Association of human herpes, papilloma and polyoma virus families with bladder cancer.

The aim of the present study was to assess the possible etiologic role of human papillomavirus (HPV), human herpes virus (HHV) and the human polyoma virus families (BKV and JCV) in the tumourigenesis of bladder cancer. Thirty biopsy specimens from patients with different grades and stages of bladder cancer, who underwent transurethral bladder cancer resection, and 30 normal bladder mucosa specimens were analysed using polymerase chain reaction (PCR) for the detection of the above three virus family members. The presence of HPV was determined in all specimens with nested PCR and real-time quantitative PCR. All cancerous specimens, including the control group, were found to be negative both by PCR and real-time qPCR for the presence of HPV DNA, whilst all samples examined by PCR tested negative for the presence of HSV-1,2 Varicella zoster virus and HSV-7 DNA. Cytomegalovirus, HHV-6 and HHV-8 exhibited similar incidence in sample positivity in both cancerous and healthy tissues. EBV showed a higher prevalence in bladder cancer specimens compared to healthy tissue (p = 0.048), whilst BKV and JCV were detected only in tumour samples. The presence of EBV in a significant proportion of bladder tumours indicates the etiological role of this virus in cancer tumourigenesis.

Detection of bacillus Galmette-Guérin (Mycobacterium bovis BCG) DNA in urine and blood specimens after intravesical immunotherapy for bladder carcinoma.

A real-time PCR targeting IS6110 was employed for the detection of Mycobacterium tuberculosis DNA in specimens collected from 10 patients treated with intravesical M. bovis bacillus Galmette-Guérin (BCG) immunotherapy for bladder malignancy. BCG DNA was detected in all urine specimens taken 24 h after the instillations, as well as in 24% of the specimens collected 7 days after the instillations; it was also detected in a single specimen taken 6 weeks after the last instillation. BCG DNA was detected in 8.3% of the blood specimens taken 1 day after instillation, and its amplification was associated with cases of self-limiting fever. These findings give indications that this real-time PCR is helpful to recognize BCG bacteremic cases, which may lead to mycobacterial infection.

The implication of initial 24-core transrectal prostate biopsy protocol on the detection of significant prostate cancer and high grade prostatic intraepithelial neoplasia.

PURPOSE: To assess the diagnostic value of an initial 24-sample transrectal ultrasound guided (TRUS) prostate biopsy protocol compared to the 10-core technique. MATERIALS AND METHODS: We retrospectively reviewed the prostate biopsy database of consecutive men undergoing prostate biopsies under local anesthesia by using the 10 (Group A) and 24 (Group B) protocols. Men were stratified according to biopsy protocol and PSA levels. Exclusion criteria were age ≥ 75 years and PSA > 20 ng/mL. The Mann-Whitney U and Fisher's exact test were used for statistical analysis. RESULTS: Between April 2007 and August 2009, 869 men underwent TRUS prostate biopsies of which 379 were eligible for the study. Group A (10-cores) consisted of 243 (64.11%) men and group B (24-cores) included 139 (35.89%) men. The overall prostate cancer detection rate was 39.09% and 34.55% in Group A and B, respectively (p = 0.43). An overall 9.8% increase in Gleason 7 detection rate was found in Group B (p = 0.24). The high-grade prostatic intraepithelial neoplasia (HGPIN) detection rate in men with negative initial biopsies was 15.54% and 35.55% in Group A and B, respectively (p < 0.001). In patients with PSA < 10 ng/mL, the 24-core technique increased Gleason 7 detection rate by 13.4% (p = 0.16) and HGPIN by 23.4% (p = 0.0008), compared to the 10 core technique. The 24-core technique increased the concordance between needle biopsy and prostatectomy specimen compared to 10-core technique (p < 0.002). CONCLUSIONS: The initial 24-core prostate biopsy protocol did not show any benefit in the detection of prostate cancer compared to the 10-core technique. However, it improved the HGPIN detection and the correlation between biopsy results and radical prostatectomy Gleason score in men with lower PSA levels.

