Reduction of Bladder Volume after BCG Immunotherapy.

Bacillus Calmette-Guérin (BCG) immunotherapy is the most effective treatment for carcinoma in situ and high-risk non-muscle invasive bladder cancer (NMIBC). However, it can also provoke diverse side effects. We found 1 patient with a significantly and rapidly reduced bladder volume after the instillation of BCG. Few such cases and corresponding treatments have been reported. We speculated that the tuberculosis infection existed, so antitubercular therapy was given. After a 3-month oral intake of rifampicin, isoniazid, and ofloxacin, the volume of bladder returned to normal and the voiding symptoms disappeared. This case indicated that the reduction of bladder volume caused by BCG instillation could be treated with antitubercular therapy. Prompt and accurate diagnosis was important for the management.

Evaluation of transrectal ultrasound-based dosimetry for brachytherapy of prostate cancer: a single-center experience.

PURPOSE: To explore the possibility of intraoperative transrectal ultrasound (TRUS)-based dose verification in transperineal brachytherapy (BT) with iodine-125 (125I) seeds for prostate cancer. MATERIAL AND METHODS: Fifteen patients with prostate cancer were treated using BT with 125I seeds. Post-implant TRUS and computed tomography (CT) images were imported into treatment planning system (TPS) for dosimetry. Dosimetry parameters, including minimum dose received by 90% of the volume (D90), percentage of the volume receiving 100% of prescribed dose (V100), and percentage of the volume receiving 200% of prescribed dose (V200) were calculated based on TRUS and CT images, separately. The D90 value of TRUS-based dosimetry was transformed to its expected value. Comparisons of the dosimetric parameters between post-operative verification and preoperative plans were made by paired t-test. One-way ANOVA model was used to assess the differences in preoperative plans. Agreements were evaluated between the preoperative planning and post-operative actual dose parameters using Bland-Altman analysis. RESULTS: In total, 825 of 125I seeds were implanted successfully in 15 patients. In TRUS-based dosimetry, 674 seeds (81%) were identified clearly in TRUS-based images, and the expected value of D90 parameter showed no significant differences compared with the preoperative planning and CT post-operation results (p > 0.05). In CT-based dosimetry, 810 seeds (98%) were identified clearly in CT-based images, and there was good consistency of D90, V100, and V200 values (p > 0.05). Post-implant CT-based dosimetry indicated that 125I seed implantation had fulfilled the expected plan. CONCLUSIONS: Intraoperative TRUS can be used for dosimetric verification of BT for prostate cancer.

LncRNA MAGI2-AS3 inhibits bladder cancer progression by targeting the miR-31-5p/TNS1 axis.

In this study, we performed bioinformatics analysis to identify the competing endogenous RNAs (ceRNAs) that regulate bladder cancer (BCa) progression. RNA-sequencing data analysis identified 2451 differentially expressed mRNAs, 174 differentially expressed lncRNAs, and 186 microRNAs (miRNAs) in BCa tissues (n=414) compared to the normal urothelial tissues (n=19) from the TGCA database. CeRNA network analysis of the differentially expressed lncRNAs and mRNAs showed strong positive correlation between lncRNA MAGI2-AS3 and Tensin 1 (TNS1) mRNA in BCa tissues. Bioinformatics analysis also showed that both MAGI2-AS3 and TNS1 mRNA sequences contain miR-31-5p binding sites. Furthermore, we observed significantly lower MAGI2-AS3 and TNS1 mRNA expression and higher miR-31-5p expression in the BCa tissues and cell lines (T24 and J82) compared with their corresponding controls. Functional and biochemical experiments in BCa cell lines including luciferase reporter assays showed that MAGI2-AS3 upregulated TNS1 by sponging miR-31-5p. Transwell assays showed that the MAGI2-AS3/miR-31-5p/TNS1 axis regulated migration and invasion ability of BCa cell lines. Moreover, immunohistochemical staining of paired BCa and normal urothelial tissues showed that low expression of TNS1 correlated with advanced tumor (T) stages and lymph node metastasis in BCa. In conclusion, our study demonstrates that the MAGI2-AS3/miR-31-5p/TNS1 axis regulates BCa progression.

Biomarkers in previous histologically negative prostate biopsies can be helpful in repeat biopsy decision-making processes.

