Objective To investigate the prognostic value of the Gleason score in prostate cancer. Patients and methods A consecutive series of 305 men with prostate cancer diagnosed at transurethral resection (1975)(1976)(1977)(1978)(1979)(1980)(1981)(1982)(1983)(1984)(1985)(1986)(1987)(1988)(1989)(1990) and with no curative treatment was analysed. There was no assessment of prostate-specific antigen level during this period. The mean (range) age at diagnosis was 73.7 (52-95) years and the mean follow-up was 6.4 (0-22) years. The influence of Gleason score and the percentage of the specimen area with tumour (% cancer) on diseasespecific survival were assessed using Kaplan-Meier analyses. Results Of 305 cancers, 22% had a Gleason score of 4-5, 29% of 6, 18% of 7 and 32% of 8-10. At the follow-up, 89% of the men had died, of whom 42% had died from prostate cancer. The disease-specific 10-year survival was 56%. The disease-specific mean survival (DSMS) for Gleason score 4-5, 6, 7 and 8-10 was 20, 16, 10 and 5 years, respectively (P<0.001).The DSMS did not differ significantly between Gleason 4 and 5 or between 8-10. There was a trend towards shorter survival for Gleason 4+3=7 (DSMS 9 years) than GS 3+4=7 (DSMS 13 years; P=0.16). Gleason score and % cancer were independent predictors of DSMS (P<0.001). Conclusion The long-term prognosis of prostate cancer on deferred treatment is predicted well by the Gleason score. Four prognostic categories of prostate cancer are suggested, i.e. Gleason score 4-5, 6, 7 and 8-10.

OBJECTIVETo estimate the age-specific prevalence and severity of lower urinary tract symptoms (LUTS) among Swedish men, the intercorrelations between different symptoms, and to assess quality of life and health-seeking behaviour among men with LUTS. SUBJECTS AND METHODSIn 1997, an International Prostate Symptom Score (IPSS) questionnaire, together with other questions about lifestyle, was mailed to all men aged 45-79 years living in two counties in Sweden; the analyses included 39 928 men. RESULTSOverall, 18.5% and 4.8% of the men were moderately and severely symptomatic; the prevalence of at least one symptom was 83%. LUTS were strongly age-dependent, with 1.8% of severe symptoms among men aged 45-49 years and increasing to 9.7% among those 75-79 years old. Frequent urination was the most common symptom among men aged < 70 years and nocturia among those aged > 70 years. Symptoms like hesitancy, poor flow and intermittency were highly correlated with each other (Spearman coefficients 0.56-0.60). There was a high correlation between the IPSS and a poor score for quality of life resulting from the bothersomeness of LUTS ( r = 0.70). Among symptomatic subjects, 36% reported a poor quality of life (fairly bad, very bad or terrible). Only 29% of symptomatic subjects (IPSS > 7) reported that they had been diagnosed previously for their urinary problems, and only 11% received medication for that.

Acute renal failure was induced in heparinized rats by clamping the renal artery for 45 min. Ten minutes after recirculation the intrarenal blood flow distribution was measured. For this purpose labelled microspheres were injected together with 86-Rb chloride. The microspheres were used for determination of cardiac output, total renal and cortical blood flow, and 86-Rb for calculations of medullary blood flow. Total renal blood flow was reduced from 7.6 to 3.8 ml . min-1 . g-1 and cortical blood flow was reduced from 11.7 to 7.0 ml . min-1 . g-1. In the outer stripe of the medulla there was a reduction from 2.5 to 1.4 ml . min-1 . g-1. In the inner stripe there was a more pronounced reduction from 1.8 to 0.2 ml . min-1 . g-1 and in the inner zone from 0.8 to 0.1 ml . min-1 . g-1. The marked reduction in the blood flow to the renal medulla after recirculation is suggestive for a medullary ischemia, which might be responsible for the characteristic dysfunctions in acute renal failure.

Men with GS 6 tumours with both low Ki67 index and endoglin vascular density staining scores have a low risk of progression. Additional studies are needed to test whether these two markers can be applied to core biopsies to select patients suitable for surveillance.