Search

Background This study evaluated the predictive value of gene signatures for biochemical recurrence (BCR) in primary prostate cancer (PCa) patients. Methods Clinical features and gene expression profiles of PCa patients were attained from Gene Expression Omnibus (GEO) and The Cancer Genome Atlas (TCGA) datasets, which were further classified into a training set (n = 419), a validation set (n = 403). The least absolute shrinkage and selection operator Cox (LASSO‐Cox) method was used to select discriminative gene signatures in training set for biochemical recurrence‐free survival (BCRFS). Selected gene signatures established a risk score system. Univariate and multivariate analyses of prognostic factors about BCRFS were performed using the Cox proportional hazards regression models. A nomogram based on multivariate analysis was plotted to facilitate clinical application. Kyoto Encyclopedia of Gene and Genomes (KEGG) and Gene Ontology (GO) analyses were then executed for differentially expressed genes (DEGs). Results Notably, the risk score could significantly identify BCRFS by time‐dependent receiver operating characteristic (t‐ROC) curves in the training set (3‐year area under the curve (AUC) = 0.820, 5‐year AUC = 0.809) and the validation set (3‐year AUC = 0.723, 5‐year AUC = 0.733). Conclusions Clinically, the nomogram model, which incorporates Gleason score and the risk score, could effectively predict BCRFS and potentially be utilized as a useful tool for the screening of BCRFS in PCa., In this work, we established the risk score consisting of six gene signatures, which can predict biochemical recurrence in primary prostate cancer. Clinically, the nomogram model, which incorporates the Gleason score and the risk score, could effectively predict BCRFS and potentially be utilized as a useful tool for the screening of BCRFS in PCa.

Purpose This prospective study was aimed at assessing the ability of 99mTc-PSMA scan to detect bone metastases in prostate cancer (PCa) against 99mTc-MDP scan as a standard and assess the correlation of these modalities in PCa staging of bone involvement. Patients and methods Forty-one patients (41) with histologically confirmed PCa were scanned using both methods. Planar imaging was performed with additional regional SPECT/CT 3 to 4 hours posttracer injection. Scans were reported as positive, negative, or equivocal. In the case of positive scans, lesions were quantified by each of the 3 reporters separately. Planar and SPECT/CT images were reported together to obtain the final report on each scan. Results Our preliminary results showed no significant difference in the detection of bone metastases between the 2 scans. 99mTc-PSMA detected 52 of the 55 bone lesions detected on 99mTc-MDP. However, 99mTc-PSMA provided extra information by reporting lymph nodal metastases in 7 patients and residual disease in the prostate in 2 patients with biochemical progression after radical therapy. In 1 patient, the PSMA scan resulted in change in management with patient now on 177Lu-PSMA radioligand therapy. Equivocal findings were reported in 4 patients on 99mTc-MDP and none on 99mTc-PSMA. Conclusions 99mTc-PSMA was comparable to 99mTc-MDP in detection of bone metastases and demonstrated an additional benefit of providing information on visceral disease. 99mTc-PSMA may be a better alternative to 99mTc-MDP in staging, restaging, and assessment of patients with biochemical progression after radical therapy of PCa in a resource-limited setup like ours while also assisting to detect patients eligible for PSMA-labeled radioligand therapy.

The true causes of sexual disorders after radiation treatment of prostate cancer, among which the central role is occupied by erectile dysfunction, are still not fully clarified. The number of patients who undergo various radiation-exposure options as a radical therapy is steadily increasing, which makes the issue very relevant. This literature review provides up-to-date data on the most studied probable mechanisms of the erectile function status decline after radiation therapy for prostate cancer.

The incidence of pancreatic cancer has been increasing in recent years. It is expected to be the second or the third leading cause of cancer deaths in high-income countries in the next decade. Standard therapeutic management for patients with resectable pancreatic cancer is surgical resection followed by adjuvant chemotherapy. The main reason for neoadjuvant therapy is that the prognosis with current strategies is unsatisfactory, and we need new treatments to improve overall survival as well as the quality of life of the patients suffering from pancreatic cancer. The aim of this paper is to provide an overview of the recent data on the subject of neoadjuvant treatment concerning resectable and borderline resectable group of patients.

Purpose: To evaluate urinary continence and sexual potency following radical prostatectomy and adjuvant radiotherapy.Materials/Methods: Expanded Prostate Cancer Index Composite (EPIC) surveys of patients with localized prostate cancer treated with surgery followed by adjuvant/salvage pelvic radiotherapy (S+RT) were analyzed. A control cohort was primary radiotherapy (RT). Reverse "bifecta" was defined as a score less than 60 in both incontinence and sexual domains. Superior urinary function was defined as a score above 90. The clinically important difference was calculated using a distribution approach.Results: Surveys at least 1 year after treatment were available for 130 S+RT and 374 RT patients. For S+RT vs. RT, the mean urinary incontinence score was 68 [6.25 -100] versus 86.4 [CI-95 39.5-100] (pConclusion: In this cross sectional study, Surgery with adjuvant/salvage RT was associated with significantly worse patient reported urinary continence outcomes at 1-year post treatment, lower odds of achieving perfect urinary continence and a threefold risk of reverse ‘bifecta’ with inferior urinary continence and sexual performance. Longitudinal studies of evolving toxicity are required to validate these findings. Patients referred for surgery with a high probability of requiring adjuvant or salvage radiotherapy should be informed regarding the potential composite toxicity of both surgery and radiotherapy.

