Benign prostatic hyperplasia

SUMMARY The minimally invasive procedures (mips) for the treatment of symptoms of benign prostatic hyperplasia (bph) are presented as attractive techniques due to their ease of accomplishment and the possibility of outpatient treatment. This guideline aims to present recommendations that may assist in decision making in patients with benign prostatic hyperplasia and indication of the different minimally invasive therapies. For this, a systematic review of the literature was performed, with the descriptors according to the pico: patient with benign prostatic hyperplasia, minimally invasive therapy, clinical outcome and adverse events. With no time restriction, in medline, cochrane central and lilacs databases via vhl, 1,007 papers were retrieved, of which 16 were selected to respond to clinical doubt. Details of the methodology and results of this guideline are set out in annex I

Probability of Extraprostatic Disease According to the Percentage of Positive Biopsy Cores in Clinically Localized Prostate Cancer

Prediction of extraprostatic disease in clinically localized prostate cancer is relevant for treatment planning of the disease. The purpose of this study was to explore the usefulness of the percentage of positive biopsy cores to predict the chance of extraprostatic cancer.

Biochemical recurrence rates are similar for pT2-positive surgical margins and pT3a

Objective Histological details of positive surgical margins in radical prostatectomy specimens have been related to outcome after surgery in rare studies recently published. Our objective is to assess whether the status of surgical margins, the extent and the Gleason score of positive margins, and the extent of the extraprostatic extension are predictive of biochemical recurrence post-radical prostatectomy.Materials and Methods Three hundred sixty-five radical prostatectomy specimens were analyzed. The length of the positive surgical margin and extraprostatic extension and the Gleason score of the margin were recorded. Statistical analyses examined the predictive value of these variables for biochemical recurrence.Results 236 patients were stage pT2R0, 58 pT2R1, 25 pT3R0 and 46 pT3R1. Biochemical recurrence occurred in 11%, 31%, 20% and 45.7% of pT2R0, pT2R1, pT3R0 and pT3R1, respectively. The extent of the positive surgical margins and the Gleason score of the positive surgical margins were not associated with biochemical recurrence in univariate analysis in a mean follow up period of 35.9 months. In multivariate analyses, only the status of the surgical margins and the global Gleason score were associated with biochemical recurrence, with a risk of recurrence of 3.1 for positive surgical margins and of 3.8 for a Gleason score > 7.Conclusion Positive surgical margin and the global Gleason score are significant risk factors for biochemical recurrence post-radical prostatectomy, regardless of the extent of the surgical margin, the extent of the extraprostatic extension, or the local Gleason score of the positive surgical margin or extraprostatic tissue. pT2R1 disease behaves as pT3R0 and should be treated similarly.

Obesity may influence the relationship between sex hormones and lower urinary tract symptoms

PurposeThe effects of serum testosterone in the lower urinary tract symptoms (LUTS) in patients with benign prostatic hyperplasia (BPH) are not well established. The objective of the study is to evaluate the association of sex hormones with LUTS and control the results by patient weight.Materials and MethodsThe study comprised a cross-sectional analysis of 725 men included in a prostate cancer screening program at University of Sao Paulo Medical School. The serum concentrations of total testosterone (TT), free testosterone (FT) and sex hormone binding globulin (SHBG) were measured. Variables analyzed were age, American Urological Association (AUA) symptom score, storage symptoms, voiding symptoms, quality of life score, prostate specific antigen levels and prostate volume. Obesity was measured through the calculation of body mass index (BMI). A regression analysis model was performed.ResultsMedian patient age was 65 years (48 to 94). A higher TT level was significantly associated with a severe AUA symptom score only among patients with a BMI ≥ 25. Median TT was 371, 370 and 427ng/dL (p = 0.017) in patients with mild, moderate and severe LUTS respectively. The multivariate regression analysis in patients with BMI ≥ 25 showed that only age, TT and sex score were related to LUTS.ConclusionsA higher TT is associated with a severe AUA score symptom index only in obese patients. Further analysis are necessary to evaluate the mechanisms through which testosterone may influence LUTS in these patients.

