The Role of Magnetic Resonance Spectroscopy Imaging Parameters to Predict Early Biochemical Recurrence after Radical Prostatectomy.

To evaluate the role of magnetic resonance spectroscopy imaging (MRSI) parameters to predict early biochemical recurrence (BCR) after radical prostatectomy (RP) in patients with non-metastatic prostate cancer (PCa). Between November 2010 and March 2012, 60 consecutive patients with clinically non-metastatic biopsy confirmed PCa underwent RP after MRSI assessment in a prospective study. Demographic, clinicopathological, magnetic resonance imaging (MRI) staging, MRSI parameters, and postoperative serum prostate-specific antigen were recorded. The univariate and multivariate Cox regression analyses were used to assess the association between potential prognosticators and early BCR (BCR less than 12 months after RP). In univariate Cox regression, preoperative serum PSA (prostate-specific antigen) (HR - hazard ratio = 1.016, p=0.003), surgical Gleason score > 7 (HR = 5.034, p=0.006) and MRSI risk score (HR = 4.061, p=0.0001); and in multivariate model, preoperative serum PSA (HR = 1.012; p=0.046), surgical GS > 7 (HR = 4.196; p=0.017) and MRSI risk score (HR = 3.256; p=0.013) were associated with early BCR. The greatest AUC (area under the curve) was related to MRSI risk score (AUC = 0.733) and the AUC of the multivariate model was 0.776. MRI/MRSI parameters specially MRSI risk score might be acceptable predictors of early BCR. These parameters can improve the accuracy of predictive nomograms to assess the risk of BCR after RP.

Combined vagino-abdominal approach for management of vesicovaginal fistulas: a 10 years' experience.

BACKGROUND: Vesicovaginal fistulas (VVF) are an uncommon but serious complication of gynecological surgery. The aim of this study was to report our experience with the repair of VVF using combined vaginal and extraperitoneal abdominal approaches. MATERIALS AND METHODS: Between 2000 and 2012, 15 consecutive females with VVF were managed with combined vaginal and extraperitoneal abdominal procedures. After assessment by voiding cystourethrography and urethrocystoscopy, the operation was performed at the standard lithotomy position. RESULT: Fifteen patients were included in this study with mean age 51.8 ± 11.9 years. The mean fistula size was 2.1 ± 0.7 cm and all of them were located in supra-trigonal region except one case that fistula defect extend to the bladder trigon. Fourteen patients reported complete resolution of urinary incontinence during mean follow-up of 3.5 years. Fistula was recurred in one female 1 year after repair due to cancer recurrence and radiotherapy treatment. No intraoperative complication including massive bleeding or ureteral damage was observed. CONCLUSION: Our experience with combined vaginal and extraperitoneal abdominal repair of a vesicovaginal fistula shows its feasibility and safety with good results.

GPX2 and BMP4 as Significant Molecular Alterations in The Lung Adenocarcinoma Progression: Integrated Bioinformatics Analysis.

Objective: Non-small cell lung adenocarcinoma (NSCLC) is the most common type of lung cancer, which is considered as the most lethal and prevalent cancer worldwide. Recently, molecular changes have been implicated to play a significant role in the cancer progression. Despite of numerous studies, the molecular mechanism of NSCLC pathogenesis in each sub-stage remains unclear. Studying these molecular alterations gives us a chance to design successful therapeutic plans which is aimed in this research. Materials and Methods: In this bioinformatics study, we compared the expression profile of 7 minor stages of NSCLC adenocarcinoma, including GSE41271, GSE42127, and GSE75037, to clarify the relation of molecular alterations and tumorigenesis. At first, 99 common differentially expressed genes (DEG) were obtained. Then, functional enrichment analysis and protein-protein interaction (PPI) network construction were performed to uncover the association of significant cellular and molecular changes. Finally, gene expression profile interactive analysis (GEPIA) was employed to validate the results by RNA-seq expression data. Results: Primary analysis showed that BMP4 was downregulated through the tumor progression to the stage IB and GPX2 was upregulated in the course of final tumor development to the stage IV and distant metastasis. Functional enrichment analysis indicated that BMP4 in the TGF-ß signaling pathway and GPX2 in the glutathione metabolism pathway may be the key genes for NSCLC adenocarcinoma progression. GEPIA analysis revealed a correlation between BMP4 downregulation and GPX2 upregulation and lung adenocarcinoma (LUAD) progression and lower survival chances in LUAD patients which confirm microarray data. Conclusion: Taken together, we suggested GPX2 as an oncogene by inhibiting apoptosis, promoting EMT and increasing glucose uptake in the final stages and BMP4 as a tumor suppressor via inducing apoptosis and arresting cell cycle in the early stages through lung adenocarcinoma (ADC) development to make them candidate genes to further cancer therapy investigations.