The evidence for stereotactic body radiotherapy (SBRT) is meagre for patients with clinical T3-4N0M0 non-small cell lung cancer (8th Edition of the Union for International Cancer Control (UICC)). This study retrospectively investigated clinical outcomes following SBRT for such patients. Among consecutive patients treated with SBRT, patients staged as cT3-4N0M0 by all criteria were examined, most of whom were unsuitable to chemoradiotherapy due to their fragile characters. Clinical outcomes were evaluated and factors associated with outcomes were investigated. Between 2005 and 2017, 70 eligible patients (T3: 58, T4: 12; median age 81 (63–93) years) were identified. Median follow-up duration was 28.6 (1.0–142.5) months. No adjuvant chemotherapy was administered. The 3-year local recurrence rates were 15.8% and 16.7% in T3 and T4 patients, respectively, and they were significantly lower in the high-dose group (3.1% vs 28.6%, P < 0.01). Multivariate analyses showed that the dose-volumetric factor was the significant factor for local recurrence. The 3-year regional and distant metastasis rates, cancer-specific mortality, and overall survival in T3 and T4 patients were 22.7% and 25.0%, 26.5% and 33.3%, 32.2% and 41.7%, and 39.5% and 41.7%, respectively. Only age was correlated with overall survival. Radiation pneumonitis ≥grade 3 and fatal hemoptysis occurred in 3 and 1 patients, respectively. SBRT for cT3-4N0M0 lung cancer patients achieved good local control. Survival was rather good considering that patients were usually frail, staged with clinical staging, and were not given adjuvant chemotherapy, and it may be comparable to surgery. To validate these outcomes following SBRT, a prospective study is warranted.

The "super-active surveillance" concept denotes any active surveillance optimization that allows longer surveillance periods, with the main intention of avoiding overtreatment, by safely eliminating or postponing radical treatment. Super-active surveillance might add to the oncological control with minimal functional impact and similar quality of life compared to active surveillance, which has proved to be safe in well-selected patients. Vascular targeted photodynamic therapy has pioneering shown to significantly reduce the upgrade on subsequent biopsies, resulting in fewer cases converted to radical therapy, and any energy source can be applied to the super-active surveillance concept allowing more men to consider a tissue-preserving therapy for prostate cancer.

1 Current status of non‐pharmacotherapies in Japan Pacemaker treatment for bradyarrhythmia was first approved for national health insurance coverage in Japan in 1974, and its use rapidly became widespread thereafter. Approximately 40 years later, in 2017, the number of patients treated with this technology has increased to 60 137 (41 895 new cases and approximately 18 242 replacements). 5 Capsule‐shaped leadless pacemaker also became available in 2016, and this technology is being established as a new option. Non‐pharmacological treatment of tachy‐arrhythmia began in 1969 from when Will C. Sealy performed surgery in patients with Wolff‐Parkinson‐White (WPW) syndrome (Figure 1). Since then, the application of surgical treatment has expanded to conditions such as ventricular tachycardia (VT) and atrial fibrillation (AF), and surgery has been the pioneer of radical therapy for tachyarrhythmias. At the present time, many surgical methods have been replaced by catheter ablation; however, surgical treatment still remains an indispensable option for patients with a tachycardia resistant to other medical treatments. Open in a separate window FIGURE 1 History of non‐pharmacotherapy of cardiac arrhythmia

BackgroundAVODART After Radical Therapy For Prostate Cancer Study (ARTS) reported dutasteride reduced PSA doubling (PSADT) at two years by 66% and disease progression by 59%. The durability of the cancer control is unknown.ObjectiveExplore the impact of dutasteride on PSADT and time to progression in men with PSA-only recurrent disease.Design, Setting and ParticipantsRetrospective examination of the impact of dutasteride on PSA kinetics and time to progression with PSA-only recurrent prostate cancer.InterventionDutasteride daily.Outcome, Measurement and Statistical AnalysisChange in PSA over time was determined by linear regression of natural log of PSA versus time. The slope of that curve was used as a measure of exponential PSA progression. Impact of dutasteride on slope was analyzed using Wilcoxon signed-rank two-sided test. Time to progression was analyzed using Kaplan-Meier, univariant and multivariant Cox regression.Results and LimitationCompared to men with BPH, patients showed little change in PSA during the first 3 months. Thereafter, the PSA resumed an exponential increase. PSADT was 10.3 months pre dutasteride and 24.8 months post dutasteride. Multivariant analysis showed a strong correlation between post dutasteride PSA kinetics and time to progression, with close to 50% relapse free at 10 years. Post-dutasteride, patients with PSADT >9 months had significantly better survival.ConclusionsDutasteride slows PSADT in PSA-only recurrent prostate cancer. This decline correlated with time to disease progression with close to 50% progression free at 10 years.Patient SummaryMen with PSA-only recurrent prostate cancer on dutasteride experience a significant drop in the rate at which the PSA increases. If the PSA does not double between months 3-12, they are likely to remain free of metastases for many years.

A systematic review relating to trimodal therapy and muscle invasive bladder cancer was conducted. This chapter covers trimodal chemotherapy, efficacy of 5FU as part of trimodal therapy, outcomes from trimodal therapy for MIBC, trimodal therapy in the elderly, trimodal therapy and radical cystectomy, proton beam therapy in trimodal therapy.

Background: With the advancement of imaging technology, focal therapy (FT) has been gaining acceptance for the treatment of select patients with localized prostate cancer (CaP). We aim to provide details of a formal physician consensus on the utilization of FT for patients with CaP who are discontinuing active surveillance (AS). Methods: A 3-stage Delphi consensus on CaP and FT was conducted. Consensus was defined as agreement by >= 80% of physicians. An in-person meeting was attended by 17 panelists to formulate the consensus statement. Results: Fifty-six respondents participated in this interdisciplinary consensus study (82% urologist, 16% radiologist, 2% radiation oncology). The participants confirmed that there is a role for FT in men discontinuing AS (48% strongly agree, 39% agree). The benefit of FT over radical therapy for men coming off AS is: less invasive (91%), has a greater likelihood to preserve erectile function (91%), has a greater likelihood to preserve urinary continence (91%), has fewer side effects (86%), and has early recovery post-treatment (80%). Patients will need to undergo mpMRI of the prostate and/or a saturation biopsy to determine if they are potential candidates for FT. Our limitations include respondent's biases and that the participants of this consensus may not represent the larger medical community. Conclusions: FT can be offered to men coming off AS between the age of 60 to 80 with grade group 2 localized cancer. This consensus from a multidisciplinary, multi-institutional, international expert panel provides a contemporary insight utilizing FT for CaP in select patients who are discontinuing AS. United States Department of Health & Human Services National Institutes of Health (NIH) - USA ; European Urological Scholarship Programme (EUSP)

