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Este mes en... Urologic Oncology

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Este mes en... Urologic Oncology:

  • Semen AMACR protein as a novel method for detecting prostate cancer
    Alpha methylacyl A coenzyme racemase (AMACR) has shown to be an excellent immunohistological biomarker for prostate cancer (CaP). Given the connection between prostate and urethra, we hypothesized that semen ejaculate would be an ideal specimen for detection of CaP specific biomarkers, such as AMACR. This study explores the detection of semen AMACR protein in men with and without CaP.
  • Heat shock proteins 60 and 70 are associated with long-term outcome of T1-stage high-grade urothelial tumors of the bladder treated with intravesical Bacillus Calmette-Guérin immunotherapy
    Bladder cancer is the ninth most frequently diagnosed cancer worldwide, with the highest incidence rates observed in North America and Europe [1]. At the time of diagnosis, approximately 75% of bladder cancers are nonmuscle invasive, 50% of which are high-grade [2,3]. Progression rates of nonmuscle invasive bladder cancer (NMIBC) range from 10% to 30% at 5years [3]. Intravesical Bacillus Calmette-Guérin (BCG) immunotherapy is the mainstay of treatment for high-grade tumors; however, patients who fail BCG immunotherapy are at the highest risk of disease progression and may benefit from early radical cystectomy [4].
  • Prostate cancer in transgender women
    As society at large begins to better recognize and understand gender dysphoria and the social and psychological issues surrounding transgender patients, we anticipate that more transgender individuals will feel comfortable in seeking urologic care. Urologists need to be better educated about social, behavioral, physiological, and anatomical issues that face transgender patients. Though estimation is difficult, attempts have been made to quantify the number of transgender persons currently in the United States.
  • A urinary microRNA (miR) signature for diagnosis of bladder cancer
    Bladder cancer is the ninth most common malignancy worldwide, with an estimated 429,000 new cases diagnosed annually. At the time of diagnosis, the majority of tumors are well differentiated and do not invade the bladder's detrusor muscle, so called low-grade non-muscle invasive bladder cancer (LGNMIBC). Despite aggressive treatment by transurethral resection and intravesical instillations, LGNMIBC recurs in approximately 50% of patients. However, these tumors rarely progress to a higher grade or stage and have therefore an excellent prognosis [1].
  • Zonal mapping of sentinel lymph nodes in penile cancer patients using fused SPECT/CT imaging and lymphoscintigraphy
    Squamous cell carcinoma of the penis is rare with an incidence of 0.3 to 1.6 new cases per 100,000 males per year in Western Europe and North America [1,2]. Anatomical and observational studies have demonstrated that the lymphatic drainage from the penis initially travels to the superficial inguinal lymph nodes followed by the deep inguinal lymph nodes before spreading to the pelvic lymph nodes [3,4]. Previous studies have also shown that the most important prognostic indicator in patients diagnosed with penile cancer is the presence of metastatic inguinal lymph node disease [5,6].
  • Aberrant expression of membranous carbonic anhydrase IX (CAIX) is associated with unfavorable disease course in papillary and clear cell renal cell carcinoma
    Carbonic anhydrases constitute a large family of transmembrane zinc metalloenzymes catalyzing hydration of carbonic dioxide to form bicarbonate and hydrogen ions (reviewed in [1]). Carbonic anhydrases play a pivotal role in tissue pH homeostasis [2]. They have further been shown to play a role in the regulation of cell adhesion [3], and they are required for cellular growth and survival under normoxia and hypoxia [4,5]. It is probably because of this later function, that carbonic anhydrase 9 (CAIX) is often deregulated in cancer.
  • What kind of patients with castration-naïve prostate cancer can benefit from upfront docetaxel and abiraterone: A systematic review and a network meta-analysis
    The field of systemic therapies for late-stage prostate cancer has remarkably progressed in the past 10 years; however, patients with metastatic castration-naïve prostate cancer (mCNPC, M1) had limited improvement in overall survival (OS) [1,2]. In this context, some experts argue that optimal sequential or early combination therapy with novel agents showing clear survival benefit in metastatic castration-resistant prostate cancer (mCRPC) have the potential to delay disease progression and bring greater opportunity to improve survival in patients with de novo mCNPC.
  • The addition of chemotherapy in the definitive management of high risk prostate cancer
    In attempt to improve disease control outcomes for high-risk prostate cancer, numerous clinical trials have tested the addition of chemotherapy (CTX)—either adjuvant or neoadjuvant—to definitive local therapy, either radical prostatectomy (RP) or radiation therapy (RT).
