Salvage robot-assisted partial nephrectomy for the management of renal cell carcinoma following failed stereotactic radiotherapy.

Nephron-sparing surgery is currently the standard of care for the management of small renal masses. While both neoadjuvant and adjuvant conventional external beam radiotherapy have failed to demonstrate an oncologic benefit for the treatment of renal cell carcinoma, more recent work aims to explore the utility of stereotactic radiotherapy. We present the case of a 70-year-old woman who failed primary treatment of a small renal mass with the CyberKnife radiotherapy system and describe her successful salvage treatment with robot-assisted partial nephrectomy. This case demonstrates the safety of robotic surgery for the management of renal tumors following failed stereotactic radiotherapy.

Intravesical methylene blue facilitates precise identification of the diverticular neck during robot-assisted laparoscopic bladder diverticulectomy.

BACKGROUND: The aim of this report is to describe our surgical technique for robot-assisted laparoscopic bladder diverticulectomy. In this technique, methylene blue is instilled into the bladder to aid in intra-abdominal identification of the diverticular neck. SUBJECTS AND METHODS: We retrospectively reviewed the records of patients who underwent robot-assisted bladder diverticulectomy by a single surgeon. RESULTS: Between September 2008 and January 2011, 5 patients successfully underwent robot-assisted laparoscopic bladder diverticulectomy using 1% intravesical methylene blue. All cases were completed without intraoperative complication or need for open conversion. Mean operative time was 216 minutes, with a mean estimated blood loss of 45 mL. Patients were discharged 1-2 days following surgery. No patient experienced a perioperative complication. CONCLUSIONS: The robot-assisted approach for bladder diverticulectomy is a viable alternative to both open and laparoscopic surgery. The use of intravesical methylene blue greatly aids in identification of the diverticular neck during this procedure.

Modified surgical technique for the management of renal cell carcinoma with level I or II tumor thrombus.

OBJECTIVE: To describe a modified open surgical technique for the resection of renal cell carcinoma with level I or II tumor thrombus. METHOD: In our modified technique, the renal artery is ligated early and the tumor thrombus is secured ahead of kidney mobilization by either milking into the renal vein or with extirpation from the inferior vena cava. We retrospectively studied patients who were managed with this technique. RESULTS: Between September 2006 and June 2010, 20 patients with a median age of 65 years underwent surgery for renal cell carcinoma with level I (n=15) or II (n=5) tumor thrombus using the modified technique. Median blood loss was 275 mL with 75% of patients requiring at least 1 transfused unit of blood. No case was complicated by an intraoperative tumor embolism. Following surgery, patients stayed a median of 5 days in the hospital and none experienced a perioperative complication. CONCLUSION: The described surgical technique allows for the safe and effective resection of renal cell carcinoma with level I or II tumor thrombus. This technique enables vascular control of the inferior vena cava with a minimal risk of tumor embolization.

Molecular characterization of kidney cancer: association of hyaluronic acid family with histological subtypes and metastasis.

BACKGROUND: Molecular profiling of renal cell carcinomas (RCCs) may improve the distinction between oncocytoma and malignant RCC subtypes and aid in early detection of metastasis. The hyaluronic acid (HA) family includes HA synthases (HAS1, HAS2, HAS3), hyaluronidases (HYAL-1, HYAL-2, HYAL-3, HYAL-4, PH20, HYAL-P1), and HA receptors (CD44s, CD44v, RHAMM). HA family members promote tumor growth and metastasis. The authors evaluated the expression of HA family members in kidney specimens. METHODS: By using quantitative polymerase chain reaction, mRNA levels of 12 HA family members were measured in tumor specimens obtained from 86 consecutive patients undergoing nephrectomy; 80 of them also provided normal specimens. Mean and median follow-up were 15.2 ± 8.8 and 13.8 months. RCC specimens included clear cell RCC: 65; papillary: 10; chromophobe: 5; oncocytoma: 6; metastasis positive: 17. RESULTS: Median HAS1, CD44s, and RHAMM transcript levels were elevated 3- to 25-fold in clear cell RCC and papillary and chromophobe tumors when compared with normal tissues. HYAL-4, CD44s, and RHAMM levels were elevated 4- to 12-fold in clear cell RCC and papillary tumors when compared with oncocytomas; only HYAL-4 levels distinguished between chromophobe and oncocytoma (P = .009). CD44s and RHAMM levels were significantly higher in tumors <4 cm (510 ± 611 and 19.6 ± 20.8, respectively) when compared with oncocytoma (46.4 ± 20 and 3.8 ± 2.5; P ≤ .006). In univariate and multivariate analyses, CD44s (P < .0001), RHAMM (P < .0001), stage, tumor size, and/or renal vein involvement were significantly associated with metastasis. The combined CD44s + RHAMM marker had 82% sensitivity and 86% specificity to predict metastasis. CONCLUSIONS: CD44s and RHAMM levels distinguish between oncocytoma and RCC subtypes regardless of tumor size and are potential predictors of RCC metastasis.