For cancer patients, health-related quality of life (HRQoL) is as important as other key outcomes, such as overall survival and tumor-free survival. Liver transplantation (LT), resection, and radiofrequency ablation (RFA) are 3 radical therapies for hepatocellular carcinoma (HCC) that result in similar survival. The main objective of this study was to assess and compare long-term HRQoL scores for patients with early-stage (tumor diameter ≤3 cm) HCC after LT, resection, or RFA.A total of 128 HCC patients with a single tumor ≤3 cm and who agreed to undergo LT, resection, or RFA were included in the present analysis. Postoperative HRQoL was evaluated by using the Medical Outcomes Study 36-Item Short Form Health Survey questionnaire. The 3 groups were compared at the 6-month and 3-year time points.The 3 groups showed comparable 3-year HCC recurrence rates (P.05). Compared with the LT and resection groups, the RFA group had significantly higher scores for bodily pain, general health, and vitality 6 months after surgery (all P values .05). Moreover, at 3 years after surgery, the RFA group had higher scores for bodily pain and vitality than the other 2 groups (P .05) and a higher general health score than the resection group. Other aspects of HRQoL were comparable among the 3 groups at both time points.Due to its comparable HCC recurrence rate and superior long-term HRQoL scores relative to other radical therapies, RFA may be the first-choice treatment for solitary early-stage HCC.

Objectives The aim of the study was to evaluate demographics and treatment outcome in young women under the age of 40 years with cervical cancer treated at a single institution in South Africa. Methods Retrospective study of patients younger than 40 years with cervical cancer referred for radiation from January 2015 to December 2018. The MOSAIQ® patient management system was used as the data source of patient names. Data collected included patient demographics; HIV status; stage; treatment and survival outcome. Results In the time period 96 patients under the age of 40 years were referred for radiotherapy. The median age was 33 years (24–38 years); 15.6% (n=15) were under the age of 30. Overall, 36.5% were HIV-positive. Disease characteristics included 91.7% squamous cell carcinoma on histology; 65.6% (n=63) were Stage IIIB and above. The very young (under 30 years) had a high proportion presenting with advanced stage disease, 73.3% (n=11). Seventy-one patients (74%) received radical CCRT, RT or adjuvant CRT. HIV-negative patients were significantly more likely to be prescribed curative therapy (82% vs 60%; p=0.018). The majority of the cohort, 77 patients (80.2%), received a minimum of 40Gy EBRT. Of the 71 patients who received radical therapy, 17 (23.9%) had a recorded date of death by study end, with no significant difference by HIV-status. Conclusions The young women presenting with cervical carcinoma at our institution had a high prevalence of HIV and advanced stage. Though HIV status impacted treatment intent, more than 80% of the total cohort received radical radiation or high dose palliation.

Intraductal carcinoma of the prostate gland (IDCP), which is now categorised as a distinct entity by WHO 2016, includes two biologically distinct diseases. IDCP associated with invasive carcinoma (IDCP-inv) generally represents a growth pattern of invasive prostatic adenocarcinoma while the rarely encountered pure IDCP is a precursor of prostate cancer. This review highlights issues that require further discussion and clarification. The diagnostic criterion “nuclear size at least 6 times normal” is ambiguous as “size” could refer to either nuclear area or diameter. If area, then this criterion could be re-defined as nuclear diameter at least three times normal as it is difficult to visually compare area of nuclei. It is also unclear whether IDCP could also include tumours with ductal morphology. There is no consensus whether pure IDCP in needle biopsies should be managed with re-biopsy or radical therapy. A pragmatic approach would be to recommend radical therapy only for extensive pure IDCP that is morphologically unequivocal for high-grade prostate cancer. Active surveillance is not appropriate when low-grade invasive cancer is associated with IDCP, as such patients usually have unsampled high-grade prostatic adenocarcinoma. It is generally recommended that IDCP component of IDCP-inv should be included in tumour extent but not grade. However, there are good arguments in favour of grading IDCP associated with invasive cancer. All historical as well as contemporary Gleason outcome data are based on morphology and would have included an associated IDCP component in the tumour grade. WHO 2016 recommends that IDCP should not be graded, but it is unclear whether this applies to both pure IDCP and IDCP-inv.

Liver transplantation is the optimal radical therapy for patients with cirrhosis and hepatocellular carcinoma (HCC). The Milan criteria are widely applied for deceased donor liver transplantation (DDLT) in the western countries. Living donor liver transplantation (LDLT), however, prevails in Asian countries due to the extreme shortage of deceased donor organs. In contrast to DDLT, the feasibility of LDLT is not restricted by the national allocation system, and therefore the indications for LDLT in patients with HCC depend on institutional policies that consider both the operative risk to the donor and the survival benefit for the recipient. The results of a nationwide survey as well as the experiences of individual centers demonstrate similar outcomes for patients whose tumors fall within the Milan criteria and those whose tumors extend beyond the Milan criteria.

The management of high-risk prostate cancer has become increasingly sophisticated, with refinements in radical therapy and the inclusion of adjuvant local and systemic therapies. Despite this, high-risk prostate cancer continues to have significant treatment failure rates, with progression to metastasis, castrate resistance and ultimately disease-specific death. In an effort to discuss the challenges in this field, the UK National Clinical Research Institute’s Prostate Cancer Clinical Studies localised subgroup convened a multidisciplinary national meeting in the autumn of 2014. The remit of the meeting was to debate and reach a consensus on the key clinical and research challenges in high-risk prostate cancer and to identify themes that the UK would be best placed to pursue to help improve outcomes. This report presents the outcome of those discussions and the key recommendations for future research in this highly heterogeneous disease entity.

