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Este mes en... European Urology:

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  • Re: Analysis of Papillary Urothelial Carcinomas of the Bladder with Grade Heterogeneity: Supportive Evidence for an Early Role of CDKN2A Deletions in the FGFR3 Pathway

    Footnotes

    Department of Pathology, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, UPMC Paris VI, Paris, France

    Corresponding author. Department of Pathology, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, UPMC Paris VI, 4, Rue de la Chine, Paris 75020, France.

  • Re: Detection of Micrometastases by Flow Cytometry in Sentinel Lymph Nodes from Patients with Renal Tumours

    Footnotes

    Department of Urology, Division of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands

    Corresponding author. Department of Urology, Division of Surgical Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066CX Amsterdam, The Netherlands.

  • Re: Management of Nonmuscle Invasive Bladder Cancer: A Comprehensive Analysis of Guidelines from the Unites States, Europe, and Asia

    Footnotes

    Department of Urology, UC Davis Cancer Center, Sacramento, CA, USA

    4501 X Street, Suite 3003, Sacramento, CA 95817, USA.

  • Re: Inherited DNA-repair Gene Mutations in Men with Metastatic Prostate Cancer

    Footnotes

    Center for Prostate Disease Research, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA

    Corresponding author. Center for Prostate Disease Research, Department of Surgery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.

  • Re: Low Adherence to Guidelines in Nonmuscle-invasive Disease

    Footnotes

    a University of Aberdeen, Academic Urology Unit, Foresterhill, Aberdeen, UK

    b Vita-Salute University San Raffaele, Milan, Italy

    c Ottawa Hospital Research Institute, Ottawa, Canada

    Corresponding author. University of Aberdeen, Academic Urology Unit, Health Sciences Building (2nd floor), Foresterhill, Aberdeen AB252ZD, UK.

  • Medical Treatment of Male Lower Urinary Tract Symptoms: Does One Fit All?

    Refers to article:

    Comparative Effectiveness of Newer Medications for Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: A Systematic Review and Meta-analysis eulogo1

    Philipp Dahm, Michelle Brasure, Roderick MacDonald, Carin M. Olson, Victoria A. Nelson, Howard A. Fink, Bruce Rwabasonga, Michael C. Risk and Timothy J. Wilt

    Accepted 16 September 2016

    April 2017 (Vol. 71, Issue 4, pages 570 - 581)

    Footnotes

    a Department of Urology, Medical University Vienna, Vienna, Austria

    b University of Basel, Basel, Switzerland

    c Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany

    Corresponding author. Department of Urology, Medical University Vienna, Währinger Gürtel 18–20, 1090 Vienna, Austria.

  • Re: The Important Role for Intravenous Iron in Perioperative Patient Blood Management in Major Abdominal Surgery: A Randomized Controlled Trial

    Footnotes

    Department of Urology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, UK

    Corresponding author. Department of Urology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Glossop Road, Sheffield, South Yorkshire, S10 2JF, UK.

  • Facing the Fate of the Remnant Urothelium After Radical Cystectomy: There Is Room for Improvement

    Refers to article:

    Systematic Review on the Fate of the Remnant Urothelium after Radical Cystectomy eulogo1

    Georgios Gakis, Peter C. Black, Bernard H. Bochner, Stephen A. Boorjian, Arnulf Stenzl, George N. Thalmann and Wassim Kassouf

    Accepted 22 September 2016

    April 2017 (Vol. 71, Issue 4, pages 545 - 557)

    Footnotes

    Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Corresponding author. Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany. Tel. +49 160 97734488; Fax: +49 40 741042444.

  • Re: Daniel E. Spratt, Hebert A. Vargas, Zachary S. Zumsteg, et al. Patterns of Lymph Node Failure after Dose-escalated Radiotherapy: Implications for Extended Pelvic Lymph Node Coverage. Eur Urol. In press. http://dx.doi.org/10.1016/j.eururo.2016.07.043: A Step Forward in the Era of Functional Imaging?

    Refers to article:

    Patterns of Lymph Node Failure after Dose-escalated Radiotherapy: Implications for Extended Pelvic Lymph Node Coverage

    Daniel E. Spratt, Hebert A. Vargas, Zachary S. Zumsteg, Jennifer S. Golia Pernicka, Joseph R. Osborne, Xin Pei and Michael J. Zelefsky

    Accepted 22 July 2016

    January 2017 (Vol. 71, Issue 1, pages 37 - 43)

    Footnotes

    a Radiation Oncology, Sacro Cuore Don Calabria Cancer Care Center, Negrar-Verona, Italy

    b Radiation Oncology School, University of Palermo, Italy

    c Nuclear Medicine, Sacro Cuore Don Calabria Cancer Care Center, Negrar-Verona, Italy

    Corresponding author. Radiation Oncology, Sacro Cuore Don Calabria Cancer Care Center, Via Don Sempreboni 5, Negrar-Verona 37024, Italy. Tel. +39 045 6014800.

  • Magnetic Resonace Imaging–targeted Prostate Biopsies: Is the Right Technique the Right Question?

    Refers to article:

    Comparing Three Different Techniques for Magnetic Resonance Imaging-targeted Prostate Biopsies: A Systematic Review of In-bore versus Magnetic Resonance Imaging-transrectal Ultrasound fusion versus Cognitive Registration. Is There a Preferred Technique?

    Olivier Wegelin, Harm H.E. van Melick, Lotty Hooft, J.L.H. Ruud Bosch, Hans B. Reitsma, Jelle O. Barentsz and Diederik M. Somford

    Accepted 22 July 2016

    April 2017 (Vol. 71, Issue 4, pages 517 - 531)

    Footnotes

    Departments of Urology and Epidemiology & Biostatistics, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA

    Departments of Urology and Epidemiology & Biostatistics, UCSF Helen Diller Family Comprehensive Cancer Center, 550 16th Street, San Francisco, CA 94143, USA. Tel. +1 415 8853660; Fax: +1 415 8857443.

  • Reply to Filippo Alongi, Dario Aiello, and Rosario Mazzola's Letter to the Editor re: Re: Daniel E. Spratt, Hebert A. Vargas, Zachary S. Zumsteg, et al. Patterns of Lymph Node Failure after Dose-escalated Radiotherapy: Implications for Extended Pelvic Lymph Node Coverage. Eur Urol. In press. http://dx.doi.org/10.1016/j.eururo.2016.07.043. A Step Forward in the Era of Functional Imaging?: Functional Imaging and Micrometastatic Disease: Implications for Radiotherapy Field Design

    Refers to article:

    Patterns of Lymph Node Failure after Dose-escalated Radiotherapy: Implications for Extended Pelvic Lymph Node Coverage

    Daniel E. Spratt, Hebert A. Vargas, Zachary S. Zumsteg, Jennifer S. Golia Pernicka, Joseph R. Osborne, Xin Pei and Michael J. Zelefsky

    Accepted 22 July 2016

    January 2017 (Vol. 71, Issue 1, pages 37 - 43)

    Refers to article:

    Re: Daniel E. Spratt, Hebert A. Vargas, Zachary S. Zumsteg, et al. Patterns of Lymph Node Failure after Dose-escalated Radiotherapy: Implications for Extended Pelvic Lymph Node Coverage. Eur Urol 2017;71:37–43: A Step Forward in the Era of Functional Imaging?

    Filippo Alongi, Rosario Mazzola, Dario Aiello and Matteo Salgarello

    Accepted 31 October 2016

    April 2017 (Vol. 71, Issue 4, pages e121 - e122)

    Footnotes

    a Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA

    b Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Corresponding author. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Box 22, New York, NY 10065, USA. Tel. +1 212 6396802; Fax: +1 212 6398876.

  • Reply to Jae Heon Kim's Letter to the Editor re: Mauro Gacci, Giovanni Corona, Arcangelo Sebastianelli, et al. Male Lower Urinary Tract Symptoms and Cardiovascular Events: A Systematic Review and Meta-analysis. Eur Urol. In press. http://dx.doi.org/10.1016/j.eururo.2016.07.007

    Refers to article:

    Re: Mauro Gacci, Giovanni Corona, Arcangelo Sebastianelli, et al. Male Lower Urinary Tract Symptoms and Cardiovascular Events: A Systematic Review and Meta-analysis. Eur Urol 2016;70:788–96

    Jae Heon Kim

    Accepted 13 October 2016

    April 2017 (Vol. 71, Issue 4, pages e117 - e118)

    Refers to article:

    Male Lower Urinary Tract Symptoms and Cardiovascular Events: A Systematic Review and Meta-analysis

    Mauro Gacci, Giovanni Corona, Arcangelo Sebastianelli, Sergio Serni, Cosimo De Nunzio, Mario Maggi, Linda Vignozzi, Giacomo Novara, Kevin T. McVary, Steven A. Kaplan, Stavros Gravas and Christopher Chapple

    Accepted 4 July 2016

    November 2016 (Vol. 70, Issue 5, pages 788 - 796)

    Footnotes

    a Department of Urology, University of Florence, Careggi Hospital, Florence, Italy

    b Andrology Unit, University of Florence, Careggi Hospital, Florence, Italy

    c Endocrinology Unit, Maggiore-Bellaria Hospital, Bologna, Italy

    Corresponding author. Department of Urology, University of Florence, Viale A. Gramsci 7, Florence 50121, Italy. Tel. +39 3396640070.

  • Re: Mauro Gacci, Giovanni Corona, Arcangelo Sebastianelli, et al. Male Lower Urinary Tract Symptoms and Cardiovascular Events: A Systematic Review and Meta-analysis. Eur Urol. In press. http://dx.doi.org/10.1016/j.eururo.2016.07.007

    Refers to article:

    Male Lower Urinary Tract Symptoms and Cardiovascular Events: A Systematic Review and Meta-analysis

    Mauro Gacci, Giovanni Corona, Arcangelo Sebastianelli, Sergio Serni, Cosimo De Nunzio, Mario Maggi, Linda Vignozzi, Giacomo Novara, Kevin T. McVary, Steven A. Kaplan, Stavros Gravas and Christopher Chapple

    Accepted 4 July 2016

    November 2016 (Vol. 70, Issue 5, pages 788 - 796)

    Footnotes

    Department of Urology, Soonchunhyang University Hospital, Soonchuhyang University Medical College, Seoul, South Korea

    Department of Urology, Soonchunhyang University Seoul Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul 140-743, South Korea. Tel. +82 2 7099376; Fax: +82 2 7103190.

  • The Role of Lymphadenectomy for Renal Cell Carcinoma: Are we any Closer to an Answer?

    Refers to article:

    Radical Nephrectomy With or Without Lymph Node Dissection for Nonmetastatic Renal Cell Carcinoma: A Propensity Score-based Analysis

    Boris Gershman, R. Houston Thompson, Daniel M. Moreira, Stephen A. Boorjian, Matthew K. Tollefson, Christine M. Lohse, Brian A. Costello, John C. Cheville and Bradley C. Leibovich

    Accepted 7 September 2016

    April 2017 (Vol. 71, Issue 4, pages 560 - 567)

    Footnotes

    Swedish Urology Group, Seattle, WA, USA

    Swedish Urology Group, 1101 Madison, Suite 1400, Seattle, WA 98104, USA. Tel.+1-206-386-6266; Fax: +1-206-622-1052.

