scholarly journals Systematic Review of the Role of BCG in the Treatment of Urothelial Carcinoma of the Prostatic Urethra

2021 ◽  
pp. 1-8
Author(s):  
Oliver Patschan ◽  
Philippe E. Spiess ◽  
George N. Thalmann ◽  
Joan Palou Redorta ◽  
Georgios Gakis
Keyword(s):  
Side Effects ◽  
Urothelial Carcinoma ◽  
Evidence Synthesis ◽  
Tnm Classification ◽  
Transitional Cell ◽  
Prostatic Urethra ◽  
Local Response ◽  
Pubmed Database ◽  
Bcg Therapy ◽  
Tumor Stages

BACKGROUND: In patients with non-invasive urothelial carcinoma of the prostatic urethra (PUC), treatment with Bacillus Calmette-Guárin (BCG) could be beneficial. OBJECTIVE: To assess the response rates to BCG in the different tumor stages, to describe the clinical impact of transurethral resection of the prostate (TURP) before BCG treatment, and to review the side effects of BCG treatment for PUC. METHODS: A systematic search was conducted using the PubMed database to identify original studies between 1977 and 2019 reporting on PUC and BCG. RESULTS: Of a total of 865 studies, ten were considered for evidence synthesis. An indication for BCG treatment was found in non-stromal invasive stages (Tis pu, Tis pd) and in stromal infiltrating cases (T1) of primary and secondary PUC when transitional cell carcinoma was the histology of origin. Studies including patients treated with TURP before BCG showed a better local response in the prostatic urethra with a higher DFS (80–100% vs. 63–89%) and PFS (90–100% vs. 75–94%) than patients in studies in which no TURP was performed. However, this difference in recurrence and progression in the prostate neither affected the total PFS (57–75% vs. 58–93%), nor the disease specific survival (70–100% vs. 66–100%). CONCLUSIONS: The use of resection loop biopsies of the prostatic urethra in appropriate cases during the primary work-up for suspected PUC, as well as the use of the current TNM classification for PUC, need to be improved. BCG therapy for non-stromal invasive stages of PUC show a good local response. Local response is further improved by a TURP before BCG therapy, although the overall prognosis does not seem to be affected. Further evidence for BCG treatment in the rare cases of stromal invasive PUC is needed. Specific side effects of BCG treatment for PUC are not reported.

scholarly journals Evaluation of the depth of infiltration of urothelial carcinoma in the vesical wall obtained by transurethral intravesical echotomography

2007 ◽  
Vol 64 (10) ◽  
pp. 677-683
Author(s):  
Radovan Milosevic ◽  
Novak Milovic ◽  
Borislav Stijelja ◽  
Milan Djokic ◽  
Zoran Campara ◽  
...  
Keyword(s):  
Ct Scan ◽  
Urothelial Carcinoma ◽  
Treatment Planning ◽  
Clinical Investigation ◽  
Tnm Classification ◽  
Transitional Cell ◽  
The Body ◽  
Significant Difference ◽  
The Difference ◽  
Depth Of Infiltration

Background/Aim. Transitional cell carcinoma (TCC) is the most frequent tumor of the bladder and represents 95?98% of blader neoplasams and 2?3% of all carcinomas in the body. In urogenital oncology more frequent is only prostatic cancer. Evaluation of the depth of infiltration of urothelial carcinoma in the vesical wall represents the clinical base in treatment planning and prognosis. Clinical investigation and convential radiological procedures have a low level of accuracy in estimating the local growth of the tumor. The aims of our investigation were to determine the depth of infiltration of urothelial carcinoma in the vesical wall in the investigated group of patients by transurethral intravesical echotomography (TIE) and computerised tomography (CT scan) and to compare results obtained by both methods with pathohistological (PH) results, and, based on the difference of the results determine which method was more accurate in the evaluation of the depth of infiltration of urothelial carcinoma in the vesical wall. Methods. Thirty patients with TCC of the bladder both genders, aged 51?81 years were involved in our investigation. In all of these patients, radical cystectomy (RC) was performed. This was neccessary to provide the defintive PH result. Transurethral intravesical echotomography was performed by ultrasound scanner type 1846 Bruel and Kjaer, sond type 1850, and the CT scan was perfomed by Pace plus, General Electric, U.S.A. The specimen for the definitive PH result obtained by RC includes all standards of the TNM classification. Results. Using CT scan, the most frequent was T1 stage (17 patients or 56.68%). Using TIE, the most frequent was T2 stage (22 patients or 73.33%). After RC the most frequent was T2 stage (21 patients or 70%). The Kolmogorov-Smirnov test, showed a high significant difference between the results obtained using CT and definitive PH results after RC. The same test showed no statistically significant difference between the results obtained using TIE and definitive PH results. The sensitivity and accurance of TIE compared to definitive PH results was 93.3%, but using CT it was only 33.3%. Conclusion. There was a significant difference between the results obtained using CT and TIE. The results obtained by TIE were in closer relation with the definitive PH results than the results obtained by CT scan. TIE provides more precise evaluation of the depth of infiltration of urothelial carcinoma in the vesical wall than CT scan. We conclude that the use of this procedure in local staging in TCC is justified and represents the clinical basis in the treatment planning and disease outcome prognosis.

