Salvage radical prostatectomy.

Radical salvage prostatectomy represents a secondary local treatment with curative intent in patients with organ confined PCA recurrences following radiation therapy. Preoperative risk factors predicting organ confined disease are initial LDR brachytherapy, preoperative Gleason biopsy score ≤6, ≤50% biopsy cores involved with cancer, and a PSA doubling time > 12 months. Metastatic disease should be ruled out preoperatively by skeletal scintigraphy, abdominal computed tomography or magnetic resonance imaging, and/or choline - PET/CT. Functionality of the lower urinary tract is evaluated by urethrocystosocopy and urodynamics. Most appropriate candidates for radical salvage prostatectomy are patients with organ confined disease or those with symptomatic local recurrences. In experienced hands, morbidity is low with a continence rate of 83-96% depending on the type of previous radiation therapy. Long-term oncological control can be achieved in more than 80% of the patients.

Her-2/neu expression in testicular cancer--a retrospective analysis in 57 cases.

OBJECTIVES: To evaluate her-2/neu expression in testicular germ cell tumors (GCT). METHODS: In patients with primary GCT her-2/neu expression was analyzed by immunohistochemistry (IHC). Furthermore, gene amplification was analyzed by chromogene in situ hybridization (CISH). For interpretation, the most recent Asco Guidelines were used. RESULTS: The expression patterns were analyzed according to the histologic subtype. Immunohistochemical analysis demonstrated a weak (score 1) to moderate expression (score 2) in 1% of GCT; none of the GCT revealed a score 3 expression profile. By CISH analysis, we did not observe any gene amplification in the 57 GCT. CONCLUSIONS: The analysis of her-2/neu expression in primary testicular cancer is of no therapeutic relevance. However, for the future we will explore the expression of her-2/neu in residual masses after chemotherapy to assess the role of targeted therapy in chemoresistant metastases.

[Optimizing treatment of advanced testicular germ cell tumors]. / Behandlungsoptimierung fortgeschrittener testikulärer Keimzelltumoren.

Testicular germ cell cancer represents the most frequent solid neoplasm in young men aged 20-40 years. Depending on the prognosis according to the IGCCCG classification, the treatment of choice for advanced germ cell tumors consists in three to four cycles of bleomycin, etoposide, and cisplatin (BEP) in accordance with the current European Consensus Guidelines. Although residual tumor resection (RTR) adheres to guidelines as the treatment for residual metastatic lesions, numerous questions remain unresolved, which we intend to systematically answer within the scope of our research group by conducting prospective/retrospective and clinical/molecular investigations in cooperation with national and international project groups.

[Pitfalls and outcome of nephrectomy for patients with polycystic kidney disease: Peri- and postoperative results]. / Retroperitoneale Nephrektomie bei Patienten mit polyzystischer Nephropathie : Peri- und postoperative Ergebnisse.

BACKGROUND: There are several indications to perform nephrectomy in patients with polycystic kidney disease (PCKD), including pain, hematuria, hypertension, and infections. Operative access and time to surgery are discussed controversially in the literature. We retrospectively reviewed our peri- and postoperative experiences in the surgical management of patients with PCKD and compared them to minimally invasive procedures. MATERIAL AND METHOD: Between January 2003 and January 2010, 40 patients with PCKD underwent simple (n=25) or radical nephrectomy (n=4). In 11 patients a bilateral nephrectomy was performed. The mean patient age was 59 (45-69) years. Indications for nephrectomy were flank/abdominal pain (n=19); gross recurrent hematuria (n=9), septic constellation (n=8), and suspected malignancy (n=4). There were 26 male and 14 female patients. All procedures were performed with a retroperitoneal approach or a chevron incision. RESULTS: A total of 51 nephrectomies were performed on 40 patients with a mean surgical time of 115 (60-310) min. There was one significant intraoperative complication. The mean length of the specimens was 45 (20-87) cm and mean weight was 3.5 (0.8-22.3) kg. Histological examination of the specimens identified renal cell carcinoma (RCC) in three of the four cases. In the other kidneys the pathologists described a polycystic kidney disease. Two significant complications (5%) occurred in the postoperative period: bleeding from an intercostal artery and nonocclusive mesenteric ischemia (NOMI). CONCLUSION: Although technically demanding due to size and weight, retroperitoneal nephrectomy can be performed safely in patients with PCKD. However, surgery might be associated with unusual complications such as NOMI due to nephrectomy. Compared to minimally invasive procedures there is reduced morbidity, so at least in larger specimens we recommend open surgery.

