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Purpose: The main purpose of this study was to evaluate the risk of CVD mortality in the national cohort of patients diagnosed with prostate cancer and treated with ADT compared with the ADT non-users.Materials and methods: We performed a retrospective cohort study of patients aged 40–79 years and diagnosed with prostate cancer between 1 January 2012 and 31 December 2016 using the Lithuanian Cancer registry data. In total, 13 343 prostate cancer patients were included in the final study cohort who exclusively used gonadotropin-releasing hormone agonists. The primary outcomes that were registered during the follow-up of this study were overall CVD death.Results: There was a higher risk of CVD death in the cohort of patients treated with ADT than in ADT non-users (HR 2.14, 95% CI [1.86–2.45], p < 0.001). Moreover, there was an increased risk of death from ischemic heart disease and stroke (HR 1.42, 95% CI [1.16–1.73] and 1.70, 95% CI [1.18–2.45], respectively) among ADT users. Finally, the risk of CVD-related mortality was highest in the 70–79 age group of ADT users (HR 4.78, 95% CI [3.79–6.04]).Conclusions: This study shows that ADT usage is associated with increased CVD-related mortality risk for patients diagnosed with prostate cancer compared with ADT non-users. The highest mortality risk was found for ischemic heart disease and stroke. CVD-related mortality was increased in the elder group of patients also.

Background. Renal cell carcinoma (RCC) may be metastatic, although solitary sternal metastasis of RCC is a rare medical condition. Here we report an unusual case of a 63-year-old male with a solitary sternal metastasis as an initial presentation of clear-cell renal cell carcinoma. Materials and methods. A 63-year-old male presented with a small sternal mass. Chest computer tomography (CT) and a biopsy from the sternal tumour were performed. Histopathological examination revealed the diagnosis of renal clear cell carcinoma metastasis to the sternal bone. On the basis of a subsequently performed abdominal CT the patient was confirmed with a suspicion of a left renal lower pole tumour. Treatment with sunitinib was initiated. Due to the limited response and a growing sternal mass, the patient was admitted to the National Cancer Institute after two cycles of sunitinib therapy. Open left partial nephrectomy was performed followed by the resection of the sternal metastasis two months later. The chest wall was reconstructed with polypropylene mesh combined with transversal rectus abdominis musculocutaneous flap. Results. The postoperative course after the partial nephrectomy was uneventful. The postoperative course of metastasectomy complicated with the right pneumothorax which was successfully treated by insertion of a chest tube. Bleeding from the upper digestive tract also occurred on the seventh postoperative day but was successfully controlled by haemostasis with three 20 ml endoscopic injections of 1:10,000 solution of epinephrine. The patient had been followed up after the surgery for 30 months with biannual chest and abdominal CT scans that showed neither local nor distant recurrence of the disease. Conclusions. Radical surgical treatment of a solitary renal clear cell carcinoma metastasis may offer the best cancer-specific outcomes and improve the quality of life in some patients.

Background and objectives: Overdiagnosis, overtreatment, and the need for repeated procedures caused by transrectal ultrasound guided prostate biopsies and their related complications places a heavy burden on healthcare systems. This was a prospective cohort validating study to access the clinical accuracy of systematic and MRI-cognitive targeted transperineal prostate biopsies in detecting clinically significant prostate cancer after a previous negative biopsy and persistent suspicion of malignancy. The primary goal was to assess the ability of multiparametric magnetic resonance imaging (mpMRI) to detect clinically significant prostate cancer with an additional goal to assess the diagnostic value of systematic and MRI-cognitive transperineal biopsies. Materials and Methods: In total, 200 patients were enrolled who had rising serum prostate specific antigen (PSA) levels for at least 4 months after a previous negative transrectal ultrasound (TRUS) biopsy. All eligible men underwent 1.5T prostate mpMRI, reported using the Prostate Imaging Reporting and Data System version 2 (PI-RADS v2), followed by a 20-region transperineal prostate systematic biopsy and additional targeted biopsies. Results: Systematic 20-core transperineal prostate biopsies (TPBs) were performed for 38 (19%) patients. Systemic 20-core TPB with additional cognitive targeted biopsies were performed for 162 (81%) patients. Clinically significant prostate cancer (csPC) was detected for 31 (15.5%) patients, of which 20 (64.5%) cases of csPC were detected by systematic biopsy, eight (25.8%) cases were detected by targeted biopsy, and three (9.7%) both by systematic and targeted biopsies. Conclusions: Cognitive mpMRI guided transperineal target biopsies increase the detection rate of clinically significant prostate cancer after a previously negative biopsy. However, in a repeat prostate biopsy setting, we recommend applying a cognitive targeted biopsy with the addition of a systematic biopsy.

