Latent carcinoma of the prostate in a 24-year-old man receiving cyclophosphamide and azathioprine
WORKSHOP ON WRITING FOR PHYSICIANS Tuesday, June 21, 1977
Auberge des Gouverneurs, Quebec * Do you want to make your scientific writing more effective, more interesting, more acceptable? * Are you interested in the principles of effectively organizing medical papers and reports? * Do you want to learn how to prepare papers to convince editors, reviewers and readers? If so, attend a 1-day workshop to be held during the CMA annual meeting. Workshop will include discussion of preworkshop assignments and various aspects of medical writing. Faculty: David A. E. Shephard, MB, FRCP[CI, Scientific editor, CMAJ David Woods, Consultant, Medical Communications Services * Registration limited to 25 participants; 0 Fee: $50 * Deadline for registration: May 27, 1977 * For further details write to: Dr. David A. E. Shephard, Scientific editor CANADIAN MEDICAL ASSOCIATION JOURNAL Box 8650, Ottawa, Ont. KIG 0G8
1973. The serum creatinine value was 4.1 leagues1'2 showed that the steepest mg/dI on May 25, 5.3 mg/dI on June 21, curve of increase was that for prostatic 6.6 mg/dl on July 22 and 12.3 mg/dI on carcinoma. The curve can be transAug. 24. Long-term hemodialysis was formed into a straight-line relationship started and no more cyclophosphamide if incidence is plotted against the fourth was given. The prednisone dose was repower of age, assuming that exposure duced to 20 mg every other morning. starts only at about 30 to 35 years of On Sept. 19 the atrophic, grossly scarred left kidney and narrow, scarred left ureter age. By retropolation there should be were excised. On Oct. 1, 1973 right neph- an incidence of 0 at 32.5 years. Anrectomy was performed; this kidney had other way of considering this is to a similar gross and microscopic appear- assume that effective exposure to carciance. Rectal examination on both these nogens starts before 30 to 35 years admissions was reported as yielding nor- of age. mal findings. The patient remained well Patients with earlier occurrence of on long-term hemodialysis. He died suddenly Dec. 31, 1973 after overeating, pos- prostatic cancer may therefore be reasibly because of hyperkalemia and pul- sonably suspected to have been exposed to unusually effective doses much monary edema. His prostate was grossly normal. The earlier. The fourth-power relationship whole organ was sectioned at 5-mm inter- also implies that the carcinogenic provals. It contained a laminar, microacinar, cess may be in four stages. The reclear-cell carcinoma, 20 x 15 x 6 mm, ported case fits some of these criteria: which extended on both sides of the mid- early age, exposure to unusually high line in the periphery of each posterior doses of cyclophosphamide, possibly quadrant, just invading the plain muscle potentiated by other immunosuppresand capsule without distorting its symmetry. There was no permeation of the sive agents, and the presence of a perineural spaces and there were no distant "latent" carcinoma. The incidence of latent prostatic carmetastases. cinoma is far greater than that of any other carcinoma in older age groups. Discussion Although this tumour is considered In statistical analysis of age-inci- nominally a stage A cancer it behaves dence curves for different types of differently from other progressive metacancer occurring spontaneously in dif- stasizing carcinomas. and therefore may ferent countries Cook, Doll and col- represent a step in a multistage process.
Our study, which detected 40 prostatic cancers, showed that these tumours do not form palpable nodules; they conform to the prostatic capsule, causing no distortion when in contact with it, and often are distorted themselves by more central benign hyperplasia. In other words, they grow more slowly in the oldest peripheral part of the prostate and remain dormant. Any factor removing this latency would transform them into an immense health hazard, greater than that of bronchogenic carcinoma. Conclusion This report suggests that wholeprostate surveys should be planned among patients under 32.5 years of age who die after immunosuppressive or mutagenic therapy. Such monitoring may give information on the duration of exposure and dose necessary for carcinogens to be effective, information often Jacking for human cancers. References 1. COOK PJ, DOLL R, FELLINUHAM SA: A mathematical model for the age distribution of cancer in man. mt / Cancer 4: 93 1969 2. DOLL R: The age distribution of cancer: implications for models of carcinogenesis. J R Statis Soc Ser A (Gen) 134: 133, 1971 3. CORREA RJ, ANDERSON RG, GIBBONS RP, et al: Latent carcinoma of the prostate: why the controversy? I Urol 111: 644, 1974
Whatever kind of asthma she has...