  • Getting Ready for Penile Transplantation

    Refers to article:

    Ex Vivo Model of Human Penile Transplantation and Rejection: Implications for Erectile Tissue Physiology

    Nikolai A. Sopko, Hotaka Matsui, Denver M. Lough, Devin Miller, Kelly Harris, Max Kates, Xiaopu Liu, Kevin Billups, Richard Redett, Arthur L. Burnett, Gerald Brandacher and Trinity J. Bivalacqua

    Accepted 4 July 2016

    April 2017 (Vol. 71, Issue 4, pages 584 - 593)

    Footnotes

    a Department of Urology, University Hospitals Leuven, Leuven, Belgium

    b Laboratory for Experimental Urology, University of Leuven, Leuven, Belgium

    Laboratory for Experimental Urology, University of Leuven, Herestraat 49, Leuven 3000, Belgium. Tel. +32486334999.

  • Generalizability of Clinical Trials: Why It Matters for Patients and Public Policy

    Refers to article:

    Generalizability of the Prostate Cancer Intervention Versus Observation Trial (PIVOT) Results to Contemporary North American Men with Prostate Cancer

    Deepansh Dalela, Patrick Karabon, Jesse Sammon, Akshay Sood, Björn Löppenberg, Quoc-Dien Trinh, Mani Menon and Firas Abdollah

    Accepted 22 August 2016

    April 2017 (Vol. 71, Issue 4, pages 511 - 514)

    Footnotes

    Department of Surgery, University of Chicago, Chicago, IL, USA

    Department of Surgery, University of Chicago, 5841 South Maryland, Mail Code 6038, Chicago, IL 60637, USA. Tel. +1-773-702-5195; Fax: +1-773-702-1001.

  • Open Access. Open Science. Open Urology

    Take Home Message

    Open access means open urology and better care for our patients.

    Footnotes

    Division of Pediatric Urology, Children's National Health System, Washington, DC, USA

    Corresponding author. Division of Pediatric Urology, Children's National Health System, 111 Michigan Avenue NW, Washington, DC 20010, USA. Tel. +1 202 4765042; Fax: +1 202 4764739.

  • The Detection of Androgen Receptor Splice Variant 7 in Plasma-derived Exosomal RNA Strongly Predicts Resistance to Hormonal Therapy in Metastatic Prostate Cancer Patients

    Abstract

    Background

    The androgen receptor splice variant 7 (AR-V7) is associated with resistance to hormonal therapy in castration-resistant prostate cancer (CRPC). Due to limitations of the methods available for AR-V7 analysis, the identification of a reliable detection method may facilitate the use of this biomarker in clinical practice.

    Objective

    To confirm AR-V7 as a predictor of resistance to hormonal therapy and develop a new approach to assess AR-V7 by highly sensitive digital droplet polymerase chain reaction (ddPCR) in plasma-derived exosomal RNA.

    Design, setting, and participants

    Plasma samples were collected from 36 CRPC patients before they began second-line hormonal treatment. Exosomes were isolated and RNA extracted for analysis of AR-V7 by ddPCR.

    Outcome measurements and statistical analysis

    The absolute target gene concentration as copies per milliliter (copies/ml) was determined by ddPCR. Statistical analyses were performed with SPSS software (IBM Corp., Armonk, NY, USA).

    Results and limitations

    A total of 26 patients received abiraterone and 10 enzalutamide; 39% of patients were found to be AR-V7 positive (AR-V7+). Median progression-free survival was significantly longer in AR-V7 negative (AR-V7) versus AR-V7+ patients (20 vs 3 mo; p < 0.001). Overall survival was significantly shorter in AR-V7+ participants at baseline compared with AR-V7 participants (8 mo vs not reached; p < 0.001).

    Conclusions

    This study demonstrates that plasma-derived exosomal RNA is a reliable source of AR-V7 that can be detected sensitively by ddPCR assay. We also showed that resistance to hormonal therapy may be predicted by AR-V7, making it a clinically relevant biomarker.

    Patient summary

    We report a first study on a method for androgen receptor splice variant 7 (AR-V7) detection in RNA extracted from cancer cell vesicles released in blood. Results confirmed the role of AR-V7 as a predictive biomarker of resistance to hormonal therapy. Our assay showed that vesicles are a reliable source of AR-V7 RNA and that the method is fast, highly sensitive, and affordable.

    Take Home Message

    The detection of androgen receptor splice variant 7 in plasma-derived exosomal RNA is feasible and strongly predicts resistance to hormonal therapy in castration-resistance prostate cancer. This minimally invasive approach can monitor the development of pharmacologic resistance reliably and with a short turnaround time, encouraging its integration in clinical laboratory practice.

    Keywords: AR-V7, Exosomes, Digital droplet PCR, Prostate cancer, Pharmacogenetics, Resistance, Hormonal therapy.

    Footnotes

    a Clinical Pharmacology and Pharmacogenetics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy

    b Medical Oncology Unit, Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa, Italy

    c Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy

    d Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands

    e Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, The Netherlands

    Corresponding author. University of Pisa, 55, Via Roma, 56126 Pisa, Italy. Tel. +39 0502218646; Fax: +39 0502218758.

    Current affiliation: Medical Oncology, Institut Gustave Roussy, Villejuif, France.

  • The Role of Urodynamics in the Evaluation of Urinary Incontinence: The European Association of Urology Recommendations in 2016

    Take Home Message

    This article summarises the European Association Urology guidelines position on the role of urodynamic studies in investigating the problem of urinary incontinence. The guidelines recommend that urodynamics should not be necessary to help decide the best treatment for uncomplicated urinary incontinence, but may help if there is any uncertainty over the choice of invasive treatments. The guidelines also stress the importance of conducting urodynamic tests to the highest possible quality standards for the results to be useful in the decision-making process.

    Footnotes

    a Department of Urology, Freeman Hospital, Newcastle-upon-Tyne, UK

    b Department of Urology, University of Texas Southwestern Medical Centre, TX, USA

    c Royal Hallamshire Hospital, Sheffield, UK

    d Department of Urology, University Hospital Bern, Bern, Switzerland

    Corresponding author. Department of Urology, Freeman Hospital, Freeman Road, Newcastle-upon-Tyne, NE7 7DN, UK. Tel. +44 790 7824797.

  • Systematic Review on the Fate of the Remnant Urothelium after Radical Cystectomy

    Abstract

    Context

    Urothelial carcinoma is considered a pan-urothelial disease. As such, the remnant urothelium in the upper urinary tract and urethra following radical cystectomy (RC) remains at risk for secondary urothelial tumors (SUTs).

    Objective

    To describe the incidence, diagnosis, treatment, and outcomes of patients with SUTs after RC.

    Evidence acquisition

    A systematic search was conducted using PubMed database according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines to identify studies between 1970 and 2016 reporting on malignant diseases of the urothelium after RC for bladder cancer. The search strategy separated between upper and lower tract urothelial tumors.

    Evidence synthesis

    Of a total of 1069 studies, 57 were considered for evidence synthesis. SUTs occured in approximately 4–10% of patients after RC. Carcinoma in situ of the bladder, a history of nonmuscle invasive bladder cancer, and tumor involvement of the distal ureter are the strongest risk factors for secondary upper tract tumors. Risk factors for secondary urethral tumors represent urothelial malignancy in the prostatic urethra/prostate and bladder neck (in women), nonorthotopic diversions, and positive findings on permanent sections. The majority of patients (84%) with SUTs, presented with urothelial recurrence without evidence of metastasis. Of those, 84.0% were treated with surgery, 10.5% with systemic chemotherapy and/or radiotherapy, and 5.6% with topical chemotherapy and/or immunotherapy. After a median follow-up of 91 mo (range: 26–155), 65.9% of patients died of disease and 21.5% died of other causes. Detection and treatment of SUTs at an asymptomatic stage can reduce the risks of cancer-specfific and overall mortality by 30%. A limitation of the study is that the available data were retrospective.

    Conclusions

    SUTs are rare oncological events and most patients have an adverse prognosis despite absence of distant disease at diagnosis. Therefore, surveillance of the remnant urothelium should be implemented for patients with histological features of panurothelial disease as it may improve timely detection and treatment.

    Patient summary

    Secondary tumors of the renal pelvis, ureters, and urethra occur in approximately 4–10% of patients after radical removal of the bladder for bladder cancer. These patients’ prognoses are reduced, likely due to delayed diagnosis. Therefore, routine surveillance might be important to detect tumors at an early stage.

    Take Home Message

    Secondary tumors of the remnant urothelium after radical cystectomy occur in approximately 4–10% of patients. Since many of these patients have an impaired prognosis due to delayed diagnosis, surveillance of patients with histological features of pan-urothelial disease may improve timely detection and treatment.

    Keywords: Bladder cancer, Radical cystectomy, Recurrence, Remnant, Upper urinary tract, Urethra, Urothelium.

    Footnotes

    a Department of Urology, Eberhard-Karls University of Tübingen, Germany

    b Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada

    c Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    d Department of Urology, Mayo Clinic, Rochester, MN, USA

    e Department of Urology, Inselspital Bern, University of Bern, Switzerland

    f Division of Urology, McGill University, Montreal, QC, Canada

    Corresponding author. Department of Urology, University Hospital Tübingen, Eberhard-Karls University of Tübingen, Hoppe-Seyler Strasse 3, Tübingen D-72076, Germany. Tel. +49-7071-2985092; Fax: +49-7071-295092.

    Please visit www.eu-acme.org/europeanurology to read and answer questions on-line. The EU-ACME credits will then be attributed automatically.

  • Reply to Glen D. Santok and Koon H. Rha’ Letter to the Editor re: Pär Stattin, Fredrik Sandin, Frederik Birkebæk Thomsen, et al. Association of Radical Local Treatment with Mortality in Men with Very High-risk Prostate Cancer: A Semiecologic, Nationwide, Population-based Study. Eur Urol. In press. http://dx.doi.org/10.1016/j.eururo.2016.07.023

    Refers to article:

    Re: Pär Stattin, Fredrik Sandin, Frederik Birkebæk Thomsen, et al. Association of Radical Local Treatment with Mortality in Men with Very High-risk Prostate Cancer: A Semiecologic, Nationwide, Population-based Study. Eur Urol. In press. http://dx.doi.org/10.1016/j.eururo.2016.07.023: Radical Treatment in Very High-risk Prostate Cancer: Venturing Down a Path Less Travelled

    Glen Denmer Santok and Koon Ho Rha

    Accepted 22 September 2016

    April 2017 (Vol. 71, Issue 4, pages e113 - e114)

    Refers to article:

    Association of Radical Local Treatment with Mortality in Men with Very High-risk Prostate Cancer: A Semiecologic, Nationwide, Population-based Study

    Pär Stattin, Fredrik Sandin, Frederik Birkebæk Thomsen, Hans Garmo, David Robinson, Ingela Franck Lissbrant, Håkan Jonsson and Ola Bratt

    Accepted 15 July 2016

    Footnotes

    a Department of Surgical Sciences, Uppsala University, Uppsala

    b Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University Hospital, Umeå, Sweden

    c Department of Translational Medicine Urology, Division of Urological Cancer, Lund University, Sweden

    d CamPARI Clinic, Department of Urology, Cambridge University Hospitals, Cambridge, UK

    Corresponding author. Deptartment of Surgical Sciences, Uppsala University Hospital, Urology, Akademiska sjukhuset, Uppsala 75185, Sweden. Tel. +46 18 15 19 77; Fax: +46 90 12 53 96.

