Association between tumor-associated macrophages and microvessel density on prostate cancer progression

AbstractBackgroundTo evaluate tumor-associated macrophages (TAMs) infiltration and microvessel density as possible prognostic factors related to prostate cancer (PCa) progression.MethodsImmunostaining of TAMs in prostate biopsy specimens was performed using a monoclonal antibody CD68 and microvessel density (MVD) using von Willebrand factor (vWF) from 25 specimens with high-grade prostatic intraepithelial neoplasia (HGPIN) and 25 specimens with PCa after transurethral resection of the prostate (TURP). Six microscopic (×200) fields were selected for TAM counting and six microscopic (×100) fields were selected for MVD counting around the cancer foci. Association between age, preoperative prostate-specific antigen (PSA), pathologic Gleason sum (GS), TAM, MVD, extracapsular extension, and metastasis were assessed using Pearson/Spearman, Student t test/Mann-Whitney U test and one-way analysis of variance/Kruskal-Wallis test.ResultsThe mean of age, PSA, TAMs, and MVD were 69.1±9.9, 67.1±92.4, 26.2±11.9, and 31.4±14.0, respectively, from 50 specimens with PCa and HGPIN. Increasing TAMs number was not correlated with increasing MVD number and there was no significant mean difference statistically (P>0.05) in TAMs and MVD although the mean of TAMs number was higher in PCa versus HGPIN but significant in PSA level (P<0.001). In PCa specimens, age, PSA, TAMs, and MVD number were higher in patients with metastatic and extracapsular extension, but not significant statistically (P>0.005). There was no correlation between TAMs and MVD (P>0.001).ConclusionsTAMs and MVD had increased PCa but did not provide independent prognostic value. Increasing numbers of TAMs was not always followed by an increase in MVD. HGPIN is the most likely precursor for PCa

Role of methylprednisolone on mRNA expression of BAX, BCL-2 genein testicular torsion-detorsion of male albino Wistar rats

Study Background : Testicular torsion is a genitourinary emergency most common in children and emergencies requiring second surgery in adolescents after acute appendicitis1. Testicular torsion is more common on the left with a 1.2: 1 ratio, which is probably caused by a slightly longer spermatic cord on the left2. Testicular torsion can occur at any age, but the peak incidence is at age 14, with a peak of second occurrence at 1 year of age3. At 1 year of age, testicular torsion is a major cause of acute scrotum (83%). At the age of 3 - 13 years, the most frequent diagnosis is the torsion of the testicular appendix. After the age of 17 years, epididymitis is the most frequent diagnosis (75%)4. Method: This study is an experimental study, post-test only control group design, the sample was randomly divided into 4 groups, 2 intervention groups and 2 control groups. In this study the independent variables are the duration of the right torsion-detection treatment of the testes and the injection of Methylprednisolone in Wistar male rats. The dependent variables are mRNA expression in apoptosis and anti-apoptosis genes in rats’ ipsilateral and contralateral testes. . Results and Discussion: In this study, two-way ANOVA is used to analyze data between groups. Significant decrease in BAX gene mRNA expression (

Diagnosis value of prostate specific antigen density (PSAD) and prostate specific antigen (PSA) in bone metastases of prostate cancer among Indonesian population

Cancer prostate (PCa) is currently reported as the most diagnosed cancer in males. Bone metastases in PCa indicate poor prognosis and the major cause of pain and death. Early diagnosis of metastases is important in PCa management. Prostate specific antigen (PSA) velocity was used to predict overall survival and metastasis-free survival. However, this test should be conducted 2 times, for at least 4 weeks apart. Therefore, a cross-sectional test with higher positive probability value is needed. This study aimed to compare PSA density (PSAD) and PSA level to evaluate patients at risk of bone metastases in Yogyakarta, Indonesia. Aretrospective study with a total subject of 106 patients with (n = 31) and without (n = 75) bone metastases were analyzed. The initial PSA measurement, as well as bone scan and prostate volume, were evaluated in all patients. Bone survey found to be positive in 31/106 (29.2%) patients. The total of 50(47.2%), 10(9.4%) and 46(43.4%) patients had PSA level 100ng/mL, respectively. Furthermore, receiver operating characteristic (ROC) area under the curve of PSAD (0.75) was higher that that ofPSA (0.65).PSAD more than 0.15 indicated sensitivity of 93% and specificity of 38%, while PSA more than 20 ng/mL shown sensitivity 82% and specificity 21%. In conclusion, PSAD level more than 0.15 shows high sensitivity and specificity in causing potential skeletal metastases. Using this PSAD cut-off value, unnecessary investigation canbe avoided.