PGC and PSMA in prostate cancer diagnosis: tissue analysis from biopsy samples

Purpose The discovery of new diagnostic tools for the diagnosis of prostate cancer (PCa) has become an important field of research. In this study, we analyzed the diagnostic value of the expression of the pepsinogen C (PGC) and prostate-specific membrane antigen (PSMA) genes in tissue samples obtained from prostate biopsies. Materials and Methods This study was comprised of 51 consecutive patients who underwent transrectal ultrasound (TRUS)-guided prostate biopsies between January 2010 and March 2010. The biopsies were performed with 12 cores, and an additional core was randomly retrieved from the peripheral zone from each patient for study purposes. The expression of the PGC and PSMA genes was analyzed from the cDNA from the samples via the qRT-PCR technology. The expression patterns of patients with PCa were compared with those of patients without a PCa diagnosis. Results PSMA was overexpressed in only 43.4% of PCa cases, and PGC was overexpressed in 72.7% of cases. The median expression of PSMA was 1.5 times (0.1 to 43.9) and the median PGC expression was 8.7 times (0.1 to 50.0) the expression observed in prostatic tissue from TRUS-guided biopsies of normal patients. Analysis of patients with high-risk PCa indicated that PGC was overexpressed in 71.4% of cases (with a median expression of 10.6 times), and PSMA was overexpressed in only 35.7% of cases (with a median expression of 4.5 times). Among patients with low-risk PCa, PGC was also overexpressed in 71.4% of cases (with a median expression of 5.9 times), and PSMA was overexpressed in only 42.8% of cases (with a median expression of 2.5 times). Conclusions PGC gene expression is significantly higher in prostatic tissue in men affected by PCa when compared to normal prostates. Further analyses are necessary to confirm our results. .

The histology of prostate tissue following prostatic artery embolization for the treatment of benign prostatic hyperplasia

Objective Prostatic artery embolization (PAE) for the treatment of patients with symptomatic benign prostatic hyperplasia (BPH) is believed to be a safe procedure with a low risk of adverse side effects. Artery embolization is a viable treatment option in patients who are refractory to the classic noninvasive treatments. Knowledge of the histological characteristics of prostate tissue following the procedure is still limited. In this study, we describe the microscopic aspects of the prostate following PAE for BPH. Materials and Methods Two patients underwent transurethral resections of the prostate (TURP) after PAE. Embolizations were performed under local anesthesia with an initial pelvic angiography to evaluate the iliac vessels and the prostate arteries using a 2.8 French microcatheter. The prostate was embolized with 300-500µm Microspheres (Embosphere®), using complete blood stasis as the end point. The prostate tissues were analyzed histologically to characterize the effects of the embolization. Results The embolic material within the prostate tissue was easily identified as homogeneous, bright eosin-red spheroids filling the vessel lumens. Ischemic necrosis surrounded or not by chronic inflammatory reactions containing macrophages were considered as a result of the artery embolization. Also, some aspects related to the healing process were observed being fibrotic nodules surrounded by glands with squamous metaplasia of the epithelial lining the most important. In the remaining sections, due to the precocious surgical intervention, the classic findings of BPH were still present with the glandular and stromal hyperplasia associated with nonspecific chronic prostatitis. Conclusions This is the first description of prostate histology in BPH patients treated by PAE, a new procedure that is being used increasingly as a therapeutic intervention. The recognition of the changes caused by this new modality of treatment has ...

Prima-1 induces apoptosis in bladder cancer cell lines by activating p53

OBJECTIVES: Bladder cancer represents 3% of all carcinomas in the Brazilian population and ranks second in incidence among urological tumors, after prostate cancer. The loss of p53 function is the main genetic alteration related to the development of high-grade muscle-invasive disease. Prima-1 is a small molecule that restores tumor suppressor function to mutant p53 and induces cancer cell death in various cancer types. Our aim was to investigate the ability of Prima-1 to induce apoptosis after DNA damage in bladder cancer cell lines. METHOD: The therapeutic effect of Prima-1 was studied in two bladder cancer cell lines: T24, which is characterized by a p53 mutation, and RT4, which is the wild-type for the p53 gene. Morphological features of apoptosis induced by p53, including mitochondrial membrane potential changes and the expression of thirteen genes involved in apoptosis, were assessed by microscopic observation and quantitative real-time PCR (qRT-PCR). RESULTS: Prima-1 was able to reactivate p53 function in the T24 (p53 mt) bladder cancer cell line and promote apoptosis via the induction of Bax and Puma expression, activation of the caspase cascade and disruption of the mitochondrial membrane in a BAK-independent manner. CONCLUSION: Prima-1 is able to restore the transcriptional activity of p53. Experimental studies in vivo may be conducted to test this molecule as a new therapeutic agent for urothelial carcinomas of the bladder, which characteristically harbor p53 mutations.