  • Re: Pär Stattin, Fredrik Sandin, Frederik Birkebæk Thomsen, et al. Association of Radical Local Treatment with Mortality in Men with Very High-risk Prostate Cancer: A Semiecologic, Nationwide, Population-based Study. Eur Urol. In press. http://dx.doi.org/10.1016/j.eururo.2016.07.023: Radical Treatment in Very High-risk Prostate Cancer: Venturing Down a Path Less Travelled

    Refers to article:

    Association of Radical Local Treatment with Mortality in Men with Very High-risk Prostate Cancer: A Semiecologic, Nationwide, Population-based Study

    Pär Stattin, Fredrik Sandin, Frederik Birkebæk Thomsen, Hans Garmo, David Robinson, Ingela Franck Lissbrant, Håkan Jonsson and Ola Bratt

    Accepted 15 July 2016

    Footnotes

    Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea

    Corresponding author. Department of Urology and Urological Science Institute, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea. Tel. +82 2 22282310; Fax: +82 2 3122538.

  • Comparative Effectivenes of Newer Medications for Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: A Systematic Review and Meta-analysis

    Abstract

    Context

    Alpha-blockers (ABs) and 5-alpha reductase inhibitors have an established role in treating male lower urinary tract symptoms (LUTS) attributed to benign prostatic hyperplasia (BPH). Recently, newer drugs have shown promise for this indication.

    Objective

    To assess the comparative effectiveness and adverse effects (AEs) of newer drugs to treat LUTS attributed to BPH through a systematic review and meta-analysis.

    Evidence acquisition

    Ovid MEDLINE, the Cochrane Central Register of Controlled Trials, and Ovid Embase bibliographic databases (through June 2016) were hand searches for references of relevant studies. Eligible studies included randomized controlled trials published in English of newer ABs, antimuscarinics, a beta-3 adrenoceptor agonist, phosphodiesterase type-5 inhibitors, or combination therapy with one of these medications as an active comparator. Observational studies of the same agents with a duration ≥1 yr that reported AEs were also included.

    Evidence synthesis

    We synthesized evidence from 43 randomized controlled trials as well as five observational studies. Based on improvement of mean International Prostate Symptom Score and quality of life scores, the effectiveness of the newer ABs was not different from the older ABs (moderate strength of evidence [SOE]), but had more AEs (low SOE). Antimuscarinics/AB combination therapy had similar outcomes as AB monotherapy (all moderate SOE), but often had more AEs. Phosphodiesterase type-5 inhibitors alone or in combination with ABs had similar or inferior outcomes than ABs alone. Evidence was insufficient for the beta-3 adrenoceptor agonist. For all newer agents, the evidence was generally insufficient to assess long-term efficacy, prevention of symptom progression, or AEs.

    Conclusions

    None of the drugs or drug combinations newly used to treat LUTS attributed to BPH showed outcomes superior to traditional AB treatment. Given the lack of superior outcomes, the studies’ short time-horizon, and less assurance of their safety, their current value in treating LUTS attributable to BPH appears low.

    Patient summary

    In this paper, we reviewed the evidence of newer drugs to treat men with urinary problems attributable to an enlarged prostate. We found none of the new drugs to be better but there was more concern about side effects.

    Take Home Message

    Drugs and drug combinations newly used to treat lower urinary tract symptoms attributed to benign prostatic hyperplasia did not show outcomes superior to traditional alpha-blocker treatment. Given the lack of superior outcomes and less assurance of their safety, their current value appears low.

    Keywords: Lower urinary tract symptoms, Benign prostatic hyperplasia, Alpha blockers, 5-alpha reductase inhibitor, Systematic review, Comparative effectiveness, Randomized trials.

    Footnotes

    a Minneapolis VA Health Care System, Minneapolis, MN, USA

    b Division of Health Policy and Management, University of Minnesota, School of Public Health, Minneapolis, MN, USA

    c Geriatric Research Education and Clinical Center, Minneapolis Veterans Affairs Healthcare System, Minneapolis, MN, USA

    d Department of Urology, University of Minnesota, Minneapolis, MN, USA

    e Minneapolis Veterans Affairs Healthcare System, Minneapolis, MN, USA

    f Department of Medicine, University of Minnesota, Minneapolis, MN, USA

    Corresponding author. Minneapolis VA Health Care System, Urology Section, 1 Veterans Drive, Mail Code 112D, Minneapolis, MN 55417, USA. Tel. +1 352 6825130; Fax: +1 612 626 0428.

    Please visit www.eu-acme.org/europeanurology to read and answer questions on-line. The EU-ACME credits will then be attributed automatically.

  • Re: Thomas Seisen, Benoit Peyronnet, Jose Luis Dominguez-Escrig, et al. Oncologic Outcomes of Kidney-sparing Surgery Versus Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: A Systematic Review by the EAU Non-muscle Invasive Bladder Cancer Guidelines Panel. Eur Urol. In press. http://dx.doi.org/10.1016/j.eururo.2016.07.014: Preoperative Bladder Cancer History and Chronic Kidney Disease Are Associated with Occult Renal Pelvis Cancer in Preoperative Solitary Ureteral Cancer

    Refers to article:

    Oncologic Outcomes of Kidney-sparing Surgery Versus Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: A Systematic Review by the EAU Non-muscle Invasive Bladder Cancer Guidelines Panel

    Thomas Seisen, Benoit Peyronnet, Jose Luis Dominguez-Escrig, Harman M. Bruins, Cathy Yuhong Yuan, Marko Babjuk, Andreas Böhle, Maximilian Burger, Eva M. Compérat, Nigel C. Cowan, Eero Kaasinen, Joan Palou, Bas W.G. van Rhijn, Richard J. Sylvester, Richard Zigeuner, Shahrokh F. Shariat and Morgan Rouprêt

    Accepted 11 July 2016

    December 2016 (Vol. 70, Issue 6, pages 1052 - 1068)

    Footnotes

    a Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

    b Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan

    Corresponding author. Department of Urology, Kaohsiung Chang Gung Memorial Hospital, 123 Ta-Pei Road, Niaosung, Kaohsiung, Taiwan. Tel. +886 7 7317123; Fax: +886 7 7317123.

  • Radical Nephrectomy With or Without Lymph Node Dissection for Nonmetastatic Renal Cell Carcinoma: A Propensity Score-based Analysis

    Abstract

    Background

    It is uncertain whether lymph node dissection (LND) provides a therapeutic benefit in renal cell carcinoma (RCC).

    Objective

    To evaluate the association of LND with oncologic outcomes among patients undergoing radical nephrectomy (RN) for nonmetastatic RCC.

    Design, setting, and participants

    A retrospective cohort study of 1797 patients treated with RN for M0 RCC between 1990 and 2010, including 606 (34%) who underwent LND.

    Intervention

    RN with or without LND.

    Outcome measurements and statistical analysis

    The associations of LND with the development of distant metastases, cancer-specific mortality (CSM), and all-cause mortality (ACM) were evaluated using 1:1 propensity score (PS) matching, adjustment for/stratification by PS quintile, and inverse probability weighting. Cox models were used to evaluate the association of the number of lymph nodes removed with oncologic outcomes.

    Results and limitations

    A total of 111 (6.2%) patients were pN1. The median follow-up after surgery was 10.6 yr. Following PS adjustment, there were no significant differences in clinicopathologic features between patients with and without LND. In the overall cohort, LND was not significantly associated with a reduced risk of distant metastases, CSM, or ACM. Moreover, LND was not associated with improved oncologic outcomes even among patients at increased risk of pN1 disease, including those with preoperative radiographic lymphadenopathy, or across increasing threshold probabilities for pN1 disease from 0.05 to 0.50. Among patients who underwent LND, the extent of LND was not significantly associated with the development of distant metastases, CSM, or ACM. Limitations include the retrospective design.

    Conclusions

    We did not identify an oncologic benefit to LND in the overall cohort or among patients at increased risk of nodal disease. These findings do not support a therapeutic benefit to LND in patients with M0 RCC.

    Patient summary

    Lymph node dissection does not appear to provide a therapeutic benefit in patients with nonmetastatic renal cell carcinoma.

    Take Home Message

    Lymph node dissection was not associated with improved oncologic outcomes among all patients undergoing radical nephrectomy or among patients at increased risk of nodal disease. These findings do not support a therapeutic benefit to lymph node dissection in patients with nonmetastatic renal cell carcinoma.

    Keywords: Lymph node dissection, Lymphadenopathy, Nephrectomy, Renal cell carcinoma, Survival.

    Footnotes

    a Division of Urology, Rhode Island Hospital and The Miriam Hospital, Providence, RI, USA

    b Department of Urology, Mayo Clinic, Rochester, MN, USA

    c Department of Urology, University of Illinois at Chicago, Chicago, IL, USA

    d Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA

    e Department of Oncology, Mayo Clinic, Rochester, MN, USA

    f Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA

    Corresponding author. Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA. Tel. +1-507-266-0191; Fax: +1-507-284-4951.

  • Reply to Hao Lun Luo, Yen Ta Chen, Yuan Tso Cheng, and Po Hui Chiang's Letter to the Editor re: Re: Thomas Seisen, Benoit Peyronnet, Jose Luis Dominguez-Escrig, et al. Oncologic Outcomes of Kidney-sparing Surgery Versus Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: A Systematic Review by the EAU Non-muscle Invasive Bladder Cancer Guidelines Panel. Eur Urol. In press. http://dx.doi.org/10.1016/j.eururo.2016.07.014: The Key Role of Flexible Ureterorenoscopy in Kidney-sparing Surgery for Upper Tract Urothelial Carcinoma

    Refers to article:

    Oncologic Outcomes of Kidney-sparing Surgery Versus Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: A Systematic Review by the EAU Non-muscle Invasive Bladder Cancer Guidelines Panel

    Thomas Seisen, Benoit Peyronnet, Jose Luis Dominguez-Escrig, Harman M. Bruins, Cathy Yuhong Yuan, Marko Babjuk, Andreas Böhle, Maximilian Burger, Eva M. Compérat, Nigel C. Cowan, Eero Kaasinen, Joan Palou, Bas W.G. van Rhijn, Richard J. Sylvester, Richard Zigeuner, Shahrokh F. Shariat and Morgan Rouprêt

    Accepted 11 July 2016

    December 2016 (Vol. 70, Issue 6, pages 1052 - 1068)

    Refers to article:

    Re: Thomas Seisen, Benoit Peyronnet, Jose Luis Dominguez-Escrig, et al. Oncologic Outcomes of Kidney-sparing Surgery Versus Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: A Systematic Review by the EAU Non-muscle Invasive Bladder Cancer Guidelines Panel. Eur Urol 2016;70:1052–68: Preoperative Bladder Cancer History and Chronic Kidney Disease Are Associated with Occult Renal Pelvis Cancer in Preoperative Solitary Ureteral Cancer

    Hao Lun Luo, Yen Ta Chen, Yuan Tso Cheng and Po Hui Chiang

    Accepted 13 September 2016

    April 2017 (Vol. 71, Issue 4, pages e109 - e110)

    Footnotes

    a Academic Department of Urology, Pitié-Salpétrière Hospital, Assistance-Publique Hôpitaux de Paris, Pierre et Marie Curie Medical School, University Paris 6, Paris, France

    b Department of Urology, Hospital Motol, Second Faculty of Medicine, Charles University, Praha, Czech Republic

    Corresponding author. Department of Urology, Pitié-Salpétrière Hospital, 47-83 Boulevard de l’Hôpital, 75013 Paris, France.

