Termination rates and histological reclassification of active surveillance patients with low- and early intermediate-risk prostate cancer: results of the PREFERE trial

Purpose

Active surveillance (AS) strategies for patients with low- and early intermediate-risk prostate cancer are still not consistently defined. Within a controlled randomized trial, active surveillance was compared to other treatment options for patients with prostate cancer. Aim of this analysis was to report on termination rates of patients treated with AS including different grade groups.

Methods

A randomized trial comparing radical prostatectomy, active surveillance, external beam radiotherapy and brachytherapy was performed from 2013 to 2016 and included 345 patients with low- and early intermediate-risk prostate cancer (ISUP grade groups 1 and 2). The trial was prematurely stopped due to slow accrual. A total of 130 patients were treated with active surveillance. Among them, 42 patients were diagnosed with intermediate-risk PCA. Reference pathology and AS quality control were performed throughout.

Results

After a median follow-up time of 18.8 months, 73 out of the 130 patients (56%) terminated active surveillance. Of these, 56 (77%) patients were histologically reclassified at the time of rebiopsy, including 35% and 60% of the grade group 1 and 2 patients, respectively. No patients who underwent radical prostatectomy at the time of reclassification had radical prostatectomy specimens ≥ grade group 3.

Conclusion

In this prospectively analyzed subcohort of patients with AS and conventional staging within a randomized trial, the 2-year histological reclassification rates were higher than those previously reported. Active surveillance may not be based on conventional staging alone, and patients with grade group 2 cancers may be recommended for active surveillance in carefully controlled trials only.

Challenges and potential for RNA nanoparticles (RNPs)

The current research of our group focuses on delivery of oligonucleotides and gene vaccines targeted against infectious disease and cancer. Recently we reported a strategy for associating DNA to gold via protamine delivery enhancing material which here we suggest might be applicable to RNA and to other nanoparticles. An important new modality for such RNA based nanoparticles (RNPs) is the myriad of genes now known to undergo alternative splicing. Here we will review some important issues for the binding, stabilization and delivery of RNA, particularly splice-site switching oligomers (SSOs) via these RNPs in order to achieve selective molecular therapeutic effects and unlock their potential as chemotherapeutic agents.

Indications for penile revascularization and long-term results

The purpose of this study was to analyse long-term results of penile revascularization using Hauri's method in 124 patients with a mean follow-up of 54 months. Of 176 patients undergoing this procedure, 124 were available for detailed analysis. The patients ranged in age from 22 to 71. A total of 25.8% of the patients (32/124) responded to intracavernous injection (ICI). Postoperatively, 74 patients (59.7%) exhibited spontaneous erections. Patients were classified as 'satisfied' or 'dissatisfied'. In those who were satisfied, a high correlation was found (63/74 = 85%) between graft patency, as judged by ultrasound, and erectile function. The benefit for non-responders to ICI (60/92) was higher than for responders (14/32). Only five of 12 diabetics profited from penile revascularization. A serious complication was glans hyperemia in 9/124 cases (7%). Based on this experience, the following indicators are recommended for case selection: (i) non-responder to ICI; (ii) age less than 55 years; (iii) nondiabetic; (iv) cavernous leakage excluded; (v) stenosis in the internal pudendal artery.

[Microsurgical testicular denervation as therapy option in chronic testalgia]

Chronic testicular pain represents a challenging urological chronic pain syndrome in terms of adequate diagnosis and therapy. Reported success rates of 55-73% and 10-40% of conservative and surgical interventions are extremely low. We report on microsurgical testicular denervation as therapeutic option in patients with chronic testicular pain (CTP). 12 consecutive patients with CTP were included in our study. After complete diagnostic workup and positive response to testicular nerve blockade, all patients underwent surgery: the cremasteric muscle was dissected by electrocautery, the periadventitial layer of the testicular artery was dissected over a length of 2-3 cm. After a median follow-up of 20.6 months (4-62) 11/12 patients (92%) are pain free. None of the patients suffered from intraa- or postoperative complications. Based on our experience microsurgical testicular denervation should be performed in patients with CTP and no underlying organic disease. However, the high success rate of our surgical procedure can only be maintained if the selection of suitable patients is performed very carefully and a specific organic origin of CTP has been excluded prior to surgery.

Inhibition of human immunodeficiency virus type 1 (HIV-1) replication by the dipyridodiazepinone BI-RG-587

The dipyridodiazepinone human immunodeficiency virus type 1 (HIV-1)-specific reverse transcriptase (RT) inhibitor BI-RG-587 was tested for its ability to inhibit HIV-1 replication in both acutely and chronically infected cell lines. The ability of BI-RG-587 to inhibit steps in the virus replicative cycle other than reverse transcription was also assessed. BI-RG-587 was found to be a potent inhibitor of HIV-1 replication in acutely infected cells (50% inhibitory concentration [IC50] = 37.2 nM), and the sensitivity and kinetics of that inhibition was similar to the known RT inhibitor zidovudine (AZT). Even at 100x IC50, BI-RG-587 had no effect on gp120/CD4 interaction, syncytia formation, or envelope glycoprotein processing. In addition, no inhibition of viral replication or protein production was noted in a chronically infected cell line that produces viral products in an RT-independent manner. Finally, no inhibition of acute HIV-2 replication was noted, even with very high (2500x IC50 for HIV-1) concentrations of BI-RG-587. These results demonstrate that BI-RG-587 is a potent inhibitor of HIV-1 replication and that this inhibition occurs at the point of reverse transcription.

Inhibition of HIV-1 replication by a nonnucleoside reverse transcriptase inhibitor

A series of dipyridodiazepinones have been shown to be potent inhibitors of human immunodeficiency virus-1 (HIV-1) reverse transcriptase (RT). One compound, BI-RG-587, had a Ki of 200 nanomolar for inhibition of HIV-1 RT that was noncompetitive with respect to deoxyguanosine triphosphate. BI-RG-587 was specific for HIV-1 RT, having no effect on feline and simian RT or any mammalian DNA polymerases. BI-RG-587 inhibited HIV-1 replication in vitro as demonstrated by in situ hybridization, inhibition of protein p24 production, and the lack of syncytia formation in cultured human T cell lines and freshly isolated human peripheral blood lymphocytes. Cytotoxicity studies of BI-RG-587 on human cells showed a high therapeutic index (greater than 8000) in culture.