Non-urologic Cancers Research Articles

Development of a new radical cystectomy surveillance protocol and nurse-led cystectomy follow-up clinic in Australia.

This study determined, implemented, and assessed a nurse-led radical cystectomy follow-up protocol. In 2021, an evidence-based risk-stratified protocol (non-urological cancers and benign [N-UC&B], low, or high risk) was developed from current guidelines, local and national expert opinion, and after formal discussion with the Urological Society of Australia and New Zealand (USANZ) Western Australia (WA) and Australia and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group. Retrospective and prospective assessment of cystectomy follow-up occurred between 2015 and 2023. Patients received 'surgeon-led' follow-up March 2015 to August 2021, and 'nurse-led' follow-up August 2021 to April 2023. Adherence to follow-up, cost-analysis, and healthcare efficiency calculations were performed. Of 176 cystectomy patients, 159 (90.3%) were eligible for inclusion. Overall adherence to nurse-led follow-up was 78.6% compared to 43.4% in surgeon-led (P < 0.001). Adherence to nurse-led follow-up was higher in all risk categories (high-risk 79.1% vs. 43%, P < 0.001; low risk 75% vs. 52.3%, P = 0.110; N-UC&B 71% vs. 30%, P = 0.153). Nurse-led consultation saved $59.50 per consultation with overall cost savings of $179.50, $416.50, and $595 for the entire follow-up period for N-UC&B, low, and high-risk groups based on consultation alone. A total of 1072 appointments (536 h, $62 390.40) would have been saved if the surgeon-led cohort of patients were seen in nurse-led clinics. Protocol driven nurse-led cystectomy follow-up demonstrates excellent adherence and may be more cost-effective than surgeon-led follow-up.

Unlocking the potential of tumor-derived DNA in urine for cancer detection: methodological challenges and opportunities.

High cancer mortality rates and the rising cancer burden worldwide drive the development of innovative methods in order to advance cancer diagnostics. Urine contains a viable source of tumor material and allows for self-collection from home. Biomarker testing in this liquid biopsy represents a novel approach that is convenient for patients and can be effective in detecting cancer at a curable stage. Here, we set out to provide a detailed overview of the rationale behind urine-based cancer detection, with a focus on non-urological cancers, and its potential for cancer diagnostics. Moreover, evolving methodological challenges and untapped opportunities for urine biomarker testing are discussed, particularly emphasizing DNA methylation of tumor-derived cell-free DNA. We also provide future recommendations for technical advancements in urine-based cancer detection and elaborate on potential mechanisms involved in the transrenal transport of cell-free DNA.

CtDNA transiting into urine is ultrashort and facilitates noninvasive liquid biopsy of HPV+ oropharyngeal cancer.

BACKGROUNDTransrenal cell-free tumor DNA (TR-ctDNA), which transits from the bloodstream into urine, has the potential to enable noninvasive cancer detection for a wide variety of nonurologic cancer types.MethodsUsing whole-genome sequencing, we discovered that urine TR-ctDNA fragments across multiple cancer types are predominantly ultrashort (<50 bp) and, therefore, likely to be missed by conventional ctDNA assays. We developed an ultrashort droplet digital PCR assay to detect TR-ctDNA originating from HPV-associated oropharyngeal squamous cell carcinoma (HPV+ OPSCC) and confirmed that assaying ultrashort DNA is critical for sensitive cancer detection from urine samples.ResultsTR-ctDNA was concordant with plasma ctDNA for cancer detection in patients with HPV+ OPSCC. As proof of concept for using urine TR-ctDNA for posttreatment surveillance, in a small longitudinal case series, TR-ctDNA showed promise for noninvasive detection of recurrence of HPV+ OPSCC.ConclusionOur data indicate that focusing on ultrashort fragments of TR-ctDNA will be important for realizing the full potential of urine-based cancer diagnostics. This has implications for urine-based detection of a wide variety of cancer types and for facilitating access to care through at-home specimen collections.FundingNIH grants R33 CA229023, R21 CA225493; NIH/National Cancer Institute grants U01 CA183848, R01 CA184153, and P30CA046592; American Cancer Society RSG-18-062-01-TBG; American Cancer Society Mission Boost grant MBGI-22-056-01-MBG; and the A. Alfred Taubman Medical Research Institute.

