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Indications, Techniques, Outcomes, and Limitations for Minimally Ischemic and Off-clamp Partial Nephrectomy: A Systematic Review of the Literature

Abstract Context

On-clamp partial nephrectomy (PN) has been considered the standard approach to minimize intraoperative bleeding and thus achieve adequate control of tumor margins. The potential negative impact of ischemia on renal function (RF) led to the development of techniques to minimize or avoid renal ischemia, such as off-clamp PN and minimally ischemic PN techniques.

Objective

To review current evidence on the indications and techniques for and outcomes of minimally ischemic and off-clamp PN.

Evidence acquisition

A systematic review of English-language publications on PN without a main renal artery clamp from January 2005 to July 2014 was performed using the Medline, Embase, and Web of Science databases.

Evidence synthesis

The searches retrieved 52 papers. Off-clamp PN has been more commonly applied to small and peripheral renal tumors, while minimally ischemic PN is best suited for hilar and medially located renal tumors. These approaches are associated with increased intraoperative blood loss and perioperative transfusion rates compared to on-clamp PN. Minimally ischemic and off-clamp PN have potential functional benefits when longer ischemia time is anticipated, particularly for patients with lower baseline RF. Limitations include the lack of prospective randomized trials comparing minimally ischemic and off-clamp to on-clamp techniques, and the small sample size and short follow-up of most published series. The impact of different resection and renorrhaphy techniques on postoperative RF and its assessment via renal scintigraphy requires further investigations.

Conclusions

Minimally ischemic and off-clamp PN are established procedures that may be particularly applicable for patients with decreased baseline RF. However, these techniques are technically demanding, with potential for increased blood loss, and require considerable experience with PN surgery. The role of ischemia in patients with a contralateral healthy kidney and consequently an indication for elective minimally ischemic or off-clamp PN remains a debatable issue.

Patient summary

In this review we analyzed available evidence on minimally ischemic and off-clamp partial nephrectomy. These techniques, although technically demanding, may be particularly applicable for patients with decreased baseline renal function.

Take Home Message

Minimally ischemic and off-clamp partial nephrectomy are established procedures that facilitate optimal preservation of renal function. These approaches are technically demanding and should be considered in patients with low renal function at baseline.

Keywords: Clampless, Ischemia, Off-clamp, Parenchymal clamp, Partial nephrectomy, Selective clamp, Segmental clamp, Unclamped, Zero-ischemia.

Footnotes

a Department of Urology, “Regina Elena” National Cancer Institute, Rome, Italy

b Department of Urology, San Giovanni Bosco Hospital, Turin, Italy

c USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

d OLV Vattikuti Robotic Surgery Institute, Aalst, Belgium

e Division of Urologic Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA

f Department of Urology, Bicêtre Hospital, Paris XI University, Le Kremlin-Bicêtre, France

g Department of Urology, Hospital Clínic i Provincial de Barcelona, Barcelona, Spain

h Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA

Corresponding author. Department of Urology, “Regina Elena” National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy. Tel. +39 039 24689214; Fax: +39 06 52666983.

Article information

PII: S0302-2838(15)00322-X
DOI: 10.1016/j.eururo.2015.04.020
© 2015 European Association of Urology, Published by Elsevier B.V.

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Utility of Risk Models in Decision Making After Radical Prostatectomy: Lessons from a Natural History Cohort of Intermediate- and High-Risk Men

Abstract Background

Current guidelines suggest adjuvant radiation therapy for men with adverse pathologic features (APFs) at radical prostatectomy (RP). We examine at-risk men treated only with RP until the time of metastasis.

Objective

To evaluate whether clinicopathologic risk models can help guide postoperative therapeutic decision making.

Design, setting, and participants

Men with National Comprehensive Cancer Network intermediate- or high-risk localized prostate cancer undergoing RP in the prostate-specific antigen (PSA) era were identified (n = 3089). Only men with initial undetectable PSA after surgery and who received no therapy prior to metastasis were included. APFs were defined as pT3 disease or positive surgical margins.

Outcome measurements and statistical analysis

Area under the receiver operating characteristic curve (AUC) for time to event data was used to measure the discrimination performance of the risk factors. Cumulative incidence curves were constructed using Fine and Gray competing risks analysis to estimate the risk of biochemical recurrence (BCR) or metastasis, taking censoring and death due to other causes into consideration.