332: Transitional Cell Carcinoma of the Prostatic Urethra: Long Term Outcome After Radical Cystoprostatectomy

2004 ◽  
Vol 171 (4S) ◽  
pp. 87-87
Author(s):  
Pablo Gomez ◽  
Murugesan Manoharan ◽  
Paul D. Sved ◽  
Sandy Kim ◽  
Mark S. Soloway
Keyword(s):  
Transitional Cell Carcinoma ◽  
Cell Carcinoma ◽  
Transitional Cell ◽  
Prostatic Urethra ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Radical Cystoprostatectomy

Safety of Vinflunine in Patients with Advanced Urothelial Carcinoma Refractory to Platinum-based Chemotherapy: A Prospective Pilot Study

2019 ◽  
Vol 14 (1) ◽  
pp. 31-36
Author(s):  
Raafat Abdel-Malek ◽  
Kyrillus S. Shohdy ◽  
Noha Abbas ◽  
Mohamed Ismail ◽  
Emad Hamada ◽  
...  
Keyword(s):  
Pilot Study ◽  
Adverse Events ◽  
Urothelial Carcinoma ◽  
Transitional Cell ◽  
Chemotherapeutic Agents ◽  
Serious Adverse Events ◽  
Platinum Based Chemotherapy ◽  
Number Of Patients ◽  
Advanced Urothelial Carcinoma ◽  
Grade 3

Background: Several single chemotherapeutic agents have been evaluated as the second-line treatment of advanced urothelial carcinoma. Despite encouraging efficacy outcomes, toxicity has often led to dose modifications or discontinuation. We aimed to assess the safety of vinflunine in a particular population of advanced transitional cell carcinoma of urothelium (TCCU), that were exposed to the previous toxicity of chemotherapy. Methods: This is an open-label, prospective, single-center pilot study to evaluate the response rate and safety profile of vinflunine in patients with advanced TCCU. It was planned to enroll 25 evaluable patients. Eligible patients are those with progressive disease after first-line platinum-based regimen for advanced or metastatic disease. Results: The study was prematurely closed due to two sudden deaths that were judged by the review board as treatment-related. Only ten patients were evaluated and received at least one cycle of vinflunine. All but one were male and seven underwent radical surgery. Eight had a distant metastasis (mainly lung and/or liver). Disease control rate was 40%, four patients had a partial response with median duration of response of 3.5 months. The median overall survival was 3.2 months (95% CI:1.67- 4.73). There were three serious adverse events namely two sudden deaths and one grade 4 thrombocytopenia. Nine grade 3/4 adverse events occurred. The most common all-grade adverse events were fatigue (50%), constipation (40%) and vomiting (40%). Moreover, grade 3 fatigue occurred in 30% of patients. Only one patient, who achieved PR for 5 months, was fit to receive further cytotoxic chemotherapy. Conclusion: The activity of vinflunine in advanced urothelial carcinoma came at the expense of its safety. The use of vinflunine has to be limited to the selected group of patients. However, this is a single institute experience in a limited number of patients.

scholarly journals Revisiting an Old Conundrum: A Systematic Review and Meta-Analysis of Intravesical Therapy for Treatment of Urothelial Carcinoma of the Prostate

