Higher second fourth digit ratio predicts higher incidence of prostate cancer in prostate biopsy.

OBJECTIVES: To analyze the validity of the ratio between the second and fourth finger (digit ratio; 2D/4D) of the left hand as a predictor for prostate cancer (PCa) in a group of men undergoing prostate biopsy. METHODS: We prospectively recruited 204 consecutive patients referred for transrectal prostate biopsy due to PSA elevation or abnormal digital rectal examination between January 2008 and June 2009. The same physician performed all clinical examinations, digit ratio measurements and transrectal biopsy in all cases. Digit ratio determination was done with a Vernier caliper in the left hand. Patients underwent determination of hormone profile (testosterone and sexual hormone binding globulin (SHBG)) between 7:00AM and 11:00AM. Age, digital rectal examination, PSA, free PSA, PSA density, testosterone and SHBG, pathological report and D2 and D4 measurements were recorded prospectively. RESULTS: Variables age and SHBG were directly related to PCa. Prostate volume was inversely related to neoplasia. 2D/4D ratio >0,95 (OR (CI 95%) 4,4 (1,491-13,107) was related to neoplasia. No differences in PCa were seen regarding PSA, free PSA, PSA density, digital rectal examination and testosterone. CONCLUSION: High digit ratio predicts PCa in men undergoing prostate biopsy. Digit ratio >0,95 has 4-fold risk of PCa compared to men with digit ratio ≤0.95.

Active surveillance in prostate cancer: the need to standardize.

Active surveillance has been proposed as an option for patients with low-risk prostate cancer in order to reduce the effects caused by overdiagnosis. Delaying treatment and applying it only if there is evidence of progression requires a careful identification of these patients. Prostate-specific antigen (PSA) serum levels lower than 10 µg/L and Gleason score lower than 7 are the main criteria used to select patients for active surveillance based on experience accumulated in the last two decades. In the selection of patients with active surveillance two points are taken into consideration: (a) Gleason score changes introduced by the Consensus Conference of 2005; (b) differences between assays in the measurement of PSA serum levels, in the selection of patients for active surveillance. Improving the accuracy of patient's selection for active surveillance requires that Gleason score reassignment must be taken into account, as well as the harmonization between PSA assays. The use of incorrect results leads to misclassification of patients, undermining the goals of active surveillance.

Prognostic value of tissue-polypeptide specific antigen (TPS) in bladder cancer.

BACKGROUND: To evaluate, by means of a prospective study, the usefulness of tissue polypeptide specific antigen (TPS) as a tumor marker in follow-up and prognosis of bladder cancer. PATIENTS AND METHODS: A total of 438 subjects were included in the study and divided into three groups. The first group (n = 216) had active bladder cancer disease, the second group (n = 168) known bladder tumor disease but with no recurrence at the time of study, while the third group (n = 54) consisted of healthy volunteers. TPS in serum was measured using an EIA-kit, a solid phase two-site immunosorbent assay with polyclonal antibodies against cytokeratin 18. RESULTS: Serum TPS was significantly higher in patients with bladder tumors (p < 0.05). There was a significant correlation between TPS and stage (p < 0.05), presence of metastatic lymph nodes (p < 0.01), metastasis (p < 0.01), urinary cytology (p < 0.05), tumor shape (p < 0.01) and tumor size (p < 0.05). Grade, number of tumors, relapses and recurrences were not significantly correlated with serum TPS. With a TPS concentration of 100 U/L as the cut-off point, the sensitivity was 37% and the specificity 77%. With a 95% specificity, the sensitivity was 9%. CONCLUSION: Serum TPS is a marker for bladder carcinoma correlated with stage, urine cytology, tumor shape and size. Its clinical usefulness is not, however, established and it does not appear to be of use in the follow-up of patients with bladder tumor disease.

Ligasure versus sutures in bladder replacement with Montie ileal neobladder after radical cystectomy.

OBJECTIVES: Electrocoagulation became an indispensable tool for surgeons. Ligasure is a computer-based, temperature-controlled bipolar electrocoagulation system designed as an alternative to suture ligatures, staplers, hemoclips and ultrasonic coagulators for legating vessels and tissue bundles. Our aim was to analyse the procedure time and intraoperative blood loss of the ileal neobladder in a series of 30 highly selected patients. PATIENTS AND METHODS: From March 1999 to May 2002, 30 patients (all men), 47 to 74 years old (mean age 57) with good performance status (American Society of Anesthesiology score 1 and 2) underwent radical cystectomy for bladder cancer and Montie ileal neobladder reconstruction, using standard surgical technique, with the exception of 15 patients that the Ligasure device was used for haemostasis. RESULTS: Procedure time was significantly less in the Ligasure arm 170 minutes (range: 150 min - 200 min ) versus 220 minutes (range: 160 min - 250 min) in the suture arm (p < 0.001). Blood loss was significantly less in the Ligasure arm an average 849 cc (range: 820 cc - 900 cc) versus 968 cc (range: 1110 cc - 897 cc) in the suture arm p < 0.02). There was no post-operative hemorrhage or return to the operating room in either arm. Two patients, one in each arm, received two units of blood for a slowly decreasing hematocrit on postoperative day 3. There was no evidence of collateral tissue injure and no injuries to the urinary or intestinal tract in either arm. CONCLUSIONS: Ligasure is a safe and effective alternative to sutures in cystectomy and bladder replacement, resulting in decreased blood loss and significant time saving.

