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We present the first and a rare case of orthotopic renal auto-transplantation in the management of postchemotherapy residual retroperitoneal mass encasing the left renal vessels but sparing the parenchyma in a 24-year-old patient with Stage IIIC nonseminomatous germ cell tumor after 4 cycles of chemotherapy. Immediate postoperative and 6 months’ follow-up renograms confirmed the maintained glomerular filtration rate of the transplanted kidney with no residual disease. This case report shows the feasibility of renal autotransplantation in carefully selected patients as they are young and have long-term survival.

Objective To compare health-related quality of life (HRQOL) in patients undergoing radical cystectomy with ileal conduit (RC) or bladder preservation (BP) with (chemo)radiotherapy for bladder cancer.Methods and analysis Patients with bladder cancer, stage cT1–T4, cN0–N1, M0 with a minimum follow-up of 6 months from curative treatment (RC or BP) and without disease were eligible for inclusion. Two HRQOL instruments were administered: Bladder Cancer Index (BCI) for bladder cancer-specific HRQOL and European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). The mean QOL scores across various domains and specific questions were compared between the two treatment groups using an independent t-test.Results Out of the 104 enrolled patients, 56 underwent RC and 48 opted for BP, with 95 (91.3%) being male. The median time from treatment completion to QOL assessment was 22 months (IQR 10–56). The median age for the entire cohort was 62 years (IQR 55–68), 65.5 years (IQR 55–71) in BP and 59.5 years (IQR 55–66) in RC. There was no significant difference in mean BCI urinary and bowel scores in function or bother subdomains between the two groups. Overall, BCI sexual scores were low in both groups but significantly better after BP (BPmean 56.9, RCmean 41.5, p=0.01). Mean scores for sexual function subdomain were BPmean 38.4 and RCmean 25 (p=0.07) and for sexual bother were BPmean 81 RCmean 62 (p=0.02). The EORTC QLQ-C30 outcomes did not show a significant difference in either group.Conclusion The BP group showed significantly better results in the sexual domain compared with the RC group. Both groups had good QOL in terms of urinary and bowel functions

This study aims to examine the factors influencing the adoption of health insurance and buy intention among Generation Z in India during the period after the COVID-19 pandemic. The COVID-19 pandemic has highlighted the significance of healthcare readiness and fiscal stability, hence emphasizing the crucial role of health insurance in the lives of individuals and households. Generation Z, encompassing individuals born approximately from the mid-1990s to the early 2010s, constitutes a noteworthy demographic cohort characterised by distinct inclinations and conduct. This study investigates the demographic features of individuals, their level of knowledge and awareness regarding health insurance, their attitudes towards risk, and the influence of the pandemic on their perceptions. Preliminary data suggest that the Gen Z population in India understands the significance of health insurance. However, some obstacles impede their adoption of such insurance, including a lack of comprehensive knowledge, budgetary limitations, and a tendency to prioritise immediate financial objectives. Moreover, the ongoing global pandemic has significantly impacted individuals' perception of healthcare risks and financial planning, potentially affecting their inclination to allocate resources towards health insurance investments. This study enhances our comprehension of the changing patterns of health insurance adoption in India, specifically among the youngest cohort, and offers valuable insights for insurers, policymakers, and healthcare providers to customise their offerings and communication approaches in order to effectively address the requirements of Generation Z in the aftermath of the pandemic. In conclusion, promoting the adoption of health insurance among this particular cohort has the potential to enhance financial resilience and facilitate improved access to healthcare for future generations in India.

The long-term financial health of a corporation is assessed by its capacity to meet short-term financial commitments. Optimum working capital that maximizes enterprise value varies across companies. The purpose of this paper is to investigate whether Indian manufacturing enterprises’ firm values are influenced by working capital management efficiency. The data are taken from 2016 to 2022 (a seven-year period) for 223 top BSE-listed manufacturing companies. Firm value (explained variable) is proxied using Tobin’s Q, and the constituents of working capital, which include the net trade cycle, inventory period, debtors’ collection period, and creditor payment period, are taken as explanatory variables. The study also controls for any differences in firm characteristics and economic conditions by employing firm size, age, current ratio, net profit ratio, sale growth and GDP growth rate. Balanced-panel data analysis is conducted by employing a two-step generalized method of moment technique. Net trade cycle, inventory period and debtors’ collection period are found to have a strong and significant positive impact on Tobin’s Q. The findings however did not report any evidence of the significant relationship between creditor payment period and Tobin’s Q. Additionally, the outcomes also evidenced that firm value is positively impacted by company size, net profit ratio, sales growth and GDP, whereas negatively affected by firm age. This paper suggests that manufacturing firms may potentially enhance their firm value by prolonging the net trade cycle, period of inventory and lengthening the credit period to customers till the level of attainment of an optimum working capital.