Chronic prostatitis effectively managed by transurethral prostatectomy (TURP) in a spinal cord injury male.

Introduction: Spinal cord injury (SCI), specifically suprasacral SCI, results in high intravesical pressures, elevated post-void residual and urinary incontinence which are all risk factors for urinary tract infections (UTIs). The management of UTIs usually is conservative medical antibiotic treatment. However, recurrent UTIs in the SCI patient population warrant further investigation. The method of urinary drainage (intermittent or indwelling urinary catheters, urinary diversion) and untreated complications of NLUTD (vesicoureteral reflux, stone formation, chronic incomplete emptying of the bladder) are risk factors for recurrent UTIs (rUTIs). Removal of these UTI risk factors and improving urinary drainage are goals of urologic management; however, when conservative interventions do not succeed, surgery may be a viable solution in select cases of rUTIs. Case presentation: We present a case of complicated persisting rUTIs and associated urethral discharge in a middle-aged SCI male who manages his bladder with intermittent catheterization (IC). We detail the evaluation and management approach that leads to an eventual transurethral prostatectomy (TURP) as a final solution for his rUTIs. Fortunately, the surgical intervention was successful, and the patient is free of UTIs after 4 years of follow-up. Discussion: In SCI male patients with rUTIs and suspected chronic prostatitis, TURP may be a valuable treatment option once all predisposing factors have been remediated.

Predictive value of the bone markers osteocalcin and C-terminal telopeptide for jaw osteonecrosis in high-risk prostate cancer patients on bisphosphonate therapy: A prospective study. / Valor predictivo de los marcadores oseos osteocalcina y telopéptido C terminal para la osteonecrosis mandibular en pacientes con cáncer de próstata (CaP) de alto riesgo bajo tratamiento con bifosfonatos: estudio prospectivo.

OBJECTIVE: To examine the predictive value of osteocalcin (OC) and C-terminal telopeptide (CTX) levels for jaw osteonecrosis in high-risk prostate cancer (PCa) patients taking bisphosphonates (BPs). METHODS: Twenty-four patients were prospectively recruited in this study and followed from 2011 to 2015. All patients were diagnosed with metastatic PCa with secondary bone deposits and were on androgen deprivation therapy (ADT). All participants were started on 4mg of zoledronic acid intravenously every 4 weeks for two years. The patients were reviewed every three months with full blood count, blood biochemistry, PSA and measurement of OC and CTX. Patients also underwent dental/oral examination. OC and CTX levels in serum were calculated using the ELISA method. RESULTS: A significant decrease in PSA levels was found (ß=-0.06, SE=0.02, p=0.006). The levels of OC (ß=-0.46, SE=0.14, p=0.001) and CTX (ß=-0.01, SE=0.004, p=0.007) also decreased significantly during the two years of follow up. Osteonecrosis of the jaw was identified in three patients at two years. Patients with osteonecrosis also showed a decrease in OC and CTX levels. The mean OC reduction was 77.3% for patients with osteonecrosis and 12.6% for patients without osteonecrosis. The mean CTX reduction was 44.1% for patients with osteonecrosis and 9.62% for patients without osteonecrosis. CONCLUSION: Our study demonstrated no clear association between the levels of serum OC and CTX and bisphosphonate-related osteonecrosis of the jaw (BRONJ). To date, there is no clinically useful biomarker for the prediction of jaw osteonecrosis. More studies are needed using different bone turnover markers in order to identify patients at risk for BRONJ.