Results and limitations

Overall, 43% of the cohort (n = 1327) had APFs at RP. Median follow-up for censored patients was 5 yr. Cumulative incidence of metastasis was 6% at 10 yr after RP for all patients. Cumulative incidence of metastasis among men with APFs was 7.5% at 10 yr after RP. Among men with BCR, the incidence of metastasis was 38% 5 yr after BCR. At 10 yr after RP, time-dependent AUC for predicting metastasis by Cancer of the Prostate Risk Assessment Postsurgical or Eggener risk models was 0.81 (95% confidence interval [CI], 0.72–0.97) and 0.78 (95% CI, 0.67–0.97) in the APF population, respectively. At 5 yr after BCR, these values were lower (0.58 [95% CI, 0.50–0.66] and 0.70 [95% CI, 0.63–0.76]) among those who developed BCR. Use of risk model cut points could substantially reduce overtreatment while minimally increasing undertreatment (ie, use of an Eggener cut point of 2.5% for treatment of men with APFs would spare 46% from treatment while only allowing for metastatic events in 1% at 10 yr after RP).

Conclusions

Use of risk models reduces overtreatment and should be a routine part of patient counseling when considering adjuvant therapy. Risk model performance is significantly reduced among men with BCR.

Patient summary

Use of current risk models can help guide decision making regarding therapy after surgery and reduce overtreatment.

Take Home Message

Use of risk models reduces overtreatment and should be a routine part of patient counseling when considering adjuvant therapy. Risk model performance is significantly reduced among men with biochemical recurrence.

Keywords: Prostate cancer, Adverse pathologic features, Biochemical recurrence, Metastasis, Adjuvant therapy, Salvage therapy, Nomograms.

Footnotes

a James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA

b GenomeDx Biosciences Inc., Vancouver, Canada

Corresponding author. John Hopkins Brady Urological Institute, 600 North Wolfe Street, Marburg 145, Baltimore, MD 21287, USA. Tel. +1 443 287 7225; Fax: +1 410 614 8096.

Article information

PII: S0302-2838(15)00318-8
DOI: 10.1016/j.eururo.2015.04.016
© 2015 European Association of Urology, Published by Elsevier B.V.

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Long-term Efficacy and Safety Results: Can Enzalutamide Challenge the Dogma of Androgen Deprivation Therapy in Hormone-naïve Prostate Cancer?

Refers to article:

Long-term Safety and Antitumor Activity in the Phase 1–2 Study of Enzalutamide in Pre- and Post-docetaxel Castration-Resistant Prostate Cancer

Celestia S. Higano, Tomasz M. Beer, Mary-Ellen Taplin, Eleni Efstathiou, Mohammad Hirmand, David Forer and Howard I. Scher

Accepted 26 January 2015

Refers to article:

Long-term Efficacy and Safety of Enzalutamide Monotherapy in Hormone-naïve Prostate Cancer: 1- and 2-Year Open-label Follow-up Results

Bertrand Tombal, Michael Borre, Per Rathenborg, Patrick Werbrouck, Hendrik Van Poppel, Axel Heidenreich, Peter Iversen, Johan Braeckman, Jiri Heracek, Edwina Baskin-Bey, Taoufik Ouatas, Frank Perabo, De Phung, Benoit Baron, Mohammad Hirmand and Matthew R. Smith

Accepted 26 January 2015

Footnotes

Department of Cancer Medicine, Institut Gustave Roussy, University of Paris Sud, Villejuif, France

Corresponding author. Gustave Roussy, Cancer Campus, Grand Paris, University of Paris-Sud, Department of Cancer Medicine, 114 rue Edouard Vaillant, Villejuif, 94800, France. Tel. +33 0142115276; Fax: +33 142115230.

Article information

PII: S0302-2838(15)00321-8
DOI: 10.1016/j.eururo.2015.04.019
© 2015 European Association of Urology, Published by Elsevier B.V.

