Changes in circulating microRNA levels associated with prostate cancer

BACKGROUND: The aim of this study was to investigate the hypothesis that changes in circulating microRNAs (miRs) represent potentially useful biomarkers for the diagnosis, staging and prediction of outcome in prostate cancer. METHODS: Real-time polymerase chain reaction analysis of 742 miRs was performed using plasma-derived circulating microvesicles of 78 prostate cancer patients and 28 normal control individuals to identify differentially quantified miRs. RESULTS: A total of 12 miRs were differentially quantified in prostate cancer patients compared with controls, including 9 in patients without metastases. In all, 11 miRs were present in significantly greater amounts in prostate cancer patients with metastases compared with those without metastases. The association of miR-141 and miR-375 with metastatic prostate cancer was confirmed using serum-derived exosomes and microvesicles in a separate cohort of patients with recurrent or non-recurrent disease following radical prostatectomy. An analysis of five selected miRs in urine samples found that miR-107 and miR-574-3p were quantified at significantly higher concentrations in the urine of men with prostate cancer compared with controls. CONCLUSION: These observations suggest that changes in miR concentration in prostate cancer patients may be identified by analysing various body fluids. Moreover, circulating miRs may be used to diagnose and stage prostate cance

Profiling tumour infiltrating lymphocytes in prostate cancer

© 2013 Dr. Nieroshan RajarubendraThe purpose of this study was to understand the T cell processes that take place in prostate pathology. The subset of T cells and their functional and activational status was determined using flow cytometry and immunohistochemistry. Furthermore the use of androgen deprivation therapy (ADT) on the impact on T cells was also determined. The three main conditions of prostate pathology investigated were benign prostatic hyperplasia (BPH), chronic abacterial prostatitis (CAP) and prostate cancer (PCa). Patients with BPH were used as the control group. The results in CAP showed a trend of an active immune process, where there was an influx of CD4+ T lymphocytes cells (9.45%, p 0.1407) in prostate tissue and a reduction in T regulatory (Treg) cells (2.32%, p 0.0675) in the tissue and the blood (3.13%, p 0.0042). In PCa tissue there was an influx of both CD4+ T lymphocytes (9.63%, p 0.0296) and CD8+ lymphocytes (12.81%, p 0.0063). Correspondingly a trend was seen with an increase in Treg cells in prostate tissue (2.12%, p 0.2480). This resulted in the ratios between CD4:CD8, CD4:Treg and CD8:Treg in PCa to be similar to BPH indicating a net homeostasis in immune action. The use of Treg cells as a prognostic indicator was compared to current pathological markers, where a higher number of Treg cells was seen in patients with extraprostatic spread (3.52%, p 0.0371), seminal vesicle extension (10.74%, p 0.0249), PSA relapse (4.39%, p 0.0162) and higher Gleason score (3.89%, p 0.0376). Despite showing a homeostatic picture in PCa, the functional status of CD8+ T lymphocytes was assessed. There were lower proportions of naïve T cells (9.86%, p 0.0068) and central memory T cells (8.60%, p 0.0258) in PCa tissue. While there was an increase in terminal effector T cells (12.06%, p 0.0019) and effector memory T cells (8.63%, p 0.0253). This implied that the tumour cells had been recognized and a shift in the dynamics towards a local cytotoxic environment. These cytotoxic T lymphocytes were activated as demonstrated by increased expression of CD69 (13.35%, p 0.0083). Despite showing activation, the effectiveness of these cells in the implementation of an anti-tumour response was assessed by evaluating the distribution of cytokines IFNγ, TGFβ and IL-10. However no clear pattern was seen, but it will require further investigation with a larger sample population. The use of ADT has been shown to reverse thymic involution and restore peripheral T cell population. However from this study there was no difference seen in the subset numbers, functional and activational status of T lymphocytes. From this study, the profile of prostatic pathology is better understood. The T cell profile especially in the in the local tumour environment of PCa shows a dynamic process between cytotoxic and immunosuppressive cells. This will allow for the development of further studies to understand the immune interaction with PCa

