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Objective: To evaluate the prognostic significance of lymph node count (LNC) at post‐chemotherapy retroperitoneal lymphadenectomy (PC‐RPLND) in metastatic non‐seminomatous germ cell tumour (NSGCT) using the Surveillance, Epidemiology, and End Results (SEER) database and National Cancer Database (NCDB). Patients and methods: SEER (2000–2013, n = 572) and NCDB (2004–2013, n = 731) identified patients undergoing PC‐RPLND for Stage II and III NSGCT. Correlation between linear or categorial variables and LNC was conducted using Spearman's rank correlation or Kruskal–Wallis test by ranks. Patients were stratified by ≤20, 21–40, and >40 LNs for Kaplan–Meier analysis. Cox proportional hazards models evaluated the association of LNC at PC‐RPLND with overall mortality (OM) in the NCDB and cancer‐specific mortality (CSM) in the SEER database. The relationship between LNC and OM or CSM was also modelled as a non‐linear function to determine a threshold for survival benefit. Results: Amongst all patients, the median (interquartile range) LNC was 17 (3–26) LNs in the NCDB, and 18 (6–31) LNs in the SEER database. More recent diagnosis year, higher hospital volume, higher median income, private insurance status, and positive LNC were associated with greater total LNC in one or both databases (P < 0.05). On Kaplan–Meier analysis, >40 LNs was associated with 5‐year cancer‐specific survival (CSS) of 99% and overall survival (OS) of 96%, whereas ≤20 LNs had a 5‐year CSS of 91% and OS of 78% (CSS, P = 0.04; OS, P < 0.01). Risk‐adjusted Cox model showed increasing LNC (per node) was inversely associated with OM (hazard ratio [HR] 0.96, 95% confidence interval [CI], 0.94–0.98; P < 0.01) and CSM (HR 0.96, 95% CI, 0.94–0.99; P = 0.01). Non‐linear modelling showed the greatest benefit in OM at between 10 and 20 LNs, but continued survival benefit for OM and CSM beyond 20 LNs. Conclusions: Greater LNC during PC‐RPLND appears to be associated with improved CSS and OS in NSGCT. Our data support the role of thorough RPLND for post‐chemotherapy metastatic NSGCT. [ABSTRACT FROM AUTHOR]

Background: The Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial assessed the effect of screening with prostate-specific antigen and a digital rectal examination on prostate cancer mortality. Another endpoint of interest was the burden of total metastatic disease.Methods: All men in PLCO were assessed for metastatic prostate cancer at diagnosis; men with clinical stage I/II disease were assessed for metastatic progression. The rate of total metastatic disease was defined as metastases found either at diagnosis or through progression divided by person-years (PYs) of follow-up for all men in the trial. Metastatic progression rates were computed among men with clinical stage I/II prostate cancer. Survival among men with metastases at diagnosis was compared with survival among men with metastatic progression.Results: Among 38,340 men in the intervention arm and 38,343 men in the control arm in PLCO, there were 4974 and 4699 prostate cancer cases, respectively. The rates of total metastatic disease were 4.72 and 4.83 per 10,000 PYs in the intervention and control arms, respectively (rate ratio, 0.98; 95% CI, 0.81-1.18). The rates of metastatic progression among men with clinical stage I/II prostate cancer were 43.7 and 50.5 per 10,000 PYs in the intervention and control arms, respectively (P = .30). Prostate cancer-specific 5- and 10-year survival rates were significantly worse for men with metastatic progression (24% and 19%, respectively) than men with metastases at diagnosis (40% and 26%, respectively).Conclusions: Rates of total metastatic disease and metastatic progression were similar across arms in PLCO. Survival was worse for men with metastatic progression in comparison with those with metastatic disease at diagnosis. [ABSTRACT FROM AUTHOR]