  • Predictive role of changes in the tumor burden and International Metastatic Renal Cell Carcinoma Database Consortium class during active surveillance for metastatic renal cell carcinoma
    Renal cell carcinoma (RCC) occurs with synchronous metastases at diagnosis in about 25% to 30% of cases. Furthermore, about another 30% of patients radically treated for localized disease will develop metastases during their lifetime [1].
  • Current controversies and developments on the role of lymphadenectomy for penile cancer
    Penile squamous cell carcinoma is a rare cancer in men. The main prognosticators of survival for penile cancer patients remain the presence and the extent of lymph node metastasis. While radical inguinal lymphadenectomy has been the cornerstone of regional lymph node management for many years, it is still associated with significant morbidity and psychological distress. Recent developments in penile squamous cell carcinoma management have been met with some controversy in the urologic oncology community.
  • Focal therapy in localised prostate cancer: Real-world urological perspective explored in a cross-sectional European survey
    Modern surgical oncology is increasingly moving towards tissue-preserving strategies over radical approaches in the vast majority of malignancies, provided that such approaches are technically feasible and oncologically effective [1–4]. Whilst there is some interest in such a concept for prostate cancer (PCa), the prostate does still remain the last solid organ for which whole-gland treatments are carried out as standard of care. It is indeed an exception to treat in the same manner men harbouring measurable disease ranging from high volume low-risk to high-risk disease.
  • Prediction of acute kidney injury after radical cystectomy and urinary diversion
    The recent article by Furrer et al. [1] assessing theincidence and perioperative risk factors of early postoperative acute kidney injury (AKI) in 912 patientsundergoing radical cystectomy and urinary diversion was of great interest to us. By multiple logistic regression analysis, they showed that prolonged duration of surgery (>400 minutes) was a risk factor identified for postoperative AKI and further independent predictors of postoperative AKI were male sex, alow preoperative plasma creatinine, obesity, and intraoperative blood loss.
  • Molecular carcinogenesis in equine penile cancer: A potential animal model for human penile cancer
    Human penile cancer is a rare disease in developed countries with an incidence rate of around 1 per 100,000 [1]. In contrast, it is more common in developing countries accounting for up to 10% to 17% of cancer in males with an incidence that reaches 4 per 100,000 [1,2]. Squamous cell carcinoma (SCC) is the predominant cancer type and accounts for over 95% of penile cancer cases [3–5]. The main treatment for advanced tumors is phalectomy and, when inguinal lymph node metastasis is present, bilateral inguinal lymphadenectomy is also performed.
  • Tumor–parenchyma interface and long-term oncologic outcomes after robotic tumor enucleation for sporadic renal cell carcinoma
    Current guidelines recommend prioritizing partial nephrectomy (PN) for the treatment of localized renal masses when surgery is indicated [1, 2].
  • Combining anticancer drugs with osteoprotective agents in prostate cancer—A contemporary update
    Treatment of metastatic hormone-sensitive (mHSPC) and castration-resistant prostate cancer (mCRPC) is a multimodal and interdisciplinary process that frequently affects an elderly and frail population. In these patients, changes in bone metabolism can imply a significant impact on all-cause morbidity as well as cancer-related outcomes. Uniquely, these changes can rely on metastatic bone disease itself, but also on treatment-related changes in bone mineral density that are inherent to long-term androgen deprivation therapy (ADT).
  • Malignant testicular germ cell tumors in children and adolescents: The AIEOP (Associazione Italiana Ematologia Oncologia Pediatrica) protocol
    Testicular germ cell tumors (TGCT) are rare in children, and histologically and genetically similar to extragonadal tumors [1], whereas in adolescents they reveal genetic and clinical patterns similar to the disease in adults. These differences have led to TGCT being classified as type I for children with yolk sac tumor (YST) and/or teratoma (T) or type II for adolescents and young men with other, pure or mixed, sub entities [2]. In a previous Italian study [3], 36 TGCT patients (≤16 years old) underwent surgery, with or without radiotherapy and carboplatin-based chemotherapy (CT).
  • The impact of age at the time of radiotherapy for localized prostate cancer on the development of second primary malignancies
    Radical prostatectomy (RP) and radiotherapy (RT) represent the main treatment modalities for localized prostate cancer (CaP) [1]. RT is also used in the adjuvant setting for patients with pT3 CaP or positive surgical margins, and as salvage treatment for biochemical failure after RP. As treatments become more effective, the increase in survivorship has led to the observation of second primary malignancies (SPMs) in cancer survivors. Radiation is believed to contribute to development of SPMs, and studies have shown relationships between radiation, urothelial dysplasia, and DNA damage [2,3].