OBJETIVO: Examinar el valor predictivo de los niveles de osteocalcina (OC) y telopéptido C terminal (TCT) para la osteonecrosis mandibular en pacientes con cáncer de próstata de alto riesgo en tratamiento con bifosfonatos.MÉTODOS: Veintidós pacientes fueron reclutados prospectivamente en este estudio y seguidos desde 2011 a 2015. Todos los pacientes tenían el diagnóstico de CaP de próstata de alto riesgo con depósitos óseos secundarios y seguían tratamiento de deprivación androgénica (TDA). Todos los pacientes comenzaron con 4 mg de ácido zolendrónico IV cada 4 semanas durante 2 años. Los pacientes siguieron revisiones cada tres meses con hemograma, bioquímica sanguínea, PSA y mediciones de OC y TCT. Los pacientes fueron sometidos a evaluación dental/oral. Los niveles de OC y TCT en suero fueron medidos utilizando un método de ELISA. RESULTADOS: Se encontró un descenso significativo de los niveles de PSA (ß=-0,06, SE=0,02, p=0,006). Los niveles de OC (ß=-0,46, SE=0,14, p=0,001) y TCT ß=-0,01, SE=0,004, p=0,007) también disminuyeron significativamente durante los dos años de seguimiento. Se identificó osteonecrosis en tres pacientes en dos años. Los pacientes con osteonecrosis de mandíbula en tres pacientes a los dos años. Los pacientes con osteonecrosis también mostraron un descenso de los niveles de OC y TCT. La reducción media de OC fue del 77,3% en los pacientes con osteonecrosis y 12,6% en los pacientes sin osteonecrosis. La reducción media de TCT fue del 44,1% en los pacientes con osteonecrosis y 9,62% en los pacientes sin osteonecrosis. CONCLUSIONES: Nuestro estudio no demuestra una clara asociación entre los niveles séricos de OC y TCT y la osteonecrosis mandibular relacionada con bifosfonatos. Hasta la fecha, no hay un marcador clínico útil para la predicción de la osteonecrosis mandibular. Son necesarios más estudios utilizando diferentes marcadores de renovación ósea para identificar los pacientes en riesgo de osteonecrosis mandibular relacionada con bifosfonatos.

Differential Expression of IGF-I Transcripts in Bladder Cancer.

BACKGROUND/AIM: A growing body of evidence shows that the differential expression of E domain-related insulin-like growth factor-I (IGF-I) transcripts (IFG-IEa, IGF-IEb and IGF-IEc) in normal and cancerous tissues, implicating specific biological roles for the putative Ea, Eb, and Ec peptides, beyond IGF-I. Herein, we investigated the expression profile of IGF-IEa, IGF-IEb and IGF-IEc transcripts in bladder cancer and compared them with samples from the normal adjacent bladder tissue. MATERIALS AND METHODS: Biopsies from 46 patients (39 men and 7 women), aged 73.3±10.9 years, were analyzed for the expression of IGF-I transcripts using semi-quantitative real time-PCR (qRT-PCR). RESULTS: The presence of all three IGF-I transcripts was detected in both normal urothelium and bladder carcinomas. The relative expression of the IGF-IEa and IFG-IEb was marginally increased in bladder cancer tissues compared to normal tissue (p>0.05). In contrast, the expression of the IGF-IEc was significantly decreased in bladder cancer as compared to normal adjacent urothelium (p<0.05). This specific suppression of IGF-IEc expression was evident and positively correlated with the histological and/or clinical characteristics of an advanced disease, referring to clinical stage, tumor grade and disease recurrence (p<0.05); however, in situ carcinomas exhibited an increased expression of all IGF-I transcripts. CONCLUSION: Our data confirm the differential expression of IGF-I transcripts in bladder cancer, revealing a distinct suppression of IGF-IEc. These findings suggest that IGF-IEc expression and putative Ec product may possess discrete biological role in disease progression beyond IGF-I.

Symptomatic relief of patients with advanced bladder carcinoma after regional intra-arterial chemotherapy.

Thirty-two patients (30 men, 2 women), median age 68 years (range 47-85) with histologically confirmed advanced bladder carcinoma (Stages T3 and T4 according to the International Union Against Cancer staging system), who were poor surgical candidates, were prospectively treated with 1-6 (median 4) cycles of intra-arterial epirubicin (60 mg/cycle) delivered through two infusion pumps that were surgically implanted to each internal iliac artery, along with intravenous leucovorin 200 mg per day and 5-fluorouracil 750 mg per day for three consecutive days. Regional intra-arterial chemotherapy was well tolerated. There were 12 complete and 10 partial responses for an overall objective response rate of 69%. Eight patients had stable disease and 2 demonstrated progressive disease. All participating patients had gross hematuria prior to therapy. After the end of treatment, 24 out of 32 patients had resolution of their gross hematuria. Eight out of 15 patients with tumor-associated dysuria at the time of initiation of chemotherapy had significant pain relief at the end of the treatment. Regional intra-arterial chemotherapy is a safe and effective technique for patients with advanced, muscle invasive bladder carcinoma and can improve the quality of life of most affected patients by decreasing the degree of hematuria and dysuria associated with this malignancy.