MP45-09 CANCER SURVIVORSHIP IN MALE PATIENTS: THE IMPORTANCE OF INVOLVING THE ANDROLOGIST IN THE REAL-LIFE WORLD

You have accessJournal of UrologyCME1 Apr 2023MP45-09 CANCER SURVIVORSHIP IN MALE PATIENTS: THE IMPORTANCE OF INVOLVING THE ANDROLOGIST IN THE REAL-LIFE WORLD Simone Cilio, Edoardo Pozzi, Federico Belladelli, Giuseppe Fallara, Luigi Candela, Alessandro Bertini, Christian Corsini, Francesco Lanzaro, Donato Cannoletta, Massimiliano Raffo, Fausto Negri, Ludovica Cella, Margherita Fantin, Luca Boeri, Paolo Capogrosso, Alessia D'arma, Francesco Montorsi, and Andrea Salonia Simone CilioSimone Cilio More articles by this author , Edoardo PozziEdoardo Pozzi More articles by this author , Federico BelladelliFederico Belladelli More articles by this author , Giuseppe FallaraGiuseppe Fallara More articles by this author , Luigi CandelaLuigi Candela More articles by this author , Alessandro BertiniAlessandro Bertini More articles by this author , Christian CorsiniChristian Corsini More articles by this author , Francesco LanzaroFrancesco Lanzaro More articles by this author , Donato CannolettaDonato Cannoletta More articles by this author , Massimiliano RaffoMassimiliano Raffo More articles by this author , Fausto NegriFausto Negri More articles by this author , Ludovica CellaLudovica Cella More articles by this author , Margherita FantinMargherita Fantin More articles by this author , Luca BoeriLuca Boeri More articles by this author , Paolo CapogrossoPaolo Capogrosso More articles by this author , Alessia D'armaAlessia D'arma More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Andrea SaloniaAndrea Salonia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003291.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Male cancer survivors may develop sexual dysfunction (SD) even many years after the recovery from the original malignant disease. An andrological assessment of these patients is not routinely provided in the everyday clinical practice. We aimed to evaluate the prevalence of and the clinical characteristics of cancer survivors in a cohort of men seeking medical help for SD (any) in the real-life setting of an andrological tertiary-referral centre. METHODS: Complete data from 2841 men consecutively assessed for new-onset SD between 2005 and 2022 were analysed. All patients were assessed with a comprehensive sexual and medical history, including history of any non-metastatic cancer (i.e., urological cancers, non-urological solid cancers, haematological cancer). All patients were invited to complete the International Index of Erectile Function (IIEF), and the Beck’s Depression Index (BDI). The IIEF-Erectile function (IIEF-EF) domain was categorized according to Cappelleri’s criteria. RESULTS: Of all, 237 (8.34%) patients reported a history of non-metastatic cancer, either solid or haematological. Of 237, 118 (49.8%) patients had a history of urological cancer, 92 (38.8%) of non-urological solid cancer, and 27 (11.4%) of haematological malignancies. Overall, the most frequent complaint was ED (76.4% of patients), followed by Peyronie’s disease (PD) (13.9%), low sexual desire/interest (LSD/I) (13.5%), premature ejaculation (PE) (6.8%), and delayed ejaculation (2.1%). Moreover, the most frequent concurrent complaints were ED and LSD/I reported together by 11.4% of patients, followed by ED and PD reported by 8.4% of patients. Of all, prostate cancer (PCa) survivors accounted for 41.0% of solid cancer survivors and 37.1% of the whole cohort. The most frequent non-urological cancer was colorectal cancer (CRC), reported by 10.6% of patients. Men with a history of either PCa or CRC complained more of ED [98 (92.5%) vs .68 (62.4%) men; p=0.001] and had lower rates of normal IIEF-EF [1 (0.9%) vs. 6 (5.5%) men; p=0.03], with respect to patients with a history of other types of cancers, whom conversely reported higher rates of PE [4 (3.8%) vs. 12 (11%) men; p=0.03] and of PD [9 (8.5%) vs. 21 (19.3%) men; p=0.007]. CONCLUSIONS: Almost 10% of men seeking first medical help for SD in a tertiary-referral andrology centre are cancer survivors. Following the improvement of survivorship rates in male patients, an andrological assessment should always be included throughout the follow-up of cancer survivors. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e624 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Simone Cilio More articles by this author Edoardo Pozzi More articles by this author Federico Belladelli More articles by this author Giuseppe Fallara More articles by this author Luigi Candela More articles by this author Alessandro Bertini More articles by this author Christian Corsini More articles by this author Francesco Lanzaro More articles by this author Donato Cannoletta More articles by this author Massimiliano Raffo More articles by this author Fausto Negri More articles by this author Ludovica Cella More articles by this author Margherita Fantin More articles by this author Luca Boeri More articles by this author Paolo Capogrosso More articles by this author Alessia D'arma More articles by this author Francesco Montorsi More articles by this author Andrea Salonia More articles by this author Expand All Advertisement PDF downloadLoading ...

