A review of urinary bladder microbiome in patients with bladder cancer and its implications in bladder pathogenesis.

PURPOSE: The recent discovery of the urinary microbiome has led to an emerging field of investigation about the potential role of microorganisms in the pathogenesis of urinary bladder cancer. Few preliminary data have been reported so far implicating urobiome as causative and prognostic factor of bladder tumorigenesis. In the present study, a review of the current evidence is presented about microbiome composition among patients with bladder cancer and healthy individuals as well as possible implications of microbiome on urothelial carcinoma of the bladder. METHODS: A literature review was conducted using PubMed/MEDLINE, Scopus, and the Cochrane library until December 2023. Search algorithm was constructed using the following terms and their associated Mesh terms and Boolean operators: "urinary microbiome" and "urinary microbiota". Studies written in English language, identifying, and comparing urinary microbiome among bladder cancer patients and healthy control group were included in the review. RESULTS: A total of 2,356 reports were identified. From this total 16 articles complied with the inclusion criteria were selected for analysis. These articles represent a total of about 486 bladder cancer patients. CONCLUSION: Recent studies revealed the colonization of the urinary tract and the bladder by micro-organisms using both enhanced culture- and molecular-based techniques for microbial characterization. However, several limitations exist in the literature decreasing the reliability of the current reports. As a result, urinary microbiome consist an ambitious era in bladder cancer research with an increasing number of evidence about its potential pathogenetic, prognostic and therapeutic role.

Clinical impact of ERG and PTEN status in prostate cancer patients underwent radical prostatectomy.

OBJECTIVES: Phosphate and tensin homolog gene (PTEN) acts as a regulator of PI3-KAkt molecular pathway. ETS Related gene (ERG), an oncogene located in chromosome 21q22.2, is involved in prostate cancer (PCa) by serine 2 (TMPRSS2), a protein encoded by TMPRSS2 gene. The aim of this study is to evaluate the clinical impact of PTEN loss and ERG rearrangement in terms of oncologic results in patients diagnosed with localized PCa who underwent radical prostatectomy. MATERIALS AND METHODS: Prospective data were collected from a total of 74 patients who underwent open radical retropubic prostatectomy for localized PCa and immunohistochemical study was performed in tissue samples. The primary antibodies for anti-ERG antibody as well as anti-PTEN antibody were obtained from DAKO. ERG was considered positive if at least 20% of the evaluated cells were stained at least with medium intensity. PTEN protein loss was considered when the intensity of cytoplasmic and nuclear staining was mild or entirely negative across > 10% of tumor cells. RESULTS: Homogenous loss of PTEN was associated with higher clinical International Society of Urological Pathology (ISUP) grade (p = 0.018) while no statistical significant association was present regarding the presence of ERG rearrangement with either ISUPc or ISUPp. After a median follow up of 34 months, 24 patients developed biochemical recurrence. No statistical significant correlation of ERG status with biochemical recurrence was noted while PTEN was associated with biochemical recurrence development in a statistical significant way. Lastly the combination of PTEN loss with ERG rearrangement presence was detected more often in higher ISUPc and ISUPp as well as biochemical recurrence development, although in a non statistical significant way. CONCLUSIONS: Homogenous and heterogenous PTEN loss was associated with biochemical recurrence. No association of ERG and biochemical recurrence was noted. The combination of PTEN loss and ERG rearrangement presented a trend for higher ISUPc and ISUPp as well as biochemical recurrence but not in a statistical significant way.

Outcomes of radical cystectomy in pT4 bladder cancer frail patients: Α high-volume single center study.

Objectives: This study aims to evaluate the effect of frailty in patients undergoing radical cystectomy (RC) for locally advanced bladder cancer. Methods: In this retrospective, single center study we evaluated 51 patients with pT4 bladder cancer treated with radical cystectomy between 2016-2020. Patient frailty was assessed with the Clinical Frailty Scale (CFS). Furthermore, six separate parameters (early mortality index within 30 days after surgery, death after one year, length of stay, respiratory complications, readmission index, total hospital charges) were also evaluated. The patients were categorized on three groups (Group 1, 2, 3) based on the CFS. Results: A total of 51 pT4 RC patients were included in the study. Mean age was 75.6 years. Early mortality rate at 30 days after surgery was low all the groups. One year mortality rate was higher in Group 2 (22%) and 3 (69%). The length of stay and the number of patients with respiratory complications were also higher in the frailer groups. 30 days readmission rate was 22% in Group 2 and 38% in Group 3. Conclusions: Preoperative frailty is associated with worse postoperative results after RC. CFS is an objective tool for patient risk stratification and can predict postoperative complications and mortality.

