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Objectives Patients diagnosed with bladder carcinoma in situ ( CIS) and treated with intravesical Bacillus Calmette-Guerin ( BCG) often undergo post-induction random bladder biopsies to assess treatment response. We sought to determine the correlation between post-induction urinary cytology/cystoscopy and histopathological findings obtained by random bladder biopsies. Methods Patients who were treated with BCG between 2006 and 2010 for CIS, had surveillance cystoscopy and cytology, and subsequently underwent random bladder biopsies were selected for analysis. Patients with a history of or concomitant urothelial cell carcinoma ( UCC) stage T1 or higher were excluded. Cystoscopic finings were characterized as follows: negative - no mucosal erythema, raised lesions or papillary tumours; suspicious - mucosal erythema, but no raised lesions or papillary tumours; and positive - sessile or papillary tumours. The accuracy of cytology in predicting the results of subsequent random bladder biopsies was analysed. Results Of 21 patients included, surveillance cystoscopy findings were characterized as negative in nine, suspicious in seven and positive in five. Of 16 patients with negative/suspicious cystoscopy, 13 had agreement between cytology and biopsy, nine of whom were negative and four positive. Three of 16 patients had positive cytology, but negative biopsies; on further investigation of these three, one had CIS and two subsequent UCC. In the positive cystoscopy group, four of five patients had agreement between cytology and biopsy, two of whom were negative and two positive. One of the five patients had negative cytology, but a positive biopsy. Conclusion Our data suggest foregoing random bladder biopsies in patients with negative urine cytology and no evidence of intravesical recurrence on cystoscopy following an induction course of BCG for CIS of the urinary bladder. [ABSTRACT FROM AUTHOR]

The introduction of prostate-specific antigen (PSA) revolutionized prostate cancer (PCa) screening and ushered the PSA era. However, its use as a screening tool remains controversial and changes in the epidemiology of PCa have strongly limited its prognostic role. Therefore, we need novel approaches to improve our ability to detect PCa and foretell the course of the disease. To improve the specificity of total PSA, several approaches based on PSA derivatives have been investigated such as age-specific values, PSA density (PSAD), PSAD of the transition zone, PSA velocity and assessment of various isoforms of PSA. With recent advances in biotechnology such as high-throughput molecular analyses, many potential blood biomarkers have been identified and are currently under investigation. Given the plethora of candidate PCa biomarkers, we have chosen to discuss a select group of candidate blood-based biomarkers including human glandular kallikrein, early prostate cancer antigens, insulin-like growth factor-I (IGF-I) and its binding proteins (IGFBP-2 and IGFBP-3), urokinase plasminogen activation system, transforming growth factor-β1, interleukin-6, chromogranin A, prostate secretory protein, prostate-specific membrane antigen, PCa-specific autoantibodies and α-methylacyl-CoA racemase. While these and other markers have shown promise in early phase studies, no single biomarker is likely to have the appropriate degree of certainty to dictate treatment decisions. Consequently, the future of cancer prognosis may rely on small panels of markers that can accurately predict PCa presence, stage, metastasis, and serve as prognosticators, targets and/or surrogate end points of disease progression and response to therapy.Prostate Cancer and Prostatic Diseases (2008) 11, 112–120; doi:10.1038/sj.pcan.4501026; published online 13 November 2007 [ABSTRACT FROM AUTHOR]

At present, bladder cancer screening is not an accepted standard of care; however, there is potential for non-invasive screening for this disease. Urine cytology has a high sensitivity and specificity for the detection of high-grade urothelial carcinoma, but lacks the sensitivity to detect low-grade tumors and is not cost-effective for screening. Use of hemoglobin dipstick has been utilized for screening but suffers from a low positive predictive value. An accurate bladder tumor marker would be useful for both screening of high-risk populations and for monitoring of patients with a history of bladder cancer to help identify recurrence early and prevent disease progression. A number of markers that take advantage of exfoliated cells in the urine for detection of cell surface antigens, nuclear morphology, or gene expression as well as markers for detection of excreted proteins have been studied in bladder cancer. In our previous review, we have discussed cytology and commercially available FDA-approved urine markers. Herein, we review the potential for bladder cancer screening as well as the most promising urine-based markers that are currently under investigation. [ABSTRACT FROM AUTHOR]

