The sentinel node with technetium-99m for prostate cancer. A safe and mature new gold standard?

BACKGROUND

The objective was to carry out a prospective study to compare the current extended pelvic lymph node dissection (ePLND) to the sentinel node (SN) technique with 99mTcnanocolloid.

METHODS

We conducted a prospective study between January 2013 and May 2020. In the first 74 patients, 99mTc-nanocolloid was used. Then from June 2017 onwards, in 38 patients we used a combined radiotracer prepared by adding indocyanine green (ICG). A preoperative SPECT/CT was also performed to check on the SNs. We extracted the SNs guided by a laparoscopic gamma-ray detection probe and/or a fluorescence camera.

RESULTS

We included 112 patients with a Briganti nomogram-assessed risk of 5% or more. In 4 out of the total, the radiotracer did not migrate. The mean number of extracted nodes was 21.56 (13.46-29.71) and the mean of extracted SNs was 5.17 (1.83-8.51) (P<0.001). The technique that registered the most nodes with high activity was SPECT/CT, with an average of 4.33 nodes (2.42-6.23) (P<0.001). We found SNs outside the template in 78% of the patients. A total of 46% of the complications were related to ePLND. The SN biopsy showed a sensitivity of 100%, specificity of 97.5%, PVV of 92.86%, and NPV of 100%.

CONCLUSIONS

Our results prove that ePLND is a technique with significant morbidity; up to 46% of the complications were related to the ePLND. The SN surgery showed great accuracy in detecting metastases due to the SPECT/CT and a lower rate of complications than ePLND.

Bladder cancer patients have increased NETosis and impaired DNaseI-mediated NET degradation that can be therapeutically restored in vitro

Background

Neutrophils, key players of the immune system, also promote tumor development through the formation of neutrophil extracellular traps (NETs) in a process called NETosis. NETs are extracellular networks of DNA, histones and cytoplasmic and granular proteins (calprotectin, myeloperoxidase, elastase, etc.) released by neutrophils upon activation. NETs regulate tumor growth while promoting angiogenesis and invasiveness, and tumor cells also stimulate NETosis. Although NETosis seems to be increased in cancer patients, an increase of NETs in plasma may also be mediated by an impaired degradation by plasma DNaseI, as evidenced in several immunological disorders like lupus nephritis. However, this has never been evidenced in bladder cancer (BC) patients. Herein, we aimed to evaluate the occurrence of increased NETosis in plasma and tumor tissue of BC patients, to ascertain whether it is mediated by a reduced DNaseI activity and degradation, and to in vitro explore novel therapeutic interventions.

Methods

We recruited 71 BC patients from whom we obtained a plasma sample before surgery and a formalin-fixed paraffin embedded tumor tissue sample, and 64 age- and sex-matched healthy controls from whom we obtained a plasma sample. We measured NETs markers (cell-free fDNA, calprotectin, nucleosomes and neutrophil elastase) and the DNaseI activity in plasma with specific assays. We also measured NETs markers in BC tissue by immunofluorescence. Finally, we evaluated the ability of BC and control plasma to degrade in vitro-generated NETs, and evaluated the performance of the approved recombinant human DNaseI (rhDNaseI, Dornase alfa, Pulmozyme^®, Roche) to restore the NET-degradation ability of plasma. In vitro experiments were performed in triplicate. Statistical analysis was conducted with Graphpad (v.8.0.1).

Results

NETosis occurs in BC tissue, more profusely in the muscle-invasive subtype (P<0.01), that with the worst prognosis. Compared to controls, BC patients had increased NETosis and a reduced DNaseI activity in plasma (P<0.0001), which leads to an impairment to degrade NETs (P<0.0001). Remarkably, this can be therapeutically restored with rhDNaseI to the level of healthy controls.

Conclusion

To the best of our knowledge, this is the first report demonstrating that BC patients have an increased NETosis systemically and in the tumor microenvironment, in part caused by an impaired DNaseI-mediated NET degradation. Remarkably, this defect can be therapeutically restored in vitro with the approved Dornase alfa, thus Pulmozyme^® could become a potential therapeutic tool to locally reduce BC progression.