Juxtaglomerular cell tumour of the kidney: a rare cause of resistant hypertension.

SUMMARY: Juxtaglomerular cell tumour (JGCT) is an unusually encountered clinical entity. A 33-year-old man with severe long-standing hypertension and hypokalaemia is described. The patient also suffered from polyuria, polydipsia, nocturia and severe headaches. On admission, laboratory investigation revealed hypokalaemia, kaliuresis, high aldosterone and renin levels, and the abdomen CT identified a mass of 4 cm at the right kidney. Kidney function was normal. Following nephrectomy, the histological investigation revealed the presence of a JGCT. Immunostaining was positive for CD34 as well as for smooth muscle actin and vimentin. Following surgery, a marked control of his hypertension with calcium channel blockers and normalization of the serum potassium, renin or aldosterone levels were reached. According to our findings, JGCT could be included in the differential diagnosis of secondary hypertension as it consists of a curable cause. The association of JGCT with hypertension and hypokalaemia focusing on the clinical presentation, diagnostic evaluation and management is herein discussed and a brief review of the existing literature is provided. LEARNING POINTS: Juxtaglomerular cell tumours (JGCT), despite their rarity, should be included in the differential diagnosis of secondary hypertension as they consist of a curable cause of hypertension. JGCT could be presented with resistant hypertension along with hypokalaemia, kaliuresis and metabolic alkalosis. Early recognition and management can help to prevent cardiovascular complications. Imaging (enhanced CT scans) may be considered as the primary diagnostic tool for the detection of renal or JGCT. For the confirmation of the diagnosis, a histopathologic examination is needed.

Incidental prostate cancer in patients who underwent radical cystectomy for high risk non muscle invasive bladder cancer: Is it clinically significant?

INTRODUCTION AND OBJECTIVE: Non muscle invasive, high-risk, bladder cancer is an entity which is usually treated with radical cystectomy. Incidental prostate cancer refers to prostate cancer detected in radical cystectomy specimens in patients with no signs of the disease. Objective of this study is to report the prevalence, characteristics, and clinical significance of incidental prostate cancer in non-muscle invasive bladder cancer patients treated with radical cystectomy in our department. MATERIAL AND METHODS: We retrospectively reviewed data from 41 patients who underwent radical cystectomy for non-muscle invasive, high risk, bladder cancer during the years 2016-2020 in our department. Prostate cancer was described as clinically significant when there were positive surgical margins, extraprostatic extension, Gleason score >6, or tumor volume ⩾0.5 cm3. Two groups of patients were formed according to the presence or absence of clinically significant prostate cancer. RESULTS: Incidental prostate cancer in the cystectomy specimens was detected in 21 of the 35 patients investigated. Clinically significant prostate cancer was detected in five patients. Positive surgical margins and extraprostatic extension were present in one patient, respectively. Gleason score was more than six in four of the five patients and PCa tumor volume was above 0.5 cm3 in three patients. Two patients with clinically significant prostate cancer were diagnosed with biochemical recurrence during their follow up. CONCLUSIONS: In non-muscle invasive, high-risk patients undergoing radical cystectomy, clinically significant incidental PCa is an important issue as it may affect prognosis, quality of life, metastasis free survival, and overall survival.

ERCC1 19007 Polymorphism in Greek Patients with Advanced Urothelial Cancer Treated with Platinum-Based Chemotherapy: Effect of the Changing Treatment Paradigm: A Cohort Study by the Hellenic GU Cancer Group.

