Vrijednosti prostata specifičnog antigena (PSA) u bolesnika s adenokarcinomom prostate niskog i visokog rizika

Prostatic adenocarcinoma (PC) comprises around 19% of malignancies in Croatian male population. On the basis of PSA value, Gleason score, grading group and clinical stage, PC can be classified into low- and high-risk groups which is significant for different therapeutic regimens and prognostic outcomes. In this retrospective study, we analyzed the difference in preoperative PSA value in a group of 272 patients who underwent radical prostatectomy and were diagnosed with PC adenocarcinoma in our institution in a period from January 1st, 2018 untill December 31st, 2018. Subsequently, they were divided into low- and high-risk prostatic adenocarcinoma groups. Our results demonstrated positive correlation in preoperative PSA values between the groups and therefore support the use of PSA as one of the parameters in defining low- and high-risk prostatic adenocarcinoma categories.Adenokarcinom prostate čini oko 19% maligniteta u muškoj populaciji Hrvata. Svi dijagnosticirani adenokarcinomi prostate se s obzirom na vrijednost PSA, Gleason zbroj i klinički stadij mogu svrstati u skupine niskog i visokog rizika. U ovoj retrospektivnoj studiji analizirali smo razliku u vrijednostima preoperativnog PSA u skupini od 272 pacijenta kojima je dijagnosticiran adenokarcinom prostate nakon radikalne prostatektomije učinjene u našoj ustanovi u razdoblju od jedne godine (01. siječnja do 31. prosinca 2018.), a koji su podijeljeni u skupine adenokarcinoma prostate niskog i visokog rizika. Rezultati naše studije pokazuju pozitivnu korelaciju u vrijednostima preoperativnog PSA između grupa. Nadalje, rezultati naše analize podupiru upotrebu PSA kao jednog od parametara u definiranju kategorija niskog i visokog rizika karcinoma prostate

„Large nested” varijanta urotelnog karcinoma – prikaz bolesnika

Urotelni karcinom čini oko 90% malignih tumora mokraćnog mjehura, sa sklonošću raznolike diferencijacije. Različiti podtipovi imaju jedinstven histološki izgled i klinički tijek. Među podtipovima, jedan od najnovijih i rjeđih entiteta uvrštenih u najnoviju Klasifikaciju Svjetske zdravstvene organizacije (SZO) jest tzv. „large nested” varijanta urotelnog karcinoma koju karakterizira s jedne strane dobroćudan histološki izgled, a s druge agresivan klinički tijek te stoga predstavlja dijagnostički problem. Ovdje donosimo prikaz slučaja pacijenta obrađivanog zbog bezbolne makrohematurije

Početna iskustva u usporedbi CT-vođene radiofrekventne i mikrovalne ablacije u terapiji karcinoma bubrega

Percutaneous ablative techniques under imaging guidance have become a frequently used treatment method in the therapy of primary T1a or secondary renal tumours, especially in patients who were burdened with comorbidities and are not surgical candidates. Radiofrequency ablation with single or multiple electrodes has been the primary ablative technique used and the mainstay of percutaneous therapy for a long time but with the evolution of technologies, microwave ablation and cryoablation have emerged as possibly more effective methods of treatment. After the initial experience with CT-guided radiofrequency ablation for renal carcinoma treatment in 6 patients, we started using microwave ablation with the following 6 patients. Our results showed microwave ablation to have bett er results in achieving complete tumour ablation, while requiring shorter hospitalization time and better patient satisfaction. There have not been any major complications, while minor complications were more frequent with microwave ablation. Due to shorter procedure time patients treated with microwave ablation, we no longer used general anaesthesia but only local anaesthetic with conscious sedation.Perkutane ablativne tehnike pod kontrolom slikovnih metoda su postale često korištena metoda u terapiji primarnih tumora bubrega T1a stadija ili sekundarnih bubrežnih tumora, ponajprije kod pacijenata koji zbog komorbiditeta nisu primarno kirurški kandidati. Radiofrekventna ablacija s jednom ili više elektroda je bila prva korištena ablativna metoda i dugo vremena glavna okosnica perkutane terapije, no s razvojem novih tehnologija, mikrovalna ablacija i krioablacija su se pojavile kao potencijalno učinkovitije opcije liječenja. Nakon početnih iskustava s CT-vođenom radiofrekventnom ablacijom karcinoma bubrega kod šest pacijenata, započeli smo koristiti mikrovalnu ablaciju kod idućih šest pacijenata. Naši rezultati su pokazali da s mikrovalnom ablacijom postižemo bolje rezultate u smislu potpune ablacije tumora uz kraće potrebno vrijeme hospitalizacije i veću razinu zadovoljstva pacijenata nakon zahvata. Nisu zabilježene veće komplikacije, dok su manje komplikacije bile učestalije nakon mikrovalne ablacije. Pacijenti tretirani mikrovalnom ablacijom nisu zahtijevali opću anesteziju zbog kraćeg vremena ablacije