  • Will the kidney function be reduced in patients with renal cell carcinoma following laparoscopic partial nephrectomy? Baseline eGFR, warm ischemia time, and RENAL nephrometry score could tell
    The incidence of small renal cell carcinoma (RCC) is increasing and cases are frequently often detected incidentally due to the widespread use of abdominal imaging technologies [1]. For small local cortical renal masses, partial nephrectomy (PN) is the preferred surgical treatment, as it provides an equivalent oncological outcome and superior renal function preservation compared to radical nephrectomy (RN) [2,3].
  • Prostate cancer tissues with positive TMPRSS2-ERG-gene-fusion status may display enhanced nerve density
    Innervation of prostate cancer (CaP) tissue favors tumor progression and metastasis but the regulation of innervation in CaP is unclear. The oncogenic transcription factor ERG is commonly induced by a typical TMPRSS2-ERG (TE) gene fusion in CaP and may affect innervation. Here, we analyzed whether nerve density of CaP tissue is related to TE status or perineural infiltration status of CaP tissue. In parallel, we measured several members of the neuropilin/plexin/semaphorin family (NRP, PLXN, and SEMA) as possible targets mediating innervation.
  • Seniority of primary care physicians is associated with a decrease in PSA ordering habits in the years surrounding the United States Preventative Services Task Force recommendation against PSA screening
    Screening practices in primary care environments have changed dramatically in the past 5 decades. Currently, primary care providers (PCPs) are advised by various regulatory and specialty groups to screen for patient issues from colon cancer to smoking status to safety in the home [1–5] with discordance between specialty advisory groups on many issues. The most recent summary of preventative screening recommendations from the American Academy of Family Physicians advised on screening practices for 134 different diseases and adverse social situations [5].
  • Robotic-assisted vs. open radical prostatectomy: A machine learning framework for intelligent analysis of patient-reported outcomes from online cancer support groups
    Robot-assisted radical prostatectomy (RARP) is being increasingly utilised in treatment of prostate cancer (CaP). In addition to the minimally invasive nature, some of the reported perioperative advantages of RARP include lower surgical margin rate for intermediate-risk disease and high-risk disease, lower blood loss, lower risk of blood transfusions, and shorter hospital stays [1–7]. However, quality of life (QOL) in the longer term is more contentious. Clinical trials conducted in high volume centres depend on willing participants filling out questionnaires on a long-term basis in a ‘trial setting’ and thereby likely to be impacted by a variety of follow-up biases and may not accurately capture ‘real-life’ issues experienced by patients.
  • Immediate intravesical chemotherapy for low-grade bladder tumors in California: An underutilized practice and its impact on recurrence
    The delivery of quality care in cancer in the United States has been described as being in a state of crisis [1], while the cost of health care continues to grow to unsustainable levels [2]. Furthermore, the burden of bladder cancer in the United States is significant, with over 79,030 new cases estimated in 2017, and it remains the most prevalent malignancy of the urinary system with an estimated prevalence in the United States of 696,440 in 2014 [3]. The majority of incident cases represent nonmuscle invasive and low-grade disease.
  • Self-reported Black race predicts significant prostate cancer independent of clinical setting and clinical and socioeconomic risk factors
    In 2017, 161,360 estimated cases of prostate cancer (CaP) were diagnosed in the United States [1]. Men of high genetic West African ancestry (WAA) face disparities in CaP incidence worldwide. As a corollary, several studies have demonstrated that US Black men have increased risk of CaP diagnosis on prostate biopsy relative to White men [2]. It is unclear whether this is predominantly attributable to socioeconomic or biologic factors [3,4].
  • Reported rates of clostridium difficile following radical cystectomy in national datasets compared to individual institutions
    The Centers for Disease Control and Prevention (CDC) estimates that there were approximately 453,000 cases and 30,000 deaths caused by Clostridium difficile infection (CDI) in 2011, making it the most common healthcare acquired infection [1]. Rates of CDI in US hospitals range from 3.8 to 9.5 cases per 10,000 patient days [2]. Clostridium difficile is a gram-positive anaerobic organism that typically colonizes the gut asymptomatically. Symptoms may manifest if the microenvironment is disrupted, which is usually due to antibiotic exposure, but may also be due to intestinal surgery.
  • Association between renal mass biopsy and upstaging to perinephric fat involvement in a contemporary cohort of patients with clinical T1a renal cell carcinoma
    The appropriate management of small renal masses has been debated extensively. Numerous management options, including extirpative surgery, ablative techniques, and active surveillance are available for these tumors [1]. From a population standpoint, the increased detection and treatment, without a resultant survival benefit, raises a concern for overtreatment of these tumors [2]. Currently, tumor size, growth rate, and histopathologic evaluation of tumor biopsy samples (in selected patients) are used for risk stratification and decision making in small renal tumors [3,4].