Tedrals.
'1
gives her more room to breathe In the treatment of asthma in all its forms, TEDRAL SA has established itself as an antiasthmatic drug of good reliability. During 1976 alone, Canadian doctors wrote over 200,000 prescriptions for TEDRAL
/
652 CMA JOURNAL/MARCH 19, 1977/VOL. 116
TEDRAL SA gives the asthmatic more room to breathe - and its sustained action allows convenient "round-the-clock" protection. Prescribing Infomustlon Composition: Each biconvex tablet of Tedral SA contains ephednne 48 mg, theophylline 180 mg, and phenobarbital 25 mg. Indications: The prophylaxis of asthmatic attacdcs. The symptomatic rebel otbronchial asthma, asthmatic bronchitis, and other bronchospastic disorders Contrslndlcations: Sensiti to any of the components, patients receMng MAO inhibitors. Precautions: Administer with caution in patients with cardiovascular disease and/or severe hypertension, circulatory collapse, hyperthyroidism, prostatic hypertrophy, or glaucoma. Phenobarbital may be habit forming Side effecte: Mild gastric distress, pal8itation, tremor, insomnia, difficulty of micturitlon and NS stimulation have been reported. Dosage: Tedral SA- 1 tablet every 12 hours. Full preecrlblnglnformatlon Isavallableon request, MEMBER
EE. .TeckalSAtrom
WaI'ner/Chllcott Laboratories Co. Limited.Toronto. Canada
WORKSHOP ON WRITING FOR PHYSICIANS Tuesday, June 21, 1977
Auberge des Gouverneurs, Quebec * Do you want to make your scientific writing more effective, more interesting, more acceptable? * Are you interested in the principles of effectively organizing medical papers and reports? * Do you want to learn how to prepare papers to convince editors, reviewers and readers? If so, attend a 1-day workshop to be held during the CMA annual meeting. Workshop will include discussion of preworkshop assignments and various aspects of medical writing. Faculty: David A. E. Shephard, MB, FRCP[CI, Scientific editor, CMAJ David Woods, Consultant, Medical Communications Services * Registration limited to 25 participants; 0 Fee: $50 * Deadline for registration: May 27, 1977 * For further details write to: Dr. David A. E. Shephard, Scientific editor CANADIAN MEDICAL ASSOCIATION JOURNAL Box 8650, Ottawa, Ont. KIG 0G8
1973. The serum creatinine value was 4.1 leagues1'2 showed that the steepest mg/dI on May 25, 5.3 mg/dI on June 21, curve of increase was that for prostatic 6.6 mg/dl on July 22 and 12.3 mg/dI on carcinoma. The curve can be transAug. 24. Long-term hemodialysis was formed into a straight-line relationship started and no more cyclophosphamide if incidence is plotted against the fourth was given. The prednisone dose was repower of age, assuming that exposure duced to 20 mg every other morning. starts only at about 30 to 35 years of On Sept. 19 the atrophic, grossly scarred left kidney and narrow, scarred left ureter age. By retropolation there should be were excised. On Oct. 1, 1973 right neph- an incidence of 0 at 32.5 years. Anrectomy was performed; this kidney had other way of considering this is to a similar gross and microscopic appear- assume that effective exposure to carciance. Rectal examination on both these nogens starts before 30 to 35 years admissions was reported as yielding nor- of age. mal findings. The patient remained well Patients with earlier occurrence of on long-term hemodialysis. He died suddenly Dec. 31, 1973 after overeating, pos- prostatic cancer may therefore be reasibly because of hyperkalemia and pul- sonably suspected to have been exposed to unusually effective doses much monary edema. His prostate was grossly normal. The earlier. The fourth-power relationship whole organ was sectioned