L-dopa decarboxylase (DDC) gene expression is related to outcome in patients with prostate cancer.

UNLABELLED: What's known on the subject? and What does the study add? L-dopa decarboxylase (DDC) has been documented as a novel co-activator of androgen receptor transcriptional activity. Recently, it was shown that DDC gene expression is significantly higher in patients with PCa than in those with BPH. In the present study, there was a significant association between the DDC gene expression levels and the pathological stage and Gleason score of patients with prostate cancer (PCa). Moreover, DDC expression was shown to be an unfavourable prognostic marker of biochemical recurrence and disease-free survival in patients with PCa treated by radical prostatectomy. OBJECTIVE: To determine whether L-dopa decarboxylase gene (DDC) expression levels in patients with prostate cancer (PCa) correlate to biochemical recurrence and disease prognosis after radical prostatectomy (RP). PATIENTS AND METHODS: The present study consisted of 56 samples with confirmed malignancy from patients with PCa who had undergone RP at a single tertiary academic centre. Total RNA was isolated from tissue specimens and a SYBR Green fluorescence-based quantitative real-time polymerase chain reaction methodology was developed for the determination of DDC mRNA expression levels of the tested tissues. Follow-up time ranged between 1.0 and 62.0 months (mean ± SE, 28.6 ± 2.1 month; median, 31.5 months). Time to biochemical recurrence was defined as the interval between the surgery and the measurement of two consecutive values of prostate-specific antigen (PSA) ≥0.2 ng/mL. RESULTS: DDC expression levels were found to be positively correlated with the tumour-node-metastasis stage (P = 0.021) and Gleason score (P = 0.036) of the patients with PCa. Patients with PCa with raised DDC expression levels run a significantly higher risk of biochemical recurrence after RP, as indicated by Cox proportional regression analysis (P = 0.021). Multivariate Cox proportional regression models revealed the preoperative PSA-, age- and digital rectal examination-independent prognostic value of DDC expression for the prediction of disease-free survival (DFS) among patients with PCa (P = 0.036). Kaplan-Meier survival analysis confirms the significantly shorter DFS after RP of PCa with higher DDC expression levels (P = 0.015). CONCLUSIONS: This is the first study indicating the potential of DDC expression as a novel prognostic biomarker in patients with PCa who have undergone RP. For further evaluation and clinical application of the findings of the present study, a direct analysis of mRNA and/or its protein expression level in preoperative biopsy, blood serum and urine should be conducted.

Expression analysis and study of the KLK15 mRNA splice variants in prostate cancer and benign prostatic hyperplasia.

Prostate cancer is the most commonly diagnosed malignancy in male populations in the Western world. The KLK15 gene, the newest member of the kallikrein family, is expressed in the prostate gland. The purpose of this study is the expression analysis and the clinical evaluation of the KLK15 mRNA spliced variants in prostate cancer (CaP) and benign prostatic hyperplasia (BPH) patients. Total RNA was isolated from 104 CaP and BPH tissue specimens. After testing the quality of the RNA, cDNA was produced by reverse transcription, and PCR was performed for the amplification of the KLK15 mRNA transcripts. GAPDH and HPRT genes were used as endogenous controls Our data revealed that mRNA spliced variants of KLK15 were differentially expressed in prostate tissue specimens. Analysis of data showed a statistically significant (P < 0.001) increase in the frequency of overexpression of KLK15 transcripts encoding for both the active isoform and for the isoform 3 in CaP compared to BPH samples. Furthermore, KLK15 transcripts were found to be highly expressed in more aggressive tumors (P = 0.017). These results suggest that KLK15 expression analysis could be employed as a valuable tool for the discrimination between BPH and CaP tissue specimens and as an unfavorable prognostic marker for prostate cancer.

Renal cell carcinoma with bilateral synchronous adrenal gland metastases: a case report.