Plasmacytoma of the testis in a patient with relapsed and refractory multiple myeloma: Case report and review of the literature

Testicular plasmacytoma, whether occurring as a primary lesion or as a reflection of underlying multiple myeloma (MM), is a rare disease. We report the case of a 38-year-old male with multiply relapsed MM, who was found to have a testicular plasmacytoma. He presented with a gradually enlarging scrotal mass. Following orchidectomy, pathologic examination of the specimen demonstrated a plasmacytoma. In the context of active MM, the specimen was also sent for cytogenetic analysis but this was unhelpful in guiding a chemotherapy regime, which still continues at time of reporting. Although a rare lesion, there remains no definitive treatment protocol for the management of testicular plasmacytoma representing an extramedullary manifestation of MM

Conducto ileal intracorp{\'o}reo rob{\'o}tico: Aspectos t{\'e}cnicos,Robotic intracorporeal ileal conduit: Technical aspects

To present a review of the technical aspects of robotic intracorporeal ileal conduit (IC) reconstruction after robot assisted radical cystectomy (RARC). METHODS: A non-systematic review is performed in order to summarize technical aspects on robot assisted ileal conduit procedure following radical cystectomy in patients with muscle invasive bladder cancer. RESULTS: Radical cystectomy with pelvic lymph node dissection and urinary diversion is the gold-standard therapy for localized muscle-invasive bladder cancer. IC is the most common diversion utilized by surgeons. Minimally invasive approaches to IC were proposed with the intention of decreasing the morbidity associated to open surgery. Several oncological, and functional factors should be taken into consideration for the selection of patients undergoing this procedure together with surgeons and patients' preferences. The stoma marking of the patient is of critical importance. Identification of the ureters should be done assuring careful handling of the tissue and then isolation of the bowel segments should be performed after confirming proper length of the segment. Side to side anastomosis of the antimesenteric borders of the bowel is performed with linear staplers, and the ureteroileal anastomosis is done. Finally, the ileal conduit is positioned close to the stoma marking site and is fixed to the skin. Urinary diversion and radical cystectomy is a very morbid procedure. Mainly, complications are gastrointestinal, stoma-related, or associated to the ureter-enteric anastomosis. CONCLUSIONS: The advantages of the robotic platform concerning postoperative outcomes may be more evident if the procedure is done in an intracorporeal fashion. Proper knowledge and mastery of the technical aspects of this procedure are critical

Timing, Patterns and Predictors of 90-Day Readmission Rate after Robotic Radical Cystectomy

Purpose: We examine the timing, patterns and predictors of 90-day readmission after robotic radical cystectomy. Materials and methods: From September 2009 to March 2017, 271 consecutive patients undergoing robotic radical cystectomy with intent to cure bladder cancer (intracorporeal diversion 253, 93%) were identified from our prospectively collated institutional database. Readmission was defined as any subsequent inpatient admission or unplanned visit occurring within 90 days from discharge after the index hospitalization. Multiple readmissions were defined as 2 or more readmissions within a 90-day period. Logistic regression analysis was used to identify independent factors related to single and multiple 90-day readmissions. Results: A total of 78 (28.8%) patients were readmitted at least once within 90 days after discharge, of whom 20 (25.6%) reported multiple readmissions. The cumulative duration of readmission was 6.2 (6.17) days with 6 (7.6%) patients having less than 24 hours readmission. Metabolic, infectious, genitourinary and gastrointestinal complications were identified as the primary cause of readmission in 39.5%, 23.5%, 22.3% and 17%, respectively. Fifty percent of readmissions occurred in the first 2 weeks after hospital discharge. On multivariable logistic regression analysis in-hospital infections (OR 2.85, p=0.001) were independent predictors for overall readmission. Male gender (OR 3.5, p=0.02) and in-hospital infections (OR 4.35, p=0.002) were independent predictors for multiple readmissions. Conclusions: The 90-day readmission rate following robotic radical cystectomy is significant. In-hospital infections and male gender were independent factors for readmission. Most readmissions occurred in the first 2 weeks following discharge, with metabolic derangements and infections being the most common causes