Pre-therapeutic lymphocytopenia: a new prognostic factor for failure of endovesical BCG-immunotherapy in non-muscle invasive bladder cancer

BackgroundInflammation plays a key role in the initiation and development of cancers. The prognostic value of inflammation biomarkers is proven in several urological and non-urological cancers. Knowing that the mechanism of action of endovesical BCG-immunotherapy in the treatment of non-muscle-invasive bladder cancer (NMIBC) is based on inflammation; lymphocytes have a key role in this reaction, particularly in the cytotoxic phase and can be predictive biomarkers of the response to BCG-therapy. The main objective of our work is therefore to study the impact of the number of lymphocytes on the response to endovesical BCG-immunotherapy, and more specifically lymphocytopenia (Lp) as a prognostic factor for BCG-failure.MethodsOur study is a monocentric retrospective cohort carried for prognostic purposes, including 200 patients neodiagnosed with non-muscle-invasive bladder cancer (Ta -T1 stages), who required adjuvant treatment to TURB by BCG-immunotherapy, over a period of 5 years from January 2012 to December 2016. The cutoff value chosen was 1.67 × 109/L using maximized Log-Rank test. Survival analysis was studied using a Kaplan–Meier model. The comparison between the thresholds (L ≤ Vs > 1.67 × 109/L) concerning the recurrence and progression rates was carried out using the Log-Rank test. The association between lymphocytopenia and BCG-therapy failure was assessed in univariate and multivariate analysis by the Cox model. Statistical analysis was performed using Jamovi statistical software.ResultsOne hundred and eight patients had a lymphocyte count > 1.67 × 109/L while 92 had a lymphocyte count ≤ 1.67 × 109/L. The median lymphocyte value was 1.64 (1.19; 2.4). The median survival without failure of BCG treatment was significantly better in the high lymphocyte-count group, with median of 22 months in the > 1.67 × 109/L group versus 11 months until failure in the ≤ 1.67 × 109/L group. A lymphocyte count ≤ 1.67 × 109/L was associated with failure of BCG-therapy in univariate (HR = 4.80, P ≤ 0.001) and multivariate (HR = 1.88, P = 0.025) studies. Other factors associated in the univariate study were found: T1 stage (P = 0.001), high-grade urothelial carcinoma (P = 0.001), multifocal tumor (P = 0.001), tumor size > 3 cm (P = 0.001), concomitant carcinoma in situ (Cis) (P = 0.001) and vascular emboli (P = 0.001). Multivariate study showed significant factors that are, in addition to lymphocytopenia, the presence of T1 stage (P = 0.011) and vascular emboli (P = 0.013).ConclusionOur study has shown an association between lymphocytes count and NMIBC progression. Patients with lymphocytopenia carry an increased risk of endovesical BCG-immunotherapy failure. These results should be further validated.

Prediction of Stent Failure for Malignant Ureteral Obstruction in Non-Urological Cancer.

