In Reply: Re

LETTERS TO THE EDITOR carrier embryos were transferred and a healthy boy (AF508 carrier) was born. At our institution 4 patients with congenital bilateral aplasia of the vas deferens without a family history of this condition or of cystic fibrosis were investigated for cystic fibrosis mutations and 1 was heterozygous for bF508. To minimize the risk of a child with cystic fibrosis we believe that preoperative screening for cystic fibrosis mutations and genetic counseling are of major importance. Screenine should be performed in patients with congenital bilateral iplasia 07 the vas deferens before intracytoplasmic injection of spermatozoa. Respectfully, Eugen Plas and Heinz Pfluger Department of Urology and LBI for Urology and Andrology Lainz Hospital Vienna Wolkersbergenstr. 1 A-1130 Vienna Austria 1. Oates, R. D. and Amos, J. E.: The genetic basis of congenital

bilateral absence of the vas deferens and cystic fibrosis. J. Androl., 16: 1, 1994. 2. Patrizio, P., Asch, R. H., Handelin, B. and Silber, S. J.: Aetiology of congenital absence of vas deferens: genetic study of three generations. Hum. Reprod., 8 215,1993. 3. Liu, J., Lissens, W., Silber, S. J., Devroey, P., Liebaers, I. and Van Steirteghem, A.: Birth after preimplantation diagnosis of the cystic fibrosis delta F508 mutation by polymerase chain reaction in human embryos resulting from intracytoplasmatic sperm injection with epididymal sperm. J.A.M.A., 272: 1858, 1994.

Reply by Authors. We agree that genetic testing and counseling should be offered to all patients with congenital bilateral aplasia of the vas deferens undergoing epididymal or testicular aspiration because of the data cited. Genetic testing and counseling were provided to the couple in our article. The constraints of the article did not allow complete elaboration on the genetic transmission of congenital bilateral aplasia of the vas deferens.

RE: THE PERIURETHRAL GLANDS DO NOT SIGNIFICANTLY INFLUENCE THE SERUM PROSTATE SPECIFIC ANTIGEN CONCENTRATION

J. E. Oesterling, A. H. Tekchandani, S. K. Martin,

E.J . Bergstralh, E. Reichstein, E. P. Diamandis, C. Yemoto and T. A. Stamey J . Urol., 1 5 6 1658-1660, 1996

TO the Editor. The authors address the influence of penurethral

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0.1 to 0.6 ng./ml. (by Tandem-R* assay) served as negative and positive controls to calculate the functional sensitivity of the 2 assays used a t this low level. We concluded that intact periurethral glands and/or other extraprostatic sources of PSA could not infer the subjective biochemical recurrence (that is serum PSA 0.1 to 0.6ng.lml.1 after curative radical prostatectomy. We are concerned that the authors are not aware of our previous studies on the same topic. Respectfully, A. Elgamal and L. Baert Department of Urology University Hospitals of KU. Leuven 3000 Leuven, Belgium

1. Elgamal, A. A,, Van de Voorde, W., Van Poppel, H., Lauweryns, J. and Baert, L.: Immunohistochemical localization of prostate-s ecific markers within the accessory male sex glands of Eowper, Littre and Morgagni. Urology, 44:84,1994. 2. Elgamal, A. A., Billen, J., Van de Voorde, W., Van Poppel, H., Blanckaert, N. and Baert, L.: Verification and sigdicance of PSA production,by the periurethral glands. Read at annual meeting of International Conference of Androgenic Hormones, Prostate Cancer and Benign Prostatic Hyperplasia. New Orleans, Louisiana, March 13-15,abstract 11, 1995. 3. Elgamal, A. A., Billen, J., Van de Voorde, W., Van Poppel, H., Blanckaert, N., De Roo, M. and Baert, L.: Extra prostatic sources of PSA, does it infer the subjective biochemical recurrence after radical prostatectomy. J. Urol., part 2, 153:518A. abstract 1157,1995.

