[Show abstract][Hide abstract] ABSTRACT: Background
There is a worldwide debate involving clinicians, uropathologists as well as patients and their families on whether Gleason score 6 adenocarcinoma should be labelled as cancer.Case descriptionWe report a case of man diagnosed with biopsy Gleason score 6 acinar adenocarcinoma and classified as low risk (based on a PSA of 5 ng/mL and stage cT2a) whose radical prostatectomy specimen initially showed organ confined Gleason score 3¿+¿3¿=¿6, WHO nuclear grade 3, acinar adenocarcinoma with lymphovascular invasion and secondary deposit in a periprostatic lymph node. When deeper sections were cut to the point that almost all the slice present in the paraffin block was sectioned, a small tumor area (<5% of the whole tumor) of Gleason pattern 4 (poorly formed glands) was found in an extraprostatic position.Conclusion
The epilogue was that the additional finding changed the final Gleason score to 3¿+¿3¿=¿6 with tertiary pattern 4 and the stage to pT3a.Virtual SlidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/13000_2014_190.
[Show abstract][Hide abstract] ABSTRACT: Introduction
Data regarding long-term oncologic outcomes of laparoscopic renal cryoablation (LRC) as first treatment for small renal masses (SRMs) are lacking. We hypothesized that LRC might provide an effective long-term cancer control in patients with a single cT1a SRM without a previous history of renal cell carcinoma (RCC).
Materials and methods
The study design was a retrospective analysis of 174 consecutive patients who received LRC as first treatment for a single computed tomography or magnetic resonance imaging contrast-enhancing cT1a SRM between 2000 and 2013. Patients with a previous history of RCC were excluded. Treatment failure was evaluated 1 day after surgery. Local recurrence, metachronous SRM, systemic progression, disease relapse, cancer-specific mortality, and all-cause mortality were evaluated 10 years after surgery. Kaplan-Meier plots were used to depict outcome-free survival rate.
Median patient age was 66 years. Median tumor size was 20 mm. Median follow-up was 48 months. Among patients with biopsy-proven RCC (63%, n = 109), the treatment failure–free rate was 98%. The 10-year recurrence-free survival rate was 95% and the 10-year metachronous SRM–free survival rate was 87%. The 10-year systemic progression–free survival rate was 100% and the 10-year disease relapse–free survival rate was 81%. The cancer-specific mortality–free survival rate was 100%, and the all-cause mortality–free survival rate was 61%.
LRC provides safe long-term cancer control in patients newly diagnosed with a single cT1a SRM. Treatment failure and local recurrence are uncommon. Systemic progression–free survival and cancer-specific–free survival are optimal.
Urologic Oncology: Seminars and Original Investigations. 10/2014;
[Show abstract][Hide abstract] ABSTRACT: Background
Some reports have suggested that nephron-sparing surgery (NSS) may protect against cardiovascular events (CVe) when compared with radical nephrectomy (RN). However, previous studies did not adjust the results for potential selection bias secondary to baseline cardiovascular risk.
To test the effect of treatment type (NSS vs RN) on the risk of developing CVe after accounting for individual cardiovascular risk.
Design, setting, and participants
A multi-institutional collaboration including 1331 patients with a clinical T1a–T1b N0 M0 renal mass and normal renal function before surgery (defined as an estimated glomerular filtration rate ≥60 ml/min/1.73 m2).
RN (n = 462, 34.7%) or NSS (n = 869, 65.3%) between 1987 and 2013.
Outcome measurement and statistical analyses
CVe was defined as onset during the follow-up period of coronary artery disease, cardiomyopathy, hypertension, vasculopathy, heart failure, dysrhythmias, or cerebrovascular disease not known before surgery. Cox regression analyses were performed. To adjust for inherent baseline differences among patients, we performed multivariate analyses adjusting for all available characteristics depicting the overall and cardiovascular-specific profile of the patients.
Results and limitations
When stratifying for treatment type, the proportion of patients who experienced CVe at 1, 5, and 10 yr was 5.5%, 9.9%, and 20.2% for NSS patients compared to 8.7%, 15.6%, and 25.9%, respectively, for RN patients (p = 0.001). In multivariate analyses, patients who underwent NSS showed a significantly lower risk of developing CVe compared with their RN counterparts (hazard ratio 0.57, 95% confidence interval 0.34–0.96; p = 0.03) after accounting for clinical characteristics and cardiovascular profile. Limitations include the retrospective design of the study because other potential confounders may exist.