BACKGROUND: Deregulation of apoptosis is a characteristic of human carcinogenesis. We aimed to investigate expression of the apoptosis markers Bcl-2, caspase-3, P53, and survivin and the association with oncological outcomes of patients treated by radical cystectomy and bilateral lymphadenectomy for urothelial-cell carcinoma of the bladder. METHODS: Bcl-2, caspase-3, P53, and survivin immunostaining was undertaken on serial tissue microarrays containing cores from 226 consecutive patients (median follow-up 36.9 months [IQR 13.3-79.0]). 200 bootstrap resamples with replacement were done to reduce overfit bias and for internal validation. FINDINGS: Expression of Bcl-2, caspase-3, P53, and survivin was altered in 73 (32%), 111 (49%), 120 (53%), and 141 (64%) patients, respectively. By univariate analysis, altered expression of Bcl-2, caspase-3, P53, and survivin were all associated with high probability of disease recurrence (hazard ratio 2.24 [95% CI 1.51-3.32], p<0.001; 1.73 [1.16-2.59], p=0.007; 2.70 [1.77-4.12], p<0.001; and 2.32 [1.48-3.63], p<0.001) and disease-specific mortality (2.06 [1.33-3.18], p=0.001; 2.35 [1.48-3.73], p<0.001; 3.23 [1.98-5.28], p<0.001; and 2.64 [1.57-4.44], p<0.001; respectively). Risk of recurrence and disease-specific mortality progressively grew with increasing number of altered biomarkers. By multivariate analysis, alteration of four markers was independently associated with high rates of disease recurrence (4.03 [1.23-13.16], p=0.021) and disease-specific mortality (6.84 [1.43-32.63], p=0.016). Addition of the number of altered markers to a model that included standard predictors significantly enhanced its predictive accuracy for disease recurrence and disease-specific survival. INTERPRETATION: Bcl-2, caspase-3, P53, and survivin have a cooperative effect on progression of bladder cancer. Assessment of combined apoptosis marker status and number of altered markers in patients treated by radical cystectomy provides prognostic information that could help to identify those at high risk for disease recurrence and mortality, who could benefit from early adjuvant treatment. [ABSTRACT FROM AUTHOR]

Bladder cancer is currently diagnosed using cystoscopy and cytology in patients with suspicious signs and symptoms. These tests are also used to monitor patients with a history of bladder cancer. The recurrence rate for bladder cancer is high, thus necessitating long-term follow-up. Urine cytology requires an experienced cytopathologist. It has high specificity, but low sensitivity for low-grade bladder tumors. Recently, multiple non-invasive urine-based bladder cancer tests have been developed. Many markers have already been approved by the Food and Drug Administration (FDA) for bladder cancer surveillance, but only one marker is approved for detection of bladder cancer in high risk patients (NMP22 BladderChek). [ABSTRACT FROM AUTHOR]

The most important tools for making therapeutic decisions include stage and grade for bladder and kidney cancer, as well as PSA for prostate cancer. Unfortunately, all tumors of the same stage and grade do not behave the same, indicating the need for additional markers that can provide more accurate prognostic ability. The exponential increase in our understanding of the molecular mechanisms of disease during the past 2 decades has been aided by a large array of bladder, prostate, and kidney cancer biomarkers with potential diagnostic and prognostic value. This article reviews the molecular bio-markers that have shown to be clinically useful in the diagnosis and prognosis of urologic tumors. Ultimately, molecular markers may pro-vide information that can be used to tailor the treatment of individual patients. [ABSTRACT FROM AUTHOR]

Studies the clearance rates of total prostate specific antigen (PSA) after radical prostatectomy in African-Americans and Caucasians. Racial differences in serum PSA values in men with and without prostate cancer; Levels of PSA found in Afro-American and Caucasian men; Elimination of PSA from the serum of men with prostate cancer following prostatectomy.