Circulating Cell-Free DNA in Liquid Biopsies as Potential Biomarker for Bladder Cancer: A Systematic Review

Bladder cancer (BC) is among the most frequent cancer types in the world and is the most lethal urological malignancy. Presently, diagnostic and follow-up methods for BC are expensive and invasive. Thus, the identification of novel predictive biomarkers for diagnosis, progression, and prognosis of BC is of paramount importance. To date, several studies have evidenced that cell-free DNA (cfDNA) found in liquid biopsies such as blood and urine may play a role in the particular scenario of urologic tumors, and its analysis may improve BC diagnosis report about cancer progression or even evaluate the effectiveness of a specific treatment or anticipate whether a treatment would be useful for a specific patient depending on the tumor characteristics. In the present review, we have summarized the up-to-date studies evaluating the value of cfDNA as potential diagnostic, prognostic, or monitoring biomarker for BC in several biofluids.

FIRST STEPS TOWARDS ORGAN BANKS: VITRIFICATION OF RENAL PRIMORDIAL

BACKGROUND

Kidney transplantation from deceased or living human donors has been limited by donor availability as opposed to the increasing demand, by the risks of allograft loss rejection and immunosuppressive therapy toxicity and by limitations of organ preservation protocols, which is essential to organise staff and facilities, transport organs, and perform necessary laboratory tests. However, the cryopreservation of composite tissues poses technical challenges beyond those seen in the preservation of single tissue types or organs.

OBJECTIVE

The purpose of our study was to establish a protocol for long-term storing of renal primordia, that generates new adult kidneys after transplant into a syngeneic non-immunosuppressed host.

MATERIALS AND METHODS

Metanephroi from 16-days-old embryos were microdissected and vitrified following the minimum essential volume method and using Cryotop as a device and VM3 as vitrification solution. After 3 months of storage in liquid nitrogen (-196 degree C), 20 metanephroi were warmed and transplanted using minimally invasive laparoscopic surgery into retroperitoneal fat of 5-month-old immune-competent New Zealand rabbits. In the same way, 22 fresh metanephroi were transplanted. Twenty-one days after transplantation, hosts were euthanized and developed kidneys were recovered and evaluated morphologically and histologically.

RESULTS

Significant growth and fully differentiated mature glomeruli and tubule were observed in all kidney graft explants recovered. In total, 5 metanephroi (25.0%) were successfully grown after vitrification. In the same way, 12 metanephroi (54.5%) were successfully grown in the fresh group.

CONCLUSION

These encouraging results reported that metanephroi not only survive vitrification, but they vascularized and developed morphologically normal glomeruli after their allotransplantation. These results suggest that it's possible to create a long-term biobank of kidney precursors as an unlimited source of organs for transplantation, and open new therapeutic possibilities for the patients with chronic renal failure.

Cutaneous horn in glans penis: a new clinical case

This report presents a case of a 65-year-old male suffering from a penile cutaneous horn. This lesion is usually seen in sun-exposed areas and its occurrence on the penis is rare. One-third of cases of penile horns are associated with underlying malignancies. Standard treatment is electrosurgical excision with removal of a broad base.

Intravesical immunoprophylaxis in recurrent superficial bladder cancer (Stage T1): multicenter trial comparing bacille Calmette-Guérin and interferon-alpha

OBJECTIVES

To estimate and compare recurrence rates, index of recurrence, and disease-free interval in patients with superficial recurrent bladder cancer receiving bacille Calmette-Guérin (BCG) or interferon (IFN) for immunoprophylaxis.

METHODS

One hundred twenty-two patients with recurrent superficial Stage pT1, grade 1 to 3 tumors were enrolled in a randomized, prospective, multicenter trial with two treatment arms of endovesical immunoprophylaxis: 150 mg of BCG versus 54 MU of recombinant IFN-alpha-2a. Administration was weekly during the first month, biweekly for 2 months, and monthly for 9 months. Both groups were similar with regard to tumor stage, grade, size, and number.