Correlation of neutrophil ratio to lymphocyte levels before therapy with the incidence of metastasis, lymph node involvements, in urothelial type muscle invasive bladder cancer in Indonesia

Bladder cancer is cancer originated from the bladder mucosa or urothelium. Bladder cancer is the 9th most common malignancy worldwide and the most common malignancy of the urinary tract. Studies show that cancer triggers an inflammatory response, which causes changes in circulating inflammatory cells. Examination of neutrophils and lymphocytes is an inexpensive examination, reproducible, and easily obtained. Neutrophil to lymphocyte ratio (NLR) values have been used in several studies to evaluate the inflammatory response that occurs in tumors. In urology, the importance of NLR has been recognized in predicting progression and aggressiveness in urothelial bladder tumors, kidney cancer (RCC/renal cell carcinoma), and upper tract urothelial carcinoma (UTUC). This study was a cross-sectional study obtained retrospectively by evaluating the medical records of patients diagnosed with muscle-invasive bladder cancer (MIBC) at Dr. Sardjito General Hospital, Yogyakarta, Indonesia from January 2017 to December 2019. The NLR data were categorized into NLR 2.5. As much as 150 patients with bladder cancer were included in this study, with a mean age of 56.43 ± 13.60 years. In the comparison of NLR values and the incidence of metastasis, there were 15 people (20%) with NLR values 2.5 had metastasis (p = 0.003). In the comparison of NLR values and nodule involvement, there were 25 (33.3%) patients with NLR 2.5 (p = 0.021). This study showed that patients with metastatic bladder tumors and lymph node involvement had a significantly higher NLR value. It can be concluded the NLR value can be used to predict the metastatic level and lymph node involvement in patients with bladder tumors. Even though it is not a specific marker of inflammation, the NLR examination is simple, affordable, easy to obtain, and widely available

mRNA expression of CYP17A1, CYP11A1, CYP19A1, HSD3B1 and AKR1C2 in metastatic and non-metastatic prostate cancer patients

The progression of prostate cancer (PCa) mainly occurs caused by androgens. There is a linkbetween intratumoral steroidogenesis and castration-resistant prostate cancer. This studyaimed to determine the mRNA expression of various steroidogenic enzymes (CYP17A1,CYP11A1, CYP19A1, HSD3B1, and AKR1C2) in metastatic and non-metastatic prostatecancer patients. This study was conducted at the Anatomical Pathology Laboratory andUrologi Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing,Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta from September-November 2017. Samples were taken from 30 paraffin blocks with adenocarcinoma ofprostate, stained with hematoxylin-eosin (HE) and then classified into metastatic and nonmetastaticgroups. Samples then underwent deparaffinization procedure and examinationof mRNA expression of CYP17A1, CYP11A1, CYP19A1, HSD3B1, AKR1C2 genes usingReal-Time PCR. The mean mRNA expressions of CYP11A1, CYP17A1, CYP19A1,HSD3B1, and AKR1C2 genes in the metastatic adenocarcinoma prostate group were 7.08,10.11, 3.94, 4.84 and 3.58, respectively. In the non-metastatic group, the mean mRNAexpressions of CYP11A1, CYP17A1, CYP19A1, HSD3B1, and AKR1C2 genes were 4.62,9.45, 3.46, 2.68 and 4.92, respectively. The mean of mRNA expression of CYP11A1,CYP17A1, CYP19A1, and HSD3B1 genes were higher in the metastatic group than nonmetastaticadenocarcinoma prostate group. However, it was not statistically significant(p>0.05). The highest mRNA expression of steroidogenic enzymes was the CYP17A1gene. In conclusion, the mRNA expressions of CYP17A1, CYP11A1, CYP19A1, HSD3B1were higher in the metastatic prostate cancer patients compared to that in non-metastaticprostate cancer patients but statistically not significant