Independent predictors of failure of shockwave lithotripsy for ureteral stones employing a second-generation lithotripter.

PURPOSE: To define factors associated with the failure of shockwave lithotripsy (SWL) in the treatment of ureteral stones. PATIENTS AND METHODS: We retrospectively studied 405 men and 283 women (mean age 52.6 years) who underwent SWL with a second-generation lithotripter in the period 1994 to 2001. We evaluated available clinical and radiologic features that might have been related to failure of SWL therapy. RESULTS: Treatment was successful in 502 patients (73%). The 186 patients (27%) in whom treatment failed underwent endourologic alternatives or open surgery. Multivariate logistic regression analysis revealed that unsuccessful outcome was significantly related to: (1) pelvic ureteral stones (odds ratio [OR] 4.02; 95% CI 1.97, 8.19); (2) stone size >10 mm (OR 3.46; 95% CI 2.16, 5.53); (3) obstruction (OR 1.93; 95% CI 0.99, 3.77); and (4) obesity (OR 1.87; 95% CI 0.95, 3.77). Although the predictive value of each individual parameter was relatively low (15.3%-27.9%) the cumulative risk was 82.95% when patients had all four features. The strongest independent predictors of failure were pelvic stones and stones >10 mm (cumulative predictive value 57.3%). CONCLUSIONS: These variables may enable identification of a subgroup of patients who will fail initial SWL. These patients may be candidates for endourologic alternatives as first-line treatment.

Giant ureteral stone in association with primary megaureter presenting as an acute abdomen.

A 20-year-old woman presented with abdominal pain of 4-h duration and of sudden onset. A plain abdominal radiograph showed a giant ureteral stone measuring 12 cm causing ureteral obstruction. Abdominal ultrasound revealed severe dilatation of the two upper thirds of the left ureter and a hydronephrotic ipsilateral kidney. Subsequent renal scan demonstrated that it was a non-functional kidney while the contralateral kidney was normal. A left nephroureterectomy was performed.

Membrane androgen binding sites are preferentially expressed in human prostate carcinoma cells.

BACKGROUND: Prostate cancer is one of the most frequent malignancies in males. Nevertheless, to this moment, there is no specific routine diagnostic marker to be used in clinical practice. Recently, the identification of a membrane testosterone binding site involved in the remodeling of actin cytoskeleton structures and PSA secretion, on LNCaP human prostate cancer cells has been reported. We have investigated whether this membrane testosterone binding component could be of value for the identification of prostate cancer. METHODS: Using a non-internalizable testosterone-BSA-FITC analog, proven to bind on membrane sites only in LNCaP cells, we have investigated the expression of membrane testosterone binding sites in a series of prostate carcinomas (n = 14), morphologically normal epithelia, taken from areas of the surgical specimens far from the location of the carcinomas (n = 8) and benign prostate hyperplasia epithelia (n = 10). Isolated epithelial cells were studied by flow cytometry, and touching preparations, after 10-min incubation. In addition, routine histological slides were assayed by confocal laser microscopy. RESULTS: We show that membrane testosterone binding sites are preferentially expressed in prostate carcinoma cells, while BPH and non-malignant epithelial cells show a low or absent binding. CONCLUSIONS: Our results indicate that membrane testosterone receptors might be of use for the rapid routine identification of prostate cancer, representing a new diagnostic marker of the disease.

Electrothermal bipolar coagulation for radical prostatectomies and cystectomies: a preliminary case-controlled study.