Budd-Chiari syndrome in urology: Impact on nephrectomy for advanced renal cell carcinoma.

OBJECTIVES: Budd-Chiari syndrome (BCS) is a poorly understood entity in urology. It results from obstruction of the hepatic veins and the subsequent complications. It has been infrequently reported to be secondary to hepatic venous obstruction from invasion by an inferior vena cava (IVC) tumor thrombus in renal cell carcinoma (RCC). We report the largest known series of patients with RCC and BCS. PATIENTS AND METHODS: Ten patients presented to a tertiary hospital with locally advanced RCC with IVC tumor thrombus. All were evaluated and had clinical or radiographic evidence of BCS. All underwent nephrectomy, IVC thrombectomy or ligation, and tumor removal from the hepatic veins. The perioperative and pathological factors were measured. These included estimated blood loss (EBL) and transfusions. Inpatient factors including duration of intubation, length of intensive care unit (ICU) stay, and overall length of stay (LOS) were recorded. The tumor-free status was evaluated. RESULTS: The average age was 59 years. No intraoperative deaths occurred. Two intraoperative complications were noted. The mean EBL was 4244 cc; mean surgery length was 8 hours 12 minutes; and the mean ICU stay was nine days. The overall LOS averaged 13.25 days. One patient died postoperatively of sepsis and multisystem organ failure. One patient required reoperation for an abdominal wall hematoma caused by subcutaneous enoxaparin administration. Average follow-up was 28 months. Five patients are alive with no evidence of disease. CONCLUSIONS: Budd-Chiari syndrome is a rare entity in urology, with a potential for significant morbidity and mortality. Surgical excision of the primary tumor along with thrombectomy results in alleviation of BCS and improvement in the patient.

Surgical resection of a virilizing adrenal mass with extensive tumor thrombus.

Adrenocortical carcinoma with tumor thrombus and concomitant testosterone production is a rare entity. We describe a case of a 53-year-old woman with a testosterone producing left-sided adrenocortical carcinoma with tumor extending to the right atrium and tumor embolus to the right pulmonary artery. To our knowledge, there exist no such reported cases in the medical literature. We describe our use of techniques derived from transplant surgery for the removal of this mass. Critical components for successful resection included early renal artery ligation, hepatic mobilization off the inferior vena cava, and minimization of cardiopulmonary bypass time thus eliminating the need for deep hypothermic circulatory arrest.

Liver transplantation techniques for the surgical management of renal cell carcinoma with tumor thrombus in the inferior vena cava: step-by-step description.

BACKGROUND: Renal cell carcinoma (RCC) with tumor thrombus in the inferior vena cava (IVC) poses a challenge to the surgeon given the operative difficulty, potential for massive hemorrhage, and possibility of tumor thromboemboli. OBJECTIVE: To determine the applicability of a self-developed technique based on orthotopic liver transplantation procedures for safe resection of these tumors. DESIGN, SETTING, AND PARTICIPANTS: From August 1997 to February 2008, 68 consecutive patients underwent resection of RCC with suprahepatic and/or retrohepatic (level 3 and 4) tumor thrombus in a single referral institution. SURGICAL PROCEDURE: A triradiate incision over the upper abdomen permits the placement of a Rochard retractor. Early vascular control of the renal artery is achieved by creating a posterior plane of dissection. Venous collateral decompression permits development of a bloodless anterior plane by mobilizing the liver in a "piggy-back" fashion and the spleen-pancreas en bloc to the midline. Thrombus extraction requires circumferential control at the renal veins, hepatic hilum, and IVC before cavotomy. The central tendon of the diaphragm may be opened for cranial control and gentle traction over the right atrium performed. Repositioning of the proximal clamp and Pringle release avoid veno-venous bypass and cardiopulmonary bypass (CPB) in most cases. MEASUREMENTS: The extent of the tumor thrombus was retrohepatic in 56 patients and suprahepatic/intra-atrial in 12 patients. RESULTS AND LIMITATIONS: Mean operative time was 5 h 32 min. Mean estimated blood loss (EBL) was 2112±3834 ml (range: 100-25 000), with a mean transfusion being 4.2±4.1 U (range: 0-30). Five patients (7.3%) required CPB. Three patients (4.4%) died in the immediate postoperative period. All had complete tumor resection. No patient developed intraoperative thromboembolism. CONCLUSIONS: This surgical approach provides excellent exposure and control of the IVC in cases with level 3 and 4 tumor thrombus, avoiding CPB except in rare circumstances.