Meta-analysis of Optimal Management of Lower Pole Stone of 10 - 20 mm: Flexible Ureteroscopy (FURS) versus Extracorporeal Shock Wave Lithotripsy (ESWL) versus Percutaneus Nephrolithotomy (PCNL)

Background: the optimal management of lower calyceal stones is still controversial, because no single method is suitable for the removal of all lower calyceal stones. Minimally invasive procedures such as extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL) and flexible ureteroscopy (fURS) are the therapeutic methods for lower calyceal stones. The aim of this study was to identify the optimal management of 10-20 mm lower pole stones. Methods: a meta-analysis of cohort studies published before July 2016 was performed from Medline and Cochrane databases. Management of 10-20 mm lower pole stone treated by fURS, ESWL and PCNL with follow-up of residual stones in 1-3 months after procedure were include and urinary stone in other location and size were excluded. A fixed-effects model with Mantzel-Haenzel method was used to calculate the pooled Risk Ratio (RRs) and 95% Confidence Interval (CIs). We assessed the heterogeneity by calculating the I2 statistic. All analyses were performed with Review manager 5.3. Results: we analized 8 cohort studies. The stone free rate from 958 patients (271 PCNL, 174 fURS and 513 ESWL), 3 months after operation, was 90.8% (246/271) after PCNL; 75.3% (131/174) after fURS; and 64.7% (332/513) after ESWL. Base on stone free rate in 10-20 mm lower pole stone following management, PCNL is better than fURS (overall RR was 1.32 (95% CI 1.13 – 1.55); p<0.001 and I2=57%) and ESWL (overall risk ratio 1.42 (95% CI 1.30 – 1.55); p=<0.001 and I2 = 85%). But, if we compare between fURS and ESWL, fURS is better than ESWL base on stone free rate in 10-20 mm lower pole stone management with overall RR 1.16 (95% CI 1.04 – 1.30; p=0.01 and I2=40%). Conclusion: percutaneus nephrolithotomy provided a higher stone free rate than fURS and ESWL. This meta-analysis may help urologist in making decision of intervention in 10-20 mm lower pole stone management

Mutational heterogeneity between different regional tumour grades of clear cell renal cell carcinoma

Only a limited number of studies have explored the possible associations between tumour grade and mutated genes in clear cell renal cell carcinoma (ccRCC), and we set out to investigate this further using a multiple sampling and next generation sequencing (NGS) approach in a series of ccRCCs. Multiple regions were sampled from formalin-fixated paraffin-embedded ccRCC tumour blocks from seven patients. In 27 samples from six patients, we performed targeted NGS using a custom 42-gene panel based on the most frequently mutated genes in ccRCC reported in public databases. In four samples from the seventh patient, we performed whole exome sequencing (WES) and array comparative genomic hybridisation for detection of copy number variants (CNVs). Mutated genes and the tumour grades of the samples in which they had been identified were compared both within and between all individual tumours. CNVs were compared across all samples from patient 7. We identified clear genetic heterogeneity within and across tumours, but VHL mutations were seen in all patients. Looking across all samples, we identified eleven genes that were only mutated in samples with one particular tumour grade. However, these genes were never mutated in all samples with that tumour grade. Increasing chromosomal instability corresponded with increasing tumour grade, but we observed minimal association between tumour grade and total mutational load in the WES data. Our study confirms the genetic heterogeneity and tumour grade heterogeneity of ccRCC. Although a relatively small number of samples was analysed, genes were identified that could potentially be specific, though insensitive, markers of higher ccRCC tumour grades

