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We evaluated the impact of salvage lymph node dissection with adjuvant radiotherapy in patients with nodal recurrence of prostate cancer. By default, nodal recurrence of prostate cancer is treated with palliative antihormonal therapy, which causes serious side effects and invariably leads to the development of hormone refractory disease.A total of 47 patients with nodal recurrence of prostate cancer based on evidence of (11)C-choline/(18)F-choline ((18)F-fluorethylcholine) positron emission tomography-computerized tomography underwent primary (2 of 52), secondary (45 of 52), tertiary (4 of 52) and quaternary (1 of 52) salvage lymph node dissection with histological confirmation. Of 52 salvage lymph node dissections 27 were followed by radiotherapy. Biochemical response was defined as a prostate specific antigen less than 0.2 ng/ml after salvage therapy. The Kaplan-Meier method, binary logistic regression and Cox regression were used to analyze survival as well as predictors of biochemical response and clinical progression.Mean prostate specific antigen at salvage lymph node dissection was 11.1 ng/ml. A mean of 23.3 lymph nodes were removed per salvage lymph node dissection. Median followup was 35.5 months. Of 52 salvage lymph node dissections 24 resulted in complete biochemical response followed by 1-year biochemical recurrence-free survival of 71.8%. Gleason 6 or less (OR 7.58, p = 0.026), Gleason 7a/b (OR 5.91, p = 0.042) and N0 status at primary therapy (OR 8.01, p = 0.011) were identified as independent predictors of biochemical response. Gleason 8-10 (HR 3.5, p = 0.039) as a preoperative variable, retroperitoneal positive lymph nodes (HR 3.76, p = 0.021) and incomplete biochemical response (HR 4.0, p = 0.031) were identified as postoperative predictors of clinical progression. Clinical progression-free survival was 25.6% and cancer specific survival was 77.7% at 5 years.Based on (11)C/(18)F-choline positron emission tomography-computerized tomography as a diagnostic tool, salvage lymph node dissection is feasible for the treatment of nodal recurrence of prostate cancer. Most patients experience biochemical recurrence after salvage lymph node dissection. However, a specific population has a lasting complete prostate specific antigen response.

INTRODUCTION AND OBJECTIVES: Accurate imaging of lymph node metastases (LNM) is a prerequisite for metastases directed therapies such as salvage lymph node dissection (salvage-LND) in nodal recurrent prostate cancer (PCa). Our aim was to evaluate the diagnostic accuracy of 68PSMA-PET/CT (DKFZ-11) for nodal relapse of PCa according to different topographical locations and the size of tumor deposits in lymph nodes (LN). METHODS: 25 patients with the suspicion of nodal PCa-relapse after primary therapy underwent pelvic and/or retroperitoneal salvage-LND after a whole body PET/CT with 68Ga-PSMA showing PET-positive lesions. Time from PET/CT to salvage-LND was median 2.3 months. Diagnostic accuracy of PET/CT for dissected main-regions (pelvic left/right, retroperitoneal) and subregions (common, external, internal iliac, obturatoria, presacral, aortic-bifurcation, aortal, caval, interaortocaval) was determined by comparing histopathologic results with PET/CT-findings. Size ofmetastatic infiltration inLNwasmeasuredbasedonhistopathology. RESULTS: Mean PSA at salvage-LND was 3.03 ng/ml (SD 3.2 / median 1.74 ng/ml). Overall, 833 LN were resected in 25 patients, containing 98 LNM, corresponding to a mean of 33.3 LN and 3.9 LNM per patient. In 5 patients (8 subregions) tissue containing solid non-nodal local relapse was additionally resected. LN were removed in portions out of 10 subregions per patient leading to 251 subregions available for evaluation. Median 3 LN were removed per subregion. For 2/25 patients and in 7/251 subregions, the suspected tumor involvement was verified by follow-up PET/CT showing progress of the lesions and PSA increase. 35/60 (58.3%) of the main regions and 63/251 (25%) of the subregions were PET-positive. Sensitivity, specifity, positive predictive value (PPV), negative predictive value (NPV) and accuracy based on a main-region analysis was 92.1% (35/38), 100% (22/22), 100% (35/35), 88.0% (22/25) and 95.0% (57/60). Based on a subregion-analyses sensitivity, specifity, PPV, NPV and accuracy was 80.7 % (63/78), 100% (173/173), 100% (63/63), 92.0% (173/188) and 94.0% (236/251). Median diameter (6 mm) of tumor deposits in LNM removed from true-positive subregions was significantly different to LNM resected from false-negative subregions (2 mm) (p

The aim of the present study was to elucidate whether only local, or also systemic immunomodulatory effects may be induced by intravesical BCG therapy of superficial urinary bladder cancer.A total of 37 patients with stages Ta to T1b superficial transitional cell bladder carcinomas received 6 weekly BCG instillations after transurethral resection of the tumor. In a first group of 19 patients blood was taken before each BCG instillation and 6 weeks after the last one. In a second group of 18 patients blood and urine was taken before and 2, 6, and 24 hours after each BCG instillation. In the mitogen-stimulated whole blood cell cultures and in the urine samples the levels of the cytokines IL-1beta, IL-2, IL-10, TNF-alpha and IFN-gamma were determined by enzymoimmunological tests. Additionally, in all plasma and urine samples the levels of TNF-p75-receptor (TNF-p75-R) were measured.Comparison of ex vivo leukocyte cytokine production in the blood cell cultures of the patients of group I revealed no significant change in the levels of the cytokines. In contrast, TNF-p75-R plasma levels increased significantly during the experimental time of 12 weeks (por =0.01). In the blood cell cultures of the group II patients a different daytime variation of cytokine production was seen, compared to the 19 healthy controls. After BCG instillation the normal peak cytokine production in the evening was suppressed. A significant rise in plasma TNF-p-75-R levels was measured 24 hours after BCG instillation (por =0.05). In the urine of these patients significantly higher levels of all measured cytokines and TNF-p75-R were observed 6 to 24 hours after the instillation.The results suggest that besides the well known local immune activation, BCG instillation also leads to a modulation of peripheral immune mechanisms.

Patients with immunosuppression after renal transplantation are at risk of developing neoplastic disease. Several cases of invasive squamous cell carcinoma, adenocarcinoma and transitional cell carcinoma of the bladder develo ing years after renal transplantation have been reported.'*'Invasive bladder tumors require radical surgery with several possible methods of urinary diversion in renal transplant patients3 However, to our knowledge a continent orthotopic ileal neobladder in a female patient aRer renal transplantation has not been described previously. We report a rare case of a woman with multifocal transitional cell carcinoma of the renal pelvis, ureter and bladder 8 years after renal transplantation.