Background: Focal laser ablation (FLA) is a minimally invasive thermal ablation, guided by MRI through an optical fiber, to induce coagulative necrosis in cancer.Purpose: To evaluate the feasibility of high spectral and spatial resolution imaging using multiecho gradient echo (MEGE) MRI for identification of ablation zones, after FLA of prostate cancers.Study Type: Prospective.Population: Fourteen patients with biopsy-confirmed localized prostate cancers.Field Strength/sequence: FLA was performed under monitored conscious sedation with a 1.5T MRI scanner. Axial MEGE images were acquired before and after the last FLA. Pre- and postcontrast enhanced T1 -weighted (pT1 W) images were acquired to assess the FLA zone as a reference standard.Assessment: The T2* maps and water resonance peak height (WPH) images were calculated from the MEGE data. Ablation area was outlined using an active contour method. The maximum ablation area and total ablation volume were calculated from T2* and WPH images, and compared with the sizes measured from pT1 W images.Statistical Tests: Nonparametric Kruskal-Wallis tests were performed to determine whether there was significant difference in calculated ablation areas and volumes between T2* , WPH, and pT1 W images.Results: Average T2* (38.9 ± 14.1 msec) in the ablation area was significantly shorter (P = 0.03) than the preablation area T2* (57.8 ± 25.3 msec). The normalized WPH value over the ablation area (1.3 ± 0.6) was significantly decreased (P = 0.02) more than the preablation area (2.0 ± 0.9). The maximum ablation areas measured by T2* (295.7 ± 96.4 mm2 ), WPH (312.2 ± 63.0 mm2 ), and pT1 W (320.3 ± 82.9 mm2 ) images were all similar. Furthermore, there was no significant difference (P = 0.31) for measured ablation volumes 3310.5 ± 649.5, 3406.4 ± 684.9, and 3672.5 ± 832.4 mm3 between T2* , WPH, and pT1 W images, respectively. DATA CONCLUSION: T2* and WPH images provide acceptable measurements of ablation zones during FLA treatment of prostate cancers without the need for contrast agent injection. This might allow repeated assessment following each heating period so that subsequent ablations can be optimized.Level Of Evidence: 2 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2019;49:1374-1380. [ABSTRACT FROM AUTHOR]

Purpose: Prostate cancer is the most common noncutaneous cancer among men in the USA. Focal laser thermal ablation (FLA) has the potential to control small tumors while preserving urinary and erectile function by leaving the neurovascular bundles and urethral sphincters intact. Accurate needle guidance is critical to the success of FLA. Multiparametric magnetic resonance images (mpMRI) can be used to identify targets, guide needles, and assess treatment outcomes. In this study, we evaluated the location of ablation zones relative to targeted lesions in 23 patients who underwent FLA therapy in a phase II trial. The ablation zone margins and unablated tumor volume were measured to determine whether complete coverage of each tumor was achieved, which would be considered a clinically successful ablation. Methods: Preoperative mpMRI was acquired for each patient 2–3 months preceding the procedure and the prostate and lesion(s) were manually contoured on 3 T T2‐weighted axial images. The prostate and ablation zone(s) were also manually contoured on postablation 1.5 T T1‐weighted contrast‐enhanced axial images acquired immediately after the procedure intraoperatively. The lesion surface was nonrigidly registered to the postablation image using an initial affine registration followed by nonrigid thin‐plate spline registration of the prostate surfaces. The margins between the registered lesion and ablation zone were calculated using a uniform spherical distribution of rays, and the volume of intersection was also calculated. Each prostate was contoured five times to determine the segmentation variability and its effect on intersection of the lesion and ablation zone. Results: Our study showed that the boundaries of the segmented tumor and ablation zone were close. Of the 23 lesions that were analyzed, 11 were completely covered by the ablation zone and 12 were partially covered. A shift of 1.0, 2.0, and 2.6 mm would result in 19, 21, and all tumors completely covered by the ablation zone, respectively. The median unablated tumor volume across all tumors was 0.1 mm3 with an IQR of 3.7 mm3, which was 0.2% of the median tumor volume (46.5 mm3 with an IQR of 46.3 mm3). The median extension of the tumors beyond the ablation zone, in cases which were partially ablated, was 0.9 mm (IQR of 1.3 mm), with the furthest tumor extending 2.6 mm. Conclusion: In all cases, the boundary of the tumor was close to the boundary of the ablation zone, and in some cases, the boundary of the ablation zone did not completely enclose the tumor. Our results suggest that some of the ablations were not clinically successful and that there is a need for more accurate needle tracking and guidance methods. Limitations of the study include errors in the registration and segmentation methods used as well as different voxel sizes and contrast between the registered T2 and T1 MRI sequences and asymmetric swelling of the prostate postprocedurally. [ABSTRACT FROM AUTHOR]

Patient‐centered and clinician‐centered biases are obstacles to optimal prostate cancer decisions. Striving for true patient‐centered prostate cancer recommendations is improved through multidisciplinary visits. [ABSTRACT FROM AUTHOR]