Objective:Prostate specific antigen (PSA) PSA density (dPSA) is a PSA derivative used for increasing the accuracy of PSA. dPSA is calculated by dividing the prostate volume measured with transrectal ultrasonography by the total PSA value. In this study, we evaluated the role of dPSA in the prediction of radical therapy requirement in localised prostate cancer.Materials and Methods:A total of 398 patients, who underwent radical prostatectomy in our department, were included in the study. Preoperative data of the patients (demographic data, total PSA, prostate volume, dPSA and tumor percent IE on biopsy) were evaluated retrospectively. D’Amico risk stratification was performed according to the radical prostatectomy pathological examination. Evaluated parameters were compared between low-risk group (Group 1), who were candidates for active surveillance, and intermediate-high-risk group (Group 2) who were candidates for radical therapies. A dPSA cut-off value was investigated for the prediction of radical therapy requirement for patients with ROC curve analysis.Results:Mean age of the patients was similar between the two groups (62.6±6.6 vs. 62.6±58; p=0.999). PSA (8.9±6.9 vs. 5.5±1.5; p

Ectopic ACTH-syndrome is a relatively rare neuroendocrine disease. It is characterized by hypercortisolemia-associated severe complications that justifies need for timely diagnosis and radical therapy. Case report of young patient with ACTH-producing lung tumor is presented. There was 1-year diagnostic search on background of endogenous hypercorticism. Treatment resulted severe postoperative adrenal insufficiency that demonstrates current difficulties in management of these patients.Эктопическая секреция адренокортикотропного гормона (АКТГ-эктопический синдром) - сравнительно редкое нейроэндокринное заболевание. В связи с развитием гиперкортизолемии оно характеризуется формированием тяжелых осложнений со стороны различных органов и систем, что диктует необходимость своевременного установления диагноза и проведения радикальной терапии. Представленный клинический случай (пациентка молодого возраста с АКТГ-продуцирующей опухолью легкого, диагностический поиск которой продолжался около года на фоне сохранения эндогенного гиперкортицизма, а лечение завершилось развитием ярко выраженной послеоперационной надпочечниковой недостаточностью) демонстрирует трудности в ведении больных с данной нозологией.

Ovarian neoplasms arising from the surface epithelium are rare in the pediatric population, their knowledge is therefore limited and the appropriate management is poorly defined. We describe our experience and suggest our surgical approach to adolescents affected by voluminous ovarian masses. Two 15-year-old adolescents were admitted to our institution in 2017 for multilobulated, fluid-filled masses measuring over 30 cm arising from the ovaries. The cystic component was drained intraoperatively with a spillage-free technique, consisting in the application of a sterile autoadhesive transparent drape on the cyst and the insertion of a 12 Ch pleural drain, secured with a purse-string suture. Unilateral salpingo-oophorectomy was then carried out. Histology revealed mucinous cystadenoma in both patients. Surgical treatment of ovarian masses should aim at both radically excising the tumor and preserving the fertility of the patients. Decompression with spillage-free techniques can be useful to achieve radical therapy with limited manipulation of tissues.

There are few quality of life (QOL) studies that have focused on the experiences of oral cancer patients. Therefore, the present study aimed to investigate how the QOL for patients with oral cancer changed perioperatively.Eighty-three participants undergoing radical therapy completed assessments of QOL at pre-treatment, treatment completion, and 1-, 3-, and 6-months post-treatment. The Japanese version of the FACT-HN, comprising the subscales of "physical well-being (PWB)," "social/family well-being (SWB)," "emotional well-being (EWB)," "functional well-being (FWB)," and "additional head- and neck-specific concerns(HN)" was used to assess QOL. There were two study groups: those who required reconstructive surgery (r+, 31 patients) and those who did not (r-, 52 patients).The FACT-HN, PWB, FWB, and HN, were lowest at treatment completion due to declines; then, it showed significant improvement over time (p 0.05). SWB was the highest at the completion of treatment, and thereafter decreased significantly until 3 months after treatment (p 0.05). EWB was the lowest before treatment but improved over time (p 0.01). HN was significantly lower at 6 months after treatment than before treatment (p 0.05). The QOL of the r+ group was significantly lower than that of the r- group (p 0.01).The treatment-associated declines in subscale area may be compensated for by gains in other subscale areas. Psychological support is better introduced prior to cancer treatment. As it is often difficult to recover from declines in HN functioning subscale, strategies that promote compensation in other areas must be explored. Clinicians should become thoroughly familiar with how patients' QOL changes over time and provide holistic treatments that honor patients' autonomy.

Fewer than 2% of patients with metastatic prostate cancer (pca) develop brain metastases. Autopsy series have confirmed the rarity of brain metastases. When present, brain metastases occur in end stage, once the pca is castrate-resistant and spread to other sites is extensive. Here, we present a rare case of a patient with pca who developed a solitary parenchymal brain metastasis as first site of relapse 9 years after radical therapy. The patient underwent craniotomy and excision of the tumour. A second recurrence was also isolated to the brain. In the literature, pca patients with brain metastases have a poor mean survival of 1&ndash, 7.6 months. The patient in our case report experienced a relatively favourable outcome, surviving 19 months after his initial brain relapse.

Background Photodynamic therapy (PDT) is well known for its direct cytotoxicity of the free radical-producing photochemical reaction, indirect mechanisms of action including modulation of intrinsic anti-tumour immune activity, and occlusion of pathologically altered tumour vessels leading to tumour ischaemia. The aim of this work is to critically review the evidence base for the use of vascular targeted PDT (VTP) to treat low-risk prostate cancer, and to discuss perspectives and challenges yet to be overcome. A brief general overview of focal prostate cancer therapy was provided, followed by a discussion of both basic and clinical research pertaining to prostate cancer VTP, with a focus on the palladium-based WST-09 and WST-11 photosensitisers. Materials and method Literature on VTP for prostate cancer with the fallowing medical subject headings search terms: prostate cancer, photodynamic therapy, vascular targeted photodynamic therapy, bacteriopheophorbide were reviewed. The articles were selected by their relevance to the topic. Results The clinical and basic research data available to date show much promise for WST-09, and WST-11 based VTP eventually joining the standard urologist’s armamentarium against prostate cancer. With good reported tolerability and efficacy VTP can be proposed as an intermediate treatment for local low risk disease, halfway between watchful waiting and radical therapy.

Until prospective data demonstrate the oncologic efficacy of focal therapy for clinically significant, localized prostate cancer, it should be considered as experimental and only performed within the confines of a clinical trial.

Ameloblastoma is locally aggressive benign odontogenic tumour with increased risk of recurrence rate. The choice of treatment depends on the histologic subtype. Radical therapy is the recommended modality for solid ameloblastomas. The possibilities of recurrence even after enbloc resection are still high. The author presents two case reports of recurrent ameloblastomas postradical resection. First case describes the recurrence of ameloblastoma in the bone graft which was used for reconstruction, and the second case depicts recurrence in the infratemporal fossa. Intraoperative radiography of the frozen section of the soft tissue margin plays an important role in the holistic management of these lesions.

