Self-Normalized Detection of ANXA3 from Untreated Urine of Prostate Cancer Patients without Digital Rectal Examination

A noninvasive quantitative assay that is capable of identifying prostate cancer biomarkers in untreated urine is an attractive diagnosis tool, but this method is subject to various obstacles. Difficulties presented by untreated urine include varying salt concentrations, and pH levels that may be different even though they are from the same patient. Untreated urine also presents interference from other biomolecules and possesses a fewer number of cancer biomarkers than can be found in serum. As a result, urine preconditioning processes and digital rectal examination (DRE) to increase biomarker secretion are mandatory in current urine assays. To address these challenges, an ion-responsive urine sensor (IRUS) that measures differential electrical signals is proposed as a self-normalized detection method. The proposed IRUS is based on a FET biosensor with a disposable sensing gate and has the capability to detect the prostate cancer antigen ANXA3 in untreated patient urine. The IRUS can detect ANXA3 at <1 fg mL^-1 with high reliability. In addition, it is found that ANXA3 levels in urine show clinically significant correlation with real tumor volumes. This paper provides a guideline in developing a clinically ready accurate noninvasive platform, which is capable of predicting prostate cancer using untreated urine without DRE.

Adaptive functional change of the contralateral kidney after partial nephrectomy

Partial nephrectomy aims to maintain renal function by nephron sparing; however, functional changes in the contralateral kidney remain unknown. We evaluate the functional change in the contralateral kidney using a diethylene triamine penta-acetic acid (DTPA) renal scan and determine factors predicting contralateral kidney function after partial nephrectomy. A total of 699 patients underwent partial nephrectomy, with a DTPA scan before and after surgery to assess the separate function of each kidney. Patients were divided into three groups according to initial contralateral glomerular filtration rate (GFR; group 1: <30 ml·min−1·1.73 m−2, group 2: 30–45 ml·min−1·1.73 m−2, and group 3: ≥45 ml·min−1·1.73 m−2). Multiple-regression analysis was used to identify the factors associated with increased GFR of the contralateral kidney over a 4-yr postoperative period. Patients in group 1 had a higher mean age and hypertension history, worse American Society of Anesthesiologists score, and larger tumor size than in the other two groups. The ipsilateral GFR changes at 4 yr after partial nephrectomy were −18.9, −3.6, and 3.9% in groups 1, 2, and 3, respectively, whereas the contralateral GFR changes were 10.8, 25.7, and 38.8%. Age [β: −0.105, 95% confidence interval (CI): −0.213; −0.011, P < 0.05] and preoperative contralateral GFR (β: −0.256, 95% CI: −0.332; −0.050, P < 0.01) were significant predictive factors for increased GFR of the contralateral kidney after 4 yr. The contralateral kidney compensated for the functional loss of the ipsilateral kidney. The increase of GFR in contralateral kidney is more prominent in younger patients with decreased contralateral renal function.

Downregulation of androgen receptors by NaAsO2 via inhibition of AKT-NF-κB and HSP90 in castration resistant prostate cancer

BACKGROUND

Androgen and androgen receptor (AR) play essential roles in the development and maintenance of prostate cancer. The recently identified AR splice variants (AR-Vs) have been considered as a plausible mechanism for the primary resistance against androgen deprivation therapy (ADT) in castration-resistant prostate cancer (CRPC). Sodium meta-arsenite (NaAsO₂ ; KML001; Kominox), a trivalent arsenical, is an orally bioavailable and water soluble, which is currently in phase I/II clinical trials for the treatment of prostate cancer. It has a potent anti-cancer effect on prostate cancer cells and xenografts. The aim of this study was to examine the effect of NaAsO₂ on AR signaling in LNCaP and 22Rv1 CRPC cells.

METHODS

We used hormone-sensitive LNCaP cells, hormone-insensitive 22Rv1 cells, and CRPC patient-derived primary cells. We analyzed anti-cancer effect of NaAsO₂ using real-time quantitative reverse transcription-PCR, Western blotting, immunofluorescence staining and CellTiter Glo® luminescent assay. Statistical evaluation of the results was performed by one-way ANOVA.