To evaluate whether the addition of biomarkers to traditional clinicopathological parameters may help to increase the accurate prediction of prostate re-biopsy outcome. A training cohort with 98 patients and a validation cohort with 72 patients were retrospectively recruited into our study. Immunohistochemical analysis was used to evaluate the immunoreactivity of a group of biomarkers in the initial negative biopsy normal-looking tissues of the training and validation cohorts. p-STAT3, Mcm2, and/or MSR1 were selected out of 10 biomarkers to construct a biomarker index for predicting cancer and high-grade prostate cancer (HGPCa) in the training cohort based on the stepwise logistic regression analysis; these biomarkers were then validated in the validation cohort. In the training cohort study, we found that the biomarker index was independently associated with the re-biopsy outcomes of cancer and HGPCa. Moreover supplementing the biomarker index with traditional clinical-pathological parameters can improve the area under the receiver operating characteristic curve of the model from 0.722 to 0.842 and from 0.735 to 0.842, respectively, for predicting cancer and HGPCa at re-biopsy. In the decision-making analysis, we found the model supplemented with the biomarker index can improve patients' net benefit. The application of the model to clinical practice, at a 10% risk threshold, would reduce the number of biopsies by 34.7% while delaying the diagnosis of 7.8% cancers and would reduce the number of biopsies by 73.5% while delaying the diagnosis of 17.8% HGPCas. Taken together, supplementing the biomarker index with clinicopathological parameters may help urologists in re-biopsy decision-making processes.

Impact of enhanced recovery after surgery or fast track surgery pathways in minimally invasive radical prostatectomy: a systematic review and meta-analysis.

BACKGROUND: The enhanced recovery after surgery (ERAS) and fast track surgery (FTS) protocols have been applied to a variety of surgeries and have been proven to reduce complications, accelerate rehabilitation, and reduce medical costs. However, the effectiveness of these protocols in minimally invasive radical prostatectomy (miRP) is still unclear. Thus, this study aimed to evaluate the impact of ERAS and FTS protocols in miRP. METHODS: We searched PubMed, Cochrane Library, Embase, and Web of Science databases to collect randomized and observational studies comparing ERAS/FTS versus conventional care in miRP up to July 1, 2019. After screening for inclusion, data extraction, and quality assessment by two independent reviewers, the meta-analysis was performed with the RevMan 5.3 and STATA 15.1 software. Results were expressed as risk ratio (RR) and weighted mean difference (WMD) with 95% confidence intervals (CIs). RESULTS: In total, 11 studies involving 1,207 patients were included. Pooled data showed that ERAS/FTS was associated with a significant reduction in length of stay (LOS) (WMD: -2.41 days, 95% CI: -4.00 to -0.82 days, P=0.003), time to first anus exhaust (WMD: -0.74 days, 95% CI: -1.14 to -0.34 days, P=0.0003), and lower incidence of postoperative complications (RR: 0.70, 95% CI: 0.53 to 0.92, P=0.01). No significant differences were found between groups for operation time, estimated blood loss, postoperative pain, blood transfusion rate, and readmission rate (P>0.01). CONCLUSIONS: Our meta-analysis suggests that the ERAS/FTS protocol is safe and effective in miRP. However, more extensive, long-term, prospective, multicenter follow-up studies, and randomized controlled trials (RCTs) are required to validate our findings.

Efficacy and safety of periprostatic nerve block combined with perineal subcutaneous anaesthesia and intrarectal lidocaine gel in transrectal ultrasound guided transperineal prostate biopsy: A Prospective Randomised Controlled Trial.