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New finding could help develop test for kidney disease

MedicalNewsToday - Fri, 2015-04-24 03:00
Scientists at The University of Manchester have made an important finding that could help develop an early test for kidney disease.
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Flexible Cystourethroscopy in the Follow-up of Posturethroplasty Patients and Characterisation of Recurrences

Abstract Background

Urethral strictures can be difficult to diagnose at an early stage because the urinary flow rate does not diminish until the urethral calibre is ≤3 mm. In the past, posturethral surgery follow-up has relied upon flow rates and contrast imaging.

Objective

To evaluate the role of flexible urethroscopy in the follow-up of patients undergoing urethroplasty.

Design, setting, and participants

Prospective flexible urethroscopy follow-up of 144 male patients who underwent urethroplasty by a single surgeon over a 10-yr period at a tertiary referral centre.

Intervention

Flexible urethroscopy at 3, 6, and 12 mo postoperatively, and annually thereafter.

Outcome measurements and statistical analysis

Type of recurrence, based on urethroscopy findings, and further interventions were measured. Actuarial analysis was performed using Kaplan-Meier curves and a log-rank test.

Results and limitations

All 144 patients underwent flexible urethroscopy follow-up over a median postoperative follow-up of 22 mo (range: 1–96 mo). No further intervention was required for 117 patients (81.25%); 27 (18.75%) developed recurrences that required further treatment. Recurrences included diaphragms (13 patients) or significant restenosis (14 patients). Diaphragms were treated by urethrotomy, gentle dilatation, or a short course of intermittent self-dilatation. Restenosis required repeated simple procedures or surgical revision. Most recurrences (26 of 27, 96%) were detected within the first year. Urinary peak flow-rate data were available for 11 of 27 of these recurrences; 7 patients had flow rates >15 ml/s. Anastomotic procedures had greater success than augmentation urethroplasty (p = 0.0136); there was no significant difference in outcomes between redo and non-redo surgery (p = 0.2093)

Conclusions

Endoscopic follow-up of patients after urethroplasty enables earlier identification and treatment of recurrences compared to the use of urinary flow rates alone. It also enables the identification of two different morphologic recurrence patterns that require different types of intervention.

Patient summary

Endoscopy detects most stricture recurrences within 1 yr after urethroplasty and is more sensitive than using urinary flow rates alone.

Take Home Message

Endoscopy detects most stricture recurrences within 1 yr of urethroplasty and is more sensitive than symptom/uroflowmetry-based follow-up. Using this approach, two distinct recurrence patterns can be identified: (1) diaphragms that respond to simple interventions and (2) restenosis, which may necessitate redo surgery.

Keywords: Urethra, Urethral stricture, Urethroplasty, Urethroscopy.

Footnotes

a Department of Urology, Karapitiya Teaching Hospital, Galle, Sri Lanka

b Department of Urology, Royal Hallamshire Hospital, Sheffield, UK

c Western NSW Local Health District, Orange, New South Wales, Australia

Corresponding author. Office H26, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK. Tel. +44 114 271 3048; Fax: +44 114 279 7841.

Article information

PII: S0302-2838(15)00315-2
DOI: 10.1016/j.eururo.2015.04.013
© 2015 Published by Elsevier B.V.

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The Importance of Accurate Life Expectancy Prediction in Men with Prostate Cancer

Refers to article:

Predicting Life Expectancy in Men Diagnosed with Prostate Cancer

Jesse D. Sammon, Firas Abdollah, Anthony D’Amico, Matthew Gettman, Alexander Haese, Nazareno Suardi, Andrew Vickers and Quoc-Dien Trinh

Accepted 5 March 2015

Footnotes

Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA

Department of Urology, University of California, Los Angeles, 300 Stein Plaza, Wasserman Building, 3rd Floor, Los Angeles, CA 90095, USA. Tel. +1 310 2066766 ext. 24455; Fax: +1 310 7940987.

Article information

PII: S0302-2838(15)00271-7
DOI: 10.1016/j.eururo.2015.03.040
© 2015 European Association of Urology, Published by Elsevier B.V.

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Cancer Risk in Relatives of Testicular Cancer Patients by Histology Type and Age at Diagnosis: A Joint Study from Five Nordic Countries

Abstract Background

None of the population-based epidemiologic studies to date has had a large enough sample size to show the familial risk of testicular cancer (TC) by age at diagnosis for patients and their relatives or for rare histologic subtypes.