Abstract Background To assess urinary symptoms and urine cytology as screening tools for cystoscopic detection of local recurrence after bladder‐preserving trimodality treatment (TMT). Methods Patients with muscle‐invasive bladder cancer receiving definitive TMT follow‐up three monthly for 2 years, six monthly for the next 3 years and then yearly, with a clinical review, urine cytology and cystoscopy at each visit (triple assessment, TA). Grade 2+ cystitis/haematuria absent/present was scored 0/1, and urine cytology reported negative/suspicious or positive was scored 0/1, respectively. The performance of these two parameters for predicting local recurrence in cystoscopic biopsy was tested. Other hypothetical surveillance schedules included cystoscopy on alternate visits (COAV), or suspected recurrence (COSR), six‐monthly COSR and six‐monthly TA. Results A total of 630 follow‐up visits in 112 patients with 19 recurrences (7 muscle invasive, 12 non‐muscle invasive) at a median follow‐up of 19 months were analysed. The sensitivity and specificity of clinical symptoms were 47.4% and 92%, and for urine cytology 58% and 85%, respectively. The combination of clinical symptoms and cytology (COSR) was 95% sensitive and 78% specific for local recurrence but 100% sensitive for muscle‐invasive recurrence. Both COAV and COSV schedules showed a high area under the curve (AUC) for detecting local recurrence (COAV = 0.84, COSR = 0.83), muscle‐invasive recurrence (AUC = 0.848 each) and non‐muscle‐invasive recurrence (COAV = 0.82, COSR = 0.81); reducing the need for TAs by 64% and 67% respectively, and overall cost by 18% and 33%, respectively. Conclusion Cystoscopy at suspected recurrence during follow‐up is safe and the most cost‐effective for detecting muscle‐invasive local recurrences, while cystoscopy at alternate visits may be more optimal for detecting any local recurrence.

Key Clinical Message Timely diagnosis, comprehensive assessment, and a multidisciplinary treatment approach are essential for young patients with esophageal squamous cell carcinoma, even when conventional risk factors are absent. This report emphasizes the need for increased clinical awareness and improved patient outcomes in an evolving epidemiological landscape.

None.

Low-grade Oncocytic Tumor (LOT) of kidney is an emerging neoplasm that forms an important differential diagnosis in a spectrum of entities with oncocytic morphology. It has overlapping features with renal oncocytoma and eosinophilic variant of chromophobe renal cell carcinoma, but with distinct clinical, histomorphological and immunohistochemical features. LOT exhibits characteristic low grade oncocytic morphology with a CD117 negative/CK7 positive immunophenotype. Herein, we describe two cases of this emerging entity, LOT, with emphasis on the diagnostic aspects, including the histomorphology, immunoprofile and discussion on the close differentials.

Epithelioid trophoblastic tumor is an extremely rare tumor which occurs in women of the reproductive age group following a previous gestation. Its occurrence in male patients is remarkably rare, with only six cases reported in the English literature. Herein, we discuss the unusual occurrence of this tumor in a 31-years-old male patient as a component of non-seminomatous germ cell tumor. It presented as retroperitoneal metastasis with associated testicular microlithiasis (regressed germ cell tumor).