RESULTS

NaAsO₂ significantly reduced the translocation of AR and AR-Vs to the nucleus as well as their level in LNCaP and 22Rv1 cells. Besides, the level of the prostate-specific antigen (PSA), downstream target gene of AR, was also decreased. This compound was also an effective modulator of AKT-dependent NF-κB activation which regulates AR. NaAsO₂ significantly inhibited phosphorylation of AKT and expression and nuclear translocation of NF-κB. We then investigated the effect of NaAsO₂ on AR stabilization. NaAsO₂ promoted HSP90 acetylation by down-regulating HDAC6, which reduces the stability of AR in prostate cancer cells.

CONCLUSIONS

Here, we show that NaAsO₂ disrupts AR signaling at multiple levels by affecting AR expression, stability, and degradation in primary tumor cell cultures from prostate cancer patients as well as CRPC cell lines. These results suggest that NaAsO₂ could be a novel therapeutics for prostate cancer.

Neurovascular bundle size measured on 3.0-T magnetic resonance imaging is associated with the recovery of erectile function after robot-assisted radical prostatectomy

BACKGROUND AND OBJECTIVE

Erectile dysfunction is one of the complications occurring after radical prostatectomy (RP), and recovery of erectile function is quantitatively related to the preservation of the neurovascular bundles (NVB).We evaluated the significance of NVB area on functional outcomes after RP.

MATERIALS AND METHODS

Preoperative magnetic resonance imaging was performed on 141 patients who underwent bilateral, nerve-sparing, robot-assisted RP for clinically localized prostate cancer (clinically T2N0M0 on magnetic resonance imaging) and were evaluated at least 12 months after surgery. NVB area was measured as a region of interest that coincided with the outline of the maximum area of the posterolateral region of the prostate on T2-weighted axial imaging. Factors associated with functional outcomes were evaluated using logistic regression analysis.

RESULTS

Of 141 patients, 36 patients (25.5%) had no preoperative potency (group 1), 66 patients (46.8%) recovered potency (group 2), and 39 patients (27.7%) did not recover potency (group 3). Although the mean age of the entire cohort was 65.4 years, the mean age of group 1 was greater than groups 2 and 3 (P = 0.001). The NVB area of group 2 was larger than those of groups 1 and 3 (P = 0.001). Potency evaluations involved 105 patients (74.5%; groups 2 and 3), and patients with pre-existing erectile dysfunction were excluded. The median time to potency recovery was 3.0 months after surgery. The multivariable analysis revealed that the NVB area was the only significant factor predictive of potency recovery.

CONCLUSIONS

The NVB area in the posterolateral region of the prostate is an independent factor for predicting potency recovery. The degree of postoperative erectile function can be predicted based on the preoperative NVB area.

Prognostic Factors for Survival of Patients With Synchronous or Metachronous Brain Metastasis of Renal Cell Carcinoma

INTRODUCTION

We evaluated the oncological outcomes of synchronous or metachronous brain metastasis (BM) of metastatic renal cell carcinoma (RCC) according to clinicopathologic factors.

PATIENTS AND METHODS

Patients with metastatic RCC (n = 93) with synchronous and metachronous BM were retrospectively identified. We analyzed patients and tumor characteristics, treatment methods, prognostic factors, BM progression, and overall survival (OS).

RESULTS

Seventy-six patients (81.7%) received local therapy (stereotactic radiosurgery [60.2%], radiation therapy [22.6%], and neurosurgery [10.8%]), and 54 patients (58.1%) were treated with systemic medical therapy. In multivariable analysis, poor Memorial Sloan-Kettering Cancer Center (MSKCC) risk (hazard ratio [HR] 3.672; 95% confidence interval [CI], 1.441-9.36; P = .0064), sarcomatoid component (HR 4.264; 95% CI, 2.062-8.820; P = .0001), and multiple BMs (HR 2.838; 95% CI, 1.690-4.767; P = .0001) were prognostic indicators of a poorer OS outcome. Local (HR 0.436; 95% CI, 0.237-0.802; P = .0076) and systemic treatment (HR 0.322; 95% CI, 0.190-0.548; P < .0001) were independent factors for a better OS. Although OS from initial RCC diagnosis in patients with metachronous BM was better than that for patients with synchronous BM, there were no differences found between synchronous and metachronous patients in terms of BM progression and OS after the diagnosis of BM.