RESULTS

Sixty-one patients were evaluable in the BCG group and 49 in the IFN group. Tumors recurred in 34 (69.4%) of 49 patients in the IFN group (890 months of follow-up) and in 24 (39.3%) of 61 in the BCG group (1272 months of follow-up). The total number of recurrences (28 for BCG, 47 for IFN), disease-free interval (mean 19.3 months for BCG, 15.3 months for IFN), and index of recurrence (2.2 for BCG, 5.5 for IFN) were statistically significant (P = 0.001) in favor of BCG. Progression to invasive carcinoma was similar in both study arms. Neither systemic nor local side effects were seen in the IFN group. However, the previously reported toxicity of BCG was confirmed.

CONCLUSIONS

According to our trial, BCG remains the most efficacious agent for immunoprophylaxis of recurrent superficial bladder tumors.

Carcinoma of prostatic ducts

Carcinoma of prostatic ducts is a rare clinical feature. We have reviewed 398 histories of patients with histologic diagnosis of prostatic carcinoma and found 10 patients with the ductal variety (2.51%). Four had pure ductal transitional cell carcinoma, 5 had mixed acinar adenocarcinoma plus ductal transitional cell carcinoma, and the last one had mixed acinar and ductal adenocarcinoma. Age, symptoms, physical findings, and imaging diagnoses were similar to those of acinar carcinoma. Rectal examination disclosed hard prostate in 9 patients. The metastatic way depended on the histologic elements present in each patient. Cystoscopy showed a malignant-resembling image in 4 cases. The mean survival (23 months) was lower than that of patients with acinar carcinoma. Early diagnosis and radical surgery still are the only way to increase the expectation of life of patients affected by this pathology.

Follow-up of superficial bladder cancer: how to spare cystoscopies?

To study the efficacy, specificity and sensitivity of ultrasonography, cytology and phospholipid/fatty acid quotient (PL/FA) in the detection of recurrences in patients with superficial bladder cancer we performed these three examinations simultaneously with cystoscopy. In over 405 cystoscopies, 348 were negative and 57 were positive for tumor. Sensitivity, the most important parameter, was 73% for the three examinations together. Each method separately had the following sensitivity: ultrasound 26%; cytology 14%, and PL/FA 47%. Considering that there were only 15 false-negatives, with this follow-up scheme we save the patient from a lot of cystoscopies, avoiding their inherent morbidity.

Selective chemoprophylaxis guided by multifactorial analysis in superficial bladder cancer

One hundred and five patients with superficial bladder cancer (60 primary and 45 recurrent tumors) entered a prospective chemoprophylaxis trial after transurethral resection of the tumor. The drug for chemoprophylaxis was chosen by a computer which received the tumor data and analyzed them through a previous program of recurrence risk factors (multivariant analysis). In comparison with the aleatory selection of the drug, this statistical computerized choice has diminished the recurrence index (from 8 to 3) and increased the interval free of disease (from 70 to 83.5 months) in this group of patients.

[The phenomenon of obstructive uropathy with minimal or no dilatation]

Obstructive anuria does not necessarily show a marked dilatation of the urinary tract on evaluation with imaging techniques. A case with acute renal failure of this type is presented. We discuss why this condition is caused and how diagnosis can be made quickly. Likewise, we discuss the length of time we can defer renal diversion before rupture of the collecting system supervenes and, consequently, urinary extravasation.

Immunoprophylaxis with Calmette-Guérin bacillus in recurrent superficial bladder tumors

26 patients with superficial bladder cancer underwent complete removal of tumors by transurethral resection and entered a prospective trial of immunoprophylaxis with Calmette-Guérin bacillus (BCG). The entire group had recurrent tumors that failed to respond to previous prophylaxis with thiotepa (13 patients) or other drugs (13 patients). Intravesical administration of BCG reduced the recurrence index and increased the disease-free interval. Side effects were mild and well tolerated. BCG seems to be effective in the prophylaxis of superficial bladder tumor recurrence after the failure of other drugs.

Retroperitoneal malignant fibrous histiocytoma

Five cases of malignant fibrous histiocytoma located in the retroperitoneum are reported. Paraneoplastic syndrome, abdominal mass, tendency to local recurrence, laborious therapy and poor prognosis are the clinical characteristics of this tumor. Accuracy of actual diagnosis is evaluated and pathological features are analyzed.