A Prospective Study on [68Ga]-PSMA PET/CT Imaging in Newly Diagnosed Intermediate- and High-Risk Prostate Cancer.

OBJECTIVES: Prostate-specific membrane antigen (PSMA) ligand positron emission tomography/computed tomography (PET/CT) is an emerging modality to detect metastatic disease in patients with prostate cancer (PCa). This prospective study aimed to evaluate the role of [68Ga]-PSMA PET/CT in the initial workup of intermediate and high-risk PCa. METHODS: Twenty-five patients with newly transrectal ultrasound biopsy-proven, untreated intermediate- and high-risk PCa (mean age, 68.5±6.2 years; range 55-83 years) were enrolled in this prospective study between September 2018 and June 2020 and underwent a [68Ga]-PSMA PET/CT examination. All images were analyzed both visually and semiquantitatively by measuring the maximum standardized uptake value (SUVmax) of the primary prostatic tumor and metastatic lesions. The diagnostic sensitivity of [68Ga]-PSMA PET/CT for the diagnosis of PCa was established by histopathology as the reference standard. The associations between SUVmax of the primary tumors and prostate-specific antigen (PSA) levels, Gleason scores (GSs), and metastatic extent of the disease were studied. RESULTS: All patients had a positive [68Ga]-PSMA PET/CT exam. Seventeen patients (58%) showed [68Ga]-PSMA avidity in both prostate lobes and 8 (32%) had unilateral uptake. SUVmax in the primary tumor significantly correlated with serum PSA values (r=0.57, P=0.003). PSMA PET/CT depicted regional lymph node metastases in 32% of patients, distant lymph node metastases in 20%, osseous metastases in 16% and pulmonary metastases in 8% of patients. Sixty percent of PSMA-positive bone metastases and 21.4% of intraprostatic tumoral lesions were missed on the contemporaneous bone scintigraphy and magnetic resonance imaging, respectively. CONCLUSION: [68Ga]-PSMA PET/CT shows promise as a valuable imaging modality with high diagnostic sensitivity in the setting of intermediate and high-risk PCa. Moreover, the SUVmax of the primary tumor has a positive correlation with PSA levels at the time of the scan.

Phyllodes tumor of the prostate: Long-term follow up of a rare condition.

We describe an extremely rare case of Phyllodes tumor of the prostate in a 35-year-old man. The patient was referred to our hospital for the recurrent episodes of urinary retention. He complained of severe obstructive lower urinary tract symptoms and dysuria. Serum prostate-specific antigen (PSA) was within the normal range. Transabdominal ultrasonography showed a few heterogenous echoic areas in a 110-gm prostate and some cystic areas with invasion to the urinary bladder. In the past, transurethral resections of the prostate (TURP) had been performed for him twice and microscopic examination of the specimens had shown cystically dilated glands consisting of bizarre cells with nuclear atypia. Finally, radical retropubic prostatectomy was performed against the recurrences of the tumor. Here we describe the morphological features and immuno-histochemical presentations of Phyllodes tumor of the prostate and its long-term follow-up in the patient.

A prospective study of the efficacy of magnetic resonance spectroscopy imaging for predicting locally advanced prostate cancer.

