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Poletajew S, Brzózka MM, Krajewski W, Kamecki H, Nyk Ł, Kryst P. Glycosaminoglycan Replacement Therapy with Intravesical Instillations of Combined Hyaluronic Acid and Chondroitin Sulfate in Patients with Recurrent Cystitis, Post-radiation Cystitis and Bladder Pain Syndrome: A Narrative Review. Pain Ther 2024; 13:1-22. [PMID: 37917298 PMCID: PMC10796878 DOI: 10.1007/s40122-023-00559-1] [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] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/18/2023] [Indexed: 11/04/2023] Open
Abstract
Defects in the glycosaminoglycan layer (GAG) of the bladder mucosa have been identified as a significant contributor to the pathogenesis and clinical progression of chronic inflammatory diseases of the bladder, such as post-radiation cystitis, bladder pain syndrome and recurrent urinary tract infections. This narrative review aims to explore the contemporary evidence on the role of GAG reconstitution with intravesical installations of hyaluronic acid and chondroitin sulfate in the management of those patients, with a goal to provide valuable insights for clinical practice. The reviewed studies consistently demonstrate that GAG reconstitution can result in varying degrees of clinical improvement in patients with post-radiation cystitis, bladder pain syndrome and recurrent urinary tract infections, and is associated with a very favorable safety profile. While the available evidence is growing, its level is still limited, mainly by relatively low number of randomized controlled trials, with small sample sizes. Further research with larger, well-designed trials is needed to solidify the findings and optimize the clinical application of GAG reconstitution.
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Affiliation(s)
- Sławomir Poletajew
- Second Department of Urology, Medical Centre of Postgraduate Education, Warsaw, Poland.
| | | | - Wojciech Krajewski
- Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, Wroclaw, Poland
| | - Hubert Kamecki
- Second Department of Urology, Medical Centre of Postgraduate Education, Warsaw, Poland
| | - Łukasz Nyk
- Second Department of Urology, Medical Centre of Postgraduate Education, Warsaw, Poland
| | - Piotr Kryst
- Second Department of Urology, Medical Centre of Postgraduate Education, Warsaw, Poland
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Tayara OM, Pełka K, Kunikowska J, Malewski W, Sklinda K, Kamecki H, Poletajew S, Kryst P, Nyk Ł. Comparison of Multiparametric MRI, [ 68Ga]Ga-PSMA-11 PET-CT, and Clinical Nomograms for Primary T and N Staging of Intermediate-to-High-Risk Prostate Cancer. Cancers (Basel) 2023; 15:5838. [PMID: 38136382 PMCID: PMC10741730 DOI: 10.3390/cancers15245838] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/26/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
PURPOSE OF THE REPORT Although multiparametric magnetic resonance imaging (mpMRI) is commonly used for the primary staging of prostate cancer, it may miss non-enlarged metastatic lymph nodes. Positron emission tomography-computed tomography targeting the prostate-specific membrane antigen (PSMA PET-CT) is a promising method to detect non-enlarged metastatic lymph nodes, but more data are needed. MATERIALS AND METHODS In this single-center, prospective study, we enrolled patients with intermediate-to-high-risk prostate cancer scheduled for radical prostatectomy with pelvic node dissection. Before surgery, prostate imaging with mpMRI and PSMA PET-CT was used to assess lymph node involvement (LNI), extra-prostatic extension (EPE), and seminal vesicle involvement (SVI). Additionally, we used clinical nomograms to estimate the risk of these three outcomes. RESULTS Of the 74 patients included, 61 (82%) had high-risk prostate cancer, and the rest had intermediate-risk cancer. Histopathology revealed LNI in 20 (27%) patients, SVI in 26 (35%), and EPE in 52 (70%). PSMA PET-CT performed better than mpMRI at detecting LNI (area under the curve (AUC, 95% confidence interval): 0.779 (0.665-0.893) vs. 0.655 (0.529-0.780)), but mpMRI was better at detecting SVI (AUC: 0.775 (0.672-0.878) vs. 0.585 (0.473-0.698)). The MSKCC nomogram performed well at detecting both LNI (AUC: 0.799 (0.680-0.918)) and SVI (0.772 (0.659-0.885)). However, when the nomogram was used to derive binary diagnoses, decision curve analyses showed that the MSKCC nomogram provided less net benefit than mpMRI and PSMA PET-CT for detecting SVI and LNI, respectively. CONCLUSIONS mpMRI and [68Ga]Ga-PSMA-11 PET-CT are complementary techniques to be used in conjunction for the primary T and N staging of prostate cancer.
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Affiliation(s)
- Omar Marek Tayara
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland; (W.M.); (S.P.); (P.K.); (Ł.N.)
| | - Kacper Pełka
- Department of Nuclear Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland; (K.P.); (J.K.)
- Department of Methodology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Jolanta Kunikowska
- Department of Nuclear Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland; (K.P.); (J.K.)
| | - Wojciech Malewski
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland; (W.M.); (S.P.); (P.K.); (Ł.N.)
| | - Katarzyna Sklinda
- Department of Radiology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland
- Diagnostic Radiology Department, Central Clinical Hospital of the Ministry of the Interior in Warsaw, 02-507 Warsaw, Poland
| | - Hubert Kamecki
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland; (W.M.); (S.P.); (P.K.); (Ł.N.)
| | - Sławomir Poletajew
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland; (W.M.); (S.P.); (P.K.); (Ł.N.)
| | - Piotr Kryst
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland; (W.M.); (S.P.); (P.K.); (Ł.N.)
| | - Łukasz Nyk
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland; (W.M.); (S.P.); (P.K.); (Ł.N.)