We previously showed that ERCC1 19007 C>T polymorphism was associated with cancer-specific survival (CSS) after platinum-based chemotherapy in patients with advanced urothelial cancer (aUC). We aimed to confirm this association in a different cohort of patients. Genotyping of the 19007C>T polymorphism was carried out by polymerase chain reaction (PCR) amplification and restriction fragment length polymorphism (RFLP) in 98 aUC patients, treated with platinum-based chemotherapy. Median age of the patients was 68.8, 13.3% of them were female, 90.8% had ECOG PS of 0 or 1, and 48% received cisplatin-based chemotherapy. In addition to chemotherapy, 32.7% of the patients received immunotherapy, and 19.4% vinflunine. Eighty-one patients (82.7%) were carriers of the 19007T polymorphic allele: 46 (46.9%) were heterozygotes, and 35 (35.7%) were homozygotes. The ERCC1 polymorphism was not associated with CSS, progression-free (PFS), or overall (OS) survival in the total population. Nevertheless, there was a significant interaction between the prognostic significance of ERCC1 polymorphism and the use of modern immunotherapy: the T allele was associated with worse outcome in patients who received chemotherapy only, while this association was lost in patients who received both chemotherapy and immune checkpoint inhibitors. Our study suggests that novel therapies may influence the significance of ERCC1 polymorphism in patients with aUC. Its determination may be useful in the changing treatment landscape of the disease.

Association of metabolic syndrome with prostate cancer diagnosis and aggressiveness in patients undergoing transrectal prostate biopsy.

INTRODUCTION AND OBJECTIVE: Even though the only established risk factors for prostate cancer (PCa) are age, ethnic origin and family history, there are data suggesting that environmental factors, such as the presence of metabolic syndrome (MetS), may also play a role in the etiology of the disease. The aim of this study is to correlate MetS with PCa diagnosis and Gleason score (GS) in patients undergoing transrectal ultrasound guided prostate biopsy. MATERIALS AND METHODS: This is a prospective, single-center study including 378 patients who underwent transrectal ultrasound guided prostate biopsy in our department during the years from 2018 to 2019. Patients were divided into two groups according to the presence of PCa. Group A included 197 patients diagnosed with PCa while Group B consisted of 181 patients without PCa in their biopsy result. Multiple variables such as the presence of MetS and its components were evaluated in correlation to the presence of PCa and PCa characteristics. Statistical analysis was performed using the IBM SPSS Statistics v.23 program. RESULTS: Mean PSA value was 8.7 ng/dl in the PCa group and 7.1 ng/dl in the non PCa group, respectively. MetS was diagnosed in 108 patients (54.8%) with PCa and 80 patients (44.2%) without PCa and the difference was statistically significant. Hypertriglyceridemia was the MetS component with statistically higher frequency in PCa patients. Furthermore, the prevalence of MetS was higher in higher Gleason score PCa (GS ≥ 4+3) patients vs lower Gleason score PCa (GS ≤ 3+4) patients. More specifically, MetS, hypertriglyceridemia, and low HDL levels were independent factors associated with higher Gleason score PCa (GS ≥ 4+3). CONCLUSIONS: Patients suffering from MetS who undergo prostate biopsy present with higher rates of PCa diagnosis and higher GS in comparison with patients with a normal metabolic profile.

Novel treatments in BCG failure. Where do we stand today? / Nuevos tratamientos en fallo a BCG. ¿Dónde estamos?

OBJECTIVES: Most patients at first diagnosis of bladder cancer (BC) present with non muscle invasive disease (NMIBC). BCG intravesical therapy after transurethral resection of the bladder tumor is the gold standard in intermediate and high risk NMIBC patients. However, it is estimated that approximately 50% of these patients will present with BCG failure which increases their risk for progression to muscle invasive disease. Currently, the best option for these patients is radical cystectomy. Thus, it is of great interest to pursue new, therapeutic options for BCG failure patients to avoid the necessity of radical cystectomy. We hereby review novel treatment modalities for BCG failure patients. METHODS: This is a narrative review. Keywords for the search were BCG failure, BCG unresponsive, BCG refractory, BCG relapsing and BCG intolerance. Evidence was identified through a search for publications with a ''BCG unresponsive'' tag through 2020. Studies were selected if they contained clinical data on BCG unresponsive therapeutics with near-term availability. Clinical trial landscape evaluation for emerging therapies was performed by searching ClinicalTrials.gov for recruiting/ open interventional trials in 2020. RESULTS: Novel treatment modalities for BCG failure include intravesical chemotherapy, BCG re-challenge or combination of BCG with IFN-α2ß, valrubicin, radiotherapy, electromotive drug administration, vicinium, chemohyperthermia, photodynamic therapy, gene therapy, vaccine therapy and immunotherapy. For patients in whom BCG has once failed a repeat course of BCG or BCG plus interferon appears to be a reasonable practice. Likewise, single agent gemcitabine may be considered a treatment modality. However, after 2 or more BCG failures, especially in patients with earlier relapses or cancer persistence, single agent intravesical chemotherapy with valrubicin, gemcitabine or docetaxel appears to be less active than doublet/triplet intravesical chemotherapy or mitomycin chemothermotherapy. Gene therapy or conjugated antibodies may play a role upon further relapse. Single agent pembrolizumab is unlikely to be used as first line, but may be useful, along with multiple new immunotherapeutics, as part of a multimodal approach towards BCG unresponsive disease. CONCLUSIONS: Results from ongoing trials will provide us useful information about many of the existing regimens and probably new drugs will soon be available for this group of patients.