at 5-mm inter- also implies that the carcinogenic provals. It contained a laminar, microacinar, cess may be in four stages. The reclear-cell carcinoma, 20 x 15 x 6 mm, ported case fits some of these criteria: which extended on both sides of the mid- early age, exposure to unusually high line in the periphery of each posterior doses of cyclophosphamide, possibly quadrant, just invading the plain muscle potentiated by other immunosuppresand capsule without distorting its symmetry. There was no permeation of the sive agents, and the presence of a perineural spaces and there were no distant "latent" carcinoma. The incidence of latent prostatic carmetastases. cinoma is far greater than that of any other carcinoma in older age groups. Discussion Although this tumour is considered In statistical analysis of age-inci- nominally a stage A cancer it behaves dence curves for different types of differently from other progressive metacancer occurring spontaneously in dif- stasizing carcinomas. and therefore may ferent countries Cook, Doll and col- represent a step in a multistage process.
Our study, which detected 40 prostatic cancers, showed that these tumours do not form palpable nodules; they conform to the prostatic capsule, causing no distortion when in contact with it, and often are distorted themselves by more central benign hyperplasia. In other words, they grow more slowly in the oldest peripheral part of the prostate and remain dormant. Any factor removing this latency would transform them into an immense health hazard, greater than that of bronchogenic carcinoma. Conclusion This report suggests that wholeprostate surveys should be planned among patients under 32.5 years of age who die after immunosuppressive or mutagenic therapy. Such monitoring may give information on the duration of exposure and dose necessary for carcinogens to be effective, information often Jacking for human cancers. References 1. COOK PJ, DOLL R, FELLINUHAM SA: A mathematical model for the age distribution of cancer in man. mt / Cancer 4: 93 1969 2. DOLL R: The age distribution of cancer: implications for models of carcinogenesis. J R Statis Soc Ser A (Gen) 134: 133, 1971 3. CORREA RJ, ANDERSON RG, GIBBONS RP, et al: Latent carcinoma of the prostate: why the controversy? I Urol 111: 644, 1974
Whatever kind of asthma she has...
Tedrals.
'1
gives her more room to breathe In the treatment of asthma in all its forms, TEDRAL SA has established itself as an antiasthmatic drug of good reliability. During 1976 alone, Canadian doctors wrote over 200,000 prescriptions for TEDRAL
/
652 CMA JOURNAL/MARCH 19, 1977/VOL. 116
TEDRAL SA gives the asthmatic more room to breathe - and its sustained action allows convenient "round-the-clock" protection. Prescribing Infomustlon Composition: Each biconvex tablet of Tedral SA contains ephednne 48 mg, theophylline 180 mg, and phenobarbital 25 mg. Indications: The prophylaxis of asthmatic attacdcs. The symptomatic rebel otbronchial asthma, asthmatic bronchitis, and other bronchospastic disorders Contrslndlcations: Sensiti to any of the components, patients receMng MAO inhibitors. Precautions: Administer with caution in patients with cardiovascular disease and/or severe hypertension, circulatory collapse, hyperthyroidism, prostatic hypertrophy, or glaucoma. Phenobarbital may be habit forming Side effecte: Mild gastric distress, pal8itation, tremor, insomnia, difficulty of micturitlon and NS stimulation have been reported. Dosage: Tedral SA- 1 tablet every 12 hours. Full preecrlblnglnformatlon Isavallableon request, MEMBER
EE. .TeckalSAtrom
WaI'ner/Chllcott Laboratories Co. Limited.Toronto. Canada