INTRODUCTION: Hemostasis is of utmost importance in urologic cancer surgery. The aim of this initial case-controlled study was to evaluate the use of an electrothermal biporal coagulator (Ligasure device) in major urologic procedures, including open radical prostatectomies and radical cystectomies. MATERIALS AND METHODS: Over the years 2001 to 2002, 58 patients aged 56-74 years (mean: 65 years) underwent open radical prostatectomies and open radical cystectomies performed by the same surgeon, employing either conventional ligation in the control group (radical prostatectomy, n = 15; radical cystectomy n = 9) or the Ligasure device in the study group (radical prostatectomy, n = 24; radical cystectomy n = 10) to ensure blood vessel patency. Effectiveness and postoperative outcomes were evaluated. RESULTS: The 2 groups were similar regarding demographic and clinical variables. The mean operation time was significantly shorter in the Ligasure group compared with the control group for both the prostatectomy (125 minutes vs. 144 minutes, p < 0.001) and the cystectomy procedures (253 minutes vs. 281 minutes, p < 0.001). The mean intra-operation blood loss was significantly lower in the Ligasure group compared with the control group for both prostatectomy (569 ml vs. 685 ml, p = 0.04) and cystectomy procedures (637 ml vs. 744 ml, p = 0.02). Intraoperative blood transfusion was only required in 2 patients (1 radical prostatectomy, 1 radical cystectomy) in the Ligasure group and in 7 patients in the control group respectively (p = 0.01). There was no effect of surgical specimen size on operation time for both prostatectomy (r = -0.03, p = 0.8, n = 39) and cystectomy procedures (r = 0.02, p = 0.9, n = 19). There were no serious intra-operation or postoperative complications related to the use of the Ligasure device. CONCLUSIONS: Ligasure radical prostatectomy and radical cystectomy are safe, and significantly decrease both the operation time and the blood loss, when compared to the conventional ligation method.

Spontaneous perirenal hemorrhage: a 10-year experience at our institution.

OBJECTIVE: To report our experience in patients with spontaneous perirenal hemorrhage (SPH) seen at our institution over a 10-year period. MATERIAL AND PATIENTS: Over the years from 1992 to 2002, 13 patients with SPH without a history of trauma, were treated at our hospital. There were 5 male and 8 female patients with a mean age of 55.7 years (range 36-79 years). The patients' records were reviewed retrospectively with respect to etiology, clinical presentation, radiologic findings and therapeutic management of SPH. RESULTS: All patients were presented with flank or abdominal pain. Radiological evaluation included ultrasonography (U/S) in 7 cases and computed tomography (CT) in 13 cases. An underlying renal mass was indentified employing U/S in 2 cases and using CT in 10 cases respectively. The etiology of SPH was determined in 12 cases. The most common causes were angiomyolipoma (5 patients) and renal cell carcinoma (4 patients). Out of the remaining 4 cases with SPH, one was associated with anticoagulant therapy; polyarteritis nodosa and Wegener angeitis were the underlying diseases in 2 cases respectively; finally, the etiology could not be determined in 1 case. All but two patients were managed surgically. Complete nephrectomy was performed in 6 cases, partial nephrectomy in 4 and simple evacuation of the haematoma was performed in 1 case. CONCLUSIONS: SPH presence should arouse suspicions concerning its etiology, since the most common cause is a renal tumor and approximately 50% of such tumors are malignant. CT scanning is a useful imaging modality for the initial evaluation of SPH, permitting identification of the underlying cause in most instances.

Linking pre-diabetes with benign prostate hyperplasia. IGFBP-3: a conductor of benign prostate hyperplasia development orchestra?

