Sarcomatoid renal cell carcinoma: rapid dissemination detected on FDG PET-CT.

We present the FDG PET-CT findings in a patient with persistent pain 7 weeks after a nephrectomy and lymph node dissection for a sarcomatoid renal cell carcinoma. Although conventional imaging was unable to detect evidence of metastatic spread outside the para-aortic nodes, a PET-CT scan showed unexpected extensive dissemination. Currently, there are no reports in the literature of the PET-CT findings in sarcomatoid renal cell carcinomas.

Treatment of localized prostate cancer using a combination of high dose rate Iridium-192 brachytherapy and external beam irradiation: initial Australian experience.

Combination high dose rate brachytherapy (HDRB) and external beam radiation therapy is technically and clinically feasible as definitive treatment for localized prostate cancer. We report the first large Australian experience using this technique of radiation dose escalation in 82 patients with intermediate- and high-risk disease. With a median follow up of 3 years (156 weeks), complications were low and overall prostate-specific antigen progression-free survival was 91% using the American Society for Therapeutic Radiology and Oncology consensus definition. The delivery of hypofractionated radiation through the HDRB component shortens overall treatment time and is both biologically and logistically advantageous. As a radiation boost strategy, HDRB is easy to learn and could be introduced into most facilities with brachytherapy capability.

Prognostic significance of pathologic features in localized prostate cancer treated with radical prostatectomy: implications for staging systems and predictive models.

PURPOSE: Although predicting outcome for men with clinically localized prostate cancer (PC) has improved, the staging system and nomograms used to do this are based on results from the North American health system. To be internationally applicable, these models require testing in cohorts from a variety of different health systems based on the predominant PC case identification methods used. PATIENTS AND METHODS: We studied 732 men with localized PC treated with radical prostatectomy and no preoperative therapy between 1986 and 1999 at one Australian institution to determine the effect of clinicopathologic features on disease-free survival. RESULTS: Preoperative serum prostate-specific antigen (PSA) concentration, Gleason score, pathologic stage, and year of surgery were independent predictors of outcome. Although margin status demonstrated only a trend toward significance in multivariate modeling overall, it proved to be independent in subgroups based on later year of surgery (1986 to 1994 v 1995 to 1998), preoperative PSA of less than 10 ng/mL, and Gleason score > or = 7. Adjuvant radiation therapy improved disease-free survival rates in patients with multiple surgical margin involvement. CONCLUSION: This work confirms the prognostic significance of pathologic stage, Gleason score, and preoperative serum PSA. In the context of a contemporaneous screening effect in Australia, these findings may have implications for methods that predict outcome following surgery as screening becomes more prevalent in a population. The independent prognostic effect of margin status may alter with an increase in the proportion of screening-identified PCs. Staging systems and nomograms that predict outcome following surgery require validation in cohorts with different health practices before being universally applied.

Tiaprofenic acid as a cause of non-bacterial cystitis.

OBJECTIVE: To draw attention to a relationship between the taking of tiaprofenic acid (Surgam) and the development of severe non-bacterial cystitis. DESIGN: Seven case reports. PATIENTS: Six women and one man aged between 62 and 83 years with severe chronic cystitis who were taking tiaprofenic acid regularly for osteoarthritis. Six of the seven had initially been diagnosed as having interstitial cystitis. RESULTS: All patients had classic symptoms and minimal signs on physical examination of chronic cystitis but urinalyses showed sterile pyuria, microscopic haematuria and proteinuria. Their upper urinary tracts were normal. All had severe and diffuse mucosal inflammation noted on cystoscopy, which became more marked with distension. Histological examination of bladder biopsies showed severe acute and chronic inflammation. Symptoms were present for an average period of six months, resulting in great morbidity. All patients recovered completely after the withdrawal of tiaprofenic acid within four to eight weeks (average 5.7 weeks). CONCLUSION: A strong case for a cause-and-effect relationship between tiaprofenic acid and non-bacterial cystitis has been presented and a clinical pattern of disease established. Awareness of this condition is needed to reduce its morbidity in the community and to remove the need for expensive investigations.