OBJETIVOS: La mayoría de pacientes al primer diagnóstico de cáncer de vejiga se presentan como canceres no musculo-invasivos. El tratamiento con BCG intravesical después de resección transuretral de vejiga es el tratamiento de elección en los pacientes de riesgo intermedio y alto. Aunque, se estima que aproximadamente el 50% de estos pacientes presentaran un fallo a BCG, que incrementa su riesgo de progresión a enfermedad musculo-invasiva. Actualmente, la mejor opción para estos pacientes es la cistectomía radical. Por tanto, es de alto interés la investigación de nuevos tratamientos para pacientes con fallo a BCG para evita rla cistectomía radical. Hemos revisado las nuevas modalidades de tratamiento en pacientes con fallo a BCG.MÉTODOS: Es una revisión narrativa. Las palabras clave para la búsqueda fueron BCG failure, BCG unresponsive, BCG refractory, BCG relapsing y BCG intolerance. La evidencia se identifico a través de una búsqueda para las publicaciones con BCG un responsive hasta 2020. Los estudios fueron seleccionados si contenían datos clínicos con tratamiento para BCG unresponsive. La evaluación de ensayos clínicos para terapias emergentes se realizó a través de clinicaltrials.gov para ensayos abierto o en recrutamiento, intervencionales en 2020. RESULTADOS: Las nuevas modalidades de tratamiento para el fallo de la BCG incluyen quimioterapia intravesical, reemplace de BCG o combinación de BCG con INF-α2ß, valrubicina, radioterapia, administración electromotiva del tratamiento (EMDA), vicinium, quimiohipertermia, terapia fotodinámica, terapia genética, terapia por vacunas e immunoterapia. Para pacientes en que la BCG ha fallado una vez, el reemplace de BCG o BCG junto interferón parece ser una opción razonable. De la misma forma, gemcitabina sola puede ser utilizada como modalidad de tratamiento. Aunque, después de 2 o mas fallos a BCG, especialmente en pacientes con fallos precoces o persistencia de cáncer, el tratamiento único intravesical con quimioterapia de valrubicina, gemcitabina o docetaxel parece ser menos activa que los dobletes/tripletes de quimioterapia intravesical o mitomicina quimiotermoterapia. La terapiagénica o anticuerpo conjugados parece que juegan un papel en futuras recurrencias. La administración de pembolizumabúnicamente, es poco probable que se utilice como primera línea, pero parece ser útil, junto con los nuevos immunoterápicos como parte de un tratamiento multimodal para la enfermedad refractaria a BCG. CONCLUSIONES: Los resultados de los ensayos clínicos en funcionamiento nos dará información útil de muchos de los regímenes existentes y probablemente nuevas drogas que pronto estarán preparadas para usar en este grupo de pacientes.

Novel treatments in bcg failure. Where do we stand today? / Nuevos tratamientos en el fracaso de bcg. ¿Dónde estamos hoy?

Objetives: Most patients at first diagnosis of bladder cancer (BC) present with nonmuscleinvasive disease (NMIBC). BCG intravesical therapyafter transurethral resection of the bladder tumor is thegold standard in intermediate and high risk NMIBC patients. However, it is estimated that approximately 50%of these patients will present with BCG failure whichincreases their risk for progression to muscle invasive disease. Currently, the best option for these patients is radical cystectomy. Thus, it is of great interest to pursue new,therapeutic options for BCG failure patients to avoid thenecessity of radical cystectomy. We hereby review novel treatment modalities for BCG failure patients.Methods: This is a narrative review. Keywords for thesearch were BCG failure, BCG unresponsive, BCG refractory, BCG relapsing and BCG intolerance. Evidencewas identified through a search for publications with a ’BCG unresponsive’’ tag through 2020. Studies wereselected if they contained clinical data on BCG unresponsive therapeutics with near-term availability. Clinicaltrial landscape evaluation for emerging therapies wasperformed by searching ClinicalTrials.gov for recruiting/open interventional trials in 2020.Results: Novel treatment modalities for BCG failureinclude intravesical chemotherapy, BCG re-challengeor combination of BCG with IFN-α2β, valrubicin, radiotherapy, electromotive drug administration, vicinium,chemohyperthermia, photodynamic therapy, gene therapy, vaccine therapy and immunotherapy. For patients inwhom BCG has once failed a repeat course of BCG orBCG plus interferon appears to be a reasonable practice. Likewise, single agent gemcitabine may be considered a treatment modality. However, after 2 or moreBCG failures, especially in patients with earlier relapsesor cancer persistence, single agent intravesical chemotherapy with valrubicin, gemcitabine or docetaxel...(AU)