  • Re: Christof Bernemann, Thomas J. Schnoeller, Manuel Luedeke, et al. Expression of AR-V7 in Circulating Tumour Cells Does Not Preclude Response to Next Generation Androgen Deprivation Therapy in Patients with Castration Resistant Prostate Cancer. Eur Urol. In press. http://dx.doi.org/10.1016/j.eururo.2016.07.021

    Refers to article:

    Expression of AR-V7 in Circulating Tumour Cells Does Not Preclude Response to Next Generation Androgen Deprivation Therapy in Patients with Castration Resistant Prostate Cancer

    Christof Bernemann, Thomas J. Schnoeller, Manuel Luedeke, Konrad Steinestel, Martin Boegemann, Andres J. Schrader and Julie Steinestel

    Accepted 14 July 2016

    January 2017 (Vol. 71, Issue 1, pages 1 - 3)

    Footnotes

    Department of Urology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany

    Corresponding author. Department of Urology, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany. Tel. +49 (451) 500-6112.

  • Reply to Marcus V. Cronauer, Axel S. Merseburger, and M. Raschid Hoda's Letter to the Editor re: Christof Bernemann, Thomas J. Schnoeller, Manuel Luedeke, et al. Expression of AR-V7 in Circulating Tumour Cells Does Not Preclude Response to Next Generation Androgen Deprivation Therapy in Patients with Castration Resistant Prostate Cancer. Eur Urol. In press. http://dx.doi.org/10.1016/j.eururo.2016.07.021

    Refers to article:

    Expression of AR-V7 in Circulating Tumour Cells Does Not Preclude Response to Next Generation Androgen Deprivation Therapy in Patients with Castration Resistant Prostate Cancer

    Christof Bernemann, Thomas J. Schnoeller, Manuel Luedeke, Konrad Steinestel, Martin Boegemann, Andres J. Schrader and Julie Steinestel

    Accepted 14 July 2016

    January 2017 (Vol. 71, Issue 1, pages 1 - 3)

    Refers to article:

    Re: Christof Bernemann, Thomas J. Schnoeller, Manuel Luedeke, et al. Expression of AR-V7 in Circulating Tumour Cells Does Not Preclude Response to Next Generation Androgen Deprivation Therapy in Patients with Castration Resistant Prostate Cancer. Eur Urol 2017;71:1–3

    Marcus V. Cronauer, Axel S. Merseburger and M. Raschid Hoda

    Accepted 7 September 2016

    April 2017 (Vol. 71, Issue 4, pages e105 - e106)

    Footnotes

    a Clinic of Urology, University Hospital Muenster, Muenster, Germany

    b Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA

    Corresponding author. Clinic of Urology, University Hospital Münster, Albert-Schweitzer-Campus 1, Münster 48149, Germany. Tel. +49 251 8347442; Fax: +49 251 8349739.

  • Sentinel Node Procedure in Prostate Cancer: A Systematic Review to Assess Diagnostic Accuracy

    Abstract

    Context

    Extended pelvic lymph node dissection (ePLND) is the gold standard for detecting lymph node (LN) metastases in prostate cancer (PCa). The benefit of sentinel node biopsy (SNB), which is the first draining LN as assessed by imaging of locally injected tracers, remains controversial.

    Objective

    To assess the diagnostic accuracy of SNB in PCa.

    Evidence acquisition

    A systematic literature search of Medline, Embase, and the Cochrane Library (1999–2016) was undertaken using PRISMA guidelines. All studies of SNB in men with PCa using PLND as reference standard were included. The primary outcomes were the nondiagnostic rate (NDR), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and false positive (FP) and false negative (FN) rates. Relevant sensitivity analyses based on SN definitions, ePLND as reference standard, and disease risk were undertaken, including a risk of bias (RoB) assessment.

    Evidence synthesis

    Of 373 articles identified, 21 studies recruiting a total of 2509 patients were eligible for inclusion. Median cumulative percentage (interquartile range) results were 4.1% (1.5–10.7%) for NDR, 95.2% (81.8–100%) for sensitivity, 100% (95.0–100%) for specificity, 100% (87.0–100%) for PPV, 98.0% (94.3–100%) for NPV, 0% (0–5.0%) for the FP rate, and 4.8% (0–18.2%) for the FN rate. The findings did not change significantly on sensitivity analyses. Most studies (17/22) had low RoB for index test and reference standard domains.

    Conclusions

    SNB appears to have diagnostic accuracy comparable to ePLND, with high sensitivity, specificity, PPV and NPV, and a low FN rate. With a low FP rate (rate of detecting positive nodes outside the ePLND template), SNB may not have any additional diagnostic value over and above ePLND, although SNB appears to increase nodal yield by increasing the number of affected nodes when combined with ePLND. Thus, in high-risk disease it may be prudent to combine ePLND with SNB.

    Patient summary

    This literature review showed a high diagnostic accuracy for sentinel node biopsy in detecting positive lymph nodes in prostate cancer, but further studies are needed to explore the effect of sentinel node biopsy on complications and oncologic outcome.

    Take Home Message

    The accuracy of sentinel node biopsy (SNB) in detecting positive lymph nodes in prostate cancer appears to have diagnostic accuracy comparable to that of extended pelvic lymph node dissection (ePLND). However, SNB may not have any additional diagnostic value over and above ePLND.

    Keywords: Prostate cancer, Sentinel node, Targeted lymph node biopsy, Pelvic lymph node dissection, Diagnostic accuracy, Systematic review.

    Footnotes

    a Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands

    b Department of Urology, Eryaman Hospital, Ankara, Turkey

    c Academic Urology Unit, University of Aberdeen, Aberdeen, UK

    d Department of Urology, Skåne University Hospital Malmö and Department of Translational Medicine Lund University, Sweden

    e Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands

    f University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Germany

    g Department of Urology, Paracelsus Medical University, Salzburg, Austria

    h Department of Nuclear Medicine, Hospital Clinic Universitari de Barcelona, Barcelona, Spain

    i Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK

    Corresponding author. Department of Urology, Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam 1066CX, The Netherlands. Tel. +31 20 5122553; Fax: +31-205122459.

  • Generalizability of the Prostate Cancer Intervention Versus Observation Trial (PIVOT) Results to Contemporary North American Men with Prostate Cancer

    Abstract

    The Prostate Cancer Intervention Versus Observation Trial (PIVOT) concluded that radical prostatectomy (RP) offered no survival benefit compared with observation in men with clinically localized prostate cancer (PCa). We identified patients within the National Cancer Database (NCDB) for the period 2004-2012 who met the inclusion criteria of PIVOT (ie, histologically confirmed PCa, clinical stage T1–2NxM0, prostate-specific antigen <50 ng/ml, age <75 yr, estimated life expectancy >10 yr, and undergoing RP or observation as initial treatment within 12 mo of diagnosis) to confirm the generalizability of the PIVOT results to the US population. Life expectancy was calculated using the US Social Security Administration life tables and was adjusted for comorbidities at diagnosis. Compared with PIVOT, men in the NCDB were younger (mean age 60.3 vs 67.0 yr) and healthier (Charlson-Deyo comorbidity index of 0: 93% vs 56%; both p < 0.001). Furthermore, 42% of men randomized to receive RP in PIVOT harbored D’Amico low-risk PCa, whereas 32% of men undergoing RP in the NCDB had low-risk disease. Our findings were confirmed in a sensitivity analysis including men regardless of life expectancy but satisfying all other inclusion criteria of PIVOT. Given that the NCDB represents nearly 70% of all incident cancers diagnosed in the United States, our data provide further evidence that PIVOT results may not be generalizable to contemporary clinical practice.

    Patient summary

    We observed that men diagnosed with clinically localized prostate cancer within the National Cancer Database (2004–2012) were younger, healthier, and more likely to have radical prostatectomy for higher risk disease than men in the Prostate Cancer Intervention Versus Observation Trial (PIVOT), raising questions about the applicability of PIVOT conclusions to the contemporary US population.

    Take Home Message

    We compared the demographics and tumor characteristics of men represented in the Prostate Cancer Intervention Versus Observation Trial (PIVOT) with contemporary (2004–2012) US men diagnosed with clinically localized prostate cancer using a large nationwide tumor registry. We found that contemporary men were significantly younger, healthier, and more likely to receive radical prostatectomy for higher risk disease than their PIVOT counterparts and may demonstrate an overall mortality benefit with radical prostatectomy versus observation, questioning the generalizability of the PIVOT results.

    Keywords: Prostate cancer, Radical prostatectomy, Observation, PIVOT, National Cancer Database.

    Footnotes

    a VUI Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA

    b Public Health Sciences, Henry Ford Health System, Detroit, MI, USA

    c Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA

    Corresponding author. VUI Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, 2799 West Grand Boulevard K-9, Detroit, MI 48202, USA. Tel. +1 313 916 7129; Fax: +1 313 916 4352.

  • Partial Nephrectomy Versus Radical Nephrectomy for Clinical T1b and T2 Renal Tumors: A Systematic Review and Meta-analysis of Comparative Studies

    Abstract

    Background

    Partial nephrectomy (PN) is the reference standard of management for a cT1a renal mass. However, its role in the management of larger tumors (cT1b and cT2) is still under scrutiny.

    Objective

    To conduct a meta-analysis assessing functional, oncologic, and perioperative outcomes of PN and radical nephrectomy (RN) in the specific case of larger renal tumors (≥cT1b). The primary endpoint was an overall analysis of cT1b and cT2 masses. The secondary endpoint was a sensitivity analysis for cT2 only.

    Evidence acquisition

    A systematic literature review was performed up to December 2015 using multiple search engines to identify eligible comparative studies. A formal meta-analysis was performed for studies comparing PN to RN for both cT1b and cT2 tumors. In addition, a sensitivity analysis including the subgroup of studies comparing PN to RN for cT2 only was conducted. Pooled estimates were calculated using a fixed-effects model if no significant heterogeneity was identified; alternatively, a random-effects model was used when significant heterogeneity was detected. For continuous outcomes, the weighted mean difference (WMD) was used as summary measure. For binary variables, the odds ratio (OR) or risk ratio (RR) was calculated with 95% confidence interval (CI). Statistical analyses were performed using Review Manager 5 (Cochrane Collaboration, Oxford, UK).

