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Video: Upstage, downstage: the spotlight on FDG-PET/CT for managing bladder cancer

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Impact of 18F-fluorodeoxyglucose (FDG)-positron-emission tomography/computed tomography (PET/CT) on management of patients with carcinoma invading bladder muscle

Laura S. Mertens, Annemarie Fioole-Bruining*, Erik Vegt†, Wouter V. Vogel†, Bas W. van Rhijn and Simon Horenblas

Departments of Urology, *Radiology and †Nuclear Medicine, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands

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OBJECTIVE

• To evaluate the clinical impact of 18F-fluorodeoxyglucose (FDG)-positron-emission tomography/computed tomography (PET/CT) scanning, compared with conventional staging with contrast-enhanced CT imaging (CECT).

PATIENTS AND METHODS

• The FDG-PET/CT results of 96 consecutive patients with bladder cancer were analysed. Patients included in this study underwent standard CECT imaging of the chest and abdomen/pelvis <4 weeks before FDG-PET/CT.

• Based on the original imaging reports and recorded tumour stage before and after FDG-PET/CT imaging, the preferred treatment strategies before FDG-PET/CT and after FDG-PET/CT were determined for each patient using an institutional multidisciplinary guideline. One of the following treatment strategies was chosen: (i) local curative treatment; (ii) neoadjuvant/induction chemotherapy; or (iii) palliation.

• The changes in management decisions before and after FDG-PET/CT were assessed.

RESULTS

• The median (range) interval between CECT and FDG-PET/CT was 0 (029) days.

• In 21.9% of the patients, stage on FDG-PET/CT and CECT were different. Upstaging by FDG-PET/CT was more frequent than downstaging (19.8 vs 2.1%).

• Clinical management changed for 13.5% of patients as a result of FDG-PET/CT upstaging. In eight patients, FDG-PET/CT detected second primary tumours. This led to changes of bladder cancer treatment in another four of 96 patients (4.2%).

• All the management changes were validated by tissue confirmation of the additional lesions.

CONCLUSIONS

• FDG-PET/CT provides important additional staging information, which influences the treatment of carcinoma invading bladder muscle in almost 20% of cases.

• Patient selection for neoadjuvant/induction chemotherapy was improved and futile attempts at curative treatment in patients found to have metastases were avoided.

Article of the week: Discovery provides new means for regenerative bladder reconstruction

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Every week the Editor-in-Chief selects the Article of the Week from the current issue of BJUI. The abstract is reproduced below and you can click on the button to read the full article, which is freely available to all readers for at least 30 days from the time of this post.

In addition to the article itself, there is an accompanying editorial written by a prominent member of the urological community. This blog is intended to provoke comment and discussion and we invite you to use the comment tools at the bottom of each post to join the conversation.

Finally, the third post under the Article of the Week heading on the homepage will consist of additional material or media. This week we feature a video of Dr Verdi discussing his paper.

If you only have time to read one article this week, it should be this one.

Endometrial stem cell differentiation into smooth muscle cell: a novel approach for bladder tissue engineering in women

Alireza Shoae-Hassani*, Shiva Sharif, Alexander M. Seifalian†, Seyed Abdolreza Mortazavi-Tabatabaei‡, Sassan Rezaie§ and Javad Verdi

Departments of Applied Cell Sciences and §Medical Biotechnology, School of Advanced Technologies in Medicine, and *Department of Stem cell and Tissue Engineering, Research Center for Science and Technology in Medicine (RCSTiM), Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran, †University College London, UCL Centre for Nanotechnology and Regenerative Medicine, London, UK, and ‡Proteomics Research Center, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran

Read the full article
OBJECTIVE

• To investigate manufacturing smooth muscle cells (SMCs) for regenerative bladder reconstruction from differentiation of endometrial stem cells (EnSCs), as the recent discovery of EnSCs from the lining of women’s uteri, opens up the possibility of using these cells for tissue engineering applications, such as building up natural tissue to repair prolapsed pelvic floors as well as building urinary bladder wall.

MATERIALS AND METHODS

• Human EnSCs that were positive for cluster of differentiation 146 (CD146), CD105 and CD90 were isolated and cultured in Dulbecco’s modified Eagle/F12 medium supplemented with myogenic growth factors.