Risk of metastatic disease in the cluster 2-related pheochromocytoma/paraganglioma (PPGL) is low. In MEN2 patients, identification of origin of met astases from pheochromocytoma (PCC) or medullary thyroid carcinoma (MTC) is challenging as both are of neuroendocrine origin. We aim to describe our experience and perform a systematic review to assess prevalence, demographics, biochemistry, diagnostic evaluation, management, and predictors of cluster 2-related metastatic PPGL. Retrospective analysis of 3 cases from our cohort and 43 cases from world literature was done. For calculation of prevalence, all reported patients (n = 3063) of cluster 2 were included. We found that the risk of metastasis in cluster 2-related PPGL was 2.6% (2% i n RET, 5% in NF1, 4.8% in TMEM127 and 16.7% in MAX variation). In metastatic PCC in MEN2, median age was 39 years, bilateral tumors were present in 71% and median tumor si ze was 9.7 cm (range 4–19) with 43.5% mortality. All patients had a primary tumor si ze ≥4 cm. Origin of primary tumor was diagnosed by histopathology of metastatic lesion in 1 1 (57.9%), 131I-MIBG scan in 6 (31.6%), and selective venous sampling and CT in 1 (5.3%) patient each. In subgroup of neurofibromatosis 1 (NF1), median age was 46 years (range 14– 59) with median tumor size 6 cm and 57% mortality. To conclude, the risk of metastati c disease in cluster 2-related PPGL is low, being especially high in tumors with size ≥4 cm and associated with high mortality. One-third patients of NF1 with metastatic PPGL had presented in second decade of life. Long-term studies are needed to formulate management recommendations.

Introduction TFE Translocation renal cell carcinoma (TRCC) represents 1 to 5% of all cases of renal cell carcinoma, with the highest frequency among children and young adults. Management of these tumors is not very well defined in literature. Although in pediatric age group it has favorable prognosis, in adults it has an aggressive nature, with poor outcome. This is a retrospective analysis of treatment outcome in adult patient 18 years or above treated at our hospital between January 2013 and November 2018. Material and Methods Clinical and pathological data of 26 patients from a single institution diagnosed with TRCC between January 2013 and November 2018 were retrospectively reviewed. All cases of TRCC were confirmed with immunohistochemistry or fluorescence in situ hybridization. We analyzed our data of patients treated with surgery only or who progressed after surgery and treated with systemic therapy or who presented with upfront unresectable or metastatic disease treated with systemic therapy with respect to event-free survival (EFS) and overall survival (OS). Results Between January 2013 and November 2018, 26 adult patients who were treated at our center were eligible for this analysis as per our criteria. Out of 26 patients, 25 patients had radical surgery after evaluation and 1 had metastatic disease who was started on systemic therapy. Out 25 patients who were treated with radical surgery, 16 patients progressed and they were started on systemic therapy except for 1 patient who defaulted. Median time to start systemic therapy among patient treated with curative nephrectomy was 13 months. Median EFS and median OS among overall population were 22 and 30 months, respectively. Among 16 patients who were treated with systemic therapy, median EFS to first-line therapy was 8 months and to second-line therapy was 2.5 months. Median OS was 17 months in patients treated with systemic therapy. Conclusion TRCC is rare in adult population but carries significant risk of disease progression even after initial curative treatment with potential response to targeted therapy for short duration.

Introduction: The grading system of chromophobe renal cell carcinoma (ChRCC) is not well established. In this study, we aimed to compare the application of Fuhrman nuclear grade (FNG) with the novel chromophobe tumor grade (CTG). We also evaluated the correlation of these two grading systems with the clinical outcome. Materials and Methods: Consecutive cases of ChRCC diagnosed on nephrectomy during 2005–2014 were identified. The clinical details of the patients were retrieved. Histopathology slides were reviewed and the nuclear grading was assigned using standard FNG and the CTG system. The CTG and FNG gradings were correlated with clinical outcome. Results: A total of 80 cases were retrieved. Distribution of FNG was as follows: FNG-1, 1 (1.3%); FNG-2, 23 (28.3%); FNG-3, 44 (55.0%); and FNG-4, 12 (15%). CTG distribution was as follows: CTG-1, 48 (60.0%); CTG-2, 20 (25.0%); and CTG-3 12 (15.0%). Follow-up data was available in 46 cases; the median follow-up was 23.9 months (range 1–96.4 months). The median time to recurrence/metastasis was 17.2 months (range 3.2–31.2 months). Mean disease-free survival (DFS) was 68.5 months. Both CTG (P < 0.001) and FNG (P = 0.001) correlated with DFS; however, only CTG retained this significance when only the nonsarcomatous cases were analyzed. On receiver operating characteristics curve analysis, CTG had higher predictive accuracy for DFS for the entire group, while FNG lost the statistical significance when the nonsarcomatous cases were analyzed. CTG (P = 0.001) but not FNG (P = 0.106) correlated with the disease-specific adverse events in non-sarcomatous cases. Conclusions: It is possible to apply CTG in ChRCC. It is a better predictor of DFS and disease-specific adverse events. CTG is more appropriate and applicable than the FNG in grading ChRCC.