To analyze prognostic factors associated with ureteral stent failure and to develop a prediction model for malignant ureteral obstruction (MUO) in patients with non-urological cancers. We retrospectively reviewed patients with non-urological cancers who underwent ureteral stenting or percutaneous nephrostomy (PCN) for MUO between 2006 and 2014. Variables predicting stent failure were identified using Cox regression analysis. Of the 743 patients, 468 (63.0%) underwent ureteral stenting only, and 275 (37.0%) underwent PCN owing to technical (n=215) or functional (n=60) stent failure. The median overall survival was 4 [interquartile range (IQR) 1-11] months, and the median interval duration to stent failure was 2 (IQR 0-7) months. In univariate analysis, lower gastrointestinal cancer, previous radiotherapy to the pelvis, bladder invasion, lower ureteral obstruction, and low previous estimated glomerular filtration rate (eGFR) (<30 mL/min/1.73 m²) were significantly associated with a decreased survival rate. In multivariate analysis, bladder invasion and previous eGFR were significant predictors. With these two predictors, we divided patients into three groups based on their presence: low-risk (neither factor; n=516), intermediate-risk (one factor; n=206), and high-risk (both factors; n=21). The median stent failure-free survival rates of patients in the low-, intermediate-, and high-risk groups were 26 (8-unreached), 1 (0-18), and 0 (0-0) months, respectively (p<0.001). In cases of ureteral obstruction caused by non-urological cancers, patients with bladder invasion and a low eGFR showed poor stent failure-free survival. Therefore, PCN should be considered the primary procedure for these patients.

Defining radical cystectomy using the ICD-10 procedure coding system.

The International Classification of Diseases-10-Procedure Coding System (ICD-10-PCS) is markedly more complex than the preceding ICD-9 system, which has increased the difficulty of identifying radical cystectomy (RC) in administrative datasets. Given the absence of a consensus code definition for RC, we sought to develop and internally validate a list of ICD-10-PCS codes for RC. All RCs performed from January 2019 to December 2020 were identified from our prospectively maintained registries and split into training (2019) and validation (2020) cohorts. A list of candidate ICD-10-PCS codes to identify RC were compiled using an online ICD-9 to ICD-10 converter. Codes were used to identify RCs from hospital billing data and referenced against registry cases in the training cohort; when discrepancies were found, the working ICD-10 code definition was iteratively revised. Accuracy of the consensus code list was verified in the validation cohort. We identified 459 RCs over the study period, including 225 in 2019 and 234 in 2020. In the training cohort, our codes identified 241 procedures, including 222 of 225 (99%) RCs performed for bladder cancer. Misidentified cases included 15 (6.2%) RCs for benign disease or nonurologic cancers and 4 (1.7%) non-RC cases. In the validation cohort we identified 239 cases, including 227 of 234 (97%) RCs for bladder cancer and 12 (5%) RCs for benign disease or nonurologic cancers. Given high fidelity to actual procedures performed, this list of ICD-10-PCS codes may be useful for researchers seeking to identify RC within administrative datasets.

Family History and Risk of Bladder Cancer: An Analysis Accounting for First- and Second-degree Relatives.

This study found a positive association between family history and bladder cancer in first- and second-degree relatives, with an added effect attributed to smoking. Given the detriments of bladder cancer, at-risk individuals should receive family history screening and tobacco cessation and avoidance counseling.

The Effect of 10 Most Common Nonurological Primary Cancers on Survival in Men With Secondary Prostate Cancer.

BackgroundThis study aims to test the effect of the 10 most common nonurological primary cancers (skin, rectal, colon, lymphoma, leukemia, pancreas, stomach, esophagus, liver, lung) on overall mortality (OM) after secondary prostate cancer (PCa).Material and MethodsWithin the Surveillance, Epidemiology, and End Results (SEER) database, patients with 10 most common primary cancers and concomitant secondary PCa (diagnosed 2004–2016) were identified and were matched in 1:4 fashion (age, year at diagnosis, race/ethnicity, treatment type, TNM stage) with primary PCa controls. OM was compared between secondary and primary PCa patients and was stratified according to primary cancer type, as well as according to time interval between primary cancer vs. secondary PCa diagnoses.ResultsWe identified 24,848 secondary PCa patients (skin, n = 3,871; rectal, n = 798; colon, n = 3,665; lymphoma, n = 2,583; leukemia, n = 1,102; pancreatic, n = 118; stomach, n = 361; esophagus, n = 219; liver, n = 160; lung, n = 1,328) vs. 531,732 primary PCa patients. Secondary PCa characteristics were less favorable than those of primary PCa patients (PSA and grade), and smaller proportions of secondary PCa patients received active treatment. After 1:4 matching, all secondary PCa exhibited worse OM than primary PCa patients. Finally, subgroup analyses showed that the survival disadvantage of secondary PCa patients decreased with longer time interval since primary cancer diagnosis and subsequent secondary PCa.ConclusionPatients with secondary PCa are diagnosed with less favorable PSA and grade. Even after matching for PCa characteristics, secondary PCa patients still exhibit worse survival. However, the survival disadvantage is attenuated, when secondary PCa diagnosis is made after longer time interval, since primary cancer diagnosis.