Įvadas Hipertermijos indukuojama apoptozė gali lemti vėžinių ląstelių žūtį ir taip praplėsti radijo dažnio abliacijos saugią gydymo ribą net iki 10 milimetrų, taip užkertant kelią ligai atsinaujinti. Hipotezei patvirtinti atlikome eksperimentinį tyrimą, kuriuo siekėme įvertinti radijo dažnio abliacijos poveikį inkstų ląstelėms audinyje aplink susidariusią nekrozės zoną bei apibūdinti ankstyvus apoptozinius procesus šioje zonoje. Metodai Sukėlus bendrąją endotrachėjinę nejautrą, operuotos aštuonios eksperimentinės kiaulės. Joms atliktos vidurinės laparotomijos ir inkstų parenchimos radijo dažnio abliacija. Abliacijos zona ir ją supantys audiniai buvo tiriami Western bloto bei imunohistochemijos metodais siekiant nustatyti apoptozę. Rezultatai Valandą po procedūros aktyvuota trečiosios kaspazės 17-kDa dalis nustatyta tranzitorinėje abliacijos zonoje 7–9 mm atstumu nuo nekrozės ribos. Tiriant nekrozės zoną bei aplink nepažeistą inksto parenchimą, apoptozės žymenų aktyvumas nebuvo nustatytas. Išvados Mes nustatėme, kad po radijo dažnio abliacijos aštuonių milimetrų atstumu nuo nekrozės zonos daugumoje inksto ląstelių yra aktyvuojama ląstelių žūtį lemianti apoptozė. Tai patvirtina hipotezę, kad po šios procedūros dėl netiesiogiai plintančio terminio poveikio aplink nekrozės zoną gali susidaryti papildomai saugi 8 mm zona.