• The myogenic factors included: transforming growth factor β, platelet-derived growth factor, hepatocyte growth factor and vascular endothelial growth factor.

• Differentiated SMCs on bioabsorbable polyethylene-glycol and collagen hydrogels were checked for SMC markers by real-time reverse-transcriptase polymerase chain reaction (RT-PCR), western blot (WB) and immunocytochemistry (ICC) analyses.

RESULTS

• Histology confirmed the growth of SMCs in the hydrogel matrices.

• The myogenic growth factors decreased the proliferation rate of EnSCs, but they differentiated the human EnSCs into SMCs more efficiently on hydrogel matrices and expressed specific SMC markers including α-smooth muscle actin, desmin, vinculin and calponin in RT-PCR, WB and ICC experiments.

• The survival rate of cultures on the hydrogel-coated matrices was significantly higher than uncoated cultures.

CONCLUSIONS

• Human EnSCs were successfully differentiated into SMCs, using hydrogels as scaffold.

• EnSCs may be used for autologous bladder wall regeneration without any immunological complications in women.

• Currently work is in progress using bioabsorbable nanocomposite materials as EnSC scaffolds for developing urinary bladder wall tissue.

 

Read Previous Articles of the Week

 

Video: Endometrial stem cells: new hope for pelvic floor prolapsed?

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Endometrial stem cell differentiation into smooth muscle cell: a novel approach for bladder tissue engineering in women

Alireza Shoae-Hassani*, Shiva Sharif, Alexander M. Seifalian†, Seyed Abdolreza Mortazavi-Tabatabaei‡, Sassan Rezaie§ and Javad Verdi

Departments of Applied Cell Sciences and §Medical Biotechnology, School of Advanced Technologies in Medicine, and *Department of Stem cell and Tissue Engineering, Research Center for Science and Technology in Medicine (RCSTiM), Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran, †University College London, UCL Centre for Nanotechnology and Regenerative Medicine, London, UK, and ‡Proteomics Research Center, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran

Read the full article
OBJECTIVE

• To investigate manufacturing smooth muscle cells (SMCs) for regenerative bladder reconstruction from differentiation of endometrial stem cells (EnSCs), as the recent discovery of EnSCs from the lining of women’s uteri, opens up the possibility of using these cells for tissue engineering applications, such as building up natural tissue to repair prolapsed pelvic floors as well as building urinary bladder wall.

MATERIALS AND METHODS

• Human EnSCs that were positive for cluster of differentiation 146 (CD146), CD105 and CD90 were isolated and cultured in Dulbecco’s modified Eagle/F12 medium supplemented with myogenic growth factors.

• The myogenic factors included: transforming growth factor β, platelet-derived growth factor, hepatocyte growth factor and vascular endothelial growth factor.

• Differentiated SMCs on bioabsorbable polyethylene-glycol and collagen hydrogels were checked for SMC markers by real-time reverse-transcriptase polymerase chain reaction (RT-PCR), western blot (WB) and immunocytochemistry (ICC) analyses.

RESULTS

• Histology confirmed the growth of SMCs in the hydrogel matrices.

• The myogenic growth factors decreased the proliferation rate of EnSCs, but they differentiated the human EnSCs into SMCs more efficiently on hydrogel matrices and expressed specific SMC markers including α-smooth muscle actin, desmin, vinculin and calponin in RT-PCR, WB and ICC experiments.

• The survival rate of cultures on the hydrogel-coated matrices was significantly higher than uncoated cultures.

CONCLUSIONS

• Human EnSCs were successfully differentiated into SMCs, using hydrogels as scaffold.

• EnSCs may be used for autologous bladder wall regeneration without any immunological complications in women.

• Currently work is in progress using bioabsorbable nanocomposite materials as EnSC scaffolds for developing urinary bladder wall tissue.

Article of the week: Prostate biopsy: shaking up the old standard

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Every week the Editor-in-Chief selects the Article of the Week from the current issue of BJUI. The abstract is reproduced below and you can click on the button to read the full article, which is freely available to all readers for at least 30 days from the time of this post.