BACKGROUND: To determine the efficacy and safety of a periprostatic nerve block combined with perineum subcutaneous anaesthesia and intrarectal lidocaine gel for transrectal ultrasound-guided transperineal prostate biopsy (TPBx) through a prospective randomised controlled trial. METHODS: In total, 216 patients from May 2018 to November 2018 were randomly assigned to the experimental group and the control group at a ratio of 1:1. The experimental group received a periprostatic nerve block combined with subcutaneous perineal anaesthesia and intrarectal lidocaine gel. The control group received total intravenous anaesthesia. A visual analogue scale (VAS) score (0-10) was used to evaluate pain at different stages. The operative time, duration of hospitalisation, intraoperative vital signs, perioperative complications and clinicopathological features were recorded. RESULTS: The overall detection rate of prostate cancer was 40.74%, and the median Gleason score was 8 for all patients diagnosed with prostate cancer. No significant differences in terms of detection rates, Gleason scores and ISUP/WHO Grade Groups were found between the two groups (P > 0.05). The experimental group had no pain or just met the criteria for mild pain during the biopsy, which was significantly alleviated after the biopsy, and had a shorter operation time compared with that of the control group (P < 0.05). Compared with the control group, the experimental group had more stable haemodynamics and respiratory status and fewer surgical complications (P < 0.05). CONCLUSIONS: In multiple aspects, a periprostatic nerve block combined with subcutaneous perineal anaesthesia and intrarectal lidocaine gel is a safer and more efficient approach to local anaesthesia for TPBx that can almost replace total intravenous anaesthesia and is worthwhile applying in the clinical setting.

Knockdown of the long noncoding RNA HOTTIP inhibits cell proliferation and enhances cell sensitivity to cisplatin by suppressing the Wnt/ß-catenin pathway in prostate cancer.

BACKGROUND: Prostate cancer (PCa) is a prevalent and deadly cancer worldwide. Considering the malignant progression and therapeutic resistance of PCa, further dissection of the underlying mechanisms and exploration of novel therapeutic targets for PCa are urgently needed. The long noncoding RNA HOTTIP has recently been revealed as an oncogenic regulator in different cancers; however, whether HOTTIP is involved in PCa remains poorly understood. Here, we examined the crucial roles of HOTTIP in the proliferation and chemoresistance of PCa. METHODS: Quantitative real-time PCR (qRT-PCR) was performed to detect the HOTTIP messenger RNA (mRNA) levels in PCa samples from patients and PCa cells. Then, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT), colony formation, and cell cycle and flow cytometry assays were performed to investigate the proliferation and cisplatin-resistance of PCa cells with silenced HOTTIP compared with a negative control. We applied Western blotting, qRT-PCR and a TOP/FOP assay to explore the relevant mechanisms. RESULTS: In this study, we found that the HOTTIP mRNA levels were increased in the PCa patient samples and PCa cell lines compared with the controls. The knockdown of HOTTIP not only inhibited the proliferation of PCa cells but also facilitated cell cycle arrest and chemosensitivity to cisplatin. Furthermore, the qRT-PCR, Western blotting, TOP/FOP assays, MTT assay, and flow cytometry revealed that Wnt/ß-catenin signaling was related to the regulation of HOTTIP in cell proliferation, cell cycle arrest, and chemoresistance to cisplatin in PCa. CONCLUSION: Taken together, our findings suggest that HOTTIP may be a potent therapeutic target for PCa, and HOTTIP inhibitors might be regarded as effective strategies for PCa therapy.

The impact of anesthetic techniques on survival for patients with colorectal cancer: evidence based on six studies.

BACKGROUND/AIMS: Epidural-supplemented general anesthesia is perceived as a more beneficial method over general anesthesia since it reduces incidence of side effects, provides better postoperative pain relief and lowers the possibility to use immunosuppressive anesthetics. However, previous prospective and retrospective studies reported conflicting results in the effects of epidural anesthesia on post-operative outcomes of colorectal cancer surgery. Therefore, this study aims to pool available evidence to assess the association between epidural anesthesia and the post- operative outcomes in this group of patients. METHODOLOGY: Relevant studies were searched in databases and a meta-analysis was performed to estimate the association between epidural anesthesia and overall survival and recurrence free survival. RESULTS: Compared with the anesthetic choice without epidural anesthesia, epidural-supplemented anesthesia is associated with significantly longer overall survival (HR: 0.72, 95% CI: 0.55-0.94, p = 0.01) but not with prolonged recurrence free survival (HR: 1.06, 95% CI: 0.96-1.16, p = 0.23). These results showed a highlevel of robustness in sensitive test. CONCLUSION: Although epidural anesthesia might not lead to improved recurrence free survival, it had significant benefit in improving overall survival and reducing all-cause of death. It might be a useful anesthetic technique for colorectal cancer patients undergoing surgery. However, prospective studies are required to confirm whether this benefit is causative with epidural anesthesia.