2021 ◽  
pp. 1-10
Author(s):  
Andrea Kokorovic ◽  
Mary E. Westerman ◽  
Kate Krause ◽  
Mike Hernandez ◽  
Nathan Brooks ◽  
...  
Keyword(s):  
Systematic Review ◽  
Urothelial Carcinoma ◽  
Meta Analysis ◽  
Complete Response ◽  
Intravesical Therapy ◽  
Cochrane Library ◽  
Carcinoma Of The Prostate ◽  
Non Invasive ◽  
Bcg Therapy ◽  
Mucosal Involvement

BACKGROUND: The optimal management of non-invasive (mucosal and/or ductal) urothelial carcinoma of the prostate remains elusive and there is a paucity of data to guide treatment. OBJECTIVE: Our objective was to systematically review and synthesize treatment responses to conservative management of non-invasive prostatic urothelial carcinoma using intravesical therapy. METHODS: A systematic literature search using MEDLINE, EMBASE, Cochrane Library, SCOPUS, and Web of Science databases from inception to November 2019 was performed. Risk of bias assessment was performed using the Newcastle-Ottawa scale for non-randomised studies. Pooled estimates of complete response in the bladder and prostate and prostate only were performed using a random effects model. Pre-specified subgroup analyses were generated to assess differences in complete responses for: BCG therapy vs other agents, ductal vs mucosal involvement, CIS vs papillary tumors and TURP vs no TURP. RESULTS: Nine studies including 175 patients were identified for inclusion in the systematic review and meta-analysis. All were retrospective case series and most evaluated response to BCG therapy. The pooled global complete response rate for intravesical therapy was 60%(95%CI: 0.48, 0.72), and for prostate 88%(95%CI: 0.81, 0.96). Pre-specified analyses did not demonstrate statistically significant differences between subgroups of interest. CONCLUSIONS: Management of non-invasive prostatic urothelial carcinoma using intravesical therapy yields satisfactory results. Caution should be taken in treating patients with papillary tumors and ductal involvement, as data for these populations is limited. TURP may not improve efficacy, but is required for staging. Current recommendations are based on low quality evidence, and further research is warranted.

Microcystic Transitional Cell Carcinoma

2002 ◽  
Vol 126 (7) ◽  
pp. 859-861 ◽  
Author(s):  
Xavier Leroy ◽  
Emmanuelle Leteurtre ◽  
Alexandre De La Taille ◽  
David Augusto ◽  
Jacques Biserte ◽  
...  
Keyword(s):  
Transitional Cell Carcinoma ◽  
Urothelial Carcinoma ◽  
Cell Carcinoma ◽  
Renal Pelvis ◽  
Transitional Cell ◽  
Macroscopic Hematuria ◽  
Computed Tomographic ◽  
First Case ◽  
History Of ◽  
Invasive Transitional Cell Carcinoma

Abstract Microcystic transitional cell carcinoma is a rare variant of urothelial carcinoma; to date, it has been described only in the urinary bladder. We report 2 cases of microcystic transitional cell carcinoma arising in the renal pelvis. The first case occurred in a 73-year-old man with a history of superficially invasive transitional cell carcinoma who presented with macroscopic hematuria and anemia. The second case occurred in a 62-year-old woman who had no relevant medical history and presented with hematuria. Computed tomographic scan revealed a tumor of the renal pelvis. In both cases, microscopic examination showed invasive transitional cell carcinoma with prominent cystic features. The cysts were irregular in size and were deeply infiltrative. The cysts were lined by single or multiple layers of cuboidal or flattened cells with minimal cytological atypia. The first patient died of his disease 18 months after presentation. The second patient remained well at her 6-month follow-up examination. Microcystic transitional cell carcinoma is an unusual, deceptively bland variant of urothelial carcinoma, which can mimic benign lesions.

scholarly journals Evaluation of the Role of Early Second Look Cystoscopy after Complete Resection of Non-Muscle Invasive Bladder Tumors