Strano tijelo u mokraćnom mjehuru kao ishod samokateterizacije: prikaz slučaja

Foreign bodies inside urinary tract are a relatively rare condition in our practice. There are several reports published and in most cases the reason for self insertion of an object was autoerotic stimulation or psychiatric illness. Self treatment by homemade instruments is a rarely seen scenario. A 62-year-old man presented to our department complaining of lower urinary tract symptoms. On examination, a foreign body was detected inside the urinary bladder. Urethral stricture was also detected for which the patient had been previously treated on several occasions. The patient stated that he had attempted self catheterization using a homemade catheter. He had succeeded in emptying his bladder; however, the catheter entered the bladder completely and was irretrievable to him. Sachse urethrotomy was performed following retrieval of the foreign body. No psychiatric illness was detected in our patient. The patient’s postoperative course was uneventful.Strana tijela unutar mokraćnog sustava su relativno rijetko stanje u našoj praksi. U većini objavljenih slučajeva razlog umetanja stranog tijela je autoerotska stimulacija ili psihijatrijska bolest. Umetanje stranog tijela kao povod za rješavanje mokraćne opstrukcije je rijedak događaj. Bolesnik u dobi od 62 godine javio se na našu kliniku zbog simptoma donjeg mokraćnog trakta. Tijekom pregleda otkriveno je strano tijelo unutar mokraćnog mjehura. Kod bolesnika je u više navrata rađena unutarnja uretrotomija, a jednom otvorena operacija uretre s terminoterminalnom anastomozom. Bolesnik je naveo da je pokušao samokateterizaciju s improviziranim kateterom. Uspio je riješiti mokraćnu opstrukciju, no dio stranog tijela je zaostao u mokraćnom mjehuru. Nakon dodatne obrade učinjena je unutarnja uretrotomija po Sachseu s ekstrakcijom stranog tijela iz mokraćnog mjehura. Psihijatrijskih bolesti se kod bolesnika ne nalazi

Dijagnostika raka prostate u 2019. - promjene u europskim smjernicama i utjecaj na svakodnevnu praksu

Changes in the diagnostic pathway for prostate cancer advised in the most recent Guidelines of the European Association of Urology bring many endeavors for everyday practice. Availability, costs and radiological expertise are still representing a challenge for the adoption of these guidelines in everyday clinical practice. In this article we discuss the current situation regarding these issues and future options.Promjene u dijagnostici karcinoma prostate preporučene u najnovijim Smjernicama Europskog udruženja za urologiju donose mnoge izazove u svakodnevnoj praksi. Dostupnost, troškovi i pouzdanost slikovnog nalaza i dalje su izazov za usvajanje ovih smjernica u svakodnevnoj kliničkoj praksi. U ovom članku raspravljamo o trenutnoj situaciji u Hrvatskoj i svijetu i o budućim opcijama

Nepovoljne kliničko-patološke značajke u bolesnika s izostavljenom limfadenektomijom tijekom radikalne prostatektomije

