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Editorial Comment

Urology (Gold Journal) In Press - Fri, 03/03/2017 - 00:00
In the accompanying article the authors present their prospective findings of the cognitive effects of androgen deprivation therapy (ADT) on a cohort of patients receiving therapy for locally advanced or metastatic (non–central nervous system) disease. Their primary finding is that after 12 months of therapy, there is a statistically significant reduction in language ability, short-term memory (as measured by Montreal Cognitive Assessment test), as well as in mental flexibility and inhibition (as measured by frontal assessment battery test) compared with a cohort of age- and comorbidity-matched men with localized prostate cancer treated by radical prostatectomy.
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Reply by Authors

After stratification based on molecular status of a previous tumor, the assay combination had a cross-sectional sensitivity of 62%. When we consider the anticipatory effect over the first 12 months after the positive urine test, sensitivity would increase to 69% for the 3-assay combination. In addition, most aggressive recurrences were detected by the combination with a cross-sectional sensitivity of 83% for stage T1 or greater, or grade 3 recurrences.
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Editorial Comment

The suggestion that this biomarker combination could be used as an alternative to cystoscopy for low grade bladder cancer challenges current practice. AUA (American Urological Association) guidelines suggest that biomarkers should not be used in place of cystoscopy, and patients with low risk tumors need infrequent cystoscopic surveillance and do not require routine biomarker testing.1 The findings of 57% sensitivity and 59% specificity for surveillance of low grade bladder cancer is a modest improvement over a coin toss.
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Editorial Comment

The search for reliable urine based tests to identify (recurrent) bladder tumors has been a disappointing journey. Different markers have been evaluated with a wide range of sensitivities and specificities, probably based on patient selection and concomitant intravesical treatment. This is the reason why these markers are not included in guidelines and only cytology is mentioned in recommendations.
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Re: Can Activities of Daily Living Predict Complications following Percutaneous Nephrolithotomy?

Leavitt et al evaluated whether deficits in activities of daily living (ADLs) could predict complications after percutaneous nephrolithotomy, and how this prediction compares to the Charlson comorbidity index (CCI) and American Society of Anesthesiologists (ASA) classification. The authors concluded that ADLs are easily evaluated preoperatively and independently predict complications following percutaneous nephrolithotomy better than CCI or ASA classification.
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The Fisher Technique for Correction of Penile Torsion in Children: Who are the Candidates?

Urology (Gold Journal) In Press - Fri, 03/03/2017 - 00:00
To report our experience in the treatment of penile torsion with a special reference to the Fisher technique.
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Low Testosterone Levels Result in Decreased Periurethral Vascularity via an Androgen Receptor-Mediated Process: Pilot Study in Urethral Stricture Tissue

Urology (Gold Journal) In Press - Fri, 03/03/2017 - 00:00
To compare expression of androgen receptor (AR) and angiopoietin 1 receptor TIE-2 and vessel density of urethral stricture tissue among eugonadal and hypogonadal men to identify a pathophysiologic basis for our observations that low testosterone is associated with urethral atrophy.
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Patterns of Disease Monitoring and Treatment among Patients with Tuberous Sclerosis Complex-Related Angiomyolipomas

Urology (Gold Journal) In Press - Fri, 03/03/2017 - 00:00
To use the tuberous sclerosis complex (TSC) Natural History Database to describe monitoring and treatment patterns among patients with TSC-related angiomyolipomas (AMLs).
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Re: Is It Necessary to Actively Remove Stone Fragments During Retrograde Intrarenal Surgery?

Footnotes

Saint John Emergency Clinical Hospital, Bucharest, Romania

Saint John Emergency Clinical Hospital, Sos. Vitan-Barzesti, 13, Bucharest Sector 1 042122, Romania.

Article information

PII: S0302-2838(17)30100-8
DOI: 10.1016/j.eururo.2017.02.011
© 2017 European Association of Urology, Published by Elsevier B.V.

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Excisional Precision Matters: Understanding the Influence of Excisional Volume Loss on Renal Function After Partial Nephrectomy

Abstract

Renal function after partial nephrectomy (PN) may depend on modifiable factors including ischemia time, excision of healthy parenchyma (excisional volume loss, EVL), and reconstructive methods. We retrospectively reviewed our institutional robotic PN database to identify the predictors of glomerular filtration rate (GFR) preservation (GFR-P) at 3–12 mo postoperatively, during which GFR decline plateaus. Baseline clinical, sociodemographic, and radiologic characteristics were captured. Univariate and multivariate (MV) linear regression analyses were performed and marginal effects were employed to examine the relative effect of EVL on renal function. A total of 647 patients who underwent robotic PN had GFR data at a median follow-up of 6 mo. On MV models, EVL was significantly correlated with GFR-P following log transformation (p = 0.001). Each doubling of EVL caused a 1.5% decrease in GFR-P. Ischemia time and tumor complexity were not significantly associated with GFR-P. In summary, GFR-P after PN appears to be significantly associated with the excised volume of benign parenchyma.