Background: Bladder cancer is one of the most common cancers in the Western world, with associated significant mortality. Once proven to be muscle invasive, radical therapy is required. Objective: We reviewed the literature associated with clinical effectiveness of neoadjuvant chemotherapy (NAC) for muscle-invasive bladder cancer. Methods: We conducted a systematic literature review of papers related to the search terms neoadjuvant chemotherapy, muscle invasive bladder cancer and clinical effectiveness; from 1984 through April 2014. We used the search terms of (neoadjuvant chemotherapy) AND (muscle invasive bladder cancer). We included primary research, but only included secondary research if it was a systematic review or meta-analyses. Papers outside this category were not included. Results: From the literature review, we found that the benefits of neoadjuvant chemotherapy for muscle-invasive bladder cancer are wide-ranging. This includes a greatly improved response rate, including complete response and improved survival rate. Potential disadvantages of NAC include less accurate staging, delays in curative surgery (risk is greater, if delay > 12 weeks) in non-responders and the well-known fact that non-responders will fare worse, later on. Conclusions: In conclusion, NAC followed by radical therapy is the gold standard for muscle-invasive bladder tumours, for patients whom are sufficiently fit; however, there are many unanswered questions. As yet, this intervention has not been examined by the National Institute for Health and Care Excellence.

INTRODUCTION: Focal therapy can offer the middle ground for treatment between active surveillance and radical therapy in patients with low- and intermediate-risk prostate cancer. Factors that prohibit focal therapy from being standard of care are numerous. Several consensus projects have been conducted to position the utilization of imaging and trial design in focal therapy. However, the literature is still scarce on patient follow-up after focal therapy. For these reasons, an international multidisciplinary consensus project was established in order to reach consensus about a uniform follow-up protocol after focal therapy. OBJECTIVE: To standardize patient follow-up after focal therapy. MATERIALS AND METHODS: A literature study was performed, and a questionnaire was constructed. The questionnaire was sent out to 76 participants (70 % urologists, 28 % radiologists and 2 % biomedical engineers) in three consecutive rounds according to the Delphi method. In each round, the panelists were presented with the results of the previous round. Participants each had the opportunity to adapt, delete or add questions. The topics discussed pertaining to follow-up after focal therapy were as follows: (1) general,(2) biopsies, (3) PSA, (4) digital rectal examination (DRE), (5) imaging, (6) quality of life (QoL) and (7) registration and pooling of data. The project was concluded with a face-to-face meeting in which final conclusions were formulated. RESULTS: The follow-up after focal therapy should be a minimum of 5 years. The following modalities should be included in assessing post-treatment outcomes: multiparametric MRI (mpMRI), biopsies, assessment of erectile function, QoL, urinary symptoms and incontinence. A systematic 12-core TRUS biopsy combined with 4–6 targeted biopsy cores of the treated area and any suspicious lesion(s) should be performed after 1 year, and thereafter only when there is suspicion on imaging. The ideal way to perform targeted biopsies is to use TRUS–MRI fusion technology. PSA should be performed for research purposes, in the first year, every 3 months, and after the first year, every 6 months. mpMRI is the optimal imaging modality for follow-up after focal therapy. On a 1.5T scanner, an endorectal coil is strongly advised by the panel, whereas on a 3T machine, it is optional, however, it will improve image quality. The following sequences should be included: T2WI, DWI including high b values of >1,000 and ADC maps of DWI, DCE and T1WI. Imaging should be performed at 6 months and at 1 year following treatment; after the first year post-treatment, it should be performed every year until 5 years following treatment. All data should ideally be pooled in a common global database. CONCLUSION: Focal therapy is a relatively new form of treatment for prostate cancer. In order to include focal therapy as a standard of care treatment, consistent follow-up is necessary. By implementing the results of this consensus study, focal therapy users will be able to provide important and standardized outcome data.

The average lifelong rate of developing a new primary lung cancer approximates 1% and 6% per year after radical therapy for non-small-cell lung cancer and small cell lung cancer, respectively. The frequency of recorded synchronous and metachronous lung cancers has been increasing in the recent years because of the development of early detection techniques and advances in cancer therapy. The distinction between multiple synchronous or metachronous primary lung cancers and intrapulmonary metastases is based on established clinicopathological criteria, however it is often difficult, although of great importance for the management and prognosis of these patients. Newly developed molecular and genomic methods are expected to contribute to a more solid and clear differentiation. Surgical treatment, whenever feasible, is considered the modality of choice for the management of patients with second primary lung cancers, as opposed to those with metastases. The type and extent of surgery are under discussion. The prognosis of patients with second primary lung cancers largely depends on the time of detection and the stage and location of the second cancer, thus surveillance after surgical resection of the initial tumor is mandatory.

Monitoring the serum level of prostate specific antigen (PSA) is indispensable for surveillance after radical therapy, and the aim of this study was to establish the optimal follow-up schedule.We retrospectively reviewed the clinicopathological data of 1,010 consecutive patients who underwent radical prostatectomy. After excluding patients who received neoadjuvant or adjuvant therapy and those without a nadir PSA level0.2ng/ml, the remaining 779 patients were enrolled. Biochemical recurrence (BCR) was defined as elevation of PSA to0.2ng/ml. We investigated the PSA doubling time (PSA-DT) following BCR at various times after surgery.During a mean follow-up of 8.8 years, BCR occurred in 180/779 patients. The annual BCR rate was 6% in the first year after surgery, 6% between 1 and 2 years, 3% between 2 and 3 years, 3% between 3 and 5 years, and 2% at5 years postoperatively. During these periods, the minimum PSA-DT after BCR was 1.6, 2.4, 3.1, 6.1, and 6.4 months, respectively. These minimum PSA-DTs were used to determine the optimal follow-up interval during each period after surgery. If the baseline level is 0.1ng/ml, PSA should be measured at approximately 3-month intervals for the first year, at 4-month intervals between 1 and 2 years, at 6-month intervals between 2 and 3 years, and annually thereafter to definitely detect BCR before the serum PSA level exceeds 0.4ng/ml.The PSA-DT following BCR varies according to the time after surgery. Our data on minimum PSA-DT values after BCR are useful for setting the optimal follow-up schedule.

