Active surveillance in prostate cancer: a critical review.

The aim of this paper was to examine the eligibility criteria, surveillance protocols and oncological outcomes of published active surveillance (AS) series. We also assessed the evidence for utility of novel tools for optimal risk stratification and surveillance of men suitable for AS. A non-systematic literature search of the Medline, Embase, and Scopus databases was performed in April 2015 using medical subject headings and free-text protocol. The search was conducted by applying free-text protocol with the following search terms: "active surveillance", "prostate cancer", "prostatic neoplasm", "watchful waiting", "low risk prostate cancer" and "very low risk prostate cancer". The definition of insignificant disease remains debatable as criteria for patient selection vary among studies. Tools for better selection of candidates and monitoring of the disease process have evolved since the conception of AS, including new biomarkers like phi, mpMRI and alternate biopsy strategies. AS is a sound strategy for reducing overtreatment of men with low-risk, and potentially selected men with intermediate-risk prostate cancer and shorter life expectancy, without compromising overall and cancer specific survival. More data are needed on the optimal integration of the new tools on AS paradigms and on the long-term health impact of AS in different populations.

Bladder papilloma in a 9-year-old girl: a case report.

Transitional cell carcinoma of the bladder is a rare entity in childhood. We report on a 9-year-old girl with transitional cell carcinoma of the bladder who presented with gross hematuria. Ultrasonography revealed a papillary lesion in the bladder, and the diagnosis was confirmed by cistoscopy. Complete transurethral resection of the lesion was performed and follow-up with urine cytology, vesical ultrasound and transurethral cystoscopy at 4 years showed no evidence of recurrence.

Health related quality of life after radical cystectomy: comparison of ileal conduit to continent orthotopic neobladder.

AIMS: To compare health related quality of life (HRQOL) between patients with two different types of urinary diversion, ileal conduit and orthotopic neobladder, and between them and an age-matched population of healthy subjects. MATERIALS AND METHODS: Eighty eight patients treated with radical cystectomy for bladder cancer at our institutions between 2002 and 2007 were contacted for this survey. All of them had a follow-up of more than 12 months after surgery and were recurrence free. The SF-36 questionnaire was provided to each patient during a follow-up visit at outpatient clinics. Overall, 79 patients (90%) returned the questionnaire and were included in this analysis. They were divided into two groups: group 1 comprised 44 patients with an ileal conduit diversion, and group 2 included 35 patients with a neobladder. As a control, normative values of an age-matched healthy Italian population were considered. RESULTS: No significant difference was found in scale scores between the neobladder and ileal conduit groups. Scale scores for role-physical functioning, social functioning and role-emotional functioning in both the neobladder and ileal conduit groups were significantly below the Italian population norm. Patients with a neobladder 65 years old or older (n=18) had significantly lower scores for role-physical functioning and role-emotional functioning than those younger than 65 years (n=17; p<0.05). CONCLUSION: Few differences between ileal conduit and orthotopic bladder substitution have been detected. Thus, the assumption that continent reconstruction provides better HRQOL than ileal conduit diversion cannot be supported. Patient education and active participation in treatment decisions seem to be the key to postoperative satisfaction.

Prulifloxacin versus levofloxacin in the treatment of chronic bacterial prostatitis: a prospective, randomized, double-blind trial.

Ninety-six patients with chronic bacterial prostatitis (CBP) and evidence of infection were randomized to receive a 4-week oral course of either prulifloxacin (a new fluoroquinolone) 600 mg or levofloxacin 500 mg once daily. They were evaluated with the Meares-Stamey test and the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) at baseline and one week after therapy completion. Patients with microbiological eradication were evaluated again with the Meares-Stamey test 6 months after therapy completion. The microbiological eradication rate was 72.73% for prulifloxacin and 71.11% for levofloxacin (p=0.86) and the reduction in the NIH-CPSI was 10.75 and 10.73, respectively (p=0.98). Safety was comparable, with 18.18% adverse events for prulifloxacin and 22.22% for levofloxacin (p=0.79). Thus, a 4-week course of prulifloxacin 600 mg once daily is at least as effective and safe as levofloxacin 500 mg once daily in the treatment of CBP.

Testicular metastasis as isolated recurrence after radical prostatectomy. A first case.

Prostate cancer synchronously or metachronously metastasizing to the testis is a rare finding. We herein report on the first case of a solitary testicular metastasis from an organ-confined prostate cancer, diagnosed 6 months after a radical prostatectomy, without evidence of previous or concomitant biochemical and local recurrence.

Cytomegalovirus and BK-Virus co-infection of a clinically non-functioning adrenal adenoma: innocent bystanders or new pathogenetic agents?

We report a case of a 64-year-old woman who underwent left adrenalectomy with removal of a 8,5 cm clinically non-functioning adrenocortical adenoma and a 4-cm myelolipoma. Molecular testing for viral infection demonstrated the presence of cytomegalovirus (CMV) DNA sequences in the adrenal adenoma, but not in the myelolipoma (confirmed by immunohistochemistry). Moreover, the adrenal adenoma was also positive for parvovirus B19, and both adrenal tumor samples were positive for polyomavirus BK (BKV) and adenovirus DNA sequences. This is the first report of co-infection of an adrenocortical adenoma by CMV and BKV. The role of these viruses in adrenal tumorigenesis was postulated.

Ninth commandment: 'Thou shalt not covet thy neighbor's wife!' Penetrating trauma to the corpora cavernosa caused by gunshot.

We describe a case of gunshot wound to the corpora cavernosa caused by a low-velocity bullet in a 43-year-old man. He volunteered that his lover's husband shot him with a handgun. The bullet had penetrated the right gluteal region with no exit wound causing a right corpus cavernosum lesion. A penile colour-duplex doppler ultrasonography did not reveal injuries of the cavernosal arteries or altered peak diastolic and systolic values. A three-dimensional computed tomography study corfirmed the presence of the bullet at the root of the right corpus cavernosum and allowed to identify the curvilinear ballistic trajectory, confirming a low-velocity penetrating bullet. The patient underwent exploratory surgery with removal of the bullet and primary repair of the identified unilateral albuginea rupture. The bullet, passing through clothing, probably slowed down causing less than expected harm. The follow-up visit after 2 months showed that the penile girth was not narrowed by such a repair. With a 2-year follow-up the patient has a normal penile ultrasound morphology and a normal sexual activity.

Surgical management of isolated bilateral adrenal metastases from colon carcinoma causing adrenal insufficiency.

Adrenal insufficiency due to histologically proven bilateral metastatic adrenal involvement from colon cancer has been clinically reported only twice. Surgical treatment of bilateral adrenal metastases is seldom performed, since other metastatic localizations are usually concomitant. To the best of our knowledge, we report the first case of relatively long-term disease-free survival after bilateral adrenalectomy in a patient with adrenal insufficiency due to bilateral metastases from colon carcinoma.

Evidence for elevated telomerase activity in small cell carcinoma of the bladder.

Telomerase activity was found to be elevated using a quantitative assay on snap-frozen protein extracts of exfoliated cells in urine and bladder washings and tumor tissue obtained from a male patient with small cell carcinoma of the bladder. To the best of our knowledge, this is the first demonstration of elevated values of telomerase activity in genitourinary small cell carcinoma and is in keeping with the findings in primary lung locations.