In addition to the article itself, there is an accompanying editorial written by a prominent member of the urological community. This blog is intended to provoke comment and discussion and we invite you to use the comment tools at the bottom of each post to join the conversation.

Finally, the third post under the Article of the Week heading on the homepage will consist of additional material or media. This week we feature a video of Dr Symons discussing his paper.

If you only have time to read one article this week, it should be this one.

Outcomes of transperineal template-guided prostate biopsy in 409 patients

James L. Symons*†, Andrew Huo*, Carlo L. Yuen‡§, Anne-Maree Haynes*, Jayne Matthews†, Robert L. Sutherland*, Phillip Brenner‡§ and Phillip D. Stricker†‡§

*Cancer Research Programme, Garvan Institute of Medical Research, †St Vincent’s Prostate Cancer Centre, ‡Department of Urology, St. Vincent’s Hospital, and §Department of Urology, St. Vincent’s Clinic, Darlinghurst, NSW, Australia

Read the full article
OBJECTIVE

• To present the template-guided transperineal prostate biopsy (TPB) outcomes for patients of two urologists from a single institution.

PATIENTS AND METHODS

• We conducted a prospective study of 409 consecutive men who underwent TPB between December 2006 and June 2008 in a tertiary referral centre using a standardized 14-region technique.

• The procedure was performed as day surgery under general anaesthesia with fluoroquinolone antibiotic cover.

• Follow-up took place within 2 weeks, during which time men were interviewed using a standardized template.

• Results were compared with those of the Australian national prostate biopsy audits performed by the Urological Society of Australia and New Zealand (USANZ).

RESULTS

• Indications for biopsy included elevated prostate-specific antigen (PSA) level (75%), with a median PSA level of 6.5 ng/mL, abnormal digital rectal examination (8%) and active surveillance (AS) re-staging (18%).

• The mean patient age was 63 years and two-thirds of patients were undergoing their first biopsy.

• A positive biopsy was found in 232 men, 74% of whom had a Gleason score of ≥7. The overall cancer detection rate was 56.7% (USANZ 2005 national audit = 56.5%). Stratified between those having their first TPB or a repeat procedure (after a previous negative biopsy), the detection rates were 64.4 and 35.6%, respectively. Significantly higher detection rates were found in prostates <50 mL in volume than in larger prostates (65.2 vs 38.3%, respectively, P < 0.001).

• Haematuria was the most common side effect (51.7%). Others included dysuria (16.4%), acute urinary retention (4.2%) and fever (3.2%). One patient (0.2%) had septicaemia requiring i.v. antibiotics.

• Repeat biopsy was not associated with increased complication rates.

CONCLUSIONS

• TPB is a safe and efficacious technique, with a cancer detection rate of 56.7% in the present series, and a low incidence of major side effects. Stratified by prostate volume, the detection rate of TPB was higher in smaller glands.

• Given the relatively low rate of serious complications, clinicians could consider increasing the number of TPB biopsy cores in larger prostates as a strategy to improve cancer detection within this group. Conversely, in patients on AS programmes, a staging TPB may be a superior approach for patients undergoing repeat biopsy so as to minimize their risk of serious infection.

Video: Transperineal prostate biopsy: how good is the tumour detection rate?

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Outcomes of transperineal template-guided prostate biopsy in 409 patients

James L. Symons*†, Andrew Huo*, Carlo L. Yuen‡§, Anne-Maree Haynes*, Jayne Matthews†, Robert L. Sutherland*, Phillip Brenner‡§ and Phillip D. Stricker†‡§

*Cancer Research Programme, Garvan Institute of Medical Research, †St Vincent’s Prostate Cancer Centre, ‡Department of Urology, St. Vincent’s Hospital, and §Department of Urology, St. Vincent’s Clinic, Darlinghurst, NSW, Australia

Read the full article
OBJECTIVE

• To present the template-guided transperineal prostate biopsy (TPB) outcomes for patients of two urologists from a single institution.

PATIENTS AND METHODS

• We conducted a prospective study of 409 consecutive men who underwent TPB between December 2006 and June 2008 in a tertiary referral centre using a standardized 14-region technique.

• The procedure was performed as day surgery under general anaesthesia with fluoroquinolone antibiotic cover.

• Follow-up took place within 2 weeks, during which time men were interviewed using a standardized template.