  • Risk prediction models for cancer-specific survival following cytoreductive nephrectomy in the contemporary era
    Level 1 evidence supports a survival benefit to cytoreductive nephrectomy (CN) followed by cytokine therapy in patients with metastatic renal cell carcinoma (mRCC) [1–3]. Although comparable randomized data do not exist for patients treated with targeted therapies, several retrospective studies suggest a similar survival benefit for CN [4–6]. However, it is unclear whether selection criteria and treatment sequencing paradigms developed during the immunotherapy era are applicable to patients treated within the contemporary targeted therapy era.
  • Abbreviated CT protocol for postoperative surveillance of renal cancer
    The current protocols for surveillance following surgery for localized renal cell carcinoma (RCC) stratify patients according to risk groups [1–4]. Periodic computed tomography (CT) scans of the chest and abdomen are recommended according to risk groups with some variations between the different guidelines. Given that CT is a very sensitive tool for detection of early and potentially curable metastasis and local recurrence [5–8], over the evolution of successive guideline recommendations more and more CT studies have been added to the protocols [1].
  • tRNA-halves are prognostic biomarkers for patients with prostate cancer
    Prostate cancer (CaP) is the second most common malignancy in men [1]. The diagnosis is based on digital rectal examination, prostate-specific antigen (PSA), prostate biopsy, and imaging modalities. Despite the efforts for accurate diagnosis, a high percentage of men diagnosed with CaP is overtreated with radical prostatectomy or radiotherapy [2,3]. On the other hand, a subset of patients with aggressive carcinoma faces the risk of CaP progression despite of treatment. Therefore, a biomarker allowing the identification of aggressive and indolent disease is required in order to improve the management of patients with CaP.
  • Real-world outcomes in patients with metastatic castration-resistant prostate cancer receiving second-line chemotherapy versus an alternative androgen receptor-targeted agent (ARTA) following early progression on a first-line ARTA in a US community oncology setting
    Prostate cancer currently represents 19% of all new cancer diagnoses in American men [1]. Despite response rates exceeding 80% with androgen deprivation therapy, effects of hormonal manipulation are temporary, and most patients progress to metastatic castration-resistant prostate cancer (mCRCaP) within a median of 3 years of diagnosis [2].
  • miR-301a expression: Diagnostic and prognostic marker for prostate cancer
    Prostate cancer (CaP) is the most common malignancy in males in the United States with an estimated 164,690 new cases in 2018 by American Cancer Society. Prostate-specific antigen (PSA) screening has led to an increase in the detection of early stage CaP. As a diagnostic test (PSA is a screening test), PSA has poor specificity, which leads to the over-diagnosis and over-treatment of CaP. Patients with low-risk or indolent tumors are often subjected to treatments that are not without complications.
  • The Whitmore aphorism
    Willet F. Whitmore Jr. served as the chief of urology at Memorial Sloan-Kettering Cancer Center from 1951 to 1984. In his New York Times obituary, he is aptly referred to as, "the dean of urologic oncology” [1]. He had a major impact on the practice of urologic oncology, particularly prostate cancer. His influence on the field extended beyond his own lifetime, as he trained many of the next generation of urologic oncology leaders.
  • Physician attitudes about genetic testing for localized prostate cancer: A national survey of radiation oncologists and urologists
    Prostate cancer is a highly prevalent male malignancy with approximately 180,000 diagnosed and 30,000 dying each year in the United States [1]. Due to the indolent natural history of prostate cancer, greater emphasis is now placed on shared decision-making and active surveillance to address concerns about overtreatment [2]. Effective treatment decision-making for localized prostate cancer therefore requires accurate predictive tools to best quantify clinical aggressiveness and risk of cancer-related morbidity and mortality at the time of diagnosis [3,4].
  • Primary care perspective and implementation of a multidisciplinary, institutional prostate cancer screening algorithm embedded in the electronic health record
    Recognizing historical widespread national prostate-specific antigen (PSA) screening programs, subsequent early prostate cancer (CaP) detection and resulting stage migration, the CaP-specific mortality rate decreased by 40% during the past three decades [1,2]. Despite this great achievement, there are still many controversies regarding the benefits/harms of CaP screening. While the United States Preventive Services Task Force (USPSTF) recently changed their recommendation against routine screening of all men at all ages (Grade D) to individualized patient–physician decision-making for men aged 55 to 69 years (Grade C) [3], other steering committees such as the National Comprehensive Cancer Network (NCCN) guidelines [4] or the American Urological Association (AUA) guidelines [5], as well as several others, propose different CaP screening recommendations among various age groups after patient-centered communication and shared decision-making.
