Segmental Ureterectomy for Upper Tract Urothelial Carcinoma: A Systematic Review and Meta-analysis of Comparative Studies

Radical nephroureterectomy (RNU) represents the standard of care for high-risk upper tract urothelial carcinoma (UTUC). In selected patients with ureteral UTUC, a conservative approach such as segmental ureterectomy (SU) can be considered. However, this therapeutic option remains controversial. The aim of this study was to perform a systematic review and meta-analysis of studies assessing the outcomes of SU versus RNU in patients with UTUC. Three search engines (Scopus, Embase, and Web of Science) were queried up to May 2019. The Preferred Reporting Items for Systematic Review and Meta-analysis Statement (PRISMA Statement) was used as a guideline for study selection. The clinical question was established as stated in the PICO (Population, Intervention, Comparator, Outcome) process. Patients in the SU group were more likely to have history of bladder cancer (odds ratio [OR], 1.99; 95% confidence interval [CI], 1.12-3.51; P = .02), but less likely to present with preoperative hydronephrosis (OR, 0.52; 95% CI: 0.31-0.88; P = .02). A higher rate of ureteral tumor location was found in the SU group (OR, 7.54; 95% CI, 4.15-13.68; P < .00001). The SU group presented with a lower rate of higher (pT ≥ 2) stage (OR, 0.66; 95% CI, 0.53-0.82; P = .0002), and high-grade tumors (OR, 0.62; 95% CI, 0.50-0.78; P < .0001). The SU group was found to have shorter 5-year relapse-free survival (OR, 0.64; 95% CI, 0.43-0.95; P = .03), but higher postoperative estimated glomular filtration rate (weighted mean difference, 10.97 mL/min; 95% CI, 2.97-18.98; P = .007). Selected patients might benefit from SU as a therapeutic option for UTUC. In advanced high-risk disease, RNU still remains the standard of care

Prostate cancer biomarkers: a practical review based on different clinical scenarios

Traditionally, diagnosis and staging of prostate cancer (PCa) have been based on prostate-specific antigen (PSA) level, digital rectal examination (DRE), and transrectal ultrasound (TRUS) guided prostate biopsy. Biomarkers have been introduced into clinical practice to reduce the overdiagnosis and overtreatment of low-grade PCa and increase the success of personalized therapies for high-grade and high-stage PCa. The purpose of this review was to describe available PCa biomarkers and examine their use in clinical practice. A nonsystematic literature review was performed using PubMed and Scopus to retrieve papers related to PCa biomarkers. In addition, we manually searched websites of major urological associations for PCa guidelines to evaluate available evidence and recommendations on the role of biomarkers and their potential contribution to PCa decision-making. In addition to PSA and its derivates, thirteen blood, urine, and tissue biomarkers are mentioned in various PCa guidelines. Retrospective studies have shown their utility in three main clinical scenarios: (1) deciding whether to perform a biopsy, (2) distinguishing patients who require active treatment from those who can benefit from active surveillance, and (3) defining a subset of high-risk PCa patients who can benefit from additional therapies after RP. Several validated PCa biomarkers have become commercially available in recent years. Guidelines now recommend offering these tests in situations in which the assay result, when considered in combination with routine clinical factors, is likely to affect management. However, the lack of direct comparisons and the unproven benefits, in terms of long-term survival and cost-effectiveness, prevent these biomarkers from being integrated into routine clinical use

Prostate cancer radiogenomics—from imaging to molecular characterization

Radiomics and genomics represent two of the most promising fields of cancer research, designed to improve the risk stratification and disease management of patients with prostate cancer (PCa). Radiomics involves a conversion of imaging derivate quantitative features using manual or automated algorithms, enhancing existing data through mathematical analysis. This could increase the clinical value in PCa management. To extract features from imaging methods such as magnetic resonance imaging (MRI), the empiric nature of the analysis using machine learning and artificial intelligence could help make the best clinical decisions. Genomics information can be explained or decoded by radiomics. The development of methodologies can create more-efficient predictive models and can better characterize the molecular features of PCa. Additionally, the identification of new imaging biomarkers can overcome the known heterogeneity of PCa, by non-invasive radio-logical assessment of the whole specific organ. In the future, the validation of recent findings, in large, randomized cohorts of PCa patients, can establish the role of radiogenomics. Briefly, we aimed to review the current literature of highly quantitative and qualitative results from well-de-signed studies for the diagnoses, treatment, and follow-up of prostate cancer, based on radiomics, genomics and radiogenomics research

