ABSTRACT
Since November 2013, the alpha emitter radium-223 dichloride (Alpharadin/Xofigo®) has been approved for the treatment of men with castration-resistant prostate cancer (CRPC) with symptomatic bone metastases and no known visceral metastatic disease. In the ASYMPCA clinical trial, radium-223 was shown to improve overall survival and to reduce the time to the first symptomatic skeletal event. The use of radium-223 was associated with a reduction of pain and an improvement of health-related quality of life compared to the placebo arm. The efficacy of radium-223 dichloride was not inhibited by the use of chemotherapy with docetaxel. Studies have demonstrated a longer overall survival (OS) in patients with a combined treatment of abiraterone or enzalutamide; however, until this data is validated in larger clinical trials, the combination of radium-223 and abiraterone/enzalutamide cannot be recommended. Patients who have received concomitant medication with denosumab appeared to have a longer OS compared to patients who did not. A second treatment cycle of radium-223 was not associated with any adverse events when compared to the outcomes reported in the ASLYMPCA trial. Here the median radiographic progression-free survival was 9 months.
Subject(s)
Prostatic Neoplasms, Castration-Resistant/radiotherapy , Radium/therapeutic use , Androstenes/therapeutic use , Benzamides , Bone Neoplasms/pathology , Bone Neoplasms/radiotherapy , Bone Neoplasms/secondary , Clinical Trials as Topic , Combined Modality Therapy , Denosumab/therapeutic use , Humans , Male , Neoplasm Staging , Nitriles , Phenylthiohydantoin/analogs & derivatives , Phenylthiohydantoin/therapeutic use , Prostatic Neoplasms, Castration-Resistant/pathology , Radioisotopes/therapeutic use , RetreatmentABSTRACT
BACKGROUND: Retroperitoneal abscesses are rare but life threatening. Renal, perinephritic, and paranephritic abscesses are distinguished depending on their location and extent. They are mainly caused by ascending urologic infections of gram-negative bacteria. SYMPTOMATOLOGY: The variable symptomatology often leads to delayed diagnosis resulting in high morbidity and mortality. Typical symptoms are flank or abdominal pain, decreased appetite, weight loss, malaise, fever, and chills. Laboratory values show increased leukocytes and Creactive protein. Creatinine levels may also be increased. CONCLUSION: If there is clinical evidence for a retroperitoneal abscess, sonography generally leads to further diagnostic via computed tomography. Small abscesses may be treated by antibiotics alone. Abscesses larger than 3 cm and those not responding to medical treatment should be percutaneously or surgically drained.
