Integrated staging systems for conventional renal cell carcinoma: a comparison of two prognostic models.

OBJECTIVE: The objective of the current study was to compare, in a single center experience, the discriminating accuracy of two prognostic models to predict the outcome of patients surgically treated for conventional renal cell carcinoma (RCC). PATIENTS AND METHODS: We retrospectively evaluated the clinical and pathological data of 100 patients surgically treated for RCC between 1998-2008 at our institution. For each patient, prognostic scores were calculated according to two models: the University of California Los Angeles integrated staging system (UISS) and the Stage, Size, Grade, and Necrosis (SSIGN) developed at the Mayo Clinic. The prognostic predictive ability of models was evaluated using receiver operating characteristic (ROC) curves. RESULTS: The median follow-up was 62 months (range 12-120). All clinical and pathological features that compound the algorithms were significantly associated with death from RCC in univariate and multivariate setting. The 5-year cancer-specific survival (CSS) according to the SSIGN score were 95% in the '0-2' category, 88% in '3-4', 60% in '5-6', 37% in '7-9' and 0% in the '> or = 10' group (long-rank p value < 0.001); according to the UISS the 5 yr CSS probabilities in non-metastatic patients were 100% in low, 80% in intermediate and 54% in high-risk groups; in metastatic patients, the respectively CSS were 40% in low and 25% in high-risk groups (long-rank p value < 0.001). The area under the ROC curve was 0.815 for the SSIGN score and 0.843 for the UISS (p = 0.632). CONCLUSION: In our series the SSIGN and UISS discriminated well, without relevant differences. Currently both algorithms represent usefuls clinical tools that allow risk assessment after surgical treatment of RCC. We encourage the uro-oncologist to begin to routinely rely on them in real-life practice.

PSA supernormalisation: a surrogate of complete adenoma removal in men with benign prostatic hyperplasia.

It is known that serum prostate-specific antigen levels (PSA) decrease gradually following surgery for benign prostatic hyperplasia (BPH), but there is not an established cut-off value for normal PSA after relief of obstruction. We evaluated the impact of prostatic adenoma enucleation on PSA levels in 110 patients who underwent transvesical suprapubic adenomectomy for symptomatic BPH. We examined PSA levels before and after open surgery and weight of the prostatic adenoma as measured by the pathologist. Forty-eight percent of the patients had a preoperative PSA level between 0 and 4, 29% between 4 and 7, and 23% between 7 and 10 ng/ml. In patients with suspected abnormality on digital rectal examination or PSA > 4.0 ng/mL systematic multisite biopsies were performed preoperatively to rule out prostate cancer. The mean weight of enucleated adenoma was 87 gr (range 50-201). The mean serum PSA decreased from 4.8 ng/ml preoperatively to 0.5 ng/ml postoperatively. The mean decrease in PSA was 90% (range 70-99%). PSA was resetted at lower level in all patients irrespectively of baseline PSA levels or BPH weight. The transvesical suprapubic adenomectomy supernormalises serum PSA lower than 1 ng/ml in 96% of patients. 100% of patients have a postoperative PSA value < 1.5 ng/ml. PSA supernormalisation represents an objective measure of complete adenoma removal. The urologists should be aware of this resetted level and they should take account of it when different ablative therapies for BPH are confronted.

Urodynamic parameters after solifenacin treatment in men with overactive bladder symptoms and detrusor underactivity.