  • Receptor activator of NF-κB (RANK)-mediated induction of metastatic spread and association with poor prognosis in renal cell carcinoma
    According to histological criteria, renal cell carcinoma (RCC) can be classified into 3 major subtypes: clear cell renal cell carcinoma (ccRCC), papillary RCC, and chromophobe RCC [1]. The most frequent subtype is ccRCC, accounting for approximately 75% of all RCC cases [1]. Metastatic renal cell carcinoma (mRCC) is a chemo- and irradiation-resistant tumor with a historical median overall survival (OS) of RCC patients of approximately 10 months [2]. Despite the recent success of new treatment strategies with targeted therapies and specific immunotherapies in the treatment of mRCC, many tumors are resistant to current standard of care agents and only a few patients can be durably cured with standard of care therapies [3–5].
  • A comparison of perinephric fat surface area and Mayo Adhesive Probability score in predicting malignancy in T1 renal masses
    Recent studies have proposed that nearby fat deposits may have metabolic influence on kidney cancer pathobiology. Both fat quantity and quality may play unique roles in this complex relationship. As such, we investigated whether perinephric fat surface area (PFA), a quantitative measure of fat, or Mayo Adhesive Probability (MAP) score, a qualitative measure, were predictive of malignant pathology or Fuhrman grade in small renal masses.
  • Nongenitourinary complications associated with robot-assisted laparoscopic and radical retropubic prostatectomy: A single institution assessment of 1,100 patients over 11 years
    The debate regarding the advantages and disadvantages of robot-assisted laparoscopic prostatectomy (RALP) and open radical retropubic prostatectomy (RRP) has largely been resolved. Currently, most evidence purporting the superiority of RALP has come from observational cohort studies and meta-analyses [1–5]. To date, no extensive randomized controlled trial comparing the two techniques has been performed [6,7].
  • Lymph node yield as a predictor of overall survival following inguinal lymphadenectomy for penile cancer
    Penile cancer is rare in the United States (US) with an incidence of 0.58/100,000 [1]. The majority of cases are squamous cell carcinoma. Management of penile squamous cell carcinoma (pSCC) is based on local invasiveness of the tumor, tumor grade, and staging of regional (inguinal and pelvic) lymph nodes (LNs) [2]. Involvement of the regional LNs is an adverse pathological finding and has been demonstrated to influence cancer-specific survival (CSS) and overall survival (OS) [3]. Inguinal lymphadenectomy (ILND) is, therefore, an important part of the treatment algorithm for clinically node positive disease (cN+) [4].
  • Racial disparity in quality of care and overall survival among black vs. white patients with muscle-invasive bladder cancer treated with radical cystectomy: A national cancer database analysis
    With an estimated 79,030 new diagnoses and 16,870 deaths in 2017, bladder cancer is the 5th most common cancer in the U.S. and conveys the highest mortality among urological malignancies [1]. Despite the significant improvement seen in cancer survival over the last three decades, racial disparities are persistent and most pronounced in Black (non-Hispanic) men and women [2]. Black patients as compared to White (non-Hispanic) patients exhibit half the bladder cancer incidence but show significantly greater mortality.
  • Predicting the tumorigenic phenotype of human bladder cancer cells by combining with fetal rat mesenchyme
    Most bladder cancers are urothelial carcinomas. Roughly 75% of patients have nonmuscle invasive bladder cancer (NMIBC) and the remainder have muscle invasive or metastatic disease [1]. For all stages, the 5-year relative survival is around 70% to 80% [2]. The rate of recurrence in NMIBC ranges from 50% to 90%. In addition, 10% to 30% of NMIBC patients progress to muscle invasive bladder cancer (MIBC) requiring radical surgery [1]. In NMIBC patients after first transurethral resection, identification of the key predictors of progression should improve overall survival by supporting the use of aggressive treatment in short-term follow-up.
  • AKR1C3, a crucial androgenic enzyme in prostate cancer, promotes epithelial-mesenchymal transition and metastasis through activating ERK signaling
    AKR1C3, as a crucial androgenic enzyme, facilitates intratumoral androgen biosynthesis and androgen receptor activation in castration-resistant prostate cancer (PCa). The data has shown that AKR1C3 expression is significantly elevated in clinical metastatic PCa specimens, indicating a potential role of AKR1C3 in PCa metastasis.