Patient summary

At a high-volume tertiary care center, we investigated the impact of surgical factors on kidney function after kidney cancer surgery. We found that the surgical precision with which the tumor is excised significantly impacts kidney function at 3–12 mo after surgery.

Take Home Message

We reviewed a 10-yr database of over 600 patients with glomerular filtration rate data at 3–12 mo after robotic partial nephrectomy. We found that excisional precision significantly mitigates the iatrogenic effects of tumor excision on renal function on multivariate models.

Keywords: Partial nephrectomy, Renal function, GFR preservation, Chronic kidney disease, Excisional volume loss, Surgical precision, Robotic surgery.

Footnotes

Glickman Urological & Kidney Institute, Department of Urology, Cleveland Clinic, Cleveland, OH, USA

Corresponding author. Department of Urology, Cleveland Clinic Foundation, 9500 Euclid Ave., Q10-1, Cleveland, OH 44195, USA. Tel. +1 216-444-2976; Fax: +1 216-636-4492.

Article information

PII: S0302-2838(17)30093-3
DOI: 10.1016/j.eururo.2017.02.004
© 2017 European Association of Urology, Published by Elsevier B.V.

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Re: Archie Fernando, James Pattison, Catherine Horsfield, David D’Cruz, Gary Cook, Tim O’Brien. [18F]-Fluorodeoxyglucose Positron Emission Tomography in the Diagnosis, Treatment Stratification, and Monitoring of Patients with Retroperitoneal Fibrosis:...

Refers to article:

[18F]-Fluorodeoxyglucose Positron Emission Tomography in the Diagnosis, Treatment Stratification, and Monitoring of Patients with Retroperitoneal Fibrosis: A Prospective Clinical Study

Archie Fernando, James Pattison, Catherine Horsfield, David D’Cruz, Gary Cook and Tim O’Brien

Accepted 26 October 2016

Footnotes

a Department of Urology, Chinese PLA General Hospital, Beijing, China

b Department of Rheumatology, Chinese PLA General Hospital, Beijing, China

Corresponding author. Department of Urology, Chinese PLA General Hospital, Beijing, China. Tel. +86 10 66938008; Fax: +86 10 68223575.

Article information

PII: S0302-2838(17)30118-5
DOI: 10.1016/j.eururo.2017.02.029
© 2017 European Association of Urology, Published by Elsevier B.V.

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Treatment Outcomes and Tumor Loss of Heterozygosity in Germline DNA Repair–deficient Prostate Cancer

Abstract Background

Germline mutations in DNA repair genes were recently reported in 8–12% of patients with metastatic castration-resistant prostate cancer (mCRPC). It is unknown whether these mutations associate with differential response to androgen receptor (AR)-directed therapy.

Objective

To determine the clinical response of mCRPC patients with germline DNA repair defects to AR-directed therapies and to establish whether biallelic DNA repair gene loss is detectable in matched circulating tumor DNA (ctDNA).

Design, setting, and participants

We recruited 319 mCRPC patients and performed targeted germline sequencing of 22 DNA repair genes. In patients with deleterious germline mutations, plasma cell-free DNA was also sequenced.

Outcome measurements and statistical analysis

Prostate-specific antigen response and progression were assessed in relation to initial androgen deprivation therapy (ADT) and subsequent therapy for mCRPC using Kaplan–Meier analysis.

Results and limitations

Of the 319 patients, 24 (7.5%) had deleterious germline mutations, with BRCA2 (n = 16) being the most frequent. Patients (n = 22) with mutations in genes linked to homologous recombination were heterogeneous at initial presentation but, after starting ADT, progressed to mCRPC with a median time of 11.8 mo (95% confidence interval [CI] 5.1–18.4). The median time to prostate-specific antigen progression on first-line AR-targeted therapy in the mCRPC setting was 3.3 mo (95% CI 2.7-3.9). Ten out of 11 evaluable patients with germline BRCA2 mutations had somatic deletion of the intact allele in ctDNA. A limitation of this study is absence of a formal control cohort for comparison of clinical outcomes.

Conclusions

Patients with mCRPC who have germline DNA repair defects exhibit attenuated responses to AR-targeted therapy. Biallelic gene loss was robustly detected in ctDNA, suggesting that this patient subset could be prioritized for therapies exploiting defective DNA repair using a liquid biopsy.

Patient summary

Patients with metastatic prostate cancer and germline DNA repair defects exhibit a poor response to standard hormonal therapies, but may be prioritized for potentially more effective therapies using a blood test.

Take Home Message

Metastatic castration-resistant prostate cancer patients with germline DNA repair defects respond poorly to androgen receptor-targeted therapy. However, biallelic gene loss was robustly detected in circulating tumor DNA, suggesting that this patient subset could be prioritized for therapies exploiting defective DNA repair using a liquid biopsy.

Keywords: BRCA2, Circulating tumor DNA, Cell-free DNA, Liquid biopsy, Enzalutamide, Abiraterone, Castration-resistant prostate cancer, DNA repair.