Radical cystectomy with bilateral pelvic lymph node dissection is the standard of care for muscle invasive bladder cancer (MIBC). The role of neoadjuvant and adjuvant therapy has evolved over the last 3–4 decades, and neoadjuvant chemotherapy (NACT) has now become the standard recommended treatment. However, there are many nuances to this and the utilization of chemotherapy has not been universal. The optimum chemotherapy regimen is still debated. Adjuvant radiation has a role in high-risk patients although not established and immunotherapy has shown promising results. We reviewed the evidence on NACT and adjuvant chemotherapy (ACT) regimens, NACT versus ACT, and the role of adjuvant radiotherapy and immunotherapy in MIBC.

Eosinophilic solid cystic renal cell carcinoma (ESC-RCC) is a recently described entity, which demonstrates distinct clinical, pathological and molecular features. We present a series of three cases, the first to be reported from the Indian subcontinent. All three patients were over 50 years of age; and presented with a large kidney mass. One patient had a locally advanced disease while the other two presented with metastases. Microscopic examination revealed a tumor displaying solid-cystic and/or papillary areas composed of clear as well as eosinophilic cells in all three cases. On immunohistochemistry, all the three cases showed a unique CK20+/α-methyl-acyl-CoA-racemase + immunophenotype. Melan-A was focally positive in Case 2. Cytokeratin 7 was focally but strongly positive in Case 3. The two patients with metastatic disease were diagnosed on core biopsies and were advised oral tyrosine kinase inhibitor therapy. The third patient underwent upfront radical nephrectomy. Due to its peculiar morphology and immunoprofile, the diagnosis of ESC-RCC can be confidently made even on a core biopsy. Most cases reported till date had an indolent course. The metastatic presentation in two of our patients emphasizes the need to gather further evidence to ascertain the biological behavior of this emerging entity.

Malignant penile neoplasms are commonly squamous etiology, with the inguinal nodes being the first echelon of spread. The disease spreads to the pelvic lymph nodes only after metastases to the groin nodes, and this is the most important prognostic factor in penile carcinoma. While treatment of penile carcinoma with proven metastases to the inguinal lymph nodes mandates ilioinguinal lymph node dissection, the treatment of patients with impalpable nodes is more controversial. Overtreatment leads to excessive treatment-related morbidity in these patients, while a wait-and-see policy runs the risk of patients presenting with inguinal and distant metastases, which would have been curable at presentation. Unfortunately, no single imaging modality has been proved to be convincingly superior in the staging, and hence, management of the clinically negative groin has been subject to debate. While some high volume centers have promoted the use of dynamic sentinel lymph node biopsy, others advocate the use of the modified inguinal lymph node template to stage the groin adequately. Newer techniques such as video endoscopic inguinal lymph node dissection have been introduced as an alternative to the original radical inguinal lymphadenectomy to reduce morbidity.