Benign prostatic hyperplasia (BPH) represents a pattern of non-malignant growth of prostatic fibromuscular stroma. Metabolic disturbances such us pre-diabetes and metabolic syndrome may have a role in BPH pathophysiology. A potential explanation for the above relationship involves the insulin-like growth factor (IGF) axis as well as IGF binding proteins, (IGFBPs) of which the most abundant form is IGFBP-3. Therefore, the aim of the present study was to investigate the association between intra-prostatic levels of IGF-1, IGF-2 as well as to evaluate the role of locally expressed IGFBP-3 in BPH development in pre-diabetes. A total of 49 patients admitted to the Urology department of a tertiary urban Greek hospital, for transurethral prostate resection, or prostatectomy and with pre-diabetes [impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) or both] were finally included. The majority of the sample consisted of subjects with IGT (51.0%), followed by IFG and IGT (32.7%) and isolated IFG (16.3%). For all participants a clinical examination was performed and blood samples were collected. In addition, total prostate (TP) volume or transitional zone (TZ) volume were estimated by transrectal ultrasonography. The results of the multivariate analysis regarding TP volume showed that higher PSA (p<0.001), larger waist circumference (p=0.007) and higher IGFBP-3 expression levels (p<0.001) independently predicted higher TP volume. The results regarding the volume of the TZ showed that higher PSA (p<0.001), larger waist circumference (p<0.001) and higher IGFBP-3 expression levels (p=0.024) were independently associated with higher TZ volume. Our findings show that intra-prostatic levels of IGFBP-3, PSA and waist circumference, but not overall obesity, are positively associated with prostate volume. IGFBP-3 seems to be a multifunctional protein, which can potentiate or inhibit IGF activity.

Statins and prostate cancer: molecular and clinical aspects.

The field of the potential applications of 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins) beyond their unambiguous cardiovascular beneficial effects is steadily increasing. In this regard, statins have also been shown to possess anti-inflammatory, immunomodulatory, antioxidant and growth inhibitory properties. Regarding their role in carcinogenesis, both preclinical and clinical studies report conflicting results. Intriguingly, accumulating evidence suggests that statins may relate to decreased prostate cancer incidence and recurrence risk. However, data from clinical studies seem to be still weak and are confounded by several factors. Nonetheless, preclinical data suggest that statins might exert a chemopreventive role against prostate cancer by inhibiting the proliferation and inducing apoptosis of prostate cancer cells and also inhibiting angiogenesis, inflammation and metastasis. Cholesterol lowering as well as statin pleiotropy through inhibition of the synthesis of isoprenoids have both been implicated in their anticancer properties. In this review, we discuss the preclinical and clinical evidence supporting the preventive or potentially harmful effects of statins on prostate tumourigenesis and conclude that statins should not be recommended for the prevention of prostate cancer development or progression based on the current data.

Environmental factors and genetic susceptibility promote urinary bladder cancer.

Cancer of the urinary bladder is the second most common malignancy of the genitourinary tract, currently accounting for up to 5% of all newly diagnosed tumours in the western world. Urinary bladder carcinogenesis seems to develop from the interaction of environmental exposure and genetic susceptibility. Smoking, specific industrial chemicals, dietary nitrates and arsenic represent the most important exogenous risk factors. Chromosomal abnormalities, silencing of certain genes by abnormal methylation of their promoter region, alterations in tumour suppressor genes and proto-oncogenes that induce uncontrolled cell proliferation and reduced apoptosis, are molecular mechanisms that have been reported in bladder carcinogenesis. In this article, we discuss the environmental risk factors of bladder cancer and we review the genetic and epigenetic alterations, including aberrant DNA methylation and deregulation of microRNAs expression. We also discuss the role of p53 and retinoblastoma suppressor genes in disease progression. Finally, we present recent reports on the use of molecular profiling to predict disease stage and grade and direct targeted therapy.

Urothelial carcinoma of the sarcomatoid variant in a young patient with spina bifida: a case report and review of the literature.

INTRODUCTION: Patients with neurogenic bladder due to spina bifida are considered to be at increased risk for aggressive bladder cancer. We present a unique case of a 32-year-old woman with spina bifida diagnosed with sarcomatoid urothelial carcinoma of the bladder and report diagnosis and management. CASE PRESENTATION: A 32 year old woman with neurogenic bladder managed with intermittent self catheterisations, presented with gross hematuria. On cystoscopy, she had a bulky bladder mass on the posterior bladder wall. Bladder biopsies revealed sarcomatoid variant of bladder transitional cell carcinoma. Treatment included radical cystectomy with ileal conduit diversion and adjuvant chemotherapy with excellent intermediate term follow up. CONCLUSION: Patents with neurogenic bladder managed with intermittent self catheterisations need periodical follow up due to increased risk for aggressive bladder cancer. Immediate radical cystectomy with adjuvant chemotherapy is the suggested treatment approach.