Marius Kinčius, Aivaras Matjošaitis Kauno medicinos universiteto Urologijos klinika, Eivenių g. 2, LT-50009 Kaunas El paštas: aivaras.mat@gmail.com Tikslas Perkutaninė nefrostomija šiuo metu yra alternatyva atvirajai nefrostomijai ir pirmo pasirinkimo operacija drenuojant viršutinius šlapimo takus dėl jų obstrukcijos. Šiuo darbu siekta apžvelgti dažniausias priežastis, sukeliančias obstrukcinę uropatiją, ir įvertinti perkutaninės nefrostomijos veiksmingumą ir saugumą. Ligoniai ir metodai Retrospektyviai ištirti 126 ligoniai, kuriems Kauno medicinos universiteto klinikų Urologijos klinikoje per trejus metus buvo atliktos perkutaninės nefrostomijos. Išsiaiškintos dažniausios ligos, kurios komplikavosi vieno ar abiejų inkstų blokada, o šlapimo nutekėjimui atkurti buvo atliktos perkutaninės nefrostomijos, taip pat nustatytos dažniausios komplikacijos po šių operacijų. Rezultatai Nuo 2002 m. rugsėjo iki 2005 m. rugsėjo Kauno medicinos universiteto klinikų Urologijos klinikoje iš viso buvo atliktos 156 perkutaninės nefrostomijos. Šlapimo nutekėjimas 47 ligoniams (37,3%) sutriko dėl nenavikinės šlapimo takų obstrukcijos, kitiems 79 (62,7%) – dėl piktybinių navikų. Dažniausios nenavikinės obstrukcijos priežastys buvo inkstų akmenligė, pieloureterinio segmento striktūra ir prostatos nepiktybinė hiperplazija. Pažengusios šlapimo pūslės, prostatos ir gimdos kaklelio karcinomos buvo dažniausios navikinės kilmės obstrukcinės uropatijos priežastys. Bendras komplikacijų skaičius siekė 19 (12,2%). Išvada Perkutaninė nefrostomija yra mažai traumuojanti ir visiškai saugi operacija, kurią atlikti turėtų mokėti kiekvienas urologas. Reikšminiai žodžiai: perkutaninė nefrostomija, obstrukcinė uropatija Percutaneous nephrostomy in the treatment of obstructive uropathies at Urology Department of Kaunas University of Medicine Hospital Marius Kinčius, Aivaras Matjošaitis Clinic of Urology, Kaunas University of Medicine, Eivenių g. 2, LT-50009 Kaunas, Lithuania E-mail: aivaras.mat@gmail.com Background Percutaneous nephrostomy is an alternative for open surgery and nowadays is the first choice operation for draining the upper urinary tract complicated with obstruction. Patients and methods Between September 2002 – September 2005 at Urology Department of Kaunas University of Medicine Hospital 126 patients underwent percutaneous nephrostomy. Percutaneous nephrostomy was used as a preparatory step towards radical elimination of obstruction and as a palliative treatment for draining the upper urinary tract complicated with obstruction. Results Percutaneous nephrostomy was done to 75 men and 51 women. The reasons for urine flow disorders were removable obstruction of the urinary tract in 47 patients (37.3%) and malignant tumors in 79 patients (62.7%). Bilateral percutaneous nephrostomies were performed for 14 patients. Haematuria appeared in almost all the patients in the early postoperative period. Four patients developed medium or great intensity bleeding (2.6%). In one case segmental renal artery obstruction was performed. The overall complication rate didn’t exceed 13%. Conclusion Percutaneous nephrostomy is a low traumatizing and safe operation which all urologists should be able to perform. Keywords: percutaneous nephrostomy, obstructive uropathy

Abstract Clear cell renal cell carcinoma (ccRCC) is the most prevalent form of renal cancer, accounting for over 75% of cases. The asymptomatic nature of the disease contributes to late-stage diagnoses and poor survival. Highly vascularized and immune infiltrated microenvironment are prominent features of ccRCC, yet the interplay between vasculature and immune cells, disease progression and response to therapy remains poorly understood. Using droplet-based single-cell RNA sequencing we profile 50,236 transcriptomes from paired tumor and healthy adjacent kidney tissues. Our analysis reveals significant heterogeneity and inter-patient variability of the tumor microenvironment. Notably, we discover a previously uncharacterized vasculature subpopulation associated with epithelial-mesenchymal transition. The cell-cell communication analysis reveals multiple modes of immunosuppressive interactions within the tumor microenvironment, including clinically relevant interactions between tumor vasculature and stromal cells with immune cells. The upregulation of the genes involved in these interactions is associated with worse survival in the TCGA KIRC cohort. Our findings demonstrate the role of tumor vasculature and stromal cell populations in shaping the ccRCC microenvironment and uncover a subpopulation of cells within the tumor vasculature that is associated with an angiogenic phenotype.

