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   Table of Contents - Current issue
January-February 2020
Volume 31 | Issue 1
Page Nos. 1-44

Online since Thursday, February 20, 2020

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Immune checkpoint therapy: A paradigm shift in combination with curative potential p. 1
Tai-Lung Cha
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Immuno-oncology: The frontier in caring urological patients p. 3
Stephen Shei-Dei Yang
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Rational combination with an immunotherapy backbone in genitourinary cancers p. 4
Jhe-Cyuan Guo, Chia-Chi Lin
Immunotherapy, especially immune checkpoint blockade treatment, has changed the landscape of anticancer therapy. In genitourinary (GU) cancer, the programmed cell death-1 (PD-1)/programmed cell death-ligand 1 (PD-L1) blockade alone has resulted in improved outcomes compared with conventional therapies, such as chemotherapy and targeted therapy in advanced urothelial carcinoma and renal cell carcinoma (RCC), respectively. To improve the efficacy of the PD-1/PD-L1 blockade, a combination of this blockade with other therapeutic modalities has been explored in the earnest. In a recent study, ipilimumab, an anticytotoxic T-lymphocyte-associated protein 4 (CTLA-4) monoclonal antibody, combined with nivolumab, an anti-PD-1 monoclonal antibody as the first-line therapy, has demonstrated superior efficacy to sunitinib in advanced RCC patients with International Metastatic RCC Database Consortium intermediate and poor risk. This mini-review article focuses on the rational combination with the PD-1/PD-L1 blockade in GU cancers.
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Current and future aspect of immunotherapy for advanced renal cell carcinoma p. 8
Fu-Jen Hsueh, Yu Tsai
Renal cell carcinoma (RCC) has been recognized as a cancer responsive to the activation of the immune system. In the 1980s, interferon-alpha and interleukin-2 were shown to prolong survival, but they were not widely used due to toxicities. Then, vascular endothelial growth factor receptor and mammalian target of rapamycin inhibitors demonstrated clinical benefits and became the principal treatment in the first- and second-line setting of metastatic RCC (mRCC). In recent years, the efficacy of immune checkpoint inhibitors (ICIs) is confirmed, either alone or in combination with ICI or antiangiogenic agents. ICI-based immunotherapies have now changed the landscape of treatment of mRCC. In this article, we will review the progress of immunotherapy in clear-cell mRCC.
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Prevalence of hand joint symptoms in androgen deprivation therapy among japanese patients with prostate cancer p. 15
Shogo Inoue, Tetsutaro Hayashi, Jun Teishima, Akio Matsubara
Purpose: The current trends in favor of androgen deprivation therapy (ADT) for nonmetastatic prostate cancer at the stage of biochemical recurrence or increasing prostate-specific antigen levels raise the issue of exposing asymptomatic patients to potential adverse effects over the longer term. The aim of this study is to assess the hand joint symptoms caused by ADT in Japanese patients with prostate cancer. Materials and Methods: We retrospectively reviewed and performed a cross-sectional survey of hand joint symptoms in patients receiving ADT for prostate cancer. The results were compared with a control group of patients with prostate cancer that was hormone-naïve group. In total, there were 279 Japanese patients with prostate cancer, of whom 150 patients were ADT treated and 129 patients were hormone naïve. Patients completed a three-item self-administered questionnaire assessing the presence of hand joint symptoms that started or worsened after initiating ADT. Results: A statistically significant difference was found between the incidence rates of hand joint symptoms of both groups (P = 0.0056). There was a statistically significant difference in the incidence rates of hand joint pain (P = 0.0273). However, the incidence rates of hand numbness (P = 0.0576) and hand muscle weakness (P = 0.1098) between both groups were not significantly different. Conclusion: Our cross-sectional study demonstrated that patients receiving ADT for prostate cancer show significant hand joint symptoms compared to hormone-naïve patients. Consequently, for patients receiving ADT who suffer from hand joint symptoms, we must consider the adverse effects of ADT.
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Comparative analysis of robot-assisted, laparoscopic, and open radical prostatectomy regarding lower urinary tract symptoms: A longitudinal study p. 21
Shogo Inoue, Tetsutaro Hayashi, Jun Teishima, Akio Matsubara