Objective

To estimate absolute and relative risks of TC in relatives of TC patients by age at diagnosis in patients and their relatives and histological subtypes.

Design, setting, and participants

In a joint population-based cohort study, 97 402 first-degree relatives of 21 254 TC patients who were diagnosed between1955 and 2010 in five European countries were followed for cancer incidence.

Outcome measurements and statistical analysis

Standardized incidence ratios (SIRs) were estimated using histology-, age-, period-, and country-specific incidence rates as references. Lifetime cumulative risks were also calculated.

Results and limitations

The lifetime cumulative risk of TC in brothers of a patient with TC was 2.3%, which represents a fourfold increase in risk (SIR 4.1, 95% confidence interval [CI] 3.6–4.6) compared to the general population. TC in a father increased the risk by up to twofold in his son (95% CI 1.7–2.4; lifetime risk 1.2%) and vice versa. When there were two or more TC patients diagnosed in a family, the lifetime TC risk for relatives was 10–11%. Depending on age at diagnosis, twins had a 9–74% lifetime risk of TC. Family history of most of the histologic subtypes of TC increased the risk of concordant and most discordant subtypes. There was a tendency toward concordant age at diagnosis of TC among relatives.

Conclusions

This study provides clinically relevant age-specific cancer risk estimates for relatives of TC patients. Familial TC patients tended to develop TC at an age close to the age at diagnosis of TC among their relatives, which is a novel finding of this study.

Patient summary

This joint European population study showed that sons and brothers of testicular cancer patients are at higher risk of developing this cancer at an age close to the age at diagnosis of their relatives.

Take Home Message

This study provides clinically relevant age- and histology-specific cancer risk estimates for family members of testicular cancer (TC) patients. Familial TC is not limited to young cases and tends to develop at an age close to the age at diagnosis of TC among their relatives.

Keywords: Familial risk, Testicular cancer, Familial testicular cancer, Population-based study, Age at onset, Histology.

Footnotes

a Division of Molecular Genetic Epidemiology, German Cancer Research Center, Heidelberg, Germany

b Center for Primary Health Care Research, Lund University, Malmö, Sweden

c School of Health Sciences, University of Tampere, Tampere, Finland

d Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland

e Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA

f Icelandic Cancer Registry, Reykjavik, Iceland

g Faculty of Medicine, University of Iceland, Reykjavik, Iceland

h Norwegian Cancer Registry, Oslo, Norway

i Institute of Cancer Epidemiology, Copenhagen, Denmark

Corresponding author. German Cancer Research Center, Molecular Genetic Epidemiology, Im Neuenheimer Feld 580, 69120 Heidelberg, Germany. Tel. +49 6221 421805; Fax: +49 6221 421810.

Article information

PII: S0302-2838(14)01387-6
DOI: 10.1016/j.eururo.2014.12.031
© 2015 Published by Elsevier B.V.

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Translating Testicular Cancer Epidemiology into Clinical Practice

Refers to article:

Cancer Risk in Relatives of Testicular Cancer Patients by Histology Type and Age at Diagnosis: A Joint Study from Five Nordic Countries

Elham Kharazmi, Kari Hemminki, Eero Pukkala, Kristina Sundquist, Laufey Tryggvadottir, Steinar Tretli, Jörgen H. Olsen and Mahdi Fallah

Accepted 16 December 2014

Footnotes

Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA

Department of Urologic Surgery, Vanderbilt University Medical Center, A-1302 Medical Center North, Nashville, TN 37204, USA. Tel. +1 615 3222101; Fax: +1 615 3228990.

Article information

PII: S0302-2838(15)00039-1
DOI: 10.1016/j.eururo.2015.01.016
© 2015 Published by Elsevier B.V.

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Adverse Pathologic Features at Radical Prostatectomy: Effect of Preoperative Risk on Oncologic Outcomes

Abstract Background

Up to 30% of patients with low-risk prostate cancer (PCa) are found to have features of aggressive disease at radical prostatectomy (RP). Several predictive nomograms and novel genomic markers have been developed to estimate the risk of adverse pathology in men eligible for active surveillance (AS). However, oncologic risk associated with these findings remains unknown.

Objective

To determine if the presence of adverse pathologic features at RP in patients eligible for AS is prognostic of poor oncologic outcome independent of pretreatment risk status.