Standard surgical treatment for benign prostatic hyperplasia is safe for patients over 75 years: analysis of 100 cases from a high-volume urologic center

OBJECTIVES: In this study, we aimed to determine the complications of standard surgical treatments among patients over 75 years in a high-volume urologic center. METHODS: We analyzed 100 consecutive patients older than 75 years who had undergone transurethral prostatic resection of the prostate or open prostatectomy for treatment of benign prostatic hyperplasia from January 2008 to March 2010. We analyzed patient age, prostate volume, prostate-specific antigen level, international prostatic symptom score, quality of life score, urinary retention, co-morbidities, surgical technique and satisfaction with treatment. RESULTS: Median age was 79 years. Forty-eight patients had undergone transurethral prostatic resection of the prostate, and 52 had undergone open prostatectomy. The median International Prostatic Symptom Score was 20, the median prostate volume was 83 g, 51% were using an indwelling bladder catheter, and the median prostatespecific antigen level was 5.0 ng/ml. The most common comorbidities were hypertension, diabetes and coronary disease. After a median follow-up period of 17 months, most patients were satisfied. Complications were present in 20% of cases. The most common urological complication was urethral stenosis, followed by bladder neck sclerosis, urinary fistula, late macroscopic hematuria and persistent urinary incontinence. The most common clinical complication was myocardial infarction, followed by acute renal failure requiring dialysis. Incidental carcinoma of the prostate was present in 6% of cases. One case had urothelial bladder cancer. CONCLUSIONS: Standard surgical treatments for benign prostatic hyperplasia are safe and satisfactory among the elderly. Complications are infrequent, and urethral stenosis is the most common. No clinical variable is associated with the occurrence of complications.

The accuracy of pathological data for the prediction of insignificant prostate cancer

The widespread screening programs prompted a decrease in prostate cancer stage at diagnosis, and active surveillance is an option for patients who may harbor clinically insignificant prostate cancer (IPC). Pathologists include the possibility of an IPC in their reports based on the Gleason score and tumor volume. This study determined the accuracy of pathological data in the identification of IPC in radical prostatectomy (RP) specimens.

Of 592 radical prostatectomy specimens examined in our laboratory from 2001 to 2010, 20 patients harbored IPC and exhibited biopsy findings suggestive of IPC. These biopsy features served as the criteria to define patients with potentially insignificant tumor in this population. The results of the prostate biopsies and surgical specimens of the 592 patients were compared.

The twenty patients who had IPC in both biopsy and RP were considered real positive cases. All patients were divided into groups based on their diagnoses following RP: true positives (n = 20), false positives (n = 149), true negatives (n = 421), false negatives (n = 2). The accuracy of the pathological data alone for the prediction of IPC was 91.4%, the sensitivity was 91% and the specificity was 74%.

The identification of IPC using pathological data exclusively is accurate, and pathologists should suggest this in their reports to aid surgeons, urologists and radiotherapists to decide the best treatment for their patients. .

Significant heterogeneity in terms of diagnosis and treatment of renal cell carcinoma at a private and public hospital in Brazil

PURPOSE: A great number of small renal lesions have now been detected. Nowadays, partial nephrectomy has more frequently been adopted for surgical treatment of earlier stage disease. Previous studies have associated patient, institutional, and health care system factors with surgery type. The aim of this study was to compare the diagnosis and treatment of renal cell carcinoma (RCC) according to hospital type, public versus private, in our country. MATERIALS AND METHODS: We retrospectively evaluated 183 patients with RCC who underwent radical nephrectomy or nephron-sparing surgery between 2003 and 2007 in two hospitals, one private and one public. Patient demographic, clinical, surgery, and pathologic characteristics were analyzed. RESULTS: The radical nephrectomy rate was higher at the public hospital than at the private hospital (75 percent vs. 57 percent, p = 0.008). Overall, patients at the public hospital presented larger tumors than did the patients who were cared for privately. Furthermore, small renal masses were significantly more prevalent in private care (57.8 percent vs. 28.3 percent). Patients at the public hospital showed a higher incidence of capsular invasion (p = 0.008), perirenal fat invasion (p < 0.01), lymph node involvement (p < 0.001), and a lower incidence of initial tumors. pT1 tumors were reported in 41 percent of patients at the public hospital and in 72 percent at the private hospital (p < 0.001). CONCLUSION: Patients with RCC cared for at our public referral hospital showed a more advanced stage than RCC treated at the private institution.