Footnotes

a Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, British Columbia, Canada

b Institute of Biosciences and Medical Technology, University of Tampere, Tampere, Finland

c Department of Medical Oncology, British Columbia Cancer Agency, British Columbia, Canada

d RSM Durham Regional Cancer Centre, Oshawa, Ontario, Canada

e University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, California, USA

Corresponding author. Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, 2660 Oak Street, Vancouver, BC V6H 3Z6, Canada. Tel. +1 604 875 4818; Fax: +1 604 875 5654.

These authors are co-first authors.

These authors are co-senior authors.

Article information

PII: S0302-2838(17)30112-4
DOI: 10.1016/j.eururo.2017.02.023
© 2017 European Association of Urology, Published by Elsevier B.V.

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Corrigendum re: “TMPRSS2-ERG in Blood and Docetaxel Resistance in Metastatic Castration-resistant Prostate Cancer” [Eur Urol 2016;70:709–13]

Refers to article:

TMPRSS2-ERG in Blood and Docetaxel Resistance in Metastatic Castration-resistant Prostate Cancer

Òscar Reig, Mercedes Marín-Aguilera, Gemma Carrera, Natalia Jiménez, Laia Paré, Susana García-Recio, Lydia Gaba, Maria Verónica Pereira, Pedro Fernández, Aleix Prat and Begoña Mellado

Accepted 11 February 2016

November 2016 (Vol. 70, Issue 5, pages 709 - 713)

Footnotes

a Translational Genomics and Targeted Therapeutics in Solid Tumours Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain

b Medical Oncology Department, Hospital Clínic, Barcelona, Spain

c Fundació Clínic per a la Recerca Biomèdica, Barcelona, Spain

d Medical Oncology Department, Hospital Plató, Barcelona, Spain

e Department of Pathology, Hospital Clónic, Barcelona, Spain

f University of Barcelona, Barcelona, Spain

Corresponding author. Medical Oncology Department, Hospital Clínic of Barcelona, Villarroel 170, Barcelona 08036, Spain. Tel. +34 93 227 54 00; Fax: +34 93 454 65 20.

1 These authors contributed equally to this work.

Article information

PII: S0302-2838(17)30116-1
DOI: 10.1016/j.eururo.2017.02.027
© 2017 Published by Elsevier B.V.

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New test distinguishes 'tigers' from 'pussycats' in prostate cancer

MedicalNewsToday - Wed, 03/01/2017 - 08:00
A new test has been developed to make the vital distinction between aggressive and less harmful forms of prostate cancer, helping to avoid sometimes-damaging unnecessary treatment.
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Youth with type 2 diabetes develop complications more often than type 1 peers

MedicalNewsToday - Wed, 03/01/2017 - 08:00
Teens and young adults with type 2 diabetes develop kidney, nerve, and eye diseases - as well as some risk factors for heart disease - more often than their peers with type 1 diabetes in the years...
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Investigational drug shows promise for hard-to-treat renal cancer

MedicalNewsToday - Wed, 03/01/2017 - 02:00
Savolitinib seems to halt tumor progression in some people with papillary renal cell carcinoma - a form of kidney cancer - according to new study results.
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Spontaneous Shrinkage of Testicular Teratoma in a Prepubertal Child

Urology (Gold Journal) In Press - Wed, 03/01/2017 - 00:00
Limited numbers of pediatric intratesticular cystic lesions have been reported. While the majority of pediatric intratesticular cystic masses are benign, natural history of testicular cystic lesion in children has been rarely reported so far. We report a case of intratesticular cystic lesion in a prepubertal child who underwent testis sparing surgery after shrinkage during conservative follow-up. As an initial strategy for intratesticular cystic lesions in prepubertal children, observational approach with serial ultrasonographic evaluations may be a management of choice.
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0:01-0:05 Robotic Ileal Interposition for Radiation-Inducted Ureteral Stricture Disease

Urology (Gold Journal) In Press - Wed, 03/01/2017 - 00:00
To present a novel surgical concept utilizing preoperative imaging to estimate length needed for ileal segment. This enables robotic ileal interposition to be completed with only one position change during surgery.
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The Effect of Oral Phosphodiesterase-5 Inhibitors on Sperm Parameters: a Meta-Analysis and Systematic Review

Urology (Gold Journal) In Press - Wed, 03/01/2017 - 00:00
To perform a systematic review and meta-analysis to evaluate the effect of PDE5 inhibitors on sperm parameters.
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Author Reply

Urology (Gold Journal) In Press - Wed, 03/01/2017 - 00:00
Patients with suspected ureteropelvic junction obstruction (UPJO) and equivocal 99mTc-mercaptoacetyltriglycine (MAG3) diuretic renographic study constitute a diagnostic challenge. The tracer uptake and excretion curve during a nuclear renal scan are functions of complex interactions between renal function, collecting system volume, and outflow obstruction. This creates challenges in translating curve morphology into an easily reported yes or no answer concerning the presence or absence of obstruction.
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