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Pregnant women who have donated a kidney are at increased risk for hypertension, preeclampsia

MedicalNewsToday - 19 hours 39 min ago
Nearly 30,000 people become living kidney donors worldwide each year, and many are young women.
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MRI-guided transurethral ultrasound prostate ablation; a pre-clinical safety and feasibility study with 28-day follow-up

To determine the safety and feasibility of MRI-guided transurethral ultrasound prostate ablation using active temperature feedback control in a pre-clinical canine model with 28-day follow-up.
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Mortality After Radical Cystectomy: The Impact of Obesity Versus Adiposity After Adjusting for Skeletal Muscle Wasting

To assess the impact of obesity as measured conventionally by body mass index (BMI) compared to excess adiposity as measured by fat-mass index (FMI) on mortality, following radical cystectomy for bladder cancer, adjusting for the presence of skeletal muscle wasting.
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Targeting the Mechanisms of Progression in Castration-resistant Prostate Cancer

Refers to article:

Understanding the Mechanisms of Androgen Deprivation Resistance in Prostate Cancer at the Molecular Level

Theodoros Karantanos, Christopher P. Evans, Bertrand Tombal, Timothy C. Thompson, Rodolfo Montironi and William B. Isaacs

Accepted 25 September 2014

Footnotes

Lund University, Department of Clinical Sciences, Division of Urological Research, Skåne University Hospital, Malmö, Sweden

Lund University, Department of Clinical Sciences, Division of Urological Research, Jan Waldenströms gata 35, CRC 91:10, Skåne University Hospital, SE20502 Malmö, Sweden. Tel. +46 (0)40391128.

Article information

PII: S0302-2838(14)01198-1
DOI: 10.1016/j.eururo.2014.11.024
© 2014 European Association of Urology, Published by Elsevier B.V.

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Differences in Treatment and Outcome After Treatment with Curative Intent in the Screening and Control Arms of the ERSPC Rotterdam

Abstract

Screening for prostate cancer (PCa) results in a favorable stage shift. However, even if screening did not result in a clinically apparent lower stage or grade, it might still lead to less disease recurrence after treatment with curative intent (radical prostatectomy [RP] and radiation therapy [RT]) because the tumor had less time to develop outside the prostate. The outcome after treatment could also differ because of variations in treatment quality (eg, radiation dosage/adjuvant hormonal therapy). To test these hypotheses, we compared differences in the treatment quality of the screening and control arms of the European Randomized Study of Screening for Prostate Cancer (ERSPC) Rotterdam and disease-free survival (DFS) after curative treatment in PCa patients with similar stage and grade. A total of 2595 men were initially treated with RP or RT. In the control arm, RT was more often combined with hormonal therapy; treatment dosage was often ≥69 Gy. This most likely resulted from changes over time in treatment that coincided with the later detection in the control arm. DFS was higher in the screening arm in all risk groups. After correction for lead time, these differences were minimal, however. We concluded that treatment quality differed between the screening and control arms of the ERSPC Rotterdam. RT quality was especially superior in the control arm with higher dosages and more often RT in combination with hormonal therapy. Despite these differences favoring the control arm, DFS differences were minimal.

Patient summary

We looked at differences in prostate cancer (PCa) treatment and outcome after PCa treatment in men diagnosed after screening and men diagnosed after normal clinical practice. Treatment differed with superior treatment given to men diagnosed in normal clinical practice. We propose a likely explanation for this apparently counterintuitive finding (progressive insight combined with, on average, a later detection of tumors in unscreened men). Although unscreened men received better treatment, this advantage seemed to be outweighed by the advantage associated with the earlier detection, on average, of the tumor in screened men.

Trial registration

ISRCTN49127736

Take Home Message

The quality of similar treatments differed between the screening and control arms of the ERSPC Rotterdam, most likely related to later detection in the control arm and progressive insight. Radiation therapy (RT) quality was especially superior in the control arm with higher dosages, and RT was more often performed in combination with hormonal therapy.

Keywords: Prostatic neoplasms, Prostate-specific antigen, Screening, Radical prostatectomy, Radiotherapy, Cure rates.