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Kamecki H, Mielczarek Ł, Szempliński S, Dębowska M, Rajwa P, Baboudjian M, Klemm J, Rivas JG, Modzelewska E, Tayara O, Malewski W, Szostek P, Poletajew S, Kryst P, Sosnowski R, Nyk Ł. Quantification of Gleason Pattern 4 at MRI-Guided Biopsy to Predict Adverse Pathology at Radical Prostatectomy in Intermediate-Risk Prostate Cancer Patients. Cancers (Basel) 2023; 15:5462. [PMID: 38001723 PMCID: PMC10670701 DOI: 10.3390/cancers15225462] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/28/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Data on Gleason pattern 4 (GP4) amount in biopsy tissue is important for prostate cancer (PC) risk assessment. We aim to investigate which GP4 quantification method predicts adverse pathology (AP) at radical prostatectomy (RP) the best in men diagnosed with intermediate-risk (IR) PC at magnetic resonance imaging (MRI)-guided biopsy. METHODS We retrospectively included 123 patients diagnosed with IR PC (prostate-specific antigen <20 ng/mL, grade group (GG) 2 or 3, no iT3 on MRI) at MRI-guided biopsy, who underwent RP. Twelve GP4 amount-related parameters were developed, based on GP4 quantification method (absolute, relative to core, or cancer length) and site (overall, targeted, systematic biopsy, or worst specimen). Additionally, we calculated PV×GP4 (prostate volume × GP4 relative to core length in overall biopsy), aiming to represent the total GP4 volume in the prostate. The associations of GP4 with AP (GG ≥ 4, ≥pT3a, or pN1) were investigated. RESULTS AP was reported in 39 (31.7%) of patients. GP4 relative to cancer length was not associated with AP. Of the 12 parameters, the highest ROC AUC value was seen for GP4 relative to core length in overall biopsy (0.65). an even higher AUC value was noted for PV × GP4 (0.67), with a negative predictive value of 82.8% at the optimal threshold. CONCLUSIONS The lack of an association of GP4 relative to cancer length with AP, contrasted with the better performance of other parameters, indicates directions for future research on PC risk stratification to accurately identify patients who may not require immediate treatment. Incorporating formulas aimed at GP4 volume assessment may lead to obtaining models with the best discrimination ability.
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Affiliation(s)
- Hubert Kamecki
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland
| | - Łukasz Mielczarek
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland
| | - Stanisław Szempliński
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland
| | - Małgorzata Dębowska
- Nałęcz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, 02-109 Warsaw, Poland
| | - Paweł Rajwa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria
- Department of Urology, Medical University of Silesia, 41-800 Zabrze, Poland
| | | | - Jakob Klemm
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria
- Department of Urology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Juan Gómez Rivas
- Department of Urology, Hospital Clinico San Carlos, 28040 Madrid, Spain
| | - Elza Modzelewska
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland
| | - Omar Tayara
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland
| | - Wojciech Malewski
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland
| | - Przemysław Szostek
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland
| | - Sławomir Poletajew
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland
| | - Piotr Kryst
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland
| | - Roman Sosnowski
- Department of Urology and Oncological Urology, Warmian-Masurian Cancer Center, 10-228 Olsztyn, Poland
| | - Łukasz Nyk
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland
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Szempliński S, Kamecki H, Mokrzyś M, Zawadzki M, Zagożdżon B, Dębowska M, Sosnowski R, Poletajew S, Kryst P, Nyk Ł. Patient-reported pain associated with grid-based transperineal magnetic resonance imaging (MRI)/ultrasound (US) software fusion biopsy of the prostate under local anesthesia: a multicenter experience. Transl Androl Urol 2023; 12:1250-1258. [PMID: 37680225 PMCID: PMC10481192 DOI: 10.21037/tau-23-139] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/07/2023] [Indexed: 09/09/2023] Open
Abstract
Background Biopsy by transperineal (TP) approach is recommended standard for prostate cancer (PC) diagnosis. To avoid pain, patients undergoing TP biopsy may be offered sedation or general anesthesia. Our aim was to investigate the degree of patient-reported pain for magnetic resonance imaging (MRI)/ultrasound (US) fusion biopsy of the prostate being performed under local anesthesia (LA) and to study for possible factors associated with increased risk of significant pain (SP) in this setting. Methods In this retrospective observational study, we reviewed data of consecutive patients without a prior diagnosis of PC who underwent MRI/US software fusion biopsy of the prostate under LA with lidocaine at two centers between May 2020 and April 2022, and who reported their periprocedural pain on a Wong-Baker FACES Pain Rating Scale (0-10). We defined SP as reported pain score of 6-10. Patient and procedure characteristics together with SP were studied for interdependencies. Results A total of 299 patients were included. Median pain score was 2 (interquartile range: 2-4), with SP having been reported by 55 (18.4%) patients. Among patient characteristics, only age demonstrated association with SP [odds ratio (OR), per 10 years =0.53, 95% confidence interval (CI): 0.35-0.80, P=0.003] and patients aged 62 or above were significantly less likely to report SP (OR =0.33, 95% CI: 0.18-0.60, P<0.001). Conclusions Performing TP MRI/US fusion prostate biopsy under LA is associated with low rates of SP, with the risk being significantly lower in older men. The results of this study can serve as evidence resource for preprocedural counselling in patients especially concerned about the risk of pain.