INTRODUCTION: Renal cell carcinoma is characterized by its potential of metastasizing widely and to unusual sites, with the metastases occasionally preceding clinical recognition of the primary tumor. Synchronous bilateral adrenal metastases from renal cell carcinoma, without other metastases, are rare and, to our knowledge, only 17 cases have been published in the literature to date. In general, patients with synchronous bilateral adrenal metastases from renal cell carcinoma have a poor prognosis. CASE PRESENTATION: We report a case of right-sided renal cell carcinoma with simultaneous bilateral adrenal metastases in a 58-year-old woman. The primary tumor was localized in the upper and mid pole of the kidney. The diagnosis was established preoperatively by abdominal ultrasound and computed tomography. Surgical treatment consisted of a right radical nephrectomy and bilateral adrenalectomy. Postoperative cortisone acetate replacement was instituted. The pathological findings of the right renal tumor showed clear cell carcinoma and both adrenal tumors showed the same pathology as the right renal tumor. There was no evidence of recurrence after 6 months of follow-up. CONCLUSION: Patients with bilateral synchronous adrenal metastases should be considered to have disseminated metastatic disease. However, good performance status, the presence of paraneoplastic syndrome and the alleviation of refractory pain are important reasons make an urologist to consider radical nephrectomy in renal cell carcinoma patient with metastases.

Electrical wire as a foreign body in a male urethra: a case report.

INTRODUCTION: Self-inflicted foreign bodies in the male urethra and urinary bladder are an emergency that urologists may rarely have to face. A case of an electrical wire inserted in the male urethra and coiled in the bladder is presented. CASE PRESENTATION: A 53-year-old male presented with the inability to void and bloody urethral discharge after having introduced an electrical wire in his urethra for masturbation 3 hours earlier. He had made several unsuccessful attempts to remove it. CONCLUSION: The variety of these objects may be impressive and removal of the foreign body may be quite challenging requiring imagination and high-level surgical skills., In this case an electrical wire was used and the diagnostic as well as the therapeutic steps for its removal are presented.

Hydronephrosis promotes expression of hypoxia-inducible factor 1 alpha.

BACKGROUND: Obstructive uropathy is argued to involve an ischemia-type tissue injury. Further, hypoxia-inducible factor 1 alpha (HIF-1 alpha) constitutes a nuclear transcription factor normally upregulated under hypoxic conditions. We hypothesized that HIF-1 alpha is expressed in the hydronephrotic renal pelvis, as a result of tissue hypoxia. PATIENTS AND METHODS: Renal pelvis tissue specimens were obtained from 2 patient groups. Group 1 (controls, n = 10) consisted of patients who underwent nephrectomy due to nonobstructive renal malignancy. Group 2 (n = 18) consisted of patients who underwent open procedures due to intractable hydronephrosis, not amenable to conservative measures. HIF-1 alpha detection was conducted via immunohistochemical techniques, while histological alterations in both groups were also recorded. RESULTS: Smooth muscle hypertrophy and urothelial hyperplasia were major findings in group 2. HIF-1 alpha-positive cells (fibroblasts and occasionally macrophages), mainly localized in the stroma, were also found to a greater extent in group 2 (p = 0.0066). CONCLUSION: We conclude that HIF-1 alpha is mainly expressed in stroma fibroblasts of the hydronephrotic renal pelvis, implying the presence of significant tissue hypoxia at the dilated upper urinary tract.

Expression analysis and clinical utility of L-Dopa decarboxylase (DDC) in prostate cancer.

BACKGROUND: L-Dopa decarboxylase (DDC) is a pyridoxal 5'-phosphate-dependent enzyme that was found to be involved in many malignancies. The aim of this study was to investigate the mRNA expression levels of DDC in prostate tissues and to evaluate its clinical utility in prostate cancer (CaP). METHODS: Total RNA was isolated from 118 tissue specimens from benign prostate hyperplasia (BPH) and CaP patients and a highly sensitive quantitative real-time RT-PCR (qRT-PCR) method for DDC mRNA quantification has been developed using the SYBR Green chemistry. LNCaP prostate cancer cell line was used as a calibrator and GAPDH as a housekeeping gene. RESULTS: DDC was found to be overexpressed, at the mRNA level, in the specimens from prostate cancer patients, in comparison to those from benign prostate hyperplasia patients (p<0.001). Logistic regression and ROC analysis have demonstrated that the DDC expression has significant discriminatory value between CaP and BPH (p<0.001). DDC expression status was compared with other established prognostic factors, in prostate cancer. High expression levels of DDC were found more frequently in high Gleason's score tumors (p=0.022) as well as in advanced stage patients (p=0.032). CONCLUSIONS: Our data reveal the potential of DDC expression, at the mRNA level, as a novel biomarker in prostate cancer.

