.

How to avoid bone loss in patients with prostatic carcinoma receiving long-term LHRH-analogue
No. 707 (Yasuyuki Suzuki)
Podium presentation on Monday, May 1; 1 -- 3 p.m.; Auditorium

Men with prostate cancer are often given luteinizing hormone-releasing hormone analogue (LHRH-a) to help fight the disease, even though LHRH-a causes osteoporosis. In 1998, these investigators reported that estrogen given at the same time may help maintain bone mass density in these patients. However, estrogen causes severe side effects. In this study, the same researchers gave 63 to 95-year-old men vitamin D instead of estrogen, and then measured bone density every 4 months. The 40 men who received LHRH-a alone lost bone mass, but the 31 given LHRH-a plus vitamin D had no bone loss. However, vitamin D did not increase low bone mass density to normal levels. The researchers suggest that bone mass density should be measured in patients with prostate cancer who are on LHRH-a, and they recommend that vitamin D should be given along with LHRH-a from the beginning of therapy.

Clinical evaluation of female sexual function: Effects of age and estrogen status on sexual arousal responses in 60 women
No. 651 (Jennifer R. Berman)
Podium presentation on Monday, May 1; 1 -- 3 p.m.; Rooms 306/307 E

Up to 50% of American women complain of sexual dysfunction because of aging, menopause and decreased estrogen. These researchers developed a method of evaluating the physiological and subjective aspects of sexual arousal in women, making it possible to determine how arousal is affected by age and estrogen. Sixty women were categorized by age, and by whether they were menopausal and/or receiving hormone therapy. Genital blood flow, vaginal pH and pressure-volume changes as well as genital vibratory perception thresholds were measured, and the participants completed a questionnaire on sexual function complaints. All women responded physiologically to sexual stimulation, but the response was significantly less in those 55 to 71 years old, and those not on hormone replacement therapy. Subjectively two-thirds reported low sexual arousal and pain or discomfort with intercourse, while more than 90% had difficulty in achieving orgasm. The frequency or kind of sexual complaint that the women reported was not related to age or estrogen status, but physiologically aging, menopause and a lack of estrogen did have a negative impact on their sexual response. Using the method that these investigators developed, sexual arousal responses in women and the efficacy of pharmacotherapy or other treatments can now be measured.

Topical alprostadil produces significant clitoral hemodynamic changes
No. 652 (Edgardo F. Becher)
Podium presentation on Monday, May 1; 1 -- 3 p.m.; Rooms 306/307 E

Ultrasound of the clitoris is often done before and after stimulation to evaluate sexual dysfunction in women. Because many women find self-stimulation unacceptable, these researchers applied the vasoactive drug, alprostadil, to increase blood flow to the clitoris and mimic the hemodynamic effects of self-stimulation. They performed ultrasound of the clitoral arteries in 18 women 18 to 61 years old before and after 0.2% alprostadil cream was applied to the clitoris. In all women the clitoris and labia became engorged, and blood flow to the clitoris significantly increased, similar to the effects of self-stimulation. Almost three-quarters of the women felt only a pleasant feeling of warmth in the genital area, and 11% had mild burning. There were no systemic effects. Applying such vasoactive drugs as alprostadil topically may be helpful for evaluating the vascular component of female sexual dysfunction, especially when self-stimulation is unacceptable to patients. Further research is needed to determine whether these drugs may be useful clinically.

Hysterectomy and sexual dysfunction: Effects of sildenafil in a clinical setting
No. 857 (Laura A. Berman)
Poster session on Tuesday, May 2; 7 a.m. -- 4:30 p.m.; Rooms 254/255 W

These researchers sought to determine whether women who undergo hysterectomy have sexual complaints, and whether sildenafil could resolve them. Fifty women with a mean age of 50 years who had a hysterectomy completed a sexual function questionnaire before and after taking sildenafil for 6 weeks. Two of them who also underwent oophorectomy were simultaneously on hormone replacement therapy. The results of the questionnaire showed that before receiving sildenafil these women had difficulties with sensation, lubrication and pain, and an inability to achieve orgasm. After sildenafil treatment, the patients noticed a statistically significant decrease in low sensation, difficult orgasm and pain during sexual stimulation or intercourse. These findings have implications for diagnosing and treating sexual dysfunction in women who undergo hysterectomy.

