Candidate diagnostic miRNAs that can detect cancer in prostate biopsy.

BACKGROUND: While histopathological evaluation remains the gold standard for diagnosis of prostate cancer (PCa), sampling errors remain a frequent problem; therefore, use of tissue biomarkers that can distinguish between benign and malignant prostate disease is a potentially beneficial diagnostic strategy. METHODS: Deep sequencing of the miRNA transcriptome of 14 benign prostatic hyperplasia (BPH) and 60 cancerous and non-cancerous prostate samples extracted from 34 cancer-bearing prostates removed by prostatectomy was performed; of the latter 60 samples, 16, 21, and 23 samples contained <10%, >30%, and no dysplastic cells, respectively. The predictive value of selected miRNAs was then tested by quantitative reverse-transcribed PCR (qRT-PCR), using two separate chemistries, Exiqon and Taqman, to evaluate the tissue samples obtained by prostatectomy. Validation experiments were also performed for a subset of miRNAs by qRT-PCR of 87 prostate core biopsies. RESULTS: We identified 123 miRNAs significantly dysregulated in PCa (adjusted P-values <0.05); 110 and 13 miRNAs were dysregulated only in cancerous samples and non-cancerous samples extracted from cancer-bearing prostates, respectively, while 31 were dysregulated regardless of the dysplastic cell content of the studied specimens. The clinical utility of eight selected miRNAs was analyzed using the same sample set with two qRT-PCR chemistries. Measurable qRT-PCR signals were obtained for seven and six miRNAs using the Exiqon and Taqman chemistries, respectively, and expression levels of six and four of these miRNAs differed significantly between BPH and PCa samples, regardless of dysplastic cell content. Validation experiments on core biopsies using qRT-PCR confirmed differential expression between BPH and PCa of four miRNAs (miR-187-3p, miR-183-5p, miR-32-5p, and miR-141-5p) using the Exiqon and one miRNA (miR-187-3p) with the Taqman chemistry. CONCLUSIONS: Our sequencing analyses identified several candidate diagnostic miRNAs and confirmed some which have previously been reported as diagnostic in prostate malignancy. The results of this study suggest also that some of selected miRNAs can differentiate between non-malignant and malignant prostates even when neoplastic cells are missing from the studied specimen.

Obesity and prostate cancer incidence and mortality: a systematic review of prospective cohort studies.

BACKGROUND: There has been a large body of research on obesity and the risk of prostate cancer (PCa) that has been published recently. However, the epidemiological evidence for such an association has not been consistent. This may be attributed to the nature of case-control and retrospective studies, which generally are more prone to biases. Therefore, we conducted a systematic review of prospective cohort studies to assess the association between obesity and the risk of PCa incidence and death. METHODS: A search of the PubMed database and references of published studies (from inception until March 2013) was conducted. Twenty-three eligible studies were identified and included in the systematic review. RESULTS: The evidence from the prospective cohort studies linking obesity with PCa incidence has not been consistent. However, cumulative data is compelling for a strong positive association between obesity and fatal PCa. CONCLUSIONS: Obesity is a significant diet-related risk factor for fatal PCa. Further well-constructed, large cohort studies on the potential association between obesity and PCa, as well as on underlying mechanisms, are needed.

Extraperitoneal laparoscopic Millin prostatectomy using finger enucleation.

PURPOSE: We evaluated the feasibilty, safety and results of extraperitoneal laparoscopic Millin prostatectomy using finger enucleation through an additional 1 cm suprapubic incision. MATERIALS AND METHODS: A total of 66 consecutive laparoscopic simple prostatectomies were performed with this technique in men with symptomatic bladder outflow obstruction and a prostate gland larger than 70 cc on transrectal ultrasound. Data such as operating time, intraoperative blood loss, transfusion rate, complications, catheterization period, hospitalization time and surgical specimen weight were prospectively collected and evaluated. Preoperative and 3-month postoperative International Prostate Symptom Score and urinary flow rates were used to assess the surgical outcome. RESULTS: Average operating time was 55 minutes with a mean estimated blood loss of 200 ml. No blood transfusion was necessary, and no conversion, complications or mortality was present. The mean postoperative catheterization period was 7.3 days with a mean hospital stay of 5.2 days. Mean enucleated tissue weight was 85.5 gm. At 3 months postoperatively the International Prostate Symptom Score improved to a mean of 5.8 (from a mean preoperative score of 29.5) while maximum urine flow improved to a mean of 18.5 ml per second (from a mean preoperative rate of 5.8 ml per second). CONCLUSIONS: This procedure is safe and fast with excellent functional outcomes. However, prolonged catheterization and hospitalization are still required.