Objetivos: La mayoría de pacientes alprimer diagnóstico de cáncer de vejiga se presentancomo canceres no musculo-invasivos. El tratamiento conBCG intravesical después de resección transuretral devejiga es el tratamiento de elección en los pacientes deriesgo intermedio y alto. Aunque, se estima que aproximadamente el 50% de estos pacientes presentaran unfallo a BCG, que incrementa su riesgo de progresióna enfermedad musculo-invasiva. Actualmente, la mejoropción para estos pacientes es la cistectomía radical.Por tanto, es de alto interés la investigación de nuevostratamientos para pacientes con fallo a BCG para evitarla cistectomía radical. Hemos revisado las nuevas modalidades de tratamiento en pacientes con fallo a BCG.Métodos: Es una revisión narrativa. Las palabrasclave para la búsqueda fueron BCG failure, BCG unresponsive, BCG refractory, BCG relapsing y BCG intolerance. La evidencia se identifico a través de unabúsqueda para las publicaciones con BCG unresponsive hasta 2020. Los estudios fueron seleccionadossi contenían datos clínicos con tratamiento para BCGunresponsive. La evaluación de ensayos clínicos paraterapias emergentes se realizó a través de clinicaltrials.gov para ensayos abierto o en recrutamiento, intervencionales en 2020.Resultados: Las nuevas modalidades de tratamientopara el fallo de la BCG incluyen quimioterapia intravesical, reemplace de BCG o combinación de BCGcon INF-α2β, valrubicina, radioterapia, administraciónelectromotiva del tratamiento (EMDA), vicinium, quimiohipertermia, terapia fotodinámica, terapia genética,terapia por vacunas e immunoterapia. Para pacientesen que la BCG ha fallado una vez, el reemplace deBCG o BCG junto interferón parece ser una opciónrazonable. De la misma forma, gemcitabina sola puedeser utilizada como modalidad de tratamiento. Aunque,después de 2 o mas fallos a BCG, especialmente enpacientes con fallos precoces o persistencia de cáncer...(AU)

Referral for "Neoadjuvant Chemotherapy" for Muscle-Invasive Bladder Cancer to a Multidisciplinary Board: Patterns, Management and Outcomes.

BACKGROUND: Utilization of neoadjuvant chemotherapy for the treatment of muscle invasive bladder cancer in everyday practice differs from that of clinical trials. We describe the patterns of referral for "neoadjuvant chemotherapy", treatment and outcomes in a multidisciplinary tumor board. METHODS: This was an observational study. Patients referred for neoadjuvant chemotherapy received 4 cycles of dose-dense gemcitabine/cisplatin and were then assessed for definitive local therapy. Patients had a minimum follow-up of 2 years. Primary objective was a 3-year disease-free survival rate. RESULTS: Forty-six patients (clinical stages II: 28, IIIA: 9, IIIB: 4, IVA: 3, missing: 2) were included. Following chemotherapy, 30 underwent radical cystectomy, 8 radiotherapy and 8 no further therapy. Pathological downstaging was observed in 14 (46.6%) of the 30 patients who underwent radical cystectomy; clinical TNM staging was correlated with disease-free survival in the whole population, while clinical and pathological stages, as well as pathological downstaging, were correlated with disease-free survival in patients undergoing radical cystectomy. Three-year disease-free survival rates for the whole cohort and for patients undergoing radical cystectomy were 67.3% (95% confidence interval [CI]: 51-79.2) and 65.2 (95% CI: 44.9-79.6), respectively. CONCLUSION: Real-world muscle invasive bladder cancer patients who receive neoadjuvant chemotherapy are characterized by more advanced diseases and less frequent radical surgery than those included in clinical trials. Nevertheless, outcomes were comparable and, therefore, offering patients with stage II-IVA muscle invasive bladder cancer neoadjuvant chemotherapy after assessment by multidisciplinary tumor boards should be strongly encouraged.

