The Approach to High Risk Bladder Cancers in the Absence of Bacillus Calmette Guerin: What should Be the Treatment and Follow Up?

Bacillus Calmette Guerin (BCG), is the optimal bladder-sparing treatment option for patients with high-risk, non-muscle invasive bladder cancer. Recently, the application of BCG has been hindered due to the problem of its availability in Turkey. Alternative treatment options are needed until this problem is solved. In this article, the recommendations about the preferred treatment options and the follow-up, are summarized in the light of the current literature

Does patient age affect survival after radical cystectomy?

OBJECTIVE To analyse the impact of patient age on survival after radical cystectomy (RC). PATIENTS AND METHODS After ethics review board approval, two databases of patients with bladder cancer (BC) undergoing RC at the University Heath Network, Toronto, Canada (1992-2008) and the University of Turku, Turku, Finland (1986-2005) were retrospectively analysed. A total of 605 patients who underwent this procedure between June 1985 and March 2010 were included. Patients were divided into four age groups: = 80 years. Demographic, clinical and pathological data were compared, as well as recurrence-free survival (RFS), disease-specific survival (DSS) and overall survival (OAS) rates. RESULTS Compared with younger patients (age = 80 years) had higher American Society of Anesthesiologists scores (P = 80 years (P = 80 years) should not be denied RC if they are deemed fit to undergo surgery. Senior adults do not suffer from adverse histopathological features as compared with younger patients

ACTIVE FOLLOW-UP DECISION IN PROSTATE CANCER; HOW SAFE IS THE BIOPSY GLEASON SCORE?

Amaç: Prostat spesifik antijenin tanımlanmasından sonra insidental prostat kanseri oranı yükselmiş ve hastalar gereksiz tedavilere maruz kalabilmişlerdir. İnsidental prostat kanseri olan hastalarda herhangi bir tedavi uygulanmadan yakın izlem kılavuzlara girmiş ve hastalara uygulanmaya başlamıştır. Ancak transrektal ultrasonografi eşliğinde biyopsi patolojilerindeki veriler ile radikal prostatektomi spesimen patolojilerindeki verilerin uyumsuzluğu, küratif tedavi ihtiyacı olabilecek hastaları riske atmaktadır. Bu çalışmada; radikal prostatektomi spesimenlerindeki Gleason skorları ile TRUS-bx Gleason skorlarının karşılaştırılması amaçlanmıştır. Materyal – Metot: Mart 2011 ile Haziran 2016 tarihleri arasında, kliniğimizde radikal prostatektomi cerrahisi geçirmiş hastaların verileri retrospektif olarak değerlendirildi. Hastaların transrektal ultrasonografi eşliğinde biyopsi öncesi PSA değerleri, biyopsi kor sayıları, kanser pozitif biyopsi kor sayıları, biyopsideki kanser yüzdeleri ve Gleason skorları tespit edilerek, radikal prostatektomi sonrası Gleason skorları, doku kanser oranları, cerrahi sınırlar ve patolojik evre ile karşılaştırıldı. Bulgular: Toplam 44 hastanın verileri değerlendirildi. Transrektal ultrasonografi eşliğinde biyopsi patolojisinde Gleason skoru 7 olan hastaların 1’inde (%16,6) prostat spesimen Gleason skoru >7 olarak tespit edildi Sonuç: Transrektal ultrasonografi eşliğinde biyopsi patolojilerinde bildirilen Gleason skorları ile radikal prostatektomi Gleason skorları arasında fark olabilmekte, bu fark özellikle biyopsi Gleason skoru 7 at 1 (16,6%) patient in both transrectal ultrasonography guided biopsy and radical prostatectomy Conclusion: There are differences between transrectal ultrasonography guided biopsy Gleason scores and the radical prostatectomy Gleason scores. This differences especially are obvious in patients with Gleason score <7. The reliability of gleason scores reported by the pathologists might be questionable so, in order to decide active surveillance for patients, other variables (core-tumor ratio, tumor core number, PSA) must also be considered

Elevated levels of MMP12 sourced from macrophages are associated with poor prognosis in urothelial bladder cancer

Abstract Background Urothelial bladder cancer is most frequently diagnosed at the non-muscle-invasive stage (NMIBC). However, recurrences and interventions for intermediate and high-risk NMIBC patients impact the quality of life. Biomarkers for patient stratification could help to avoid unnecessary interventions whilst indicating aggressive measures when required. Methods In this study, immuno-oncology focused, multiplexed proximity extension assays were utilised to analyse plasma (n = 90) and urine (n = 40) samples from 90 newly-diagnosed and treatment-naïve bladder cancer patients. Public single-cell RNA-sequencing and microarray data from patient tumour tissues and murine OH-BBN-induced urothelial carcinomas were also explored to further corroborate the proteomic findings. Results Plasma from muscle-invasive, urothelial bladder cancer patients displayed higher levels of MMP7 (p = 0.028) and CCL23 (p = 0.03) compared to NMIBC patients, whereas urine displayed higher levels of CD27 (p = 0.044) and CD40 (p = 0.04) in the NMIBC group by two-sided Wilcoxon rank-sum tests. Random forest survival and multivariable regression analyses identified increased MMP12 plasma levels as an independent marker (p < 0.001) associated with shorter overall survival (HR = 1.8, p < 0.001, 95% CI:1.3–2.5); this finding was validated in an independent patient OLINK cohort, but could not be established using a transcriptomic microarray dataset. Single-cell transcriptomics analyses indicated tumour-infiltrating macrophages as a putative source of MMP12. Conclusions The measurable levels of tumour-localised, immune-cell-derived MMP12 in blood suggest MMP12 as an important biomarker that could complement histopathology-based risk stratification. As MMP12 stems from infiltrating immune cells rather than the tumor cells themselves, analyses performed on tissue biopsy material risk a biased selection of biomarkers produced by the tumour, while ignoring the surrounding microenvironment

Comparison of the Clinical and Pathologic Staging in Patients Undergoing Radical Cystectomy, the Factors Associated with Upstaging and its Effect on Outcome

Bladder cancer is clinically understaged in about half of the cases and no improvements in solving this problem has been observed during the past 25 years. Patients who are clinically upstaged after radical cystectomy have higher recurrence and bladder cancer mortality rates when compared to those who are correctly staged. Currently, reliable predictors of extravesical upstaging at the time of radical cystectomy do not exist. In various studies of T2 staging, hydronephrosis, carcinoma in situ, high- grade disease, lymphovascular invasion, female gender and neutrophil- lymphocyte ratio are found to be associated with upstaging

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Non-Muscle Invasive Bladder Cancer Resistant to Bcg

Treatment options for patients with non-muscle invasive bladder cancer (NM/BC) refractory to intravesical bacillus Calmette-Guerin (BCG) therapy is reviewed in this article based on the recent published literature. Although intravesical BCG is the best bladder sparing treatment option for NM/BC to prevent recurrence and progression, about 1/3 of cases are refractory to this treatment. At this point radical cystectomy is the standard treatment of choice. If this option is not feasible, intravesical chemotherapy with docetaxel or gemcitabine, the combination of BCG and interferon (INF)-alpha or device-assisted intravesical strategies, such as mitomycin-EMDA or chemohyperthermia are some of the candidates for further treatment