Background: Surveillance has been recommended more frequently as a postorchiectomy management option for men with early stage nonseminomatous germ cell tumor (NSGCT) of the testicle. It is unknown how contemporary treatment patterns reflect these recommendations.Methods: Data from the National Cancer Database were extracted on all men who were diagnosed with clinical stage (CS) IA or CSIB NSGCT between 2004 and 2013. Temporal trends in the use of chemotherapy, retroperitoneal lymph node dissection (RPLND), and surveillance were measured; and multivariable logistic regression was used to analyze the association of patient and clinical covariates with use of surveillance.Results: Of the 4080 men with CSIA NSGCT, 70%, 17%, and 13% received surveillance, RPLND, and chemotherapy, respectively. Surveillance increased in this group from 65% (2004-2005) to 74% (2012-2013: adjusted odds ratio, 1.50; 95% confidence interval, 1.14-1.98; P = .004). Of the 2580 men who had CSIB NSGCT, 46%, 20%, and 34% received surveillance, RPLND, and chemotherapy, respectively. In this group, 48% of men underwent surveillance in the years 2004 to 2005 and 2012 to 2013 (adjusted P = .8). Upon multivariable analyses, higher income and the oldest age quartile were associated with increased odds of surveillance among men with CSIA NSGCT (both P < .050). Hispanic men with CSIB NSGCT were more likely to receive surveillance compared with non-Hispanic white men (P = .001).Conclusions: Nearly 75% of men with CSIA NSGCT and nearly 50% of men with CSIB NSGCT received surveillance in 2012 and 2013. The likelihood of receiving surveillance increased from 2004 through 2013 for men with CSIA NSGCT but was unchanged for men with CSIB. Cancer 2017;123:245-252. © 2016 American Cancer Society. [ABSTRACT FROM AUTHOR]

Objective To examine the ability of preoperative clinical characteristics to predict histological features of renal masses (RMs). Patients and Methods Data from consecutive patients with clinical stage I RMs treated surgically between 2010 and 2011 in the Clinical Research Office of Endourology Society (CROES) Renal Mass Registry were collected. Based on surgical histology, tumours were categorised as benign, low- or high-aggressiveness cancer. Multivariate logistic regression was used to estimate the probability of the histological group by clinical and radiographic features in the entire cohort and a subcohort of cT1a tumours. The performance of the models was studied by calibration, Nagelkerke’s R2, and discrimination (area under the receiver operating characteristic curve). Results The study cohort included 2 224 patients with a clinical stage I RM, of which 1 367 (61%) were cT1a. Benign lesions were found in 369 (16.6%), low-aggressiveness tumours in 1 156 (52%) and high-aggressiveness tumours in 699 (31.4%). Male gender, smoking history, increased tumour size, and lower exophytic rate were associated with malignancy and high-aggressiveness features (all P < 0.05). Models developed based on these characteristics had the ability to discriminate benign from malignant (bootstrap corrected c-index of 0.64) and high-aggressiveness tumours from benign and low-aggressiveness tumours (bootstrap corrected c-index of 0.66). Similar results were achieved in the cT1a subgroup. The c-index of tumour diameter as a single predictor of malignancy and high-aggressiveness tumours in the entire cohort was 0.6 and 0.63, respectively. Conclusion Although older age, male gender, smoking history, increased tumour diameter, and reduced exophytic rate are associated with malignancy and high aggressiveness of clinical stage I RMs, models incorporating these characteristics have modest discriminating power, being only slightly better than the predictive ability of tumour size alone. [ABSTRACT FROM AUTHOR]

Objective To characterise the use of social media among members of the American Urological Association (AUA), as the use of social media in medicine has greatly expanded in recent years. Subjects and Methods In December 2012 to January 2013, the AUA e-mailed a survey with 34 questions on social media use to 2000 randomly selected urologists and 2047 resident/fellow members. Additional data was collected from Symplur analytics on social media use surrounding the AUA Annual Meeting in May 2013. Results In all, 382 (9.4%) surveys were completed, indicating 74% of responders had an online social media account. The most commonly used social media platforms were Facebook (93%), followed in descending order by LinkedIn (46%), Twitter (36%) and Google+ (26%). Being aged <40 years was an important predictor of social media use (83% vs 56%), with greater uptake among residents/fellows compared with attendings (86% vs 66%). Only 28% of respondents used social media partly or entirely for professional purposes. During the 2013 AUA Annual Meeting, there were >5000 tweets from >600 distinct contributors. Conclusion As of early 2013, among respondents to an e-mail survey, most urologists and urology trainees used some form of social media, and its use in urology conferences has greatly expanded. [ABSTRACT FROM AUTHOR]