• Results were compared with those of the Australian national prostate biopsy audits performed by the Urological Society of Australia and New Zealand (USANZ).

RESULTS

• Indications for biopsy included elevated prostate-specific antigen (PSA) level (75%), with a median PSA level of 6.5 ng/mL, abnormal digital rectal examination (8%) and active surveillance (AS) re-staging (18%).

• The mean patient age was 63 years and two-thirds of patients were undergoing their first biopsy.

• A positive biopsy was found in 232 men, 74% of whom had a Gleason score of ≥7. The overall cancer detection rate was 56.7% (USANZ 2005 national audit = 56.5%). Stratified between those having their first TPB or a repeat procedure (after a previous negative biopsy), the detection rates were 64.4 and 35.6%, respectively. Significantly higher detection rates were found in prostates <50 mL in volume than in larger prostates (65.2 vs 38.3%, respectively, P < 0.001).

• Haematuria was the most common side effect (51.7%). Others included dysuria (16.4%), acute urinary retention (4.2%) and fever (3.2%). One patient (0.2%) had septicaemia requiring i.v. antibiotics.

• Repeat biopsy was not associated with increased complication rates.

CONCLUSIONS

• TPB is a safe and efficacious technique, with a cancer detection rate of 56.7% in the present series, and a low incidence of major side effects. Stratified by prostate volume, the detection rate of TPB was higher in smaller glands.

• Given the relatively low rate of serious complications, clinicians could consider increasing the number of TPB biopsy cores in larger prostates as a strategy to improve cancer detection within this group. Conversely, in patients on AS programmes, a staging TPB may be a superior approach for patients undergoing repeat biopsy so as to minimize their risk of serious infection.

Article of the week: Karakiewicz was right: nomograms are very robust

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Every week the Editor-in-Chief selects the Article of the Week from the current issue of BJUI. The abstract is reproduced below and you can click on the button to read the full article, which is freely available to all readers for at least 30 days from the time of this post.

In addition to the article itself, there is an accompanying editorial written by a prominent member of the urological community. This blog is intended to provoke comment and discussion and we invite you to use the comment tools at the bottom of each post to join the conversation.

If you only have time to read one article this week, it should be this one.

Assessing the accuracy and generalizability of the preoperative and postoperative Karakiewicz nomograms for renal cell carcinoma: results from a multicentre European and US study

Luca Cindolo1, Paolo Chiodini2, Sabine Brookman-May8, Ottavio De Cobelli3, Matthias May8, Stefano Squillacciotti4, Cosimo De Nunzio5, Andrea Tubaro5, Ioan Coman7, Bodgan Feciche7, Michael Truss9, Manfred P. Wirth10, Orietta Dalpiaz11, Thomas F. Chromecki11, Shahrock F. Shariat12,13,14, Manuel Sanchez-Chapado15, Maria del Carmen Santiago Martin15, Bernardo Rocco16, Luigi Salzano6, Giuseppe Lotrecchiano6, Francesco Berardinelli1, and Luigi Schips1

1“S. Pio Da Pietrelcina” Hospital, Dept. of Urology, Vasto, Italy, 2Second University of Naples, Dept. of Public Health, Naples, Italy, 3European Institute of Oncology, Dept. of Urology, Milan, Italy, 4“San Carlo” Hospital, Dept. of Urology, Rome, Italy, 5“S. Andrea” Hospital, Dept. of Urology, Rome, Italy, 6“G. Rummo” Hospital, Dept. of Urology, Benevento, Italy, 7Clinical Municipal Hospital, Dept. of Urology, Cluj-Napoca, Romania, 8“Ludwig-Maximilians” University Munich, Dept. of Urology, Campus Grosshadern, Munich, Germany, 9Klinikum Dortmund, Dept. of Urology, Dortmund, Germany, 10Uniklinikum “Carl Gustav Carus”; Dept. of Urology, Dresden, Germany, 11Medical University of Graz, Graz, Austria, 12Weill Cornell Medical Center, New York-Presbyterian Hospital, Dept. of Urology, New York, NY, USA, 13Weill Cornell Medical Center, New York-Presbyterian Hospital, Division of Medical Oncology, New York, NY, USA, 14University of Texas Southwestern, Dept. of Urology, Dallas, TX, USA, 15Department of Urology, Hospital Universitario Principe de Asturias, Alcala de Henares, Spain, and 16Fondazione Ca’ granda, Ospedale Maggiore Policlinico, Dept. of Urology, University of Milan, Milan, Italy

Read the full article
OBJECTIVE

• To assess the accuracy and generalizability of the pre- and postoperative Karakiewicz nomograms for predicting cancer-specific survival (CSS) in patients with renal cell carcinoma (RCC).

