NCCN Guidelines® Insights: Prostate Cancer, Version 3.2024.

The NCCN Guidelines for Prostate Cancer include recommendations for staging and risk assessment after a prostate cancer diagnosis and for the care of patients with localized, regional, recurrent, and metastatic disease. These NCCN Guidelines Insights summarize the panel's discussions for the 2024 update to the guidelines with regard to initial risk stratification, initial management of very-low-risk disease, and the treatment of nonmetastatic recurrence.

Effect of utilization of veno-venous bypass vs. cardiopulmonary bypass on complications for high level inferior vena cava tumor thrombectomy and concomitant radical nephrectomy

ABSTRACT Purpose: To determine if patients with renal cell carcinoma (RCC) with levels III and IV tumor thrombi are receive any reduction in complication rate utilizing veno-venous bypass (VVB) over cardiopulmonary bypass (CPB) for high level (III/IV) inferior vena cava (IVC) tumor thrombectomy and concomitant radical nephrectomy. Materials and Methods: From May 1990 to August 2011, we reviewed 21 patients that had been treated for RCC with radical nephrectomy and concomitant IVC thrombectomy employing either CPB (n =16) or VVB (n=5). We retrospectively reviewed our study population for complication rates and perioperative characteristics. Results: Our results are reported using the validated Dindo-Clavien Classification system comparing the VVB and CPB cohorts. No significant difference was noted in minor complication rate (60.0% versus 68.7%, P=1.0), major complication rate (40.0% versus 31.3%, P=1.0), or overall complication rate (60.0% versus 62.5%, P=1.0) comparing VVB versus CPB. We also demonstrated a trend towards decreased time on bypass (P=0.09) in the VVB cohort. Conclusion: The use of VVB over CPB provides no decrease in minor, major, or overall complication rate. The use of VVB however, can be employed on an individualized basis with final decision on vascular bypass selection left to the discretion of the surgeon based on specifics of the individual case.

Criocirugía en cáncer de próstata: una revisión exhaustiva / Cryosurgery for prostate cancer: A comprehensive review

OBJETIVO: La criocirugía del cáncer de próstata ha evolucionado hasta convertirse en un tratamiento alternativo razonable para el cáncer de próstata localizado. La llegada de la tercera generación de máquinas y crio sondas más pequeñas junto con mejores técnicas de imagen permiten un tratamiento preciso de la próstata en el escenario principal, de rescate y focal. MÉTODOS: Se llevó a cabo una revisión exhaustiva de la literatura desde 1980 a enero de 2013 buscando en la base de datos Medline. Se extrajo información con respecto a los resultados oncológicos y funcionales. RESULTADOS: Los resultados de la criocirugía han mejorado con el tiempo, con tasas de supervivencia libre de enfermedad bioquímica ahora comparables con otras modalidades de tratamiento. Inicialmente descrita en el contexto de rescate tras la radioterapia, la tecnología se amplió posteriormente como tratamiento primario y, más recientemente, para la terapia focal. Con la introducción del sistema de criocirugía de tercera generación y mejores modalidades de imágen, la morbilidad relacionada con el tratamiento ha disminuido. CONCLUSIONES: Los resultados oncológicos y funcionales han mejorado y está aumentando el uso de la técnica. Los criterios de inclusión y protocolos de seguimiento todavía necesitan de estudios prospectivos para establecer la eficacia del procedimiento en comparación con las opciones establecidas de manejo local (AU)

OBJECTIVES: Cryosurgery for prostate cancer has evolved to become a reasonable treatment alternative for localized prostate cancer. The advent of third-generation machines and smaller cryoprobes together with better imaging modalities allows for precise treatment of the prostate in the primary, salvage and focal setting. METHODS: A comprehensive review of the literature was performed from 1980 to January 2013 searching the Medline database. Information was extracted regarding oncologic and functional outcomes. RESULTS: The outcomes of cryosurgery improved over time with intermediate biochemical disease free survival rates now comparable to other treatment modalities. Initially reported in the salvage setting after radiation therapy, the technology was subsequently expanded as primary treatment and more recently for focal therapy. With introduction of the third-generation cryosurgery system and better imaging modalities, the treatment related morbidities have decreased. CONCLUSIONS: Oncologic and functional outcomes have improved and the procedure is increasing in use. Variable inclusion criteria and follow-up protocols still call for prospective studies to establish the efficacy of the procedure as compared to established local management options (AU)

Carcinoma urotelial infantil / Urothelial carcinoma in a child

OBJETIVO: El carcinoma urotelial de vejigaocurre raramente en las primeras 2 décadas de lavida. Presentamos el caso de un niño de 12 años quepresentó un carcinoma urotelial Ta grado II/III.MÉTODOS: Describimos la presentación clínica y elproceso de diagnóstico, asi como el tratamiento yseguimiento. Finalmente, revisamos la literatura paraanalizar la etiología, tratamiento, y seguimiento del carcinomaurotelial en la población pediátrica.RESULTADOS: Desde 1950, existen menos de 100casos de carcinoma urotelial reportados en pacientesmenores de 30 años, y mucho menos en niños y adolecentes.La mayoría de las pequeñas series describenestos tumors como de caracteristicas superficiales y debajo grado (I-II). Este niño presentó una hematuria asintomática y una resonancia magnética descubrió unamasa sólida y papilar que medía 2.7 cm. La cistoscopíay resección del tumor confirmó el diagnóstico. Unasegunda resección 2 meses después confirmó que noexistía tumor residual.CONCLUSIONES: No existen normas establecidasacerca de la etiología, tratamiento, y seguimiento delcarcinoma urotelial en pacientes pediátricos. Niñoscon hematuria macroscópica como síntoma principaldeberían ser sometidos a una evaluación completapara descartar la presencia de un carcinoma urotelial

OBJECTIVES: Urothelial carcinoma of ;;the bladder occurs rarely in the first 2 decades of life. ;;We report a case of a 12 year-old child that presented ;;with a Ta grade II/III urothelial carcinoma of the bladder. ;;METHODS: We describe its clinical presentation and ;;diagnostic procedures as well as treatment and followup. ;;Finally, we review the literature to analyze the etiology, ;;treatment, and surveillance of urothelial carcinoma in ;;the pediatric population. ;;RESULTS: Since 1950, there are less than 100 cases ;;of urothelial carcinoma reported in patients less than 30 ;;years, and even less in children and adolescents. Most ;;of the small series describe these tumors as being ;;characteristically superficial and low grade (I-II). This ;;child presented with silent macroscopic hematuria and ;;an MRI revealed a solid and papillary mass measuring ;;2.7 cm. A cystoscopy and resection of the tumor ;;confirmed the diagnosis. A re-resection at two months ;;confirmed no residual tumor in the bladder. ;;CONCLUSIONS: There is no established criteria for the ;;etiology, treatment, and surveillance of urothelial ;;carcinoma in the pediatric population. Children with ;;gross hematuria as the presenting complaint should ;;undergo a complete evaluation to rule out the presence ;;of urothelial carcinoma