RE: PREOPERATIVE REVERSE TRANSCRIF'TASE POLYMERASE CHAIN REACTION FOR PROSTATE SPECIFIC ANTIGEN PREDICTS TREATMENT FAILURE FOLLOWING RADICAL PROSTATECTOMY C. A. Olsson, G. M. de Vries, A. J . Raffo, M. C. Benson, K. O'Twle, Y . Cao, R. E. Buttyan and A. E. Katz J. Urol., 155:1557-1562, 1996 To the Editor. Finding the 1 test that can predict who among prostate cancer patients will not benefit from any of the currently available treatment modalities is an elusive goal that this report attempted to reach. Although the conclusions of the authors are consistent with the study results, it is important to distinguish between statistical significance and clinical usefulness. It is debatable whether one should ascribe a superior treatment predictive ability of reverse transcriptase polymerase chain reaction over traditional prognostic factors, such as preoperative serum prostate specific antigen and Gleason grade, based solely on the magnitude of the odds ratio. Furthermore, it has been noted that treatment predictive factors may be best identified within a large, randomized trial with treated and untreated patients.' Even though reverse transcriptase-polymerase chain reaction is an investigational test of unproved cost-effectiveness, its misrepresentation in some other media has driven a few patients to inquire about where they can have this new test done, how much it will cost them and whether insurance will cover the expense. There is enough evidence that preoperative serum prostate specific antigen,2,3 Gleason grade4.5and tumor volume6 are reliable prognostic factors. Nevertheless, many clinicians have been frustrated by the frequent disparity between the Gleason grade of preoperative biopsy specimens and final pathological specimen, which is explained by the multifocal nature of prostate cancer,' its heterogeneity and our mistaken anticipation of perfect correlation between the 2 samples.8 If the Gleason grade of a biopsy specimen is high (7to 10)then the Gleason grade of the pathological specimen does not matter. While we await the results of more convincing studies, careful use of established prognostic factors rather than confirmation of a few cancer cells in the peripheral blood should help urologists avoid surgery in those who are doomed to failure. Steven Ansong Bassett Healthcare One Atwell Road Cooperstown, NY 13326-1394

glands on serum prostate specific antigen (PSA) in men undergoing cystoprostato-urethrectomyversus those undergoing cystoprostatecY" alone using 3 independent assays. They concluded that follow1% radical prostatectomy a PSA of greater than the residual cancer detection limit could reflect malignant or benign residual tissue, even if obtained with ultrasensitive assays. Nevertheless, the upper ranges of PSA in both g r o ~ p were s higher than the analytical sensitivities of the assays used in few individual cases without convenient explanation. We demonstrated immunohistochemically PSA containing cells in normal Cowper's glands, and consistently supported the finding in Penurethral and intraurethral glands.' Later, we verified their role In PSA secretion in urine by comparing bladder urine versus urethral urine after radical prostatedomy.2 We discussed the potential e s serum PSA levels after presumed Contribution of these s o ~ ~ c on radical surgery when monitoring patients using hypersensitive assays.' Consequently, we reported our results.3 Our study population Included 56 consecutive patients with presumed curative radical Prosbkctomy after thorough histopathological evaluation (mean fob l0mP 19 months). This group was considered to have intact accessory 'nonprostatic" sources of PSA. Serum from this group was 1. Steineck, G., Adolfsson, J., Scher, H. I. and Whitmore, W. F. Jr.: to serum from 22 consecutive men aRer e ~ ~ t o p r o s t a ~ Distinguishing rognostic and treatment-predictive informaurethrectomy due to bladder cancer (mean followup 19 months) tion for l o c a h d prostate cancer. Urology, 4& 610,1995. who had no prostate or penurethral glands. Serum h m 3 women who * Hybritech Inc., San Diego, California. underwent anterior pelvic exenteration and 22 routine samples a t