CONCLUSIONS

Poor MSKCC risk, sarcomatoid component of histology, and multiple BMs are prognostic indicators for poor OS in patients with BM from metastatic RCC. Systemic and/or local treatment improves the OS. Because the type of BM, synchronous or metachronous, does not influence BM progression or the OS outcome, routine evaluation for BM is not recommended.

Is suspicious upstaging on multiparametric magnetic resonance imaging useful in improving the reliability of Prostate Cancer Research International Active Surveillance (PRIAS) criteria? Use of the K-CaP registry

BACKGROUND AND OBJECTIVE

To evaluate the clinical effects of suspicious upstaging on multiparametric magnetic resonance imaging (mpMRI) for improving the quality of Prostate Cancer Research International Active Surveillance (PRIAS) criteria.

MATERIAL AND METHODS

A total of 363 patients with low-risk prostate cancer (PCa) were selected from the K-CaP registry (the multicenter Korean PCa Database). Patients were divided into 2 groups according to the results of mpMRI (with or without suspicious upstaging). The variables for predicting significant PCa, defined as locally advanced PCa, Gleason score≥7, or tumor volume>0.5cc or all of these, and adverse PCa, defined as locally advanced PCa, Gleason score≥7 (4+3), or tumor volume>2.5cc or all of these, were assessed.

RESULTS

The mpMRI led to "suspicious" upstaging in 56 patients (15.4%). Significant PCa (98.2% vs. 74.6%, P<0.001) and adverse PCa (85.7% vs. 32.6%, P<0.001) were more common in patients with suspicious upstaging. The sensitivity/specificity of mpMRI for significant PCa and adverse PCa were 25.4%/98.2% and 32.4%/96.3%, respectively. On multivariate analyses, suspicious upstaging on mpMRI (odds ratio: 15.82, P = 0.007) was a predictor for significant PCa in addition to PRIAS criteria and age at diagnosis. In addition, suspicious upstaging on mpMRI (odds ratio: 11.11, P<0.001) was a significant predictor for adverse PCa in addition to PRIAS criteria, age at diagnosis, and body mass index.

CONCLUSION

Along with the PRIAS criteria, suspicious upstaging on mpMRI is a potent diagnostic tool for distinguishing patients suitable for active surveillance among patients with low-risk PCa.

Prognostic heterogeneity in T3aN0M0 renal cell carcinoma according to the site of invasion

PURPOSE

We investigated the influence of the site of invasion on recurrence and survival in patients with pT3aN0M0 renal cell carcinoma (RCC).

MATERIALS AND METHODS

We reviewed the data of 266 patients with pT3aN0M0 RCC who underwent nephrectomy and divided them into the following 5 groups according to the site of invasion: perinephric invasion (PNI), sinus fat invasion (SFI), PNI and SFI without renal vein invasion (RVI) (i.e., PNI+SFI), RVI, and RVI with PNI and/or SFI (RVI+PNI±SFI). Subgroup analysis was performed to verify the differences in prognosis according to the extent of renal vein invasion using Cox regression models.

RESULTS

A total of 111 patients (41.7%) experienced recurrence and 59 patients (22.2%) died of disease during follow-up (median = 58.1mo; interquartile range: 37.2-86.5). Patients with RVI showed significantly poorer outcomes than those with fat invasion in terms of 5-year recurrence-free survival (34.3% vs. 62.2%, P<0.001) and cancer-specific survival (62.8% vs. 84.1%; P<0.001). In multivariate analysis, RVI was an independent prognostic factor for recurrence and survival. In 94 patients with RVI, the 5-year recurrence-free survival rates were 50.0%, 33.9%, and 8.9% for the thrombus-only, the vascular wall invasion with negative surgical margin, and the vascular wall invasion with positive surgical margin groups, respectively (P<0.001), and the cancer-specific survival rates were 82.3%, 56.6%, and 20.0%, respectively (P<0.001). Wall invasion was the only independent prognostic factor for cancer-specific survival in these patients.