Incidental sonographic detection of mucosa-associated lymphoid tissue lymphoma of the urinary bladder found in a very young woman: report of a case.

We report a rare case of a mucosa-associated lymphoid tissue (MALT)-type lymphoma of the bladder, incidentally found on sonography in a 17-year-old girl during the workup of arterial hypertension. The diagnosis was established by a transurethral biopsy. Treatment consisted of transurethral resection of the bladder tumor and subsequent chemotherapy. To the best of our knowledge, this is the youngest patient with asymptomatic MALT-type lymphoma of the urinary bladder.

Renal carcinoma infiltrating inferior vena cava and combined valvular heart disease--one-stage uro-cardiological procedure: a case report.

Standard treatment of patients with coexisting cardiac and non-cardiac diseases includes two separate operations. We report a case of 55-year-old man with combined valvular heart disease and renal carcinoma infiltrating inferior caval vein, who underwent one-stage cardio-urologic procedure. In the first step, mitral and tricuspid valvuloplasty were performed by cardiac surgeons. Then, urologists performed radical nephrectomy and thrombectomy. The postoperative course was uneventful. In twelve months follow-up the patient shows no signs of recurrence and he had no symptoms of cardiac disease. To the best of our knowledge such a case has never been reported before in the literature.

Is pure laparoscopic radical cystectomy still an attractive solution for the treatment of muscle-invasive bladder cancer?

OBJECTIVE: The aim of this study is to report our experience with laparoscopic radical cystectomy (LRC), evaluating the technique and perioperative and pathological outcomes. METHODS: 47 LRCs were performed due to muscle-invasive bladder cancer. Conduits were performed in 23 patients and neobladders in 23 (one bi-intestinal). One ureterocutaneostomy was created. RESULTS: In 43 patients LRC was performed with minilaparotomy for urinary diversion. The mean operation time was 290 min. Four operations were converted. Complications included sigmoid colon injury, urinary leak, lymphatic leak, short-term paralytic ileus, and heart attack. Mean blood loss was 220 ml. Hospitalization time was 6 days. Tumor stage was pT2b, pT3a, pT3b, and pT4a in 28, 13, 5, and 1 patient, respectively. No positive margins were found. The mean number of lymph nodules was 17, while in the last 25 procedures it was 21. 17% of patients had tumor in the lymph nodes. The mean follow-up was 10 months. Local recurrence and dissemination was observed in 2%. Continence in patients receiving neobladder was fully satisfactory. CONCLUSIONS: More complications are related to neobladder than to ileac conduit. LRC with minilaparotomy seems to be an attractive treatment option for patients with muscle-invasive bladder cancer. Radical cystectomy performed intracorporeally could be reserved for 'robot-assisted' operations.

Clinical significance of transurethral tru-cut biopsy in confirmation of bladder tumor invasive character.

OBJECTIVES: To evaluate the feasibility of resection (TURBT) replacement in patients with strong suspicion of invasive bladder tumor by transurethral tru-cut biopsy carried out during cystoscopy. METHODS: Fifty-eight patients (52 men and six women; mean age 65 years, range 43-79) presenting with extensive bladder tumor suggested by ultrasound and computed tomography were included in the study. Each patient was submitted to transurethral, cystoscopically-guided tru-cut biopsy of bladder tumor before the planned TURBT. Comparison of histopathological assessment of tissue cores, resection and radical cystectomy specimens was carried out. RESULTS: Histopathological analysis of resection specimens and tissue cores were in complete accordance with previous tissue cores assessment in terms of type and grade of bladder cancer. Histological type of bladder tumor revealed by tru-cut biopsy and radical cystectomy was identical in 56 (96.6%) cases. Tumor grade was the same in biopsy cores and radical cystectomy specimens in 55 (95%) cases. CONCLUSIONS: Endoscopic tru-cut bladder tumor biopsy allows us to collect sufficient amounts of tissue material for histopathological confirmation of detrusor muscle infiltration in patients presenting with bladder tumors suspected to cause muscle invasiveness. The procedure is carried out under cystoscopic control and is fast, efficient, safe, easy to perform and less invasive than standard TURB in cases of an extensive bladder tumor.