Footnotes

a Department of Urology, Erasmus University Medical Center, Rotterdam, the Netherlands

b Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands

c Department of Pathology, Erasmus University Medical Center, Rotterdam, The Netherlands

Corresponding author. Erasmus University Medical Centre, Department of Urology, Room NA-1710, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands. Tel. +31 10 703 2243; Fax: +31 10 703 5315.

Article information

PII: S0302-2838(14)01016-1
DOI: 10.1016/j.eururo.2014.10.008
© 2014 European Association of Urology, Published by Elsevier B.V.

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A combination of 2 existing anti-cancer drugs for kidney cancer shows good patient response

MedicalNewsToday - Fri, 2014-11-21 02:00
Researchers have found that patients with an advanced form of kidney cancer, for which there is no standard treatment and a very poor prognosis, respond well to a combination of two existing...
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Ferroptosis, a novel form of non-apoptotic cell death, holds great therapeutic potential

MedicalNewsToday - Fri, 2014-11-21 02:00
Ferroptosis is a newly discovered form of cell death believed to be involved in numerous pathological processes.
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Genetic Polymorphisms in ESR1 and ESR2 Genes and Risk of Hypospadias in a Multi-ethnic Study Population

Estrogenic endocrine disruptors acting via estrogen receptors α (ESR1) and β (ESR2) have been implicated in the etiology of hypospadias, a common congenital malformation of male external genitalia. Our objective was to determine the association of single nucleotide polymorphisms (SNPs) in ESR1 and ESR2 genes with hypospadias in a racially-ethnically diverse study population of California births.
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Reply from Authors re: Sigrid V. Carlsson, Peter C. Albertsen. Better Survival After Curative Treatment for Screen-detected Prostate Cancer Compared with Clinical Diagnosis: A Real Effect or Lead-time Bias? Eur Urol. In press. http://dx.doi.org/10.1016/j.

Refers to article:

Better Survival After Curative Treatment for Screen-detected Prostate Cancer Compared with Clinical Diagnosis: A Real Effect or Lead-time Bias?

Sigrid V. Carlsson and Peter C. Albertsen

Refers to article:

Differences in Treatment and Outcome After Treatment with Curative Intent in the Screening and Control Arms of the ERSPC Rotterdam

Leonard P. Bokhorst, Ries Kranse, Lionne D.F. Venderbos, Jolanda W. Salman, Geert J.L.H. van Leenders, Fritz H. Schröder, Chris H. Bangma and Monique J. Roobol for the ERSPC Rotterdam Study Group.

Accepted 4 October 2014

Footnotes

a Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands

b Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands

Corresponding author. Erasmus University Medical Centre, Department of Urology, Room NA-1710, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands. Tel. +31 10 703 2243; Fax: +31 10 703 5315.

Article information

PII: S0302-2838(14)01190-7
DOI: 10.1016/j.eururo.2014.11.016
© 2014 European Association of Urology, Published by Elsevier B.V.

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Bipolar versus monopolar transurethral resection of the prostate: A prospective randomized trial focussing on bleeding complications

To compare monopolar versus bipolar transurethral resection of the prostate (TURP) in patients with benign prostatic hyperplasia (BPH) focussing on functional outcome, and rates of bleeding complications and TURP syndrome.
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The Use of Internal Stents in Chronic Ureteral Obstruction

Despite lack of a well-delineated definition, chronic ureteral obstruction (CUO) imposes significant quality of life loss, increased pathologic morbidity and risk of mortality as well as substantial economic burden. Ureteral stenting serves as an important therapeutic option to alleviate the obstruction. We thus assessed the recently-published literature on chronic ureteral obstruction; treatment options; types, benefits and shortcomings of current ureteral stents; as well as outcomes and complications of chronic ureteral stenting, with the goal of providing concise management guidelines.
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Reducing the Cost of Robotic Partial Nephrectomy Through Innovative Instrument Use

Footnotes

The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

Corresponding author. 600 North Wolfe Street, Park 223, Baltimore, MD 21287, USA. Tel. +1 410 502 7710; Fax: +1 410 502 7711.

Article information

PII: S0302-2838(14)01197-X
DOI: 10.1016/j.eururo.2014.11.023
© 2014 European Association of Urology, Published by Elsevier B.V.