Background: Adrenocortical carcinoma (ACC) is a rare malignancy with poor outcomes. Objectives: To analyze the clinicopathologic features, treatment patterns and outcomes of patients with ACC who received systemic therapy at our center. Patients and Methods: This was a retrospective study conducted in a tertiary cancer center in India. Patients aged 15 years and older who were diagnosed with ACC between January 2011 and December 2018 and received systemic therapy were included in this study. For tumor staging, the European Network for the Study of Adrenal Tumors (ENSAT) system was used. The outcomes were reported as progression-free survival (PFS) and overall survival (OS). All statistical calculations were performed using the SPSS statistical software for Windows version 20.0. Results: Out of the 106 patients with ACC, 54 who received systemic therapy were included in this study. The median age of the cohort was 43 years (range, 15–72); 32 (59.3%) were men. Five (9.2%) patients had ENSAT Stage II, 31 (57.4%) had Stage III, and 18 (33.3%) had Stage IV (metastatic) disease at baseline. The chemotherapy drugs used in the palliative setting included etoposide (E), doxorubicin (D), and cisplatin (P), with or without mitotane. The median OS was 140 months (95% confidence interval [CI], 38.2–241.8) for ENSAT Stage II patients; 43 months for Stage III patients (95% CI, 27.2–58.7); and 22 months (95% CI, 9.4–34.6) for Stage IV patients, P = 0.012. The median PFS for patients treated with etoposide and platin (EP) and etoposide, doxorubicin, and platin (EDP) regimens was similar at 7 months (95% CI, 0–14.9) and 6 months (95% CI: 0–14.6) (P = 0.633), respectively. The corresponding median OS was 20.9 months (95% CI, 11.7–30.2) and 13.0 months (95% CI, 2.1–23.8) (P = 0.454), respectively. The patients who received palliative intent mitotane had a median PFS of 13 months (95% CI, 0–26.3) and those who did not had a median PFS of 6 months (95% CI, 1.2–10.7) (P = 0.492). The corresponding median OS was 22.6 months (95% CI, 17.8–27.5) and 15.5 months (95% CI, 5.8–25.2) (P = 0.351), respectively. Grade 3 or higher toxicities were observed in 25% of the patients receiving EP chemotherapy and 76.9% receiving EDP chemotherapy (P = 0.013). Conclusions: The use of mitotane is limited in the real-world setting in view of the financial constraints. The results with palliative chemotherapy in patients with ACC continue to remain poor. Patients with ACC treated with EDP and EP protocols had similar survival, but the three-drug protocol was associated with higher toxicities.

Rationale and introduction: To evaluate the computerised tomography (CT) characteristics of phaeochromocytoma (PCC) that differentiate them from other no n-benign adrenal masses such as adrenocortical carcinoma (ACC), primary adrenal lymphoma (PAL) and adrenal metastases (AM). Methods: This retrospective study was conducted at a tertiary health care institute from Western India. Patients presented between January 2013 and August 2016 with histological diagnosis of PCC or other non-benign adrenal mass having adequate reviewable imaging data comprising all four CECT phases were included. Results: The study cohort consisted of 72 adrenal masses from 66 patients (33 PCC, 22 ACC, 4 PAL, 13 AM). Unlike other masses, majority of PCC (25/33) showed peak enhancement in early arterial phase (EAP). PCC had significantly higher attenuation in EAP and early venous phase (EVP), and higher calculated percentage arterial enhancement (PAE) and percentage venous enhancement (PVE) than other adrenal masses (P < 0.001). For diagnosis of PCC with 100% specificity, PAE value ≥100% and EAP attenuation ≥100 HU had 78.8 and 63.6% sensitivity respectively. ACC were significantly larger in size as compared to PCC and metastasis. The adreniform shape was exclusively found in PAL (two out of four) and AM (4 out of 13). None of the enhancement, wash-in or washout characteristics were discriminatory among ACC, PAL and AM. Conclusion: Peak enhancement in EAP, PAE value ≥100% and EAP attenuation ≥100 HU differentiate PCC from other malignant adrenal masses with high specificity.

IntroductionThere has been an interest in studying the efficacy of extreme hypofractionation in low and intermediate risk prostate cancer utilising the low alpha/beta ratio of prostate. Its role in high-risk and node-positive prostate cancer, however, is unknown. We hypothesise that a five-fraction schedule of extreme hypofractionation will be non-inferior to a moderately hypofractionated regimen over 5 weeks in efficacy and will have acceptable toxicity and quality of life while reducing the cost implications during treatment.Methods and analysisThis is an ongoing, non-inferiority, multicentre, randomised trial (NCT03561961) of two schedules for National Cancer Control Network high-risk and/or node-positive non-metastatic carcinoma of the prostate. The standard arm will be a schedule of 68 Gy/25# over 5 weeks while the test arm will be extremely hypofractionated radiotherapy with stereotactic body radiation therapy to 36.25 Gy/5# (7 to 10 days). The block randomisation will be stratified by nodal status (N0/N+), hormonal therapy (luteinizing hormone-releasing hormone therapy/orchiectomy) and centre. All patients will receive daily image-guided radiotherapy.The primary end point is 4-year biochemical failure free survival (BFFS). The power calculations assume 4-year BFFS of 80% in the moderate hypofractionation arm. With a 5% one-sided significance and 80% power, a total of 434 patients will be randomised to both arms equally (217 in each arm). The secondary end points include overall survival, prostate cancer specific survival, acute and late toxicities, quality of life and out-of-pocket expenditure.DiscussionThe trial aims to establish a therapeutically efficacious and cost-efficient modality for high-risk and node-positive prostate cancer with an acceptable toxicity profile. Presently, this is the only trial evaluating and answering such a question in this cohort.Ethics and disseminationThe trial has been approved by IEC-III of Tata Memorial Centre, Mumbai.Trial registration numberRegistered with CTRI/2018/05/014054 (http://ctri.nic.in) on 24 May 2018