Efficacy and safety of apomorphine SL vs. placebo for erectile dysfunction in patients with coronary artery disease
No. 889 (Eugene Dula)
Poster session on Tuesday, May 2; 7 a.m. -- 4:30 p.m.; Rooms 254/255 W

Coronary artery disease (CAD) is associated with erectile dysfunction (ED), and the dopaminergic agent, apomorphine, is a known initiator of erections. In this series, sublinguinal apomorphine tablets were given to men with CAD as treatment for ED. In 3 multicenter double-blind studies 1,472 men with a mean age of 59 were randomized to receive 2, 4, 5 or 6 mg. apomorphine, or placebo. Each study arm represented a separate crossover. CAD was indicated by a history of angina, coronary artery bypass surgery, angioplasty or myocardial infarction in 224 patients (15%). The primary end point of the study was to determine the percent of patients who could achieve an erection firm enough for intercourse. Compared to placebo, all doses of apomorphine resulted in a significantly greater percent of firm enough erections. The most common adverse effect was nausea in 2% to 34% of the men on the low to high doses, compared to 4% on placebo. This study shows that sublinguinal apomorphine tablets are an efficacious and safe treatment for ED in patients with CAD.

Penile reconstruction using engineered corporal tissue
No. 980 (German Falke)
Poster presentation on Tuesday, May 2; 10 a.m. -- 12 p.m.; Rooms 360/361 W

In a previous study, these researchers produced tissue composed of corporal cells in vivo using human cavernous smooth muscle and endothelial cells seeded on polymers. However, the structure of the corporal tissue was not identical to that of the native cavernosum. In this study, they produced an acellular corporal tissue matrix, seeded it with primary human cavernous smooth muscle and endothelial cells, and implanted the seeded matrixes in mice. The mice were sacrificed 3 days to 8 weeks after implantation. Scanning electron microscopy revealed that the cells had attached uniformly to the walls of the corporal tissue. By 1 week after implantation, neovasculature was visible. By 2 weeks, the corporal cells lining the wall were increasingly organized, and this organization continued with time. By 4 weeks, the tissue matrixes were completely covered by the appropriate cell structure. The presence of the seeded cells was confirmed at all time points by immunocytochemical studies, while there was no evidence of cellular organization in the control matrixes. Human cavernous cells seeded on acellular tissue matrixes form vascularized corporal structures in vivo that are similar to native erectile tissue. The ability to form these structures may be an addition to the armamentarium for managing complex cases of penile reconstruction.

Gender differences in sexual arousal responses: Implications for qualitative variations in genital engorgement
No. 1067 (Jennifer R. Berman)
Poster presentation on Tuesday, May 2; 1 -- 3 p.m.; Rooms 360/361 W

The male and female genitals have anatomical and embryological similarities, but sexual arousal and the physiological end point are different in men and women. These investigators studied how the blood flow to the penis, clitoris and labia indicates these differences. Using ultrasound, they measured the blood flow as well as the size and volume of the genitals before and after sexual stimulation in normal men and women, and in men with arteriogenic impotence and women with sexual arousal disorder. The researchers found that in normal men the blood flow to the penis increased significantly as erection began, then decreased slightly while the penis was most rigid, while blood flow was significantly increased in the genitals of normal women during the whole arousal phase. Also in contrast to the penis, the clitoris and labia became engorged rather than rigid, and they did not become longer. Genital measurements were lower in the men and women with sexual dysfunction, and they had less blood flow to the genitals than the controls. Although the mechanisms that mediate genital vasocongestion seem to be similar at the molecular level in men and women, the physiological and subjective sexual arousal end points are quite different. Therefore, they advise these differences should be taken into account when sexual arousal responses are evaluated, and when considering treatment for sexual arousal disorder in women.

