Metachronous renal cell carcinoma: an unbeatable leviathan?

Renal Cell Carcinoma Metastasis to the Small Bowel: A Rare Finding 10 Years After Nephrectomy

Renal cell carcinoma (RCC) most commonly metastasizes to the lung, lymph nodes, bone, and liver. RCC metastasizing to the small bowel is exceedingly rare (0.7%), and the ileum is the least likely site. We discuss the case of a 63-year-old male patient who presented with melena and a 10-kg unintentional weight loss in the preceding month 10 years after undergoing curative nephrectomy for RCC; he was found to have an ileal mass on CT imaging. He subsequently underwent a diagnostic gastroscopy and laparoscopy, later converted to a laparotomy, with bowel resection and anastomosis. The immunohistochemistry was consistent with RCC. This case report highlights the need for awareness about this rare but potential site of metastasis, which may present with gastrointestinal bleeding.

Neoadjuvant Strategies Before Radical Prostatectomy for High Risk Prostate Cancer in the Era of New Hormonal Agents

Prostate cancer (PCa) is a hormone-dependent disease, including several different patterns from indolent and clinically meaningless to aggressive and lethal disease. Among non -metastatic PCa, high-risk disease represents a therapeutical challenge, given the unfavorable oncological outcomes after exclusive local therapy. Deprivation therapy in the neoadjuvant setting is not recommended prior to radical prostatectomy since it did not provide any survival advantage, although reducing tumor volume, surgical margins rate, local and nodal stage. However, in the few recent years, new hormonal treatments for metastatic PCa emerged and showed a relevant increase of overall survival concerning standard androgen deprivation therapy (ADT). Thus, neo-adjuvant regimens of ADT based on these novel molecules are now under investigation and the results of ongoing clinical trials are expected in order to provide a definitive answer on the real role of neoadjuvant hormonal therapy in the treatment of high-risk localized prostate cancer. In this narrative review, we underline the role of neoadjuvant therapy before radical prostatectomy in high-risk PCa patients considering the impact of the new available hormonal agents.