Living donor nephrectomy: University of Miami technique and current results.

OBJECTIVES: Living-donor nephrectomy has significantly expanded the pool of renal transplant donors, allowing for a marked increase in transplantation. Improvements in antirejection medications and refinement of donor selection criteria have allowed for extremely favorable rates of graft survival. More recently, laparoscopic donor nephrectomy (LDN) has significantly reduced the morbidity of renal transplantation in the donor population. The University of Miami/Jackson Memorial Hospital Transplant Center performs a large number of living-donor nephrectomies, with increasing use of LDN and here we report our cumulative experience. METHODS: A retrospective review was performed of all live donor nephrectomies performed over the last 10 years, including LDN. Surgical complications, both minor and major, were ascertained. Conversion from LDN to open was similarly noted. Follow up, including creatinine one year post-transplant was recorded in open donor nephrectomy (ODN) and LDN groups. RESULTS: Over 10 years, 413 live donor nephrectomies were performed. Of these, 257 were LDN, and 156 were ODN. In two cases, LDN was converted to ODN. Three patients needed reoperation after donor nephrectomy. There were no perioperative mortalities or deep venous thrombosis. Minor complications, including hernia, fever, and C. difficile diarrhea were very rare, the most common being testicular pain in eight patients. CONCLUSION: Our extensive experience with living donor nephrectomy, with 413 cases spanning ten years, has been very favorable. The risk of major complications was extremely low, with six reported in the series. Minor complications were similarly rare. Living donor nephrectomy is a safe and feasible method of increasing the number of renal transplantation donors with minimal morbidity.

Nefrectomía del donante vivo: técnica de la Universidad de Miami y resultados actuales / Living donor nephrectomy: university of Miami technique and current results

OBJETIVO: La nefrectomía del donante vivo ha aumentado significativamente el fondo de donantes para trasplante renal, permitiendo un incremento marcado de los trasplantes. Las mejorías de la medicación contra el rechazo y el refinamiento de los criterios de selección del donante han permitido unas tasas de supervivencia del injerto extremadamente favorables. Más recientemente, la nefrectomía laparoscópica del donante vivo (NLDV) ha reducido significativamente la morbilidad en la población de donantes. La Universidad de Miami/Centro de Trasplantes del Hospital Jackson Memorial ha realizado un gran número de nefrectomías del donante vivo, con un aumento de la utilización de la nefrectomía laparoscópica del donante vivo y en el presente artículo comunicamos nuestra experiencia acumulada.MÉTODOS: Realizamos una revisión retrospectiva de todas las nefrectomías del donante vivo realiza las durante los últimos diez años, incluyendo las nefrectomías laparoscópicas. Se recogieron las complicaciones quirúrgicas, tanto menores como graves. También se registraron las conversiones de laparoscopia cirugía abierta. Se revisó el seguimiento, incluyendo las creatininas al año del trasplante en los grupos de nefrectomía abierta del donante y laparoscópica.RESULTADOS: Se han realizado 413 nefrectomías del donante vivo durante diez años. De éstas, 257 fueron laparoscópicas y 156 abiertas. En dos casos, la nefrectomía laparoscópica fue convertida a abierta. Tres donantes necesitaron de intervención después de la nefrectomía. No hubo ninguna muerte perioperatoria ni trombosis venosa profundas. Las complicaciones menores, incluyendo hernia, fiebre y diarrea por C.difficile fueron muy raras, siendo la más frecuente el dolor testicular en ocho casos(AU)

CONCLUSIONES: Nuestra amplia experiencia en nefrectomía del donante vivo, con 413 casos a lo largo de diez años, ha sido muy favorable. El riesgo de complicaciones graves fue extremadamente bajo, con seis casos comunicados en esta serie. Las complicaciones menores también fueron raras. La nefrectomía del donante vivo es un método seguro y factible de aumentar el número de donantes para trasplante renal con mínima morbilidad(AU)