Surfactant Protein D (SP-D), a pattern recognition innate immune molecule, has been implicated in the immune surveillance against cancer. A recent report showed an association of decreased SP-D expression in human prostate adenocarcinoma with an increased Gleason score and severity. In the present study, the SP-D expression was evaluated in primary prostate epithelial cells (PrEC) and prostate cancer cell lines. LNCaP, an androgen dependent prostate cancer cell line, exhibited significantly lower mRNA and protein levels of SP-D than PrEC and the androgen independent cell lines (PC3 and DU145). A recombinant fragment of human SP-D, rfhSP-D, showed a dose and time dependent binding to prostate cancer cells via its carbohydrate recognition domain. This study, for the first time, provides evidence of significant and specific cell death of tumor cells in rfhSP-D treated explants as well as primary tumor cells isolated from tissue biopsies of metatstatic prostate cancer patients. Viability of PrEC was not altered by rfhSP-D. Treated LNCaP (p53+/+) and PC3 (p53 −/−) cells exhibited reduced cell viability in a dose and time dependent manner and were arrested in G2/M and G1/G0 phase of the cell cycle, respectively. rfhSP-D treated LNCaP cells showed a significant upregulation of p53 whereas a significant downregulation of pAkt was observed in both PC3 and LNCaP cell lines. The rfhSP-D-induced apoptosis signaling cascade involved upregulation of Bax:Bcl2 ratio, cytochrome c and cleaved products of caspase 7. The study concludes that rfhSP-D induces apoptosis in prostate tumor explants as well as in androgen dependent and independent prostate cancer cells via p53 and pAkt pathways.

Purpose: This study is an "Action-Research-based" bridge that connects sketching and photographic processes. The article's objective encompasses designing, assessing and validating a perceived difference between sketching and photography through a structured task by ensuring the systematic creation and implementation of the assignments. This study is part of a larger research project exploring the differences between thinking about sketching and final photographic outcomes. Design/methodology/approach: This experimental mixed-method methodology was collected in three phases: the creation phase, where participants were asked to sketch and photograph a balanced composition; the evaluation phase, where the sketches and photographs were evaluated by "Self, Peer, and Independent" reviewers for their perceived differences. An analysis of variance (ANOVA) was implemented to test the result. In the validation phase, eye-tracking technology is applied to understand the subconscious eye movements of individuals. Findings: This study of 37 samples has helped develop a self-study model in photography, as students have learnt to evaluate themselves critically. This experience will help students be active and reflective learners, thus increasing attention and retention in their course, specifically "Photography Design Education". A pedagogical approach by design instructors for practical, student-friendly, process-oriented assignments for their photography courses in higher education. Originality/value: The trans-mediation process requires cognition amongst different mediums, such as pencil and paper for sketching and light for light painting. Photography courses in design education need knowledge of the photo/light medium, contrasting with the understanding of sketching/drawing. Exploring and addressing research gaps for transforming and designing assignments based on adaptive understanding presents an exciting opportunity.

Tumors of the genitourinary system are one of the most common tumors encountered in clinical practice. The associated morbidity and mortality and the significant proportion of affected middle-age individuals have a major bearing on the death-adjusted life years compared to other malignancies. Genitourinary system tumors encompass a very broad spectrum with regard to age, location, histology, and clinical outcomes. Advances in diagnostic imaging, surgical techniques, radiotherapy equipment, and generation of newer chemotherapeutic and targeted agents over the past few years have helped improving treatment outcome. Several focused groups within India have been working on a range of topics related to genitourinary system tumors, and a significant body of work from India in the recent years is being increasingly recognized throughout the world. The present article summarizes the key published work related to the epidemiology of genitourinary system tumors in the Indian setting. A PubMed search was made for locating and selecting articles relevant to the topic.