    Evidence synthesis

    Overall, 21 case-control studies including 11 204 patients (RN 8620; PN 2584) were deemed eligible and included in the analysis. Patients undergoing PN were younger (WMD −2.3 yr; p < 0.001) and had smaller masses (WMD −0.65 cm; p < 0.001). Lower estimated blood loss was found for RN (WMD 102.6 ml; p < 0.001). There was a higher likelihood of postoperative complications for PN (RR 1.74, 95% CI 1.34–2.2; p < 0.001). Pathology revealed a higher rate of malignant histology for the RN group (RR 0.97; p = 0.02). PN was associated with better postoperative renal function, as shown by higher postoperative estimated glomerular filtration rate (eGFR; WMD 12.4 ml/min; p < 0.001), lower likelihood of postoperative onset of chronic kidney disease (RR 0.36; p < 0.001), and lower decline in eGFR (WMD −8.6 ml/min; p < 0.001). The PN group had a lower likelihood of tumor recurrence (OR 0.6; p < 0.001), cancer-specific mortality (OR 0.58; p = 0.001), and all-cause mortality (OR 0.67; p = 0.005). Four studies compared PN (n = 212) to RN (n = 1792) in the specific case of T2 tumors (>7 cm). In this subset of patients, the estimated blood loss was higher for PN (WMD 107.6 ml; p < 0.001), as was the likelihood of complications (RR 2.0; p < 0.001). Both the recurrence rate (RR 0.61; p = 0.004) and cancer-specific mortality (RR 0.65; p = 0.03) were lower for PN.

    Conclusions

    PN is a viable treatment option for larger renal tumors, as it offers acceptable surgical morbidity, equivalent cancer control, and better preservation of renal function, with potential for better long-term survival. For T2 tumors, PN use should be more selective, and specific patient and tumor factors should be considered. Further investigation, ideally in a prospective randomized fashion, is warranted to better define the role of PN in this challenging clinical scenario.

    Patient summary

    We performed a cumulative analysis of the literature to determine the best treatment option in cases of localized kidney tumor of higher clinical stage (T1b and T2, as based on preoperative imaging). Our findings suggest that removing only the tumor and saving the kidney might be an effective treatment modality in terms of cancer control, with the advantage of preserving the kidney function. However, a higher risk of perioperative complications should be taken into account when facing larger tumors (clinical stage T2) with kidney-sparing surgery.

    Take Home Message

    Partial nephrectomy (PN) is a viable treatment option for larger renal tumors, as it offers acceptable surgical morbidity, equivalent cancer control, and better preservation of renal function, with potential for better long-term survival. In the subset of T2 tumors its use should be more selective, and specific patient and tumor factors should be considered. Further investigation, ideally in a prospective randomized fashion, is warranted to better define the role of PN in this challenging clinical scenario.

    Keywords: Kidney cancer, Partial nephrectomy, Renal neoplasm, Renal mass, Radical nephrectomy, Renal function.

    Footnotes

    a Department of Urology, Hospital del Mar-Parc de Salut Mar-IMIM, Barcelona, Spain

    b Department of Urology, UC San Diego Health System, La Jolla, CA, USA

    c Division of Urology, Department of Oncology, University of Turin San Luigi Hospital, Orbassano, Italy

    d Urology Department, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia

    e OLV Vattikuti Robotic Surgery Institute, Aalst, Belgium

    f Urology Institute, University Hospitals, Case Western Reserve University, Cleveland, OH, USA

    Corresponding author. Urology Institute, Case Western Reserve University, 27100 Chardon Road, Richmond Heights, OH 44143, USA.

  • Tension-free Vaginal Tape–Obturator for Treatment of Pure Urodynamic Stress Urinary Incontinence: Efficacy and Adverse Effects at 10-year Follow-up

    Abstract

    Background

    Inside-out transobturator tape (tension-free vaginal tape–obturator [TVT-O]) is currently one of the most effective and popular procedures for the surgical treatment of female stress urinary incontinence (SUI). However, data reporting long-term outcomes are lacking.

    Objective

    To assess the efficacy and safety of TVT-O 10 yr after implantation for the treatment of female pure SUI.

    Design, setting, and participants

    A multicenter, prospective study was conducted in five tertiary referral centers in three countries. All consecutive women with urodynamically proven pure SUI treated by TVT-O were included. Patients with mixed incontinence and/or anatomic evidence of pelvic organ prolapse were excluded.

    Intervention

    TVT-O implantation.

    Outcome measurements and statistical analysis

    Data regarding subjective outcomes (International Consultation on Incontinence Questionnaire–Short Form, Patient Global Impression of Improvement, and patient satisfaction scores), objective cure (stress test) rates, and adverse events were collected during follow-up. Univariable analysis was performed to investigate outcomes.

    Results and limitations

    One hundred sixty-eight women had TVT-O implantation. At 10-yr follow-up, 160 patients (95%) were available for the evaluation. We did not find any significant change of the surgical outcomes during this time. At 10 yr after surgery, 155 of 160 patients (97%) declared themselves cured (p = 0.7). Similarly, at 10-yr evaluation, 148 of 160 patients (92%) were objectively cured. No significant deterioration of objective cure rates was observed over time (p = 0.4). The history of failure of previous anti-incontinence procedures (hazard ratio: 5.34; 95% CI, 2.61–11.9; p = 0.009) was the only predictor of recurrence of SUI. The onset of de novo overactive bladder was reported by 23 of 160 patients (14%) at 10-yr follow-up. No other late complications were reported.

    Conclusions

    The 10-yr results of this study showed that TVT-O is a highly effective and safe option for the treatment of SUI.

    Patient summary

    At long-term follow up, tension-free vaginal tape-obturator is highly effective and safe for the treatment of stress urinary incontinence.

    Take Home Message

    The 10-yr results of this study showed that tension-free vaginal tape–obturator is a highly effective and safe option for the treatment of stress urinary incontinence.

    Keywords: Long-term follow-up, Sling, Stress urinary incontinence, Tension-free vaginal tape-obturator, TVT-O, Urinary incontinence.

    Footnotes

    a Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy

    b Department of Obstetrics and Gynecology, EOC–Beata Vergine Hospital, Mendrisio, Switzerland

    c First Department of Obstetrics and Gynecology, University of Athens, “Alexandra” Hospital, Athens, Greece

    d Department of Obstetrics and Gynecology, University of Naples Federico II, Naples, Italy

    e Department of Obstetrics and Gynecology, Second Faculty, Naples, Italy

    f Obstetrics and Gynecology Unit, Vita-Salute University and IRCCS San Raffaele Hospital, Milan, Italy

    Corresponding author. Department of Obstetrics and Gynecology, Urogynecology Unit, University of Insubria, Piazza Biroldi 1, 21100 Varese, Italy. Tel. +39 0332 299 309; Fax: +39 0332 299 307.

  • EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part II: Treatment of Relapsing, Metastatic, and Castration-Resistant Prostate Cancer

    Abstract

    Objective

    To present a summary of the 2016 version of the European Association of Urology (EAU) – European Society for Radiotherapy & Oncology (ESTRO) – International Society of Geriatric Oncology (SIOG) Guidelines on the treatment of relapsing, metastatic, and castration-resistant prostate cancer (CRPC).

    Evidence acquisition

    The working panel performed a literature review of the new data (2013–2015). The guidelines were updated, and the levels of evidence and/or grades of recommendation were added based on a systematic review of the literature.

    Evidence synthesis

    Relapse after local therapy is defined by a rising prostate-specific antigen (PSA) level >0.2 ng/ml following radical prostatectomy (RP) and >2 ng/ml above the nadir after radiation therapy (RT). 11C-choline positron emission tomography/computed tomography is of limited importance if PSA is <1.0 ng/ml; bone scans and computed tomography can be omitted unless PSA is >10 ng/ml. Multiparametric magnetic resonance imaging and biopsy are important to assess biochemical failure following RT. Therapy for PSA relapse after RP includes salvage RT at PSA levels <0.5 ng/ml and salvage RP, high-intensity focused ultrasound, cryosurgical ablation or salvage brachytherapy of the prostate in radiation failures. Androgen deprivation therapy (ADT) remains the basis for treatment of men with metastatic prostate cancer (PCa). However, docetaxel combined with ADT should be considered the standard of care for men with metastases at first presentation, provided they are fit enough to receive the drug. Follow-up of ADT should include analysis of PSA, testosterone levels, and screening for cardiovascular disease and metabolic syndrome. Level 1 evidence for the treatment of metastatic CRPC (mCRPC) includes, abiraterone acetate plus prednisone (AA/P), enzalutamide, radium 223 (Ra 223), docetaxel at 75 mg/m2 every 3 wk and sipuleucel-T. Cabazitaxel, AA/P, enzalutamide, and radium are approved for second-line treatment of CRPC following docetaxel. Zoledronic acid and denosumab can be used in men with mCRPC and osseous metastases to prevent skeletal-related complications.

    Conclusions

    The knowledge in the field of advanced and metastatic PCa and CRPC is changing rapidly. The 2016 EAU-ESTRO-SIOG Guidelines on PCa summarise the most recent findings and advice for use in clinical practice. These PCa guidelines are the first endorsed by the European Society for Therapeutic Radiology and Oncology and the International Society of Geriatric Oncology and reflect the multidisciplinary nature of PCa management. A full version is available from the EAU office or online (http://uroweb.org/guideline/prostate-cancer/).

    Patient summary

    In men with a rise in their PSA levels after prior local treatment for prostate cancer only, it is important to balance overtreatment against further progression of the disease since survival and quality of life may never be affected in many of these patients. For patients diagnosed with metastatic castrate-resistant prostate cancer, several new drugs have become available which may provide a clear survival benefit but the optimal choice will have to be made on an individual basis.

    Take Home Message

    This paper summarises the 2016 European Association of Urology (EAU)- European Society for Radiotherapy & Oncology (ESTRO) - International Society of Geriatric Oncology (SIOG) Prostate Cancer Guidelines Prostate Cancer Guidelines. Standard therapy for PSA relapse after radical prostatectomy is salvage radiotherapy at a PSA of <0.5 ng/ml. Recommendations for treatment of progression after primary radiotherapy include salvage radical prostatectomy, high-intensity focused ultrasound (HIFU) and cryosurgical ablation. Androgen deprivation therapy (ADT) remains the basis for the treatment of metastatic prostate cancer; however, docetaxel combined with ADT should be considered the standard of care for men with metastases at first presentation, provided patients are fit. In patients diagnosed with metastatic castrate-resistant PCa, chemotherapy, new bone-targeting agents and agents targeting the antiandrogen axis and immunotherapy are treatment options.

    Keywords: Prostate cancer, Staging, Relapse, Metastatic, Castration-resistant, EAU-ESTRO-SIOG Guidelines, Hormonal therapy, Chemotherapy, Follow-up, Palliative.

