2020-2 — Summary
Efficacy of neoadjuvant hormonal treatment before radical prostatectomy for high-risk clinically localised prostate carcinomas
DOI: 10.22591/magyurol.2020.2.berczics.53
Authors:
Berczi Csaba dr., Dócs János dr., Flaskó Tibor dr.
Debreceni Egyetem Általános Orvostudományi Kar, Urológiai Tanszék, Debrecen (igazgató: Flaskó Tibor dr.)
Summary
Aims: To measure the efficacy of neoadjuvant hormonal therapy before multimodal treatment of patients with clinically localized high-risk prostate carcinomas.
Methods: From January 1996 to January 2019, 394 patients underwent radical prostatectomy for clinically localized high-risk prostate cancer. In Group 1 the patients neoadjuvant hormonal treatment (n: 98) was administered, while in Group 2 the patients didn’t receive any neoadjuvant hormonal treatment (n: 296). In Group 1, the mean age of the patients was 64.6 ± 6.1 years and the mean PSA level was 32.9 ng/mL. In Group 2, the mean age of the patients was 63.8 ± 6.4 years, and the mean PSA concentration was 25.4 ng/mL. In all cases the preoperative imaging examinations showed clinically localized prostate tumor.
Results: Histology revealed locally advanced tumor (pT3) in 36 cases (36.9%) in Group 1, and in 154 patients (52.0%) in Group 2 (p = 0.012). Margin positivity was detected in 18 patients (18.3%) in Group 1, while it was proved in 91 cases (30.7%) in Group 2 (p = 0.02).
The median follow-up period was 56 months. In Group 1, biochemical progression developed in 19 patients (19.3%). Local recurrence and distant metastasis were diagnosed in 3 cases (3.0%) and in 6 occasions (6.1%) during this period. In Group 2, biochemical progression was diagnosed in 41 cases (13.8%), local recurrence in 8 patients (2.7%) and distant metastasis in 7 occasions (2.3%). There was no significant difference regarding to these parameters in the two groups. Tumor specific mortality was 3.0% in both groups (p = 0.991).
Conclusions: The results showed that the neoadjuvant hormonal therapy provided significantly better local tumor control in clinically localized high-risk prostate carcinomas. However, the neoadjuvant hormonal therapy didn’t prove any advantage according to tumor progression and tumor specific survival.
LAPSZÁM: MAGYAR UROLÓGIA | 2020 | 32. ÉVFOLYAM, 2. SZÁM
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New treatment options for non-metastatic castration resistant (nmCRPC) prostate cancer
DOI: 10.22591/magyurol.2020.2.geczil.58
Authors:
Géczi Lajos dr.
Országos Onkológiai Intézet, Urogenitalis Tumorok és Klinikai Farmakológiai Osztály, Budapest (osztályvezető: Géczi Lajos dr.)
Summary
In this rewiev the author presents the results of SPARTAN, PROSPER and ARAMIS studies in nmCRPC. In the main clinical endponds (MFS, PFS, OS) apalutamid, enzalutamid and darolutamid in combination with androgen deprivation therapy (ADT) showed significant advantage compare to placebo and ADT. After these phase III clinical studies new standard treatment possibilities are available for clinicians in nmCRPC.
LAPSZÁM: MAGYAR UROLÓGIA | 2020 | 32. ÉVFOLYAM, 2. SZÁM
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Uro-oncologic aspects of Covid-19 research
DOI: 10.22591/magyurol.2020.2.fazekast.61
Authors:
Fazekas Tamás dr., Csizmarik Anita, Szarvas Tibor dr., Szűcs Miklós dr., Nyirády Péter dr.
Semmelweis Egyetem, Urológiai Klinika, Budapest (igazgató: Nyirády Péter dr.)
Summary
The SARS-2 Coronavirus and its related disease Covid-19 has dramatically changed our medical practice and daily lives in the last few months. During the fight against the epidemic, valuable scientific data have been obtained from the field of uro-oncology. Both the TMPRSS2 protein which enables viral cell entry, and Bacillus Calmette-Guérin (BCG) vaccination, which seems to have protective effect against the virus have important urologic aspects.