CONCLUSIONS

Patients with pT3aN0M0 RCC with RVI have a significantly poorer prognosis than those with fat invasion. The prognosis differs according to the extent of RVI. Wall invasion should be considered a negative prognostic indicator in patients with T3a RCC.

Report of the Second Asian Prostate Cancer (A-CaP) Study Meeting

The Asian Prostate Cancer (A-CaP) Study is an Asia-wide initiative that has been developed over the course of 2 years. The study was launched in December 2015 in Tokyo, Japan, and the participating countries and regions engaged in preparations for the study during the course of 2016, including patient registration and creation of databases for the purpose of the study. The Second A-CaP Meeting was held on September 8, 2016 in Seoul, Korea, with the participation of members and collaborators from 12 countries and regions. Under the study, each participating country or region will begin registration of newly diagnosed prostate cancer patients and conduct prognostic investigations. From the data gathered, common research themes will be identified, such as comparisons among Asian countries of background factors in newly diagnosed prostate cancer patients. This is the first Asia-wide study of prostate cancer and has developed from single country research efforts in this field, including in Japan and Korea. At the Second Meeting, participating countries and regions discussed the status of preparations and discussed various issues that are being faced. These issues include technical challenges in creating databases, promoting participation in each country or region, clarifying issues relating to data input, addressing institutional issues such as institutional review board requirements, and the need for dedicated data managers. The meeting was positioned as an opportunity to share information and address outstanding issues prior to the initiation of the study. In addition to A-CaP-specific discussions, a series of special lectures was also delivered as a means of providing international perspectives on the latest developments in prostate cancer and the use of databases and registration studies around the world.

Comparison of outcomes between trimodal therapy and radical cystectomy in muscle-invasive bladder cancer: a propensity score matching analysis

Although radical cystectomy (RC) is considered as the standard therapy for muscle-invasive bladder cancer (MIBC), trimodal therapy (TMT) combining transurethral resection of the tumor with radiotherapy and chemotherapy is increasingly recommended as an alternative approach for bladder preservation. In the absence of randomized trials, we compared the clinical outcomes between RC and TMT using propensity score matching with 50 patients in the RC arm and 29 patients in the TMT arm. With respective median follow-up periods of 23 and 32 months for the RC and TMT groups, 5-year distant metastasis-free survival (58% vs. 67%), overall survival (56% vs. 57%), and cancer-specific survival (69% vs. 63%) rates between the RC and TMT groups, respectively, were similar. However, the 5-year local recurrence-free survival was significantly better in the RC group than in the TMT group (74% vs. 35%). Following TMT, acute grade 3 hematological (n = 2) and late grade 3 genitourinary (n = 1) toxicities were reported. These findings demonstrated that oncological outcomes of TMT were comparable with those of RC, except for poorer local control. Large-scale, randomized trials are warranted to confirm the findings of the present retrospective comparison and to guide toward best treatment options.

Re-stratification of Patients with High-Risk Prostate Cancer According to the NCCN Guidelines among Patients Who Underwent Radical Prostatectomy: An Analysis Based on the K-CaP Registry

PURPOSE

The present study aimed to re-stratify patients with high-risk prostate cancer according to the National Comprehensive Cancer Network guidelines among patients who underwent radical prostatectomy (RP).

MATERIALS AND METHODS

This study used the Korean Prostate Cancer Database registry and identified 1,060 patients with high-risk prostate cancer who underwent RP between May 2001 and April 2013. All patients were categorized into risk groups, and subgroups were identified according to the type and number of high-risk factors.