    Footnotes

    a Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK

    b Bladder Cancer Center, Dana-Farber Cancer Institute, Boston, MA, USA

    c Harvard Medical School, Boston, MA, USA

    d Department of Radiation Therapy, CHU Grenoble, Grenoble, France

    e Patient Advocate, Hasselt, Belgium

    f University of Warwick, Cancer Research Centre, Coventry, UK

    g Department of Urology, University of Bern, Inselspital, Bern, Switzerland

    h Leeds Cancer Centre, St. James's University Hospital, Leeds, UK

    i Department of Urology, University Hospitals Leuven, Leuven, Belgium

    j Academic Urology Unit, University of Aberdeen, Aberdeen, UK

    k Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK

    l Velindre Hospital, Cardiff, UK

    m Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands

    n Department of Pathology, Erasmus Medical Centre, Rotterdam, The Netherlands

    o Hospices Civils de Lyon, Radiology Department, Edouard Herriot Hospital, Lyon, France

    p Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany

    q Department of Urology, University Hospital, St. Etienne, France

    Corresponding author. Royal Liverpool and Broadgreen Hospitals NHS Trust, Department of Urology, Prescott Street, Liverpool L7 8XP, UK. Tel. +44 15 17 06 3594; Fax: +44 15 17 06 53 10.

  • Comparing Three Different Techniques for Magnetic Resonance Imaging-targeted Prostate Biopsies: A Systematic Review of In-bore versus Magnetic Resonance Imaging-transrectal Ultrasound fusion versus Cognitive Registration. Is There a Preferred Technique?

    Abstract

    Context

    The introduction of magnetic resonance imaging-guided biopsies (MRI-GB) has changed the paradigm concerning prostate biopsies. Three techniques of MRI-GB are available: (1) in-bore MRI target biopsy (MRI-TB), (2) MRI-transrectal ultrasound fusion (FUS-TB), and (3) cognitive registration (COG-TB).

    Objective

    To evaluate whether MRI-GB has increased detection rates of (clinically significant) prostate cancer (PCa) compared with transrectal ultrasound-guided biopsy (TRUS-GB) in patients at risk for PCa, and which technique of MRI-GB has the highest detection rate of (clinically significant) PCa.

    Evidence acquisition

    We performed a literature search in PubMed, Embase, and CENTRAL databases. Studies were evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 checklist and START recommendations. The initial search identified 2562 studies and 43 were included in the meta-analysis.

    Evidence synthesis

    Among the included studies 11 used MRI-TB, 17 used FUS-TB, 11 used COG-TB, and four used a combination of techniques. In 34 studies concurrent TRUS-GB was performed. There was no significant difference between MRI-GB (all techniques combined) and TRUS-GB for overall PCa detection (relative risk [RR] 0.97 [0.90–1.07]). MRI-GB had higher detection rates of clinically significant PCa (csPCa) compared with TRUS-GB (RR 1.16 [1.02–1.32]), and a lower yield of insignificant PCa (RR 0.47 [0.35–0.63]). There was a significant advantage (p = 0.02) of MRI-TB compared with COG-TB for overall PCa detection. For overall PCa detection there was no significant advantage of MRI-TB compared with FUS-TB (p = 0.13), and neither for FUS-TB compared with COG-TB (p = 0.11). For csPCa detection there was no significant advantage of any one technique of MRI-GB. The impact of lesion characteristics such as size and localisation could not be assessed.

    Conclusions

    MRI-GB had similar overall PCa detection rates compared with TRUS-GB, increased rates of csPCa, and decreased rates of insignificant PCa. MRI-TB has a superior overall PCa detection compared with COG-TB. FUS-TB and MRI-TB appear to have similar detection rates. Head-to-head comparisons of MRI-GB techniques are limited and are needed to confirm our findings.

    Patient summary

    Our review shows that magnetic resonance imaging-guided biopsy detects more clinically significant prostate cancer (PCa) and less insignificant PCa compared with systematic biopsy in men at risk for PCa.

    Take Home Message

    Based on this comprehensive review of the literature magnetic resonance imaging (MRI)-guided biopsy had similar overall prostate cancer detection rates compared with transrectal ultrasound-guided biopsy, increased rates of clinically significant cancer, and decreased rates of clinically insignificant cancer. In-bore MRI target biopsy has a superior overall prostate cancer detection compared with cognitively registered target biopsy. MRI-transrectal ultrasound fusion target biopsy and in-bore MRI target biopsy have similar detection rates. The impact of lesion characteristics such as size and localisation could not be assessed.

    Keywords: Diagnosis, Image guided biopsy, Meta-analysis, MRI, Prostate cancer, Systematic review.

    Footnotes

    a Department of Urology, St. Antonius Hospital, Nieuwegein/Utrecht, The Netherlands

    b Cochrane Netherlands, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands

    c Department of Urology, University Medical Centre Utrecht, The Netherlands

    d Department of Epidemiology, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands

    e Department of Radiology, Radboud University Nijmegen Medical Centre, The Netherlands

    f Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands

    Corresponding author. St. Antonius Hospital, Department of Urology, Koekoekslaan 1, Post Office Box 2500, 3430 EM Nieuwegein, The Netherlands. Tel. +31-(0)-88-3202554; Fax: +31-(0)-30-6092680.

  • EAU–ESTRO–SIOG Guidelines on Prostate Cancer. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent

    Abstract

    Objective

    To present a summary of the 2016 version of the European Association of Urology (EAU) - European Society for Radiotherapy & Oncology (ESTRO) - International Society of Geriatric Oncology (SIOG) Guidelines on screening, diagnosis, and local treatment with curative intent of clinically localised prostate cancer (PCa).

    Evidence acquisition

    The working panel performed a literature review of the new data (2013–2015). The guidelines were updated and the levels of evidence and/or grades of recommendation were added based on a systematic review of the evidence.

    Evidence synthesis

    BRCA2 mutations have been added as risk factors for early and aggressive disease. In addition to the Gleason score, the five-tier 2014 International Society of Urological Pathology grading system should now be provided. Systematic screening is still not recommended. Instead, an individual risk-adapted strategy following a detailed discussion and taking into account the patient's wishes and life expectancy must be considered. An early prostate-specific antigen test, the use of a risk calculator, or one of the promising biomarker tools are being investigated and might be able to limit the overdetection of insignificant PCa. Breaking the link between diagnosis and treatment may lower the overtreatment risk. Multiparametric magnetic resonance imaging using standardised reporting cannot replace systematic biopsy, but robustly nested within the diagnostic work-up, it has a key role in local staging. Active surveillance always needs to be discussed with very low-risk patients. The place of surgery in high-risk disease and the role of lymph node dissection have been clarified, as well as the management of node-positive patients. Radiation therapy using dose-escalated intensity-modulated technology is a key treatment modality with recent improvement in the outcome based on increased doses as well as combination with hormonal treatment. Moderate hypofractionation is safe and effective, but longer-term data are still lacking. Brachytherapy represents an effective way to increase the delivered dose. Focal therapy remains experimental while cryosurgery and HIFU are still lacking long-term convincing results.

    Conclusions

    The knowledge in the field of diagnosis, staging, and treatment of localised PCa is evolving rapidly. The 2016 EAU-ESTRO-SIOG Guidelines on PCa summarise the most recent findings and advice for the use in clinical practice. These are the first PCa guidelines endorsed by the European Society for Radiotherapy and Oncology and the International Society of Geriatric Oncology and reflect the multidisciplinary nature of PCa management. A full version is available from the EAU office and online (http://uroweb.org/guideline/prostate-cancer/).

    Patient summary

    The 2016 EAU-STRO-IOG Prostate Cancer (PCa) Guidelines present updated information on the diagnosis, and treatment of clinically localised prostate cancer. In Northern and Western Europe, the number of men diagnosed with PCa has been on the rise. This may be due to an increase in opportunistic screening, but other factors may also be involved (eg, diet, sexual behaviour, low exposure to ultraviolet radiation). We propose that men who are potential candidates for screening should be engaged in a discussion with their clinician (also involving their families and caregivers) so that an informed decision may be made as part of an individualised risk-adapted approach.

    Take Home Message

    The 2016 European Association of Urology prostate cancer guidelines summarise the most recent findings and provide recommendations for clinical practice. The knowledge in the field of diagnosis, staging, and treatment of localised prostate cancer is rapidly evolving.

    Keywords: Prostate cancer, Localised, EAU-ESTRO-SIOG Guidelines, Screening, Diagnosis, Staging, Treatment, Radical prostatectomy, Radiation therapy, Androgen deprivation.

    Footnotes

    a Department of Urology, University Hospital, St. Etienne, France

    b Bladder Cancer Center, Dana-Farber Cancer Institute, Boston, MA, USA

    c Harvard Medical School, Boston, MA, USA

    d Department of Radiation Therapy, CHU Grenoble, Grenoble, France

    e Patient Advocate, Hasselt, Belgium

    f Academic Urology Unit, University of Sheffield, Sheffield, UK

    g University of Warwick, Cancer Research Centre, Coventry, UK

    h Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy

    i Università Vita-Salute San Raffaele, Milan, Italy

    j Department of Urology, University of Bern, Inselspital, Bern, Switzerland

    k Leeds Cancer Centre, St. James's University Hospital, Leeds, UK; University of Leeds, Leeds, UK

    l Department of Urology, University Hospitals Leuven, Leuven, Belgium

    m Academic Urology Unit, University of Aberdeen, Aberdeen, UK

    n Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK

    o Cardiff University, Velindre Hospital, Cardiff, UK

    p N.N. Blokhin Cancer Research Center, Moscow, Russia

    q Hospices Civils de Lyon, Radiology Department, Edouard Herriot Hospital, Lyon, France

    r Department of Urology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands

    s Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands

    t Department of Pathology, Erasmus Medical Centre, Rotterdam, The Netherlands

    u Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre, Rotterdam, The Netherlands

    v Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany

    w Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK

    Corresponding author. Department of Urology, University Hospital, St. Etienne, France. Tel. +33 477828331; Fax: +33 477517179.

  • The Effect of Enzalutamide and Bicalutamide on Patient-reported Quality of Life Outcomes: Results from the TERRAIN Study

    Refers to article:

    Impact of Enzalutamide Compared with Bicalutamide on Quality of Life in Men with Metastatic Castration-resistant Prostate Cancer: Additional Analyses from the TERRAIN Randomised Clinical Trial

    Axel Heidenreich, Simon Chowdhury, Laurence Klotz, David Robert Siemens, Arnauld Villers, Cristina Ivanescu, Stefan Holmstrom, Benoit Baron, Fong Wang, Ping Lin and Neal D. Shore

    Accepted 20 July 2016

    April 2017 (Vol. 71, Issue 4, pages 534 - 542)

    Footnotes

    a Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA

    b Division of Hematology and Oncology, Mayo Clinic, Phoenix, AZ, USA

    Corresponding author. Department of Urologic Surgery, Vanderbilt University Medical Center, A1302 Medical Center North, Nashville, TN 37203, USA. Tel. +1 615 3222880; Fax: +1 615 3439815.

  • Impact of Enzalutamide Compared with Bicalutamide on Quality of Life in Men with Metastatic Castration-resistant Prostate Cancer: Additional Analyses from the TERRAIN Randomised Clinical Trial

    Abstract

    Background

    Improving health-related quality of life (HRQoL) is an important goal in metastatic castration-resistant prostate cancer (mCRPC).

    Objective

    To examine the impact of enzalutamide versus bicalutamide on HRQoL in mCRPC.