Pelvic lymph node dissection (PLND) during radical prostatectomy (RP) is the most accurate staging modality for lymph node assessment in patients with prostate cancer. It is recommended in all patients with intermediate or high-risk disease undergoing radical prostatectomy. The goal of our study was to assess unfavorable clinicopathological characteristics in patients with omitted lymphadenectomy (PLND) during radical prostatectomy based on the nomogram proposed by Briganti and colleagues. In 2011, 200 patients undertook radical prostatectomy in our institution. Among them 53 patients who fulfilled Briganti criteria and in whom we omitted lymphadenectomy based on current guidelines. Unfavorable clinicopathological features considered were: stage T3, positive surgical margins or biochemical relapse (BCR). We registered biopsy Gleason score 6 in 34 patients, and 19 patients had Gleason score 7. Stage pT2 was seen in 49 patients, and pT3 in 4. Gleason score after radical prostatectomy was upgraded from GS 6 to GS 7 in 20 patients (37%) and reduced in 1 patient (2%). After a median follow-up of 49 (44-56) months, there were 12 (22.6%) patients with BCR. Patients with biopsy Gleason score 6 (n=34) compared to biopsy Gleason 7 (n=19) patients showed no difference regarding positive margins (p=0.0738) and BCR (p=0,736) at 49 months follow-up. Thus, PLND according to current guidelines can be safely omitted in low-risk patients using Brigantinomogram.Zdjelična limfadenektomija u vrijeme radikalne prostatektomije (RP) trenutno je najpouzdaniji način otkrivanja metastaza u limfne čvorove u bolesnika s rakom prostate. Cilj našeg istraživanja bio je procijeniti nepovoljne kliničko-patološke značajke u bolesnika s izostavljenom limfadenektomijom tijekom radikalne prostatektomije temeljene na Briganteovom nomogramu. U 2011. godini, u našoj je ustanovi 200 bolesnika podvrgnuto radikalnoj prostatektomiji. Identificirali smo 53 bolesnika koji su ispunili Brigantijeve kriterije te su prema aktualnim smjernicama bili pošteđeni zdjelične limfadenektomije. Nepovoljnim kliničko-patološkim značajkama smatralo se bilježenje stadija T3 bolesti, pozitivni kirurški rubovi ili biokemijski relaps. Na patohistološkom (PH) nalazu biopsije Gleason zbroj 6 verificiran je u 34 pacijenta, a 19 je pacijenata imalo Gleason zbroj 7. Na konačnom PH nalazu nakon učinjene radikalne prostatektomije 49 bolesnika je imalo pT2 stadiji bolesti, a 4 su bolesnika imala pT3. Konačni Gleason zbroj nakon radikalne prostatektomije povećan je u 20 bolesnika na GS 7 (37%) i smanjen kod jednog bolesnika (2%). Nakon srednjeg praćenja od 49 (44-56) mjeseci, bilo je 12 (22,6%) bolesnika s biokemijskim relapsom (BR). Usporedba bolesnika s biopsijskim nalazom Gleason zbroja 6 (n = 34) i bolesnika s Gleason zbrojem7 (n = 19) nije pokazala značajnu razliku u odnosu na pozitivne kirurške rubove (p = 0,0738) i BR (p = 0,736) nakon 49 mjeseci praćenja. Stoga se zdjelična limfadenektomija prema aktualnim smjernicama može sigurno izostaviti u bolesnika s procijenjenim niskim rizikom koristeći Briganteov nomogram

Embolizacija prostate – nova terapijska mogućnost liječenja simptoma donjeg urinarnog trakta kod muškaraca s benignom hiperplazijom prostate

Prostatic artery embolization is a minimally invasive endovascular treatment that improves lower urinary tract symptoms in men with benign prostatic hyperplasia. Although further randomized studies and long-term evidence is still needed for this method to be fully incorporated into treatment guidelines for benign prostatic hyperplasia, current studies show that this method can be an effective and safe alternative in patients with a significantly enlarged prostate gland who are not good surgical candidates. Therefore, we present the theory, technical details and potential benefits of this method as we review the current evidence on prostatic artery embolization.Embolizacija prostate je minimalno invazivna endovaskularna metoda liječenja koja se koristi za liječenja simptoma donjeg urinarnog trakta kod muškaraca s benignom hiperplazijom prostate. Iako su potrebne dodatne randomizirane studije s dugoročnim praćenjem i rezultatima kako bi ova metoda bila uključena u smjernice liječenja benigne hiperplazije prostate, dosadašnje studije ukazuju da ova metoda može predstavljati učinkovitu i sigurnu alternativu kod pacijenata s uvećanom prostatom koji nisu dobri kirurški kandidati. Stoga prikazujemo teoriju, tehničke detalje i moguće prednosti ovog zahvata kroz analizu dosadašnjih studija o embolizaciji prostate