Introduction: Signet-ring cells are typically associated with mucin-secreting epithelium; thus, they are most commonly found in the gastrointestinal tract, but not exclusively. Primary signet-ring cell carcinoma of the prostate is a rare and poorly differentiated, aggressive acinar adenocarcinoma variant with a grim prognosis. Clinical Case: In June of 2023, a 54-year-old Caucasian male presented with a complaint of lower urinary tract obstructive symptoms with occasional macrohematuria, non-specific body aches, and shortness of breath. A prostate specimen obtained in transurethral resection of the prostate was sent for histopathological examination. After a series of extraprostatic diagnostic workups, including fibrogastroduodenoscopy, colonoscopy computed tomography imaging, and immunohistochemical studies, the patient was diagnosed with primary prostatic signet-ring cell adenocarcinoma stage IV. Unfortunately, due to the advanced stage of the disease, PE, and third-degree thrombocytopenia, the patient was not a candidate for chemotherapy and died of cardiopulmonary insufficiency later that week. Discussion: Prostatic signet-ring cell carcinoma accounts for 0.02% of all prostate adenocarcinoma cases. Due to its nature and epidemiology, a diligent extraprostatic investigation has to be carried out. The disease often presents with unremarkable clinical symptoms and variable serum prostate-specific antigen results, which may contribute to its late diagnosis. Inconsistent immunohistochemical findings and an unpredictable response to hormonal treatment together pose both diagnostic and therapeutic challenges that negatively affect the prognosis. Conclusions: This study highlights the importance of a multidisciplinary approach and the need for diagnostic and therapeutic consensus within the research community in search of the primary site of the disease, which may positively influence the prognosis.

Introduction Prostate cancer (PCa) is men’s second most predominant cancer worldwide. Because the prostate-specific antigen test is used in diagnostics, PCa is more often diagnosed in the early stages, making radical treatment of the disease possible. However, it is estimated that over a million men worldwide suffer from radical treatment-related complications. Thus, focal treatment has been proposed as a solution, which aims to destroy the predominant lesson that determines the progression of the disease. The main objective of our study is to compare the quality of life and efficacy of patients diagnosed with PCa before and after the treatment with focal high-dose-rate brachytherapy and to compare results with focal low-dose-rate brachytherapy and active surveillance.Methods and analysis 150 patients diagnosed with low-risk or favourable intermediate-risk PCa who meet the inclusion criteria will be enrolled in the study. Patients are going to be randomly assigned to the study groups: focal high-dose-rate brachytherapy (group 1), focal low-dose-rate brachytherapy (group 2) and active surveillance (group 3). The study’s primary outcomes are quality of life after the procedure and time without biochemical disease recurrence. The secondary outcomes are early and late genitourinary and gastrointestinal reactions after the focal high-dose and low-dose-rate brachytherapies and evaluation of the importance and significance of in vivo dosimetry used for high-dose-rate brachytherapy.Ethics and dissemination Bioethics committee approval was obtained before this study. The trial results will be published in peer-reviewed journals and at conferences.Trial registration number Vilnius regional bioethics committee; approval ID 2022/6-1438-911.

Background and objectivesThe aim of this study was to analyse trends in penile cancer incidence, mortality, and relative survival in Lithuania during the period of 1998–2017.Materials and methodsThe study was based on all cases of penile cancer reported to the Lithuanian Cancer Registry between 1998 and 2017. Age-specific rates standardized rates were calculated, using the direct method (World standard population). The Joinpoint regression model was used to provide estimated average annual percentage change (AAPC). One-year and five-year relative survival estimates were calculated using period analysis. Relative survival was calculated as the ratio of the observed survival of cancer patients and the expected survival of the underlying general population.ResultsDuring the study period, the age-standardized incidence rate of penile cancer varied between 0.72 and 1.64 per 100 000, with AAPC 0.9% (95% CI -0.8–2.7). The mortality rate of penile cancer in Lithuania during this period varied from 0.18 to 0.69 per 100 000, with AAPC of -2.6% (95% CI -5.3–0.3). Relative one-year survival of patients, diagnosed with penile cancer improved over the time from 75.84% in period 1998–2001 to 89.33% in period 2014–2017. Relative five-year survival rate of patients, diagnosed with penile cancer changed from 55.44% in period 1998-2001 to 72.90% in period 2014–2017.ConclusionsThe incidence rates of penile cancer showed an increasing trend, while mortality rates were decreasing in Lithuania during 1998-2017. One-year and five-year relative survival increased, however, it does not reach the highest scores of Northern European countries.