Purpose: This study aims to determine the significance of androgen receptor (AR) expression in urothelial carcinoma of the upper urinary tract (UTUC). Methods: AR expression was assessed on tissue microarrays containing specimens of 737 patients with UTUC who underwent radical nephroureterectomy with curative intent. AR expression was correlated with clinical and pathological tumor features as well as recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS). Results: Overall, AR was expressed in 11 % of tumors. AR expression was significantly associated with tumor necrosis as well as sessile and multifocal tumor growth but not with RFS, CSS or OS. AR was detected nearly twice as often in tumors of the ureter than of the pelvicalyceal system ( p = 0.005). Subgroup analyses showed that the significant associations of AR with unfavorable pathologic features were exclusively attributable to tumors located in the ureter. However, in both ureteral and pelvicalyceal tumors, AR status was independent of RFS, CSS and OS. Conclusions: In this cohort of patients treated with RNU, AR expression was found in approximately 10 % of UTUCs, twice as often in ureteral than in pelvicalyceal tumors. While AR expression had no impact on postoperative prognosis, it was significantly associated with unfavorable pathologic features in ureteral tumors. Steroid hormone signaling might be relevant for future investigations of differences between ureteral and pelvicalyceal tumors. [ABSTRACT FROM AUTHOR]

Background:With the increasing use of robotic surgery in the United States, the comparative effectiveness and differences in reimbursement of minimally invasive radical prostatectomy (MIRP) and open prostatectomy (ORP) in privately insured patients are unknown. Therefore, we sought to assess the differences in perioperative outcomes and hospital reimbursement in a privately insured patient population who were surgically treated for prostate cancer.Methods:Using a large private insurance database, we identified 17 610 prostate cancer patients who underwent either MIRP or ORP from 2003 to 2010. The primary outcomes were length of stay (LOS), perioperative complications, 90-day readmissions rates and hospital reimbursement. Multivariable regression analyses were used to evaluate for differences in primary outcomes across surgical approaches.Results:Overall, 8981 (51.0%) and 8629 (49.0%) surgically treated prostate cancer patients underwent MIRP and ORP, respectively. The proportion of patients undergoing MIRP markedly rose from 11.9% in 2003 to 72.5% in 2010 (P<0.001 for trend). Relative to ORP, MIRP was associated with a shorter median LOS (1.0 day vs 3.0 days; P<0.001) and lower adjusted odds ratio of perioperative complications (OR: 0.82; P<0.001). However, the 90-day readmission rates of MIRP and ORP were similar (OR: 0.99; P=0.76). MIRP provided higher adjusted mean hospital reimbursement compared with ORP (US$19 292 vs US$17 347; P<0.001).Conclusions:Among privately insured patients diagnosed with prostate cancer, robotic surgery rapidly disseminated with over 70% of patients undergoing MIRP by 2009-2010. Although MIRP was associated with shorter LOS and modestly better perioperative outcomes, hospitals received higher reimbursement for MIRP compared with ORP. [ABSTRACT FROM AUTHOR]

Background:Pelvic lymph node dissection in patients undergoing radical prostatectomy for clinically localised prostate cancer is not without morbidity and its therapeutical benefit is still a matter of debate. The objective of this study was to develop a model that allows preoperative determination of the minimum number of lymph nodes needed to be removed at radical prostatectomy to ensure true nodal status.Methods:We analysed data from 4770 patients treated with radical prostatectomy and pelvic lymph node dissection between 2000 and 2011 from eight academic centres. For external validation of our model, we used data from a cohort of 3595 patients who underwent an anatomically defined extended pelvic lymph node dissection. We estimated the sensitivity of pathological nodal staging using a beta-binomial model and developed a novel clinical (preoperative) nodal staging score (cNSS), which represents the probability that a patient has lymph node metastasis as a function of the number of examined nodes.Results:In the development and validation cohorts, the probability of missing a positive lymph node decreases with increase in the number of nodes examined. A 90% cNSS can be achieved in the development and validation cohorts by examining 1-6 nodes in cT1 and 6-8 nodes in cT2 tumours. With 11 nodes examined, patients in the development and validation cohorts achieved a cNSS of 90% and 80% with cT3 tumours, respectively.Conclusions:Pelvic lymph node dissection is the only reliable technique to ensure accurate nodal staging in patients treated with radical prostatectomy for clinically localised prostate cancer. The minimum number of examined lymph nodes needed for accurate nodal staging may be predictable, being strongly dependent on prostate cancer characteristics at diagnosis. [ABSTRACT FROM AUTHOR]