PREDICTIVE VALUE OF SERUM PROSTATE SPECIFIC ANTIGEN IN DETECTING BONE METASTASIS IN PROSTATE CANCER

Objective: We determine the utility of Prostate Specific Antigen (PSA) for predicting the presence of skeletal metastasis on Bone Scan (BS) in prostate cancer patients. Material &amp; Methods: Retrospective analysis of medical records of 70 consecutive prostate cancer patients subjected to bone scan during the last 2 years was done. 5 cases were excluded due to the following reasons: Serum PSA not available, hormonal or other therapy given prior to serum PSA measurement, and/or Bone Scan, and symptomatic for bone metastasis. In remaining 65 cases, PSA value and bone scan were evaluated. Results: BS was found to be positive in 20/65 (31%) and negative in 45(69%) patients. 24 (37%) had serum PSA &gt; 100 ng/ml, 25 (38.5%) had PSA of 20‐100 ng/ml and only 16 (24.5%) had PSA &lt; 20 ng/ml. Conclusion: Serum PSA &lt; 20 ng/ml have high predictive value in ruling out skeletal metastasis. Our data are in corroboration with results from previous studies that BS should be performed only if PSA &gt; 20 ng/ml. Using this cut‐off, unnecessary investigation can be avoided. Avoiding BS asymptomatic in this group of patients would translate into a significant cost‐saving and reduction in their psychological and physical burden

THE SIZE PROFILE OF EXTERNAL URETHRAL ORIFICIUM IN MALE ADULT

Objective: External urethral orificium (EUO) is the outermost part of the urethra. It lies on the outside, then the operation tool for endourology transurethra must pass urethra meatus externus first before they can go deeper. Unfortunately there is no study addresses the size of EUO of male adults in Indonesia. This study was aimed to know the size of the EUO in males adult. Material &amp; Methods: This study was a prospective study by taking the primary data in the Sardjito General Hospital and Kardinah General Hospital, Tegal and implemented during the period from October to December 2016. There were 50 samples of males adult. The exclusion criteria in this study were male patients with meatal stenosis or patients with a history of surgery on the penis or instrumentation of the urethra. External urethra orifice size measurements performed with a digital caliper, and then converted to scale the size of Fr. The data were then analyzed by Npar test with the Kolmogorov-Smirnov test, and then T-test with linear regression. Results: There were 50 adult male patients with a mean age of 52.54 ± 10.34 years. For sizes vary with the size of 16.5-26.4 Fr. From the analysis of the size of the EUO obtained a mean size of 22.72 ± 2.62 for Indonesian adult male. Conclusion: The average size of the adult male EUO was 22.72 ± 2.62 Fr.

NEEDLE RENAL LIFTING TECHNIQUE IN MANAGEMENT OF COMPLICATED PROXIMAL URETERAL LITHOTRIPSY: A CASE REPORT

Objective:&nbsp;To described a needle renal lifting technique using an 18-gauge needle to adjunct ureterorenoscopy (URS) in the management of complicated proximal ureteral stones.&nbsp;Case(s) Presentation:&nbsp;A 46 years old man presented with right flank pain for 1 month. This patient was diagnosed with ureteral stone and ureteral kinking that prohibits access to the proximal side of the ureter. Due to difficult access to the proximal ureter, we perform a needle renal lifting technique which is initialized by puncturing the middle renal calyx with 18-gauge needle. Then, the proximal end of the needle was pushed to the caudal direction to move the kidney to the cephalic direction and straighten the kinked ureter. After that procedure, the URS sheat can easily enter the proximal ureter to the stone site.&nbsp;Discussion:&nbsp;The success rate of this procedure is based on the operator skills to access the calyx and perform URS simultaneously. Like a previous technique, needle renal lifting is effective only when the kidney is mobile.&nbsp;Conclusion:&nbsp;The needle renal lifting technique can be used to adjunct URS in the management of complicated ureteral stones which prohibited access to the proximal ureter.&nbsp; &nbsp