  • Health-related quality of life among elderly Americans diagnosed with upper tract urothelial carcinoma
    Outcomes of cancer research are usually described in relation to cancer recurrence, progression, and/or patient survival. These outcomes are essential; however, they may not capture the full impact of cancer on patient's functioning and social well being, especially in elderly patients [1]. Elderly cancer patients are usually under-represented in clinical trials [2]. There are growing reports that in a significant proportion of the elderly cancer population, maintaining an adequate quality of life is more important than length of life [3].
  • Body mass index as independent predictor of overall survival in patients with advanced renal cell carcinoma at start of systemic treatment—Analyses from the German clinical RCC-Registry
    Although renal cell carcinoma (RCC) represents only approximately 4% of adult malignancies in Europe, it displays the highest mortality rate of all urologic tumors with 40% of RCC patients dying from the disease [1]. In Germany, about 15,100 people are expected to be diagnosed with RCC in 2018 and an estimated 5,400 patients will die of kidney cancer each year [2]. As RCC does not immediately lead to clinical symptoms, about 20% to 30% of RCC patients present with advanced or metastatic disease (mRCC) at diagnosis [3] and about 20% of patients diagnosed with localized disease will subsequently develop metastases [4,5].
  • Prognostic value of PD-1 and PD-L1 expression in patients with metastatic clear cell renal cell carcinoma
    Several molecular targeted agents have been approved since 2008 for the treatment of advanced renal cell carcinoma (RCC) in Japan and include vascular endothelial growth factor (VEGF) pathway inhibitors and mammalian target of rapamycin inhibitors. These therapeutic agents have prolonged the survival of patients with RCC. However, most patients treated with molecular targeted agents will ultimately acquire resistance to these agents, resulting in disease progression. Many potential prognostic and predictive molecular biomarkers have now been identified in RCC, although none has yet entered clinical practice [1].
  • The association between facility case volume and overall survival in patients with metastatic renal cell carcinoma in the targeted therapy era
    Renal cell carcinoma (RCC) has an estimated 63,990 new cases and 14,400 deaths in 2017 [1]. While the RCC survival rate had been traditionally poor, the 5-year survival rate had increased from 57% in 1987 to 1989 to 74% in 2006 to 2012 [1]. This improvement is likely due to 2 main factors: first is the diffuse use of imaging studies which resulted in increased detection of early-stage disease [2,3]; the other is the targeted therapy (TT) era for advanced RCC beginning at the end of 2005 with 7 antiangiogenic drugs and 2 mammalian target of rapamycin inhibitors approved from 2005 to 2016 by the Food and Drug Administration [4].
  • Dietary patterns and health-related quality of life in bladder cancer survivors
    Society and medicine are placing an increasing emphasis on cancer survivorship [1]. As the population continues to age and cancer treatment evolves, the number of cancer survivors is expected to increase. Greater numbers will then be faced with the physical and psychosocial challenges of recovering from cancer and its treatment [2,3]. This population is already known to have elevated risks of mortality and chronic health conditions [4]. Thus, it is important to align our goals of increased overall and cancer-specific survival with concomitant efforts to improve and optimize quality of life.
  • Pretreatment multiparametric MRI is independently associated with biochemical outcome in men treated with radiation therapy for prostate cancer
    Risk-stratification for localized prostate cancer remains challenging, in part due to the heterogeneous nature of the disease [1]. Determining the optimal treatment course for an individual patient requires accurate staging and appropriate risk-stratification to balance treatment efficacy with unwanted side effects. Traditional clinical risk features such as Gleason score, prostate-specific antigen (PSA) level, and clinical stage aid in this process, however significant variability in prognosis remains.
  • Transketolase like 1 (TKTL1) expression alterations in prostate cancer tumorigenesis
    Prostate cancer (CaP) is a heterogeneous disease with high variability in regards to clinical outcome and therapeutic response. While some men will develop an indolent CaP not affecting life expectancy, others might die of CaP. Thus, the process of screening and diagnosing, as well as the therapeutic options and monitoring can be difficult for the urologist—to distinguish between lethal and indolent CaP still remains a challenge.
  • Development of a translational medicine protocol for an NCTN genitourinary clinical trial: Critical steps, common pitfalls and a basic guide to translational clinical research
    Translational medicine (TM) components of prospective clinical trials provide an invaluable opportunity to test hypotheses that contribute to our knowledge of human disease biology and/or the mechanism of action of a given therapeutic intervention. Our ability to sample tumors and their microenvironment, and the depth and breadth of biological information that can be extracted from them, has increased exponentially in recent years. This information is critical to guide the next steps clinical research if we are to accelerate the pace of progress in cancer treatment.
