Metabolic syndrome and risk of prostate cancer: a systematic review and meta-analysis.

INTRODUCTION: Emerging evidence supports the hypothesis that metabolic syndrome is associated with cancer pathogenesis. In particular regarding prostate cancer, observational studies from various settings report different results. This systematic review and meta-analysis aimed to provide a quantitative estimate of the association between metabolic syndrome in prostate cancer, in particular Gleason Score >6, accounting for different study designs. EVIDENCE ACQUISITION: Systematic research of available literature in English language until 2020 was conducted through in Embase, Medline, Cochrane Library and NIH Registry of Clinical Trials. For each study, information regarding the study design, the population, the definition of metabolic syndrome, data relating to prostate cancer were collected, the association between MetS and outcome of interest was determined by calculating the generic inverse variance with random effects method. EVIDENCE SYNTHESIS: In the final sample 19 studies were included with total of 114,329 patients, 29.4% met the criteria for metabolic syndrome. We report a significant association between metabolic syndrome and prostate cancer in cross-sectional studies (OR=1.30; 95% CI: 1.13-1.49) and for patients with clinically significant prostate cancer (OR=1.56; 95% CI: 1.23-1.99). Association between metabolic syndrome and prostate cancer combining all studies, in cohort studies and case-control studies was not significant. CONCLUSIONS: Growing evidence support the association between metabolic syndrome and prostate cancer, bias derived from observational studies might conceal further findings.

Combined transurethral approach with Versapoint(®) and laparoscopic treatment in the management of bladder endometriosis: technique and 12 months follow-up.

BACKGROUND: When endometriosis infiltrates more than 5 mm beneath the peritoneum it is called deeply infiltrating endometriosis and may involve the bladder. Only 1-2% of women with endometriosis have urinary involvement, mainly in the bladder. Resectoscopic transurethral resection alone is no longer recommended because of the surgical risks and recurrence. Usually surgeons prefer a laparotomy or laparoscopic approach depending on nodule localization and personal skill. We describe a new combined transurethral approach with Versapoint(®) and laparoscopic technique in the management of bladder endometriosis and the 12-month follow-up. METHODS: We performed a prospective observational study of 12 women affected by symptomatic bladder endometriosis at the University Hospital of Padova. We utilized a transurethral approach using a 5.2-mm endoscope with a 0.6-mm-diameter bipolar electrode (Gynecare Versapoint(®)). We delimited just the edges of the lesion via cystoscopy, penetrating transmurally at 3 or 9 o'clock without trespassing into the bladder peritoneum. Then, starting from the lateral bladder hole, we excised the lesion by laparoscopy with Harmonic ACE(®). The bladder hole was repaired with a continuous 3-0 monofilament two-layer suture. RESULTS: Operating time ranged from 115 to 167 min and mean blood loss ranged from 10 to 200 ml. No conversion to laparotomy and no intraoperative complications occurred. No dysuria or hematuria were present at follow-up. There was one case of persistent suprapubic pelvic pain at the 12-month follow-up. CONCLUSIONS: A combined transurethral approach with Versapoint(®) and laparoscopic treatment is a safe and easy technique for the management of bladder endometriosis, with low risks and good resolution of symptoms.

Clinical experience and critical evaluation of the role of sorafenib in renal cell carcinoma.

Renal cell carcinoma (RCC) is a common malignancy worldwide with approximately 95,000 new cases per year and ranks as the sixth cause of cancer deaths. Until recently, the slightly active and very toxic cytokines were available for patients with advanced RCC. Advances have been made in understanding the molecular biology of renal cancer. The introduction of targeted agents has led to promising possibilities for treating these highly vascularized tumors. Angiogenesis inhibition is likely to represent the main potential therapeutic target. Sorafenib is an oral multikinase inhibitor with activity against tyrosine kinase receptors that are responsible for blood vessel development and has shown to be active in treating advanced RCC. In this review, we summarize the pharmacology, mode of action, pharmacokinetics, and safety of sorafenib use in therapy for advanced RCC.

Cardiac metastasis from renal cell carcinoma without inferior vena involvement: a review of the literature based on a case report. Two different patterns of spread?

We report the case of a 59-year-old man with advanced renal cell carcinoma (RCC), without inferior vena cava (IVC) involvement, treated with radical nephrectomy, palliative radiotherapy for bone metastasis, and medical therapy for bone and lung metastases. The patient died of cardiac arrest after evidence of massive malignant pericardial effusion. At autopsy, massive myocardial and pericardial neoplastic invasion was found. Heart involvement via the IVC is a well-known phenomenon during RCC progression, while in the absence of IVC involvement, clinically evident cardiac involvement is exceptional, with few cases reported in the worldwide literature. Analysis of prior reports and of the present case provides evidence on how the cardiac metastasis may have two distinct origins and clinical features. The first is hematogenous, via the IVC, even in the absence of renal vein involvement; it is generally circumscribed and has a good prognosis after surgery. The second is through the intrathoracic lymphatic system, in the presence of disseminated disease, especially pulmonary metastasis, and this type has a very poor prognosis.

A phase II study of gemcitabine at fixed infusion rate of 10 mg/m2/min with or without immunotherapy in advanced renal cancer.

BACKGROUND: Advanced renal cancer remains a challenge for oncologists since no treatment other than surgery has demonstrated a clear survival advantage. PATIENTS AND METHODS: Gemcitabine was given to suitable patients at a fixed infusion rate of 10 mg/m2/min. Eighteen patients received concomitant immunotherapy, mostly low doses of interleukin 2 (IL2). RESULTS: Thirty patients were enrolled. The overall response rate was 14% (22% in the subset of patients treated with both chemotherapy and immunotherapy) with a median progression-free survival time of 4.1 + months. Toxicity was not mild, mostly fatigue, nausea and anaemia, even though not life threatening. CONCLUSION: Gemcitabine at the fixed infusion rate of 10 mg/m2/min with concomitant low doses of IL2 could be useful in the palliative treatment of symptomatic patients with renal carcinoma progressing after tyrosine kinases inhibitor.