Design, setting, and participants

A total of 2660 patients underwent immediate RP at our institution between 1998 and 2008. Patients were stratified as low, intermediate, or high risk according to the D’Amico clinical risk criteria.

Outcome measurements and statistical analysis

The rates of adverse pathology were reported, and the 5-yr risk of biochemical recurrence (BCR) was calculated in the presence of aggressive disease.

Results and limitations

The 5-yr risk of BCR in patients with extracapsular extension (n = 937) was 43% (95% confidence interval [CI], 40–46) overall but only 15% (95% CI, 11–22) for those who met the criteria for low risk (n = 181). For the 473 patients with pathologic Gleason score 4 + 3, the risk of recurrence at 5 yr was 41% (95% CI, 37–46) overall, 13% (95% CI, 5–27) for low-risk men (n = 41), 41% (95% CI, 35–47) for intermediate-risk men (n = 287), and 51% (95% CI, 43–60) for high-risk men (n = 145). Limitations include use of BCR as the study end point and surrogate for oncologic outcome in men who received curative treatment.

Conclusions

The presence of pathologically unfavorable disease in patients eligible for AS is not informative as to the safety of this treatment modality. We question the relevance of adverse pathology as the end point for predictive tools designed to guide treatment decisions in low-risk PCa.

Patient summary

The risk of biochemical recurrence associated with adverse pathologic findings at prostatectomy is reduced by approximately 50% in men with clinically low-risk prostate cancer.

Take Home Message

We found that the risk of biochemical recurrence associated with adverse pathologic features at radical prostatectomy is reduced by approximately 50% in men with clinically low-risk prostate cancer.

Keywords: Prostatic neoplasm, Oncologic outcome, Biochemical risk, Prediction, Positive surgical margin.

Footnotes

a Urology Service, Department of Surgery, Sidney Kimmel Center for Prostate and Urologic Cancers, New York, NY, USA

b Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

Corresponding author. Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA. Tel. +1 718 785 6262; Fax: +1 646 735 0011.

Article information

PII: S0302-2838(15)00275-4
DOI: 10.1016/j.eururo.2015.03.044
© 2015 European Association of Urology, Published by Elsevier B.V.

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Genomic Predictors of Outcome in Prostate Cancer

Abstract Context

Given the highly variable behavior and clinical course of prostate cancer (PCa) and the multiple available treatment options, a personalized approach to oncologic risk stratification is important. Novel genetic approaches offer additional information to improve clinical decision making.

Objective

To review the use of genomic biomarkers in the prognostication of PCa outcome and prediction of therapeutic response.

Evidence acquisition

Systematic literature review focused on human clinical studies reporting outcome measures with external validation. The literature search included all Medline, Embase, and Scopus articles from inception through July 2014.

Evidence synthesis

An improved understanding of the genetic basis of prostate carcinogenesis has produced an increasing number of potential prognostic and predictive tools, such as transmembrane protease, serine2:v-ets avian erythroblastosis virus E26 oncogene homolog (TMPRSS2:ERG) gene fusion status, loss of the phosphatase and tensin homolog (PTEN) gene, and gene expression signatures utilizing messenger RNA from tumor tissue. Several commercially available gene panels with external validation are now available, although most have yet to be widely used. The most studied commercially available gene panels, Prolaris, Oncotype DX Genomic Prostate Score, and Decipher, may be used to estimate disease outcome in addition to clinical parameters or clinical nomograms. ConfirmMDx is an epigenetic test used to predict the results of repeat prostate biopsy after an initial negative biopsy. Additional future strategies include using genetic information from circulating tumor cells in the peripheral blood to guide treatment decisions at the initial diagnosis and at subsequent decision points.

Conclusions

Major advances have been made in our understanding of PCa biology in recent years. Our field is currently exploring the early stages of a personalized approach to augment traditional clinical decision making using commercially available genomic tools. A more comprehensive appreciation of value, limitations, and cost is important.

Patient summary

We summarized current advances in genomic testing in prostate cancer with a special focus on the estimation of disease outcome. Several commercial tests are currently available, but further understanding is needed to appreciate the potential benefits and limitations of these novel tests.