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Affiliation(s)
- Stanisław Szempliński
- Second Department of Urology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Hubert Kamecki
- Second Department of Urology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | | | - Marek Zawadzki
- Department of Urology, St. Anna Hospital, Piaseczno, Poland
| | - Bartłomiej Zagożdżon
- Second Department of Urology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Małgorzata Dębowska
- Nałęcz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Roman Sosnowski
- Department of Urology and Oncological Urology, Warmian-Masurian Cancer Center, Olsztyn, Poland
| | - Sławomir Poletajew
- Second Department of Urology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Piotr Kryst
- Second Department of Urology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Łukasz Nyk
- Second Department of Urology, Centre of Postgraduate Medical Education, Warsaw, Poland
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Malewski W, Milecki T, Szempliński S, Tayara O, Kuncman Ł, Kryst P, Nyk Ł. Prostate Biopsy in the Case of PIRADS 5-Is Systematic Biopsy Mandatory? J Clin Med 2023; 12:5612. [PMID: 37685679 PMCID: PMC10488368 DOI: 10.3390/jcm12175612] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 08/07/2023] [Accepted: 08/11/2023] [Indexed: 09/10/2023] Open
Abstract
Combining systematic biopsy (SB) with targeted biopsy (TB) in the case of a positive result from multiparametric magnetic resonance imaging (mpMRI) is a matter of debate. The Prostate Imaging Reporting and Data System (PIRADS) score of 5 indicates the highest probability of clinically significant prostate cancer (csPC) detection in TB. Potentially, omitting SB in the case of PIRADS 5 may have a marginal impact on the csPC detection rate. The aim of this study was to determine whether SB can be avoided in the case of PIRADS 5 and to identify potential factors allowing for performing TB only. This cohort study involved n = 225 patients with PIRADS 5 on mpMRI (PIRADS 2.0/2.1) who underwent transperineal or transrectal combined biopsy (CB). CsPC was diagnosed in 51.6% (n = 116/225) of cases. TB and SB resulted in the detection of csPC in 48% (n = 108/225) and 20.4% (n = 46/225) of cases, respectively (TB vs. SB, p < 0.001). When the TB was positive, SB detected csPC in n = 38 of the cases (38/108 = 35%). SB added to TB significantly improved csPC detection in 6.9% of cases in absolute terms (n = 8/116) (TB vs. CB, p = 0.008). The multivariate regression model proved that the significant predictors of csPC detection via SB were the densities of the prostate-specific antigen-PSAD > 0.17 ng/mL2 (OR = 4.038, 95%CI: 1.568-10.398); primary biopsy setting (OR = 2.818, 95%CI: 1.334-5.952); and abnormal digital rectal examination (DRE) (OR = 2.746, 95%CI: 1.328-5.678). In a primary biopsy setting (n = 103), SB detected 10% (n = 6/60) of the additional cases of csPC (p = 0.031), while in a repeat biopsy setting (n = 122), SB detected 3.5% (n = 2/56) of the additional cases of csPC (p = 0.5). In the case of PSAD > 0.17 ng/mL2 (n = 151), SB detected 7.4% (n = 7/95) of additional cases of csPC (p = 0.016), while in the case of PSAD < 0.17 ng/mL2 (n = 74), SB detected 4.8% (n = 1/21) of the additional cases of csPC (p = 1.0). The omission of SB had an impact on the csPC diagnosis rate in patients with PIRADS 5 score lesions. Patients who have already undergone prostate biopsy and those with low PSAD are at a lower risk of missing csPC when SB is avoided. However, performing TB only may result in missing other csPC foci located outside the index lesion, which can alter treatment decisions.
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Affiliation(s)
- Wojciech Malewski
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland; (W.M.); (P.K.)
| | - Tomasz Milecki
- Department of Urology, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | - Stanisław Szempliński
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland; (W.M.); (P.K.)
| | - Omar Tayara
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland; (W.M.); (P.K.)
| | - Łukasz Kuncman
- Department of Radiotherapy, Medical University of Lodz, 90-419 Lodz, Poland;
| | - Piotr Kryst
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland; (W.M.); (P.K.)
| | - Łukasz Nyk
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland; (W.M.); (P.K.)
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Nyk Ł, Kamecki H, Zagożdżon B, Tokarczyk A, Baranek P, Mielczarek Ł, Kryst P, Poletajew S, Sosnowski R, Szempliński S. The Impact of the Ongoing COVID-19 Epidemic on the Increasing Risk of Adverse Pathology in Prostate Cancer Patients Undergoing Radical Prostatectomy. Curr Oncol 2022; 29:2768-2775. [PMID: 35448199 PMCID: PMC9027555 DOI: 10.3390/curroncol29040225] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/11/2022] [Accepted: 04/13/2022] [Indexed: 11/16/2022] Open
Abstract
We aimed to assess whether the ongoing course of the COVID-19 epidemic has been associated with an increased risk of adverse pathology (AP) findings in prostate cancer (PC) patients treated with radical prostatectomy (RP). We performed a retrospective data analysis which included 408 consecutive, non-metastatic, previously untreated PC patients who underwent RP in our institution between March 2020 and September 2021. Patients were divided into two equally numbered groups in regard to the median surgery date (Early Epidemic [EE] and Late Epidemic [LE]) and compared. Adverse pathology was defined as either grade group (GG) ≥ 4, pT ≥ 3a or pN+ at RP. Patients in the LE group demonstrated significantly higher rates of AP than in the EE group (61 vs. 43% overall and 50 vs. 27% in preoperative non-high-risk subgroup, both p < 0.001), mainly due to higher rates of upgrading. On multivariable analysis, consecutive epidemic week (odds ratio: 1.02, 95% confidence interval: 1.00−1.03, p = 0.009) as well as biopsy GG ≥ 2 and a larger prostate volume (mL) were associated with AP in non-high-risk patients. The study serves as a warning call for increased awareness of risk underassessment in contemporarily treated PC patients.
