Triptorelin in androgen depravation therapy of advanced prostate cancer

Triptorelin as the luteinizing hormone releasing hormone (LHRH) analogue has its own place among other available forms of androgen-depravation therapy (ADT) of locally advanced and metastatic prostate cancer (PCa). Nowadays, in times of development of new therapies in castration-resistant PCa, ADT remains the back bone therapy, which may be supplemented with one of novel drugs. The results of basic research indicate, that apart from the main mechanism of action based on lowering a testosterone concentration to the castration level, triptorelin may have a direct inhibitory effect on tumor cells. Formulations of tryptorelin are available to administer as 1-month, 3-months and 6-months sustained-release forms that may be given intramuscularly or subcutaneously. Constant concentration of triptoreline is maintained by using special microspheres in drug production. Pharmacokinetic and pharmacodynamic properties of particular forms were extensively tested, which allows for safe usage and retain of predictable and high efficacy. Indicators of effective ADT are fast reduction and maintenance of the state of castration. This phenomenon translates into a decrease of the prostate-specific antigen and longer survival. Triptorelin successfully meets these objectives based on a number of phase I–III studies. There is a noticeable lack of comparative studies on effectiveness of particular ADT forms. This may stem from an assumption, that all LHRH analogues demonstrate similar effectiveness because of the class effect. However, some evidence highlight significant differences in efficacy among these drugs. Triptorelin compares especially favourably, particularly as a drug reducing the testosterone level to the lower recommended values (< 20 ng/dl). Side effect profile during the therapy with triptorelin is largely the result of inhibition of the hypothalamic pituitary-testicular axis. Hormonal disturbances linked to hipoandrogenism cause changes in lipid metabolism and glucose tolerance, which may influence the cardiovascular risk. This article is a review of key reports regarding triptorelin and a summary of the role that triptorelin plays in contemporary ADT in advanced PCa

Clinical utility of MRI in the decision-making process before radical prostatectomy: Systematic review and meta-analysis.

ContextMagnetic resonance imaging (MRI) is currently the most accurate imaging modality to assess local prostate cancer stage. Despite a growing body of evidence, incorporation of MRI images into decision-making process concerning surgical template of radical prostatectomy, is complex and still poorly understood.ObjectiveWe sought to determine the value of MRI in preoperative planning before radical prostatectomy.Materials and methodsSystematic search through electronic PubMed, EMBASE, and Cochrane databases from 2000 up to April 2018 was performed. Only studies that used preoperative MRI in decision-making process regarding extension of resection in patients with prostate cancer, in whom radical prostatectomy was an initial form of treatment were included into analysis. Their quality was scored by Risk Of Bias In Non-Randomized Studies of Interventions system. Meta-analysis was performed to calculate the weighted summary proportion under the fixed or random effects model as appropriate and pooled effects were depicted on forest plots.ResultsThe results showed that the preoperative MRI led to the modification of initial surgical template in one third of cases (35%). This occurred increasingly with the rising prostate cancer-risk category: 28%, 33%, 52% in low-, intermediate- and high-risk group, respectively. Modification of neurovascular bundle-sparing surgery based on MRI appeared to have no impact on the positive surgical margin rate. The decision based on MRI was correct on average in 77% of cases and differed across prostate cancer-risk categories: 63%, 75% and 91% in low-, intermediate- and high-risk group, accordingly.ConclusionsIn summary, MRI has a considerable impact on the decision-making process regarding the extent of resection during radical prostatectomy. Adaptation of MRI images by operating surgeons has at worst no significant impact on surgical margin status, however its ability to decrease the positive surgical margin rates remains unconfirmed

De Novo Detrusor Underactivity and Other Urodynamic Findings after Radical Prostatectomy: A Systematic Review

Background and objectives: The aim of this systematic review is to evaluate the impact of radical prostatectomy (RP) on bladder function, with special attention towards detrusor underactivity investigated with the means of urodynamic evaluation. Materials and Methods: The review was performed in accordance with the PRISMA statement and was registered in the PROSPERO (ID#: CRD42020223480). The studied population was limited to men with prostate cancer who underwent urodynamic study prior to and after radical prostatectomy. Eight hundred twenty-seven studies were screened, with twenty-five finally included. A qualitative analysis was performed. Rates of detrusor underactivity (DU) before surgery were reported in eight studies and ranged from 1.6% to 75% (median of 40.8%). DU occurred de novo after RP in 9.1% to 37% of patients (median of 29.1%). On the other hand, preexisting DU resolved in 7% to 35.5% of affected men. Detrusor overactivity (DO) was the most frequently reported outcome, being assessed in 23 studies. The rate of DO preoperatively was from 5% to 76% (median of 25%). De novo was reported in 2.3&ndash;54.4% of patients (median of 15%) and resolved after RP in 19.6% to 87.5% (median of 33%) of affected patients. Baseline rates of bladder outlet obstruction (BOO) varied between studies from 19% to 59.3%, with a median of 27.8%. The most pronounced change after surgery was the resolution of BOO in 88% to 93.8% (median of 92%) of affected patients. Results: Rates of de novo impaired bladder compliance (IBC) varied from 3.2% to 41.3% (median of 13.3%), whereas the resolution of IBC was reported with rates ranging from 0% to 47% (median of 4.8%). Conclusions: BOO, DO, and DU are frequently diagnosed in men scheduled for RP. BOO is improved after RP in most patients; however, there is still a substantial rate of patients with de novo DU as well as DO which may impair functional outcomes and quality of life