ObjectiveThe objective of this observational study was to investigate correlations between adverse effects (lower-extremity lymphedema [LEL], dysuria, and severe gastrointestinal symptoms) and quality of life (QOL) (physical well-being [PWB], social well-being, emotional well-being [EWB], and functional well-being) before treatment, at least 6 weeks after treatment (posttreatment1), and 3 or 6 months after treatment (posttreatment2) of patients with gynecologic cancer (GC).MethodsFrom August 2012 to October 2016, questionnaire responses and clinical data of 75 patients with GC were collected and assessed by treatment received. The χ2 test was used to determine the significance of correlations.ResultsParticipants with LEL had significantly poorer QOL than did those without it in the domains of PWB at posttreatment1 (P = 0.026) and EWB at posttreatment2 (P = 0.020). Moreover, patients with 2 adverse effects (LEL plus dysuria or severe gastrointestinal symptoms) had significantly poorer QOL than did those with no or single adverse effect in the domains of PWB at posttreatment1 and posttreatment2 (posttreatment1: P = 0.049, P = 0.001; posttreatment2: P = 0.002, P = 0.028) and poorer QOL compared with those with no adverse effect in the domain of EWB at posttreatment1 (P = 0.017).ConclusionsPoorer QOL in emotional and physical domains is associated with adverse effects of treatment in patients with GC. It is important to consider the effects of radical therapy not only on survival but also on the QOL of survivors.

This communication reports successful surgical removal of an injured quarter of udder in a 3.5 year old Assam Hill goat. The doe was brought to the Veterinary Clinical Complex following a long standing tea garden fencing injury on the left quarter of the udder. Clinical examination revealed unilateral protrusion of mammary tissue through the ruptured quarter of the mammary gland along with presence of hard consistency and necrotic tissue at center of the wound. The doe was subjected to unilateral mastectomy followed by supportive therapy, which brought satisfactory uneventful recovery.

Background The indications for ductus arteriosus ligation in very-low-birth-weight infants (VLBWIs) with persistent ductus arteriosus (PDA) are unclear. Increased left ventricular end-diastolic dimension (LVDd) is commonly found in patients with PDA. Here, the enlargement of LVDd in term and preterm neonates without congenital heart disease was estimated by two-dimensional echocardiography. Methods The value of the measured LVDd was divided by the normal LVDd as an index (LVDd ratio) to compare 30 patients who underwent PDA ligation with 30 patients treated with indomethacin and 30 patients who did not undergo radical therapy. Results An LVDd ratio between 122% and 197% (mean, 142%) was considered to be an indication for the ligation procedure. The proportion of patients exceeding 130% in the LVDd ratio was 87% (26/30) in those patients who underwent ligation. Catecholamines and/or vasodilators were required in 83% patients for the treatment of low ejection fraction or hypertension after operations, suggesting that patients had been in preload and/or afterload remodeling failure during the operation. The percentage of patients with less than 115% in the LVDd ratio was 90% in the non-radical-therapy patients. The LVDd ratios of 130% and 115% were regarded as cut-off values for surgical ligation and indomethacin treatment. Conclusion The LVDd ratio is a useful measure to determine the treatment of VLBWIs with PDA.

Prostate-specific antigen plays a role in active surveillance and postoperative monitoring of prostate cancer patients. The authors discuss PSA screening, and consider some of the problems involved in interpretation of PSA levels after radical prostatectomy, radical radiotherapy and brachytherapy. Copyright © 2014 John Wiley & Sons.

Objective : This study aimed to survey the pattern of the treatment choice for atopic dermatitis. Methods : The questionnaire-based survey was conducted from the parents o f 310 patients (median age 9 years, range 2 to 21 year, 158 male and 152 female) with atopic dermatitis. The questionnaire was consisted of 11 questions for the demographic information including treatment choice for atopic d ermatitis. Results : The most agonizing factor of atopic dermatitis was pruritus, w hile the most frequent regions were arms and legs. Conventional therapy (60.3%), folk-remedy (23.9%) and tre atment of Korean medicine (15.8%) were the preference of treatment by patients. Over half answers (58.4%) were negati ve for the current treatments, and the main complains was the absence of radical therapy (26.5%), insufficient inform ation (20.6%), and expensive cost of treatments (19.0%), respectively. Conclusion : This study may provide the important information for the genera l prospective of parents of patients with atopic dermatitis, which is helpful to develop the Korean medic ine-derived therapeutics for atopic dermatitis. Key words ; Atopic dermatitis; Korean Medicine; Survey

The microbiome is a collection of all microbial species that coexist with an individual.These organisms influence several aspects of individual body functions. Probiotic organisms are generally beneficial components of microflora and confer normal health status. Usually, probiotics should be provided from the outside in the diet for maintaining proper health status. Probiotics can also have a significant impact on cancer management. While the results toward cancer management with probiotics are promising, careful risk assessment of probiotics use in cancer patients, who are usually immunocompromised due to radical therapy, comes as a great demand. This article provides an overview of the current research status of probiotics use in cancer patients and discusses the role of probiotics in cancer management. Drug Dev Res •• : ••-••, 2013. © 2013 Wiley Periodicals, Inc.

Active surveillance (AS) has emerged as the standard of care for low-risk, low-volume prostate cancer. Herein we examine the rationale for AS, considering the tumor biology and available evidence on the almost nonexistent metastatic potential of Gleason 6 prostate cancer. Taken together with numerous single institutional prospective studies with long-term follow-up of men on AS, these results have led to ongoing and increased adoption of AS in North America. The limitations of AS are discussed. We identify a “gray zone” wherein trade-offs result in the absence of a clear preference for AS versus radical therapy. Focal therapy represents a potential middle ground for these patients.