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Affiliation(s)
- Łukasz Nyk
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland; (Ł.N.); (B.Z.); (A.T.); (P.B.); (Ł.M.); (P.K.); (S.P.); (S.S.)
| | - Hubert Kamecki
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland; (Ł.N.); (B.Z.); (A.T.); (P.B.); (Ł.M.); (P.K.); (S.P.); (S.S.)
- Correspondence:
| | - Bartłomiej Zagożdżon
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland; (Ł.N.); (B.Z.); (A.T.); (P.B.); (Ł.M.); (P.K.); (S.P.); (S.S.)
| | - Andrzej Tokarczyk
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland; (Ł.N.); (B.Z.); (A.T.); (P.B.); (Ł.M.); (P.K.); (S.P.); (S.S.)
| | - Piotr Baranek
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland; (Ł.N.); (B.Z.); (A.T.); (P.B.); (Ł.M.); (P.K.); (S.P.); (S.S.)
| | - Łukasz Mielczarek
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland; (Ł.N.); (B.Z.); (A.T.); (P.B.); (Ł.M.); (P.K.); (S.P.); (S.S.)
| | - Piotr Kryst
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland; (Ł.N.); (B.Z.); (A.T.); (P.B.); (Ł.M.); (P.K.); (S.P.); (S.S.)
| | - Sławomir Poletajew
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland; (Ł.N.); (B.Z.); (A.T.); (P.B.); (Ł.M.); (P.K.); (S.P.); (S.S.)
| | - Roman Sosnowski
- Department of Urogenital Cancer, Maria Skłodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland;
| | - Stanisław Szempliński
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland; (Ł.N.); (B.Z.); (A.T.); (P.B.); (Ł.M.); (P.K.); (S.P.); (S.S.)
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Kamecki H, Dębowska M, Nyk Ł, Przewor A, Demkow T, Sosnowski R. The Clinical Features of Incidentally Diagnosed Urothelial Bladder Cancer: A Retrospective Data Analysis. Urol Int 2022; 106:798-805. [DOI: 10.1159/000521684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 12/20/2021] [Indexed: 11/19/2022]
Abstract
<b><i>Introduction:</i></b> The aim of this study was to evaluate the prevalence and clinical features of incidental bladder cancer (BC) diagnosis, with special emphasis on possible associations between incidental diagnosis and primary disease stage or grade. <b><i>Methods:</i></b> We retrospectively included 501 consecutive patients who underwent transurethral resection of bladder tumor and were diagnosed with primary urothelial carcinoma of the bladder between January 2013 and February 2021 in a university hospital. The type of diagnosis (incidental or nonincidental), patient baseline characteristics and primary stage and grade were studied for interdependencies. <b><i>Results:</i></b> 28.5% of all patients and 19.8% of high grade (HG) BC patients had been diagnosed incidentally, most commonly with ultrasound. Incidental diagnosis was associated with lower primary stage and grade of the disease. Most importantly, on multivariable analysis, which included baseline patient characteristics and type of diagnosis, in the subgroup of HG BC patients, muscle-invasive BC (MIBC) or metastatic disease was three times less likely to be diagnosed incidentally than non-MIBC (odds ratio: 0.31, 95% confidence interval: 0.14–0.71, <i>p</i> = 0.006). <b><i>Conclusions:</i></b> The study is first to demonstrate that incidental diagnosis of HG BC may be surprisingly prevalent and associated with lower rates of muscle invasion or metastatic disease.
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Nyk Ł, Michalak W, Szempliński S, Woźniak R, Zagożdżon B, Krajewski W, Kryst P, Kamecki H, Poletajew S. High-Intensity Focused-Ultrasound Focal Therapy Versus Laparoscopic Radical Prostatectomy: A Comparison of Oncological and Functional Outcomes in Low- and Intermediate-Risk Prostate Cancer Patients. J Pers Med 2022; 12:jpm12020251. [PMID: 35207739 PMCID: PMC8877347 DOI: 10.3390/jpm12020251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/05/2022] [Accepted: 02/07/2022] [Indexed: 12/04/2022] Open
Abstract
To compare oncological and functional outcomes of high-intensity focused-ultrasound (HIFU) focal therapy (FT) versus laparoscopic radical prostatectomy (LRP) in patients treated for low- or intermediate-risk prostate cancer (PCa), we retrospectively analyzed data of consecutive patients comprising 30 men, who underwent HIFU-FT, and 96 men who underwent LRP, in an academic center. Oncological outcomes were assessed based on the follow-up prostate-specific antigen values. We used the International Index of Erectile Function short form score to assess erectile function (EF). Urinary continence status was defined based on the number of pads used per day. Median follow-up was 12.5 and 19.1 months in the LRP and HIFU-FT groups, respectively. The effects were computed after propensity score matching and expressed as average treatment effect (ATE). Compared to LRP, HIFU-FT was associated with increased risk of treatment failure (ATE 0.103–0.164, depending on definition, p < 0.01) and lower risk of urinary incontinence (ATE −0.808 at 12 months, p < 0.01). Risk of erectile dysfunction was higher in the LRP group (ATE 5.092, p < 0.01). Our results demonstrate that HIFU-FT may be a reasonable treatment option in selected PCa patients, willing to preserve their EF and urinary continence yet accepting a higher risk of treatment failure.