Validation of Epstein biopsy criteria for insignificant prostate cancer in contemporary cohort of Croatian patients [Patohistološki nalazi bolesnika s rakom prostate liječenih radikalnom prostatektomijom koji su bili podobni za aktivni nadzor]

Only few reports validated contemporary Epstein criteria for insignificant prostate cancer, and only one being from Europe. Patients with insignificant prostate cancer should be offered active surveillance and spared radical treatment. In our study we tested Epstein biopsy criteria for predicting unfavorable final pathology and biochemical relapse in low risk prostate cancer patients, who were eligible for active surveillance but where treated with radical prostatectomy. Between January 2003 and January 2008, 586 patients were subjected to radical prostatectomy in our institution. Among them, 106 where eligible for active surveillance according to Epstein biopsy criteria for insignificant prostate cancer. We analyzed the presence of adverse pathological findings in the final pathohistological specimen after radical prostatectomy which excludes low risk disease. Adverse pathohistological findings were noted in 41 (38.6%) patients, who could have been offered active surveillance. During the follow up of 48 (12-72) months, biochemical relapse was noted in 6 (5.6%) patients. Although active surveillance is becoming more popular because of the long natural course of prostate cancer and fear of overtreatment of patients with indolent course of disease, both doctors and patients must be aware of potentially significant disease in this group and limitations of current preoperative criteria defining low risk patients

Usporedba točnosti stupnjevanja diferencijacije raka prostate u uzorcima dobivenim ciljanom i sustavnom biopsijom prostate