BACKGROUND Prostate-specific antigen (PSA) screening for prostate cancer remains controversial. Most groups recommend informed decision making for men with 10 years of remaining life expectancy. The primary objective of this observational cohort study was to investigate the association between predicted 9-year mortality and prostate cancer screening among American men aged ≥65 years in 2005 and 2010. The second objective was to analyze the proportions of men who discussed screening with their physicians. METHODS Data were extracted from the 2005 and 2010 National Health Interview Surveys. Men aged ≥65 years without prostate cancer were divided into predicted 9-year mortality quartiles. The proportions of men confirming a screening PSA within the prior year were determined. Logistic regression was used to compare screening rates. RESULTS Screening rates for men aged ≥65 years were 48% in 2005 and 48% in 2010 ( P = .9). Men ages 65 to 74 years who had <27% predicted 9-year mortality were most commonly screened, with 56% screened in 2010, compared with 34% of men aged ≥75 years with >75% predicted 9-year mortality. Approximately 55% of screened men aged ≥75 years who had ≥53% predicted 9-year mortality recalled discussing the advantages of screening, whereas 25% recalled discussing the disadvantages. CONCLUSIONS Prostate cancer screening with PSA did not differ significantly between 2005 and 2010 for men aged ≥65 years based on predicted 9-year mortality. Approximately 33% of older men with a high likelihood of 9-year mortality were screened despite minimal clinical benefit. Twice as many men recalled discussing the potential advantages of screening compared with the disadvantages. Cancer 2014;120:1491-1498. © 2014 American Cancer Society. [ABSTRACT FROM AUTHOR]

Objective To determine the success of our clinical care pathway for laparoscopic ( LPN) and robotic partial nephrectomy ( RPN) and to examine factors predictive for success., Patients and Methods A retrospective review of our Institutional Review Board-approved prospectively maintained minimally invasive PN database yielded 263 consecutive minimally invasive PNs from 2003 to 2010., Patient, disease and surgery-related factors were collected. The primary endpoint was successful implementation of the clinical pathway with discharge on postoperative day ( POD 1)., Associated factors were modelled using univariate and multivariable logistic regression to determine factors predictive for success of the pathway., Results Overall, 157 (60%) of the patients had successful care pathway implementation with POD1 discharge, of which 46 (17%) were RPNs., The overall readmission rate was 5% (12/263) and similar for patients discharged on POD 1, 4.5% (7/157)., Several patient-related, tumour-related, and surgical factors were associated with care pathway success., In a multiple logistic regression model, only surgery period (late cohort vs early cohort) was significant for successful pathway implementation (odds ratio 4.2; 95% confidence interval 2.1-8.4, P < 0.001)., Conclusions Early discharge care pathways can be successfully implemented for LPN or RPN with low readmission rates. Care pathway success improves with institutional experience. [ABSTRACT FROM AUTHOR]

Purpose To determine whether the central gland of the prostate, composed of both central and transition zones, extends below the verumontanum in patients over age 43 based on prostate magnetic resonance imaging (MRI). Materials and Methods In all, 82 patients who underwent preoperative, multiparametric endorectal MRI (1.5T and 3T) at our institution were included. The central gland was defined as a combination of the central zone and transition zone. Two radiologists measured central gland extension below verumontanum using axial, coronal, and sagittal T2-weighted images and coregistration picture archiving and communication system software. Results The final cohort consisted of 63 patients with a mean age of 60.2 years (standard deviation: 7.1, range: 43-76). The central gland extended below the verumontanum in 60/63 (95%) patients. Mean central gland extension below the verumontanum was 6.5 mm (standard deviation = 3.7, range: 0, 18). Weak ( r = 0.35), but significant ( P = 0.005) positive correlation was found between age and the amount of central gland extension below the verumontanum. Conclusion Contrary to McNeal's classical prostatic anatomy teaching, the central gland extends below the verumontanum in 95% of men over 43, likely due to deformation of the gland by benign prostatic hyperplasia. It is important for pathologists to be aware of this observation for accurate characterization of the zonal origin of prostate cancer below the level of the verumontanum. J. Magn. Reson. Imaging 2014;39:167-171. © 2013 Wiley Periodiacls, Inc. [ABSTRACT FROM AUTHOR]

BACKGROUND Many patients with low-risk prostate cancer (PC) who are diagnosed with Gleason score 6 at biopsy are ultimately found to harbor higher grade PC (Gleason ≥ 7) at radical prostatectomy. This finding increases risk of recurrence and cancer-specific mortality. Validated clinical tools that are available preoperatively are needed to improve the ability to recognize likelihood of upgrading in patients with low-risk PC. METHODS More than 30 clinicopathologic parameters were assessed in consecutive patients with Gleason 6 PC upon biopsy who underwent radical prostatectomy. A nomogram for predicting upgrading (Gleason ≥ 7) on final pathology was generated using multivariable logistic regression in a development cohort of 431 patients. External validation was performed in 2 separate cohorts consisting of 1151 patients and 392 patients. Nomogram performance was assessed using receiver operating characteristic curves, calibration, and decision analysis. RESULTS On multivariable analysis, variables predicting upgrading were prostate-specific antigen density using ultrasound (odds ratio [OR] = 229, P = .003), obesity (OR = 1.90, P = .05), number of positive cores (OR = 1.23, P = .01), and maximum core involvement (OR = 0.02, P = .01). On internal validation, the bootstrap-corrected predictive accuracy was 0.753. External validation revealed a predictive accuracy of 0.677 and 0.672. The nomogram demonstrated excellent calibration in all 3 cohorts and decision curves demonstrated high net benefit across a wide range of threshold probabilities. The nomogram demonstrated areas under the curve of 0.597 to 0.672 for predicting upgrading in subsets of men with very low-risk PC who meet active surveillance criteria (all P < .001), allowing further risk stratification of these individuals. CONCLUSIONS A nomogram was developed and externally validated that uses preoperative clinical parameters and biopsy findings to predict the risk of pathological upgrading in Gleason 6 patients. This can be used to further inform patients with lower risk PC who are considering treatment or active surveillance. Cancer 2013;119:3992-4002. © 2013 American Cancer Society. [ABSTRACT FROM AUTHOR]