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Affiliation(s)
- Łukasz Nyk
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland; (Ł.N.); (W.M.); (S.S.); (B.Z.); (P.K.); (S.P.)
| | - Wojciech Michalak
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland; (Ł.N.); (W.M.); (S.S.); (B.Z.); (P.K.); (S.P.)
| | - Stanisław Szempliński
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland; (Ł.N.); (W.M.); (S.S.); (B.Z.); (P.K.); (S.P.)
| | - Rafał Woźniak
- Chair of Statistics and Econometrics, Faculty of Economic Sciences, University of Warsaw, 00-241 Warsaw, Poland;
| | - Bartłomiej Zagożdżon
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland; (Ł.N.); (W.M.); (S.S.); (B.Z.); (P.K.); (S.P.)
| | - Wojciech Krajewski
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wrocław Medical University, 50-556 Wrocław, Poland;
| | - Piotr Kryst
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland; (Ł.N.); (W.M.); (S.S.); (B.Z.); (P.K.); (S.P.)
| | - Hubert Kamecki
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland; (Ł.N.); (W.M.); (S.S.); (B.Z.); (P.K.); (S.P.)
- Correspondence: ; Tel.: +48-22-710-3049
| | - Sławomir Poletajew
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland; (Ł.N.); (W.M.); (S.S.); (B.Z.); (P.K.); (S.P.)
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Sosnowski R, Kamecki H, Dobruch J, Roobol MJ, Venderbos LD, Nyk Ł, Krajewski W, Drewa T. Active surveillance for low-risk prostate cancer: well established, yet avoided? Cent European J Urol 2022; 75:290-291. [PMID: 36381164 PMCID: PMC9628721 DOI: 10.5173/ceju.2022.0141] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/18/2022] [Accepted: 07/18/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Roman Sosnowski
- Department of Urogenital Cancer, Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Hubert Kamecki
- 2 Department of Urology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Jakub Dobruch
- Department of Urology, Center of Postgraduate Medical Education, Warsaw, Poland
| | - Monique J. Roobol
- Department of Urology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Lionne D.F. Venderbos
- Department of Urology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Łukasz Nyk
- 2 Department of Urology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Wojciech Krajewski
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wrocław Medical University, Wrocław, Poland
| | - Tomasz Drewa
- Department of General and Oncologic Urology, Nicolaus Copernicus Hospital, Toruń, Poland
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Poletajew S, Pawlik K, Bonder-Nowicka A, Pakuszewski A, Nyk Ł, Kryst P. Multi-Drug Resistant Bacteria as Aetiological Factors of Infections in a Tertiary Multidisciplinary Hospital in Poland. Antibiotics (Basel) 2021; 10:antibiotics10101232. [PMID: 34680812 PMCID: PMC8532629 DOI: 10.3390/antibiotics10101232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/02/2021] [Accepted: 10/08/2021] [Indexed: 11/16/2022] Open
Abstract
Global and local initiatives were recently undertaken to reduce the burden of antibiotic resistance. The aim of the study was to describe the incidence and the aetiology of bacterial infections among hospitalized patients with special attention paid to the multidrug resistant (MDR) bacteria. This retrospective study was based on prospectively collected data from 150,529 consecutive patients hospitalized in a tertiary multidisciplinary hospital in the years 2017–2019. All consecutive microbiological tests from any biological material performed in the analyzed period were included. Microbiological screening tests (n = 10,677) were excluded. The analysis was focused on aetiological factors of bacterial infections, especially the incidence of MDR bacteria and mechanisms of antibiotic resistance. There were 58,789 microbiological tests performed in the analyzed period. The highest testing rate was noticed for intensive care unit (mean of 3.1 tests per one patient), followed by neonatal intensive care unit (2.7), internal medicine (1.9), pediatrics (1.8), and urology (1.2). Among 58,789 tests, 7690 (13.1%) were positive. MDR bacteria were responsible for 1783 infections (23.2%). The most common antibiotic resistance mechanism reported was ESBL production by Klebsiella spp. or Escherichia coli or Enterobacter spp. isolates (47.3% of all MDR cases). ESBL cases were followed by MRSA (14.7%), VRE (14.2%) and MBL producing Klebsiella spp. (5.6%). Among all infections caused by MDR bacteria, 1175 (65.9%) were diagnosed after 72 h of hospitalization (hospital-acquired infections). Apart from AmpC and ESBL producing Escherichia coli, all MDR bacteria were significantly more common in hospital-acquired infection. MDR bacteria are aetiological factors of a significant portion of infections in hospitalized patients with no remarkable change in the incidence in recent years. Production of ESBL is the most common mechanism of antibiotic resistance and should be regarded as one of the most urgent problems in clinical microbiology.
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Affiliation(s)
- Sławomir Poletajew
- Second Department of Urology, Centre of Postgraduate Medical Education, 80 Cegłowska St., 00809 Warsaw, Poland; (A.B.-N.); (A.P.); (Ł.N.); (P.K.)