Conservative management of grade 4 and 5 renal injuries: A high-volume trauma center experience.

INTRODUCTION: Traumatic renal injuries represent a major public health issue concerning mostly young men. Over the last decades there is growing debate regarding the management of high-grade renal injuries due to the emerging role of conservative treatment. The aim of this study is to present our experience in the conservative management of patients presenting with grade 4 or grade 5 renal injuries in our department. MATERIAL AND METHODS: In this retrospective, single center study we evaluated data from a total of 57 hemodynamically stable patients who were managed conservatively for grade 4 or grade 5 renal injuries from 2015 to 2019 in our high-volume trauma center. Grading was based on contrast enhanced abdominal computed tomography (CT) scans. Patients managed with immediate nephrectomy due to hemodynamic instability and patients who underwent immediate laparotomy due to concomitant injuries or penetrating wounds were excluded from the study. RESULTS: A total of 54 patients diagnosed either with grade 4 or grade 5 renal trauma were finally successfully managed conservatively and included in the study. Median age was 34 years. Most patients presented with grade 4 renal trauma while five patients presented with grade 5 renal injury. Concomitant injuries not requiring surgical intervention were present in 48 patients. Continuous renal bleeding was detected in 15 patients (27.8%) and subsequent arterial embolization was performed with no further intervention required. Urine leak was diagnosed in 12 patients treated either by double j stent or by nephrostomy tube. CONCLUSIONS: Grade 4 and selected cases of grade 5 renal trauma can be treated conservatively with close monitoring and CT scan protocols in hemodynamic stable patients. In cases of continuous bleeding, arterial embolization can be performed. In cases of severe urine leak conservative management is also feasible either by inserting a double j stent or a nephrostomy tube.

Oncological cases and complications in Urology.

This collection of cases describes some unusual urological tumors and complications related to urological tumors and their treatment. Case 1: A case of left hydronephrosis referred four years after a right radical mastectomy for lobular breast carcinoma was described. Computed tomography scan revealed a left hydronephrosis with dilated ureter up to the proximal third. An exploratory laparoscopy was performed and the definitive histopathology examination showed a recurrence of the carcinoma with a right tubal metastasis and peritoneal carcinosis. Case 2: A rare case of an extensive penile squamous cell carcinoma in a young man. The patient was treated with radical surgery and modified inguinal lymphadenectomy. No recurrence was noticed so far. Case 3: A rare case of left sided Inferior Vena Cava (IVC) in a patient diagnosed with renal cell cancer who underwent open left partial nephrectomy. Case 4: A case of urethrorrhagia, caused by a recent trauma from an urinary catheter placed in a patient submitted to gastric resection due to a neoplastic pathology. Urethrorrhagia only temporarily responded to conservative treatment and ultimately resolved by coagulation with an endoscopic approach.

Clinical impact of combined PTEN and ERG rearrangements in localized prostate cancer.

To the Editor, Prostate cancer (PCa) is nowadays the second most common malignancy diagnosed among men and is responsible for one of the leading causes of cancer mortality. Clinically localized disease may present with a wide variety of clinical behavior including tumors of low clinical significance as well as highly aggressive ones. Among patients treated with either radical prostatectomy or radiotherapy there is a risk of biochemical failure (BF). As a result, it is of outmost interest to develop new markers predicting the risk of BF development.

Expression of proto-oncogene c-Myc in patients with urinary bladder transitional cell carcinoma.

