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The NCCN Guidelines for Bladder Cancer provide recommendations for the diagnosis, evaluation, treatment, and follow-up of patients with bladder cancer and other urinary tract cancers (upper tract tumors, urothelial carcinoma of the prostate, primary carcinoma of the urethra). These NCCN Guidelines Insights summarize the panel discussion behind recent important updates to the guidelines regarding the treatment of non–muscle-invasive bladder cancer, including how to treat in the event of a bacillus Calmette-Guérin (BCG) shortage; new roles for immune checkpoint inhibitors in non–muscle invasive, muscle-invasive, and metastatic bladder cancer; and the addition of antibody–drug conjugates for metastatic bladder cancer.

To quantify the heterogeneity of viscoelastic tissue properties in prostatectomy specimens from men with prostate cancer (PC) using MR elastography (MRE) with histopathology as reference.Twelve fresh prostatectomy specimens were examined in a preclinical 9.4T MRI scanner. Maps of the complex shear modulus (|G*| in kPa) with its real and imaginary part (G' and G" in kPa) were calculated at 500 Hz. Prostates were divided into 12 segments for segment-wise measurement of viscoelastic properties and histopathology. Coefficients of variation (CVs in %) were calculated for quantification of heterogeneity.Group-averaged values of cancerous vs. benign segments were significantly increased: |G*| of 12.13 kPa vs. 6.14 kPa, G' of 10.84 kPa vs. 5.44 kPa and G" of 5.45 kPa vs. 2.92 kPa, all p 0.001. In contrast, CVs were significantly increased for benign segments: 23.59% vs. 26.32% (p = 0.014) for |G*|, 27.05% vs. 37.84% (p 0.003) for G', and 36.51% vs. 50.37% (p = 0.008) for G".PC is characterized by a stiff yet homogeneous biomechanical signature, which may be due to the unique nondestructive growth pattern of PC with intervening stroma, providing a rigid scaffold in the affected area. In turn, increased heterogeneity in benign prostate segments may be attributable to the presence of different prostate zones with involvement by specific nonmalignant pathology.

Dermoid cysts rarely present in the retroperitoneal space or during adulthood. In this case report, we describe the clinical presentation, operative and post-operative course of a 31-year old with a retroperitoneal dermoid cyst. The patient presented with buttock and leg pain/paresthesia found to have a retroperitoneal mass between the psoas muscle and L5/S1 disk space. We describe the operative approach, including intra-operative images, of the resection by a team of urologists and neurosurgeons. The histology is also presented. Finally, we discuss the benefits of use of intra-operative ultrasound and neuromonitoring.

dicted miR221-targets being able to repress STAT1 signaling and confirmed these by Luciferase assay and Western Blotting. RT-PCR analysis of gene expression in native tumors were performed to proof the correlation between IRF1, IRF2 and miR-221 levels. RESULTS: Transfection of cells (PC3,DU145,LNCaP) with premiR-221 led to a strong induction of apoptosis and a significant growth arrest. Microarray-based genome-wide mRNA profiling showed an upregulation of 585 genes–among these a plethora of interferonrelated genes–and downregulation of 306 genes. Bioinformatical annotation of microarray data confirmed a highly significant involvement of genes related to immune response and apoptosis. Furthermore,expression of dysregulated genes was confirmed by RT-PCR (STAT1, IRF1, IRF9) and Western Blotting (STAT1, Phospho-STAT1, Phospho-PKR). To understand how reconstitution of miR221 enhances STAT1-mediated signaling, we were looking for bioinformatically predicted miR221-targets being able to repress STAT1 signaling. We introduce IRF2 as a new direct target of miR221 using Luciferase assay and Western Blotting. Consistently, RT-PCR analysis of gene expression in native tumors showed an inverse correlation between IRF1 and IRF2 with a significantly low expression of IRF2 in tumors with high miR221-levels. CONCLUSIONS: Our results suggest that the tumor-suppressive function of miR221 bases on the repression of IRF2, an antagonist of the STAT1-IRF1 signaling axis and known oncogene in other malignancies.

Introduction: Metformin is currently the drug of choice for management of type II diabetes mellitus. Recent epidemiological studies have reported that metformin use among diabetics decreases the risk of developing a variety of cancer types, including prostate cancer (PCa). However, the effect of metformin use on PCa outcome has yet to be clarified. The aim of this study was to investigate the association between pre-operative metformin use and biochemical recurrence (BCR) in a cohort of diabetic men who underwent radical prostatectomy (RP). Methods: We performed a retrospective analysis of 337 men from the Shared Equal Access Regional Cancer Hospital (SEARCH) database treated for PCa with RP and with a diagnosis of diabetes prior to surgery. Cox proportional hazard models were used to assess time to BCR for diabetic men taking metformin in the year prior to RP compared to diabetic men not taking metformin. Models were adjusted for age, race, year of surgery, surgical center, pre-operative PSA and biopsy Gleason score. Results: Of 337 diabetic men, 173 (51%) were taking metformin in the year before RP. The median follow-up among men who did not recur was 49 months, during which 112 men (33%) experienced BCR. Metformin use was associated with more recent year of surgery (median 2005 vs. 2001; p0.1). Diabetics taking metformin had lower pre-operative PSA (p=0.12) yet higher prostate volume (p=0.17), relative to diabetics not on metformin, though these associations did not reach statistical significance. On unadjusted analyses, metformin use was not significantly associated with BCR (log-rank, p=0.29). After adjusting for multiple pre-operative features, metformin use in the year before surgery remained not related to BCR (HR 0.97, 95% CI 0.59 to 1.60, p=0.912). Conclusion: In this cohort of diabetic men treated for PCa with RP, metformin use in the year prior to surgery was not significantly associated with time to BCR. Although this is the largest study to date to test the role of metformin among diabetics undergoing RP, larger studies with longer follow-up are needed to better assess whether metformin is associated with improved PCa outcomes, though the current study suggested no role for metformin for PCa control. Citation Format: Emma H. Allott, Michael R. Abern, Leah Gerber, Christopher J. Keto, William J. Aronson, Martha K. Terris, Joseph C. Presti, Christopher J. Kane, Christopher L. Amling, Stephen J. Freedland. Metformin use and risk of biochemical recurrence following radical prostatectomy: Results from the SEARCH database. [abstract]. In: Proceedings of the Eleventh Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2012 Oct 16-19; Anaheim, CA. Philadelphia (PA): AACR; Cancer Prev Res 2012;5(11 Suppl):Abstract nr B72.