- Correspondence: ; Tel.: +48-225690148; Fax: +48-225690150
| | - Katarzyna Pawlik
- Infection Control Team, Bielanski Hospital, 80 Cegłowska St., 00809 Warsaw, Poland;
| | - Anna Bonder-Nowicka
- Second Department of Urology, Centre of Postgraduate Medical Education, 80 Cegłowska St., 00809 Warsaw, Poland; (A.B.-N.); (A.P.); (Ł.N.); (P.K.)
| | - Artur Pakuszewski
- Second Department of Urology, Centre of Postgraduate Medical Education, 80 Cegłowska St., 00809 Warsaw, Poland; (A.B.-N.); (A.P.); (Ł.N.); (P.K.)
| | - Łukasz Nyk
- Second Department of Urology, Centre of Postgraduate Medical Education, 80 Cegłowska St., 00809 Warsaw, Poland; (A.B.-N.); (A.P.); (Ł.N.); (P.K.)
| | - Piotr Kryst
- Second Department of Urology, Centre of Postgraduate Medical Education, 80 Cegłowska St., 00809 Warsaw, Poland; (A.B.-N.); (A.P.); (Ł.N.); (P.K.)
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11
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Nyk Ł, Tayara O, Ząbkowski T, Kryst P, Andrychowicz A, Malewski W. The role of mpMRI in qualification of patients with ISUP 1 prostate cancer on biopsy to radical prostatectomy. BMC Urol 2021; 21:82. [PMID: 34006281 PMCID: PMC8130114 DOI: 10.1186/s12894-021-00850-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 05/11/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND To investigate the role of mpMRI and high PIRADS score as independent triggers in the qualification of patients with ISUP 1 prostate cancer on biopsy to radical prostatectomy. METHODS Between January 2017 and June 2019, 494 laparoscopic radical prostatectomies were performed in our institution, including 203 patients (41.1%) with ISUP 1 cT1c-2c PCa on biopsy. Data regarding biopsy results, digital rectal examination, PSA, mpMRI and postoperative pathological report have been retrospectively analysed. RESULTS In 183 cases (90.1%) mpMRI has been performed at least 6 weeks after biopsy. Final pathology revealed ISUP Gleason Grade Group upgrade in 62.6% of cases. PIRADS 5, PIRADS 4 and PIRADS 3 were associated with Gleason Grade Group upgrade in 70.5%, 62.8%, 48.3% of patients on final pathology, respectively. Within PIRADS 5 group, the number of upgraded cases was statistically significant. CONCLUSIONS PIRADS score correlates with an upgrade on final pathology and may justify shared decision of radical treatment in patients unwilling to repeated biopsies. However, the use of PIRADS 5 score as a sole indicator for prostatectomy may result in nonnegligible overtreatment rate.
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Affiliation(s)
- Łukasz Nyk
- Second Department of Urology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Omar Tayara
- Second Department of Urology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Tomasz Ząbkowski
- Department of Urology, Military Institute of Medicine, Warsaw, Poland
| | - Piotr Kryst
- Second Department of Urology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | | | - Wojciech Malewski
- Second Department of Urology, Centre of Postgraduate Medical Education, Warsaw, Poland
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Nyk Ł, Malewski W, Kaczmarek K, Kryst P, Pyźlak M, Andrychowicz A, Zabkowski T. Interobserver Variability in Assessment of Renal Mass Biopsies. Urol J 2020; 18:400-403. [PMID: 33000458 DOI: 10.22037/uj.v16i7.6024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE The main goal of this study was to assess the histopathological efficacy of renal mass biopsy and to check the concordance between pathological results and biopsy of the final specimen, as well as interobserver variability in the assessment of biopsy cores. MATERIALS AND METHODS A hundred sets of core biopsies of postoperative specimens (renal masses) have been performed. Three core biopsies of the intact specimen had been performed once the kidney with the tumor, or the tumor alone were resected. The urologist aimed to obtain two cores from the peripheral sides of the tumor and one core from its center. The surgical specimen was evaluated by a single pathologist, whereas biopsy samples were referred to three independent pathologists who were blinded to the final results of the renal mass biopsy. RESULTS Nondiagnostic biopsy rates ranged from 13% to 22%. Sensitivity and specificity ranged 83-97% and 97-99% by excluding nondiagnostic results. The concordance between assessment of surgical specimen and biopsy in the Fuhrman grading system ranged 36.5-77.0%, respectively. Interobserver agreement between the three pathologists was substantial or moderate, depending on the tumor subtype. The Krippendorff's alpha coefficient, calculated by excluding the nondiagnostic results, was 0.28 (moderate agreement) for the Fuhrman grading system. CONCLUSION The agreement regarding grading of biopsies between three pathologists ranged from moderate to substantial. Therefore, a team of dedicated uropathologists should be engaged in final diagnosis of renal mass biopsy rather than single one before implementing the proper treatment.
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Affiliation(s)
- Łukasz Nyk
- 1. Department of Urology, European Health Center, Otwock, Poland, II Urology Clinic, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Wojciech Malewski
- 1. Department of Urology, European Health Center, Otwock, Poland, II Urology Clinic, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Krystian Kaczmarek
- Department of Urology and Urological Oncology, Pomeranian Medical University, Szczecin, Poland
| | - Piotr Kryst
- 3. Department of Urology, Bielański Hospital, Warsaw, Poland, II Urology Clinic, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Michał Pyźlak
- 4. Department of Pathology and Laboratory Medicine. Maria Sklodowska-Curie Institute - Cancer Center. Roentgena 5, 02-781 Warsaw, Poland
| | | | - Tomasz Zabkowski
- Department of Urology, Military Institute of Medicine, Warsaw, Poland.