RESULTS

Of the 1,060 high-risk patients, 599 (56.5%), 408 (38.5%), and 53 (5.0%) had 1, 2, and 3 risk factors, respectively. In multivariate analysis, the Gleason score, percentage of positive biopsy cores, and number of risk factors present were identified as independent predictors of biochemical recurrence. There were significant differences in the 5-year postoperative biochemical failure-free survival (BCFFS) rate among the different high-risk factor subgroups (log-rank p < 0.001). There were no significant differences in the BCFFS rate between the subgroup of high-risk patients with a prostate-specific antigen level > 20 ng/mL alone and the intermediate-risk group with all factors (log-rank p=0.919 and p=0.781, respectively). Additionally, no significant difference was noted in the BCFFS rate between high-risk patients having all factors and those in the very-high-risk group (p=0.566).

CONCLUSION

We successfully re-stratified patients with high-risk prostate cancer and identified the combinations of high-risk criteria that will help in the selection of patients for RP.

Recovery of renal function after administration of adipose-tissue-derived stromal vascular fraction in rat model of acute kidney injury induced by ischemia/reperfusion injury

Acute kidney injury (AKI) induced by ischemia/reperfusion (I/R) injury is a major challenge in critical care medicine. The purpose of this study is to determine the therapeutic effects of the adipose-tissue-derived stromal vascular fraction (SVF) and the optimal route for SVF delivery in a rat model of AKI induced by I/R injury. Fifty male Sprague-Dawley rats were randomly divided into five groups (10 animals per group): sham, nephrectomy control, I/R injury control, renal arterial SVF infusion and subcapsular SVF injection. To induce AKI by I/R injury, the left renal artery was clamped with a nontraumatic vascular clamp for 40 min, and the right kidney was removed. Rats receiving renal arterial infusion of SVF had a significantly reduced increase in serum creatinine compared with the I/R injury control group at 4 days after I/R injury. The glomerular filtration rate of the renal arterial SVF infusion group was maintained at a level similar to that of the sham and nephrectomy control groups at 14 days after I/R injury. Masson's trichrome staining showed significantly less fibrosis in the renal arterial SVF infusion group compared with that in the I/R injury control group in the outer stripe (P < 0.001). TUNEL labeling showed significantly decreased apoptosis in both the renal arterial SVF infusion and subcapsular SVF injection groups compared with the I/R injury control group in the outer stripe (P < 0.001). Thus, renal function is effectively rescued from AKI induced by I/R injury through the renal arterial administration of SVF in a rat model.

Simple renal cyst and renal dysfunction: A pilot study using dimercaptosuccinic acid renal Scan

AIM

Little is known about the association between renal cyst and renal dysfunction. We evaluated the deterioration of renal function in patients with unilateral, large, simple renal cysts.

METHODS

Fifty patients with unilateral, simple renal cysts measuring ≥ 4 cm (cyst group) and 50 kidney donors (control group) were enrolled. Dimercaptosuccinic acid (DMSA) renal scans were performed to calculate split renal function. The differences between split renal function were calculated and compared. Clinical factors affecting decreased renal function in the cyst group were assessed.

RESULTS

The mean age of the patients in the cyst group was higher than the control group (59.1 vs 39.2 years; P = 0.001). Patients with renal cysts tended to be diagnosed with hypertension (P = 0.001), However, the two groups did not significantly differ in terms of the other characteristics. The median cyst size was 7.2 cm (range, 4.5-14.2), and 31 of the 50 patients (60.2%) in the cyst group demonstrated decreased renal function in the cystic kidney units (median: 5.8%; range, 0.2-33). Although there were no differences in split renal function (50.1% vs 49.9%; P = 0.629) in the control group, the relative renal function of the cystic kidney units were significantly lower than the contralateral kidney units in the cyst group (48.3% vs 51.7%; P = 0.001). The decrease in relative renal function (>8%) in the cystic kidney units was associated with a higher serum uric acid levels and higher RENAL complexity (P = 0.035 and P = 0.007, respectively).

CONCLUSION

A significant proportion of unilateral, large, simple renal cysts are associated with decreased relative renal function on DMSA renal scans.