Bone health is affected in patients with prostate cancer, both by the disease and its treatment. Metastases to bone leads to pain, fractures, and spinal cord compression; bone loss due to androgen deprivation therapy (ADT) leads to osteoporosis and its complications. Both these scenarios are a major cause of morbidity and adversely affect the quality of life of these patients. Maintaining an optimum bone health throughout the natural course of prostate cancer is an important aspect in the management of this disease. An understanding of the complex interplay between osteoclasts, osteoblasts, receptor activator of nuclear factor κB (RANK), and various other tyrosine kinases involved in the pathophysiology of bone metastases is essential. Zoledronic acid (ZA), an intravenously administered bisphosphonate, and Denosumab, a subcutaneously administered inhibitor of nuclear factor B ligand (RANKL), have already been approved by Food and Drug Administration (FDA) for their use in treatment of bone metastases. This article discusses the pathophysiology of bone metastases and bone loss due to ADT in prostate cancer, role of biomarkers, newer modalities of imaging, World Health Organization (WHO)/FRAX nomogram in evaluation of these patients, utility of currently available drugs and evidence supporting their use, and newer therapeutic agents like alpha-emitting Radium-223, endothelin-A receptor antagonists (Atrasentan and Zibotentan) and the proto-oncogene tyrosine-protein kinase (SRC) inhibitor, Dasatinib.

Surfactant protein D (SP-D), an innate immune molecule, has an indispensable role in host defense and regulation of inflammation. We reported a novel anti-cancer role of a recombinant fragment of human SP-D (rhSP-D) in leukemic and breast tumor cell lines. A recent study revealed correlation of SP-D expression in Prostate cancer tissues with increased Gleason score and tumor volume. In the present study, we elucidated the role of rhSP-D in prostate cancer using LNCaP (androgen dependent), PC3 (androgen independent) cell lines and primary prostate cancer cells. In accordance with our previous finding, rhSP-D induced apoptosis in LNCaP and PC3 cell lines in a time and dose dependent manner. Isolated primary prostate cancer epithelial cells from explant cultures of tissue biopsies of prostate cancer patients were characterised for the presence of Cytokeratin (epithelial cell), CD10 (negative) and CD164 (positive) markers at protein and transcript level. Anti-prostate tumor effect of rhSP-D was established in the isolated primary prostate cancer epithelial cells. Importantly, primary normal prostate epithelial cells treated with similar concentrations of rhSP-D showed no adverse effect on viability. rhSP-D upregulated phospho p53 and transcripts of Bax and reduced Bcl2 transcripts, suggesting p53 mediated apoptosis in LNCaP cells. rhSP-D induced apoptosis in PC3 cells by lowering phospho ERK1/2 levels and increased BAD transcripts, a distinct mechanism of programmed cell death. Increased release of cytochrome c upon rhSP-D confirmed the activation of mitochondrial intrinsic apoptotic pathway in both the cell types. rhSP-D treatment downregulated transcripts of Bcl2 while upregulated PUMA transcripts, suggesting p53 mediated apoptosis primary prostate cancer cells. Also, positive TUNEL assay confirmed induction of apoptosis by rhSP-D in cancer tissue biopsies. Collectively, our findings reveal an integral role of SP-D in immune surveillance against prostate cancer mediated by two distinct mitochondrial apoptotic mechanisms.

Radical cystectomy is the standard treatment for muscle invasive bladder cancer. Lymphocele is a common sequalae of pelvic lymphadenectomy. We report an unusual presentation of pelvic lymphocele developing after radical cystectomy reconstructed with an ileal conduit where the patient developed obstruction of the ileal conduit loop due to external pressure of the lymphocele. Catheter drainage of the conduit relieved the symptoms and a computerized tomography scan showed a large lymphocele causing acute angulation and resultant obstruction of the ileal conduit. The patient was treated with percutaneous drainage of the lymphocele and remains symptom-free on follow-up at 1 year.