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Drug Adherence and Clinical Outcomes for Patients Under Pharmacological Therapy for Lower Urinary Tract Symptoms Related to Benign Prostatic Hyperplasia: Population-based Cohort Study

Abstract Background

Little is known about drug adherence in men treated for lower urinary tract symptoms (LUTS). Benign prostatic hyperplasia (BPH) is one of the causes of LUTS.

Objective

To examine adherence to pharmacological therapy and its clinical value in men with LUTS.

Design, setting, and participants

Population-based cohort study using an administrative prescription database and hospital discharge codes for 1.5 million men aged ≥40 yr treated with alpha blockers (ABs) and 5-alpha reductase inhibitors (5ARIs) alone or in combination (CT).

Interventions

Therapy with ABs and/or 5ARIs.

Outcome measurements and statistical analysis

The 1-yr and long-term adherence; hospitalization rates for BPH and BPH surgery. Multivariate Cox proportional hazards regression model, propensity score matching, and sensitivity analyses.

Results and limitations

The 1-yr adherence was 29% in patients exposed to at least 6-mo therapy. Patients on CT had a higher discontinuation rate in the first 2 yr compared to those on monotherapy (p < 0.0001). Overall hospitalization rates for BPH and BPH surgery were 9.04 and 12.6 per 1000 patient-years, respectively. A lower risk of hospitalization was observed for 5ARI compared to AB therapy (hazard ratio [HR] 0.46 and 0.23;p < 0.0001). CT was associated with a reduced risk of hospitalization for BPH surgery (HR 0.94;p < 0.0001) compared to AB. Discontinuation of drug treatment was an independent risk factor for hospitalization for BPH and BPH surgery (HR 1.65 and 2.80;p < 0.0001) regardless of therapeutic group. Limitations include the paucity of clinical measures and the absence of patient-reported outcomes.

Conclusions

Adherence to pharmacological therapy for BPH is low and could affect clinical outcomes. Long-term 5ARI and CT use was associated with an independent reduced risk of hospitalization for BPH surgery. Our findings suggest the need for new strategies to increase patient adherence to prescribed treatment and more appropriate prescribing by physicians.

Patient summary

Our research shows that adherence to prescribed pharmacological therapy is crucial in the management of patients suffering from lower urinary tract symptoms. Moreover, pharmacological therapy can prevent disease progression.

Take Home Message

Adherence to pharmacological therapy for lower urinary tract symptoms is low and could affect clinical outcomes. Long-term use of 5-alpha reductase inhibitors alone or in combination with alpha blockers was associated with an independent reduced risk of hospitalization for benign prostatic hyperplasia surgery.

Keywords: Drug adherence, Drug therapy, Benign prostatic hyperplasia, Lower urinary tract symptoms, Alpha blockers, 5-Alpha reductase inhibitors, Administrative database.

Footnotes

a Department of Urology, S. Pio da Pietrelcina Hospital, Vasto, Italy

b Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy

c Department of Urology, Ospedale Sant’Andrea, University La Sapienza, Rome, Italy

d University Hospitals, Urology Institute, Cleveland, OH, USA

Corresponding author. Department of Urology, S. Pio da Pietrelcina Hospital, via Anelli 82, 66054 Vasto, Italy. Tel. +39 0873 308269; Fax: +39 0873 308578.

Article information

PII: S0302-2838(14)01180-4
DOI: 10.1016/j.eururo.2014.11.006
© 2014 European Association of Urology, Published by Elsevier B.V.

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Poor-prognosis Germ Cell Tumours: Room for Improvement

Refers to article:

A Randomised Phase 2 Trial of Intensive Induction Chemotherapy (CBOP/BEP) and Standard BEP in Poor-prognosis Germ Cell Tumours (MRC TE23, CRUK 05/014, ISRCTN 53643604)

Robert A. Huddart, Rhian Gabe, Fay H. Cafferty, Philip Pollock, Jeff D. White, Jonathan Shamash, Michael H. Cullen and Sally P. Stenning for the TE23 Trial Management Group and Collaborators and the National Cancer Research Institute Testis Cancer Clinical Studies Group.

Accepted 16 June 2014

Footnotes

Department of Urology, Düsseldorf University, Düsseldorf, Germany

Department of Urology, Düsseldorf University, Moorenstr. 5, Düsseldorf 40225, Germany. Tel. +49 211 8118110; Fax: +49 211 8118676.