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
K A Taema ◽  
M Shabayek ◽  
A M Tawfeek ◽  
A M Emam ◽  
M M S Khafaga
Keyword(s):  
Tnm Classification ◽  
Transitional Cell ◽  
Complete Resection ◽  
Prospective Clinical Study ◽  
Low Grade ◽  
Bladder Tumors ◽  
Primary Tumors ◽  
Multiple Tumors ◽  
Second Look ◽  
Muscle Invasive

Abstract Background most of the bladder cancers are non-muscle invasion at the time of diagnosis. Non-Muscle invasive tumors confined to the mucosa and invading the lamina propria are classified as stage Ta and T1, respectively, according to the Tumor, Node, Metastasis (TNM) classification system. Aim of the Study to determine the efficacy of early second look cystoscopy after complete resection of non-muscle invasive urinary bladder tumors and its impact on subsequent treatment policy. Patients and Methods this is a prospective clinical study that was done at Urology Department, Faculty of Medicine, Ain Shams University and Damanhur Oncology Centre. A total of 40 consecutive patients with newly diagnosed non-muscle invasive bladder cancer will be enrolled in this prospective study for second-look cystoscopy with TURBT in two to six weeks after initial TURBT and follow them up in one year. Results Single tumor was found in 22 cases (55%), while multiple tumors were recognized in 18 cases (45%) with average sizes ranging from 12mm to 70mm. Low-grade transitional cell carcinoma (TCC) was found in 26 cases (65%), whereas high-grade TCC was found in 14 cases (35%). Stage PTa tumors was found in 12 cases (30%) while 28 cases (70%) have had tumors of PT1 stage. All cases underwent an early second TURBT after (2-6) weeks which has reviled the following data. The majority of cases (28 cases) representing 70% of whole study population were free with no detection of any tumors either residual or recurrence. Residual tumors were detected in six cases (15%) all of which detected in patient with large primary tumor size exceeding 50mm or patients with multiple tumors. Whole detected residual tumors were found at edges of primary tumors ranging 2-5 mm in size which were completely resected and they were of the same stage and grade as the initial tumor. Conclusion Our findings in this study support the notion that second-look cystoscopy with or without TURBT is a prerequisite in patients with superficial bladder cancers except for patients with solitary, small low-grade pTa tumors. It is particularly highly recommended for patients with extensive and multiple tumors at the first TURBT

scholarly journals Metabolic Syndrome and Risk of Upper Tract Urothelial Carcinoma: A Case-Control Study From Surveillance, Epidemiology and End Results-Medicare-Linked Database

2021 ◽  
Vol 10 ◽  
Author(s):  
Yi Lu ◽  
Wei Zhang ◽  
Shujun Fan ◽  
Zhen Liang ◽  
Zhongjia Li ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Urothelial Carcinoma ◽  
Tumor Size ◽  
Significant Risk ◽  
Upper Tract Urothelial Carcinoma ◽  
Central Adiposity ◽  
Upper Tract ◽  
Tumor Stages ◽  
Diagnosis Date ◽  
End Results

BackgroundMetabolic syndrome (MetS) and its components are associated with increased risks of several cancers. However, the relationship between MetS and upper tract urothelial carcinoma (UTUC) has never been investigated before.MethodsWe identified 3,785 UTUC cases aged over 65 years old within the Surveillance, Epidemiology and End Results-Medicare database between 2007 and 2016. For comparison, non-cancer controls (n = 189,953) were selected from the 5% random sample of individuals residing within regions of SEER registries and matched with cases through diagnosis date and pseudo-diagnosis date. MetS and its components were all defined by using ICD-9-CM codes. Multivariate logistic regression models were conducted to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Time trends for MetS and its components were reported and we also performed dose-response effect analysis to test the concomitant effect of these components. The study was presented following the STROBE reporting checklist.ResultsUTUC risk was associated with metabolic syndrome (NCEP-III: OR: 1.669, 95% CI: 1.550–1.792; IDF: OR: 1.924, 95% CI: 1.676–2.172) and its component factors: elevated waist circumference/central adiposity (OR: 1.872, 95% CI: 1.693–2.055), impaired fasting glucose (OR: 1.306, 95% CI: 1.133–1.480), high blood pressure (OR: 1.295, 95% CI: 1.239–1.353), high triglycerides (OR: 1.280, 95% CI: 1.222–1.341), and low high-density lipoprotein cholesterol (OR: 1.354, 95% CI: 1.118–1.592). Consistent associations could also be observed in the subgroup analyses by tumor stages, grades, and tumor size. Additionally, the rates of MetS increased over time in both UTUC and control cohort (NCEP-III criterion; EAPC: +18.1%, P <0.001; EAPC: +16.1%, P <0.001, respectively). A significantly gradual increase in UTUC rates could be seen as the No. of the MetS components increase (χ² = 37.239, Ptrend = 0.000).ConclusionsAmong people aged over 65, MetS and its components were significant risk factors for UTUC with consistent associations in different tumor stages, grades, and tumor size. Even if a subject who did not meet the criteria for MetS had only one of the components, he (she) still had an elevated risk for UTUC. Strategies to control the epidemic of MetS and its components might contribute to a reduction in the UTUC burden. The findings should be considered tentative until ascertained by more researches.

