Management Of Urologic Malignancies Research Articles

#2892 The role of physical activity in onco-nephrology; a new weapon in the management of urological malignancies

Abstract Background and Aims New clinical evidence demonstrated that Physical Activity (PA) brings numerous benefits both at the level of Health-RelatedQuality of Life (HRQoL), biological mechanisms and at the psychological level. Indeed, it is well known that cancer treatments results in a series of symptoms and side effects that debilitates the patients with cancer and can be counteracted with physical activity. PA has an effect on several aspects of biological mechanisms: sex hormones, metabolic hormones, inflammation and adiposity, and immune function. Furthermore, strong evidence shows that aerobic or combined (aerobic and endurance) training reduces symptoms of anxiety, depression and fatigue. Combined training also leads to improvements in HRQoL, preventing and improving muscle loss and sarcopenia. This study aims to assess the influence of physical activity on this improved scenario. Method A consecutive cohort of 82 pts was enrolled in the Urological Department at San Raffaele Scientific Institute between 2018-2021. The control group (CT) was composed of 31 patients affected by CKD alone (GFR < 60 ml/min/1.73 m2, K-DIGO 2012 classification) and 51 patients with CKD and a recent history of urological malignancies (within 12 months) represented the case group (CS). Inclusion criteria were: Age (>18 years old), eGFR (<60 ml/min/1.73), Malnutritional Screening Tool (MST<2), Urological Cancer aggressiveness (no metastatic process), Informed consent (signed). Each patient underwent an initial nephrological and nutritional evaluation during which a conventional CKD Mediterranean-like diet with a controlled protein intake (MCPD) (0.6-1 g total protein/kg body weight/die and 30-35 kcal/kg body weight/die) was prescribed together with physical activity recommendation according to The National Kidney Foundation (NKF) for a period of 6 months (±2 months). Physical activity recommendations included some aerobic exercise for 30 min on most days of the week, plus other activities to increase muscle strength (exercises with resistance bands) e/o to improve flexibility (such as stretching) once or twice a week. To assess the influence of physical activity within the collaborative nephrologist-nutritionist approach (NNCA) on enhanced kidney function, the Rapid Assessment of Physical Activity (RAPA) test was administered to each patient. The test consists of two indicators: RAPA 1 will indicate aerobic physical activity levels (from 0=sedentary to 7=physically active), while RAPA 2 will indicate other types of exercises (0=none; 1=strength; 2=flexibility; 3=both). Subsequently, Bioelectrical Impedance Analysis (BIA) was conducted on all participants in the cohort to collect data on Body Cell Mass per height squared (BCM/h2), Phase Angle (PA), Extracellular Mass (ECM)/BCM, and Extracellular to Intracellular water ratio (ECW/ICW). Statistical analysis: Linear regression and Pearson's Chi-Squared test; Data analysis: R programming language and RStudio integrated development environment. Results Table 1 shows the patient's baseline characteristics. Table 2 shows anthropometric indices and parameters at pre- and post-dietary and nephrological intervention. Table 3 underlines the poor condition prevalent in CKD patients with or without oncological history, also confirmed by the low level of usual physical activity detected by the RAPA test at T0. Sure enough, our population was mainly inactive and sedentary. Results show that, after the intervention, our patients became regularly active (RAPA 1 score T0: 2.47; RAPA 1 score T1: 3.17; Delta = + 0.7, p < 0.0001); the same trend was observed for RAPA 2 score (observed increase 14%, p < 0.002). Conclusion Based on these findings, it can be inferred that standard clinical care should incorporate thorough assessment of both nutritional status and PA. The adoption of a MCPD, coupled with exercise training within a collaborative nephrologist-nutritionist approach, emerges as a potential strategy to enhance the HRQoL of this particular kind of patient.

The hammer and nail phenomenon: The expanding acceptance of active surveillance in urologic oncology

With the advent of improved biomarkers, genetics and imaging, the natural history of urologic malignancies has become more predictable. This has led to an increased acceptance of active surveillance (AS) in selected patients. Herein is a review of the current state of AS in the management of urologic malignancies.

Personalized Medicine in Urologic Oncology

In 2019, the Société Internationale d’Urologie (SIU), the International Consultation on Urological Diseases (ICUD) and the World Urologic Oncology Forum (WUOF) convened key opinion leaders from around the world to review the current use of molecular markers for the diagnosis and management of urologic malignancies, as well as developments in research. This special edition of the SIUJ presents a summary of their work.

Summary and considerations in genitourinary cancer patient care during the COVID-19 Pandemic.

