Excision of the seminal vesicles for locally advanced and recurrent rectal and sigmoid cancer.

BACKGROUND: This study aims to define the clinical and oncological outcome of 'en-bloc' excision of the seminal vesicles for locally advanced and recurrent tumours of the sigmoid and rectum. METHODS: Eight patients were identified from a prospective colorectal cancer database at a tertiary centre as having undergone excision of the seminal vesicles in continuity with a locally advanced or recurrent sigmoid or rectal adenocarcinoma. The presentation, operative details, histopathology, oncological outcome and morbidity of the procedure were assessed. RESULTS: Three patients were referred with recurrent tumours related to an anastomosis and five had a locally advanced sigmoid or rectal cancer. The need for resection of the seminal vesicles was determined from the preoperative pelvic magnetic resonance imaging scan or from an intraoperative finding of loss of the plane of dissection anterior to Denonvilliers' fascia. Restorative resection was achieved in all three patients where the primary tumour was located in the sigmoid or rectosigmoid, while all five patients with a rectal tumour had a permanent stoma. After a median follow-up of 43 months, seven patients are alive and disease-free and one patient has died of distant metastases. No patient has suffered a local recurrence. All five patients who were sexually active before surgery suffered from post-operative impotence. Two patients had temporary urinary retention with overflow. CONCLUSIONS: In carefully selected patients with locally advanced or recurrent rectal and sigmoid cancers that are attached to the seminal vesicles, en-bloc excision confers excellent local control but is associated with a high rate of sexual morbidity.

Patterns of failure after iodine-125 seed implantation for prostate cancer.

PURPOSE: To determine the site of relapse when biochemical failure (BF) occurs after iodine-125 seed implantation for prostate cancer. MATERIALS AND METHODS: From 2001-2009, 500 men underwent implantation in Wellington, New Zealand. Men who sustained BF were placed on relapse guidelines that delayed restaging and intervention until the prostate-specific antigen (PSA) was ⩾20 ng/mL. RESULTS: Most implants (86%) had a prostate D90 of ⩾90%, and multivariate analysis showed that this parameter was not a variable that affected the risk of BF. Of 21 BFs that occurred, the site of failure was discovered to be local in one case and distant in nine cases. Restaging failed to identify the site of relapse in two cases. In nine cases the trigger for restaging had not been reached. CONCLUSIONS: If post-implant dosimetry is generally within the optimal range, distant rather than local failure appears to be the main cause of BF. Hormone treatment is therefore the most commonly indicated secondary treatment intervention (STI). Delaying the start of STI prevents the unnecessary treatment of men who undergo PSA 'bounce' and have PSA dynamics initially mimicking those of BF.

Ertapenem prophylaxis reduces sepsis after transrectal biopsy of the prostate.

OBJECTIVE: To prospectively trial ertapenem prophylaxis in patients with known risk factors of sepsis undergoing transrectal biopsy of the prostate. PATIENTS AND METHODS: In this prospective audit, patients were identified as having a low- or high-risk of sepsis based on a questionnaire about established risk factors: previous biopsy; recurrent urine infections; receiving ciprofloxacin in the 12 months prior; travel to South-East Asia or South America in the previous 6 months; or diabetes, immune system impairment or receipt of immunosuppressant drugs. All received ciprofloxacin and amoxicillin-clavulanate and high-risk patients additionally received ertapenem. Sepsis requiring hospital admission was recorded. Data was analysed using a two-tailed Fisher's exact test. RESULTS: In all, 80 men were identified as high risk of sepsis and 90 as low risk during the audit period. Six patients in the low-risk group (6.7%, 95% confidence interval 2.1-11.3) and none in the high-risk group developed sepsis (P = 0.03). Of the six developing sepsis, two grew ciprofloxacin-resistant organisms, two had no growth and two grew a ciprofloxacin-sensitive organism, although one of these grew extended-spectrum ß-lactamase-producing Escherichia coli. CONCLUSION: The addition of ertapenem to standard prophylaxis is effective at reducing sepsis after prostate biopsy. Risk stratification is not effective at identifying those men at low risk of sepsis, as these men still have a high sepsis rate. Ertapenem prophylaxis for all patients undergoing prostate biopsy is likely to be the most effective strategy in our population group.