Obesity and renal cancer incidence and mortality--a systematic review of prospective cohort studies.

INTRODUCTION AND OBJECTIVE: There have been many studies published recently on obesity and the risk of renal cancer; however, the epidemiological evidence for such an association has not been consistent. Therefore, a systematic review was conducted of the prospective cohort studies to assess the association between obesity and the risk of renal cancer incidence and death. MATERIALS AND METHODS: A search was conducted of the PubMed database and references to published studies from inception until May 2013. Guidelines for Assessing Quality in Prognostic Studies on the Basis of Framework for Potential Biases were followed for quality assessment of studies included in the systematic review. RESULTS: Twenty eligible studies were identified and included in the systematic review. Among the 20 selected studies, overall study quality was high. Although the evidence from the prospective cohort studies, linking obesity with renal cancer incidence, has not been entirely consistent, there is a convincing body of data for a positive relationship. Moreover, cumulative data is compelling for a strong positive association between obesity and fatal renal cancer. CONCLUSIONS: There is a relatively consistent amount of evidence that obesity increases the risk of renal cancer and fatal renal cancer. Further research is needed as better understanding of mechanisms by which obesity may influence renal cancer development and progression will aid the fostering of strategies for prevention and treatment of one of the most lethal human malignancies.

The impact of nutrition in urogenital cancers.

Prostate, bladder and kidney cancers remain the most common cancers of the urinary tract. Despite improved primary prevention, detection and treatment, the incidence of age-related cancers of the urinary tract is likely to rise as a result of global population ageing. An association of diet with prostate, bladder and kidney carcinogenesis is plausible since the majority of metabolites, including carcinogens, are excreted through the urinary tract. Moreover, large regional differences in incidence rates of urologic tumours exist throughout the world. These rates change when people relocate to different geographic areas, which is suggestive of a strong environmental influence. As a result of these observations, numerous studies have been conducted to assess the effects of diet and nutritional status in kidney, bladder and prostate carcinogenesis. Here, we review the literature assessing the effect of diet and nutritional status on urological cancer risk, which has attracted the most interest.

Contralateral adrenal metastasis from renal cell carcinoma with tumor thrombus in the adrenal vein: a case report.

A 64-year-old woman presented with contralateral right adrenal metastasis with adrenal vein thrombus, which was diagnosed many years after left nephrectomy with adrenalectomy due to renal cell cancer. The patient underwent right adrenalectomy with adrenal vein tumor thrombectomy for treatment. The pathologic examination confirmed metastatic clear cell carcinoma. The remote but existing risk of developing contralateral adrenal metastasis (CAM) after primary radical nephrectomy supports the idea of sparing the adrenal gland in suitable patients who undergo radical nephrectomy. Contralateral adrenal metastasis from RCC is a rare finding with the potential benefit of cure after resection. Care must be taken in preoperative diagnostics, as this metastasis is capable of causing inferior vena cava tumor thrombus via the suprarenal venous route. According to our knowledge, our case is the second similar entity described in literature so far.

Laparoscopic implantation of an artificial urinary sphincter around the prostatic urethra.