Underreporting of erectile dysfunction in men with unrelated urological conditions
No. 1080 (Kelly C. Baldwin)
Poster presentation on Tuesday, May 2; 1 -- 3 p.m.; Rooms 360/361 W

These investigators evaluated the rate of erectile dysfunction (ED) in men older than 50 who were visiting their urologist for other urological problems. They asked 500 men whether they were having problems with potency. When patients answered yes, they were asked to complete a questionnaire giving their reasons for not mentioning the problem, and indicating whether they had discussed the problem with their primary care physician. Two hundred eighteen of the 500 men (44%) had noticed some ED but did not discuss it with their urologist. One hundred sixty-one (74%) were too embarrassed to do so, 27 (12%) thought impotence was a natural part of aging, 20 (9%) did not know that urologists treated impotence and 10 (5%) did not think the problem warranted medical attention. Only 48 men with ED had discussed the problem with their primary care physician. One hundred forty (82%) of the 170 men who did not have such discussions would have liked their primary care physician to initiate a discussion of impotence during their routine visits. The results of this study show that a significant percent of men who see a urologist for a problem unrelated to impotence also have some degree of ED, which remains undiagnosed unless patients are specifically questioned. Patient embarrassment is the most common reason for underreporting. Urologists can obtain this information by targeted questioning, but men seem to be comfortable and willing to discuss potency with their primary care physicians.

A pretreatment nomogram for predicting the outcome of 3-dimensional conformal radiotherapy in prostate cancer
No. 1158 (Michael W. Kattan)
Poster presentation on Tuesday, May 2; 3:30 -- 5:30 p.m.; Rooms 360/361 W

Most models predicting the outcome of external beam radiation for localized prostate cancer have a limited value for predicting the outcome in individual patients because they were based on a narrow range of prognostic estimates. In addition, none included the dose of radiation as a variable. These investigators developed a nomogram to improve the accuracy of predicting the outcome of radiotherapy. They constructed a model using a database of 1,042 men with prostate cancer treated with 3-dimnensional conformal radiation therapy at Memorial Sloan-Kettering Cancer Center. The parameters considered were cancer stage, biopsy Gleason score, serum prostate specific antigen (PSA) before treatment, whether neoadjuvant androgen deprivation therapy was given and the dose of radiation. The investigators tried several prediction methods and then used the most accurate one to develop their nomogram. The nomogram was validated by statistical analysis on their data set and by using it on a cohort of patients treated at the Cleveland Clinic. The most accurate model that they developed predicted the outcome of external beam radiotherapy for localized prostate cancer with more validity and accuracy than 8 other risk stratification systems published in the literature. Their nomogram may be used by physicians and patients to help select treatment for this disease.

Bone mineral density changes in men receiving androgen deprivation for advanced prostate cancer
No. 1163 (David M. Preston)
Poster presentation on Tuesday, May 2; 3:30 -- 5:30 p.m.; Rooms 360/361 W

Men with advanced or recurrent prostate cancer are often treated with androgen deprivation therapy (ADT), even though it may accelerate bone loss and increase the risk of osteoporosis. These investigators compared changes in bone mineral density in 38 men with prostate cancer who were on ADT for 6 to 66 months and in 38 age-matched controls. ADT consisted of luteinizing hormone-releasing hormone administration or orchiectomy with or without antiandrogen therapy. Bone mineral density was measured by performing dual photon x-ray absorptiometry at the forearm, femoral neck, trochanter, total hip and lumbar spine beginning at study entry and then every 6 months for 24 months. At all measured sites except the lumbar spine, the annual decrease in bone mineral density was significantly greater in the men with prostate cancer on ADT than in the controls.