    Design, setting, and participants

    TERRAIN is a multinational, phase 2, randomised, double-blind study in asymptomatic/mildly symptomatic men with mCRPC (ClinicalTrials.gov, NCT01288911). Patients were randomised (1:1) via an interactive voice and web response system to enzalutamide 160 mg/d (n = 184) or bicalutamide 50 mg/d (n = 191), with androgen deprivation therapy.

    Outcome measurements and statistical analysis

    HRQoL was assessed using Functional Assessment of Cancer Therapy–Prostate (FACT-P), European Quality of Life 5-Domain Scale (EQ-5D), and Brief Pain Inventory, Short-form questionnaires every 12 wk. Primary and secondary analyses utilised mixed models for repeated measures and pattern mixture models, respectively.

    Results and limitations

    At 61 wk, 84 (46%) enzalutamide and 39 (20%) bicalutamide patients in the study were assessed. At 61 wk, changes from baseline favoured enzalutamide versus bicalutamide on three FACT-P domains in mixed models for repeated measures analyses and seven in pattern mixture models analyses. There were no differences in changes for EQ-5D index/visual analogue scale scores. Risk of first deterioration was lower with enzalutamide for FACT-P total (hazard ratio: 0.64, 95% confidence interval: 0.46–0.89, p= 0.007), FACT-G total (hazard ratio: 0.70, 95% confidence interval: 0.50–0.98, p = 0.04), PCS pain (hazard ratio: 0.74, 95% confidence interval: 0.54–1.00, p = 0.048), and EQ-5D index (hazard ratio: 0.66, 95% confidence interval: 0.47–0.93, p = 0.02) scores versus bicalutamide. Brief Pain Inventory, Short-form scores increased in both groups. There was no difference in time-to-pain progression. Study limitations include the exploratory nature of the HRQoL analyses, lack of multiple comparisons corrections, and unknown effects of anxiety/depression on HRQoL.

    Conclusions

    In patients with asymptomatic/mildly symptomatic mCRPC, enzalutamide provides HRQoL benefit versus bicalutamide.

    Patient summary

    Enzalutamide treatment was associated with better health-related quality of life in several domains versus bicalutamide in asymptomatic/mildly symptomatic metastatic castration-resistant prostate cancer. This likely relates to previously reported lower rates of symptomatic disease progression.

    Take Home Message

    Enzalutamide provides a health-related quality of life benefit compared with bicalutamide in patients with asymptomatic or mildly symptomatic metastatic castration-resistant prostate cancer.

    Keywords: Bicalutamide, Enzalutamide, Metastatic castration-resistant prostate cancer, Quality of life.

    Footnotes

    a Department of Urology, Cologne University, Cologne, Germany

    b Department of Urology, Guy's, King's, and St Thomas’ Hospital, London, UK

    c Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    d Centre for Applied Urological Research, Queen's University, Kingston, ON, Canada

    e Department of Urology, Lille University Medical Center, Lille University, Lille, France

    f Quintiles Advisory Services, Hoofddorp, the Netherlands

    g Astellas Pharma Inc., Leiden, The Netherlands

    h Medivation Inc., San Francisco, CA, USA

    i Carolina Urologic Research Centre, Myrtle Beach, SC, USA

    Corresponding author. Klinik und Poliklinik für Urologie, Universitätsklinikum Köln, Kerpener Straße 62, 50937 Köln, Germany. Tel. +49 221 478 82108; Fax: +49 221 478 82372.

  • Medical Expulsive Therapy in View of Current Discussion: The EAU Position in 2016

    Abstract

    Medical expulsive therapy (MET), in particular α-blockers, have been recommended as supportive medication if observational treatment of a ureteral stone was an option. Over the years, a considerable number of randomized controlled trials (RCT) as well as several meta-analyses have been published on MET, supporting the use of α-blockers. However, several recently published high quality, large, placebo-controlled randomized trials raised serious doubts about the effectiveness of α-blockers. The contradictory results of meta-analyses of small RCTs versus the findings of large, well conducted multicenter trials show the methodological vulnerability of meta-analyses, in particular if small single center, lower quality, papers have been included. Small single center trials, for instance, tend to show larger treatment effects compared to multicenter RCTs. It also shows the responsibility of careful planning when conducting a RCT. Trial registration as a prerequisite for approval by ethics committees could in addition minimize publication bias. Weighting the current evidence on whether to use MET, or not, it seems that in distal ureteral stones larger than 5 mm, there may be a potential therapeutic benefit for the use of α-blockers. Patients should be informed about the possible, but as yet unproven benefit of using α-blockers in this situation, as well as their off-label use and potential side effects.

    Take Home Message

    The evidence on the use of α-blockers as medical expulsive therapy (MET) remains controversial when comparing findings of several meta-analyses of small, single center RCTs against the results of large multicentric studies. Currently, patients diagnosed with distal ureteral stones larger than 5 mm may potentially benefit from α-blockers as MET, provided they are well informed.

    Keywords: Urinary calculi, MET, EAU guidelines.

    Footnotes

    a Urologische Praxis und Steinzentrum, Vienna, Austria

    b Department of Urology, Sindelfingen-Böblingen Medical Center, University of Tübingen, Sindelfingen, Germany

    c Department of Urology, Medical University of Vienna, Vienna, Austria

    d Second Department of Urology, Sismanoglio Hospital, Athens Medical School, Athens, Greece

    e Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK

    f Aberdeen Royal Infirmary, NHS Grampian and University of Aberdeen, Aberdeen, UK

    Corresponding author. Ziehrerplatz 7/7, 1030 Vienna, Austria. Tel. +43 1 7126574.

  • Ex Vivo Model of Human Penile Transplantation and Rejection: Implications for Erectile Tissue Physiology

    Abstract

    Background

    Penile transplantation is a potential treatment option for severe penile tissue loss. Models of human penile rejection are lacking.

    Objective

    Evaluate effects of rejection and immunosuppression on cavernous tissue using a novel ex vivo mixed lymphocyte reaction (MLR) model.

    Design, setting, and participants

    Cavernous tissue and peripheral blood mononuclear cells (PBMCs) from 10 patients undergoing penile prosthesis operations and PBMCs from a healthy volunteer were obtained. Ex vivo MLRs were prepared by culturing cavernous tissue for 48 h in media alone, in media with autologous PBMCs, or in media with allogenic PBMCs to simulate control, autotransplant, and allogenic transplant conditions with or without 1 μM cyclosporine A (CsA) or 20 nM tacrolimus (FK506) treatment.

    Outcome measurements and statistical analysis

    Rejection was characterized by PBMC flow cytometry and gene expression transplant array. Cavernous tissues were evaluated by histomorphology and myography to assess contraction and relaxation. Data were analyzed using two-way analysis of variance and unpaired Student t test.

    Results and limitations

    Flow cytometry and tissue array demonstrated allogenic PBMC activation consistent with rejection. Rejection impaired cavernous tissue physiology and was associated with cellular infiltration and apoptosis. CsA prevented rejection but did not improve tissue relaxation. CsA treatment impaired relaxation in tissues cultured without PBMCs compared with media and FK506. Study limitations included the use of penile tissue with erectile dysfunction and lack of cross-matching data.

    Conclusions

    This model could be used to investigate the effects of penile rejection and immunosuppression. Additional studies are needed to optimize immunosuppression to prevent rejection and maximize corporal tissue physiology.

    Patient summary

    This report describes a novel ex vivo model of human penile transplantation rejection. Tissue rejection impaired erectile tissue physiology. This report suggests that cyclosporin A might hinder corporal physiology and that other immunosuppressant agents, such as FK506, might be better suited to penile transplantation.

    Take Home Message

    Penile transplant models are lacking, and it is unknown how rejection and immunosuppression affect erectile physiology. Ex vivo mixed lymphocyte reaction simulates transplantation and demonstrated that rejection and certain immunosuppression treatments, such as cyclosporine A, impair erectile function.

    Keywords: Penile transplantation, Erectile dysfunction, Tissue myography.

    Footnotes

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

    b Department of Urology, Doai Memorial Hospital and The University of Tokyo, Tokyo, Japan

    c Department of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation (VCA) Laboratory, The Johns Hopkins University School of Medicine, Baltimore, MD

    Corresponding author. The Johns Hopkins Hospital, Marburg Bldg 420, 1800 Orleans Street, Baltimore, MD 21287, USA. Tel. +1 410 614 0197; Fax: +1 410 614 3695.

    Contributed equally to this work.

  • Robotic Laparoendoscopic Single-site Retroperitioneal Renal Surgery: Initial Investigation of a Purpose-built Single-port Surgical System

    Abstract

    Background

    Robotic single-site retroperitoneal renal surgery has the potential to minimize the morbidity of standard transperitoneal and multiport approaches. Traditionally, technological limitations of non–purpose-built robotic platforms have hindered the application of this approach.

    Objective

    To assess the feasibility of retroperitoneal renal surgery using a new purpose-built robotic single-port surgical system.

    Design, setting, and participants

    This was a preclinical study using three male cadavers to assess the feasibility of the da Vinci SP1098 surgical system for robotic laparoendoscopic single-site (R-LESS) retroperitoneal renal surgery.

    Surgical procedure

    We used the SP1098 to perform retroperitoneal R-LESS radical nephrectomy (n = 1) and bilateral partial nephrectomy (n = 4) on the anterior and posterior surfaces of the kidney. Improvements unique to this system include enhanced optics and intelligent instrument arm control. Access was obtained 2 cm anterior and inferior to the tip of the 12th rib using a novel 2.5-cm robotic single-port system that accommodates three double-jointed articulating robotic instruments, an articulating camera, and an assistant port.

    Measurements

    The primary outcome was the technical feasibility of the procedures, as measured by the need for conversion to standard techniques, intraoperative complications, and operative times.

    Results and limitations

    All cases were completed without the need for conversion. There were no intraoperative complications. The operative time was 100 min for radical nephrectomy, and the mean operative time was 91.8 ± 18.5 min for partial nephrectomy. Limitations include the preclinical model, the small sample size, and the lack of a control group.

    Conclusions

    Single-site retroperitoneal renal surgery is feasible using the latest-generation SP1098 robotic platform. While the potential of the SP1098 appears promising, further study is needed for clinical evaluation of this investigational technology.

    Patient summary

    In an experimental model, we used a new robotic system to successfully perform major surgery on the kidney through a single small incision without entering the abdomen.

    Take Home Message

    Retropertioneal renal surgery is technically feasible using the third-generation purpose-built da Vinci SP1098 robotic system for single-site surgery.

    Keywords: Laparoendoscopic single site, Nephrectomy, Renal cell carcinoma, Robotics, Robotic surgical procedures, Single site.

    Footnotes

    Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA

    Corresponding author. Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA. Tel. +1 216 4442976; Fax: +1 216 6364492.

  • Subsequent Chemotherapy and Treatment Patterns After Abiraterone Acetate in Patients with Metastatic Castration-resistant Prostate Cancer: Post Hoc Analysis of COU-AA-302

    Abstract

    Background

    Treatment patterns for metastatic castration-resistant prostate cancer (mCRPC) have changed substantially in the last few years. In trial COU-AA-302 (chemotherapy-naïve men with mCRPC), abiraterone acetate plus prednisone (AA) significantly improved radiographic progression-free survival and overall survival (OS) when compared to placebo plus prednisone (P).