Urine as a Source of Liquid Biopsy for Cancer.

Simple SummaryTissue biopsy is essential for diagnosis and characterization of a tumor. Recently circulating tumor cells and other tumor-derived nucleic acid can be detected from blood, which is called liquid biopsy. Now this concept has been expanded to many other body fluids including urine. Urine is the least invasive method to obtain a liquid biopsy and can be done anywhere, which allows longitudinal repeated sampling. Here, we review the latest update on urine liquid biopsy in urological and non-urological cancers.Tissue biopsy is the gold standard for diagnosis and morphological and immunohistochemical analyses to characterize cancer. However, tissue biopsy usually requires an invasive procedure, and it can be challenging depending on the condition of the patient and the location of the tumor. Even liquid biopsy analysis of body fluids such as blood, saliva, gastric juice, sweat, tears and cerebrospinal fluid may require invasive procedures to obtain samples. Liquid biopsy can be applied to circulating tumor cells (CTCs) or nucleic acids (NAs) in blood. Recently, urine has gained popularity due to its less invasive sampling, ability to easily repeat samples, and ability to follow tumor evolution in real-time, making it a powerful tool for diagnosis and treatment monitoring in cancer patients. With the development and advancements in extraction methods of urinary substances, urinary NAs have been found to be closely related to carcinogenesis, metastasis, and therapeutic response, not only in urological cancers but also in non-urological cancers. This review mainly highlights the components of urine liquid biopsy and their utility and limitations in oncology, especially in non-urological cancers.

A Systematic Review and Scoping Analysis of Smoking Cessation after a Urological Cancer Diagnosis

Smoking cessation after a urologic cancer diagnosis significantly benefits patients. It is not well known how often patients quit after diagnosis or how urologists intervene to support patients' smoking cessation efforts. To examine rates of smoking cessation after diagnosis among patients with urologic cancers and to assess how often patients are given advice and support to quit smoking in the urology setting. Following the PRISMA guidelines, a systematic review was conducted of the available studies on smoking cessation after a urologic cancer diagnosis during April 2020 by a trained medical librarian using the MEDLINE, PsycInfo, Embase, and Cochrane CENTRAL databases. Studies were included based on three independent reviews and if they met a priori inclusion/exclusion criteria. In total, 2568 records were identified, 31 of which were included for final analysis. Four studies (patient n=587) reported outcomes related to the prospective implementation of a smoking cessation program with patient-level quit rates ranging from 3.2% to 47.3%. Twenty one studies reported outcomes of passive (no directed, active intervention) smoking cessation after the diagnosis of a urologic cancer (patient n=3669) with widely varying quit rates. In general, the quality of included studies was poor. There was no standardization of the measurement or timing of outcomes and few studies included validated survey instruments or biochemical confirmation of cessation. Seventeen studies included data on whether patients received advice to quit smoking after diagnosis. The proportion of patients in each study who were told to quit ranged from 2.8-78.3%. There are few smoking cessation interventions that have been prospectively implemented and reported in the urology literature and studies on quit rates after diagnosis are limited. The paucity of quality data and lack of smoking cessation interventions being used in routine urologic oncology care underscores the need for more rigorous study and implementation of evidence-based practices in this area.

Clinical Outcomes After Urinary Diversion for Malignant Ureteral Obstruction Secondary to Non-urologic Cancer: An Analysis of 778 Cases.

