G. Giusti

Mast cells as a potential prognostic marker in prostate cancer.

Despite years of intensive investigation that has been made in understanding prostate cancer, it remains one of the major mens health issues and the leading cause of death worldwide. It is now ascertained that prostate cancer emerges from multiple spontaneous and/or inherited alterations that induce changes in expression patterns of genes and proteins that function in complex networks controlling critical cellular events. It is now accepted that several innate and adaptive immune cells, including T- and B-lymphocytes, macrophages, natural killer cells, dendritic cells, neutrophils, eosinophils, and mast cells (MCs), infiltrate the prostate cancer. All of these cells are irregularly scattered within the tumor and loaded with an assorted array of cytokines, chemokines, and inflammatory and cytotoxic mediators. This complex framework reflects the diversity in tumor biology and tumor-host interactions. MCs are well-established effector cells in Immunoglobulin-E (Ig-E) associated immune responses and potent effector cells of the innate immune system; however, their clinical significance in prostate cancer is still debated. Here, these controversies are summarized, focusing on the implications of these findings in understanding the roles of MCs in primary prostate cancer.

Senescent Remodeling of the Innate and Adaptive Immune System in the Elderly Men with Prostate Cancer

Despite years of intensive investigation that has been made in understanding prostate cancer, it remains a major cause of death in men worldwide. Prostate cancer emerges from multiple alterations that induce changes in expression patterns of genes and proteins that function in networks controlling critical cellular events. Based on the exponential aging of the population and the increasing life expectancy in industrialized Western countries, prostate cancer in the elderly men is becoming a disease of increasing significance. Aging is a progressive degenerative process strictly integrated with inflammation. Several theories have been proposed that attempt to define the role of chronic inflammation in aging including redox stress, mitochondrial damage, immunosenescence, and epigenetic modifications. Here, we review the innate and adaptive immune systems and their senescent remodeling in elderly men with prostate cancer.

242 RESECTION OF RENAL CELL CARCINOMA (RCC) WITH EXTENDED VENA CAVA INVOLVEMENT WITH CARDIOPULMONARY BY PASS, HYPOTHERMIA AND CARDIAC ARREST USING EITHER STANDARD TECHNIQUE OR HEARTPORT® PORT-ACCESS™ SYSTEMS

resulting in permanent dialysis and 1 returned to theatre for secondary haemorrhage with conservation of the kidney. Median follow up was 35 months. 13 patients had temporary haemodialysis and 3 progressed to permanent dialysis. 3 patients have developed distal metastasis and 1 patient developed nodal disease. 1 patient died of metastasis. No local recurrence occurred. CONCLUSIONS: The peri-operative morbidity of nephron sparing surgery is higher in patients with a single kidney than is reported for patients undergoing elective PN. The case mix of patients needs to be considered when reviewing the literature on outcome from PN. Early nephrological and oncological results of PN in this group of patients are excellent.

PERCUTANEOUS NEPHROLITHOTOMY: TUBELESS OR NOT TUBELESS?

The objective of this study is to evaluate the safety and outcomes of tubeless PCNL in comparison with standard PCNL. Since June 2002, we have performed 99 tubeless PCNL. Tubeless technique involves antegrade placement of a 6Fr double-J stent without nephrostomy tube at the end of the procedure. This series has been compared with a total of 110 patients in which revision of operative reports ruled out the presence of intraoperative conditions necessary to candidate a patient to tubeless procedure but standard PCNL was performed because prior to its introduction or because of surgeon’s attitude afterward. Mean stone burden was 5.4 for standard group and 4.9 cm2 for tubeless group, respectively. Mean BMI was 24.1 in the first group and 23.6 in the second one. In this retrospective study, complications rate, postoperative pain, length of hospitalization and convalescence were evaluated by chart review. Hematocrit drop did not differ significantly between tubeless PCNL and standard PCNL (5.5 vs. 5.9%). Conversely, there was statistically significant difference between tubeless and standard PCNL in terms of the amount of analgesics (49.5 vs. 84.2 mg), immediate postoperative patients’ discomfort, hospitalization (2.2 vs. 5.3 days) and time to resume normal activities (11.0 vs. 16.5 days). In conclusion, in our series, tubeless approach did not determine increase in complication rate. Conversely, tubeless PCNL reduced analgesics’ requirement, patients’ discomfort, hospitalization and time to recovery. As such, at our institution, tubeless PCNL has become routine procedure that actually is feasible in almost two-third of renal calculi suitable for percutaneous treatment.