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Hertz AM, Childers CK, Wingate JT, Perry JT, Kitley CA, Brand TC, Anderson MI. Malignant Solitary Fibrous Tumor of the Renal Vein Presenting as a Giant Renal Artery Aneurysm: A Case Report and Review of Literature. Int J Surg Pathol 2018; 27:72-76. [PMID: 29992862 DOI: 10.1177/1066896918787650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To discuss an unusual presentation of solitary fibrous tumor (SFT) as well as the first description of SFT originating from the renal vein. CASE REPORT In this article, we report the case of a 56-year-old man who presented with nonspecific epigastric pain and was found on computed tomography to have a large 10-cm renal artery aneurysm with evidence of contained rupture, segmental ischemia of the kidney, and suggestion of renal vein thrombosis. This was treated by a multidisciplinary team of urologists, vascular surgeons, and interventional radiologists with both renal artery coil embolization and radical nephrectomy. The thrombosis was found on pathologic review to be a malignant SFT originating from the renal vein with likely erosion into the renal artery. CONCLUSION This report describes the first case of SFT originating from the renal vein and demonstrates the potential for mimicry as a giant renal artery aneurysm.
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Lim DM, Gulati R, Aleshin-Guendel S, Gawne A, Wingate JT, Cheng HH, Etzioni R, Yu EY. Undetectable prostate-specific antigen after short-course androgen deprivation therapy for biochemically recurrent patients correlates with metastasis-free survival and prostate cancer-specific survival. Prostate 2018; 78:10.1002/pros.23666. [PMID: 29987912 PMCID: PMC6328347 DOI: 10.1002/pros.23666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 06/07/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND Optimal utilization of novel therapies for advanced prostate cancer is challenging without a validated surrogate efficacy endpoint. Ongoing trials are using durable undetectable prostate-specific antigen (PSA) levels as a marker of efficacy. The clinical relevance of prolonged undetectable PSA after a short course of androgen deprivation therapy (ADT) is uncertain. METHODS The University of Washington Caisis database was queried for radical prostatectomy patients who received 6-12 months of ADT after biochemical recurrence (BCR), defined as PSA ≥0.2 ng/mL and no radiographically detectable metastasis. Proportions of men with undetectable PSA 12 and 24 months after ending ADT were compared to a hypothesized 5% rate using exact binomial tests. Associations with patient and tumor characteristics were examined using logistic regression, and associations with risk of subsequent metastasis and death were evaluated by log-rank tests. RESULTS After ineligibility exclusions, 23/93 (25%; 95%CI 16-35%; P < 0.001) and 14/93 (15%; 95%CI 9-24%; P < 0.001) had undetectable PSA 12 and 24 months after ending ADT, respectively. Detectable PSA at 12 months was associated with increased risk of metastasis (P = 0.006), prostate cancer-specific death (P = 0.028), and death from any cause (P = 0.065). Being 1 year older at diagnosis was associated with a 14% (95%CI 5-24%; P = 0.006) decrease in the odds of having a detectable PSA after controlling for PSA at diagnosis, PSA doubling time, grade group, and time from initial therapy to BCR. CONCLUSIONS This single-institution retrospective analysis shows that it is not uncommon to have undetectable PSA 12 or 24 months after a short course of ADT. No baseline prognostic characteristic other than age was associated with a durable (12 month) undetectable PSA. Because a durable undetectable PSA was associated with lower risks of metastasis and prostate cancer-specific death, it may be a reasonable clinical trial endpoint.