This study investigated patient outcomes after urinary diversion in order to manage malignant ureteral obstruction caused by non-urologic cancers and to evaluate predictive factors for overall survival. The study retrospectively reviewed patients with non-urologic malignancies who underwent ureteral stenting or percutaneous nephrostomy for ureteral obstruction between 2006 and 2014. The variables for predicting overall survival were identified by Cox regression analysis. The study enrolled 778 patients, including 522 patients who underwent ureteral stenting and 256 patients who underwent percutaneous nephrostomy. Renal function was assessed immediately and then 2weeks after urinary diversion. The median survival period was 5months (interquartile range [IQR] 2-12months). A total of 708 patients died. The patients who received chemotherapy after urinary diversion had a survival gain of 7months compared with the patients who did not receive subsequent chemotherapy (p < 0.001). The survival rate did not differ between the various types of urinary diversion (p = 0.451). In the multivariate analysis, lower survival rates were significantly associated with male sex; previous chemotherapy without radiotherapy; an increasing number of events related to malignant dissemination; low preoperative hemoglobin (< 10mg/dL), albumin (< 3g/dL), and estimated glomerular filtration (< 60mL/min/1.73m2) rates; and no subsequent chemotherapy or radiotherapy. In cases of ureteral obstruction caused by non-urologic malignancies, the overall survival was poor. However, the patients who received chemotherapy after urinary diversion had a survival gain of 7months. Therefore, urinary diversion could be considered to preserve renal function for subsequent chemotherapy, whereas patients with the poor prognostic factors should be presented with the option of no intervention.

Mycobacteria-Based Vaccines as Immunotherapy for Non-urological Cancers.

The arsenal against different types of cancers has increased impressively in the last decade. The detailed knowledge of the tumor microenvironment enables it to be manipulated in order to help the immune system fight against tumor cells by using specific checkpoint inhibitors, cell-based treatments, targeted antibodies, and immune stimulants. In fact, it is widely known that the first immunotherapeutic tools as immune stimulants for cancer treatment were bacteria and still are; specifically, the use of Mycobacterium bovis bacillus Calmette-Guérin (BCG) continues to be the treatment of choice for preventing cancer recurrence and progression in non-invasive bladder cancer. BCG and also other mycobacteria or their components are currently under study for the immunotherapeutic treatment of different malignancies. This review focuses on the preclinical and clinical assays using mycobacteria to treat non-urological cancers, providing a wide knowledge of the beneficial applications of these microorganisms to manipulate the tumor microenvironment aiming at tumor clearance.

The outcomes of isolated ureteral resection and reconstruction in non-urologic cancer patients who underwent cytoreductive surgery (CRC) and hyperthermic intraperitoneal chemotherapy (HIPEC)

BackgroundUrinary system resections are performed during the cytoreductive surgery with hypertermic intraperitoneal chemotherapy (CRS-HIPEC). However, isolated ureter resection and reconstruction results are uncertain. The aim of this study was to evaluate the postoperative outcomes of isolated ureteral resection and reconstructions in patients who underwent CRC and HIPEC procedure.MethodsA total of 257 patients that underwent CRC and HIPEC between 2015 and 2017 in the Department of Surgical Oncology, Faculty of Medicine, Ankara University, were retrospectively analyzed. Twenty patients that had undergone isolated ureteral resection and reconstruction were included in the study. Predisposing factors were investigated in patients who developed postoperative complications.ResultsThe mean age of the patients was 55.1 years. The mean follow-up time of all the patients was 11.6 months. Postoperative mortality occurred in two patients. The mean PCI score was 13.9. Postoperative urologic complications were observed in eight patients after ureter reconstruction. There was no statistically significant difference between the groups in terms of reconstruction techniques and postoperative complications (P = 302). There was no correlation between age (P = 0.571) and gender (P = 0.161) with complications. CRS-HIPEC was performed mostly due to gynecologic malignancy. However, there was no correlation between the primary cancer diagnosis and the development of complications (P = 0.514). The hospital stay duration was higher in the group with complications (16.3 vs 8.8 days, P = 0.208).ConclusionsUreteral resections and reconstructions can be performed for R0/1 resections in CRS-HIPEC operations. It leads to an increase in hospital stay. But there is no significant difference in the development of complications. In the management of complications, conservative approach was sufficient.

Urinary exosomal proteins as (pan-)cancer biomarkers: insights from the proteome.