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Kozikowski M, Powroźnik J, Malewski W, Kawecki S, Piotrowicz S, Michalak W, Nyk Ł, Gola M, Dobruch J. 3.0-T multiparametric magnetic resonance imaging modifies the template of endoscopic, conventional radical prostatectomy in all cancer risk categories
. Arch Med Sci 2018; 14:1387-1393. [PMID: 30393494 PMCID: PMC6209726 DOI: 10.5114/aoms.2018.77222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 01/23/2017] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION We aimed to evaluate the diagnostic performance of 3.0-T multiparametric magnetic resonance imaging (mpMRI) in preoperative staging of prostate cancer (PCa) and its influence on the extent of resection during endoscopic radical prostatectomy (ERP) among cancer risk groups. MATERIAL AND METHODS The data of 154 patients with PCa in whom mpMRI was performed prior to ERP between 2011 and 2015 were included. The initial decision whether to perform neurovascular bundle (NVB) sparing surgery was based on EAU guidelines. mpMRI images were reevaluated prior to prostatectomy to modify the surgical template. Imaging was compared with pathological reports to investigate the diagnostic performance of mpMRI. RESULTS The surgical template was modified in 69 (44.8%) patients after reevaluation of mpMRI. More preserving NVB sparing was attempted in 17 (11.0%) men, in whom NVB would have been resected if mpMRI had not been available. More aggressive NVB resection was performed in 52 (33.8%) men, in whom innervation would have been spared if basing solely based on guidelines. Among all PCa risk groups mpMRI had an impact on the surgical template with more aggressive surgery in 63.0% and 33.3% of men in the low- and intermediate-risk group, respectively, and more preserving in 21.4% of the high-risk patients. The change in extent of resection was not correlated with a higher risk of positive surgical margins (p = 0.196). CONCLUSIONS Preoperative mpMRI exerts a significant impact on decision making concerning the extent of resection during ERP irrespective of the PCa risk group.
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Affiliation(s)
- Mieszko Kozikowski
- Urology Clinic, Centre of Postgraduate Medical Education, Department of Urology, European Health Centre – Otwock, Poland
| | - Jan Powroźnik
- Urology Clinic, Centre of Postgraduate Medical Education, Department of Urology, European Health Centre – Otwock, Poland
| | - Wojciech Malewski
- Urology Clinic, Centre of Postgraduate Medical Education, Department of Urology, European Health Centre – Otwock, Poland
| | - Szymon Kawecki
- Urology Clinic, Centre of Postgraduate Medical Education, Department of Urology, European Health Centre – Otwock, Poland
| | - Sebastian Piotrowicz
- Urology Clinic, Centre of Postgraduate Medical Education, Department of Urology, European Health Centre – Otwock, Poland
| | - Wojciech Michalak
- Urology Clinic, Centre of Postgraduate Medical Education, Department of Urology, European Health Centre – Otwock, Poland
| | - Łukasz Nyk
- Urology Clinic, Centre of Postgraduate Medical Education, Department of Urology, European Health Centre – Otwock, Poland
| | - Magdalena Gola
- Department of Diagnostic Imaging, European Health Centre – Otwock, Poland
| | - Jakub Dobruch
- Urology Clinic, Centre of Postgraduate Medical Education, Department of Urology, European Health Centre – Otwock, Poland
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Piotrowicz S, Muśko N, Kozikowski M, Nyk Ł, Borówka A, Dobruch J. Contralateral adrenal metastasis from renal cell carcinoma with tumor thrombus in the adrenal vein: a case report. J Ultrason 2016; 15:438-42. [PMID: 26807301 PMCID: PMC4710695 DOI: 10.15557/jou.2015.0041] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 10/22/2015] [Accepted: 10/26/2015] [Indexed: 11/29/2022] Open
Abstract
A 64-year-old woman presented with contralateral right adrenal metastasis with adrenal vein thrombus, which was diagnosed many years after left nephrectomy with adrenalectomy due to renal cell cancer. The patient underwent right adrenalectomy with adrenal vein tumor thrombectomy for treatment. The pathologic examination confirmed metastatic clear cell carcinoma. The remote but existing risk of developing contralateral adrenal metastasis (CAM) after primary radical nephrectomy supports the idea of sparing the adrenal gland in suitable patients who undergo radical nephrectomy. Contralateral adrenal metastasis from RCC is a rare finding with the potential benefit of cure after resection. Care must be taken in preoperative diagnostics, as this metastasis is capable of causing inferior vena cava tumor thrombus via the suprarenal venous route. According to our knowledge, our case is the second similar entity described in literature so far.