Unusual surgical approach to the treatment of renal cell carcinoma extending into the right atrium through the inferior vena cava.

We report an unusual surgical management of renal cell carcinoma with inferior vena cava and right atrial thrombosis. Successful management is dependent upon preoperative assessment to determine the extent of the disease, tumor thrombi has not infiltrated the walls of the vena cava, and a well planned surgical resection.

Prognostic value of IL-6 in localized prostatic cancer.

AIM: The usefulness of interleukin 6 (IL-6) and its soluble receptor IL-6sR in the prediction of the biochemical recurrence was evaluated in patients with prostate cancer treated with radical prostatectomy. PATIENTS AND METHODS: IL-6 and sIL-6R serum levels were measured in 96 patients with prostate cancer. RESULTS: Using the log-rank test, it was evident that patients with preoperative serum levels of IL-6 higher than 1.2 pg/ml had a significantly increased probability of biochemical recurrence (p=0.031). We also observed that the Gleason score was associated with the risk of progression (p=0.033), but no relation was observed with TNM classification, PSA, % free PSA or sIL-6R. In a multivariate analysis, only IL-6 serum levels remained as a predictor of biochemical recurrence (p=0.040). CONCLUSION: The results presented here demonstrated the usefulness of IL-6 in predicting the biochemical progression of prostate cancer, pointing towards an association between inflammation and the aggressiveness of the tumor.

Usefulness of tissue polypeptide antigen in the follow-up of bladder cancer.

OBJECTIVES: To evaluate the sensitivity and specificity of serum tissue polypeptide antigen (TPA) as a tumor marker for monitoring tumor recurrence in a prospective Phase II study. METHODS: This study consisted of 421 subjects allocated to three groups: 241 patients treated for bladder cancer between 1991 and 1995, 126 subjects with a previous history of bladder tumor but with no recurrence at the time of study enrollment, and 54 healthy volunteers. Soluble TPA concentrations were measured by radioimmunoassay. RESULTS: On the basis of receiver operating characteristic plot analysis, the normal test threshold was set at 63 U/L. For bladder cancer detection, the TPA specificity was 73% and sensitivity was 45%. TPA levels correlated with tumor stage (P <0.01), histologic grade, nodal stage, and metastatic stage and with urinary cytology in univariate analysis. In the subsets of patients with a history of bladder cancer and normal TPA levels, 34.9% experienced a relapse compared with 37.5% of patients with elevated TPA levels (no statistically significant difference). Among the patients with normal TPA levels who experienced recurrence, the mean disease-free interval was 30.6 months compared with 25.1 months in patients with elevated TPA levels (no statistically significant difference). Multivariate analysis showed that TPA was not an independent prognostic biomarker for tumor relapse. CONCLUSIONS: In patients with bladder cancer, the TPA serum level correlated with initial tumor stage and grade, but it was not useful for detecting or monitoring relapses.

Percutaneous renal artery embolisation of non-functioning renal allografts with clinical intolerance.

The aim of the study was to evaluate the efficacy and safety of percutaneous renal artery embolisation of non-functioning renal allografts in patients with graft intolerance syndrome (GIS). Transcatheter artery embolisation was performed in 30 kidney transplant recipients with GIS. The duration of graft function had been 60+/-45 months. Infectious disease was ruled out in all patients. Embolisation consisted of the injection of polyvinyl alcohol microspheres followed by the insertion of a stainless steel coil in the renal artery branches. Symptoms of GIS included: fever-graft pain (44%, n=13), fever-hematuria-pain (20%, n=6), fever-hematuria (13%, n=4) and fever alone (23%, n=7). Latency time between graft failure and embolisation was 184+/-227 (17-1181) days. Embolisation was clinically successful with the prolonged disappearance of GIS in 24 patients (80%). Six patients showed initial clinical improvement, but GIS reappeared at 40+/-18 days, and graft nephrectomy was required. There were no major complications associated with embolisation and no deaths. Perirenal collateral supply was a risk factor for the reappearance of GIS. Renal vascular embolisation is a simple, safe and effective technique for treating renal allograft intolerance syndrome and could be a feasible alternative for the first-line treatment.