OBJECTIVES: Living-donor nephrectomy has significantly expanded the pool of renal transplant donors, allowing for a marked increase in transplantation. Improvements in antirejection medications and refinement of donor selection criteria have allowed for extremely favorable rates of graft survival. More recently, laparoscopic donor nephrectomy (LDN) has significantly reduced the morbidity of renal transplantation in the donor population. The University of Miami/Jackson Memorial Hospital Transplant Center performs a large number of living-donor nephrectomies, with increasing use of LDN and here we report our cumulative experience.METHODS: A retrospective review was performed of all live donor nephrectomies performed over the last 10 years, including LDN. Surgical complications, both minor and major, were ascertained. Conversion from LDN to open was similarly noted. Follow up, including creatinine one year post-transplant was recorded in open donor nephrectomy (ODN) and LDN groups.RESULTS: Over 10 years, 413 live donor nephrectomies were performed. Of these, 257 were LDN, and 156 were ODN. In two cases, LDN was converted to ODN. Three patients needed reoperation after donor nephrectomy. There were no perioperative mortalities or deep venous thrombosis. Minor complications, including hernia, fever, and C. difficile diarrhea were very rare, the most common being testicular pain in eight patients.CONCLUSION: Our extensive experience with living donor nephrectomy, with 413 cases spanning ten years, has been very favorable. The risk of major complications was extremely low, with six reported in the series. Minor complications were similarly rare. Living donor nephrectomy is a safe and feasible method of increasing the number of renal transplantation donors with minimal morbidity(AU)

Antitumor activity of hyaluronic acid synthesis inhibitor 4-methylumbelliferone in prostate cancer cells.

4-Methylumbelliferone (4-MU) is a hyaluronic acid (HA) synthesis inhibitor with anticancer properties; the mechanism of its anticancer effects is unknown. We evaluated the effects of 4-MU on prostate cancer cells. 4-MU inhibited proliferation, motility, and invasion of DU145, PC3-ML, LNCaP, C4-2B, and/or LAPC-4 cells. At IC(50) for HA synthesis (0.4 mmol/L), 4-MU induced >3-fold apoptosis in prostate cancer cells, which could be prevented by the addition of HA. 4-MU induced caspase-8, caspase-9, and caspase-3 activation, PARP cleavage, upregulation of Fas-L, Fas, FADD and DR4, and downregulation of bcl-2, phosphorylated bad, bcl-XL, phosphorylated Akt, phosphorylated IKB, phosphorylated ErbB2, and phosphorylated epidermal growth factor receptor. At IC(50), 4-MU also caused >90% inhibition of NF-kappaB reporter activity, which was prevented partially by the addition of HA. With the exception of caveolin-1, HA reversed the 4-MU-induced downregulation of HA receptors (CD44 and RHAMM), matrix-degrading enzymes (MMP-2 and MMP-9), interleukin-8, and chemokine receptors (CXCR1, CXCR4, and CXCR7) at the protein and mRNA levels. Expression of myristoylated-Akt rescued 4-MU-induced apoptosis and inhibition of cell growth and interleukin-8, RHAMM, HAS2, CD44, and MMP-9 expression. Oral administration of 4-MU significantly decreased PC3-ML tumor growth (>3-fold) when treatment was started either on the day of tumor cell injection or after the tumors became palpable, without organ toxicity, changes in serum chemistry, or body weight. Tumors from 4-MU-treated animals showed reduced microvessel density ( approximately 3-fold) and HA expression but increased terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling-positive cells and expression of apoptosis-related molecules. Therefore, the anticancer effects of 4-MU, an orally bioavailable and relatively nontoxic agent, are primarily mediated by inhibition of HA signaling.

Surgical technique of removal of inferior vena cava leiomyosarcoma extending into the right atrium without deep hypothermic circulatory arrest.

BACKGROUND: Leiomyosarcoma of the inferior vena cava is a rare tumor with potential for significant morbidity and mortality. Surgical extirpiration remains the optimal treatment choice. A case of caval leiomyosarcoma with right atrial extension is presented with management techniques and literature review. METHODS: A 54 year old woman with constitutional symptoms was found to have advanced caval leiomyosarcoma with atrial extension. Surgical excision was performed without deep hypothermic circulatory arrest (DHCA), including right nephrectomy, adrenalectomy, and en-bloc resection of the vena cava along with Gore-Tex interposition graft. RESULTS: There were no operative complications. The patient was extubated on postoperative day one. Renal function remained normal. Final pathology was high grade leiomyosarcoma. Margins were negative. The patient is well at latest follow up. CONCLUSION: Resection of extensive caval leiomyosarcoma allows the best chance of cure and is possible without DHCA. Perioperative planning and coordination and adherence to oncologic techniques is critical.