PATIENTS AND METHODS

• This retrospective study included 3231 patients from European and US centres, who were treated by radical or partial nephrectomy for RCC between 1992 and 2010.

• Prognostic scores for each patient were calculated and the primary endpoint was CSS.

• Discriminating ability was assessed by Harrell’s c-index for censored data. The ‘validation by calibration’ method proposed by Van Houwelingen was used for checking the calibration of covariate effects. Calibration was graphically explored.

RESULTS

• Local and systemic symptoms were present in 23.2% and 9.1% of the patients, respectively.

• The median follow-up (FU) was 49 months. At the last FU, 408 cancer-related deaths were recorded, Kaplan–Meier estimates of CSS (with 95% confidence intervals [CIs]) at 5 and 10 years were 0.86 (0.84–0.87) and 0.77 (0.75–0.80), respectively.

• Both nomograms discriminated well. Stratified c-indices for CSS were 0.784 (95% CI 0.753–0.814) for the preoperative nomogram, and 0.842 (95% CI 0.816–0.867) for the postoperative one, with a significant difference between the two values (P < 0.001).

• The covariate-based predictions on our data for both nomograms were valid. The calibration plots showed no relevant departures from ideal predictions.

CONCLUSIONS

• The results suggest that the postoperative Karakiewicz nomogram discriminates substantially better than the preoperative one.

• These nomogram-based predictions may be used as benchmark data for pretreatment and postoperative decision-making in patients at various stages of RCC.

 

Read Previous Articles of the Week

 

Article of the week: LESS nephroureterectomy: is it a good alternative?

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Every week the Editor-in-Chief selects the Article of the Week from the current issue of BJUI. The abstract is reproduced below and you can click on the button to read the full article, which is freely available to all readers for at least 30 days from the time of this post.

In addition to the article itself, there is an accompanying editorial written by a prominent member of the urological community. This blog is intended to provoke comment and discussion and we invite you to use the comment tools at the bottom of each post to join the conversation.

Finally, the third post under the Article of the Week heading on the homepage will consist of additional material or media. This week we feature a video by Prof. Rha and colleagues of LESS nephroureterectomy.

If you only have time to read one article this week, it should be this one.

Laparoendoscopic single-site nephroureterectomy for upper urinary tract urothelial carcinoma: outcomes of an international multi-institutional study of 101 patients

Sung Yul Park, Koon Ho Rha1, Riccardo Autorino2, Ithaar Derweesh3, Evangelos Liastikos4, Yao Chou Tsai5, Ill Young Seo6, Ugo Nagele7, Aly M. Abdel-Karim8, Thomas Herrmann9, Deok Hyun Han10, Soroush Rais-Bahrami11, Seung Wook Lee, Kyu Shik Kim, Paolo Fornara12, Panagiotis Kallidonis4, Christopher Springer12, Salah Élsalmy8, Shih-Chieh Jeff Chueh13, Chen-Hsun Ho14, Kamol Panumatrassamee2, Ryan Kopp3, Jens-Uwe Stolzenburg15, Lee Richstone11, Jae Hoon Chung, Tae Young Shin1, Francesco Greco12 and Jihad H. Kaouk2