Predictive value of the bone markers osteocalcin and c-terminal telopeptide for jaw osteonecrosis in high-risk prostate cancer patients on bisphosphonate therapy: a prospective study / Valor predictivo de los marcadores oseos osteocalcina y telopéptido C terminal para la osteonecrosis mandibular en pacientes con cáncer de próstata (CaP) de alto riesgo bajo tratamiento con bifosfonatos: estudio prospectivo

OBJECTIVE: To examine the predictive value of osteocalcin (OC) and C-terminal telopeptide (CTX) levels for jaw osteonecrosis in high-risk prostate cancer (PCa) patients taking bisphosphonates (BPs). METHODS: Twenty-four patients were prospectively recruited in this study and followed from 2011 to 2015. All patients were diagnosed with metastatic PCa with secondary bone deposits and were on androgen deprivation therapy (ADT). All participants were started on 4 mg of zoledronic acid intravenously every 4 weeks for two years. The patients were reviewed every three months with full blood count, blood biochemistry, PSA and measurement of OC and CTX. Patients also underwent dental/oral examination. OC and CTX levels in serum were calculated using the ELISA method. RESULTS: A significant decrease in PSA levels was found (β= - 0.06, SE = 0.02, p = 0.006). The levels of OC (β = -0.46, SE = 0.14, p = 0.001) and CTX (β = -0.01, SE = 0.004, p = 0.007) also decreased significantly during the two years of follow up. Osteonecrosis of the jaw was identified in three patients at two years. Patients with osteonecrosis also showed a decrease in OC and CTX levels. The mean OC reduction was 77.3% for patients with osteonecrosis and 12.6% for patients without osteonecrosis. The mean CTX reduction was 44.1% for patients with osteonecrosis and 9.62% for patients without osteonecrosis. CONCLUSION: Our study demonstrated no clear association between the levels of serum OC and CTX and bisphosphonate-related osteonecrosis of the jaw (BRONJ). To date, there is no clinically useful biomarker for the prediction of jaw osteonecrosis. More studies are needed using different bone turnover markers in order to identify patients at risk for BRONJ

Objetivo: Examinar el valor predictivo de los niveles de osteocalcina (OC) y telopéptido C terminal (TCT) para la osteonecrosis mandibular en pacientes con cáncer de próstata de alto riesgo en tratamiento con bifosfonatos. Métodos: Veintidós pacientes fueron reclutados prospectivamente en este estudio y seguidos desde 2011 a 2015. Todos los pacientes tenían el diagnóstico de CaP de próstata de alto riesgo con depósitos óseos secundarios y seguían tratamiento de deprivación androgénica (TDA). Todos los pacientes comenzaron con 4 mg de ácido zolendrónico IV cada 4 semanas durante 2 años. Los pacientes siguieron revisiones cada tres meses con hemograma, bioquímica sanguínea, PSA y mediciones de OC y TCT. Los pacientes fueron sometidos a evaluación dental/oral. Los niveles de OC y TCT en suero fueron medidos utilizando un método de ELISA. Resultados: Se encontró un descenso significativo de los niveles de PSA (β = -0,06, SE = 0,02, p = 0,006). Los niveles de OC (β = -0,46, SE = 0,14, p = 0,001) y TCT β = -0,01, SE = 0,004, p = 0,007) también disminuyeron significativamente durante los dos años de seguimiento. Se identificó osteonecrosis en tres pacientes en dos años. Los pacientes con osteonecrosis de mandíbula en tres pacientes a los dos años. Los pacientes con osteonecrosis también mostraron un descenso de los niveles de OC y TCT. La reducción media de OC fue del 77,3% en los pacientes con osteonecrosis y 12,6% en los pacientes sin osteonecrosis. La reducción media de TCT fue del 44,1% en los pacientes con osteonecrosis y 9,62% en los pacientes sin osteonecrosis. Conclusiones: Nuestro estudio no demuestra una clara asociación entre los niveles séricos de OC y TCT y la osteonecrosis mandibular relacionada con bifosfonatos. Hasta la fecha, no hay un marcador clínico útil para la predicción de la osteonecrosis mandibular. Son necesarios más estudios utilizando diferentes marcadores de renovación ósea para identificar los pacientes en riesgo de osteonecrosis mandibular relacionada con bifosfonatos