Prior research has questioned the need for overnight observation (OBS) following artificial urinary sphincter (AUS) surgery. We sought to analyze our institutional experience transitioning from OBS to same day surgery (SDS) for AUS surgery. We retrospectively reviewed AUS surgeries performed by a single surgeon at our tertiary academic medical center between 08/2013 and 03/2020. Medical records were reviewed for patient demographics, immediate postoperative complications, timing of postoperative discharge, need for readmission, emergency department (ED) visit, outpatient phone call, or non-routine clinic visit within 7 days of discharge, and need for device explant or revision within 90 days of discharge. Patients were grouped based on discharge status: OBS vs. SDS. Catheters were removed prior to discharge (OBS group) or self-removed at home (SDS group) on the morning of postoperative day 1 (POD1). Cost savings associated with SDS were estimated using room and bed charges from a contemporary group of AUS patients (09/2017 through 08/2020). Student's t and Chi-squared tests were used to compare groups. We identified 528 men who met inclusion criteria. Men in the SDS group (n = 308) were more likely to have undergone a virgin AUS insertion and were slightly younger and healthier (Table). Men in the OBS group (n = 220) were more likely to suffer an immediate postoperative complication and to be readmitted within 90 days of surgery. The groups did not vary with respect to multiple other perioperative outcomes measures. Among patients who underwent AUS surgery between 09/2017 and 08/2020, those with OBS status (n = 39) had mean additional room and bed charges of $ 745 ± 302 vs. none for SDS patients (n = 183). SDS for AUS insertion is safe, effective, and associated with significant cost savings. Routine overnight observation after AUS insertion appears to be unnecessary. Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific and Coloplast [ABSTRACT FROM AUTHOR]

Background:The impact of statin use on biochemical recurrence (BCR) in patients treated with radical prostatectomy (RP) remains controversial.Methods:We retrospectively evaluated 6842 patients who underwent RP for clinically localized prostate cancer (PC) between 2000 and 2011. Uni- and multivariable cox regression models addressed the association of statin use with BCR.Results:Overall, 2275 (33.3%) patients used statins. Statin users were older and had a higher rate of positive surgical margins than patients not using statins (P-values 0.05). Within a median follow-up of 25 months (interquartile range: 8-42 months), 778 (11.4%) patients experienced BCR. Actuarial estimate 5-years BCR-free survival was 82%±1 for patients without statin use and 84±1% for patients using statins (P=0.05); statin use was not associated with BCR (hazard ratio: 0.88, 95% confidence interval: 0.76-1.03, P=0.10) after adjusting for the effects of standard clinicopathologic features.Conclusions:In PC patients undergoing RP, statin use was not independently associated with lower risk of BCR. [ABSTRACT FROM AUTHOR]

Background:The European Organization for Research and Treatment of Cancer (EORTC) risk tables and the Spanish Urological Club for Oncological Treatment (CUETO) scoring model are the two best-established predictive tools to help decision making for patients with non-muscle-invasive bladder cancer (NMIBC). The aim of the current study was to assess the performance of these predictive tools in a large multicentre cohort of NMIBC patients.Methods:We performed a retrospective analysis of 4689 patients with NMIBC. To evaluate the discrimination of the models, we created Cox proportional hazard regression models for time to disease recurrence and progression. We incorporated the patients calculated risk score as a predictor into both of these models and then calculated their discrimination (concordance indexes). We compared the concordance index of our models with the concordance index reported for the models.Results:With a median follow-up of 57 months, 2110 patients experienced disease recurrence and 591 patients experienced disease progression. Both tools exhibited a poor discrimination for disease recurrence and progression (0.597 and 0.662, and 0.523 and 0.616, respectively, for the EORTC and CUETO models). The EORTC tables overestimated the risk of disease recurrence and progression in high-risk patients. The discrimination of the EORTC tables was even lower in the subgroup of patients treated with BCG (0.554 and 0.576 for disease recurrence and progression, respectively). Conversely, the discrimination of the CUETO model increased in BCG-treated patients (0.597 and 0.645 for disease recurrence and progression, respectively). However, both models overestimated the risk of disease progression in high-risk patients.Conclusion:The EORTC risk tables and the CUETO scoring system exhibit a poor discrimination for both disease recurrence and progression in NMIBC patients. These models overestimated the risk of disease recurrence and progression in high-risk patients. These overestimations remained in BCG-treated patients, especially for the EORTC tables. These results underline the need for improving our current predictive tools. However, our study is limited by its retrospective and multi-institutional design. [ABSTRACT FROM AUTHOR]