Exosomes are extracellular vesicles (EVs) released from cells under both physiological and pathological conditions, and may, thus, be present in biofluids. Urine is one of the most accessible biofluids implemented in clinical diagnostics. Recent mass spectrometry (MS)-based proteomic analyses have enabled high-throughput, deep proteome profiling of urinary EVs for the discovery, quantification and characterization of cancer-specific exosome biomarkers. The protein cargo of urine exosomes is emerging as an attractive source for biomarkers, not only for urological cancers, such as prostate, bladder and kidney cancer, but potentially also for nonurological cancers, including gastric, lung, oesophageal and colorectal cancer. More recently, exosome proteomics dissected protein cargo in the lumen and at the surface of EVs, and unexpectedly indicated that RNA- and DNA-binding proteins might also be present on vesicular surfaces. Here, we analyse MS-based proteomic data on urinary exosomes from cancer patients, and discuss the potential of urinary exosome-derived biomarkers in cancer.

Urine-Based Liquid Biopsy for Nonurological Cancers.

The use of circulating cell-free DNA for detection of cancer genetics has been studied extensively. Liquid biopsy often refers to the use of blood as a minimally invasive source of body fluid for detecting circulating tumor DNA (ctDNA). However, urine collection, which is completely noninvasive, has been shown to also have great promise to serve as an alternate body fluid source for ctDNA. In this review article, we focus on the clinical utility of urine for genetic liquid biopsy of nonurological cancers. Although still in early stages as compared with blood-based liquid biopsy, recent studies have demonstrated the value of urine-based liquid biopsies for: nonurological cancer screening; early detection; monitoring for recurrence and metastasis; and therapeutic efficacy. Overall, the completely noninvasive and patient-friendly nature of the urine-based biopsy warrants further development and offers a promising alternative to blood-based biopsies.

PD47-10 EPIDURAL USE AT RADICAL CYSTECTOMY IS ASSOCIATED WITH HIGHER PERIOPERATIVE MORBIDITY AND INCREASED READMISSION RATES WITHOUT IMPROVING DISEASE SPECIFIC SURVIVAL: A POPULATION BASED STUDY

INTRODUCTION AND OBJECTIVES:Epidural anesthesia is used to improve pain control after major surgery and has been associated with improved survival in some non-urologic cancers. Perioperative epidur...

Evaluation of Hospital-Based Hematuria Diagnosis and Subsequent Cancer Risk Among Adults in Denmark

Data on the long-term risk of urologic and nonurologic cancer after hematuria diagnosis are sparse. Such data can improve understanding of hematuria and cancer and can provide insight into the clinical course of patients with hematuria. To assess the risk of urologic or nonurologic cancer after a hospital-based diagnosis of hematuria. This cohort study used population-based, nationwide health care databases covering all hospitals in Denmark. The data set included records of all adults (n = 134 173) with an inpatient, outpatient, or emergency department diagnosis of hematuria. The study was conducted from January 1, 1995, to December 31, 2013. Follow-up ended on December 31, 2013. Data analysis was performed from January 16, 2017, to September 18, 2018. Cumulative risk of cancer was computed, and observed cancer incidence was compared with incidence expected in the general population, using standardized incidence ratios. Of the 134 173 patients included, 52 367 (39.0%) were women, 81 806 (61.0%) were men, and the median (interquartile range) age was 59 (44-72) years. Within 3 months after hematuria diagnosis, 2647 patients (1.9%) received an invasive bladder cancer diagnosis, 1077 (0.8%) a noninvasive bladder cancer diagnosis, 569 (0.4%) a kidney cancer diagnosis, and 908 (1.1%) a prostate cancer diagnosis. The 3-month cumulative incidence (or absolute risk) of any cancer diagnosis was 4.81% (95% CI, 4.70%-4.93%), the 1-year risk was 6.65% (95% CI, 6.51%-6.78%), and the 5-year risk was 12.34% (95% CI, 12.15%-12.53%). The cumulative incidence of bladder cancer only increased from 1.20% (95% CI, 1.11%-1.30%) after 1 year to 1.36% (95% CI, 1.26%-1.46%) after 5 years of follow-up in women and from 2.93% (95% CI, 2.82%-3.05%) to 3.31% (95% CI, 3.19%-3.44%) in men. For noninvasive bladder cancer, the standardized incidence ratio in the 1 year to less than 5 years of follow-up was 5.39 (95% CI, 4.58-6.30) in patients without initial cystoscopy and was 0.16 (95% CI, 0.04-0.42) in patients with cystoscopy within 3 months after hospital-based diagnosis of hematuria. For kidney cancer, the standardized incidence ratio in the 1 year to less than 5 years of follow-up was 2.63 (95% CI, 2.15-3.18) in patients without cystoscopy and 1.20 (95% CI, 0.87-1.61) in patients with cystoscopy within 3 months after hospital-based diagnosis of hematuria. After 1 year, the risk of gynecologic and colorectal cancers was as expected or even lower, whereas the risk of hematologic malignant neoplasms remained slightly elevated. Increased risk of bladder and kidney cancers even more than 1 year after hospital-based hematuria diagnosis, as well as the slightly elevated risk of invasive bladder cancer after 5 years, may indicate that it is a marker of greater cancer risk; these findings could inform follow-up recommendations for hematuria.