  • Robotic versus open partial nephrectomy for highly complex renal masses: Comparison of perioperative, functional, and oncological outcomes
    Considerable evidence suggests that partial nephrectomy (PN) for localized renal cell carcinoma has equivalent oncological outcomes when compared to radical nephrectomy [1,2]. Another unique feature of PN over radical nephrectomy relates to better renal functional preservation, which may confer a lower risk of cardiovascular disease, translating into better overall survival [3]. Various surgical approaches for PN have been described, including open (OPN) and minimally invasive techniques, namely laparoscopic (LPN) and the robot-assisted (RAPN).
  • Mechanisms and funding opportunities in genitourinary cancer clinical research
    Progress in the prevention, diagnosis, and treatment of genitourinary cancers is dependent on well-conducted clinical trials. The complexity and cost of clinical research continues to escalate, and success is dependent on adequate funding. Opportunities to fund such research include federal, industry, and private sources. The mechanisms whereby larger trials are conducted include contract research organizations, publically- and privately funded consortia, and the National Clinical Trials Network of the National Cancer Institute.
  • Current controversies on the role of lymphadenectomy for bladder cancer
    Significant evidence exists regarding the diagnostic and therapeutic roles of pelvic lymph node dissection at the time of radical cystectomy for patients with bladder cancer. Despite this, lymphadenectomy for bladder cancer is still underutilized and even where performed, controversies exist in regard to what defines an adequate dissection and whether or not the indications for lymphadenectomy have changed now that we are firmly entrenched in the neoadjuvant chemotherapy era. A comprehensive literature review was performed to touch on these important issues and highlight future directions and current trials that will soon provide more clarity for surgeons and patients dealing with bladder cancer.
  • Re: “Current surgical standards of care in Wilms tumor”
    The authors have published a valuable article that outlines the current status of surgical care in Wilms tumor, highlighting key technical points as well as addressing areas of controversy and future research directions. One point to clarify for the readership [1]:
  • Lifestyle and nutritional modifiable factors in the prevention and treatment of bladder cancer
    Bladder cancer is one of the top 5 most common cancers diagnosed in the U.S. It is also one of the most expensive cancers to treat through the life course given its high rate of recurrence. While cigarette smoking and occupational exposures have been firmly established as risk factors, it is less certain whether modifiable lifestyle factors such as diet and physical activity play roles in bladder cancer etiology and prognosis. This literature review based on a PubMed search summarizes the research to date on key dietary factors, types of physical activity, and smoking in relation to bladder cancer incidence, and discusses the potential public health implications for formalized smoking cessation programs among recently diagnosed patients.
  • Role of lymph node dissection in renal cell cancer
    Lymph node metastasis in renal cell cancer (RCC) portends an extremely poor prognosis. Despite proven staging benefit, the therapeutic value of lymph node dissection in RCC remains questionable. The only prospective randomized trial examining its role failed to show any benefit. However, subsequent retrospective publications have attempted to identify high-risk cohorts and clinical scenarios where removal of nodes may improve survival. The aim of this article is to provide a comprehensive review looking at the role of lymph node dissection in RCC if any, the ideal extent of dissection, and also tools a clinician could employ to identify those who would most likely benefit from this exercise.
  • Key design and analysis principles for quality of life and patient-reported outcomes in clinical trials
    Advances in early detection and therapy have increased the number of prostate cancer survivors, leading to a greater emphasis on examining patient-reported outcomes (PROs). PROs augment clinical outcomes, providing a more comprehensive assessment of the patient experience, including symptoms and quality of life, that may impact the overall evaluation of new therapies. The successful incorporation of PROs into clinical trials requires adherence to key design and analysis principles. We present these principles and argue that adherence to these principles is vital to ensure valid interpretation of clinical trial findings, identify meaningful differences among investigational strategies, and better translate clinical trial results to diverse stakeholders.
  • From the other side: The patient perspective on cancer clinical trials
    This article provides the patient perspective on cancer clinical trials.
  • Contribution of bladder cancer pathology assessment in planning clinical trials
    Bladder cancer is a heterogeneous disease that demonstrates a wide spectrum of histologic features. The modern classification of bladder cancer is largely based on pathologic analysis, which assesses tumor grade, stage, type, size, and other features that are essential for understanding the biological behavior of bladder cancer. Bladder cancers with similar histologic features are likely to show comparable responses to a new therapeutic agent in clinical trial. Furthermore, pathologic analysis also evaluates the quality of tissue samples in clinical trial to ensure the integrity of various molecular tests.