Department of Urology, Hanyang University College of Medicine, Seoul, Korea, 1Department of Urology, Yonsei University College of Medicine, Seoul, Korea, 2Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA, 3Division of Urology, University of California San Diego, La Jolla, CA, USA, 4Department of Urology, School of Medicine, University of Patras, Patras, Greece, 5Division of Urology, Buddhist Tzu Chi General Hospital, TaipeiBranch, Taipei, Taiwan, 6Department of Urology, Wonkwang University School of Medicine and Hospital, Iksan, Korea, 7Department of Urology, LKH, Hall in Tirol, Austria, 8Department of Urology, Alexandria University, Alexandria, Egypt, 9Department of Urology, Hannover Medical School, Hannover, Germany, 10Department of Urology, Samsung Medical Center, Sungkyunkwan University, Seoul, Korea, 11The Arthur Smith Institute for Urology, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, NY, USA, 12Department of Urology and Kidney Transplantation, Martin-Luther-University, Halle/Saale, Germany, 13Cleveland Clinic Urology Charleston Office, Charleston, WV, USA, 14Division of Urology, National Taiwan University Hospital, Taipei, Taiwan, 15Department of Urology, University of Leipzig, Leipzig, Germany

Read the full article
OBJECTIVE

• To report a large multi-institutional series of laparoendoscopic single-site (LESS) nephroureterectomy (NU).

MATERIALS AND METHODS

• Data on all cases of LESS-NU performed between 2008 and 2012 at 15 institutions were retrospectively gathered.

• The main demographic data and perioperative outcomes were analysed.

RESULTS

• The study included 101 patients whose mean (sd) age was 66.4 (9.9) years and mean (sd) body mass index was 24.8 (4) kg/m2, and of whom 29.7% had undergone previous abdominal/pelvic surgery.

• The mean (sd) operating time was 221.4 (73.7) min, estimated blood loss 231.7 (348.0) mL.

• A robot-assisted LESS technique was applied in 25.7% of cases. An extra trocar was inserted in 28.7% of cases to complete the procedure. Conversion to open surgery was necessary in three cases (3.0%). There was no bladder cuff excision in 20.8% of cases, and excision was carried out using a variety of techniques in the remaining cases.

• Six intra-operative complications occurred (5.9%). The mean (sd) length of hospital stay was 6.3 (3.5) days. The overall postoperative complication rate was 10.0%, and most of the complications were low grade (Clavien grades 1 and 2).

• The mean tumour size was 3.1 (1.9) cm. Pathological staging was pTis in two patients, pTa in 12 patients, pT1 in 42 patients, pT2 in 20 patients, pT3 in 23 patients and pT4 in two patients. Pathological grade was high in 71 and low in 30 patients.

• At a mean follow-up of 14 months, six patients (5.9%) had died. Disease recurrence (including distant and bladder recurrence) was detected in 22.8% of patients, with a mean time to recurrence of 11.5 months.

CONCLUSIONS

• This study reports the largest multi-institutional experience of LESS-NU to date.

• Peri-operative outcomes mirror those of published standard laparoscopy series.

• Despite encouraging early findings, longer follow-up is needed to determine the oncological efficacy of the procedure.

 

Read Previous Articles of the Week

 

Video: Is LESS more when it comes to nephroureterectomy?

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Laparoendoscopic single-site nephroureterectomy for upper urinary tract urothelial carcinoma: outcomes of an international multi-institutional study of 101 patients

Sung Yul Park, Koon Ho Rha1, Riccardo Autorino2, Ithaar Derweesh3, Evangelos Liastikos4, Yao Chou Tsai5, Ill Young Seo6, Ugo Nagele7, Aly M. Abdel-Karim8, Thomas Herrmann9, Deok Hyun Han10, Soroush Rais-Bahrami11, Seung Wook Lee, Kyu Shik Kim, Paolo Fornara12, Panagiotis Kallidonis4, Christopher Springer12, Salah Élsalmy8, Shih-Chieh Jeff Chueh13, Chen-Hsun Ho14, Kamol Panumatrassamee2, Ryan Kopp3, Jens-Uwe Stolzenburg15, Lee Richstone11, Jae Hoon Chung, Tae Young Shin1, Francesco Greco12 and Jihad H. Kaouk2