OBJECTIVE: To report the first laparoscopic periprostatic implantation of an artificial urinary sphincter (AUS) after a transurethral resection of the prostate. BACKGROUND: The implantation of an AUS is a standard procedure for severe urinary incontinence. In men it is usually implanted through a perineal approach, with the cuff placed around the bulbous urethra, bladder neck, or even around the prostate. METHOD: We report a laparoscopic periprostatic implantation of an AUS after a transurethral resection of a prostate in a 72-year-old-man with incontinence. RESULTS: The operative duration was 180 min and the blood loss was 150 mL. There were no complications. After activating the AUS the patient was totally continent. CONCLUSION: The laparoscopic periprostatic implantation of an AUS is a safe, effective and considerably less invasive procedure.

Is determination of transition zone volume by transrectal ultrasound in patients with clinically benign prostatic enlargement sufficiently reliable in the clinical setting?

INTRODUCTION: Controversies exist regarding the accuracy of transrectal ultrasound (TRUS) determination of transition zone volume (TZV) when compared with enucleated adenoma weight. AIM: To determine the accuracy and reliability of measurements of the TZV by TRUS, by comparing preoperative radiological findings with the enucleated prostate adenoma volume, measured by fluid displacement volumetry (FDV), after retropubic prostatectomy performed by the Millin method, and, moreover, to evaluate changes in the surgical capsule size in the intermediate postoperative period. MATERIAL AND METHODS: We measured TZV preoperatively using TRUS and postoperatively with FDV in 112 patients who underwent retroperitoneal prostatectomy for benign prostatic hyperplasia (BPH). RESULTS: The TRUS volume correlated well with specimen volumes (r = 0.945, p < 0.0001). The median (quartile 1, quartile 3) absolute error was 7.35 ml (4.15 ml, 9.28 ml) and the median percent error was 9.12% (4.75%, 14.98%). Percent error, but not absolute error, was significantly related to TRUS TZV (p < 0.001 and 0.217, respectively). Adenomas > 80 cc were associated with lower percent error. The median volume of the residual prostate tissue measured 3.5 years after prostatectomy was 92.65 cc (65.75 cc, 109.58 cc), whereas the median volume of the surgical capsule, depending on the equation used for its calculation, was 24.80 cc (16.25 cc, 37.37 cc) and 31.43 cc (23.14 cc, 43.32 cc). CONCLUSIONS: The TRUS TZV correlated well with values determined by FDV. It can be reliably used in clinical management of BPH.

Determination of prostate adenoma weight reduction due to vaporisation process occurring during transurethral resection of the prostate.

INTRODUCTION: Transurethral resection of the prostate (TURP) is regarded as the gold standard surgical treatment for benign prostatic hyperplasia (BPH). The completeness of TURP may be assessed indirectly by estimation of the weight of glandular tissue removed. This parameter is often lower than expected. Tissue vaporisation in the course of TURP could be a contributory cause. AIM: To quantitatively evaluate tissue vaporisation occurring in the course of transurethral resection of the prostate and electrovaporisation of the prostate (EVAP) performed under experimental conditions. MATERIAL AND METHODS: The study was performed on 26 prostate glands removed during retropubic prostatectomy. Immediately following surgery all adenomas were halved and TURP or EVAP were carried out on both halves of each gland for period of 5 min. The amount of prostate tissue which vaporised during EVAP and TURP were calculated. RESULTS: The mean weight (± standard deviation) of the adenoma lost due to resection and vaporisation in the TURP group was 10.00 ±2.92 g and 4.26 ±1.59 g, respectively. The latter accounted for 30.10 ±7.71% of total prostate weight reduction. The mean prostate weight lost in the course of EVAP was 5.03 ±1.58 g. CONCLUSIONS: The vaporisation significantly contributes to the prostate tissue loss occurring during transurethral resection of the prostate.

Clinical value of transurethral second resection of bladder tumor: systematic review.