The risk of CVe after renal surgery is not negligible. Patients treated with NSS have roughly half the risk of developing CVe relative to their RN counterparts. After accounting for clinical characteristics, comorbidities, and cardiovascular risk at diagnosis, NSS independently decreases the risk of CVe relative to RN.
The risk of having a cardiovascular event after renal surgery decreases if a portion of the affected kidney is spared.
[Show abstract][Hide abstract] ABSTRACT: The role of adjuvant radiotherapy (aRT) in treating patients with pN1 prostate cancer is controversial. We tested the hypothesis that the impact of aRT on cancer-specific mortality (CSM) in these individuals is related to tumor characteristics.
Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 09/2014;
[Show abstract][Hide abstract] ABSTRACT: To evaluate the concordance and prognostic role of histologic variants of bladder urothelial carcinoma in transurethral resection of bladder tumor (TURBT) and radical cystectomy (RC) specimens.
[Show abstract][Hide abstract] ABSTRACT: Assess knowledge and awareness concerning human papillomavirus (HPV) infection, HPV-associated diseases, and the existence of a specific vaccine among non-HPV-screened Caucasian-European adults after the market introduction of HPV vaccines.
World Journal of Urology 09/2014; · 2.89 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A recent study observed a survival benefit in men diagnosed with metastatic prostate cancer (mPCa) and managed with local treatment of the primary tumor (LT; either radical prostatectomy plus pelvic lymph node dissection or radiation therapy). We tested the hypothesis that only specific mPCa patients would benefit from LT and that the potential benefit would vary based on primary tumor characteristics. A total of 8197 mPCa patients at diagnosis (M1a, M1b, and M1c) were identified using the Surveillance Epidemiology and End Results database (2004–2011) and were divided according to treatment type: LT versus nonlocal treatment of the primary tumor (NLT; either androgen deprivation therapy or observation). Multivariable Cox regression analysis was used to predict cancer-specific mortality (CSM) in patients that received NLT. To assess whether the benefit of LT was different by baseline risk, we tested an interaction with CSM risk and LT. At multivariable analysis, all predictors were significantly associated with CSM, and the interaction test was statistically significant (p < 0.0001). Local treatment of the primary tumor, compared with NLT, conferred a higher CSM-free survival rate in patients with a predicted CSM risk <40%. The number needed to treat according to the predicted CSM risk at 3 yr after diagnosis remained substantially constant from 10% to 30%, whereas it exponentially increased for predicted CSM risk >40%. These results should serve as a foundation for future prospective trials.
Among metastatic prostate cancer patients, the potential benefit of local treatment to the primary tumor depends greatly on tumor characteristics, and patient selection is essential to avoid either over- or undertreatment.
[Show abstract][Hide abstract] ABSTRACT: Introduction: Benign prostatic hyperplasia (BPH) is a very common condition in men over 50 years, often resulting in lower urinary tract symptoms (LUTS). Medical therapy aims at improving quality of life and preventing complications. The range of drugs available to treat LUTS is rapidly expanding. Areas covered: Silodosin is a relatively new α1-adrenoreceptor antagonist that is selective for α1A-adrenergic receptor. While causing smooth muscle relaxation in the lower urinary tract, it minimizes blood pressure-related adverse effects. Tadalafil, a PDEs type 5 inhibitor, is a drug recently approved for the treatment of BPH/LUTS that challenges the standard therapy with α1-blockers, especially in men with concomitant erectile dysfunction (ED). Mirabegron is the first β3-adrenoceptor agonist approved for the treatment of symptoms of overactive bladder. BPH-related detrusor overactivity (DO) may be successfully targeted by mirabegron. Gonadotropin-releasing hormone antagonists, intraprostatic injections with NX-1207 and vitamin D3 receptor analogues exerted beneficial effects on LUTS but need further evaluation in clinical studies. Expert opinion: Choosing the right treatment should be guided by patients' symptoms, comorbidities and potential side effects of available drugs. Silodosin is a valid option for elderly and for people taking antihypertensive drugs. BPH patients affected by ED can target both conditions with continuous tadalafil therapy. The encouraging data on mirabegron use in BPH-DO have to be further assessed in larger prospective randomized clinical trials.
Expert Opinion on Pharmacotherapy 08/2014; · 2.86 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To test the effect of radiotherapy administered within 6 months after radical prostatectomy on cancer-specific mortality in prostate cancer patients after stratification according to a risk score.
International Journal of Urology 08/2014; · 1.73 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Surgical site infection (SSI) represents the second most common cause of hospital-acquired infection and the most common type of infection in patients undergoing surgery. However, evidence is scarce regarding the effect of the surgical approach (open surgery vs minimally invasive surgery [MIS]) on the risk for SSIs.