Department of Urology, Hanyang University College of Medicine, Seoul, Korea, 1Department of Urology, Yonsei University College of Medicine, Seoul, Korea, 2Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA, 3Division of Urology, University of California San Diego, La Jolla, CA, USA, 4Department of Urology, School of Medicine, University of Patras, Patras, Greece, 5Division of Urology, Buddhist Tzu Chi General Hospital, TaipeiBranch, Taipei, Taiwan, 6Department of Urology, Wonkwang University School of Medicine and Hospital, Iksan, Korea, 7Department of Urology, LKH, Hall in Tirol, Austria, 8Department of Urology, Alexandria University, Alexandria, Egypt, 9Department of Urology, Hannover Medical School, Hannover, Germany, 10Department of Urology, Samsung Medical Center, Sungkyunkwan University, Seoul, Korea, 11The Arthur Smith Institute for Urology, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, NY, USA, 12Department of Urology and Kidney Transplantation, Martin-Luther-University, Halle/Saale, Germany, 13Cleveland Clinic Urology Charleston Office, Charleston, WV, USA, 14Division of Urology, National Taiwan University Hospital, Taipei, Taiwan, 15Department of Urology, University of Leipzig, Leipzig, Germany

Read the full article
OBJECTIVE

• To report a large multi-institutional series of laparoendoscopic single-site (LESS) nephroureterectomy (NU).

MATERIALS AND METHODS

• Data on all cases of LESS-NU performed between 2008 and 2012 at 15 institutions were retrospectively gathered.

• The main demographic data and perioperative outcomes were analysed.

RESULTS

• The study included 101 patients whose mean (sd) age was 66.4 (9.9) years and mean (sd) body mass index was 24.8 (4) kg/m2, and of whom 29.7% had undergone previous abdominal/pelvic surgery.

• The mean (sd) operating time was 221.4 (73.7) min, estimated blood loss 231.7 (348.0) mL.

• A robot-assisted LESS technique was applied in 25.7% of cases. An extra trocar was inserted in 28.7% of cases to complete the procedure. Conversion to open surgery was necessary in three cases (3.0%). There was no bladder cuff excision in 20.8% of cases, and excision was carried out using a variety of techniques in the remaining cases.

• Six intra-operative complications occurred (5.9%). The mean (sd) length of hospital stay was 6.3 (3.5) days. The overall postoperative complication rate was 10.0%, and most of the complications were low grade (Clavien grades 1 and 2).

• The mean tumour size was 3.1 (1.9) cm. Pathological staging was pTis in two patients, pTa in 12 patients, pT1 in 42 patients, pT2 in 20 patients, pT3 in 23 patients and pT4 in two patients. Pathological grade was high in 71 and low in 30 patients.

• At a mean follow-up of 14 months, six patients (5.9%) had died. Disease recurrence (including distant and bladder recurrence) was detected in 22.8% of patients, with a mean time to recurrence of 11.5 months.

CONCLUSIONS

• This study reports the largest multi-institutional experience of LESS-NU to date.

• Peri-operative outcomes mirror those of published standard laparoscopy series.

• Despite encouraging early findings, longer follow-up is needed to determine the oncological efficacy of the procedure.

Article of the week: Fit to a T-cell: measuring host immunity in renal cell carcinoma

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Every week the Editor-in-Chief selects the Article of the Week from the current issue of BJUI. The abstract is reproduced below and you can click on the button to read the full article, which is freely available to all readers for at least 30 days from the time of this post.

In addition to the article itself, there is an accompanying editorial written by a prominent member of the urological community. This blog is intended to provoke comment and discussion and we invite you to use the comment tools at the bottom of each post to join the conversation.

Finally, the third post under the Article of the Week heading on the homepage will consist of additional material or media. This week we feature a video of Dr. Scala discussing her article.

If you only have time to read one article this week, it should be this one.

Regulatory T cells, interleukin (IL)-6, IL-8, Vascular endothelial growth factor (VEGF), CXCL10, CXCL11, epidermal growth factor (EGF) and hepatocyte growth factor (HGF) as surrogate markers of host immunity in patients with renal cell carcinoma

Marianeve Polimeno, Maria Napolitano, Susan Costantini*, Luigi Portella, Arianna Esposito, Francesca Capone*, Eliana Guerriero*, AnnaMaria Trotta, Serena Zanotta, Luigi Pucci†, Nicola Longo†, Sisto Perdonà‡, Sandro Pignata‡, Giuseppe Castello* and Stefania Scala

Oncological Immunology, National Cancer Institute ‘G. Pascale’, *National Cancer Institute ‘G. Pascale’ Cancer Research Center, Mercogliano, Avellino, †Genitourinary Oncology and Rare Cancer Center, Federico II University, ‡Department of Urology, National Cancer Institute ‘G. Pascale’, Naples, Italy

M.P. and M.N. contributed equally to this work.

