Oncologic outcome after radical prostatectomy in men with PSA values above 20 ng/ml: a monocentric experience.

OBJECTIVE: To assess the cancer control afforded by radical prostatectomy (RP) in patients with prostate-specific antigen (PSA) values above 20 ng/ml. METHODS: We performed a retrospective review of prostate cancer patients who had initial PSA values above 20 ng/ml and were treated with surgery between 1995 and 2006. Biochemical recurrence was defined as a single rise in PSA levels over 0.2 ng/ml after surgery. RESULTS: Overall, 41 patients were included. The mean age was 62 +/- 6.43 years. The mean PSA was 27.39 +/- 13.57 ng/ml (range 20.3-80). After pathological analysis, prostate cancer was organ-confined in 21 cases (51.2%) and locally advanced in 20 cases (48.8%). Positive surgical margins were detected in 36.5% of cases (n = 15). Five patients had lymph node involvement (12%). The mean prostate volume was 58 +/- 28.9 cc. The mean length of follow-up after surgery was 94 +/- 37 months. Median time to biochemical recurrence was 44.6 +/- 22 months. The 5-year PSA-free survival rate was 53%. Through univariate analysis, the pathologic stage (p = 0.016), biopsy and pathological Gleason scores (p = 0.013; p = 0.02) and positive margin (p = 0.04) were associated with recurrence. Overall, 24 patients (58.5%) experienced a biochemical recurrence. Only margin status and pathological Gleason were significant in multivariate analysis (p < 0.05). CONCLUSION: RP can be recommended as a viable primary treatment option in selected cases of the high-risk cohort of patients with pre-operative PSA values above 20 ng/ml. However, the modalities of adjuvant treatments following RP remain to be defined in patients who are likely to evolve unfavourably.

Detection and prediction of active tuberculosis disease by a whole-blood interferon-gamma release assay in HIV-1-infected individuals.

BACKGROUND: The sensitivity of whole-blood interferon-gamma release assays to detect or predict active tuberculosis in individuals infected with human immunodeficiency virus type 1 (HIV-1) has as yet not been determined. Methods. In this prospective, longitudinal, single-center study, 830 HIV-1-infected patients underwent testing with the QuantiFERON-TB Gold In-Tube (QFT-GIT) assay. Clinical screening for active tuberculosis was performed at least every 3 months for a median follow-up time of 19 months. RESULTS: At baseline, the QFT-GIT assay yielded positive or indeterminate results in 44 (5.3%) and 47 (5.7%) of the 830 patients, respectively. A positive QFT-GIT assay result occurred at significantly higher frequencies among black individuals than among white individuals (odds ratio, 4.84; 95% confidence interval, 2.25-9.97; P< .001), among patients from Africa than among patients from Austria (odds ratio, 6.57; 95% confidence interval, 2.99-14.25; P< .001), and among patients from high-prevalence countries than among patients from low-prevalence countries (odds ratio, 5.86; 95% confidence interval, 2.41-13.44; P< .001). In patients with indeterminate QFT-GIT assay results, both median actual and nadir CD4(+) T cell counts were significantly lower than in patients with interpretable QFT-GIT assay results (P< .001). At the time of baseline QFT-GIT screening, active tuberculosis was found in 7 (15.9%) of 44 individuals with a positive result and in 1 (0.1%) of 739 patients with a negative result. During the follow-up period, however, progression to active tuberculosis occurred exclusively in patients with a positive QFT-GIT assay result, at a rate of 8.1% (3 of 37 patients; P< .001). Collectively, the sensitivity of the QFT-GIT assay for active tuberculosis was 90.9% (95% confidence interval, 62.3%-98.4%). CONCLUSIONS: Our results suggest that the QFT-GIT assay may be a sensitive tool for the detection and prediction of active tuberculosis in HIV-1-infected individuals.

Molecular and histological markers in urothelial carcinomas of the upper urinary tract.

Urothelial cell carcinomas (UCCs) are one of the most common types of malignancies. Recently, different mechanisms of carcinogenesis, as well as discrepancies in the natural history of urothelial cancers of the bladder and of the upper urinary tract (UUT), have been identified. As a result several teams have focused on specific markers in UUT-UCCs, a very rare type of cancer. This review gives a brief overview on the current markers of interest. Microsatellite instabilities (MSI) are independent molecular makers for prognosis. In addition, MSI can help detect a germline mutation and therefore allows for the detection of possible hereditary cancers. The loss of proteins of the mismatch repair system can also facilitate the detection of a germline mutation but should be followed by DNA sequencing. Epithelial cadherin has been shown to be an independent marker of prognosis, as well as hypoxia-inducible factor-1alpha (HIF-1alpha) and telomerase RNA component. Furthermore HIF-1alpha is significantly associated with the grade and pattern of growth and the telomerase RNA component could possibly also be used in diagnosis. The active form of the L-type amino acid transporter 1 (LAT1) was a significant prognostic marker in univariate analysis only. There are contrasting studies on the significances of p27 and Ki-67 as prognostic markers in UUT-UCCs. MET is a factor that correlates with vascular invasion of invasive cancer and bcl-2 oncoprotein correlates with stage. The ongoing identification of these markers might help to find specific treatments tailored to the molecular pattern of each tumour. Therefore a subgroup of patients with a higher risk of recurrence could be identified as well as patients that could benefit from minimal invasive surgery.