Objective To determine the impact of empiric antibiotics on men with an elevated prostate-specific antigen ( PSA) level., Subjects/Patients and Methods Men of any age with a PSA level of >2.5 ng/mL and normal digital rectal examination undergoing their first prostate biopsy were recruited from five medical centres., Patients with previous biopsy, prostate cancer, urinary tract infection ( UTI) or prostatitis within the prior year, antibiotic use within 1 month, 5α-reductase inhibitor use, allergy to fluoroquinolones or clinical suspicion of UTI were excluded., Men were randomised to 2 weeks of ciprofloxacin or no antibiotic. A PSA measurement was obtained 21-45 days after randomisation immediately before prostate biopsy., The primary endpoint was the change in PSA level between baseline and immediately before biopsy., Results Complete data were available for 77 men with a mean (interquartile range) age of 60.6 (53-66) years., In the control group of men not receiving antibiotic (39 men), the mean baseline and pre-biopsy PSA levels were 6.5 and 6.9 ng/mL, respectively ( P = 0.8)., In men receiving ciprofloxacin (38 men), the mean baseline PSA level was 7.6 ng/mL and after 2 weeks of ciprofloxacin was 8.5 ng/mL ( P = 0.7)., Compared with controls not receiving antibiotic, use of ciprofloxacin was not associated with a statistically significant change in PSA level ( P = 0.33)., Prostate cancer was detected in 36 (47%) men, 23 (59%) in the control group and 13 (34%) in the antibiotic group ( P = 0.04). Detection rates were not significantly associated with the change in PSA level between baseline and biopsy. The primary limitation of the study is early stoppage due to an interim futility analysis and poor accrual., Conclusion Despite not meeting the target accrual goal, empiric use of antibiotics for asymptomatic men with an elevated PSA level does not appear to be of clinical benefit. [ABSTRACT FROM AUTHOR]

What's known on the subject? and What does the study add? It has been suggested that a very short positive margin does not confer additional risk of BCR after radical prostatectomy., This study shows that even very short PSM is associated with increased risk of BCR., Objective To re-evaluate, in a larger cohort with longer follow-up, our previously reported finding that a positive surgical margin ( PSM) ≤1 mm may not confer an additional risk for biochemical recurrence ( BCR) compared with a negative surgical margin ( NSM)., Patients and Methods Margin status and length were evaluated in 2866 men treated with radical prostatectomy ( RP) for clinically localized prostate cancer at our institution from 1994 to 2009., We compared the BCR-free survival probability of men with NSMs, a PSM ≤ 1 mm, and a PSM < 1 mm using the Kaplan-Meier method and a Cox regression model adjusted for preoperative prostate-specific antigen ( PSA) level, age, pathological stage and pathological Gleason score ( GS)., Results Compared with a NSM, a PSM ≤ 1 mm was associated with 17% lower 3-year BCR-free survival for men with pT3 and GS ≥ 7 tumours and a 6% lower 3-year BCR-free survival for men with pT2 and GS ≤ 6 tumours (log-rank P < 0.001 for all)., In the multivariate model, a PSM ≤ 1 mm was associated with a probability of BCR twice as high as that for a NSM (hazard ratio [ HR] 2.2), as were a higher PSA level ( HR 1.04), higher pathological stage ( HR 2.7) and higher pathological GS ( HR 3.7 [all P < 0.001])., Conclusion In men with non-organ-confined or high grade prostate cancer, a PSM ≤ 1 mm has a significant adverse impact on BCR rates. [ABSTRACT FROM AUTHOR]

