No abstract

Pelvic lipomatosis may increase significantly the difficulty and morbidity of many urologic procedures. Radical prostatectomy in this setting has not been described previously. Such a case is presented and the reported surgical experience in pelvic lipomatosis is reviewed. Considerations in the management of prostatic cancer in patients with this condition are discussed.

The classification of patients with incidental carcinoma of the prostate into focal (Stage A1) or diffuse (Stage A2) subgroups depends primarily on the microscopic findings on tissue removed from transurethral resection (TUR) or open enucleation. However, these procedures sample only a portion of the entire prostate, and some patients staged A1 may have residual diffuse cancer that should properly be classified as Stage A2. This study is a review of 86 patients with Stage A1 cancer of the prostate in whom additional prostatic tissue was available because of repeat transurethral resection or radical prostatectomy. Only six patients (7%) were found to have diffuse cancer in the remaining prostatic tissue. Therefore, it appears that the classification of patients into Stage A1 or Stage A2 is generally accurate when based on the findings from initial TUR alone and that the incidence of understaging in this group is low. Repeat transurethral resection does not appear to contribute significantly to the accuracy of staging.

SummaryCrude bovine Factor VIII preparations have been modified by passage over a column of trypsin-agarose. Factor VIII prepared without an early adsorption step utilizing either barium sulfate or aluminum hydroxide gel generated significant Factor Xa activity by passage over such a column and was unsuitable for further characterization. Factor VIII prepared using adsorption with barium sulfate contained no Factor Xa activity after passage over trypsin-agarose. This trypsin-modified material showed a decreased molecular size as judged by behavior on gel filtration and an increased rate of reaction with bovine Factor IXa.

Patients with stage A2 carcinoma of the prostate are a heterogeneous population and not all of them progress to clinically manifest disease. We found a similar variability in terms of the pathological findings in a group of 34 patients with stage A2 disease undergoing pelvic lymphadenectomy and radical prostatectomy. While 8 patients (24 per cent) had metastatic disease on staging lymphadenectomy, 9 patients (27 per cent) had negative lymphadenectomy, with minimal or no residual tumor in the radical specimen. The histologic grade and extent of tumor on transurethral resection did not predict reliably patients with stage A2 disease and minimally invasive cancer at radical prostatectomy. It appears that present criteria for separating stage A tumors into focal and diffuse categories are adequate for selecting therapy for patients with incidental carcinoma of the prostate.