M0CRPC overview of management options.

Though prostate cancer usually responds to androgen deprivation therapy (ADT) in the beginning, the majority of prostate cancers will develop castration resistance over time. The androgen receptor (AR) pathway is often found to be activated in castration resistant prostate cancer (CRPC). Thus, AR signalling remains a therapeutic target upon the development of CRPC. The term M0CRPC is used when ADT leads to castration resistance and there are no metastases detectable by means of conventional imaging. Until recently, there was no therapeutic standard for this group of patients. With the PROSPER-, SPARTAN- and ARAMIS-studies three large placebo-controlled phase III trials have been published lately that showed a significant benefit in metastasis-free survival in men with M0CRPC and short PSA doubling time (PSADT). The efficacy data are very similar in these studies, meaning that the drugs' safety profiles, final analyses of overall survival and their availability will be more important to help clinicians decide which of these three drugs they use for their patients with M0CRPC.

[Social support in gender reassignment surgery]. / Soziale Unterstützung bei genitalangleichender Operation.

BACKGROUND: Gender reassignment surgery (GRS) can lead to discrimination. This transition makes great demands on the individual and also affects the social environment. OBJECTIVES: To evaluate the social support of male-to-female (MtF) transgender people. MATERIALS AND METHODS: Group A comprised 254 consecutive MtF transsexuals, who received a penile inversion vaginoplasty between 2004 and 2010. These women were surveyed retrospectively. Group B comprised 144 consecutive MtF transsexuals who presented for preoperative counselling. These patients were asked to answer the survey in advance of the planned GRS. RESULTS: The return rate was 46.9 % (A) and 95.1 % (B). In both groups, approximately two-thirds lived with their parents or children at ease. About 13.4 % (A) and 16.9 % (B) estimated the relationship towards their parents and one- seventh (A) or one-sixth (B) woman rated their relationship towards their children as poor. The acceptance of the parents regarding GRS was 65.6 % (A) and 77.1 % (B). In total 20 % (A) and 9.2 % (B) did not, however, accept GRS in their children. The acceptance of children regarding GRS was 64.9 % (A) and 71.1 % (B) with 10.8 % (A) and 6.7 % (B) who did not approve the decision. DISCUSSION: Social support is an important resource in the context of gender reassignment surgery. Understanding can help to improve the situation for transsexuals and to reduce consecutive healthcare utilisation.

[Effect of disturbing factors on the specificity of exfoliative urinary cytology]. / Einfluss von Störfaktoren auf die Spezifität der exfoliativen Urinzytologie.

In the clarification of hematuria and subsequent treatment, a high specificity is expected from urinary cytology when no tumor is present, because false positive results lead to unnecessary diagnostic measures. The aim of this study was to investigate different disturbing factors to determine the specificity of urinary cytology and whether the specificity can be increased by cytometry. Out of 150 patients with no malignant disease, 125 were affected by the following disturbing factors: urinary infection, urolithiasis, transurethral electroresection, utilisation of hypo-osmolar flushing solution or administration of contrast agents. In 5 patients who were diagnosed with urinary infection or urolithiasis, the urine was falsely cytologically determined to be tumor positive, an error which was corrected by cytometric analysis. Therefore, cytometric analysis should be carried out in patients in whom a tumor has been cytologically diagnosed in order to increase the specificity of urinary cytology.

[Proapoptotic antibodies as new therapeutic agents for tumor treatment]. / Proapoptotische Antikörper als neue Tumortherapeutika.

To convert the concept already successful in mice into clinical practice and commercialize it, a human anti-CD95-antibody must be produced. In a second step experiments must be performed on various normal healthy cells and tissues to determine whether these human anti-CD95-antibodies administered in very low doses have any effect on human cells (particularly hepatocytes) or at least cause only minimal side effects. If these studies yield positive results, then clinical trials can be conducted in which increasing doses are given to exclude an acute hepatotoxic effect and then the effect exerted by the antibody in combination with irradiation on tumor growth can be investigated.The advantage of this concept lies in the fact that systemic stimulus (low doses of anti-CD95-antibodies) is highly intensified by local radiotherapy and only then initiates cell death. Since the anti-CD95-antibodies trigger apoptosis primarily in tumor endothelia, this approach could be employed not only for prostate cancer and melanomas, which have already been tested, but also for many other tumors.