All malignancies, including prostate cancer, require accurate diagnosing and staging before making a treatment decision. The introduction of targeted biopsies based on prostate MRI findings has raised prostate biopsy accuracy. Guided biopsies target the tumor itself during the biopsy instead of the most common tumor sites as is the case with a systemic biopsy. Some studies report that targeted biopsies should lower prostate cancer biopsy undergrading and overgrading. To determine the incidence of prostate cancer biopsy undergrading in patients who underwent a classic systemic biopsy compared to patients who underwent a mpMRI cognitive targeted biopsy. We identified the patients from our database who underwent a radical prostatectomy at our institution from January 1st, 2021, to June 30th, 2021.There were 112 patients identified. Patients were stratified into two groups based on the type of biopsy that confirmed prostate cancer. The mpMRI (N=50) group had a mpMRI cognitive guided transrectal ultrasound (TRUS) prostate biopsy performed, and the non-mpMRI group (N=62) received a classic, systemic TRUS biopsy. We compared the biopsy results with the final pathological results, and searched for undergrading or overgrading in the biopsies compared to the final histological reportThe undergrading was found in 17,7 % (N=11) cases in the non-mpMRI group and in 12,0 % (N=6) of cases in the mpMRI group (p=0,02, Mann-Whitney U test). No overgrading was found in our cohort. All cases of undergrading had Grade Group 1 in the biopsy report and Grade Group 2 in the final specimen report. The charasteristics of patients are listed in Table 1. In our cohort, the patients who underwent a mpMRI targeted biopsy had a lower undergrading incidence. During a systemic TRUS biopsy, the urologist targets the areas of the prostate where cancer is most commonly located, which is usually the peripheral zone of the prostate. Since different areas of the tumor have different areas of differentiation, only a low-grade part of the tumor is sometimes biopsied, which results in a sampling error. Once the prostate is removed, the whole tumor is analyzed, so the obtained pathological results related to the removed prostate are far more accurate than the analysis of prostate cores obtained by biopsy.Sve maligne bolesti, uključujući rak prostate, zahtijevaju preciznu dijagnostiku prije odluke o liječenju. Uvođenjem ciljanih biopsija na temelju nalaza MRI prostate povećana je točnost biopsije prostate. Vođene biopsije ciljaju na sam tumor u umjesto na najčešće lokacije tumora u prostati kao što je slučaj sa sistemskom biopsijom. Neke studije pokazuju da bi ciljane biopsije trebale smanjiti podcjenjivanje stupnja diferenciranosti raka prostate u uzorcima dobivenim biopsijom prostate. Odrediti incidenciju podcjenjivanje stupnja diferenciranosti raka prostate kod pacijenata koji su bili podvrgnuti klasičnoj sistemskoj biopsiji u usporedbi s pacijentima koji su bili podvrgnuti mpMRI kognitivnoj ciljanoj biopsiji. Identificirali smo pacijente iz naše baze podataka koji su podvrgnuti radikalnoj prostatektomiji u našoj ustanovi od 1. siječnja 2021. do 30. lipnja 2021. Identificirano je 112 pacijenata. Pacijenti su podijeljeni u dvije skupine na temelju vrste biopsije kojom je potvrđen rak prostate. Skupina mpMRI (N=50) primila je mpMRI kognitivno vođenu transrektalnu ultrazvučnu (TRUS) biopsiju prostate, a skupina non-mpMRI (N=62) primila je klasičnu, sistemsku TRUS biopsiju. Usporedili smo rezultate biopsije s konačnim patološkim nalazima i tražili smo podcjenjivanje stupnja diferenciranosti karcinoma prostate u biopsijama u usporedbi s konačnim histološkim nalazom. Podcjenjivanje stupnja diferenciranosti nađeno je u 17,7 % (N=11) u non-mpMRI skupini i u 12,0 % (N=6) slučajeva u mpMRI skupini (p=0,02, Mann-Whitney U test). U našoj kohorti nije pronađeno precjenjivanje stupnja diferenciranosti. Svi slučajevi podcjenjivanja imali su Gradus grupu 1 na nalazu biopsije prostate i Gradus grupu 2 u konačnom patohistološkom nalazu. U našoj kohorti, pacijenti koji su bili podvrgnuti ciljanoj biopsiji imali su nižu incidenciju podcjenjivanja stupnja diferenciranosti što je posljedica točnijeg uzorkovanja. Tijekom sistemske TRUS biopsije, urolog cilja na područja prostate gdje se rak najčešće nalazi, što je obično periferna zona prostate. Budući da različita područja tumora imaju različita područja diferencijacije, ponekad se bioptira samo dio tumora koji je bolje diferenciran, što rezultira pogreškom uzorkovanja. Nakon što je prostata uklonjena, analizira se cijeli tumor, tako da su rezultirajući patohistolološki rezultati uklonjene prostate daleko točniji od analize uzoraka prostate dobivenih biopsijom

Validation of Epstein Biopsy Criteria for Insignificant Prostate Cancer in Contemporary Cohort of Croatian Patients

Only few reports validated contemporary Epstein criteria for insignificant prostate cancer, and only one being from Europe. Patients with insignificant prostate cancer should be offered active surveillance and spared radical treatment. In our study we tested Epstein biopsy criteria for predicting unfavorable final pathology and biochemical relapse in low risk prostate cancer patients, who were eligible for active surveillance but where treated with radical prostatectomy. Between January 2003 and January 2008, 586 patients were subjected to radical prostatectomy in our institution. Among them, 106 where eligible for active surveillance according to Epstein biopsy criteria for insignificant prostate cancer. We analyzed the presence of adverse pathological findings in the final pathohistological specimen after radical prostatectomy which excludes low risk disease. Adverse pathohistological findings were noted in 41 (38.6 %) patients, who could have been offered active surveillance. During the follow up of 48 (12 – 72) months, biochemical relapse was noted in 6 (5.6%) patients. Although active surveillance is becoming more popular because of the long natural course of prostate cancer and fear of overtreatment of patients with indolent course of disease, both doctors and patients must be aware of potentially significant disease in this group and limitations of current preoperative criteria defining low risk patients