Normative values of female genital sensation
No. 1178 (Yoram Vardi)
Poster presentation on Tuesday, May 2; 3:30 -- 5:30 p.m.; Rooms 364/365 W

There are clinical diagnostic tests to measure organic sexual dysfunction in men, but few for women. These researchers developed new stimulation probes to assess cold, warm and vibration sensation thresholds in the vagina and clitoris. They used the probes to evaluate 78 healthy women aged 18 to 78 years with normal sexual function, and they established normal and pathological results by testing and re-testing 25 of the volunteers. The most repeatable results were obtained for vibration at the vagina and clitoris, while the most consistent results were for the sensation of cold at the vagina. Because there was a significant relationship between age and all sensation threshold values, the investigators were able to calculate age-based nomograms indicating the upper and lower 95% normative responses. This reliable, consistent and quantitative test of temperature and vibration sensation at the clitoris and vagina may be used in the future to evaluate normal and abnormal sexual function in women.

Localized prostate cancer (PCA) treated by high intensive focused ultrasound (HIFU)
No. 1258 (Christian Chaussy)
Poster presentation on Wednesday, May 3; 7 a.m. -- 4:30 p.m.; Rooms 254/255 W

Prostate cancer is confined to the prostate gland in 70% of the men with this disease. While surgical and/or radiation treatment is chosen by 25%, these therapies are invasive and have side effects. The rest of the patients choose watchful waiting, which may involve possible disease progression, or hormone ablation, which also has side effects. These researchers present high intensive focused ultrasound (HIFU) as an alternative treatment that coagulates prostate tissue in a minimally invasive, high precision way. They performed HIFU transrectally on the whole prostate in 205 men with cancer, then followed up at 1, 3 and 6 months, and every 6 months thereafter with prostate specific antigen (PSA) measurement, sextant biopsies, international prostate symptom score and quality of life questionnaires, and documentation of patients' complaints. A mean of 2 sets of biopsies per patient showed no cancer in 85%, while in men with residual cancer the tumor was reduced more than 90%. HIFU caused no severe side effects and resulted in a low PSA nadir. The only additional treatments were a suprapubic tube inserted for a mean of 29 days in all patients and the transurethral resection of necrotic tissue in 19%. All men were discharged from the hospital within 23 hours. Short-term followup in this study indicates that transrectal HIFU provides minimally invasive local ablation of prostate tissue with a high rate of negative biopsies, low PSA nadir and few complications when done for localized prostate cancer.

Quality of life after radical prostatectomy vs. brachytherapy for localized prostate cancer
No. 1272 (John W. Davis)
Poster presentation on Wednesday, May 3; 7 a.m. -- 4:30 p.m.; Rooms 254/255 W

In this series, the researchers used retrospective questionnaires to evaluate the general health and quality of life in 264 men treated with radical prostatectomy and 142 treated with 103palladium implantation for prostate cancer. The questionnaires included the RAND 36-Item Health Survey (SF-36), UCLA Prostate Cancer Index (PCI), Technology Assessment Group Cancer Interference With Family and Life General Scales, Memorial Anxiety Scale for Prostate Cancer and AUA Symptom Index. All participants were similar in age, race, pretreatment prostate specific antigen (PSA), Gleason score, cancer stage and disease-free status. The completed questionnaires revealed a longer mean time from treatment to the survey in the men with prostatectomy but no mean differences in age, race, previous PSA, Gleason score, cancer stage or disease-free status. On the SF-36 prostatectomy patients had better physical function, fewer role limitations caused by physical health and better energy-fatigue levels, while their role limitations due to emotional problems, emotional well-being, social function, pain and general health were similar to those of the men with brachytherapy. On the PCI, brachytherapy patients had better sexual and urinary function, and less sexual bother, but their bowel function and bother, and urinary bother were similar to those of the prostatectomy patients. When the men were grouped into 5-year intervals from treatment to survey, the researchers found that symptoms tended to improve with time, although there was still an advantage for prostatectomy on the SF-36 and for brachytherapy on the PCI. Overall men treated with 103palladium implantation had better urinary function, better sexual function and less sexual bother, but prostatectomy patients had equal or better overall health-related quality of life.