What's known on the subject? and What does the study add? Focal therapy techniques are emerging in prostate cancer treatment. However, several key questions about patient selection, treatment and monitoring still have to be addressed. The concept of focal therapy is barely discussed in current urological guidelines. In the present manuscript, we report the results of a consensus meeting focused on ultrasonography, the most common used urological imaging method, in relation to focal therapy of prostate cancer. To establish a consensus on the utility of ultrasonography (US) to select patients for focal therapy. Topics were the current status of US to determine focality of prostate cancer, to monitor and assess outcome of focal therapy and the diagnostic advantages of new US methods. In addition, the biopsy techniques required to identify focal lesions were discussed., Urological surgeons, radiation oncologists, radiologists, and basic researchers from Europe and North America participated in a consensus meeting on the use of transrectal US (TRUS) in focal therapy of prostate cancer. The consensus process was face-to-face and specific clinical issues were raised and discussed with agreement sought when possible., TRUS is commonly used and essential for diagnosing men with prostate cancer. It is particularly useful for targeting specific anatomical regions or visible lesions. However, it has several limitations and there is a need for improvement. Newer visualisation techniques, e.g. colour Doppler US, contrast-enhanced US and elastography, are being developed but currently there is no US technique that can accurately characterise a cancer suitable for focal therapy. Systematic biopsy is the only known procedure that allows the identification of prostate cancers suitable for focal therapy. Scarce data exist about the role of US for monitoring patients during or after ablative therapy., Consensus was reached on all key aspects of the meeting., US cannot reliably identify focal prostate cancer. New US methods show promising results in identifying prostate cancer focality., Currently selecting appropriate candidates for focal therapy should be performed using dedicated protocols and biopsy schemes. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate feasibility of high-resolution, high-field ex vivo prostate magnetic resonance imaging (MRI) as an aid to guide pathologists' examination and develop in vivo MRI methods. Materials and Methods: Unfixed excised prostatectomy specimens ( n = 9) were obtained and imaged immediately after radical prostatectomy under an Institutional Review Board-approved protocol. High-resolution T2-weighted (T2W) MRI of specimens were acquired with a Bruker 9.4 T scanner to correlate with whole-mount histology. Additionally, T2 and apparent diffusion coefficient (ADC) maps were generated. Results: By visual inspection of the nine prostate specimens imaged, high-resolution T2W MRI showed improved anatomical detail compared to published low-resolution images acquired at 4 T as published by other investigators. Benign prostatic hyperplasia, adenocarcinomas, curvilinear duct architecture distortion due to adenocarcinomas, and normal radial duct distribution were readily identified. T2 was ≈10 msec longer ( P < 0.03) and the ADC was ≈1.4 times larger ( P < 0.002) in the normal peripheral zone compared to the peripheral zone with prostate cancer. Conclusion: Differences in T2 and ADC between benign and malignant tissue are consistent with in vivo data. High-resolution, high-field MRI has the potential to improve the detection and identification of prostate structures. The protocols and techniques developed in this study could augment routine pathological analysis of surgical specimens and guide treatment of prostate cancer patients. J. Magn. Reson. Imaging 2011. © 2011 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

Study Type - Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Accurate preoperative staging for upper-tract urothelial carcinoma (UTUC) lesions is presently limited. Urinary cytology has shown promise for characterizing pathological features of bladder cancer. The role of cytology for UTUC is at present poorly defined. In this large multi-institutional cohort of patients, urinary cytology was limited in its ability to accurately predict the grade and stage of upper-tract lesions. Selective ureteral sampling improved the diagnostic accuracy of cytology when compared to bladder specimens. Improved preoperative surrogate markers for staging UTUC remain necessary. OBJECTIVE • To evaluate the diagnostic accuracy of urine cytology for detecting aggressive disease in a multi-institutional cohort of patients undergoing extirpative surgery for upper-tract urothelial carcinoma (UTUC). METHODS • We reviewed the records of 326 patients with urinary cytology data who underwent a radical nephroureterectomy or distal ureterectomy without concurrent or previous bladder cancer. • We assessed the association of cytology (positive, negative and atypical) with final pathology. Sensitivity and positive predictive value (PPV) of a positive (± atypical) cytology for high-grade and muscle-invasive UTUC was calculated. RESULTS • On final pathology, 53% of patients had non-muscle invasive disease (pTa, pTis, pT1) and 47% had invasive disease (≥pT2). Low-grade and high-grade cancers were present in 33% and 67% of patients, respectively. • Positive, atypical and negative urine cytology was noted in 40%, 40% and 20% of cases. Positive urinary cytology had sensitivity and PPV of 56% and 54% for high-grade and 62% and 44% for muscle-invasive UTUC. • Inclusion of atypical cytology with positive cytology improved the sensitivity and PPV for high-grade (74% and 63%) and muscle-invasive (77% and 45%) UTUC. Restricting analysis to patients with selective ureteral cytologies further improved the diagnostic accuracy when compared with bladder specimens (PPV > 85% for high-grade and muscle-invasive UTUC). CONCLUSIONS • In this cohort of patients with UTUC treated with radical surgery, urine cytology in isolation lacked performance characteristics to accurately predict muscle-invasive or high-grade disease. • Improved surrogate markers for pathological grade and stage are necessary, particularly when considering endoscopic modalities for UTUC. [ABSTRACT FROM AUTHOR]

