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Objective: To evaluate the significance of close surgical margins in organ‐sparing surgery (OSS) in the treatment of penile squamous cell carcinoma (pSCC) and clinicopathological factors that may influence local recurrence. Patients and Methods: At our tertiary referral centre, between March 2001 and September 2012, 332 patients treated with OSS for pSCC had clear surgical margins. As the focus was the impact of close clear margins on local recurrence, patients with positive margins were excluded for the purpose of this study. Our overall positive margin rate for OSS in penile cancer is 7.6% (42 patients). Analysis was carried out on an on‐going prospective database, including prospective accurate pathological recording of surgical margins. Patients underwent OSS after multidisciplinary team (MDT) discussion. Local recurrence was the primary outcome measured and Fisher's exact test and time‐to‐recurrence curves were used in the analysis. All local recurrences were scrutinised by the MDT and were categorised into: true recurrences or metachronous new occurrences (i.e. tumours arising from a background of penile intraepithelial neoplasia and forming on an epithelial surface not related to the site of initial resection). A multivariate analysis was also conducted to elucidate other factors influencing local recurrence. Results: In all, 64% of the patients had a <5 mm clear deep surgical margin, with 16% clear by <1 mm. Overall, 4% of patients had a true local recurrence, with a median time to recurrence of 6 months. In all, 53% were due to embolic spread, with residual occult local disease accounting for 47%. There was a statistically significant relationship between cavernosal involvement (P = 0.014) and lymphovascular invasion (LVI; P = 0.001) and local recurrence. Although multivariate analysis revealed that the extent of clear margin was not a predictor of disease (P = 0.405), we found an increased risk of local recurrence in the clear margin cohort of <1 mm compared to those of >1 mm (P < 0.001). Those patients considered to have metachronous tumours were scrutinised by our MDT, and eight patients (2.4%) were found to have new occurrences. Our overall proportion of patients therefore needing further treatment for either new occurrences or recurrent disease after OSS stands at 6.4%. Conclusions: Overall the presence of local recurrent disease in OSS in our experience is low (4%). We report an embolic mechanism of local recurrence, strongly suggested by the presence of cavernosal involvement and LVI. We conclude that a deep clear margin of >1 mm has a very low risk of local recurrence in penile OSS. [ABSTRACT FROM AUTHOR]

Introduction: Hyperthermic mitomycin (HM) is a novel treatment modality for selected patients with high-risk non-muscle invasive bladder cancer (NMIBC). We sought to determine predictors of response to this therapy. Patients and Methods: A longitudinal, cohort study of 97 patients with high-risk NMIBC treated with ≥4 HM instillations on a prophylactic schedule was conducted. The primary outcome was time-to-progression survival; secondary outcomes were overall survival, cancer-specific survival, and adverse events. Descriptive statistics, Kaplan-Meier survival analyses, Cox proportional hazards modelling, and univariate and multivariable regression were performed. Results: The presence of initial complete response (CR; no evidence of disease at first check video-cystoscopy and urine cytology) post-HM treatment was an independent predictor of good response to HM. Female patients and those without carcinoma in situ (CIS) also appeared to respond better to the intervention. The overall bladder preservation rate at a median of 27 months was 81.4%; 17/97 (17.5%) patients died during the course of the study. Conclusions: High-risk NMIBC patients can be safely treated with HM and have good oncological outcome. However, those without an initial CR have a poor prognosis and should be counselled towards adopting other treatment methodologies such as cystectomy. Female gender and lack of CIS may be good prognostic indicators for response to HM. © 2015 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Benjamin Ayres discusses the use of BCG in the management of non-muscle-invasive bladder cancer, emphasising the importance of controlling the inevitable side-effects of this toxic treatment. Copyright © 2013 John Wiley & Sons [ABSTRACT FROM AUTHOR]

Study Type - Diagnostic (exploratory cohort) Level of Evidence 3b What's known on the subject? and What does the study add? The optimal method of active surveillance in prostate cancer remains unknown. This study is one of the first to report on the role of transperineal template prostate biopsies in active surveillance. It demonstrates that around one third of men are reclassified with more significant prostate cancer at an early stage in their management. This is a higher proportion than reported in contemporary cancers using standard transrectal biopsies for restaging. OBJECTIVE [ABSTRACT FROM AUTHOR]

The article focuses on the role of photodynamic diagnosis (PDD) in detecting non-muscle-invasive bladder cancer. According to the findings of the European Association of Urology (EAU), the use of PPD plays a significant role in the detection of malignant tumours as it reduces residual tumour rates by at least 20%. Moreover, the quality of life of patients assessed and treated with PDD reduces anxiety for it provides more accurate diagnosis and reduces risk of cancer recurrence.

The article focuses on the use of intravesical bacillus Calmette-Guérin (BCG) in treating non-muscle-invasive bladder cancer. It says that maintaining BCG therapy is more beneficial than mitomycin C (MMC) in treating the cancer. It suggests that maintaining of BCG therapy must only be given for at least one year to achieve benefits in reducing cancer recurrence and possibly progression.

The article investigates the function of postoperative intravesical chemotherapy in treating non-muscle-invasive bladder cancer (NMIBC). It examines the case of 111 patients with multiple tumours who received the chemotherapy but had cancer recurrence in 65.2%. It found that patients with intermediate-risk NMIBC have benefit from immediate postoperative intravesical chemotherapy to reduce tumour seeding, but a further course of the chemotherapy is needed to provide a longer-term benefit.

The article comments on the importance of chronic kidney disease (CKD) guidelines in urology. The authors remark that this guideline was published to aid the investigation, identification, management and referral of CKD in adults in Great Britain. It adopted the international classification system based on the presence or absence of markers of CKD, like proteinuria and urologically unexplained hematuria, and on estimated glomerular filtration rate.

The article comments on a study regarding the stress response in laparoscopic urological surgery. Laparoscopic surgery is gaining popularity in the treatment of many urological conditions. The stress response results in catabolism and repair, mediated by cytokines, catecholamines, cortisol, insulin, growth hormone and antidiuretic hormone. There is growing evidence that laparoscopy causes an altered stress and immune response compared with open surgery.

A letter to the editor is presented about the collaboration of the BAUS Section of Oncology with the South West Public Health Observatory to enhance the clinical database of the section.

A letter to the editor is presented in response to the article by M. E. Nielsen and his colleagues stating that a delay in radical cystectomy of less than three months is not related with a worse clinical outcome.