Przerzut raka nerkowokomórkowego do przeciwległego nadnercza z czopem nowotworowym w żyle nadnerczowej: opis przypadku

A 64-year-old woman presented with contralateral right adrenal metastasis with adrenal vein thrombus, which was diagnosed many years after left nephrectomy with adrenalectomy due to renal cell cancer. The patient underwent right adrenalectomy with adrenal vein tumor thrombectomy for treatment. The pathologic examination confirmed metastatic clear cell carcinoma. The remote but existing risk of developing contralateral adrenal metastasis (CAM) after primary radical nephrectomy supports the idea of sparing the adrenal gland in suitable patients who undergo radical nephrectomy. Contralateral adrenal metastasis from RCC is a rare finding with the potential benefit of cure after resection. Care must be taken in preoperative diagnostics, as this metastasis is capable of causing inferior vena cava tumor thrombus via the suprarenal venous route. According to our knowledge, our case is the second similar entity described in literature so far.U 64-letniej chorej stwierdzono przerzut do przeciwległego nadnercza wraz z obecnością czopu nowotworowego w żyle nadnerczowej, który został rozpoznany wiele lat po lewostronnej nefrektomii wraz z adrenalektomią, wykonanej z powodu raka nerkowokomórkowego. Pacjentka została poddana prawostronnej adrenalektomii z usunięciem czopa nowotworowego z żyły nadnerczowej. W badaniu histopatologicznym potwierdzono przerzut raka jasnokomórkowego. Ryzyko wystąpienia przerzutu do przeciwległego nadnercza po pierwotnej radykalnej nefrektomii istnieje, choć jest niewielkie, dlatego zasadne wydaje się zachowanie nadnercza w wybranej grupie chorych poddawanych radykalnej nefrektomii. Występowanie zmian wtórnych raka nerkowokomórkowego w przeciwległym nadnerczu jest rzadko spotykane, natomiast resekcja guza wiąże się z możliwością wyleczenia. Konieczna jest staranna diagnostyka przedoperacyjna w związku ze zdolnością przerzutu raka nerkowokomórkowego do tworzenia czopa nowotworowego w żyle głównej dolnej drogą żył nadnerczowych. Wedle wiedzy autorów niniejszy przypadek jest drugim tego rodzaju opisywanym dotąd w literaturze przedmiotu

Contralateral adrenal metastasis from renal cell carcinoma with tumor thrombus in the adrenal vein: a case report

A 64-year-old woman presented with contralateral right adrenal metastasis with adrenal vein thrombus, which was diagnosed many years after left nephrectomy with adrenalectomy due to renal cell cancer. The patient underwent right adrenalectomy with adrenal vein tumor thrombectomy for treatment. The pathologic examination confi rmed metastatic clear cell carcinoma. The remote but existing risk of developing contralateral adrenal metastasis (CAM) after primary radical nephrectomy supports the idea of sparing the adrenal gland in suitable patients who undergo radical nephrectomy. Contralateral adrenal metastasis from RCC is a rare fi nding with the potential benefi t of cure after resection. Care must be taken in preoperative diagnostics, as this metastasis is capable of causing inferior vena cava tumor thrombus via the suprarenal venous route. According to our knowledge, our case is the second similar entity described in literature so far

Urobiome in Gender—Related Diversities of Bladder Cancer

Bladder cancer (BC) remains the most common malignancy of urinary tract. Sex-related differences in BC epidemiology, diagnosis, therapy, and outcomes have been reported. Throughout the recent years, extensive research has been devoted to genetic and molecular alterations in BC. Apart from the molecular background, another related concept which has been speculated to contribute to gender diversities in BC is the role of urinary pathogens in bladder carcinogenesis. Microbiome studies, fueled by the availability of high-throughput DNA-based techniques, have shown that perturbation in the microbiome is associated with various human diseases. The aim of this review is to comprehensively analyze the current literature according to sex-related differences in the microbiome composition in BC