Socioeconomic status is an independent predictor of biochemical recurrence among patients with prostate cancer who undergo radical prostatectomy

PURPOSE: Socioeconomic status (SES) may influence cancer characteristics and behavior in several aspects. We analyzed PCa characteristics and behavior among low income uninsured men, and compare them to high income patients with health insurance in a developing country. MATERIALS AND METHODS: A retrospective case-control study was performed on 934 patients with clinically localized PCa who underwent radical prostatectomy between March, 1999 and July, 2009. Patients were divided in two groups, according to their SES. In group 1 (n=380), all had low income, low educational levels and couldn't afford medical insurance. In group 2 (n=554), all had higher income, higher education and had medical insurance. RESULTS: Patients from group 1 were older, had higher Gleason scores, higher rates of seminal vesicle and bladder neck involvement. The Kaplan Meier disease-free survival curve demonstrated that after a follow-up of four years, about 50 percent of uninsured patients had biochemical recurrence, versus 21 percent of insured patients (Log rank test: p < 0.001). A multivariate Cox regression analysis for the risk of disease recurrence demonstrated that only PSA levels, Gleason score, seminal vesicle involvement and SES were statistically significant variables. Patients with a low SES presented 1.8 times the risk of recurrence as compared to patients with a high SES. CONCLUSIONS: Patients with low SES were older, presented more aggressive PCa characteristics and a high rate of disease recurrence. A low SES constituted an independent predictor for disease recurrence.

Urinary incontinence following surgery for BPH: the role of aging on the incidence of bladder dysfunction

PURPOSE: The reported incidence of urinary incontinence (UI) due to bladder dysfunction following surgery of BPH is variable. We described the causes of incontinence in a large group of men that developed this unsual complication and analyzed the influence of age on the prevalence of bladder dysfunction. MATERIALS AND METHODS: We wvaluated a total of 125 patients with urinary incontinence following surgical treatment for BPH : Transurethral resection of the prostate (81men) and open prostatectomy (44 men). A third group of 21 patients with incontinence following radical prostatectomy was used for comparison. All patients underwent urodynamic analysis. Urethral Sphincter Insufficiency (USI)was defined as involuntary loss of urine induced by Valsalva maneuver in the absence of a detrusor contraction. Bladder dysfunction was defined as detrusor overactivity and/or decreased compliance. RESULTS: Urethral sphincter insufficiency was the most common etiology of urinary incontinence in the three groups of patients. However, bladder dysfunction was observed in 59.3 percent, 56.8 percent and 57.1 percent of patients who underwent transurethral resection, open prostatectomy and radical prostatectomy, respectively. Median patient age was 69 and 75 years for patients with and without bladder dysfunction, respectively. A logistic regression model for the presence of bladder dysfunction showed that age was a statistically significant predictor. CONCLUSIONS: Urethral Sphincter insufficiency is the main cause of incontinence following surgery for BPH. Bladder dysfunction may be the isolated cause of incontinence in approximately 25 percent of patients. The chances of bladder dysfunction rises 5.3 percent for each year added to patient age. Patients older than 70 years have twice the probablility of post procedural incontinence.

The use of immunohistochemistry for diagnosis of prostate cancer

PURPOSE: Atypical glands (ASAP) are diagnosed in 5.0 percent of prostate biopsies, and cancer identification in a rebiopsy is higher than 40.0 percent. The use of antibodies to mark basal cells is currently a common practice, in order to avoid rebiopsies. There has been no reported study that has reviewed characteristics of radical prostatectomies (RPs) when immunohistochemistry (IHC) was necessary for definitive diagnosis. MATERIALS AND METHODS: Out of 4127 biopsies examined from 2004 to 2008, 144 (3.5 percent) were diagnosed with ASAP. IHC was performed using antibody anti-34ßE12 and p63. The results of surgical specimens of 27 patients treated by RP after the diagnosis of prostate cancer (PC) was made using IHC (Group 1) were compared with 1040 patients where IHC was not necessary (Group 2). RESULTS: IHC helped to diagnose PC in 103 patients (71.5 percent). Twenty-seven (26.2 percent) underwent RP. In Group 1, two (7.4 percent) adenocarcinomas were insignificant versus 29 (2.9 percent) for Group 2. Patients from Group 1 were younger (p = 0.039), had lower Gleason scores (GS) (p < 0.001), lower percentage of Gleason pattern 4 (p < 0.001), and smaller tumors (p < 0.001). CONCLUSION: The use of IHC did not lead to diagnosis of insignificant tumors as illustrated by absence of differences in pathological stage or positive surgical margins in men submitted to RP. Therefore, our results suggest that this modality should be routinely used for a borderline biopsy and ASAP cases.