The retroperitoneum is the initial metastatic site in 90% of patients with nonseminomatous germ cell tumours (NSGCTs) of the testis. A retroperitoneal lymph node dissection (RPLND) provides accurate staging and effective therapy, minimizes the need for adjuvant chemotherapy in patients with low-volume metastases, and optimizes durable cure rates. We review the rationale for and development of RPLND, focusing specifically on the advantages and limitations of the variable surgical templates. Bilateral RPLND has a long-standing record of maximizing cancer control and minimizing secondary therapy. Both modified templates and prospective nerve-sparing techniques were introduced to optimize rates of antegrade ejaculation. Limited resections as advocated by modified templates are appealing in the setting of primary RPLND but can be associated with a 3–23% risk of residual disease. Modified templates have also been advocated for highly selected patients after chemotherapy but, if applied to all patients undergoing surgery after chemotherapy, will lead to an unacceptably high rate of residual disease, even in patients with small masses after chemotherapy. For patients undergoing primary or post-chemotherapy RPLND, a full bilateral template (with nerve-sparing when appropriate) maximizes cure rates while minimizing ejaculatory morbidity and the subsequent need for chemotherapy. [ABSTRACT FROM AUTHOR]

In this article, the author provides insights to a study, published within the issue, in men who had postchemotherapy retroperitoneal teratoma. He remarks that the study reiterates various concepts in the management of patients who have germ cell tumors, and has provide additional understanding of postchemotherapy carcinoma. The author also offers brief descriptions of teratoma.

The article focuses on the accuracy of several models used for predicting biochemical disease recurrence (BCR) after radical prostatectomy. Studies were conducted on several models including postoperative BCR monogram, Cox regression clinical failure (CF) model, and two CF systems pathology models. The studies report that the accuracy levels of these models are similar and are high. It is stated that the clinical and pathological variables seem to be the primary determinants of the results.

The incidence of transitional cell carcinoma of the kidney and ureter is low and for that reason limited data exists regarding the appropriate management of regional retroperitoneal lymph nodes. Lymph node metastases have consistently been associated with an adverse prognosis. However, five-year cancer-specific survival following nephroureterectomy and lymphadenectomy for patients with lymph node involvement ranges from 0-39%, suggesting a therapeutic benefit. This review covers the primary tumor characteristics associated with lymph node involvement, imaging of the lymph nodes, as well as the rationale, role, patient selection, suggested anatomic templates, and technical considerations for lymphadenectomy. [ABSTRACT FROM AUTHOR]

Background: Mortality rates from kidney cancer have continued to rise despite increases in the detection of smaller renal tumors and rates of renal surgery. To explore the factors associated with this treatment-outcome discrepancy, the authors evaluated how changes in tumor size have affected disease progression in patients after nephrectomy for localized kidney cancer, and they sought to identify the factors associated with disease progression and overall patient survival after resection for localized kidney cancer.Methods: In total, 1618 patients with localized kidney cancer were identified who underwent nephrectomy at Memorial Sloan-Kettering Cancer Center from 1989 to 2004. Patients were categorized by year of surgery: from 1989 to 1992, from 1993 to 1996, from 1997 to 2000, and from 2001 to 2004. Tumor size was classified according to the following strata: <2 cm, from 2 cm to 4 cm, from 4 cm to 7 cm, and >7 cm. Disease progression was defined as the development of local recurrence or distant metastases. Five-year progression-free survival (PFS) was calculated for patients in each tumor size strata according to the year of operation using the Kaplan-Meier method. The patient-, tumor-, and surgery-related characteristics associated with PFS and overall survival (OS) were explored using univariate analysis, and all significant variables were retained in a multivariate Cox regression analysis.Results: Overall, the number of nephrectomies increased for all tumor size categories from 1989 to 2004. A tumor size migration was evident during this period, because the proportion of patients with tumors <2 cm and with tumors from 2 cm to 4 cm increased, whereas the proportion of patients with tumors >7 cm decreased. One hundred seventy-nine patients (11%) developed disease progression after nephrectomy. Sixteen patients (1%) developed local recurrences, and 163 patients (10%) developed distant metastases. When 5-year PFS was calculated for each tumor size strata according to 4-year cohorts, trends in PFS did not improve or differ significantly over time. Compared with historic cohorts, patients in more contemporary cohorts were more likely to undergo partial nephrectomy rather than radical nephrectomy and were less likely to undergo concomitant lymph node dissection and adrenalectomy. Multivariate analysis demonstrated that pathologic stage and tumor grade were associated with disease progression, whereas patient age and tumor stage were associated with overall patient survival.Conclusions: Despite an increasing number of nephrectomies and a size migration toward smaller tumors, trends in 5-year PFS and OS did not improve or differ significantly over time. These findings require further research to identify causative mechanisms, and they argue for the consideration of active surveillance for patients who have select renal tumors and a re-evaluation of the current treatment paradigm of surgically removing solid renal masses on initial detection. [ABSTRACT FROM AUTHOR]