The implication of initial 24-core transrectal prostate biopsy protocol on the detection of significant prostate cancer and high grade prostatic intraepithelial neoplasia

PURPOSE: To assess the diagnostic value of an initial 24-sample transrectal ultrasound guided (TRUS) prostate biopsy protocol compared to the 10-core technique. MATERIALS AND METHODS: We retrospectively reviewed the prostate biopsy database of consecutive men undergoing prostate biopsies under local anesthesia by using the 10 (Group A) and 24 (Group B) protocols. Men were stratified according to biopsy protocol and PSA levels. Exclusion criteria were age = 75 years and PSA > 20 ng/mL. The Mann-Whitney U and Fisher's exact test were used for statistical analysis. RESULTS: Between April 2007 and August 2009, 869 men underwent TRUS prostate biopsies of which 379 were eligible for the study. Group A (10-cores) consisted of 243 (64.11 percent) men and group B (24-cores) included 139 (35.89 percent) men. The overall prostate cancer detection rate was 39.09 percent and 34.55 percent in Group A and B, respectively (p = 0.43). An overall 9.8 percent increase in Gleason 7 detection rate was found in Group B (p = 0.24). The high-grade prostatic intraepithelial neoplasia (HGPIN) detection rate in men with negative initial biopsies was 15.54 percent and 35.55 percent in Group A and B, respectively (p < 0.001). In patients with PSA < 10 ng/mL, the 24-core technique increased Gleason 7 detection rate by 13.4 percent (p = 0.16) and HGPIN by 23.4 percent (p = 0.0008), compared to the 10 core technique. The 24-core technique increased the concordance between needle biopsy and prostatectomy specimen compared to 10-core technique (p < 0.002). CONCLUSIONS: The initial 24-core prostate biopsy protocol did not show any benefit in the detection of prostate cancer compared to the 10-core technique. However, it improved the HGPIN detection and the correlation between biopsy results and radical prostatectomy Gleason score in men with lower PSA levels.

Nephron-sparing surgery for localized renal cell carcinoma with a normal contralateral kidney: a European three-center experience.

OBJECTIVES: To assess the long-term effectiveness and safety of nephron-sparing surgery for the treatment of localized renal cell carcinoma with a normal contralateral kidney. METHODS: Since 1973, 118 patients have undergone nephron-sparing surgery for renal cell carcinoma on an elective basis at our institutions. The vast majority of these tumors were incidental findings, with a mean tumor diameter of 3.35 cm (range 0.7 to 5.6). The median follow-up was 8.5 years (range 0.5 to 18), and of those patients alive, 27 (28%) were followed up for more than 10 years. RESULTS: The pathologic stage was pT1N0M0 in 110 cases (93.2%) and pT3aN0M0 in 8 (6.7%); 59 were grade 1, 52 were grade 2, and 7 were grade 3. Complications occurred in 4 patients, including retroperitoneal bleeding in 1 treated by reoperation, urinomas in 2, and ureteral stricture in 1 treated conservatively. Renal function remained normal during the whole follow-up period, and slight proteinuria was observed in 13 patients. The 10-year distant and local recurrence rate was 4% and 3.9%, respectively. The cancer-specific 5, 10, and 15-year survival rate was 97.3%, 96.4%, and 96.4%, respectively. CONCLUSIONS: Our experience, based on a long median follow-up, suggests that nephron-sparing surgery on an elective basis can achieve long-term survival for the treatment of incidental and low-stage renal cell carcinomas without compromising the efficacy of cancer treatment.