One purported advantage of electronic medical records (EMRs) is to improve patient care. This study uses a search of EMR to identify patients at risk for prostate cancer who were not evaluated by an urologist. The University of Texas Southwestern Medical Center (UTSW) has an institutional outpatient EMR that is used by all providers in all specialties. Since March 2009, all PSA tests were reported with specific interpretative comments including a recommendation for referral to urology for a PSA >2.5 ng ml−1. All PSA tests were performed on campus since institution of these recommendations were analyzed, and charts reviewed for all patients not seen in urology with a serum PSA >2.5 ng ml−1. Of the 2884 non-urology patients that had a serum PSA drawn between March 2009 and February 2010 at UTSW, 293 patients had a serum PSA >2.5 ng ml−1. Of these, 39 patients had known prostate cancer and were seeing an oncologist. There were 59 patients seeing urologists outside the institution. A total of 195 patients were not seen by an urologist and only 11 patients were recommended to see one but did not make an appointment. There were 151 patients with more than one PSA in the system, and of these 103 had a rise in PSA with a median rise of 0.53 ng ml−1 per year. EMR allows identification of patients at increased risk of prostate cancer who are not evaluated. Prospective studies are needed to identify ways to improve appropriate evaluation and detection of prostate cancer. [ABSTRACT FROM AUTHOR]

Purpose/objective(s): Hydrogel rectal spacer placement (HSP) has been shown to minimize rectal dose during prostate cancer radiotherapy, yet its potential benefit for modulating rectal toxicity could in large part depend upon the quality of prostate-rectal separation achieved from HSP. We therefore developed a practical quality metric to evaluate HSP, validating its association with rectal dose reduction, as well as physician- and patient-reported rectal toxicity using a prospective dataset of men treated with prostate stereotactic body radiotherapy (SBRT).Materials/methods: Using the axial T2-weighted MRI images from a small pilot cohort of men with HSP who had been treated at our institution with prostate SBRT, a hydrogel spacer quality metric was devised from prostate-rectal space thickness (PRST) measurements. A score of 0, 1, or 2 was assigned to a PRST of < 0.3 cm, 0.3-0.9 cm, or ≥1 cm, respectively; an overall spacer quality score (SQS) was computed from individual scores (total of 9) at rectal midline and 1 cm to the right and left, located at the level of the prostate base, midgland, and apex. This quality metric was then applied to MRI simulation scans of 43 men with low/intermediate risk prostate cancer who had been enrolled on a multi-institutional phase II study to assess safety and efficacy of HSP during prostate SBRT. Associations between SQS and rectal dosimetry, late gastrointestinal (GI) toxicity, and EPIC bowel quality of life were quantified in these men treated with 45 Gy in 5 fractions.Results: Among this cohort, the majority had a SQS of 1 (n = 18; 42%) or 2 (n = 18; 42%). SQS was associated with maximum rectal point dose (rectal Dmax; P = 0.001), maximum dose to 1 cc of rectum (D1cc; P = 0.003), and volume of rectum receiving ≥100% of prescription dose (V45; P = 0.03). For those with SQSs of 0, 1 and 2, the median rectal Dmax (cGy) was 4683, 4600, and 3921, respectively. SQS was associated with incidence of late GI toxicity (P = 0.03) and highest late GI toxicity score (P = 0.02). Among the 20 men who developed late GI toxicity, 57%, 67% and 22% with Grade ≥1 had a SQS of 0, 1, and 2, respectively. Men with SQSs of 2 compared to 0-1 had 1.36 times lower odds of an increased rectal Dmax (95% CI: 1.14-1.63); and 1.20 times lower odds of an increased rectal D1cc (95% CI: 1.07-1.34). Men with SQSs of 2 versus 0-1 had 3.30 times lower odds of a higher late GI toxicity score (95% CI: 1.18-9.28). While evidence of a significant difference in baseline EPIC bowel summary score between SQSs was not observed (P = 0.07) as expected, men with SQSs of 2 compared to 0-1 had 3.52 times higher odds (95% CI: 0.91-13.64) of a superior bowel summary score 12 months from prostate SBRT.Conclusion: We developed a reliable, easy to use, and informative metric for assessing HSP, which appears to be associated with rectal dosimetry and late GI toxicity in men treated with prostate SBRT. [ABSTRACT FROM AUTHOR]