[Locally recurrent prostate cancer following radiation therapy: radical salvage prostatectomy]. / Lokales Prostatakarzinomrezidiv nach Strahlentherapie: Radikale Salvageprostatektomie.

Radical salvage prostatectomy represents a secondary local treatment with curative intent in patients with organ-confined prostate cancer (PC) recurrences following radiation therapy. Preoperative risk factors predicting organ-confined disease are initial low dose rate (LDR) brachytherapy, preoperative Gleason biopsy score12 months. Metastatic disease should be ruled out preoperatively by skeletal scintigraphy, abdominal computed tomography or magnetic resonance imaging, and/or choline-PET/CT. Functionality of the lower urinary tract needs to be preoperatively evaluated by urethrocystoscopy and urodynamics. With appropriate patient selection, oncological control can be achieved in 80% of patients. A continence rate of 83%-96% depending on the type of previous radiation therapy is achievable.

[Radical salvage prostatectomy : Treatment of local recurrence of prostate cancer after radiotherapy]. / Die radikale Salvageprostatektomie : Therapie der lokalen Prostatakarzinomrezidivs nach Strahlentherapie.

External beam radiation and low- and high-dose interstitial brachytherapy represent therapeutic alternatives to radical prostatectomy for organ-confined and locally advanced prostate cancer. Local recurrences are described in 5-35% of the patients depending on the individual risk profile, and most recurrences are detected due to asymptomatic PSA rise only. According to the most recent data, recurrences are defined by a PSA increase >2 ng/ml above the post-radiation nadir. Radical salvage prostatectomy represents a secondary local treatment with curative intent in patients with organ-confined recurrences. Preoperative risk factors predicting organ-confined disease are initial LDR brachytherapy, preoperative Gleason biopsy score < or =6, < or =50% biopsy cores involved with cancer, and a PSA doubling time >12 months. Metastatic disease should be ruled out preoperatively by skeletal scintigraphy, computed tomography, or magnetic resonance imaging of the abdomen and the small pelvis, and/or choline PET/CT. Functionality of the lower urinary tract is evaluated by urethrocystoscopy and urodynamics. The most appropriate candidates for radical salvage prostatectomy are patients with organ-confined disease or those with symptomatic local recurrences. In experienced hands, morbidity is low with a continence rate of 83-96% depending on the type of previous radiation therapy. Long-term oncological control can be achieved in more than 80% of the patients.

[Value of targeted therapy for penile cancer]. / Der Stellenwert der Tageted-Therapie beim Peniskarzinom.

With an incidence of 0.1-0.9/100,000 men/year, penile cancer is a rare cancer of the urogenital tract in Western Europe. At the time of initial diagnosis up to 45% of the patients already demonstrate metastatic disease and need some type of systemic treatment. Objective remission rates and 3-year survival rates of 30 and < 10%, respectively, are depressingly low. Identification of molecular targets for the introduction of molecular triggered therapies such as monoclonal antibodies and tyrosine kinase inhibitors might improve the poor prognosis and could replace non-targeted systemic chemotherapies with a less toxic targeted therapy.However, a MEDLINE search does not identify any current clinical trial with regard to targeted therapeutic approaches in penile cancer. Based on a systematic review of the molecular events involved in the metastatic process of penile cancer, therapeutic approaches with bevacizumab or COX-2 inhibitors appear to have the greatest potential to improve the prognosis. In order to perform a prospective clinical phase 2/3 trial in such a low frequency cancer, international cooperative structures have to be established.

[Indications and techniques in urethrectomy]. / Urétrectomie : techniques et indications.

The indications for urethrectomy during cystectomy for bladder cancer have substantially changed during the last years. Many years ago, prophylactic urethrectomy was performed in most patients undergoing cutaneous diversion. Today, transitional cell carcinoma at the level of the prostatic urethra or at the bladder neck is recognized to be the most important risk factor of urethral recurrence. Since the development of bladder substitutions, the indications for prophylactic urethrectomy have been dramatically reduced. Pre - and intra operative evaluation of the prostatic urethra in men and that of the bladder neck in women is the major determinant in the appropriate treatment strategy for the urethra in patients with bladder cancer.