    Objective

    This post hoc analysis investigated clinical responses to docetaxel as first subsequent therapy (FST) among patients who progressed following protocol-specified treatment with AA, and characterized subsequent treatment patterns among older (≥75 yr) and younger (<75 yr) patient subgroups.

    Design, setting, and participants

    Data were collected at the final OS analysis (96% of expected death events). Subsequent therapy data were prospectively collected, while response and discontinuation data were collected retrospectively following discontinuation of the study drug.

    Intervention

    At the discretion of the investigator, 67% (365/546) of patients from the AA arm received subsequent treatment with one or more agents approved for mCRPC.

    Outcome measurements and statistical analysis

    Efficacy analysis was performed for patients for whom baseline and at least one post-baseline prostate-specific antigen (PSA) values were available.

    Results and limitations

    Baseline and at least one post-baseline PSA values were available for 100 AA patients who received docetaxel as FST. While acknowledging the limitations of post hoc analyses, 40% (40/100) of these patients had an unconfirmed ≥50% PSA decline with first subsequent docetaxel therapy, and 27% (27/100) had a confirmed ≥50% PSA decline. The median docetaxel treatment duration among these 100 patients was 4.2 mo. Docetaxel was the most common FST among older and younger patients from each treatment arm. However, 43% (79/185) of older patients who progressed on AA received no subsequent therapy for mCRPC, compared with 17% (60/361) of younger patients.

    Conclusions

    Patients with mCRPC who progress with AA treatment may still derive benefit from subsequent docetaxel therapy. These data support further assessment of treatment patterns following AA treatment for mCRPC, particularly among older patients.

    Trial registration

    ClinicalTrials.gov NCT00887198.

    Patient summary

    Treatment patterns for advanced prostate cancer have changed substantially in the last few years. This additional analysis provides evidence of clinical benefit for subsequent chemotherapy in men with advanced prostate cancer whose disease progressed after treatment with abiraterone acetate. Older patients were less likely to be treated with subsequent therapy.

    Take Home Message

    Treatment patterns for metastatic castration-resitant prostate cancer (mCRPC) have changed substantially. This analysis shows a clinical benefit for subsequent docetaxel therapy among men with mCRPC whose disease progressed after treatment with abiraterone acetate. Older patients were less likely to be treated with subsequent therapy.

    Keywords: Abiraterone acetate, Docetaxel, Elderly, Metastatic castration-resistant prostate cancer, Subsequent therapy, Treatment patterns.

    Footnotes

    a The Institute of Cancer Research and The Royal Marsden Hospital, Sutton, UK

    b Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA

    c Centre Hospitalier University of Montréal, Montréal, Québec, Canada

    d Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, USA

    e Radboud University Medical Centre, Nijmegen, The Netherlands

    f Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA

    g Carolina Urologic Research Center, Atlantic Urology Clinics, Myrtle Beach, SC, USA

    h Institut Gustave Roussy, University of Paris Sud, Villejuif, France

    i Janssen Research & Development, Beerse, Belgium

    j Janssen Research & Development, San Diego, CA, USA

    k Johnson & Johnson Medical China, Shanghai, China

    l Janssen Global Services, Raritan, NJ, USA

    m University of Colorado Cancer Center, Aurora, CO, USA

    Corresponding author. Tel. +44-208-7224029; Fax: +44 208 6427979.

  • Reporting Magnetic Resonance Imaging in Men on Active Surveillance for Prostate Cancer: The PRECISE Recommendations—A Report of a European School of Oncology Task Force

    Abstract

    Background

    Published data on prostate magnetic resonance imaging (MRI) during follow-up of men on active surveillance are lacking. Current guidelines for prostate MRI reporting concentrate on prostate cancer (PCa) detection and staging. A standardised approach to prostate MRI reporting for active surveillance will facilitate the robust collection of evidence in this newly developing area.

    Objective

    To develop preliminary recommendations for reporting of individual MRI studies in men on active surveillance and for researchers reporting the outcomes of cohorts of men having MRI on active surveillance.

    Design, setting, and participants

    The RAND/UCLA Appropriateness Method was used. Experts in urology, radiology, and radiation oncology developed a set of 394 statements relevant to prostate MRI reporting in men on active surveillance for PCa. Each statement was scored for agreement on a 9-point scale by each panellist prior to a panel meeting. Each statement was discussed and rescored at the meeting.

    Outcome measurements and statistical analysis

    Measures of agreement and consensus were calculated for each statement. The most important statements, derived from both group discussion and scores of agreement and consensus, were used to create the Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) checklist and case report form.

    Results and limitations

    Key recommendations include reporting the index lesion size using absolute values at baseline and at each subsequent MRI. Radiologists should assess the likelihood of true change over time (ie, change in size or change in lesion characteristics on one or more sequences) on a 1–5 scale. A checklist of items for reporting a cohort of men on active surveillance was developed. These items were developed based on expert consensus in many areas in which data are lacking, and they are expected to develop and change as evidence is accrued.

    Conclusions

    The PRECISE recommendations are designed to facilitate the development of a robust evidence database for documenting changes in prostate MRI findings over time of men on active surveillance. If used, they will facilitate data collection to distinguish measurement error and natural variability in MRI appearances from true radiologic progression.

    Patient summary

    Few published reports are available on how to use and interpret magnetic resonance imaging for men on active surveillance for prostate cancer. The PRECISE panel recommends that data should be collected in a standardised manner so that natural variation in the appearance and measurement of cancer over time can be distinguished from changes indicating significant tumour progression.

    Take Home Message

    The Prostate Cancer Radiological Estimation of Change in Sequential Evaluation panel recommends that prostate magnetic resonance imaging reports for men on active surveillance include index lesion size in absolute values at each time point and an estimation of the likelihood of significant change between baseline and current images.

    Keywords: Prostate cancer, Prostate MRI, Active surveillance.

    Footnotes

    a Division of Surgical and Interventional Science, University College London, London, UK

    b Department of Urology, University College London Hospitals Trust, London, UK

    c Department of Radiology, University College London Hospital Trust, London, UK

    d Department of Radiology and Centre for Experimental Imaging, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy

    e Division of Urology, University of Connecticut Health Center, Farmington, CT, USA

    f Department of Urology, Erasmus University Medical Centre, Rotterdam, The Netherlands

    g Department of Urology, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy

    h Department of Urology, UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA

    i Department of Medical Imaging, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada

    j Department of Urology, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada

    k Department of Urology, CHU Lille, Université de Lille, Lille, France

    l Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, Middlesex, UK

    m Department of Radiological Sciences, Oncology and Pathology, Prostate Unit Diagnostic University of Rome, “La Sapienza”, Rome, Italy

    n Urologic Oncology Branch, National Institutes of Health, National Cancer Institute, Bethesda, MD, USA

    o Department of Radiology, CHU Lille, Université de Lille, Lille, France

    p Department of Urology, Helsinki University Central Hospital, Helsinki, Finland

    q Department of Radiology, Pitié-Salpetrière Hospital, AP-HP, UPMC Paris 06, Paris, France

    r Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    s Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA

    t Department of Urology, University Hospitals of KU Leuven, Leuven, Belgium

    u Radiation Oncology, Fondazione IRCSS Istituto Nazionale dei Tumori, Milan, Italy

    v Diagnostic Imaging and Radiotherapy, Università degli Studi di Milano, Milan, Italy

    w Department of Urology, Institut Paoli-Calmettes, Marseille, France

    x Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre, Rotterdam, The Netherlands

    Corresponding author. Division of Surgical and Interventional Science, University College London, 3rd Floor, Charles Bell House, 67-73 Riding House Street, London W1W7EJ, UK. Tel. +44 0 7817 431 668.

    These authors share first authorship.

    Please visit www.eu-acme.org/europeanurology to read and answer questions on-line. The EU-ACME credits will then be attributed automatically.

  • Application of the Stage, Size, Grade, and Necrosis (SSIGN) Score for Clear Cell Renal Cell Carcinoma in Contemporary Patients

    Abstract

    Background

    The tumor stage, size, grade, and necrosis (SSIGN) score was originally defined using patients treated with radical nephrectomy (RN) between 1970 and 1998 for clear cell renal cell carcinoma (ccRCC), excluding patients treated with partial nephrectomy (PN).

    Objective

    To characterize the original SSIGN score cohort with longer follow-up and evaluate a contemporary series of patients treated with RN and PN.

    Design, setting, and participants

    Retrospective single-institution review of 3600 consecutive surgically treated ccRCC patients grouped into three cohorts: original RN, contemporary (1999–2010) RN, and contemporary PN.

    Intervention

    RN or PN.

    Outcome measurements and statistical analysis

    The association of the SSIGN score with risk of death from RCC was assessed using a Cox proportional hazards regression model, and predictive ability was summarized with a C-index.

    Results and limitations

    The SSIGN scores differed significantly between the original RN, contemporary RN, and contemporary PN cohorts (p < 0.001), with SSIGN ≥4 in 53.5%, 62.7%, and 4.7%, respectively (p < 0.001). The median durations of follow-up for these groups were 20.1, 9.2, and 7.6 yr, respectively. Each increase in the SSIGN score was predictive of death from RCC (hazard ratios [HRs]: 1.41 for original RN, 1.37 for contemporary RN, and 1.70 for contemporary PN; all p < 0.001). The C-indexes for these models were 0.82, 0.84, and 0.82 for original RN, contemporary RN, and contemporary PN, respectively. After accounting for an era-specific improvement in survival among RN patients (HR: 0.53 for contemporary vs original RN; p < 0.001), the SSIGN score remained predictive of death from RCC (HR: 1.40; p < 0.001).

    Conclusions

    The SSIGN score remains a useful prediction tool for patients undergoing RN with 20-yr follow-up. When applied to contemporary RN and PN patients, the score retained strong predictive ability. These results should assist in patient counseling and help guide surveillance for ccRCC patients treated with RN or PN.

    Patient summary

    We evaluated the validity of a previously described tool to predict survival following surgery in contemporary patients with kidney cancer. We found that this tool remains valid even when extended to patients significantly different than were initially used to create the tool.

    Take Home Message

    Updated with longer follow-up and with new cohorts managed with radical or partial nephrectomy, the tumor stage, size, grade, and necrosis (SSIGN) score remains a validated prognostic tool to predict cancer-specific survival for patients with clear cell renal cell carcinoma.

    Keywords: Partial nephrectomy, Prognosis, Radical nephrectomy, Renal cell carcinoma, Survival.

    Footnotes

    a Department of Urology, Mayo Clinic, Rochester, MN, USA

    b Department of Pathology, Mayo Clinic, Rochester, MN, USA

    c Department of Health Services Research, Mayo Clinic, Rochester, MN, USA

    Corresponding author. Department of Urology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. Tel. +1 507 266 9968; Fax: +1 507 284 4951.

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Si desea información diseñada para pacientes y público general. puede visitar:

Portal de Información Urológica para Pacientes

 

 

Carlos Tello Royloa

 

Actualizada el: 08-Abr-2013

 

uroportal@gmail.com