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Affiliation(s)
- Daniel M. Lim
- Department of Medicine, Division of Oncology, University of Washington, Seattle Cancer Care Alliance, Seattle, WA
| | - Roman Gulati
- Biostatistics and Biomathematics, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Serge Aleshin-Guendel
- Biostatistics and Biomathematics, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Agnes Gawne
- Biostatistics and Biomathematics, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jonathan T. Wingate
- Biostatistics and Biomathematics, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Heather H. Cheng
- Department of Medicine, Division of Oncology, University of Washington, Seattle Cancer Care Alliance, Seattle, WA
| | - Ruth Etzioni
- Biostatistics and Biomathematics, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Evan Y. Yu
- Department of Medicine, Division of Oncology, University of Washington, Seattle Cancer Care Alliance, Seattle, WA
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Yu EY, Gulati R, Aleshin-Guendel S, Cheng HH, Gawne AM, Wingate JT, Etzioni RD, Lim DM. Association of undetectable PSA with time to metastasis and survival after short-course androgen deprivation therapy for biochemically-recurrent prostate cancer patients. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e17073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Evan Y. Yu
- Seattle Cancer Care Alliance, Seattle, WA
| | - Roman Gulati
- Fred Hutchinson Cancer Research Center, Seattle, WA
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Wingate JT, Erickson BA, Murphy G, Smith TG, Breyer BN, Voelzke BB. Multicenter Analysis of Patient Reported Outcomes Following Artificial Urinary Sphincter Placement for Male Stress Urinary Incontinence. J Urol 2018; 199:785-790. [DOI: 10.1016/j.juro.2017.09.089] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2017] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Gregory Murphy
- University of California-San Francisco, San Francisco, California
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Lim DM, Gulati R, Aleshin-Guendel S, Cheng HH, Gawne AM, Wingate JT, Etzioni RD, Yu EY. Proportion of biochemically-recurrent prostate cancer patients with durable undetectable PSA after short-course androgen deprivation therapy. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.6_suppl.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
207 Background: Optimal utilization of novel therapies for advanced prostate cancer is challenging without a validated surrogate efficacy endpoint. Ongoing trials are using durable undetectable prostate specific antigen (PSA) levels as a marker of efficacy. The proportion of patients and clinical relevance of those with a prolonged undetectable PSA after a short course of androgen deprivation therapy (ADT) is uncertain. Methods: The University of Washington Caisis database was queried for radical prostatectomy patients who received 6–12 months of ADT after biochemical recurrence (BCR), defined as PSA ≥ 0.2 ng/mL and no radiographically detectable metastasis. Proportions of patients with undetectable PSA 12 and 24 months after ending ADT were compared to a hypothesized 5% rate using exact binomial tests. Associations with patient and tumor characteristics were examined using logistic regression, and associations with risk of subsequent metastasis and death from any cause were evaluated by log-rank tests. Results: After ineligibility exclusions, data were abstracted from 93 patients. Proportions of patients with undetectable PSA 12 and 24 months after ending ADT were n=23/93 (24.7%; 95% CI 16.4–34.8%; P<0.001) and n=14/93 (15.1%; 95% CI 8.5–24.0%; P<0.001), respectively. Proportions of patients with undetectable PSA 12 and 24 months after testosterone recovery ≥ 50 ng/dL were n=16/65 (24.6%; 95% CI 14.8-36.9%) and n=10/65 (15.4%; 95% CI 7.6-26.5%), respectively. Being 1 year older at diagnosis was associated with an 11.5% (95% CI 3.1–21.9%; P=0.01) increase in the odds of having a detectable PSA after controlling for PSA at diagnosis, Gleason sum and time from initial therapy to BCR. Detectable PSA was associated with increased risk of metastasis (P=0.006) with marginal evidence of association with death from any cause (P=0.07). Conclusions: This single-institution retrospective analysis shows that it is not uncommon to have undetectable PSA 12 or 24 months after a short course of ADT. Additional analysis is needed to demonstrate the clinical value of this measure as a surrogate for prostate cancer outcomes and for consideration as a trial endpoint.
