Perioperative Oral Nutrition Supplementation Reduces Prevalence of Sarcopenia following Radical Cystectomy: Results of a Prospective Randomized Controlled Trial.

PURPOSE: We designed a prospective randomized, controlled pilot trial to investigate the effects of an enriched oral nutrition supplement on body composition and clinical outcomes following radical cystectomy. MATERIALS AND METHODS: A total of 61 patients were randomized to an oral nutrition supplement or a multivitamin multimineral supplement twice daily during an 8-week perioperative period. Body composition was determined by analyzing abdominal computerized tomography images at the L3 vertebra. Sarcopenia was defined as a skeletal muscle index of less than 55 cm/m in males and less than 39 cm/m in females. The primary outcome was the difference in 30-day hospital free days. Secondary outcomes included hospital length of stay, complications, readmissions and mortality. RESULTS: The oral nutrition supplement group lost less weight (-5 vs -6.5 kg, p = 0.04) compared to the multivitamin multimineral supplement group. The proportion of patients with sarcopenia did not change in the oral nutrition supplement group but increased 20% in the multivitamin multimineral supplement group (p = 0.01). Mean length of stay and 30-day hospital free days were similar in the groups. The oral nutrition supplement group had a lower rate of overall and major (Clavien grade 3 or greater) complications (48% vs 67% and 19% vs 25%, respectively) and a lower readmission rate (7% vs 17%) but the differences did not reach statistical significance. CONCLUSIONS: Patients who undergo radical cystectomy after consuming an oral nutrition supplement perioperatively have a reduced prevalence of sarcopenia and may also experience fewer and less severe complications and readmissions. A larger blinded, randomized, controlled trial is necessary to determine whether oral nutrition supplement interventions can improve outcomes following radical cystectomy.

ICUD-SIU International Consultation on Bladder Cancer 2017: management of non-muscle invasive bladder cancer.

PURPOSE: To provide a summary of the Third International Consultation on Bladder Cancer recommendations for the management of non-muscle invasive bladder cancer (NMIBC). METHODS: A detailed review of the literature was performed focusing on original articles for the management of NMIBC. An international committee assessed and graded the articles based on the Oxford Centre for Evidence-based Medicine system. The entire spectrum of NMIBC was covered such as prognostic factors of recurrence and progression, risk stratification, staging, management of positive urine cytology with negative white light cystoscopy, indications of bladder and prostatic urethral biopsies, management of Ta low grade (LG) and high risk tumors (Ta high grade [HG], T1, carcinoma in situ [CIS]), impact of BCG strain and host on outcomes, management of complications of intravesical therapy, role of alternative therapies, indications for early cystectomy, surveillance strategies, and new treatments. The working group provides several recommendations on the management of NMIBC. RESULTS: Recommendations were summarized with regard to staging; management of primary and recurrent LG Ta and high risk disease, positive urine cytology with negative white light cystoscopy and prostatic urethral involvement; indications for timely cystectomy; and surveillance strategies. CONCLUSION: NMIBC remains a common and challenging malignancy to manage. Accurate staging, grading, and risk stratification are critical determinants of the management and outcomes of these patients. Current tools for risk stratification are limited but informative, and should be used in clinical practice when determining diagnosis, surveillance, and treatment of NMIBC.

Guideline-based management of non-muscle invasive bladder cancer.

INTRODUCTION: Non-muscle invasive bladder cancer (NMIBC) represents a broad spectrum of disease, the hallmarks of which include disease recurrence and progression. Clinicians have a number of surgical and therapeutic options at their disposal when treating this disease, and the underlying evidence continues to evolve. A number of professional organizations have invested in the development of clinical practice guidelines to guide patient management. MATERIALS AND METHODS: We review and summarize four major guidelines, the American Urological Association, the European Association of Urology, the International Consultation on Urological Disease and the National Comprehensive Cancer Network. RESULTS: Guideline panels differed in their composition, methodological approach and structure of recommendations. Despite this, many recommendations were similar between various panels, although differences are present in panel recommendations related to initial diagnosis and treatment, adjuvant therapy and disease surveillance. CONCLUSIONS: Guideline recommendations are similar at many decision points that clinicians face when managing NMIBC, although they are far from uniform. While future prospective, well-designed studies will hopefully clarify NMIBC management, urologists ultimately must rely on a combination of evidence-based recommendations, which they should seek to integrate with patients' values and preferences and the individual circumstances to provide the best possible patient care.

Performance-enhancing supplement use in patients with testicular cancer.

OBJECTIVES: To identify supplement use among patients diagnosed with testicular cancer. The incidence of testicular cancer has increased, as has supplement use, including those designed specifically for exercise performance enhancement. METHODS: A questionnaire was administered to patients with testicular germ cell cancer treated at our institution between 1990 and 2004. This survey addressed the use of supplements before, during, and after the diagnosis of cancer. RESULTS: Of the 129 patients who completed the questionnaire, 26 (20.1%) used some form of supplements, most of which were ingested for exercise performance enhancement. The most common supplement taken was protein/amino acids (12.4%) followed by creatine (9.3%) and androstenedione (1.6%). The mean duration of supplement use was 17.0 months. The mean age of the patients who had used supplements was 27.6 years (median 26, range 17 to 47) compared with 35.7 years (median 34, range 14 to 76) for patients who had not used supplements. Of the 57 patients diagnosed before 2000, 9 (16%) reported supplement use and 3 (5%) reported creatine use. Of the 72 patients diagnosed during or after 2000, 17 (24%) reported supplement use and 9 (13%) reported creatine use. CONCLUSIONS: Supplement use is common and increasing among patients with testicular cancer. The use of exercise performance-enhancing supplements was as great as 20%. Given the increasing incidence of testicular cancer, coupled with the widespread use of these performance-enhancing supplements in this at-risk group, additional study is required to determine what association, if any, exists between the use of these substances and the development of testicular cancer.

Exploring the effects of luteinizing hormone-releasing hormone agonist therapy on bone health: implications in the management of prostate cancer.

Osteoporosis is a complication that may be associated with long-term androgen deprivation therapy (ADT) in men with prostate cancer. Androgen deprivation increases bone resorption, thereby leading to a more rapid decrease of bone mineral density (BMD) at multiple skeletal sites as compared with age-matched healthy men. ADT has been associated with an increased risk of skeletal fracture in several retrospective analyses. The role of androgens in maintaining bone health appears to be mediated indirectly through their conversion to estrogens, although testosterone may be an important factor in bone formation. Physicians need to be aware of the potential for osteoporosis and should inform patients of appropriate lifestyle and diet modifications, such as calcium and vitamin D supplementation, and exercise at the initiation of ADT. Evaluating BMD may become the accepted norm. Several studies suggest that bisphosphonates may be beneficial in preventing and treating osteoporosis in patients with prostate cancer. The overall benefit of ADT in men with prostate cancer will continue to improve as potential side effects, such as osteoporosis, are recognized and addressed successfully.