OBJECTIVE: To systematically review prospective trials aimed at the role of restaging transurethral resection (reTUR) to define the group of patients with bladder cancer who would benefit. MATERIALS AND METHODS: A systematic review of the literature in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines was conducted. RESULTS: Of 120 trials, 7 met the inclusion criteria. Most studied populations were high-risk non-muscle-invasive bladder cancer patients. Low-risk cancers as well as muscle-invasive disease were analyzed in only 1 trial. Consistently through the publications, reTUR improved staging with the rates of muscle-invasive disease mounting to 17.6% when primary resection was deemed to be complete. Although all trials corroborated staging role of reTUR, only 4 provided recurrence and progression outcomes, the first being significantly lower in the group of second early resection. In 2 studies with the longest follow-up and the greatest number of patients with high-risk non-muscle-invasive bladder cancer, progression rates were found to be improved. In one trial, reTUR was associated with better response to bacille Calmette-Guérin. CONCLUSION: The data convincingly suggest that early second resection improves staging and reduces the recurrence as well as progression rates of high-risk bladder tumors. reTUR brings benefit to those subjected to bacille Calmette-Guérin. However, additional surgery would not modify treatment plan in those with low-risk disease.

Infected urachal cyst in a young adult.

The urachus is the remnant of the cloaca, which in adults attaches the bladder dome to the umbilicus. After birth it obliterates and presents as the midline umbilical ligament. Patent urachal anomalies are usually detected in childhood. In adults they occur very rarely and the presentation and diagnosis may be occasionally challenging. We present and discuss the case of an infected urachal cyst found in a 30-year-old adult.

Should all specimens taken during surgical treatment of patients with benign prostatic hyperplasia be assessed by a pathologist?

INTRODUCTION: In some patients submitted to transurethral resection of the prostatic (TURP) or prostatectomy (OAE) due to benign prostate hyperplasia (BPH), pathological evaluations (PE) revealed coexistence of prostate cancer (PCa) and BPH. The aim of the study is to evaluate the incidence of PCa diagnosed incidentally in prostate specimens taken during BPH surgery, to assess the need of routine PE and to define the group of patients in whom PE could be abandoned without the risk of omitting clinically significant PCa. MATERIAL AND METHODS: 968 consecutive men were subjected to surgical treatment due to BPH in Jan. 2004-Sep. 2010. RESULTS: 823 (85%) underwent TURP and 145 (15%) OAE. Incidental (Inc) PCa was diagnosed in 34(3.5%) pts. T1a and T1b stages were determined in 19 (2%) and 15 (1.5%) cases. Preoperative prostate biopsy due to abnormal prostate specific antigen (PSA) or digital rectal exam (DRE) was performed in 85 (8.8%) pts. Of PCa pts, 7 (20.58%) had undergone a cancer negative biopsy preoperatively. In BPH pts, 78 (8.35%) had undergone a prostate biopsy previously (p <0.01). Univariate and logit regression analyses had not revealed any correlations between age, Pv, serum PSA and frequency of IncPCa. The difference in rate of PCa diagnosed in patients with PSAD ≥0.15 and <0.15 was 8 pts (14.04%) and 20 pts (4.05%), respectively (p <0.001). Gls in those pts was >6 only in 4 cases. CONCLUSIONS: Despite the fact of low PCa detection rate observed in our study, this condition was clinically relevant in 15 (1.5%) subjects. It is difficult to establish any cut off values of pts' age, Pv, serum PSA level suggestive of negligible risk for prostate cancer.

Lower urinary tract symptoms and their severity in men subjected to prostate biopsy.

INTRODUCTION: Lower urinary tract symptoms (LUTS) are one of most frequent complaints among men over 50 years of age. They usually result from benign prostate hyperplasia, which often coexists with cancer. The aim of the present study is to evaluate prospectively the incidence of LUTS and their character in men subjected to prostate biopsy. MATERIAL AND METHODS: Data of men who were subjected to transrectal ultrasound guided prostate core biopsy from 1st July 2007 to 30th July 2008 in selected urological departments in Poland were analyzed. LUTS were measured with International Prostate Symptom Score (IPSS). RESULTS: Prostate biopsy was performed in 747 men aged between 34 and 93 years (mean - 67.4; median - 68). LUTS of mild degree or no LUTS (≤7 IPSS points) were reported by 29.5% of patients. PCa was found in 60.0% of them. Among men with moderate or severe LUTS (IPSS >7 points), PCa was found in 51.4% and 55.0% of them respectively. Median PSA was 9.5 ng/ml, 9.4 ng/ml and 12.0 ng/ml in men with mild, moderate and severe LUTS respectively (NS). However, among men with severe LUTS, PCa was more likely to be less differentiated and locally advanced. CONCLUSIONS: LUTS are weak predictors of a positive result of transrectal ultrasound guided prostate biopsy. However, there is a trend to diagnose more locally advanced and less highly differentiated cancers among men with severe lower urinary tract symptoms.

