Atrophy of the Tongue as the Presenting Feature of Metastatic Prostate Cancer

Prostate cancer is the most frequently diagnosed solid organ cancer in men and is the second leading cause of cancer-related deaths in men in the United Kingdom. Commonly, it metastasizes to bones and lymph nodes, however, in advanced hormonerefractory disease it may involve the skull base leading to associated cranial nerve palsies. Cranial nerve palsy as the presenting feature of advanced hormone-sensitive prostate cancer is extremely rare. To the best of our knowledge, we report the first case of solitary hypoglossal nerve palsy as the presenting feature of advanced prostate cancer. Neurologists, neurosurgeons and otolaryngologists may be the first clinicians to see such a patient; therefore, prostate cancer should be amongst the differential diagnoses considered in middle-aged and elderly men presenting with a cranial neuropathy and evidence of skull metastasis

Concurrent bladder cancer in patients undergoing photodynamic diagnostic ureterorenoscopy:how many lesions do we miss under white light cystoscopy?

INTRODUCTION: There is an ongoing debate on panurothelial changes in the upper and lower urinary tract as multifocal presentation of urothelial cancer is well recognised. Concurrent bladder cancer impacts the outcome of the upper urinary tract urothelial cancer treatment, while its detection still relies on the white light cystoscopy. MATERIAL AND METHODS: We retrospectively reviewed all patients who underwent photodynamic diagnostic ureterorenoscopy, choosing those who had synchronous bladder biopsies. Each patient received 20 mg/kg body weight of oral 5-Aminolevulinic acid around 3–4 hours before endoscopy. All procedures were performed by a single endourologist experienced in photodynamic diagnosis and flexible ureterorenoscopy. RESULTS: Between July 2009 and June 2013, 69 patients underwent bladder biopsies at the time of photodynamic diagnostic endoscopic inspection of the upper urinary tract. In total, 43.5% (30/69) patients were found to have bladder lesions, of which 43.3% (13/30) were proven to be carcinoma in situ. White light inspection of the bladder missed bladder cancer in 16 (23.1%) patients, of which 12 were carcinoma in situ. There were 14 bladder cancer lesions missed under white light which were concomitant to the upper urinary tract urothelial cancer. Twelve (17.4%) patients developed minor complications relevant to the photosensitizer. CONCLUSIONS: The study raises a concern about missing small bladder cancer/carcinoma in situ lesions on the initial diagnosis or in surveillance of the upper urinary tract urothelial cancer. Higher than previously reported, the rate of concomitant bladder cancer may suggest utilisation of photodynamic diagnosis to ensure the cancer free status of the bladder, but this needs to be ratified in a multi-institutional randomised trial

Photodynamic diagnostic ureterorenoscopy:a valuable tool in the detection of upper urinary tract tumour

Background: photodynamic diagnosis increases the detection rate and hence decreases recurrence rates of urothelial cancer (UC) of the bladder. This technique has been implemented in the upper urinary tract and like in the bladder, has shown to increase the detection rate of urothelial lesions.Objectives: to determine the sensitivity, specificity, and detection rates for photodynamic diagnostic flexible ureterorenoscopy (PDD-FURS) and white light ureterorenoscopy (WL-FURS).Design: between 2009 and 2013, PDD-FURS was performed within 106 Upper urinary tract (UUT) Units (Mean age—72.6 ± 9.5). Indications for the procedure included abnormal upper urinary tract on imaging, normal flexible cystoscopy with abnormal urine cytology, endoscopic treatment and follow-up of UUT UC. Oral 5-aminolevulinic acid was used as the photosensitizer administered 3-4 h pre-operatively.Results: 48 lesions were detected, of which 95.8% (46/48) where visualised by PDD-FURS compared to 47.9% (23/48) shown by WL-FURS (P < 0.0001). PDD-FURS detected significantly more carcinoma in situ (CIS) or dysplasia lesions than WL-FURS (93.75% (15/16) vs. 18.75% (3/16), respectively, (P = 0.0006)). Furthermore, PDD-FURS detected significantly more UC lesions than WL-FURS (96.9% (31/32) vs. 62.5% (20/32) (P = 0.007)).PDD-FURS was more sensitive (95.8; range: 85.7–99.5) than WL-FURS (53.5; range: 37.7–68.8) in detecting UUT-UC (P < 0.0001). There was no difference (P = 0.716) in the specificity between PDD-FURS (96.6; range: 88.1–99.6) and WL-FURS (95.2; range: 86.7–99).Conclusions: our results PDD-FURS with oral 5-ALA as photosensitizer suggest higher sensitivity and detection rate of urothelial tumours than WL-FURS, with a good safety profile. In our series, PDD-FURS enhanced the visualisation of flat lesions, such as CIS and dysplasia that otherwise would have been missed