The present study reported a nearly asymptomatic case of intracranial capillary hemangioma (ICHs), which are rare benign vascular tumors or tumor-like lesions. A 33-year-old female came to the hospital with a complaint of a slight but recurring morning headache concentrated in the left posterior occipital area. These headaches spontaneously resolved without any treatment. Computed tomography and magnetic resonance imaging revealed a mass inside the left occipital lobe. The patient refused to undergo conservative observation at home and insisted on radical therapy. Prior to surgery, an atypical meningioma or astrocytoma was suspected. A navigation-guided brain-mass resection was performed under general anesthesia and a solid mass closely associated with the tentorium cerebelli was completely resected. Histopathological analysis confirmed diagnosis of an ICH. The patient recovered well and experienced no major neurological defects, apart from an issue with the right visual field. The present study also conducted a retrospective literature review of papers published in English describing cases of intracranial capillary hemangiomas. A PubMed search identified 19 articles comprising 29 cases. The clinical symptoms of ICH are diverse and all reported cases in the literature were symptomatic. Previous studies demonstrated that diagnoses of intracranial capillary hemangioma are usually made during surgical resection by histopathological examination. Treatment for ICH remains empirical and surgery is the most common method of treatment. Patient prognosis is generally good-the majority of patients achieve long-term, event- and progression-free survival.

Positron emission tomography–computed tomography (PET-CT) is recommended by NICE to stage all lung cancer patients considered for curative treatment. Increasing numbers of PET-CTs are being performed at our trust (93 in 2012 vs 128 in 2015) with an unknown effect on outcomes. This study aims to determine its impact on treatment at the Royal United Hospital, Bath by reviewing outcomes of all patients who had a PET-CT through our lung MDT in 2015. Figure 1 illustrates treatment outcomes following PET-CT. For patients who had surgery, mean time from PET-CT to surgery was 58.3 days for upstaged patients vs 39.6 days for those not upstaged (p = 0.02, unpaired t-test). 22% (10/45) who had surgery had non-cancerous disease on histology. PET-CT identified 16% (20/128) with low avidity lesions and 22% (29/128) with upstaged disease for whom radical treatment was inappropriate. 5% (7/128) had highly avid lesions, were not upstaged and yet had no radical therapy. These data suggest that PET-CT significantly impacts the management of suspected lung cancer patients by triaging suitability for radical treatment. However, the current pathway means patients who had surgery but were upstaged faced significant delays to treatment, while a proportion of patients who had surgery had non-malignant disease. This indicates a need for improvements in diagnostics. In addition some patients with limited disease had no radical therapy, highlighting the need to ensure appropriate PET-CT use.

There is increasing low-quality evidence rationalizing the use of radical therapy for men at high risk of disseminated prostate cancer.To investigate, using high-quality epidemiologic data, whether initial radical therapy in men at high risk of disseminated prostate cancer improves survival.An observational population-based Swedish study from 1996 to 2010 of men at high risk of disseminated prostate cancer (prostate-specific antigen [PSA]50) initially treated by radical therapy (radiation therapy [n=630] or radical prostatectomy [n=120]) or androgen deprivation therapy (n=17 602), and followed for up to 15 yr.Prostate-cancer and other-cause mortality was estimated for the treatment groups. We also matched the two cohorts for grade, T stage, M stage, Charlson score, year of diagnosis, age, and PSA, and found androgen deprivation therapy patient matches for 575 of the radical therapy patients, and then repeated comparative effectiveness analyses.Prostate-cancer mortality was substantially greater in the androgen deprivation therapy group compared with the radically treated one, in unmatched (9062/17 602 vs 86/750) and matched (177/575 vs 71/575) cohorts. Among matched cohorts, initial androgen deprivation therapy was associated with nearly three-fold higher hazard of prostate-cancer death compared with initial radical therapy (2.87; 95% confidence interval 2.16-3.82). Multiple sensitivity analyses suggested that the findings were robust, although the general limitations of nonrandomized studies remain. Further, the study cohort may have included men with both systemic and nonsystemic disease, as a sole eligibility criterion of PSA50 was used.This large and comprehensive population-based study suggests that initial radical therapy in men at high risk of disseminated prostate cancer improves survival.This large Swedish study suggests that men with prostate cancer that has spread beyond the prostate benefit from treating the prostate itself with radiation therapy or surgery rather than treating the disease with hormones alone.

Study Type – Needs assessment survey Level of Evidence 2b What's known on the subject? and What does the study add? Although androgen deprivation therapy (ADT) is widely used to treat men with prostate cancer, little is known about the information needs of patients on ADT. We found that patients are generally very satisfied with using ADT and expressed minimal decisional regret with its use up to four years later. For men receiving ADT in the adjuvant setting, their survival estimates with the addition of ADT were quite reasonable when compared to findings in randomized trails. A key area to enhance patient education appears to be side effects, especially around hot flashes and fatigue, which were also the most bothersome treatment sequelae for patients. OBJECTIVE • To evaluate information needs of men receiving androgen deprivation therapy (ADT). PATIENTS AND METHODS • A cross-sectional survey was distributed to English-speaking prostate cancer patients receiving ADT adjuvant to radical therapy or for biochemical relapse. • Three cohorts were recruited based on duration of ADT use

Background: Stage progression of 374 small hepatocellular carcinomas (HCC) was retrospectively analysed. Patients and methods: During 8 years, 236 patients with the early stage of HCC received radiofrequency ablation (RFA), and 138 underwent surgery as an initial therapy. More patients of young age and with better liver function tended to undergo surgical treatment. Based on 1892 patient-year data, the Markov model analysed the stepwise progression of early stage (multiple up to three nodules, 3 cm or less each) to intermediate stage (four nodules or more, or larger than 3 cm), to advanced stage (portal invasion, extrahepatic metastasis or Child–Pugh C) and to death. Results: The recurrence rates after RFA and surgery were 53.3 and 40.6% in the third year. The annual progression rates from the early stage to the intermediate stage, advanced stage and death were 5.40, 1.63 and 1.73% in the RFA group and 3.90, 1.87 and 0.62% in the surgery group respectively. The progression rate from the early to the intermediate stage was significantly lower (2.34% annually) in the younger patient group (

Acrometastasis to the hand is an unusual presentation which might mimic an infectious, inflammatory, or a metabolic pathology. We herein describe a case series of three patients of acrometastasis to the hand. We encountered three cases of acrometastasis to the hand attending the departmental clinics from 2007 to 2010. The median age at presentation was noted to be 55 years. All were males. The primaries included squamous cell carcinoma of the skin, larynx, and esophagus. In two patients, acrometastasis was detected at presentation and in one it was detected 2 years postcompletion of radical therapy. Two patients were offered palliative radiation to acrometastasis, and best supportive care was given to one. Palliation achieved after radiation was noted to be modest to good. The brief report highlights the importance of the clinical awareness of metastatic dissemination to unusual sites in the face of increasing cancer survivorship. Acrometastasis portends a poor prognosis with limited survival, and optimal integration of the best supportive care is mandatory. A short course of hypofractionated palliative radiation therapy results in modest to good palliation.