ABSTRACTPurpose:To provide a summary and recommendations for the set-up of strategies for cancer patients care in genitourinary oncology clinics during the pandemic and in the recovery period.Material and Methods:A non-systematic review of available literature on the management of urological malignancies during the COVID-19 pandemic was performed to summarize recommendations to improve the diagnosis and treatment of urological cancers during and after the contingence, including clinical and research aspects.Results:Urological cancer diagnosis and management should be tailored according to the severity of the COVID-19 crisis in each region and the aggressiveness of each tumor. Clinicians should adhere to strict protocols in order to prioritize the attention of patients with high-risk malignancies while optimizing resources to avoid the saturation of critical care services.Conclusions:During the COVID-19 pandemic urological cancer care has been severely impaired. For proper patient management, multidisciplinary approach is encouraged tailoring therapy according to COVID-19 regional behavior and local institutional resources. Patients with high-risk malignancies should be prioritized.

Current Status of Robot-Assisted Radical Cystectomy and Intracorporeal Urinary Diversion.

Robot-assisted surgery has become a widely used surgical approach in the management of urologic malignancies. With its initial experience in the treatment of prostate cancer, the technology rapidly expanded to other urologic malignancies including bladder cancer. Since its introduction in 2003, robot-assisted radical cystectomy has seen refinement and increased penetration over the last decade. Furthermore, urologic surgeons have expanded its use to perform urinary diversions. The concept of intracorporeal urinary diversion is still in development but continues to see increased refinement among high volume academic centers.

Potential role for metformin in urologic oncology.

Metformin is one of the most commonly used drugs worldwide. It is currently considered first-line pharmacological agent for management of diabetes mellitus type 2. Recent studies have suggested that metformin may have further benefits, especially in the field of urologic oncology. Use of metformin has been shown to be associated with decreased incidence and improved outcomes of prostate, bladder, and kidney cancer. These studies suggest that metformin does have a future role in the prevention and management of urologic malignancies. In this review, we will discuss the latest findings in this field and its implications on the management of urologic oncology patients.

Advanced prostate cancer: Every Voice Matters

Heather Payne speaks to Gemma Westcott, Commissioning Editor: Heather Payne was appointed as a consultant in Clinical Oncology at University College Hospital (London, UK) in 1997. Following her training at St Mary's Hospital London Medical School and after qualifying, she spent time working in general medicine in both London and Haiti. Currently, she specializes in the management of urological malignancies, and is actively involved in clinical research as well as being the principal investigator in a number of international multicenter and local studies. She enjoys helping patients with quality of life and decision-making issues with regard to their treatment options. In addition, she is the chairman of the British Uro-oncology Group, and is a member of the Department of Health Prostate Cancer Advisory Group. Further to this, she is a trustee of the Prostate Cancer Research Centre and clinical lead for the National Prostate Cancer Audit.

Robot-assisted nephroureterectomy for upper urinary tract urothelial carcinoma without intraoperative reposition or redocking

The gold standard for treatment of upper urinary tract urothelial carcinoma remains nephroureterectomy with the ipsilateral bladder cuff excision. With the introduction of robot system, robot-assisted surgery has become popular in the management of urological malignancies. We report a single institute experience of robot-assisted nephroureterectomy (RANU) for the treatment of upper urinary tract urothelial carcinoma (UC) without re-docking the robot system or reposition of the patient. The perioperative and oncologic outcomes are discussed.

Management of urological malignancies: Has positron emission tomography/computed tomography made a difference?

Positron emission tomography/computed tomography (PET/CT) technology has been a significant, but expensive addition to the oncologist's armamentarium. The aim of this review was to determine the clinical utility of PET/CT in urological oncology, its impact on disease outcome and cost-effectiveness. We searched MedLine and peer reviewed journals for all relevant literature available online from the year 2000 until January 2014 regarding the use of PET/CT in the management of urological malignancies. 11C-choline PET/CT has emerged as a powerful tool for assessment of biochemical relapse in prostate cancer. Use of novel radiotracers like 124I-girentuximab has shown promise in the diagnosis of clear cell renal carcinoma. Fluorodeoxyglucose PET has a proven role in seminoma for the evaluation of postchemotherapy residual masses and has shown encouraging results when used for detection of metastasis in renal, bladder, and penile cancer. Introduction of novel radiotracers and advanced technology has led to a wider application of PET/CT in urological oncology. However, testicular seminoma aside, its impact on disease outcome and cost-effectiveness still needs to be established.

