ABSTRACT
Early detection of cancer is a key ingredient for saving many lives. Unfortunately, cancers of the urogenital system are difficult to detect at early stage. The existing noninvasive diagnostics of prostate cancer (PCa) suffer from low accuracy (< 70%) even at advanced stages. In an attempt to improve the accuracy, a small breath study of 63 volunteers representing three groups: (1) of 19 healthy, (2) 28 with PCa, (3) with 8 kidney cancer (KC) and 8 bladder cancer (BC) was performed. Ultrabroadband mid-infrared Fourier absorption spectroscopy revealed eight spectral ranges (SRs) that differentiate the groups. The resulting accuracies of supervised analyses exceeded 95% for four SRs in distinguishing (1) vs (2), three for (1) vs (3) and four SRs for (1) vs (2) + (3). The SRs were then attributed to volatile metabolites. Their origin and involvement in urogenital carcinogenesis are discussed.
Subject(s)
Biomarkers , Breath Tests/methods , Exhalation , Prostatic Neoplasms/diagnosis , Prostatic Neoplasms/metabolism , Aged , Aged, 80 and over , Breath Tests/standards , Case-Control Studies , Data Analysis , Humans , Male , Middle Aged , Neoplasm Grading , Prognosis , Prostatic Neoplasms/etiology , Spectrum AnalysisABSTRACT
BACKGROUND: Radical cystectomy is associated with considerable morbidity and mortality. Based on the solid evidence in colorectal surgery, fast-track/ERAS® (Enhanced Recovery After Surgery) protocols have been developed to improve the perioperative management of patients undergoing radical cystectomy. OBJECTIVES: To review the literature and guidelines and evaluate the evidence regarding the different components of ERAS® protocols. MATERIALS AND METHODS: Systemic literature search and evaluation of relevant guidelines. RESULTS: The majority of ERAS® recommendations for radical cystectomy are based on extrapolations of abdominal surgery studies. Four randomized, controlled trials and one ERAS® guideline were published for radical cystectomy. ERAS® seems to shorten length of stay without increasing the complication rate. Key elements are no bowel preparation, no nasogastric tube, optimized fluid substitution, multimodal pain management, early mobilization, and oral diet. CONCLUSIONS: Implementation of ERAS® requires multidisciplinary collaboration. Individualization of an ERAS® program, identification of the most important components and adaption to the specific needs of radical cystectomy patients are future goals.
Subject(s)
Cystectomy , Urinary Bladder Neoplasms , Enhanced Recovery After Surgery , Humans , Length of Stay , Postoperative Complications/etiology , Postoperative Complications/prevention & control , Urinary Bladder Neoplasms/surgeryABSTRACT
With the advent of novel high throughput-sequencing technologies we gained greater insights into the complex and diverse interactions of the microbiome for health and disease in the human body. The concept of urinary sterility has long been dismissed and now we strive for deciphering various microbial signatures associated with a disease. A dysbalance of the microbiome appears to have a substantial impact on the pathogenesis of both malignant and benign conditions. Novel preventive and therapeutic approaches and biomarker systems have been proposed for prostate cancer, renal cell carcinoma and bladder cancer based on microbiome analyses. The exclusion of a microbial origin was always part of the diagnosis of benign disorders such as interstitial cystitis, urinary urge incontinence or chronic prostatitis/chronic pelvic pain syndrome. Now we are certain that an imbalanced microbial profile plays an essential role for the pathogenesis and disease management of these challenging conditions.