Renal carcinoma with supradiaphragmatic tumor thrombus: avoiding sternotomy and cardiopulmonary bypass.

BACKGROUND: Renal cell carcinoma with tumor thrombus extension into the inferior vena cava (IVC) is rare. Surgical resection provides the only reasonable chance for cure, but the approach poses a challenge to the surgical team. We describe our technique to safely resect these tumors through a transabdominal incision that exposes the intrapericardial IVC and right atrium (RA) transdiaphragmatically, without the use of sternotomy, cardiopulmonary bypass (CBP), or deep hypothermic circulatory arrest (DHCA). Clinical outcomes of these patients and techniques are reported. METHODS: Between May 1997 and January 2009, 102 patients (mean age, 63 years) underwent resection of renal tumor extending into the IVC by techniques developed to avoid sternotomy and CBP. The tumor thrombus in 12 patients (13%) extended into the supradiaphragmatic IVC and RA. RESULTS: Complete resection was successful through the transabdominal approach without CBP in all patients. Mean operative time was 8 hours 15 minutes. Estimated blood loss was 2960 mL, and a mean of 9 U of blood was transfused. Two patients died postoperatively, 1 on day 4 of arrhythmia and 1 on day 22 of multisystem organ failure. All discharged patients were alive at the last follow-up. Three patients had tumor recurrence and have been referred for adjuvant therapy. CONCLUSIONS: In select cases, renal cell carcinoma extending into the IVC to the intrapericardial level and RA can be resected without sternotomy, CBP, or DHCA.

Novel management of complicated renal artery aneurysm: laparoscopic nephrectomy and ex-vivo repair with heterotopic autotransplant.

BACKGROUND AND PURPOSE: Renal artery aneurysm (RAA) is an infrequently seen disease entity but one with the potential for significant morbidity and mortality. Complications related to RAA include pain, hematuria, hypertension, and, rarely, rupture. Management is often based on symptomatology or, if symptoms are not present, the potential for rupture with increased size. Treatment options include observation, endovascular methods, or open surgical approaches, including aneurysm repair or nephrectomy. Complex cases often preclude endovascular approaches. We report our initial experience with laparoscopic nephrectomy, ex vivo back-table repair of the aneurysm, and iliac fossa autotransplant in cases of complex RAA. PATIENTS AND METHODS: Two patients underwent laparoscopic nephrectomy with RAA repair and heterotopic autotransplant from May 2006 to November 2008. Etiology of the RAA was atherosclerosis in one patient and idiopathic in the second. Laparoscopic nephrectomy and back-table arterial reconstruction was performed, including aneurysmectomy and ostial closure. Patient 2 needed a gonadal vein graft for arterial reconstruction. Both patients had autotransplant into the right iliac fossa. RESULTS: Both patients were women. Mean age was 52.5 years (range 39-66 yrs). Mean operative blood loss was 550 mL (range 350-750 mL). Mean length of stay was 5.5 days (range 5-6 d). Mean discharge creatinine level was 0.8 mg/dL (range 0.5-1.1 mg/dL). No perioperative complications were reported. At last follow-up, all patients are alive with functioning autotransplant and no evidence of functional impairment. CONCLUSION: Management of complex RAA with laparoscopic nephrectomy, extracorporeal repair, and autotransplant is a feasible and successful method with minimal morbidity.

Techniques for avoidance of sternotomy and cardiopulmonary bypass during resection of extensive renal cell carcinoma with vena caval tumor thrombus extension above the diaphragm.

Renal cell carcinoma (RCC) is a commonly encountered malignancy in urology. Extensive RCC may frequently invade the renal vein and the inferior vena cava (IVC). In advanced cases, this tumor thrombus may grow cephalad up to the level of the right atrium. The mainstay of surgical treatment for such lesions remains resection of all possible tumor burden. Current techniques for resection of supradiaphragmatic RCC tumor thrombus in the IVC incorporate cardiopulmonary bypass (CBP) with deep hypothermic circulatory arrest, especially in cases where the thrombus reaches the right atrium. We report a safe technique using a transabdominal approach to such lesions that allows exposure to the level of the intrapericardial IVC and right atrium permitting safe resection of the tumor thrombus without median sternotomy, CBP, or deep hypothermic circulatory arrest.