Port-Site Metastasis After Robot-Assisted Partial Nephrectomy

Introduction: With the increasing use of minimally invasive techniques in the management of urologic malignancies, reports of port-site metastasis (PSM) have raised concerns regarding the oncologic safety of these approaches.1 The first urologic PSM was reported in 1994, after lymph node dissection for bladder transitional cell carcinoma.2 Using multi-institutional, international data, an estimate for the incidence of PSM in urologic surgery has been reported to be 0.09%,3 and a contemporary review found 51 cases of urologic PSM reported in literature.4 However, renal cell carcinomas (RCC) represent a minority of these reported cases (8/51), and none occurred after robot-assisted partial nephrectomy (RAPN). We present a video describing our case of RCC-PSM after RAPN and demonstrating our technique for laparoscopic resection of the recurrent mass. Patients and Methods: In October 2011, a 68-year-old man underwent RAPN for an incidentally discovered 4-cm right renal mass with a nephrometry score of 10a. At no point during the resection was the mass violated. The final pathology demonstrated a 3.9-cm solid, Fuhrman grade III, clear-cell RCC with negative margins. In March 2012, routine follow-up CT scan revealed a 1.7-cm mass located on the abdominal wall, associated with an RAPN port site, and no other evidence of disease recurrence. Of note, the involved port site was the camera port site, not the specimen extraction site. The patient was completely asymptomatic. Ultrasound-guided biopsy demonstrated metastatic RCC, and in the absence of other metastatic disease, the patient was scheduled for resection of the PSM. With the patient in the left lateral decubitus position, a retroperitoneal approach was used to facilitate visualization of the intraperitoneal PSM. Once the retroperitoneal space was developed, the peritoneum was entered. The mass was well visualized and was circumferentially excised with wide margins. The mass was placed in an entrapment sack. The posterior rectus fascia was reinforced with a 2-0 polygalactin suture, which was secured with Weck Hem-o-lok clips (Teleflex, Research Triangle Park, NC). Hemostasis was ensured as the insufflation pressure was decreased to five mmHg, and the specimen was extracted, and the port-sites were closed. Results and Conclusions: The total operative time was 76 minutes, with a minimal (<10 mL) blood loss. The patient tolerated the procedure well and was discharged home on postoperative day one. The final pathology of the PSM demonstrated a 3.4-cm clear-cell RCC, granular variant, with negative margins. At present, one-month follow-up CT scan has demonstrated no evidence of disease recurrence or metastasis. The patient will be followed closely, with planned repeat imaging in six months. Although technique-related factors pertaining to specimen extraction have been implicated as a cause of PSM, our patient experienced recurrence at the camera port site, underscoring the importance of tumor and local wound-related factors in PSM. Several studies have also suggested that insufflation/desufflation during laparoscopic surgery may have an impact on the movement of tumor cells within the peritoneal cavity, potentially causing implantation at the port sites.5,6 Laparoscopic resection is a feasible minimally invasive alternative to open excision of PSM. No competing financial interests exist. Runtime of video: 5 mins 30 secs

Debating controversies in the management of locally advanced prostate cancer

AbstractThe 7th Annual Meeting of the British Uro‐oncology Group in Birmingham highlighted many controversial areas in the management of urological malignancies. The authors summarise a lively debate on the optimal management for men diagnosed with locally advanced prostate cancer. They highlight areas of controversy and discuss the progress that has been made in the past decade to improve both survival and quality of life for men with this disease. In the next issue, they will cover controversies in the management of advanced prostate cancer. Copyright © 2011 Wiley Interface Ltd

Role of positron emission tomography in urological oncology

• Positron emission tomography (PET) is a diagnostic tool using radiotracers to show changes in metabolic activities in tissues. We analysed the role of PET and PET/computed tomography (CT) in the diagnosis, staging, and follow-up of urological tumours. • A critical, non-structured review of the literature of the role of PET and PET/CT in urological oncology was conducted. • PET and PET/CT can play a role in the management of urological malignancies. For prostate cancer, the advances in radiotracers seems promising, with novel radiotracers yielding better diagnostic and staging results than 18F-fluorodeoxyglucose (18F-FDG). In kidney cancer, PET and PET/CT allow a proper diagnosis before the pathological examination of the surgical specimen. For testis cancer, PET and PET/CT have been shown to be useful in the management of seminoma tumours. In bladder cancer, these scans allow a better initial diagnosis for invasive cancer, while detecting occult metastases. • PET and its combined modality PET/CT have shown their potential in the diagnosis of urological malignancies. However, further studies are needed to establish the role of PET in the management of these diseases. Future applications of PET may involve fusion techniques such as magnetic resonance imaging with PET.

The impact of a multidisciplinary approach in the management of urologic malignancies: Does it influence diagnostic and treatment decisions?