OBJECTIVE: To evaluate the efficacy of magnetic resonance spectroscopy imaging (MRSI) for predicting locally advanced prostate cancer (PC). MATERIALS AND METHODS: Between April 2009 and July 2012, 80 consecutive patients with clinically localized PC had undergone endorectal MRSI before radical retropubic prostatectomy. Clinicopathological parameters, including age, preoperative prostate-specific antigen (PSA), Gleason score (GS) at biopsy, perinural invasion at biopsy, prostate weight at surgery, GS of surgical specimen, and pathological staging were recorded. The MRSI findings were compared with the histopathological findings of the radical prostatectomy. The diagnostic accuracy measures consisting of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of MRSI, and other variables in the diagnosis of locally advanced PC (Pathology Stages pT3a, pT3b, or pT4) were evaluated. RESULTS: Sensitivity, specificity, PPV, and NPV of MRSI in detecting locally advanced PC is 42.4%, 93.6%, 82.3%, and 69.8%, respectively [area under the receiver operating characteristic (ROC) curve=0.658, p value <0.0001]. MRSI, cancer-positive core percentage at biopsy, and GS at biopsy are more accurate factors among all the predictive variables in predicting locally advanced PC. CONCLUSION: MRSI may be considered as a complementary diagnostic modality with high specificity and moderate sensitivity in predicting locally advanced PC. Combination of this modality with other predictive factors helps the surgeon and patient to select an appropriate treatment strategy.

Bladder neck preservation during radical retropubic prostatectomy and postoperative urinary continence.

INTRODUCTION: Bladder neck-sparing modification of radical retropubic prostatectomy has been reported to lower the risk of urinary incontinence after prostatectomy. We reviewed the outcomes in men with prostate cancer who had undergone prostatectomy with either bladder neck preservation or bladder neck reconstruction. MATERIALS AND METHODS: In this retrospective study, a total of 103 patients who had undergone radical retropubic prostatectomy were assessed. The patients were divided into two groups of bladder neck preservation (51 patients) and bladder neck reconstruction (52 patients). We compared frequency of biochemical failure, bladder neck stricture, and urinary incontinence between these two groups. Biochemical failure was defined as a serum prostate-specific antigen level higher than 0.2 ng/mL and its rising trend in at least 2 postoperative subsequent measurements. Continence was defined as no need to use sanitary pads or diapers. RESULTS: The two groups were comparable in terms of age, serum prostate-specific antigen level, Gleason score, and prostate volume. After a mean follow-up period of 32.5 months, all patients with bladder neck preservation and 46 (88.5%) with bladder neck reconstruction were continent (P = .03). There were no significant differences in the frequency of biochemical failure and bladder neck stricture that required dilation between the two groups of patients. CONCLUSION: Bladder neck preservation during radical retropubic prostatectomy may improve long-term results of urinary continence and be effective in eradicating prostate cancer without increasing recurrence rate.

Transanal repair of rectourethral and rectovaginal fistulas.

INTRODUCTION: We evaluated the efficacy and safety of repair of the rectourethral and rectovaginal fistulas with transanal approach using the Latzko technique. MATERIALS AND METHODS: We repaired 8 fistulas with transanal approach. Fistulas were rectourethral in 5 patients, and in the only woman of the series, they were rectovaginal and vesicovaginal. In 3 patients, The fistulas had been diagnosed following prostatectomy, urethral stricture repair, and colonic resection and radiotherapy due to rectosigmoid cancer in 3, 2, and 1 patients, respectively. Complying with Latzko technique, the fistula orifice was exposed and a fusiform incision was made with the orifice in its center. The mucosa lying between the incision and the orifice was excised in the direction of the incision to the orifice, leaving the fistula edges to meet. Then, the edges were closed, followed by closure of the muscular layers above it. Finally, the edges of the rectal mucosa were closed. RESULTS: Two patients had 2 fistulas and 4 had 1 fistula who were all managed by transanal approach. During a median follow-up period of 44 months, no serious complication was noted, except for recurrence of deep vein thrombosis in 1 patient with a positive history for this complication. Hospitalization period was 1 to 7 days. CONCLUSION: It seems that transanal repair is a simple and effective technique with minimal complication rate in the treatment of rectourethral fistulas. Regardless of the etiology, this method can be used as the preferred therapeutic technique. Further studies are necessary to confirm our findings.