BackgroundMetastatic involvement of the penis in cases of rectal cancer is exceptionally rare condition. Our clinical case report and review of the literature will contribute in complementing currently limited data on penile metastasis from rectal cancer.Case reportWe report a case of a 64-year-old male diagnosed with penile metastasis from rectal cancer. The patient was treated with neoadjuvant chemoradiotherapy followed by total mesorectal excision (TME). However, penile metastasis developed 3 years later, clinically presenting as penile pain and solid formations along the entire length of the penis with visible tumor in the head of the penis. The amputation of penis was performed, and adjuvant chemotherapy was prescribed. The patient survived only 6 months.ConclusionPenile metastasis from rectal cancer in most cases is a lethal pathology that indicates wide dissemination of oncological disease and has a very poor prognosis. Aggressive surgical treatment is doubtful in metastatic disease as this will negatively affect the quality of life.

Objectives To examine the risk of type 2 diabetes in patients with prostate cancer and its association with androgen deprivation therapy (ADT).Design and participants We performed a retrospective cohort study of patients diagnosed with prostate cancer in the Lithuanian male population between 1 January 2003 and 31 December 2012 who were identified through the Lithuanian Cancer registry. All prostate cancer cases were linked to the National Health Insurance Fund database to obtain information regarding the diagnosis of diabetes mellitus and information on prescriptions of antiandrogens and gonadotropin-releasing hormone (GnRH) agonists. Patients with prostate cancer were followed up until the diagnosis of type 2 diabetes, or 31 December 2017, or date of death, whichever came first. Cox proportional hazard models were used to estimate the risk of type 2 diabetes in patients with prostate cancer with or without ADT exposure.Results 27 580 men were diagnosed with prostate cancer, out of whom 14 502 (52.6%) did not receive ADT and 13 078 (47.4%) were treated with ADT. The incidence of type 2 diabetes for all patients with prostate cancer was 7.4/1000 person-years, for men on GnRH agonists 9.0/1000 person-years and 5.8/1000 person-years for men on antiandrogens. There was an increased risk of developing type 2 diabetes comparing ADT users and non-users (HR=1.49, 95% CI 1.34 to 1.66).Conclusion This study showed an increased risk of diabetes in patients with prostate cancer treated with ADT in comparison to ADT-free patient cohort. GnRH agonist users showed higher susceptibility, while the group on antiandrogen monotherapy showed no such increase.

Background and objectives: The aim of this study was to analyze trends in testicular cancer incidence, mortality, and survival in Lithuania during the period 1998−2013. Materials and Methods: The study was based on all cases of testicular cancer reported to the Lithuanian Cancer Registry between 1998 and 2013. Age group-specific rates and standardized rates were calculated using the direct method (European standard population). The Joinpoint regression model was used to provide the annual percentage change (APC). Five-year relative survival estimates were calculated using period analysis. Relative survival was calculated as the ratio of the observed survival of cancer patients and the expected survival of the underlying general population. Results: During the study period, the age-standardized incidence rate of testicular cancer increased from 1.97 to 3.45 per 100,000, with APC of 2.97% (95% CI 0.9 to 5.1). Incidence rate of seminomas changed from 0.71 to 1.54 per 100,000, with APC of 2.61% (95% CI −0.4 to 5.7), and the incidence rate of non-seminomas increased from 0.84 to 1.83 per 100,000, with APC of 4.16% (95% CI 1.6 to 6.8). The mortality rate of testicular cancer in Lithuania during this period declined from 0.78 to 0.51 per 100,000, with APC of −2.91% (95% CI −5.5 to −0.3). Relative five-year survival ratio for the period 2009−2013 was 89.39% (95% CI 82.2 to 94.4). In our study, the overall five-year relative survival increased slightly (10.1%) from 2004−2008 to 2009−2013 (from 79.3% to 89.4%). Conclusions: A moderate increase of testicular cancer incidence has been observed in Lithuania between the years 1998 and 2013, while the mortality rate decreased. The five-year relative survival increased according to different period estimates; however, the results could have been higher if a multidisciplinary approach to diagnostics and management in the concerned centers had been implemented in Lithuania as in other countries.