scholarly journals Using Oral and Intranasal Dosage Forms of Ketamine for Managing Treatment-Resistant Depression: A Review of the Literature

2016 ◽  
Vol 4 (2) ◽  
pp. 64-71 ◽  
Author(s):  
Patrick Arthur Twohig ◽  
Vaughn Huckfeldt
Keyword(s):  
Health Care ◽  
Side Effects ◽  
Care Setting ◽  
Dosage Forms ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Similar Reduction ◽  
Aspartate Receptor ◽  
Pubmed Database ◽  
Resistant Depression

A lack of effective treatment for patients with treatment-resistant depression (TRD) has led to the evaluation of ketamine, an N-methyl- D-aspartate receptor antagonist. Despite the demonstrated short-term benefits of using intravenous (IV) ketamine, side effects and the difficulty in administering ketamine outside the health-care setting has raised interest in alternative dosage forms. Research articles evaluating oral or intranasal (IN) ketamine were retrieved from the PubMed database. Patients who received oral or IN ketamine experienced a similar reduction in depressive symptoms within 24 hours of treatment and fewer side effects compared to patients who received IV ketamine. Novel administration forms of ketamine provide an opportunity for patients with TRD to achieve remission with fewer adverse side effects. Future studies should continue to evaluate these administration strategies in the hope of promoting ketamine’s use outside health-care settings and for longer time periods.

scholarly journals Urothelial bladder carcinoma with major clinical presentation as overactive bladder, without hematuria: case report and literature review

2018 ◽  
Vol 7 (10) ◽  
pp. 4292
Author(s):  
Alexander de J. Rafaelano M. ◽  
Junior J. Araiza Navarro ◽  
María Isabel Tolentino Sosa ◽  
Fernando López Reyes ◽  
Marlene De la Peña Gutiérrez
Keyword(s):  
Bladder Cancer ◽  
Case Report ◽  
Urothelial Carcinoma ◽  
Cell Carcinoma ◽  
Transitional Cell ◽  
The United States ◽  
Transitional Epithelium ◽  
Common Symptom ◽  
Macroscopic Hematuria ◽  
Adjacent Structures

The urothelial carcinoma is the most common type of bladder cancer, comprising approximately 90% of cases in the United States. The most common symptom of bladder cancer is macroscopic hematuria, increased urinary frequency, urgency, or irritative symptoms may occur. Generally, occurs in elderly people, about 9 out of 10 people are over 55 years old, with the average age at diagnosis of 73 years. Males are more likely than women to have this neoplasm with a probability of 1 in 27 (for women the probability is 1 in 89). Most bladder cancers begin in the inner layer, also called the urothelium or transitional epithelium. As it advances, it invades the layers of the bladder and can invade adjacent structures, often metastasizing to distant lymph nodes, bones, lungs or the liver. Among the cancers that originate in the bladder authors have: Urothelial carcinoma (transitional cell carcinoma), squamous cell carcinoma, adenocarcinoma, small cell carcinoma, sarcoma. Hematuria occurs in the majority of patients with urothelial carcinoma. Symptoms such as dysuria, frequency, urgency and pain may also occur, or it may also be asymptomatic.  In this case report, an atypical presentation of bladder cancer is shown, simulating the symptomatology of a Hyperactive Bladder Syndrome.

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