Clinical value of extended pelvic lymph node dissection in patients subjected to radical prostatectomy.

INTRODUCTION: Extended pelvic lymph node dissection (ePLND) is advised to complement radical prostatectomy (RP) in intermediate and high risk prostate cancer patients. AIM: To assess the risk of nodal involvement in patients subjected to laparoscopic radical prostatectomy and to characterize the group of patients with lymph node (LN) metastases. MATERIAL AND METHODS: Data of patients subjected to laparoscopic radical prostatectomy with ePLND between February 2011 and June 2013 were analyzed. The LN that were removed included presacral nodes, common, external and internal iliac nodes and obturator ones. RESULTS: Mean number of removed LNs was 19. Metastases within LN were found in 13 (16.6%) patients. In comparison to those without LN involvement, patients who were found to have LN metastases had a greater number of positive biopsy cores (3.7 vs. 5.3, p < 0.01), maximum percentage of cancer in biopsy core (47.0 vs. 67.6, p < 0.01), greater biopsy and specimen Gleason scores (7.0 vs. 7.7 and 7.0 vs. 7.8) and more frequently advanced clinical and pathological stage. The most frequent landing sites of prostate cancer were obturator and presacral nodes (100% and 38%). Eleven patients (85%) among those with positive LN had locally advanced disease. CONCLUSIONS: The risk of LN metastases in intermediate and high risk prostate cancer patients is significant. Therefore, if radical prostatectomy is chosen, ePLND should be performed. The majority of patients with involvement of pelvic LN have locally advanced disease which would refer them to adjuvant radiation if managed without nodal dissection.

Should active surveillance in prostate cancer patients be based on a single histological assessment?

INTRODUCTION: Active surveillance (AS) is always associated with a degree of uncertainty, whether or not prostate biopsy (TRUSBx) results indeed can be relied on for evaluation of cancer stage and histological grade, as the most commonly observed limitations of TRUSBx are undergrading, understaging and underestimating true prostate cancer (PCa) volume. We evaluated prostate cancer characteristics in men who could have been offered active surveillance based on clinical features and TRUSBx results, and compared them with the same patient's histology results following their radical prostatectomy (RP). Moreover, we assessed the level of consistency in reporting TRUSBx and RP specimens by the same pathologist on two separate occasions, as well as by another independent pathologist. MATERIAL AND METHODS: All patients who underwent RP between 2005 and 2008 had their medical records reviewed retrospectively. All histological specimens were prospectively re-evaluated by the same pathologist, as well as by a second to assess for intra- and interobserver variability, respectively. RESULTS: Eight out of a total of 124 patients who underwent RP could have been offered AS on the basis of initial microscopic reports. However, there was significant intra- and interobserver variability. The differences in the histological grade of the specimens obtained from TRUSBx and RP, reported by the same pathologist and by the second pathologist were apparent in 6 and 4 cases, and in 7 and 6 patients, respectively. CONCLUSIONS: We recommend that the decision about AS should be made after at least two pathologists have jointly reviewed and agreed on the TRUSBx histology results.

Percutaneous suprapubic endoscopy for treatment of bladder tamponade.

Suprapubic catheterisation is generally considered a safe procedure. It can, however, be associated with complications including haematuria. It is usually self-limiting and easily treated with non-surgical measures but at times formal treatment in the operating room may be required. We present an endoscopic management of bladder tamponade through a percutaneous approach in a 21-year-old man with the fibrotic defect completely occluding his posterior urethra preventing cystoscopic clot evacuation. To our knowledge, this is the first reported case of minimally invasive treatment of bladder tamponade using a suprapubic access. We believe this challenging case will serve as an aid to management of similar episodes.