Article information

PII: S0302-2838(14)01183-X
DOI: 10.1016/j.eururo.2014.11.009
© 2014 European Association of Urology, Published by Elsevier B.V.

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SUCCINCT: An Open-label, Single-arm, Non-randomised, Phase 2 Trial of Gemcitabine and Cisplatin Chemotherapy in Combination with Sunitinib as First-line Treatment for Patients with Advanced Urothelial Carcinoma

Abstract

Gemcitabine and cisplatin chemotherapy (GC regimen) represents a standard treatment for advanced urothelial carcinoma. We performed an open-label, single-arm, non-randomised, phase 2 trial evaluating the addition of sunitinib to standard GC chemotherapy (SGC regimen). Overall, 63 treatment-naïve participants were recruited and received up to six 21-d cycles of cisplatin 70 mg/m2(intravenously [IV], day 1) and gemcitabine 1000 mg/m2(IV, days 1 and 8) combined with sunitinib 37.5 mg (orally, days 2–15). Following review of toxicity after the first six patients, the sunitinib dose was reduced to 25 mg for all patients. Overall response rate was 64%, with response noted in 37 of 58 patients. At 6 mo, 30 of 58 assessable patients (52%; 90% confidence interval [CI], 40–63%) were progression free. Median overall survival was 12 mo (95% CI, 9–15) and was heavily influenced by Bajorin prognostic group. Grade 3–4 toxicities were predominantly haematologic and limited the deliverability of the triple SGC regimen. The trial did not meet its prespecified primary end point of >60% patients progression free at 6 mo. Cumulative myelosuppression led to treatment delays of gemcitabine and cisplatin and dose reduction and/or withdrawal of sunitinib in the majority of cases. The triple-drug combination was not well tolerated. Phase 3 evaluation of the triple SGC regimen in advanced transitional cell carcinoma is not recommended.

Patient summary

The addition of sunitinib to standard cisplatin and gemcitabine chemotherapy was poorly tolerated and did not improve outcomes in advanced urothelial carcinoma. Treatment delivery was limited by myelotoxicity.

Take Home Message

The addition of sunitinib to standard cisplatin and gemcitabine chemotherapy was poorly tolerated and did not improve outcomes in advanced urothelial carcinoma. Treatment delivery was limited by myelotoxicity.

Keywords: Advanced urothelial tract transitional cell carcinoma, Phase 2, Clinical trial, First-line treatment, Sunitinib.

Footnotes

a Royal Bournemouth Hospital, Bournemouth, UK

b Institute of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, UK

c St James’ University Hospital, Leeds, UK

d Wales Cancer Trials Unit, School of Medicine, Cardiff University, Cardiff, UK

e University of Southampton Faculty of Medicine, Southampton General Hospital, Southampton, UK

f Christie Hospital, Manchester, UK

g Churchill Hospital, Oxford, UK

h Institute of Cancer Research and Royal Marsden Hospital, Surrey, UK

i Velindre Cancer Centre, Velindre Hospital, Cardiff, UK

j Institute of Cancer Sciences, University of Glasgow, Beatson West of Scotland Cancer Centre, Glasgow, UK

Corresponding author. Cardiff University, Wales Cancer Trials Unit, 6th Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF144YS, UK. Tel. +44 2920687470.

Article information

PII: S0302-2838(14)01177-4
DOI: 10.1016/j.eururo.2014.11.003
© 2014 European Association of Urology, Published by Elsevier B.V.

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Metabolic Evaluation and Recurrence Prevention for Urinary Stone Patients: EAU Guidelines

Abstract Context

An optimum metabolic evaluation strategy for urinary stone patients has not been clearly defined.

Objective

To evaluate the optimum strategy for metabolic stone evaluation and management to prevent recurrent urinary stones.

Evidence acquisition

Several databases were searched to identify studies on the metabolic evaluation and prevention of stone recurrence in urolithiasis patients. Special interest was given to the level of evidence in the existing literature.