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Affiliation(s)
| | - Roman Gulati
- Fred Hutchinson Cancer Research Center, Seattle, WA
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Ramos JD, Wingate JT, Gulati R, Plimack ER, Harshman LC, Powles T, Crabb SJ, Niegisch G, Bellmunt J, Ladoire S, De Giorgi U, Hussain S, Alva AS, Baniel J, Agarwal N, Rosenberg JE, Vaishampayan UN, Galsky MD, Yu EY. Venous Thromboembolism Risk in Patients With Locoregional Urothelial Tract Tumors. Clin Genitourin Cancer 2017; 16:S1558-7673(17)30242-2. [PMID: 28923700 PMCID: PMC5826750 DOI: 10.1016/j.clgc.2017.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 08/05/2017] [Accepted: 08/13/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Venous thromboembolism (VTE) is common in cancer patients, but there is limited data on patients with urothelial tract tumors (UTT). We previously identified several associative factors for increased VTE rates in patients with metastatic UTT. In this study, we assessed the frequency, associative factors, and impact on survival of VTE in patients with locoregional UTT. METHODS Patients with locoregional bladder, upper urinary tract, or urethral cancer were included in this multi-center study from 29 academic institutions. Patients with < cT2, > N1, or M1 disease at diagnosis were excluded. Patients with incomplete clinical staging or miscoded/missing data were excluded. Cumulative, unadjusted VTE incidence was calculated from time of diagnosis of muscle-invasive disease, excluding VTEs diagnosed in the metastatic setting. χ2 statistics tested differences in VTE rates across baseline and treatment-related factors. Significant covariates were incorporated into a multivariate, logistic regression model. Overall survival stratified by VTE was estimated using Kaplan-Meier methods and evaluated using the log-rank test. RESULTS A total of 1732 patients were eligible. There were 132 (7.6%) VTEs. On multivariate analysis, non-urothelial histology (P < .001), clinical Nx stage (P < .001), cardiovascular disease (P = .01), and renal dysfunction (P = .04) were statistically significant baseline factors associated with VTE. Using surgery alone as reference, surgery with perioperative chemotherapy (P = .04) and radiation with concurrent chemotherapy (P = .04) also were significant. CONCLUSIONS The VTE incidence of 7.6% in locoregional disease is comparable with our previously reported rate in the metastatic setting (8.2%). Similar to our findings in metastatic UTT, non-urothelial histology, renal dysfunction, and CVD was associated with increased VTE risk.
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Affiliation(s)
- Jorge D Ramos
- University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Roman Gulati
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | | | - Thomas Powles
- Barts and the London School of Medicine, London, England
| | | | - Guenter Niegisch
- Medical Faculty, Department of Urology, Heinrich-Heine-University, Düsseldorf, Germany
| | | | - Sylvain Ladoire
- Georges François Leclerc Center, Dijon, France; Université de Bourgogne, Dijon, France
| | - Ugo De Giorgi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | | | | | | | | | | | | | | | - Evan Y Yu
- University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA.
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Chung PH, Wingate JT, Friedrich JB, Voelzke BB. V1-01 RADIAL FOREARM FREE FLAP SUBSTITUTION URETHROPLASTY FOR THE TREATMENT OF A LONG URETHRAL DEFECT. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wingate JT, Brandenberger J, Weiss A, Scovel LG, Kuhr CS. Ureteral stent duration and the risk of BK polyomavirus viremia or bacteriuria after kidney transplantation. Transpl Infect Dis 2017; 19. [DOI: 10.1111/tid.12644] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 08/21/2016] [Accepted: 09/09/2016] [Indexed: 12/12/2022]
Affiliation(s)
| | - Jared Brandenberger
- Department of Urology and Renal Transplantation; Virginia Mason Medical Center; Seattle WA USA
| | - Andrew Weiss
- Department of Nephrology and Renal Transplantation; Virginia Mason Medical Center; Seattle WA USA
| | - Lauren G. Scovel
- Department of Urology and Renal Transplantation; Virginia Mason Medical Center; Seattle WA USA
| | - Christian S. Kuhr
- Department of Urology and Renal Transplantation; Virginia Mason Medical Center; Seattle WA USA
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Abstract
Background: Although bladder cancer is one of the most frequently diagnosed tumors worldwide, metastatic melanoma of the bladder is a rare occurrence with only 29 cases reported in the literature. Case Presentation: We present the case of a 60-year-old male with a medical history significant for metastatic melanoma, who was referred to the urology department for gross hematuria. Transurethral resection of bladder tumor (TURBT) was performed with the assistance of hexaminolevulinate acid (HAL) with blue-light cystoscopy (BLC). Subsequent histopathologic analysis of the specimen confirmed a diagnosis of metastatic melanoma of the bladder. To our knowledge, this is the first reported case of metastatic bladder melanoma diagnosed with the assistance of HAL-BLC in a patient undergoing a TURBT. Conclusion: Although HAL-BLC is only indicated for use in the cystoscopic detection of papillary nonmuscle invasive bladder cancer, it may aid in the detection of nonconventional bladder pathologies, such as melanoma.
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Affiliation(s)
- Anant Shukla
- Department of Urology, Uniformed Services University of the Health Sciences, F. Edward Hebert School of Medicine , Bethesda, Maryland
| | | | - Karen C Baker
- Department of Urology, Madigan Army Medical Center , Tacoma, Washington
| | - Timothy C Brand
- Department of Urology, Madigan Army Medical Center , Tacoma, Washington
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