In this review we summarize the latest results on these topics and highlight unique opportunities for further research.
LAPSZÁM: MAGYAR UROLÓGIA | 2020 | 32. ÉVFOLYAM, 2. SZÁM
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Difficulties in the distinguish between in situ carcinoma and interstitial cystitis of the bladder based on 5 cases
DOI: 10.22591/magyurol.2020.2.becsia.64
Authors:
Bécsi Áron dr.1, Nyirády Péter dr.1, Székely Eszter dr.2, Majoros Attila dr.1
1Semmelweis Egyetem, Urológiai Klinika és Uroonkológiai Centrum, Budapest (igazgató: Nyirády Péter dr.)
2Semmelweis Egyetem, II. sz. Patológiai Intézet, Budapest (igazgató: Kiss András dr.)
Summary
Introduction: The clinical presentation of carcinoma in situ (CIS) and interstitial cystitis (IC) can be quite similar, but the two diseases require completely different treatment. Making the right diagnosis can be difficult ultimately the histopathologic sample from the suspicious lesion of the bladder can give us the correct answer. In this paper we present five cases in which the similarities and differences of these two diseases are pointed out. To assure safe and best possible treatment for the future patients with such symptoms we suggest some practical diagnostic recommendations.
Case reports (patients and method, results): Five cases are presented with the typical symptoms of IC, but the histopathological findings proved CIS. According to the histological diagnosis the patients received oncological treatment according the European Association Urological Guideline.
Conclusion: Although IC and CIS can present similar lower urinary symptoms, it is essential to distinguish the two diseases. The two diseases require completely different treatment. Treating CIS as if it was IC by mistake can lead to the progression of bladder cancer, therefore risking the lives of our patients. Taking histological sample is essential for the accurate diagnosis. In authors’ opinion before starting invasive treatment for IC suspect patients biopsy of the urinary bladder is necessary, for the exclusion of the CIS.
LAPSZÁM: MAGYAR UROLÓGIA | 2020 | 32. ÉVFOLYAM, 2. SZÁM
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Rare scrotal manifestation of pancreatitis – The role of early differential diagnostics
DOI: 10.22591/magyurol.2020.2.juhaszd.69
Authors:
Juhász Dániel dr., Nyirády Péter dr., Majoros Attila dr.
Semmelweis Egyetem, Urológiai Klinika és Uroonkológiai Centrum, Budapest (igazgató: Nyirády Péter dr.)
Summary
Introduction: Acute scrotum is an acute condition associated with swelling of the testicles and pain, which can be caused by inflammation, trauma and torsion of testicles and testicular appendices. As a complication of the inflammation of the pancreas an abscess can occur. Scrotal involvement is a literary rarity. This is a case report of a patient with chronic pancreatitis, scrotal swelling and pain causing problem in early differential diagnostics.
Case report: A 49-year-old male patient with progressive left side scrotal and lower abdominal pain, left side testicular swelling and penis edema attended the outpatient’s clinic. Physical examination and ultrasonography (US) of testicles arose the possibility of genital inflammation, but the intact male adnexal morphology raised the possibility of secondary process. The abdominal and pelvic CT-scan showed a large left-sided retroperitoneal multiregional abscess system with a propagation towards the back muscles presuming a pancreatic origin. After a surgical drainage the patient could be treated conservatively.
Discussion and conclusion: Scrotal swelling and pain can occur in case of acute retroperitoneal abscess, which is a rare complication of pancreatitis. In case of acute scrotum, if the etiology is unclear secondary origin shall be assumed. As a result of the correct differential diagnostics, the patient received targeted conservative therapy and no scrotal exploration was needed. In case of acute scrotum, prior to perform surgical exploration of the scrotum, correct differential diagnostics and treatment should be performed, additional tests can clarify the diagnosis.