Is Chemotherapy Related with Erectile Dysfunction in Non-Urologic Cancer Patients?

Is Chemotherapy Related with Erectile Dysfunction in Non-Urologic Cancer Patients?

MP39-19 SUNITINIB DRIVES CELL-TO-CELL MITOCHONDRIAL TRAFFICKING IN KIDNEY CANCER

You have accessJournal of UrologyKidney Cancer: Basic Research & Pathophysiology I1 Apr 2017MP39-19 SUNITINIB DRIVES CELL-TO-CELL MITOCHONDRIAL TRAFFICKING IN KIDNEY CANCER Jason Scovell, Juan Hernandez, and Richard Link Jason ScovellJason Scovell More articles by this author , Juan HernandezJuan Hernandez More articles by this author , and Richard LinkRichard Link More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1193AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES When grown under stressed conditions, a subset of neoplastic cells can undergo cell-to-cell trafficking of mitochondria through dynamic structures termed tunneling nanotubes. This horizontal mitochondrial transfer (HMT) is a relatively newly described phenomenon that may contribute to chemotherapeutic resistance in several non-urologic cancers. Since HMT might represent a novel mechanism of acquired chemoresistance in renal cell carcinoma (RCC), we sought to determine if HMT occurs in response to treatment with Sunitinib, a first line chemotherapeutic agent. METHODS RCC cell lines (A498 and 786-O) were differentially labeled by lentiviral transduction of cytoplasm-localizing enhanced green fluorescent protein (EGFP) or mitochondria-localizing mCherry. Mitochondrial localization of mCherry (mito-mCherry) was achieved by tagging the fluorescent protein with the cyclooxygenase-8 mitochondria targeting sequence. Differentially labeled RCC cells were cultured at a 1:1 ratio and were treated with sunitinib (0uM, 1.25uM, 2.5um, 5uM, 10uM, and 20uM) for 24 hours. HMT was quantified by flow cytometry and visualized by deconvolution microscopy. RESULTS HMT occurred between differentially labeled RCC cells. Co-culture of mito-mCherry A498 cells with EGFP+ A498, 786-O, and ACHN cells demonstrated mitochondrial transfer at all concentrations of sunitinib tested. 2.4% of EGFP+ A498 cells received mCherry+ mitochondria in co-culture at 0uM of sunitinib. Mitochondrial transfer was enhanced by sunitinib treatment at all doses tested (e.g. 4.26% at 10uM sunitinib). This phenomenon was not cell line specific as EGFP labeled 786-O cells also acquired mCherry+ mitochondria (8.3%). Deconvolution microscopy of fixed co-cultured cells demonstrated mCherry+ mitochondria within EGFP+ 786-O cells. CONCLUSIONS Here we demonstrate for the first time that sunitinib exposure potentiates cell-to-cell transfer of mitochondria in kidney cancer cell lines. The biologic significance of this process in vivo remains to be determined. Our hypothesis is that HMT may contribute to clinically relevant acquired chemoresistance in RCC and experiments are under way to explore this possibility further. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e501 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Jason Scovell More articles by this author Juan Hernandez More articles by this author Richard Link More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...