Purpose: This study aims to assess lower urinary tract symptoms (LUTS) after radical prostatectomy (RP) and compare longitudinally the short-time LUTS changes of three techniques: robot-assisted RP (RARP), laparoscopic RP (LRP), and open RP (ORP). Materials and Methods: We reviewed prospectively the collected longitudinal data on the International Prostate Symptom Score (IPSS) from patients who performed RP for localized prostate cancer. One-year longitudinal data (preoperatively and at postoperative 3, 6, and 12 months) on IPSS were available for 322 patients. The number of patients was 231 for RARP, 42 for LRP, and 49 for ORP. LUTS was assessed on the basis of the IPSS and the IPSS quality of life (QOL) score. Results: The IPSS and IPSS related QOL scores were significantly improved over the baseline score not for the LRP and ORP but for the RARP. For patients with moderate to severe LUTS preoperatively, the RARP group immediately improved in terms of preoperative LUTS differently from both LRP and ORP groups. Only RARP significantly improved in terms of voiding symptom composites (VSC) differently from both LRP and ORP procedures. However, none of the procedures changed in terms of storage symptom composites (SSC) longitudinally. Conclusions: The improvement of LUTS for RARP may contribute to the improvement of not only SSC but also VSC.
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Factors affecting hospital stay in patients aged >65 years who underwent urological intervention: A single-center retrospective study p. 28
Elif Bombaci
Purpose: The geriatric patient population is predominant in urologic surgeries. The perioperative period of geriatric patients is affected by several factors. This study aimed to investigate the factors affecting morbidity and hospital stay in patients aged >65 years, who underwent urological intervention. Materials and Methods: The data of patients aged >65 years, who underwent urological surgery, were retrospectively evaluated. Age; sex; the American Society of Anesthesiologists (ASA) physical status; type and method of surgical intervention; duration of surgery; anesthesia method; concomitant diseases; preoperative values of blood serum albumin, potassium, creatinine, and hemoglobin (Hb); presence of infection; admission to the intensive care unit; and duration of hospital stay were recorded. The effects of the data obtained on hospital stay were evaluated.P< 0.05 was considered statistically significant. Results: Surgical method, duration of surgery, anesthesia method, presence of a comorbid disease, ASA physical status, preoperative values of blood serum albumin and Hb, presence of infection, and intensive care hospitalization had a significant effect on hospital stay, and particularly, long duration of surgery, ASA physical status, and low serum albumin levels were found to be the most effective factors to prolong hospital stay. Conclusion: In older patients who undergo a urological intervention, advanced age is not the only risk factor. The length of hospital stay is affected by a number of interrelated factors. A detailed preoperative evaluation and preparation with a multidisciplinary approach in elderly patients may prevent additional problems that may occur, ensuring the determination of the most appropriate surgical and anesthetic method.
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Prostate tuberculosis: A rare complication of pulmonary tuberculosis with malignant features mimicking prostate cancer p. 36
Amogu K Eziyi, Waheed A Oluogun, Kamoru A Adedokun, Ganiyu A Oyeniyi
Prostate tuberculosis (PTB) is an extremely rare complication of pulmonary tuberculosis (TB) that is alien to many urologists due to unaccustomed prostate involvement, thus posing a high tendency of confusion with prostate cancer. A 55-year-old Nigerian male presented with lower urinary tract symptoms with micturition difficulty, characterized by dysuria and weak urine stream that did not improve with straining, urge incontinence, and feeling of incomplete bladder emptying, some months after the completion of anti-Koch chemotherapy. The assessment of chronic bladder outlet obstruction secondary to benign prostatic hyperplasia was done, following a digital rectal examination which showed malignant features. The finding prompted requests for serum prostate-specific antigen (PSA) level and prostate biopsy. PSA level was 22.6 ng/ml, whereas histopathological examination showed Langhans-type giant cells suggestive of PTB. There is a high chance of missing out PTB in the diagnosis. Hence, a high index of suspicion is crucial in all TB-burden countries to make a differential diagnosis of PTB from classical prostate cancer.
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A case with small renal tumor complicated with pulmonary oil embolism after transcatheter arterial embolization p. 39
Jui-Shan Hsu, Po-Ming Chow, Po-Chin Liang, Yu-An Chen
An 85-year-old gentleman was diagnosed with a small right renal cell carcinoma by a radiologist. The patient opted for cryotherapy instead of partial nephrectomy. One day before the scheduled cryoablation, the patient received trans-catheter arterial embolization (TAE) with lipiodol and it was complicated with tumor rupture and peri-renal hematoma formation. The patient was discharged under a stable condition after 12-day's conservative treatment. However, upon arriving home, the patient lost consciousness and was sent to our ER, and presented with asystole. Emergent CT revealed hypoxic-ischemic encephalopathy and pulmonary embolism with bilateral lungs filled with lipiodol. We herein describe a very rare case with complication after treating renal cell carcinoma and review the relevant literature.
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Adiponectin and proto-oncogene MYC in prostate cancer: How far are we with the evidence? p. 42
Vipul D Yagnik
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CME Test p. 43

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