Advanced ureteroscopic techniques for the management of kidney stones

PURPOSE OF REVIEW: Recent years witnessed significant changes in the endourological management of renal tones because of the development of new, more advanced instruments. Retrograde intrarenal surgery (RIRS) has gained particular advantage from such technological progress and now tends to be considered the gold standard treatment for uncomplicated less than 20 mm renal stones. Using a step-by-step approach, this review aims to highlight current achievements but also unsolved problems in RIRS. RECENT FINDINGS: Several technical details of RIRS, including preoperative stenting, use of ureteral access sheets, lithotripsy method, and renal drainage, remain open to discussion and linked to surgeon's preference. Moreover, there is a wide range of variation in efficacy and safety data, with major complications being episodic but often under-reported. SUMMARY: RIRS has gained increased popularity among the urological community. This is certainly because of the continuous technological advancements, which have continuously improved the RIRS performance but also to the perception of ease and safety of this procedure when compared with the other available treatment modalities, particularly percutaneous nephrolitotomy. Indeed, the reported advances in RIRS technique have significantly improved the outcomes of this procedure but care should be taken not to underestimate its potential challenges

Prostatic inflammation is associated with benign prostatic hyperplasia rather than prostate cancer

Background and aims. The relationship between prostatic inflammation, benign prostatic hyperplasia and prostate cancer is controversial. The present study aimed to determine the relationship between grade and aggressiveness of prostatic inflammation and the risk of being diagnosed with prostate cancer. Methods. Grade and aggressiveness of prostatic inflammation were assessed by Irani G and A scores, respectively, in prostate biopsy specimens of men having undergone this procedure because of increased serum PSA and/or digital rectal examination. We also assessed the correlation between Irani G and A scores and clinical variables related to benign prostatic obstruction. Results. Of the 1178 eligible patients, 615 (52.2%) were diagnosed with PCa; they were older, had greater PSA, suspicious digital rectal examination and peak flow rate but lower post-void residual urine volume, prostate volume and international prostate symptoms score than those without cancer. High-grade inflammation (Irani G 2-3) was significantly more common in patients with benign prostate than in those with PCa and the same applied to highly aggressive inflammation (Irani A 2-3). Indeed, patients with high-grade inflammation had greater PSA, prostate volume, post-void residual and international prostate symptoms score, suggesting high-grade inflammation to correlate with benign prostatic obstruction. Highly-aggressive inflammation conversely correlated only with prostate volume. Conclusions. Prostatic inflammation seems to be associated with benign prostatic hyperplasia rather than prostate cancer, with benign prostatic obstruction being strictly linked to the degree of inflammation

Multiparametric magnetic resonance imaging/transrectal ultrasound fusion-guided prostate biopsy: A comparison with systematic transrectal ultrasound-guided prostate biopsy

Background & Aims. Prostate biopsy is the standard method for diagnosing prostate cancer. Herein we compared the cancer detection rate of extended systematic Transrectal Prostate Biopsy with that of multiparametric Magnetic Resonance Imaging/Transrectal ultrasound fusion-guided Prostate Biopsy. Methods. Outcomes of 99 fusion prostate biopsy (Group A) were compared with those of a matched population of patients having undergone systematic transrectal prostate biopsy (Group B) in the same period. Results. The overall cancer detection rate was 60.6% in Group A and 29,2% in Group B (p = 75y. Conclusions. Multiparametric Magnetic Resonance Imaging/transrectal ultrasound fusion-guided biopsy provided better prostate cancer detection rates than standard Prostate Biopsy in the setting of both first and repeated Prostate Biopsy, showing good correlation between Prostate Imaging-Reporting and Data System scores and cancer detection rates but complications were more common in elderly patients

Elderly patients and prostate biopsy. How old is too old?

Background & aims. Based on autopsy finding that many elderly men bear clinically-insignificant prostate cancer, physicians tend to be reluctant to advise PSA testing in men > 75y and to recommend prostate biopsy, particularly in men who suffer from lower urinary tract symptoms. Herein, we compared the outcome of prostate biopsy in men ≤ 75 and > 75y to determine whether such procedure is worth in the elderly patient. Methods. We assessed the rates of prostate cancer and of clinically-significant prostate cancer in men ≤ 75 and > 75y who underwent prostate biopsy at our Institution. We also assessed prostate volume, peak flow rate, post-void residual and International Prostate Symptoms Score. Results. Of 3350 with PSA up to 20 ng/ml, 387 (11.5%) were > 75y. They had higher PSA, similar prostate volume, lower Peak Flow rate and International Prostate Symptoms Score and higher post-void residual than their younger counterpart. Prostate cancer detection rate was 62%, as opposed to 43% in their younger counterpart (p < 0.0001); clinically-significant prostate cancer rate was 42.9% as opposed to 24% (p < 0.0001). Findings were almost the same in the 2740 patients with PSA up to 10 ng/ml. Multivariate analysis pointed out that all clinical variables independently predicted clinically-significant prostate cancer but elderly patients with PSA up to 10 ng/ml had an almost 5-fold greater risk of such diagnosis than their younger counterpart. Conclusions. Given their risk of harboring clinically-significant prostate cancer, elderly patients with rising PSA deserve prostate biopsy as early detection may provide significant benefits in terms of disease-free and overall survival