AIMS: To describe the changes in urodynamic parameters and to assess patients' perceptions of voiding difficulties and improvements in symptom bother after solifenacin treatment in men with overactive bladder (OAB) and detrusor underactivity (DUA). METHODS: In this prospective study, 49 neurologically intact men were enrolled. DUA was defined as a bladder contractility index (BCI) <100. All subjects received 5 mg of solifenacin once a day for 120 days. A complete urodynamic study was carried out on the day before to the first dose of solifenacin and at day 120. RESULTS: Solifenacin treatment resulted in a decrease in Q(max) during UDS (-0.6 ml/sec; P = 0.007), P(det)Q(max) (-6.4 cmH(2)O; P < 0.001), BOOI (-7.5; P < 0.001), BCI (-3.8; P = 0.001), BVE (-4.4%; P = 0.006), and voided volume (-7.5 ml; P = 0.09). On the contrary, PVR (+6 ml; P = 0.152), and maximum cystometric capacity (+22.9 ml; P = 0.001) increased. The regression analysis suggested that changes in urodynamic parameters after solifenacin treatment were limited for BOOI (9.4%), P(det)Q(max) (8.4%), and BCI (6.5%), with no significant impact on Q(max) during UDS, BVE, volume voided and PVR. No significant change in subjective perception of voiding difficulties was found. The incidence of AUR was 2.2% and improvement in patient's experience of OAB symptoms bother after solifenacin treatment was observed. CONCLUSIONS: Solifenacin treatment results in changes of urodynamic parameters. These changes, however, seem not to be of clinical significance as suggested by the lack of subjective deterioration in voiding difficulties and by the low incidence of AUR.

Periprostatic nerve block before ultrasound-guided prostate biopsy: a comparison of two local anesthetics.

The objective of the present study was to evaluate the efficacy of the periprostatic nerve block (PNB) of the prostate-vesicular junction with low volume and high concentration of anesthetics in relieving pain during prostate biopsy. Two hundred and twenty patients were enrolled and randomized to receive PNB with 5 ml 2% lidocaine (group 1110 pts) and PNB with 5 ml 2% mepivacaine (group 2, 110 pts). The anesthetic was administered through a single puncture on each side at the prostate-vesicular junction using a 22-gauge needle. All patients filled in a ten visual analogue pain score scale (VAS) from 0 = no discomfort to 10 = severe pain, for the assessment of pain experienced during biopsy. The two groups were homogeneous concerning the anthropometrical data. The mean pain score with lidocaine was 1.4 +/- 1.02 (CI 95% = 1.53 to 3.57) and with mepivacaine was 1.3 +/- 1.06 (CI 95% = 2.66 +/- 4.84) with no statistical significant difference between groups (p = 0.43). No general or local adverse effects were observed between the anaesthetics. The use of a low volume (2.5 ml on each side) and high concentration (2%) of local anesthetics (lidocaine/mepivacaine) almost completely suppresses pain and discomfort associated with prostate biopsy. The anatomy of neurovascular bundle regions appears favourable to the administration of small amounts of anesthetic.

Gefitinib and bicalutamide show synergistic effects in primary cultures of prostate cancer derived from androgen-dependent naive patients.

We previously demonstrated that the inhibition of the epidermal growth factor receptor (EGFR) signalling affects the endocrine therapy responses of prostate cancer (PCa) cells and that bicalutamide (BCLT) is able to reinforce PI3K activity through mechanisms involving PTEN decrement and EGFR and Her2 activities. The aim of this study was to evaluate if the hormonal therapy with BCLT can affect the EGFR-targeted therapy using primary cultures obtained from 22 human PCa tissues harvested after radical prostatectomy (RP) in patients who received (n=10) BCLT and those that did not (n=12) as neoadjuvant hormone therapy (NHT). We demonstrated that cultures derived from PCa tissues harvested after NHT presented significantly higher EGFR and Her2 levels compared to cultures derived from control patients. However, cultures derived from patients with NHT were less sensitive to gefitinib when compared to cultures derived from control patients. Conversely, BCLT effectiveness did not seem to be different in the two groups and was partially additive with gefitinib in the NHT group and additive/synergistic in the control group. Cultures (8/22) were negative for the expression of the PTEN gene and we observed no differences in the two groups. Thus the different IC50 values observed for gefitinib and the partial additivity in the combination treatment with gefitinib and BCLT is influenced by EGFR/Her2 ratio because it was shown that EGFR inhibition was lower when Her2 is overexpressed. Taken together, our results indicate that anti-EGFR targeted therapies and a possible combination therapy involving gefitinib and BCLT should be performed early in naive patients when Her2 is not overexpressed and before the anti-androgenic hormone therapy induces such an undesirable effect.