The feasibility of a population-based evaluation of screening for prostate cancer in men with a raised familial risk was investigated by studying reasons for non-participation and uptake rates according to postal recruitment and clinic contact. The levels of prostate-specific antigen (PSA) and the positive predictive values (PPV) for cancer in men referred with a raised PSA and in those biopsied were analysed. First-degree male relatives (FDRs) were identified through index cases (ICs): patients living in two regions of England and diagnosed with prostate cancer at age ⩽65 years from 1998 to 2004. First-degree relatives were eligible if they were aged 45–69 years, living in the UK and had no prior diagnosis of prostate cancer. Postal recruitment was low (45 of 1687 ICs agreed to their FDR being contacted: 2.7%) but this was partly due to ICs not having eligible FDRs. A third of ICs in clinic had eligible FDRs and 49% (192 out of 389) agreed to their FDR(s) being contacted. Of 220 eligible FDRs who initially consented, 170 (77.3%) had a new PSA test taken and 32 (14.5%) provided a previous PSA result. Among the 170 PSA tests, 10% (17) were ⩾4 ng ml−1 and 13.5% (23) tests above the age-related cutoffs. In 21 men referred, five were diagnosed with prostate cancer (PPV 24%; 95% CI 8, 47). To study further the effects of screening, patients with a raised familial risk should be counselled in clinic about screening of relatives and data routinely recorded so that the effects of screening on high-risk groups can be studied.
OBJECTIVE To examine the preoperative features and pathological outcomes of clinical significance of 1001 consecutive essentially unscreened men who had a radical prostatectomy (RP) in the UK between 1988 and 2002, and their changes over time. PATIENTS AND METHODS The details of men whose RP specimen was submitted for analysis were entered into the RP database held at the University College Hospital, London; the National Health Service and private patients of 17 surgeons were included. The age, mode of diagnosis, preoperative prostate specific antigen (PSA) level, biopsy and RP findings were compared over time. RESULTS The mean (range) age of the men was 62 (40–76) years, the median PSA 8 (0.1–146) ng/mL and the median biopsy Gleason sum score 6; these preoperative features did not change over the study period. The diagnosis of prostate cancer was made by transurethral resection of the prostate alone in 48 men (5%). The maximum number of patients receiving neoadjuvant androgen ablation was 21 (33%) in 1996, and subsequently declined. The median (range) RP Gleason sum score was 7 (4–9). The biopsy Gleason score correlated with the prostatectomy Gleason score in 252 (47%) of 536 men, being lower in 170 (32%) and higher in 113 (21%). The median tumour volume was 2 mL (focus of invasive acini – 31 mL) and the incidence of positive intra‐ and extraprostatic margins was 52%. Both tumour volume and extraprostatic margin positivity declined with time. CONCLUSIONS The preoperative features and pathological findings from this UK series are similar to those of other reported cohorts from unscreened populations. The incidence of positive extraprostatic surgical margins, tumour volume and stage decreased with time.
Introduction Bladder specimens received by pathologists commonly include endoscopic biopsy specimens and tissue from transurethral resections (TURB), both of which incorporate subepithelial tissues to a varying depth, as well as those resulting from cystectomy, cystoprostato-urethrectomy and pelvic exenteration. Less frequently seen are full thickness specimens of the bladder wall carried out at laparotomy (open biopsy), diverticula, and partial cystectomy specimens such as those for urachal carcinoma in which bladder dome, urachus, and umbilicus are excised. An Endocut needle based on the Trucut principle is currently being assessed for the ease with which information on tumour invasion can be derived from the tissue specimen. The commonest indication for the examination of bladder tissue remains the diagnosis and assessment of prognostic factors in transitional cell carcinoma (TCC) which comprises 95% of bladder cancer in Britain.
Summary— A study was made of 100 cadaveric prostates (71 benign glands and 29 invaded by adenocarcinoma) using a technique that enabled per‐rectal ultrasonography to be carried out and their volumes measured by computed planimetry. These volumes were compared directly with the actual volumes of the glands measured after dissection from the cadaver specimens. A high degree of correlation was obtained for the measurement of benign glands ( r = 0.982) and glands containing cancers confined within the capsule ( r = 0.961). Estimation of the size of cancers unconfined to the gland was poor and measurement was not possible with 3 malignant prostates that had extended beyond the prostatic capsule so that the ultrasonic boundary could not be defined.
To assess differences in the histopathological diagnoses of a series of paratesticular sarcomas following changes in the morphological classification of these tumours and the availability of investigations to define their immunophenotype, and to consider the impact of these changes on clinical management.Thirty-six soft tissue tumours of the paratesticular region, originally submitted to the British Testicular Tumour Panel and Registry between 1958 and 1967 were re-examined histologically using modern diagnostic criteria, including immunohistochemical features. Where possible, follow-up was brought up to date.Thirteen (35%) of the diagnoses made in 1967 were changed; of these, seven changes were attributable to the results of immunohistochemical tests and one involved the identification of an entity not recognized in 1967 (spindle cell rhabdomyosarcoma).The changes in diagnoses of major clinical relevance involved three neoplasms (8%) in which the recent opinion was rhabdomyosarcoma, a tumour for which successful treatment protocols are currently available.
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