Objectives Materials and Methods Results Conclusions To reassess the role of primary retroperitoneal lymph node dissection (RPLND) in patients with marker‐negative non‐seminomatous germ cell tumour (NSGCT) clinical stage (CS) 2a, to explore results in patients with CS 2b and to evaluate surgical methods, recurrence, and adjuvant chemotherapy indications.Data from 17 institutions were collected, comprising 305 men who underwent primary RPLND for CS 2 NSGCT. Regression analyses were conducted to predict histology in the RPLND specimen and disease‐free survival (DFS).A larger retroperitoneal lymph node diameter was associated with pure teratoma in the RPLND specimen (odds ratio [OR] 1.02, 95% confidence interval [CI] 1.01–1.07; P = 0.03), but no association was observed with DFS. The 5‐year DFS rates in marker negative CS 2a and 2b were 79% and 76%. In men with non‐teratomatous viable cancer in the RPLND specimen, the 5‐year DFS rates for CS 2a and 2b were 95% and 87% with adjuvant chemotherapy, and 67% and 74% without adjuvant chemotherapy. We did not identify an association between the number of adjuvant chemotherapy cycles and DFS.Our study suggests considering primary RPLND not only in marker‐negative CS 2a but also in CS 2b. Further research should determine the efficacy of primary RPLND in men with CS 2c and marker‐positive CS 2, as well as which patients may benefit from adjuvant chemotherapy and the optimal cycle number. [ABSTRACT FROM AUTHOR]

Objective Patients and Methods Results Conclusion To analyse the management and outcomes of individuals diagnosed with prostate cancer either before or after organ transplantation, as the impact of organ transplantation and associated immunosuppression on the incidence, progression, and mortality of prostate cancer remains an area of substantial clinical interest and uncertainty.We conducted a retrospective analysis of patients from two tertiary care centres who had solid organ transplantation and were diagnosed with prostate cancer before or after organ transplantation. Data collected included demographics and clinical information.The cohort consisted of 110 patients with a median (interquartile range [IQR]) age at prostate cancer diagnosis of 62 (56.6–67.2) years and a median (IQR) age at transplantation of 58.6 (52.7–65.3) years. Renal transplantation was the most common (54%). The median (IQR) prostate‐specific antigen concentration at prostate cancer diagnosis was 6.2 (4.5–10) ng/mL, and the distribution of American Urological Association risk groups was: low risk, 36%; intermediate risk, 50%; and high risk, 14%. In all, 45 (41%) patients were diagnosed with prostate cancer prior to transplantation. Management included radical prostatectomy (RP; 62%), prostate radiotherapy (RT; 13%), and active surveillance (AS; 18%). During a median (IQR) follow‐up of 5.8 (2.5–10) years from prostate cancer diagnosis, one (2%) patient developed metastatic disease. In all, 65 (59%) patients were diagnosed with prostate cancer subsequent to organ transplantation. Management included AS (29%), RT (45%), and RP (15%). During a median (IQR) follow‐up of 5.3 (1–8.4) years, three patients (5%) developed metastatic disease. There were no deaths from prostate cancer.A diagnosis of localised prostate cancer should not preclude solid organ transplantation, and the presence of a transplant does not appear to substantially impact risk of prostate cancer progression. [ABSTRACT FROM AUTHOR]

The author comments on the effectiveness of active surveillance (AS) in the prevention of the rise rates of prostate cancer worldwide. The author states that despite the existence of numerous preventive strategies and measures to minimize prostate cancer, AS is deemed as the preferred option among amen. Moreover, he said that AS' success is reliant on the indications, entry criteria and follow-up techniques to ensure its curative intervention.

The author reflects on the technique of elastography for the treatment of prostate cancer. Topics that he discusses include, brachytherapy, intensity modulated radiation therapy (IMRT), and proton therapy. Also discussed are open prostatectomy, laparoscopic prostatectomy, robotic prostatectomy, and high-intensity focused ultrasound (HIFU).