Potential new urinary markers in the early detection of bladder cancer.

PURPOSE OF REVIEW: Bladder cancer remains a highly prevalent and lethal malignancy. Early diagnosis and prompt treatment have been shown to improve survival at both initial diagnosis and recurrence. A vast number of tumor markers have been identified and rigorously evaluated in attempts to improve noninvasive diagnostic accuracy of bladder cancer. Hematuria was the first tumor marker in a field that has grown to include soluble markers, cell-surface antigens, cell-cycle-related proteins, and genetic alterations. We aim to provide a critical appraisal of newer markers and the current state of research. RECENT FINDINGS: The number of tumor markers identified has been exponentially increasing. For a variety of reasons, many are unsuitable for clinical practice. More promising recent markers include those discovered in the fields of genomics, proteomics, and epigenetics. Much of the recent work is focused on molecular genetic pathways in bladder cancer. SUMMARY: The field of bladder cancer tumor markers remains a rapidly evolving area in which newer markers are constantly identified, evaluated, and often discarded if they do not add significantly to the urologists' armamentarium. Newer markers rely on genetic rearrangements, molecular changes, and cell-cycle-related proteins. Work is currently being done to identify the most promising markers.

Vascular stapling of the inferior vena cava: further refinement of techniques for the excision of extensive renal cell carcinoma with unresectable vena-caval involvement.

OBJECTIVES: To present our experience with a novel technique of tumor removal: en bloc resection of the tumor, thrombus, and inferior vena cava (IVC) via vascular staple ligation and excision, and to excise all tumor, which may include a portion of the IVC when invasion is present. Management of renal cell carcinoma (RCC) with IVC thrombus presents a challenge. Options for tumor excision include thrombectomy with or without cardiopulmonary bypass, replacement of the cava with synthetic or venous graft, or caval excision without replacement. METHODS: Six patients with extensive RCC with IVC thrombus were evaluated. All patients underwent preoperative imaging that depicted completely obstructing IVC thrombus of varying cranial extension with apparent invasion of the caval wall. None had lower extremity edema. Patients underwent IVC staple ligation and en bloc resection of tumor and thrombus. Pre-, intra-, and postoperative as well as pathological factors were measured. These included estimated blood loss, transfusions, and procedure length. Inpatient factors including duration of intubation, length of intensive care unit stay, and overall length of stay were recorded. Tumor-free status was evaluated. RESULTS: All patients had Fuhrman Grade 4 RCC. No perioperative deaths occurred. Mean estimated blood loss was 6350 mL (range 900-25 000). Length of intubation averaged 1.5 days. Mean intensive care unit stay was 4.3 days. Overall length of stay averaged 9.3 days. CONCLUSIONS: Complete excision of a portion of the IVC, using a vascular stapler in conjunction with radical nephrectomy is a satisfactory method to remove RCC with IVC invasion. Sufficient collateral circulation exists for venous return from the lower extremities.

The risk and prophylactic management of bladder cancer after various forms of radiotherapy.

PURPOSE OF REVIEW: Prostate cancer is the most common cancer diagnosed in men and remains the second most lethal malignancy. Most patients undergoing treatment elect for radical prostatectomy or radiation. As the number of patients treated has increased and survival improved, delayed complications of these modalities has assumed increased importance. Recent studies report an increased risk of certain cancers after radiation for prostate cancer. This review aims to summarize recent data. RECENT FINDINGS: Recent studies have confirmed the association of prostate radiation with secondary cancers. The most common secondary malignancy is bladder carcinoma. We have treated 44 patients with bladder cancer who had radiation therapy for prostate cancer. At diagnosis, 60% had tumor, which invaded the bladder muscle (T2 or greater disease). The mean latency from radiation to diagnosis of bladder cancer was 5.5 years. SUMMARY: Radiation therapy for prostate cancer is associated with an increased risk of bladder cancer. In our series, patients presented at higher stage than expected from population-based studies of bladder cancer. Patients and their physicians should be aware of such risks when choosing therapy for prostate cancer. Hematuria following radiation therapy for prostate cancer should be investigated rather than being attributed to radiation-induced cystitis.