BACKGROUND: c-Myc is a proto-oncogene located on human chromosome 8. It encodes a transcriptional factor which regulates the expression of approximately 10% to 15% of human genes, playing a crucial role in cell growth, differentiation, cellular metabolism, apoptosis, and cell transformation. The aim of this study is to correlate the expression of c-Myc in patients suffering from urinary bladder transitional cell carcinoma with tumor grade, stage, and lymph node metastases. MATERIALS AND METHODS: Formalin-fixed, paraffin-embedded tissue samples were obtained from 54 consecutive patients who underwent transurethral resection of bladder tumor or radical cystectomy (RC) as treatment for urinary bladder transitional cell carcinoma. Immunohistochemistry was performed using c-Myc monoclonal antibody and c-Myc expression was then analyzed for correlation with tumor stage, grade, and lymph node metastases. RESULTS: From a total of 54 patients, 42 (77.8%) had c-Myc positive staining and 12 (22.2%) were c-Myc negative. In the c-Myc positive group, 28 patients (66.7%) had low grade tumors and 33 (78.6%) presented with non-muscle-invasive disease (p < 0.05). In the c-Myc negative group, 10 patients (83.3%) had high-grade disease and 8 (66.7%) presented with muscle-invasive disease (p < 0.05). Lymph node metastases were evaluated in 17 patients who underwent RC. Of these, 5 had lymph node metastases, 4 of whom had c-Myc negative staining (p < 0.05). CONCLUSIONS: In our study, c-Myc negative staining was associated with higher grade and higher stage disease. On the contrary, most c-Myc positive tumors were low grade and non-muscle-invasive disease. In patients who underwent RC, c-Myc negative staining was associated with lymph node metastases.

Does radical prostatectomy result in lower urinary tract symptom improvement in high-risk and locally advanced prostate cancer? A Single-center experience.

PURPOSE: Radical prostatectomy represents the most popular method of prostate cancer treatment, including cases with high-risk and locally advanced cancer. Besides, men with this disease often experience lower urinary tract symptoms (LUTS) and report high International Prostate Symptom Scores (IPSS), pathological post-void residual (PVR) urine volumes and low levels of maximum urinary flow rates (Qmax). In this study we assessed the effect of radical prostatectomy on the above parameters in patients with high-risk and locally advanced disease. METHODS: A number of 240 individuals were enrolled in the study. Patients that required any post-operative manipulation up to the completion of 12 months after surgery were excluded. All patients were assessed pre- and post-operatively at 3, 6 and 12 months. Evaluation included IPSS, Qmax and PVR. RESULTS: Mean age was 66.8 years. Mean PSA value was 12.7 ng/ml and mean Gleason score was 7.9. At baseline 41.3% of the patients had Qmax ⩽10 and 42.5% had IPSS >8. There was a significant increase in Qmax during the follow-up (median value was 12 at baseline and increased to 21 at 12 months). Also, IPSS and PVR decreased significantly during the follow-up. IPSS median value decreased from 9 at baseline to 5 at 12 months. Improvement was observed in all grades of symptoms.

Risk for Venous Thromboembolic Events in Patients With Advanced Urinary Tract Cancer Treated With First-Line Chemotherapy.

BACKGROUND: Venous thromboembolic events (VTEs) frequently occur in cancer patients. Risk assessment models (RAMs) for cancer-associated thrombosis have been proposed. However, advanced urinary tract cancer (aUTC) was not adequately represented in these models. We studied the incidence of VTEs, the risk factors, and the applicability of recently described RAMs. PATIENTS AND METHODS: Data from 335 patients with aUTC treated with chemotherapy between April 1995 and September 2015 in a single institution were analyzed. RESULTS: A total of 95.2% received platinum-based first-line chemotherapy. Twenty-nine patients (8.7%) experienced VTEs. The 6-, 12-, and 24-month VTE incidence was 7.4% (95% confidence interval [CI], 4.8-10.6), 8.1% (95% CI, 5.4-11.5) and 9.4% (95% CI, 6.4-13.1), respectively. No significant association of VTE incidence with the Khorana risk score was observed. History of vascular event (VTE and/or arterial thromboembolic event) was significantly associated with the development of VTE. Patients with such history had a 6-, 12-, and 24-month VTE incidence of 16.2% (95% CI, 6.6-29.7), 19.2% (95% CI, 8.4-33.3), and 25.2% (95% CI, 12.5-40.1) compared to 6.2% (95% CI, 3.7-9.4), 6.6% (95% CI, 4.1-10), and 7.1% (95% CI, 4.4-10.6) of those who did not. The discriminatory ability of this factor adjusted for leucocyte count, sex, Eastern Cooperative Oncology Group performance status, and type of chemotherapy reached 0.79 (95% CI, 0.71-0.87) compared to the 0.58 (95% CI, 0.49-0.66) for the Khorana risk score. CONCLUSION: Development of tumor-specific algorithms for the risk of VTEs is advisable. Patients with aUTC and a history of vascular events are at high risk for VTE development, and prophylaxis should be prospectively studied in this group.