Long-term erectile function following real-time ultrasound-guided brachytherapy for prostate cancer
No. 1276 (Johnny Kao)
Poster presentation on Wednesday, May 3; 7 a.m. -- 4:30 p.m.; Rooms 254/255 W

These researchers evaluated sexual potency in men with prostate cancer before and every 6 months after implanting a radioactive seed to treat the disease. Before treatment, 85.1% of these 422 men had some erectile function, while 74.2% had enough erectile function for intercourse. Three years after implanting 125iodine or 103palladium, erectile function had decreased in a third of the men, while after 6 years it had decreased in two-thirds. The loss of potency was predicted by the degree of sexual function before implantation, the dose of radiation, and how large the prostate was before treatment. However, age over 60 or 70 years, the kind of radioactive isotope used, prostate specific antigen level, and the stage and grade of cancer did not predict the loss of potency. The most significant factors predisposing patients to decreased sexual function were the degree of potency before treatment and a high dose of radiation. Overall, 59.1% of the men in this study retained the ability to achieve an erection, although some decrease in sexual ability was also common. Men with less sexual function before treatment had the greatest risk of impotence after treatment.

Quality of life (QOL) in the first year following brachytherapy
No. 1271 (Jeffrey H. Martin)
Poster presentation on Wednesday, May 3; 7 a.m. -- 4:30 p.m.; Rooms 254/255 W

Thirty-one men with clinical stage T1-T2b prostatic cancer were treated with a 125iodine implant. These 51 to 80-year-old patients completed quality of life and AUA Symptom Score questionnaires before treatment, and up to a year after treatment. Their answers indicate that their quality of life, including physical and functional well-being, decreased in the first month after implantation, while urinary symptoms persisted for several months. A year after brachytherapy, quality of life and urinary symptoms had returned to what they were before brachytherapy. This information can be used to inform patients about what to expect when selecting among various treatments for the early stages of prostate cancer.

12-Year follow-up after transperineal brachytherapy of localized prostate cancer
No. 1493 (Haakon Ragde)
Podium presentation on Wednesday, May 3; 1:30 -- 3:30 p.m.; Auditorium

Because brachytherapy is now being performed more often for prostate cancer, these investigators evaluated 229 men with prostate cancer who received a 125iodine implant alone or in combination with external beam radiation. The study participants were an average of 71 years old, and they had up to 12 years of followup. Before brachytherapy, these men had clinical stage T1-T3, low to high Gleason grade cancer. Treatment failed after 18 to 115 months, and 60% of the patients were survivors. There was no disease 24 to 144 months after treatment in 151 of the 215 men who had enough followup. According to the researchers, today 67% of these 151 successfully treated men remain disease-free, while 33% died with no evidence of recurrence. At up to 12 years of followup, the 70% disease-free rate of prostate brachytherapy is comparable to or better than that of surgery.

Mechanical percussion, inversion, and diuresis for residual lower pole fragments following shock wave lithotripsy: A prospective, single-blinded, randomized controlled trial
No. 1508 (Kenneth T. Pace)
Poster presentation on Wednesday, May 3; 1:30 -- 3:30 p.m.; Rooms 360/361 W

After shock wave lithotripsy, there are usually stone fragments left in the lower kidney that can cause future stones and infection. In this study, 34 patients with residual fragments in the lower kidney 3 months after lithotripsy were randomized to receive 1 month of observation or mechanical percussion and inversion (MPI) using a mechanical chest percussor applied to the flank. The 13 patients under observation agreed to undergo MPI if stones persisted after 1 month. The 2 groups were similar in regard to gender, age, body mass index and initial stone burden. After treatment, the MPI group had a substantially higher stone-free rate than the observation group as well as a greater decrease in the total stone burden. There were no significant side effects in the patients who received MPI. Three months after treatment, nearly 50% of the MPI group were stone-free and the stone burden was about 70% less in other 50%.

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American Urological Association 2000 Annual Meeting Georgia World Congress Center Atlanta, GA April 29 -- May 4, 2000

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