The impact of a multidisciplinary approach in the management of urologic malignancies: Does it influence diagnostic and treatment decisions?

Mammalian target of rapamycin inhibition as a therapeutic strategy in the management of urologic malignancies

The mammalian target of rapamycin (mTOR) is a protein kinase that regulates protein translation, cell growth, and apoptosis. Recently, there has been an enormous increase in our understanding on molecular mechanisms underlying the therapeutics of rapamycin in cancer. Alterations in the pathway regulating mTOR occur in many solid malignancies including prostate, bladder, and kidney cancer; in vitro and in vivo models of prostate and bladder cancer have established the importance of the mTOR pathway in control of cancer progression and metastasis. Temsirolimus (Torisel) and everolimus (RAD-001), two ester analogues of rapamycin, as well as rapamycin itself have clear antitumor activity in in vitro and in vivo models and are under clinical trial investigations for prostate and bladder cancer. Phase II and III trials have already established the clinical efficacy of temsirolimus in renal cancer, and current renal trials are evaluating the combined effects of vascular endothelial growth factor and mTOR inhibition. Ongoing studies in prostate and bladder cancer will soon define the activity and safety profiles of everolimus and temsirolimus. Recent molecular advances have uncovered a startling complexity in the macromolecular function of mTOR complexes, with the identification of new mTOR partners (raptor, rictor, FKBP38, PRAS40, and mSIN1), putative cancer therapeutic/prognostic targets for future clinical trials.

14 Early experience with positron emission tomography (PET) in the management of urological malignancies

Objective: To demonstrate management alterations in patients with urological malignancies by the addition of PET.Patients and Methods: Ten patients with primary urological malignancies were included in this initial series (eight urothelial transitional cell and two penile squamous cell). Conventional imaging of computerised tomography (CT) and / or magnetic resonance imaging (MRI) yielded equivocal staging results pertaining to definitive management. Each patient underwent PET for further staging. Management alterations with respect to PET findings are outlined.Results: Of the 10 patients, five were downstaged and five upstaged with PET. Management changes are tabulated.Conclusion: We demonstrated in this series the role of PET in staging urological malignancies in those patients with equivocal conventional findings. Also, more accurate physiological staging allows better oncological treatment decisions and eventual patient outcome. These points highlighted need further clarification with larger series addressing the positive predictive value of PET. Downstaged TABLE1: for 14 Diagnosis CT / MRI PET Management G2T3 Bladder Pelvic LN Negative Surgery G3T2 Ureter LN at primary Negative Surgery G3T2® UO Pelvic LN Negative Surgery T2 Penis Pelvic LN Negative Surgery T2 Penis Pelvic LN Negative Surgery Upstaged TABLE2: for 14 Diagnosis CT / MRI PET Management G3T2 Ureter Pelvic LN Metastatic Chemotherapy G3T2 Bladder Pelvic LN Metastatic Chemotherapy G3T2 Bladder Pelvic LN Metastatic Radiotherapy G3T4 Bladder N0 M0 Metastatic Chemotherapy G3T3 Bladder Pelvic LN Metastatic Radiotherapy

PET in the Management of Urologic Malignancies

No AccessJournal of UrologyUrological Survey: Imaging1 Oct 2005PET in the Management of Urologic Malignancies Cary SiegelM.D. Cary SiegelCary Siegel More articles by this author View All Author Informationhttps://doi.org/10.1097/S0022-5347(01)68589-6AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "PET in the Management of Urologic Malignancies." The Journal of Urology, 174(4 Part 1), p. 1252 © 2005 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 174Issue 4 Part 1October 2005Page: 1252 Advertisement Copyright & Permissions© 2005 by American Urological Association, Inc.MetricsAuthor Information Cary Siegel More articles by this author Expand All Advertisement PDF DownloadLoading ...

Book Review Management of Urologic Malignancies Edited by Freddie C. Hamdy, Joseph W. Basler, David E. Neal, and William J. Catalona. 628 pp., illustrated. London, Churchill Livingstone, 2002. $149. 0-443-05478-9

Book Review Management of Urologic Malignancies Edited by Freddie C. Hamdy, Joseph W. Basler, David E. Neal, and William J. Catalona. 628 pp., illustrated. London, Churchill Livingstone, 2002. $149. 0-443-05478-9

Management of Urologic Malignancies

Management of Urologic Malignancies

The management of urological malignancies during pregnancy

Urological malignancies occur only rarely during pregnancy. However, when they do occur, the urologist must use judgement to deliver optimal care to the mother without unnecessary jeopardy to the fetus. Radiation exposure should be avoided if possible and therapy should be determined by the nature of the tumour and the stage of pregnancy.