Evidence synthesis

Reliable stone analysis and basic metabolic evaluation are highly recommended in all patients after stone passage (grade A). Every patient should be assigned to a low- or high-risk group for stone formation. It is highly recommended that low-risk stone formers follow general fluid and nutritional intake guidelines, as well as lifestyle-related preventative measures to reduce stone recurrences (grade A). High-risk stone formers should undergo specific metabolic evaluation with 24-h urine collection (grade A). More specifically, there is strong evidence to recommend pharmacological treatment of calcium oxalate stones in patients with specific abnormalities in urine composition (grades A and B). Treatment of calcium phosphate stones using thiazides is only highly recommended when hypercalciuria is present (grade A). In the presence of renal tubular acidosis (RTA), potassium citrate and/or thiazide are highly recommended based on the relative urinary risk factor (grade A or B). Recommendations for therapeutic measures for the remaining stone types are based on low evidence (grade C or B following panel consensus). Diagnostic and therapeutic algorithms are presented for all stone types based on the best level of existing evidence.

Conclusion

Metabolic stone evaluation is highly recommended to prevent stone recurrences.

Patient summary

In this report, we looked at how patients with urolithiasis should be evaluated and treated in order to prevent new stone formation. Stone type determination and specific blood and urine analysis are needed to guide patient treatment.

Take Home Message

All stone formers should undergo stone analysis and basic evaluation after passage of a stone. Dietary, fluid, and lifestyle preventive measures are highly recommended for lithiasis patients. High-risk stone formers require specific metabolic evaluation and guided treatment to prevent recurrences.

Keywords: Stone, Lithiasis, Urinary, Metabolic evaluation, Medical treatment, Recurrence and conservative treatment, European Association of Urology, Guidelines.

Footnotes

a Second Department of Urology, Sismanoglio Hospital, Athens Medical School, Athens, Greece

b Department of Urology, Technical University Munich, Munich, Germany

c Department of Urology, Sindelfingen-Boeblingen Medical Center, University of Tübingen, Sindelfingen, Germany

d Department of Urology, Dr Lutfi Kırdar Research and Teaching Hospital, Istanbul, Turkey

e Department of Urology, Medical University Vienna, Austria

f Department of Urology, Region Hospital, České Budějovice, Czech Republic

g Department of Urology, Charles University, 1st Faculty of Medicine, Prague, Czech Republic

h Department of Urology, Rudolfstiftung Hospital, Vienna, Austria

Corresponding author. Athens Medical School, Second Department of Urology, Sismanoglio Hospital, Athens, Greece. Tel. +30 123 0080139; Fax: +30 124 0803074.

Article information

PII: S0302-2838(14)01102-6
DOI: 10.1016/j.eururo.2014.10.029
© 2014 European Association of Urology, Published by Elsevier B.V.

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Steroids in Prostate Cancer: The Jury Is Still Out... and Even More Confused

Refers to article:

A Randomised Phase 2 Trial of Dexamethasone Versus Prednisolone in Castration-resistant Prostate Cancer

Ramachandran Venkitaraman, David Lorente, Vedang Murthy, Karen Thomas, Lydia Parker, Ruth Ahiabor, David Dearnaley, Robert Huddart, Johann De Bono and Chris Parker

Accepted 1 October 2014

Footnotes

a Medical Oncology, I.R.C.C.S. San Matteo University Hospital Foundation, Pavia, Italy

b Medical Oncology, Department of Oncology, San Donato Hospital, Tuscany Tumor Institute (ITT), Arezzo, Italy

c Clinical Pharmacology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy

Corresponding author. Medical Oncology, I.R.C.C.S. San Matteo University Hospital Foundation, Piazzale C. Golgi, 19, 27100 Pavia, Italy. Tel. +39 0382 501355; Fax: +39 0382 50123.

Article information

PII: S0302-2838(14)01176-2
DOI: 10.1016/j.eururo.2014.11.002
© 2014 European Association of Urology, Published by Elsevier B.V.

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Patients with advanced papillary kidney cancer respond well to a combination of two existing anti-cancer drugs

MedicalNewsToday - Wed, 2014-11-19 04:00
Researchers have found that patients with an advanced form of kidney cancer, for which there is no standard treatment and a very poor prognosis, respond well to a combination of two existing...
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Keryx announces results from Ferric Citrate phase 3 long-term safety extension study

MedicalNewsToday - Wed, 2014-11-19 02:00
Keryx Biopharmaceuticals, Inc. (Nasdaq:KERX) (the "Company") has announced results from a 48-week Open Label Extension (OLE) safety study in which Ferric Citrate demonstrated long-term safety and...
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