Spontaneous perforation of the ureter: clinical presentation and endourologic management.

BACKGROUND AND PURPOSE: Spontaneous perforation of the upper ureter is a rare condition that poses diagnostic and therapeutic problems. We report on five cases from three institutions and discuss the literature. PATIENTS AND METHODS: Five patients presented with renal colic and the imaging modalities used to assess them showed extravasation of urine. RESULTS: The cause of spontaneous perforation of the ureter was a ureteral stone in one case and was unknown in four cases. In all cases, a Double-J ureteral stent was inserted under fluoroscopy. Urinoma was percutaneously drained in only one patient. Repeat imaging showed normal renal function and morphology in all patients. CONCLUSION: Spontaneous perforation of the ureter should be suspected after renal colic. Endourologic treatment offers excellent results, even for the management of acute complications.

A solitary fibrous tumor of the kidney in a 26-year-old man.

BACKGROUND: Solitary fibrous tumors (SFTs) are rare spindle cell neoplasms that typically arise in the pleura. There are several reports of cases that arose from a variety of sites. SFT of the kidney is rare and, to our knowledge, only 25 cases have been published in the literature to date. SFTs in the kidney have similar morphologic and immunologic features and biologic behaviors as SFTs found elsewhere. In general, patients with SFTs of the kidney have a favorable prognosis. CASE: We report a case of SFT of the right kidney in a 26-year-old man. The tumor was localized in the upper and mid pole of the kidney. A nephrectomy was performed. The tumor was a well-circumscribed, solid mass attached to the renal capsule without necrosis or hemorrhage. Microscopically, a spindle cell neoplasm with alternating hypo- and hypercellular areas, storiform, fascilular and hemangiopericytoma-like growth pattern and less cellular dense collagen deposition was observed. Some glomeruli and renal tubules were entrapped by the tumor cells. There were no mitotic figures. Immunohistochemically, the tumor cells were consistently positive for CD34, CD99, and bcl-2. There was no evidence of recurrence after 6 months of follow-up. DISCUSSION: Although morphology is most important in formulating the initial differential diagnosis, the addition of immunohistochemistry is vital in arriving at the correct classification of renal spindle cell tumors.

Enucleoresection for the elective treatment of small renal cell carcinoma: can it be the treatment of choice?

BACKGROUND: We present our findings in a series of T1 renal cell carcinomas (RCC) treated with excision of the tumor surrounded by a minimal layer of grossly normal parenchyma. PATIENTS AND METHODS: A total of 43 patients who underwent elective nephron-sparing surgery performed with enucleoresection were studied retrospectively. None of the patients had preoperative or intraoperative suspicion of positive nodes and were free from distant metastases before surgery (N0, M0). Patients status was last evaluated in January 2006. RESULTS: Median age was 58.7 years (35-78). Median tumor size was 3.3 cm (1.5-7). There were no major complications such as bleeding and urinary leakage/ urinoma requiring re-operation. Pathological stage was pT1a in 38 (89%), pT1b in 4 (9%) and pT3a in 1 (2%) patient. Median followup was 32 months (6-89). A total of 5 patients with RCC had died as of January 2006. Overall, 3 (6.9%) patients had disease progression, of whom 2 (4.6%) were local recurrence, 1 alone and 1 associated with distant metastases. The overall cancer-specific survival was 95.4%, and the overall progression-free survival was 93%. CONCLUSIONS: Enucleoresection reproduces the results of partial and radical nephrectomy with minimal morbidity. It is a safe and acceptable approach for elective nephronsparing surgery.