Prognostic Implications of Important Genetic Alterations in Prostate Cancer

The prostate is a walnut-sized gland that is located caudally from the urinary bladder. It excretes fluid as a part of the semen of men. Prostatic neoplasia is common; in Western developed countries prostate cancer is the most common non-cutaneous malignancy in men and it is the second leading cause of all male cancer deaths. The detection of prostate cancer has markedly increased since the introduction of the serum prostatespecifi c antigen (PSA) in the late eighties. Although familial and hereditary prostate cancer occurs, sporadic cancers account for at least 85% of all prostate cancers. Age is the strongest risk factor for developing prostate cancer. From autopsy studies it is known that in the 6th decade already 55% of the male population has the disease, and more than 75% of men older than 85 years have cancer foci in their prostate. Prostate cancer is a very heterogeneous disease that can range from indolent, asymptomatic tumours in many patients to a rapidly fatal malignancy in some. At diagnosis, the majority of tumours are confined to the prostatic gland, named clinical stage cT1 and cT2 (see Table 1 for the Tumour, Node, Metastasis (TNM) classifi cation). Some tumours, however, already grow outside the prostatic capsule (cT3) or even invade the surrounding organs (cT4). Dissemination of the disease usually occurs to the regional pelvic lymph nodes and the axial skeleton. The latter will mainly cause pain, although neurological deficit due to compression of the myelum is also possible in severe cases. Diagnostic modalities to detect prostate cancer are digital rectal examination (DRE), measurement of the serum prostate-specific antigen (PSA), transrectal ultrasound of the prostate (TRUS) with subsequent ultrasound-guide

De behandeling van blaaskanker vraagt om gecentraliseerde zorg

Quality of care for bladder cancer patients differs between Dutch hospitals. Improving the collaboration between hospitals, focussing on healthcare pathways and outcome measures will be helpful in establishing quick improvements. In this respect it is important to incorporate patient related outcome measures

Rapid aneuploidy detection in prenatal diagnosis : the clinical use of multiplex ligation-dependent probe amplication

The aim of prenatal diagnosis is to provide information on chromosomal abnormalities, in order to allow parents an informed choice on the course of pregnancy. Karyotyping is the diagnostic test used to detect chromosomal abnormalities. It is highly accurate, but labour-intense, costly and slow. Karyotyping detects chromosomal abnormalities with no, mild, or unclear clinical consequences. Rapid aneuploidy detection (RAD) techniques can detect the most common chromosomal abnormalities (trisomies 13, 18, 21, X and Y). Multiplex Ligation-dependent Probe Amplification (MLPA) is a RAD test. Its diagnostic accuracy, tested on 4585 amniotic fluid samples in routine clinical practice, is comparable to that of karyotyping (P<0.001) and it reduces waiting time with 14.5 days at lower costs (-__240 per sample). Patient quality of life does not differ significantly. While caregivers prefer RAD, experts prefer a test detecting all severe chromosomal abnormalities. Patients' preferences are equally divided; they value the detection of severe chromosomal abnormalities most. Since RAD and karyotyping both detect the most common chromosomal abnormalities with severe consequences, both tests are appropriate for prenatal diagnosis. Based on decision analytic considerations and our study results, women should be offered a choice, since they will bear the responsibility of raising the child.Afdeling verloskunde, LUMC J.E. Jurriaanse Stichting Ferring BV MRC Holland Medical DynamicsUBL - phd migration 201

De rol van circulerende tumorcellen bij het urotheelcarcinoom van de blaas

Patients with muscle-invasive urothelial cell carcinoma of the bladder have a 50 % chance to develop distant metastases despite curative local treatment. Reliable markers that predict the risk of developing metastases or that could be used to determine whether or not perioperative systemic treatment should be given are lacking. Circulating tumor cells (CTCs) are cancer cells that are present in the blood stream of patients with solid tumors and originate from tumor lesions that are present in the body. The enumeration of CTCs is an attractive option to assess the chance to develop distant metastases in individual patients. Here, we set out to review the most relevant literature to date regarding the clinical value of CTCs in bladder cancer. Moreover, the CirGuidance study is presented, which is the first interventional trial, which uses CTCs to guide treatment choices regarding the administration of neoadjuvant chemotherapy in patients with muscle-invasive urothelial cell carcinoma

Selecting the right treatment:Health outcome priorities in older patients with bladder cancer

Introduction: Selecting the appropriate treatment for older patients with non-muscle invasive (NMIBC) or muscle-invasive bladder cancer (MIBC) is challenging due to smoking-related comorbidities, treatment toxicity, and an increased risk of adverse health outcomes. Considering patient preferences prior to treatment is therefore crucial. Here, we aimed to identify the health outcome priorities of older patients with high-risk NMIBC (HR-NMIBC) or MIBC. Materials and Methods: Patients aged 70 years or older or at risk for frailty, diagnosed with HR-NMIBC or MIBC without distant metastases, were referred for a comprehensive geriatric assessment (CGA). The CGA consisted of an interview, physical examination, and several tests to examine physical, cognitive, functional, and social status. Quality of life was assessed using EQ5D and EORTC QLQ-C30 questionnaires. Health outcome priorities were discussed using the Outcome Prioritization Tool (OPT) and associations between health outcome priorities and CGA-determinants and quality of life were studied. Results: Of 146 patients (14 HR-NMIBC, 132 MIBC), OPT data was available for 139. Life extension was most often prioritized (44%), closely followed by preserving independence (40%). Reducing pain (7%) and other symptoms (9%) were less often prioritized. Patients prioritizing life extension had fewer musculoskeletal problems than patients prioritizing reducing pain or other symptoms (p = 0.02). Patients at risk of or suffering from malnutrition more frequently selected reducing pain or other symptoms as their health outcome priority (p = 0.004). For all other CGA-determinants and quality of life, there were no significant differences between groups based on health outcome priorities. Discussion: In older patients with HR-NMIBC and MIBC, life extension and preserving independence are the most common health outcomes priorities. CGA-determinants and quality of life are generally not associated with the prioritization of health outcomes. As health outcome priorities cannot be predicted by CGA-determinants or quality of life, it is crucial to discuss health outcome priorities with patients to promote shared decision-making.</p