Intravesical therapies for bladder cancer - indications and limitations.

• Intravesical therapy is a well-established treatment option for non-muscle-invasive bladder cancer (NMIBC). • Choosing the appropriate intravesical agent, schedule and duration of treatment has long been an area of debate. • We review the intravesical agents that are currently used in the management of NMIBC and examine the indications and limitations of their use. • Given the relative high rates of toxicity, failure and non-completion of traditional treatments we also examine some of the newer treatment options available.

Bladder, penile, renal pelvis and testis cancers: A population based analysis of incidence and survival 1977-2013.

BACKGROUND: Cancers comprise a significant proportion of urologic workload. The epidemiology of prostate and renal cancers is well described. We report the incidence, survival and predictors of survival for non-prostate, non-renal urologic cancers between 1977 and 2013. METHODS: All patients in the South Australian Cancer Registry diagnosed with bladder, testis, penis, renal pelvis, ureteric and other male genital organ cancers between 1977 and 2013 were included. Demographic data included age, sex, year of diagnosis, grade, and metropolitan/rural status. Changes in incidence, survival and predictors of survival are reported for each cancer type. RESULTS: Between 1977 and 2013, bladder cancer was the most common of the studied urologic cancers (6465/9317). Age standardized incidence rate for bladder cancer decreased from 15.6-9.0 per 100,000 in 2013 (Annual Percentage Change (APC) -0.97 %, p < 0.05 %). Between 1977 and 2013 mortality has increased in patients with bladder cancer (HR 1.01 per year, p = 0.004). Testicular cancer diagnoses increased from 1.7 to 4.7 per 100,000 through 1977-2012 (APC 2.41 %, p < 0.05 %). Survival has increased (HR 0.95 per year, p < 0.001). Incidence of penile cancers has increased from 0.23 to 0.46 per 100,000 (APC 2.8 %); Penile cancer survival has remained static (HR 1.02 p = 0.23).Five and ten year survival estimates were highest for testicular cancer - 93.4 % and 91.1 % respectively; and lowest for renal pelvis - 36.3 % and 24.6 %. CONCLUSION: The incidence of non-prostate, non-renal urologic cancers remains low and stable. The age-standardized incidence of testicular cancer has increased whilst there has been a decline in the age-standardized incidence of bladder cancer. Bladder cancer survival has decreased since the 1970s.

Does the Prostate Imaging-Reporting and Data System (PI-RADS) version 2 improve accuracy in reporting anterior lesions on multiparametric magnetic resonance imaging (mpMRI)?

INTRODUCTION: Multiparametric MRI (mpMRI) is useful in detecting anterior prostate tumours. Due to the location of anterior tumours, they are often diagnosed with a large size and may be suspicious for extra-prostatic extension (EPE). We aim to evaluate whether PI-RADS v2 is more accurate in assessing anterior prostate lesions identified on mpMRI compared to PI-RADS v1. METHODS: Patients with anterior prostate lesions diagnosed on mpMRI who proceeded to a cognitive fusion transperineal prostate biopsy were identified. Each mpMRI was blinded and read by two experienced prostate MRI radiologists and assigned a PI-RADS v1 and PI-RADS v2 score, and the presence of EPE was estimated. Correlation was made with transperineal histopathology and, where relevant, radical prostatectomy histopathology. Concordance measures between PI-RADS v1 and PI-RADS v2, and between examiners of the same PI-RADS score were calculated using a weighted kappa. RESULTS: Fifty-eight consecutive men were identified. Concordance between the examiners for PI-RADS v1 and for v2 showed substantial agreement (version 1: weighted kappa 0.71; version 2: weighted kappa 0.69). There was no difference in accuracy when using PI-RADS v1 or PI-RADS v2 to predict clinically significant cancer. There was poor correlation between EPE measured on mpMRI compared with EPE in radical prostatectomy histopathology. CONCLUSION: PI-RADS v2 is reproducible between radiologists but does not have improved accuracy for diagnosing anterior tumours of the prostate when compared to PI-RADS v1. Multiparametric MRI is accurate at detecting anterior tumours with a sensitivity of 86-88%.