Take Home Message

Personalized genetic profiling of primary and metastatic tumor cells is available for routine clinical decision making. Greater understanding of the potential long-term benefits and limitations of these tests and their optimal use in clinical decision making is important.

Keywords: Prostate cancer, Prognostic, Predictive, Outcome, Gene panel, Expression panel, Genetic test, RNA, Cell cycle, DNA.

Footnotes

a Department of Urology, Turku University Hospital, Turku, Finland

b Department of Urology, Skåne University Hospital Malmö, Lund University, Lund Sweden

c Academic Urology Unit, University of Sheffield, Sheffield, UK

d Section of Urology, University of Chicago, Chicago, IL, USA

e Departments of Laboratory Medicine, Surgery (Urology), and Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA

f Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK

g Institute of Biomedical Technology, University of Tampere, Tampere, Finland

h Department of Urology and Population Health, New York University and Manhattan Veterans Affairs Medical Center, New York, NY, USA

i Department of Urology, Radboud University Medical Center, Nijmegen, the Netherlands

j Martini-Clinic, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

k Departments of Urology and Epidemiology and Biostatistics, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA

Corresponding author. Department of Urology, Turku University Hospital, Kiinamyllynkatu 4–8, 20520, Turku, Finland. Tel. +358 44 2059004.

Article information

PII: S0302-2838(15)00310-3
DOI: 10.1016/j.eururo.2015.04.008
© 2015 European Association of Urology, Published by Elsevier B.V.

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Sexual Health Outcomes in Adult Complete Male Epispadias Patients

Complete male epispadias (CME) is a rare congenital anomaly characterized by failed closure of the entire penopubic dorsal urethra. Epispadias repair is typically performed during infancy, and resultant genitourinary abnormalities can have a large impact on adult life. This study assesses long-term post-reconstruction sexual health and fertility outcomes in adult CME patients.
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Transarterial Embolization of Angiomyolipoma - A Systematic Review

Transarterial embolization (TAE) is increasingly used in the management of renal angiomyolipoma (AML). The level of evidence establishing the safety and efficacy of TAE has not increased in parallel.
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Neutrophil gelatinase-associated lipocalin is an independent predictor of poor prognosis in papillary renal cell carcinoma

Neutrophil gelatinase-associated lipocalin (NGAL), also known as lipocalin-2, is a 25-kDa protein now considered the biochemical gold standard for early diagnosis of acute kidney injury. Recently, NGAL was suggested to play an important role in several human neoplasias. We sought to assess NGAL expression in 2 different renal tumor types and analyze its association with clinicopathological parameters and prognosis.
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Age and Obesity Promote Methylation and Suppression of 5-Alpha Reductase 2– Implications for Personalized Therapy in Benign Prostatic Hyperplasia

5α reductase inhibitors (5ARIs) are a main modality of treatment for men suffering from symptomatic benign prostatic hyperplasia (BPH). Over 30% of men do not respond to the therapeutic effects of 5ARIs. We have found that 1/3 of adult prostate samples do not express 5AR2 secondary to epigenetic modifications. We sought to evaluate whether 5AR2 expression in BPH specimens of symptomatic men was linked to methylation of the 5AR2 gene promoter and identify associations with age, obesity, cardiac risk factors, and prostate specific antigen (PSA).
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The Aging Prostate Is Never “Normal”: Implications from the Genomic Characterization of Multifocal Prostate Cancers

Take Home Message

We argue against the recently published statement that tumor-specific molecular alterations found in “normal” prostate tissue from cancer patients challenge focal therapy approaches that only target a visible cancer lesion and not the adjacent molecular field.

Footnotes

a Martini-Clinic, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

b Genome Biology Unit, European Molecular Biology Laboratory, Heidelberg, Germany

c Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

Corresponding author. Martini-Clinic, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Martinistrasse 55, 20246 Hamburg, Germany. Tel. +49 40 741051300; Fax: +49 40 741051323.

Article information

PII: S0302-2838(15)00314-0
DOI: 10.1016/j.eururo.2015.04.012
© 2015 European Association of Urology, Published by Elsevier B.V.