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Affiliation(s)
- Sebastian Piotrowicz
- Department of Urology, Centre of Postgraduate Medical Education, European Health Centre Otwock, Poland
| | - Natalia Muśko
- Department of Urology, Centre of Postgraduate Medical Education, European Health Centre Otwock, Poland
| | - Mieszko Kozikowski
- Department of Urology, Centre of Postgraduate Medical Education, European Health Centre Otwock, Poland
| | - Łukasz Nyk
- Department of Urology, Centre of Postgraduate Medical Education, European Health Centre Otwock, Poland
| | - Andrzej Borówka
- Department of Urology, Centre of Postgraduate Medical Education, European Health Centre Otwock, Poland
| | - Jakub Dobruch
- Department of Urology, Centre of Postgraduate Medical Education, European Health Centre Otwock, Poland
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Skrzypczyk MA, Nyk Ł, Szostek P, Szempliński S, Borówka A, Dobruch J. The role of endoscopic bladder tumour assessment in the management of patients subjected to transurethral bladder tumour resection. Eur J Cancer Care (Engl) 2015; 26. [PMID: 26714143 DOI: 10.1111/ecc.12431] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2015] [Indexed: 11/26/2022]
Abstract
Despite complete resection, non-muscle invasive bladder cancers tend to recur. Therefore, their risk stratification was implemented to select adjuvant therapy. Immediate intravesical chemotherapeutic instillations were shown to decrease the risk of recurrence in those with low-risk disease. The purpose of the study was to determine the role of endoscopic assessment in the management of patients subjected to transurethral resection of the bladder tumour (TURBT). In 262 patients submitted to TURBT due to primary bladder tumour, the size and the number of the lesion(s) were noted and the stage as well as the grade of the tumour(s) were typed. The individual features were then scored according to the European Organisation of Research and Treatment of Cancer 'Bladder Calculator' and the lesions were classified into the low, intermediate and high risk of recurrence group. Clinical evaluation was then compared with pathological report and final triage. Based on the clinical data, 95 (36.25%), 105 (40.07%) and 3 (1.14%) patients were endoscopically assigned to the groups of low, intermediate and high risk of recurrence respectively. After pathological report, correct risk stratification was confirmed in 86 (90.5%), 95 (90.5%) and 3 (100%) patients respectively. Endoscopic assessment of bladder cancers allows to accurately establish the risk of recurrence and may facilitate implementation of adjuvant therapy before histological evaluation.
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Affiliation(s)
- M A Skrzypczyk
- Clinical Department of Urology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Ł Nyk
- Clinical Department of Urology, Centre of Postgraduate Medical Education, European Health Centre in Otwock, Otwock, Poland
| | - P Szostek
- Clinical Department of Urology, Centre of Postgraduate Medical Education, European Health Centre in Otwock, Otwock, Poland
| | - S Szempliński
- Clinical Department of Urology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - A Borówka
- Clinical Department of Urology, Centre of Postgraduate Medical Education, European Health Centre in Otwock, Otwock, Poland
| | - J Dobruch
- Clinical Department of Urology, Centre of Postgraduate Medical Education, Warsaw, Poland.,Clinical Department of Urology, Centre of Postgraduate Medical Education, European Health Centre in Otwock, Otwock, Poland
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Nyk Ł, Golabek T, Dobruch J, Skrzypczyk MA, Dzik T, Wysocki M, Chłosta PL, Borówka A. Should active surveillance in prostate cancer patients be based on a single histological assessment? Cent European J Urol 2014; 67:242-6. [PMID: 25247080 PMCID: PMC4165681 DOI: 10.5173/ceju.2014.03.art6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Revised: 05/05/2014] [Accepted: 06/16/2014] [Indexed: 11/25/2022] Open
Abstract
Introduction Active surveillance (AS) is always associated with a degree of uncertainty, whether or not prostate biopsy (TRUSBx) results indeed can be relied on for evaluation of cancer stage and histological grade, as the most commonly observed limitations of TRUSBx are undergrading, understaging and underestimating true prostate cancer (PCa) volume. We evaluated prostate cancer characteristics in men who could have been offered active surveillance based on clinical features and TRUSBx results, and compared them with the same patient's histology results following their radical prostatectomy (RP). Moreover, we assessed the level of consistency in reporting TRUSBx and RP specimens by the same pathologist on two separate occasions, as well as by another independent pathologist. Material and methods All patients who underwent RP between 2005 and 2008 had their medical records reviewed retrospectively. All histological specimens were prospectively re–evaluated by the same pathologist, as well as by a second to assess for intra– and interobserver variability, respectively. Results Eight out of a total of 124 patients who underwent RP could have been offered AS on the basis of initial microscopic reports. However, there was significant intra– and interobserver variability. The differences in the histological grade of the specimens obtained from TRUSBx and RP, reported by the same pathologist and by the second pathologist were apparent in 6 and 4 cases, and in 7 and 6 patients, respectively. Conclusions We recommend that the decision about AS should be made after at least two pathologists have jointly reviewed and agreed on the TRUSBx histology results.
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Affiliation(s)
- Łukasz Nyk
- Postgraduate Medical Education Centre, Department of Urology, European Health Centre, Otwock, Poland
| | - Tomasz Golabek
- Department of Urology, Collegium Medicum of the Jagiellonian University, Cracow, Poland
| | - Jakub Dobruch
- Postgraduate Medical Education Centre, Department of Urology, European Health Centre, Otwock, Poland
| | - Michał Andrzej Skrzypczyk
- Postgraduate Medical Education Centre, Department of Urology, European Health Centre, Otwock, Poland
| | - Tomasz Dzik
- Department of Urology and Pathomorphology, Central Railway Hospital, Warsaw, Poland
| | - Maciej Wysocki
- Postgraduate Medical Education Centre, Department of Pathomorfology – Bielański Hospital, Warsaw, Poland
| | - Piotr L. Chłosta
- Department of Urology, Collegium Medicum of the Jagiellonian University, Cracow, Poland
| | - Andrzej Borówka
- Postgraduate Medical Education Centre, Department of Urology, European Health Centre, Otwock, Poland
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