Case Report: Echinocandin-Resistance Candida glabrata FKS Mutants From Patient Following Radical Cystoprostatectomy Due to Muscle-Invasive Bladder Cancer

Invasive Candida glabrata infections are not common complications after radical cystoprostatectomy. Furthermore, resistance to echinocandins arising during the course of a patient’s treatment is rarely recognised. We described a case of development of echinocandin resistance in a patient with muscle-invasive bladder cancer (pT2b N0 M0, high grade) diagnosis, subjected to radical cystoprostatectomy and exposed to echinocandins. A male patient with a previous surgical history after a traffic accident, who was operated on due to bladder cancer, underwent an episode of candidemia and mixed postoperative wound and urinary tract infection caused by C. glabrata and extended spectrum β-lactamase (ESBL)-producing Escherichia coli during hospital treatment. The patient was started on caspofungin. Repeat blood cultures showed clearance of the bloodstream infection; however, infection persisted at the surgical site. Resistance to echinocandins developed within 2 months from the day of initiation of therapy with caspofungin in the C. glabrata strain obtained from the surgical site. The isolates sequentially obtained during the patient’s treatment demonstrated resistance to echinocandins due to the mutation in hotspot 1 FKS2. Although resistance to echinocandins is relatively rare, it should be considered in oncological patients with increased complexity of treatment and intestinal surgery.

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C99 Occurrence of prostate cancer in patients with muscle-invasive bladder cancer after radical cystoprostatectomy

European Urology Supplements ◽

10.1016/s1569-9056(09)75124-3 ◽

2009 ◽

Vol 8 (8) ◽

pp. 690-691

Author(s):

J. Košina ◽

M. Brodak ◽

M. Louda ◽

J. Pacovský ◽

L. Holub ◽

...

Keyword(s):

Prostate Cancer ◽

Bladder Cancer ◽

Invasive Bladder Cancer ◽

Muscle Invasive Bladder Cancer ◽

Radical Cystoprostatectomy ◽

Muscle Invasive

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The incidence of prostate cancer and urothelial cancer in the prostate in cystoprostatectomy specimens in a tertiary care Canadian centre

Canadian Urological Association Journal ◽

10.5489/cuaj.212 ◽

2013 ◽

Vol 7 (1-2) ◽

pp. 35 ◽

Cited By ~ 5

Author(s):

Sri Sivalingam ◽

Darrel Drachenberg

Keyword(s):

Prostate Cancer ◽

Bladder Cancer ◽

Urothelial Cancer ◽

Tertiary Care ◽

Invasive Bladder Cancer ◽

Muscle Invasive Bladder Cancer ◽

Radical Cystoprostatectomy ◽

Functional Benefit ◽

Clinically Significant ◽

Muscle Invasive

Introduction: Radical cystoprostatectomy remains the gold standard treatment for muscle invasive bladder cancer. However, given the treatment related complications of compromised potency and continence with this procedure, prostate/sexuality sparing cystectomyin orthotopic neobladder candidates has emerged in an effort to minimize these quality of life concerns. Recent evidence suggests only a marginal functional benefit from these technical refinements. We sought to determine the incidence of occult prostate cancer and urothelial cancer of the prostate in cystoprostatectomy specimens conducted for muscle invasive bladder cancer.Methods: We retrospectively reviewed 83 male patients who underwent radical cystoprostatectomy for muscle invasive bladder cancer between April 2004 and March 2007. The median age ofour study group was 71 years. Pathologic findings of prostate/urothelia lcancer in the prostate were identified. Clinically significant prostate cancer was defined as Gleason score >6, tumour volume >0.5cc, extracapsular extension or perineural invasion.Results: Our review yielded a 30% (±10%, 0.95 CI) rate of prostate cancer, with 19% (± 8.5%, 0.95 CI) of total specimens being positive for clinically significant prostate cancer. Urothelial cancer in the prostate was identified in 16% (±8.5%, 0.95 CI) of patients, with an overlap with prostate cancer in 2 patients. The overall rate of an underlying cancer within the prostate of our cystoprostatectomy specimens was about 46% (±10.7%, 0.95 CI).Conclusion: These findings suggest that the oncological risk of leaving behind residual cancer may not justify the practice of prostate sparing cystectomies.

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