Background Hydatid disease is a global problem. We report our experience with such cases where the dominant cysts were located outside the liver and lungs. In particular, these cysts were found in the peritoneum which is an uncommon location. Methods Between 1967 and 2007 a total of 34 patients were operated for primary or secondary peritoneal cysts. Most of the patients were asymptomatic or had atypical symptoms. The diagnosis was based on the preoperative history, rupture of the cysts, serology, ultrasound (USS) and computer tomography (CT). Open surgery was the procedure of choice with conservative (18 cysts) and radical (25 cysts) methods. Results The outcome of surgery was good without postoperative mortality or severe morbidity and the recurrence rate was 23.5%. Conclusions Conservative surgery can provide good results in symptomatic peritoneal cysts. Radical therapy is also ideal but only in properly selected cases. The management of this situation is difficult requiring sound operative experience preferably with a one-stage procedure after an appropriate preoperative preparation.

129 Background: ADT is the first-line treatment for men experiencing recurrence after undergoing radical therapy for prostate cancer. However, timing of ADT initiation is controversial and there are limited data on prognostic factors in patients starting ADT. Methods: We identified consecutive men who underwent radical prostatectomy (RP) for localized prostate cancer at our institution between 1987 and 2007 and who subsequently received salvage ADT. Early progression on ADT was defined as development of metastatic disease within 2yrs of initiation. The primary outcomes of interest were cancer-specific (CSS) and overall survival (OS). Results: A total of 2418 men were included. Median age at RP was 64yrs and median follow-up was 13.9yrs. 48% and 20% of men had pathologic Gleason scores of 7 and 8-10 respectively. The median PSA was 2.6ng/ml, while 385 men (16%) had metastatic disease at receipt of ADT. Overall, 1060 men (44%) developed clinical metastases, with 625 (59%) of these doing so within 2yrs of starting ADT. On multivariable analysis, longer PSA DT before ADT was associated with lower odds of early progression on ADT (DT 3-9mths, OR = 0.19; DT ≥9mths, OR = 0.10, both p < 0.001). 10- and 20-year CSS were 89% and 70%, and 10- and 20-year OS were 82% and 40% respectively. Independent predictors of lower CSS included metastatic disease at time of ADT (HR = 2.60), PSA at ADT of 5-50ng/ml (HR = 2.68) and > 50ng/ml (HR = 4.33, all p < 0.001), while longer PSA DT was associated with higher CSS (DT 3-9mths, HR = 0.54; DT ≥9mths, HR = 0.45, both p < 0.001). PSA at ADT of 5-50ng/ml (HR = 3.10) and > 50ng/ml (HR = 5.20, both p < 0.001) were independent predictors of OS. Conclusions: PSA DT < 3mths and absolute PSA at ADT initiation of ≥ 5ng/ml are adverse prognostic indicators in men receiving salvage ADT for relapse after RP. For patients with these features, their risk of early progression and death should be part of a discussion about the timing of ADT and consideration given to more aggressive treatment strategies. Conversely, men with biochemical relapse who have longer DT and PSA < 5ng/ml are at lower risk and could make an informed decision to defer ADT initiation.

165 Background: Detection of the extent of local recurrence and of metastases in biochemical recurrence (BCR) of prostate cancer facilitates selection of appropriate treatment. The FALCON trial (NCT02578940) assessed the impact of 18F-fluciclovine PET/CT on the clinical management of men with BCR of prostate cancer following initial radical therapy. Methods: Men being considered for curative-intent salvage therapy following first BCR were recruited at 6 UK sites. Management plans were documented prior to and following 18F-fluciclovine PET/CT imaging. Post-scan changes to treatment modality such as salvage radiotherapy [RT] to systemic therapy were classed as ‘major’, while changes within a modality (e.g. modified RT fields) were classed as ‘other’. A pre-planned interim analysis of the first 85 patients was conducted; recruitment was to be stopped for efficacy if the number of treatment changes was > 45 (52.9%; 97.5% CI: 40.3–62.3%), or for futility if ≤ 8 (9.4%, 97.5% CI: 3.6–18.9%). Results: The 85 enrolled patients were a mean 4.8 y post-initial diagnosis, with a median age of 67 y and median PSA of 0.63ng/mL. Twelve (14.1%) had a Gleason score ≤ 6, 60 (70.6%) had a score of 7 and 13 (15.3%) had a score ≥ 8. Most (56; 65.9%) had previously undergone radical prostatectomy (RP), with 27 having received RT (± other therapy). The majority of those imaged (52; 61.2%) had a change in management (CIM) post-scan (Table). Recruitment was subsequently stopped as the pre-specified condition defining overwhelming efficacy was met. Conclusions: This prospective trial shows 18F-fluciclovine PET/CT has substantial impact on clinical decisions for men with a first BCR of prostate cancer after curative-intent primary therapy. Clinical trial information: NCT02578940. [Table: see text]

With the requirement to accurately risk stratify men in order to prioritise their treatment allocation (active surveillance vs radical therapy) the questions that we ask of our staging investigations are different from those that we have traditionally posed. Less important is the question, 'Is cancer present?'. More and more important becomes the question, 'Is this cancer important?'. The current interest in focal therapies requires us to ask even more novel questions such as: 'What are the limits of the cancer?'; 'How many lesions are present?'; 'What is the relationship between index and satellite lesions?' All these questions require precise imaging of the tumour at low threshold volumes, probably at the 0.2 cm3 or 0.1 cm3 level, something that until very recently was beyond the specification of imaging platforms. Developments in MRI and in the rapidly evolving field of tissue characterisation will hopefully provide the inputs that modern management of prostate cancer requires. Crown Copyright © 2008.