Penile prosthesis implantation in an academic institution in Latin America

PURPOSE: We performed a retrospective study to analyze the effectiveness of implantable penile prostheses in the treatment of erectile dysfunction. MATERIALS AND METHODS: This study included 249 patients who received implants between 2001 and 2008. A total of 139 patients who underwent penile prosthesis implantation were interviewed. RESULTS: Approximately half of patients had previously used oral drugs before implantation of the prosthesis. About 45 percent had diabetes, 25.9 percent had previously undergone radical prostatectomy (RP), and 64 percent had hypertension. Exchange was performed in 5.7 percent for fracture, inadequate size, or extrusion. A total of 24.5 percent of men had immediate postoperative pain, 7.9 percent had local infection, and 8.6 percent had other complications. Patients who had previously undergone RP were 3.2 times more likely to experience a postoperative complication than patients who had not (p = 0.061). Eighty-nine (64 percent) patients returned to having sex as they had before being diagnosed with ED. Ninety-two of the men (66.2 percent) had sexual intercourse one to two times per week. One hundred twenty patients (86.3 percent) rated their level of satisfaction as good, excellent or very good, which was similar to the percentage of partners. The mean follow-up was 40 months. CONCLUSION: Higher rates of postoperative infections and mechanical problems with the implant were found in this study as compared to other studies, which was probably associated with the relative lack of experience of the trainees who were performing the surgeries. Patients with a history of RP or diabetes mellitus prior to implantation were at higher risk of postoperative complications.

Tumor banks: the cornerstone of basic research in urology

PURPOSE: Tumor banks have the primary responsibility for collecting, cataloging, storing and disseminating samples of tissues, cells and fluids, which are used by researchers to identify diagnostic molecular markers, prognostic indicators and therapeutic targets. The objective of this review was to describe a simple, reliable and reproducible protocol for obtaining and storing samples of urological tumors. MATERIALS AND METHODS: Urogenital tumor tissues were collected by the surgeons from the Urology Division of University of Sao Paulo Medical School. The obtained surgical specimens were immediately placed in liquid nitrogen, dry ice or in a tube containing RNAlater ®, and then stored by cryopreservation (-80°C). A mirror fragment was fixed in 10 percent formalin processed routinely and embedded in Paraplast®. RESULTS: We developed a protocol for the collection, cataloging, storage, conservation and use of tumor samples. During a period of one year the Urological Tumor Bank of the Urology Division stored 274 samples of prostate, bladder, kidney, penis and testicle tumors of different histological types, 74 urine and 271 serum samples. CONCLUSIONS: Having biological materials characterized and available along with the clinical patient information provides an integrated portrait of the patients and their diseases facilitating advances in molecular biology. It also promotes the development of translational research improving methods of diagnosis and cancer treatment.

Transurethral resection of the prostate for the treatment of lower urinary tract symptoms related to benign prostatic hyperplasia: how much should be resected?

Objective: To assess the impact of the percent of resected tissue on the improvement of urinary symptoms. Materials and methods: The study included a prospective analysis of 88 men with benign prostatic hyperplasia. Patients were divided in three groups according to the percent of resected tissue: Group 1 < 30 percent; Group 2, 30 percent to 50 percent; and Group 3, > 50 percent. Each patient was re-evaluated 3 months after surgery. We assessed the international prostatic symptom score, nocturia and serum prostate specific antigen levels. Results: All patients presented a significant decrease on mean International Prostate System Score (IPSS) (23 to 5.9), Quality of Life (QoL) (4.9 to 1.0) and nocturia (3.2 to 1.9). Variation in the IPSS was 16.7, 16.6 and 18.4 for patients from Group 1, 2 and 3 respectively (P = 0.504). Although the three groups presented a significant decrease in QoL, patients in Group 3 presented a significantly greater decrease when compared to Group 1. Variation in QoL was 3.1, 3.9 and 4.2 for patients from Group 1, 2 and 3 respectively (p = 0.046). There was no significant difference in nocturia variation according to the percent of resected tissue (p = 0.504). Median pre and postoperative PSA value was 3.7 and 1.9 ng/mL respectively. Patients from Group 1 did not show a significant variation (p = 0.694). Blood transfusions were not required in any group. Conclusions:Resection of less than 30 percent of prostatic tissue seems to be sufficient to alleviate lower urinary tract symptoms related to benign prostate hyperplasia. However, these patients may not show a significant decrease in serum PSA level.

