Surgical treatment of renal cell carcinoma recurrence at the renal fossa following radical nephrectomy.

CONTEXT: Isolated renal cell carcinoma recurrence at the renal fossa is a rare event. This condition occurs in 1 to 2% of radical nephrectomy cases. It is usually seen in postoperative follow-up imaging examinations such as abdominal computed tomography or abdominal ultrasound. There is controversy among urologists and oncologists regarding the best way to treat this rare situation, because of the few cases in the literature. CASE REPORT: We report on a case of isolated recurrence at the renal fossa due to renal cell carcinoma (RCC), four and a half years after radical nephrectomy, without evidence of metastases in other organs. The diagnosis was made from abdominal tomography performed during outpatient follow-up, in which a retroperitoneal mass was observed in the renal fossa. Excision was carried out by means of a subcostal transversal incision, without complications. One and a half years after the procedure, there was evidence of metastasis in the left lung and, six months later, another recurrence at the ninth anterior right rib, while the patient remained asymptomatic. Aggressive surgical treatment is a good method for controlling this rare situation of single retroperitoneal RCC recurrence. Abdominal tomography must continue to be performed over long periods of follow-up, to monitor for RCC following radical nephrectomy, in order to diagnose any late retroperitoneal recurrences. These must be treated as single RCC metastases.

What is the ideal core number for ultrasound-guided prostate biopsy?

PURPOSE: We evaluated the utility of 10-, 12-, and 16-core prostate biopsies for detecting prostate cancer (PCa) and correlated the results with prostate-specific antigen (PSA) levels, prostate volumes, Gleason scores, and detection rates of high-grade prostatic intraepithelial neoplasia (HGPIN) and atypical small acinar proliferation (ASAP). MATERIALS AND METHODS: A prospective controlled study was conducted in 354 consecutive patients with various indications for prostate biopsy. Sixteen-core biopsy specimens were obtained from 351 patients. The first 10-core biopsy specimens were obtained bilaterally from the base, middle third, apex, medial, and latero-lateral regions. Afterward, six additional punctures were performed bilaterally in the areas more lateral to the base, middle third, and apex regions, yielding a total of 16-core biopsy specimens. The detection rate of carcinoma in the initial 10-core specimens was compared with that in the 12- and 16-core specimens. RESULTS: No significant differences in the cancer detection rate were found between the three biopsy protocols. PCa was found in 102 patients (29.06%) using the 10-core protocol, in 99 patients (28.21%) using the 12-core protocol, and in 107 patients (30.48%) using the 16-core protocol (p=0.798). The 10-, 12-, and 16-core protocols were compared with stratified PSA levels, stratified prostate volumes, Gleason scores, and detection rates of HGPIN and ASAP; no significant differences were found. CONCLUSIONS: Cancer positivity with the 10-core protocol was not significantly different from that with the 12- and 16-core protocols, which indicates that the 10-core protocol is acceptable for performing a first biopsy.