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A Brief Survey of Active Surveillance

Refers to article:

Fifteen-year Outcomes Following Conservative Management Among Men Aged 65 Years or Older with Localized Prostate Cancer

Grace L. Lu-Yao, Peter C. Albertsen, Dirk F. Moore, Yong Lin, Robert S. DiPaola and Siu-Long Yao

Accepted 5 March 2015

Footnotes

Department of Urology, University of Western Ontario, London Health Sciences Centre, London, Ontario, Canada

Department of Urology, University of Western Ontario, London Health Sciences Centre, 800 Commissioners Road East, Suite E2 - 650, London, Ontario N6G 5W9, Canada. Tel. +1 519 685 84 51; Fax: +1 519 685 84 55.

Article information

PII: S0302-2838(15)00307-3
DOI: 10.1016/j.eururo.2015.04.005
© 2015 Published by Elsevier B.V.

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Re: Byron H. Lee, Adam S. Kibel, Jay P. Ciezki, et al. Are Biochemical Recurrence Outcomes Similar After Radical Prostatectomy and Radiation Therapy? Analysis of Prostate Cancer–Specific Mortality by Nomogram-predicted Risks of Biochemical Recurrence. Eur

Refers to article:

Are Biochemical Recurrence Outcomes Similar After Radical Prostatectomy and Radiation Therapy? Analysis of Prostate Cancer–Specific Mortality by Nomogram-predicted Risks of Biochemical Recurrence

Byron H. Lee, Adam S. Kibel, Jay P. Ciezki, Eric A. Klein, Chandana A. Reddy, Changhong Yu, Michael W. Kattan and Andrew J. Stephenson

Accepted 11 September 2014

February 2015 (Vol. 67, Issue 2, pages 204 - 209)

Footnotes

a Division of Urology, Department of Surgery, E-Da Hospital, Kaohsiung City, Taiwan, Republic of China

b School of Medicine, I-Shou University, Kaohsiung City, Taiwan, Republic of China

4 Fl. Bldg. C, 1, Yi-Da road, Yan-Chao District, 82457, Kaohsiung County, Taiwan, Republic of China. Tel. +886 7 6150011 ext. 2975; Fax: +886 7 6150982.

Article information

PII: S0302-2838(15)00317-6
DOI: 10.1016/j.eururo.2015.04.015
© 2015 European Association of Urology, Published by Elsevier B.V.

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Re: Gunnar Steineck, Anders Bjartell, Jonas Hugosson, et al. Degree of Preservation of the Neurovascular Bundles During Radical Prostatectomy and Urinary Continence 1 Year after Surgery

Refers to article:

Degree of Preservation of the Neurovascular Bundles During Radical Prostatectomy and Urinary Continence 1 Year after Surgery

Gunnar Steineck, Anders Bjartell, Jonas Hugosson, Elin Axén, Stefan Carlsson, Johan Stranne, Anna Wallerstedt, Josefin Persson, Ulrica Wilderäng, Thordis Thorsteinsdottir, Ove Gustafsson, Mikael Lagerkvist, Thomas Jiborn, Eva Haglind and Peter Wiklund on behalf of the LAPPRO steering committee 1 .

Accepted 7 October 2014

March 2015 (Vol. 67, Issue 3, pages 559 - 568)

Footnotes

St George's University Hospitals NHS Foundation Trust, London, UK

Corresponding author. St. George's Hospital, Blackshaw Road, London SW17 0QT, UK. Tel. +44 798 9589066; Fax: +44 207 7270921.

Article information

PII: S0302-2838(15)00316-4
DOI: 10.1016/j.eururo.2015.04.014
© 2015 European Association of Urology, Published by Elsevier B.V.

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Editorial Comment

This interesting article accurately shows that 2-stage proximal hypospadias repair carries with it a high complication rate. The authors are to be commended for such a critical review of their data. However, their conclusions do not necessarily fit with the results. To say that the use of SIS and dermal patch grafts increased the risk of complications such as fistula and diverticula is a bit of a stretch. In their study a tunica vaginalis flap was used during the second stage procedure in only 6 of 56 patients (11%), and no mention was made of any other type of secondary coverage in the rest of the cohort.
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New kidney disease findings may lead to test for early diagnosis

MedicalNewsToday - Wed, 2015-04-22 09:00
Researchers have identified structural differences in the kidney filters of mice more susceptible to kidney disease, which could inform a new early-diagnosis test for humans.
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