The role of extended prostate biopsy on prostate cancer detection rate: a study performed on the bench

INTRODUCTION: The aim of this prospective study was to compare the advantage of performing prostate biopsy with a greater number of cores using the classic sextant procedure, with the aim of reducing false negative results. MATERIALS AND METHODS: 100 prostates were acquired from consecutive radical prostatectomies performed by the same surgeon. Fourteen cores were obtained on the bench following surgery using an automatic pistol with an 18-gauge needle. Six of these cores were obtained according to the sextant technique, as described by Hodge et al.; with the addition of a further three lateral cores from each lobe and one from the bilateral transition zone. The whole gland and the fragments were assessed by the same pathologist. An analysis of the frequency of the cancers identified in the cores of the sextant and the extended biopsies was undertaken and the results evaluated comparatively. The chi-square test was used for the comparative analysis of the cancer detection rate, according to the technique used. RESULTS: When 6 cores were removed, the positive cancer rate was 75 percent, which was increased to 88 percent when 14 cores were (p < 0.001). The withdrawal of 14 cores resulted in a significant 13 percent (95 percent CI [5 percent-21 percent]) increase in the positive rate of cancer detection. CONCLUSION: Extended biopsy, with the removal of 14 cores, is more efficient than the sextant procedure in improving the rate of prostate cancer detection.

Patient's reactions to digital rectal examination of the prostate

OBJECTIVE: In recent years, there has been a rise in the incidence of prostate cancer (PCa), and routine screening for the disease has become a well accepted clinical practice. Even with the recognized benefit of this approach, some men are still reluctant to undergo digital rectal examination (DRE). For this reason, we designed the present study in order to better understand men's reactions about this method of screening. The aim was to identify possible drawbacks that could be overcome to increase DRE. MATERIALS AND METHODS: We randomly selected 269 patients that were enrolled in an institutional PCa screening program. They were first asked to answer a question regarding their preferred position to undergo the examination. Following this step, they answered a questionnaire in which physical and psychological reactions regarding the DRE were presented. Finally, we used a visual analogical scale (VAS) to analyze the perception of pain during DRE. RESULTS: The supine position was preferred for most patients (53.9 percent). Before DRE, about 59.4 percent of patients felt that the exam would be acceptable. After DRE, this figure increased to 91.5 percent (p < 0.001). Mean VAS score during DRE was 1.69 on a scale with a range between 0 and 10 (0 = no pain; 10 = extreme pain). CONCLUSION: Patient expectations about DRE were negative before examination and changed significantly following the exam. Pain during examination was negligible, contrary to the prevalent belief. These two findings must be clearly presented to patients in order to improve PCa screening acceptance.

Prognostic relevance of the histological subtype of renal cell carcinoma

OBJECTIVE: According to several studies, when the histological subtype of renal cell carcinoma is established it is possible to attribute a different life expectancy to each patient. We analyzed the prognostic significance of the histological subtype in renal cell carcinoma. MATERIALS AND METHODS: The authors retrospectively analyzed the follow-up of 230 patients after radical or conservative renal surgery. The histological characteristics of the different subtypes of tumor were obtained and the disease-free and cancer-specific survival curves for the clear cell, cromophobic, papillary, collecting duct (Bellini) subtypes and those with sarcomatoid differentiation were individualized. RESULTS: The disease-free and cancer-specific survival rates for clear cell tumors were 76.6 percent and 68.0 percent respectively, 71.2 percent and 82.1 percent respectively for the cromophobic type, 71.1 percent and 79.8 percent respectively for the papillary type, 26.9 percent and 39.3 percent respectively for the sarcomatoid type, and 0.0 percent and 0.0 percent respectively for the collecting ducts (p < 0.001). CONCLUSION: The histological subtypes of renal tumors can stratify patients into different prognostic groups only when the sarcomatoid differentiation is present.