Read the full article
OBJECTIVE

• To identify a phenotype that could be informative and prognostic in patients with renal cell carcinoma (RCC) peripheral blood was evaluated for TH1, TH2, regulatory T cells (Tregs), natural killer (NK) and NKT cells and for cytokines/chemokines.

PATIENTS AND METHODS

• Peripheral blood from 77 patients with RCC and 40 healthy controls was evaluated by flow cytometry using monoclonal antibodies against CD4, CD25, FoxP3, CD45RA, CD45RO, CD152, CD184, CD279, CD3, CD16, CD56, CD161, CD158a, CD4, CD26, CD30, CD183 and CD184.

• A concomitant evaluation of 38 molecules was conducted in patients’ serum using a multiplex biometric ELISA-based immunoassay.

RESULTS

• The number of NK cells CD3−/CD16+, CD3−/CD16+/CD161+ (NK) and CD3−/CD16+/CD161+/CD158a+ (NK- Kir 2+) was greater in the patients with RCC (P < 0.05); and the number of Treg cells CD4+/CD25high+/FOXP3+ and the subset CD4+/CD25high+/FOXP3+/CD45RA+ (naïve) and CD45R0+(memory) cells, were greater in the patients with RCC (P < 0.001).

• An increase in the following was observed in the serum of patients with RCC compared with healthy controls: interleukin (IL)-4, IL-6, IL-8, IL-10, G-CSF, CXCL10, CXCL11, hepatocyte growth factor (HGF) and vascular endothelial growth factor (VEGF). According to Ingenuity Pathway Analysis (IPA), CXCL10, IL-6, IL-8, epidermal growth factor (EGF), HGF and VEGF were associated with a network that controls cellular movement, tissue development and cellular growth.

• Kaplan–Meier analysis for disease-free survival showed that high numbers of CD4+/CD25high+/FOXP3+/CD45RA+ (Treg naïve) and low numbers of CD3−/CD16+/CD161+/CD158a+ (NK-Kir+) cells predict short disease-free survival in patients with RCC.

CONCLUSION

• Concomitant evaluation of Treg (CD4+/CD25high+/FOXP3+ and CD4+/CD25high+/FOXP3+/CD45RA+) and of six soluble factors (IL-6, IL-8 ,VEGF, CXCL10, CXCL11, EGF, HGF) might be a surrogate marker of host immunity in patients with RCC.

 

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Article of the week: The AUA speaks: prostate cancer detection guideline

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Every week the Editor-in-Chief selects the Article of the Week from the current issue of BJUI. The abstract is reproduced below and you can click on the button to read the full article, which is freely available to all readers for at least 30 days from the time of this post.

If you only have time to read one article this week, it should be this one.

American Urological Association (AUA) Guideline on prostate cancer detection: process and rationale

H. Ballentine Carter

The Johns Hopkins University School of Medicine, Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, MD, USA

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ABSTRACT

To review the process and rationale for the American Urological Association (AUA) guideline on prostate cancer detection. The AUA guideline on detection of prostate cancer involved a systematic literature review of >300 studies that evaluated outcomes important to patients (prostate cancer, incidence/mortality, health-related quality of life, diagnostic accuracy and harms of testing). A multidisciplinary panel interpreted the evidence and formulated statements to assist the urologist and the asymptomatic average-risk man in decision-making about prostate cancer detection. Other than prostate-specific antigen (PSA)-based prostate cancer screening, there was no evidence to address the outcomes of interest to patients. The strongest evidence that benefits may outweigh harms was in men aged 55–69 years undergoing PSA-based screening. This led the panel to recommend shared decision-making for these men at average risk, but recommend against routine screening for other age groups at average risk. Further, to reduce the harms associated with screening (false positive tests, over diagnosis, over treatment), the panel recommended against annual screening for those who choose to be screened. A panel under the auspices of the AUA recommended shared decision-making for the average risk asymptomatic man aged 55–69 years considering PSA-based screening for prostate cancer detection.

 

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