  • Organizing a clinical trial for the new investigator
    Clinical trials organization can be daunting especially when orienting to a new system. The steps to a successful clinical trial are not concrete and vary based on the system.
  • Optimizing androgen deprivation therapy with radiation therapy for aggressive localized and locally advanced prostate cancer
    Radiation therapy with androgen deprivation therapy (ADT) has historically been one of the mainstays of treatment for intermediate- and high-risk prostate cancer. The benefit of ADT likely derives from both enhancing local control and inhibiting micrometastatic disease. While level 1 evidence has demonstrated the benefits of 4–6 months of ADT for all men with intermediate-risk disease, further stratification of intermediate-risk prostate cancer into favorable and unfavorable subgroups indicates that ADT may not be necessary for favorable intermediate-risk disease but likely still provides a survival advantage for unfavorable intermediate-risk disease, even in the dose escalation era.
  • Characterizing recurrent and lethal small renal masses in clear cell renal cell carcinoma using recurrent somatic mutations
    Small renal masses (SRMs) with evidence of clear cell renal cell carcinoma (ccRCC) are understudied. Current algorithms for the management of SRMs include surgical resection, ablation, and active surveillance. We sought to identify genomic biomarkers that could potentially refine the management of ccRCC in SRMs, especially in patients being evaluated for active surveillance.
  • Insight into novel biomarkers in penile cancer: Redefining the present and future treatment paradigm?
    Biomarkers are increasingly used in the diagnosis and management of various malignancies. Selected biomarkers may also play a role in management of certain cases of penile carcinoma. In this article, we provide an overview of the clinical role of such markers in the management of penile cancer.
  • An update of research evidence on nutrition and prostate cancer
    Prostate cancer (PCa) remains a leading cause of mortality in US and other countries. Preclinical and clinical studies have examined the role of nutrition and dietary intake on the incidence and progression of PCa with mixed results.
  • An open label, single-arm, phase II multicenter study of the safety and efficacy of CG0070 oncolytic vector regimen in patients with BCG-unresponsive non–muscle-invasive bladder cancer: Interim results
    CG0070 is a replication-competent oncolytic adenovirus that targets bladder tumor cells through their defective retinoblastoma pathway. Prior reports of intravesical CG0070 have shown promising activity in patients with high-grade non–muscle invasive bladder cancer (NMIBC) who previously did not respond to bacillus Calmette-Guérin (BCG). However, limited accrual has hindered analysis of efficacy, particularly for pathologic subsets. We evaluated interim results of a phase II trial for intravesical CG0070 in patients with BCG-unresponsive NMIBC who refused cystectomy.
  • Prognostic factors for tumor recurrence in patients with clinical stage I seminoma undergoing surveillance—A systematic review
    To systematically evaluate evidence on prognostic factors for tumor recurrence in patients with clinical stage I seminoma undergoing surveillance.
  • The expanding repertoire of targets for immune checkpoint inhibition in bladder cancer: What lies beneath the tip of the iceberg, PD-L1
    Over the last decade, a new understanding of tumor-immune system interplay has been ushered in, lead in large part by the discovery of immune checkpoints mediated through B7-CD28 family interactions. Therapeutic blockade of the PD-L1 immune checkpoint pathway has already shown great success as a cancer immunotherapy for advanced urothelial carcinoma, leading to durable clinical remissions in an otherwise incurable disease. There are newly described members of the B7-CD28 family including B7-H3, B7x, and HHLA2.
  • Role of ultrasensitive prostate-specific antigen in the follow-up of prostate cancer after radical prostatectomy
    Prostate-specific antigen (PSA) is an important tool in the follow-up of prostate cancer after radical prostatectomy (RP). However, the relevance of ultrasensitive PSA (uPSA) after RP is not well defined. The aim of this study was to investigate the value of uPSA in follow-up after RP and to determine whether ultrasensitive PSA doubling time (uDT) correlates with traditional PSA doubling time (tDT).
  • Table of Contents
  • Editorial Board
  • A novel preoperative model to predict 90-day surgical mortality in patients considered for renal cell carcinoma surgery
    Kidney cancer is the 8th leading cancer diagnosis in the United States with an estimated 63,990 of new cases resulting in 14,400 deaths based on 2016 data [1]. In contrast to many of the other most commonly diagnosed malignancies, the incidence of kidney cancer has risen over the last few decades in men and women of every racial and ethnic group [2]. The rise in incidence of kidney cancer has coincided with a downward drift stage migration likely secondary to the more frequent diagnosis of small, incidental renal masses on cross-sectional imaging [3–6].


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Actualizada el: 08-Abr-2013