Iqbal Shergill

Percutaneous needle biopsy for indeterminate renal masses: a national survey of UK consultant urologists

BackgroundThe use of percutaneous needle biopsy in the evaluation of indeterminate renal masses is controversial and its role in management remains largely unclear. We set to establish current practice on this issue in UK urology departments.MethodsWe conducted a national questionnaire survey of all consultant urologists in the UK, to establish current practice and attitudes towards percutaneous needle biopsy in the management of indeterminate renal masses.Results139 (43%) consultant urologists never use biopsy, whereas 111 (34%) always employ it for the diagnosis of indeterminate renal masses. 75 (23%) urologists use biopsy only for a selected patient group. Mass in a solitary kidney, bilateral renal masses and a past history of non-renal cancer were the main indications for use of percutaneous biopsy. The risk of false negative results and biopsy not changing the eventual management of their patients were the commonest reasons not to perform biopsy.ConclusionThere is a wide and varied practice amongst UK Consultant Urologists in the use of percutaneous biopsy as part of the management of indeterminate renal masses. The majority of urologists believe biopsy confers no benefit. However there is a need to clarify this issue in the wake of recent published evidence as biopsy results may provide critical information for patients with renal masses in a significant majority. It not only differentiates benign from malignant tissue but can also help in deciding the management option for patients undergoing minimally invasive treatments.

HYPOANDROGEN‐METABOLIC SYNDROME: A SIGNIFICANT ISSUE FOR MEN’S HEALTH

1 Gould DC, Amoroso P, Kirby RS. Hypoandrogen-metabolic syndrome: a significant issue for men’s health. BJU Int 2006; 98 : 494–6 2 Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 1998; 15 : 539– 53 3 Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults. Executive summary of the Third Report of the National Cholesterol Education Programme (NCEP) Expert Panel on Detection, Evaluation And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA 2001; 285 : 2486–97 4 Zimmet P, Magliano D, Matsuzawa Y, Alberti G, Shaw J. The metabolic syndrome: a global public health problem and a new definition. J Atheroscler Thromb 2005; 12 : 295–300 5 American College of Endocrinology Task Force on Insulin Resistance Syndrome. American College of Endocrinology Position Statement on the Insulin Resistance Syndrome. Endocr Pract 2003; 9 : 236–52 6 Grundy SM, Brewer HB Jr, Cleeman JI, Smith SC Jr, Lenfant C; National Heart. Lung, and Blood Institute; American Heart Association. Definition of metabolic syndrome: report of the National Heart, Lung, and Blood Institute/ American Heart Association conference on scientific issues related to definition. Arterioscler Thromb Vasc Biol 2004; 24 : e13–8 7 Nieschlag E, Swerdloff R, Behre HM et al. Investigation, treatment, and monitoring of late-onset hypogonadism in males: ISA, ISSAM, and EAU Recommendations. J Androl 2006; 27 : 135–7 8 Ozden C, Ozdal OL, Urgancioglu G, Koyunku H, Gokkaya S, Memis A. The correlation between metabolic syndrome and prostatic growth in patients with benign prostatic hyperplasia. Eur Urol 2006 [Epub ahead of print]

MANAGEMENT OF SMALL INDETERMINATE RENAL TUMOURS: IS THERE A CASE FOR NEEDLE BIOPSY?

The incidence of RCC has increased over the last 50 years, largely due to enhanced detection of asymptomatic renal masses with the expanded use of imaging techniques such as ultrasonography and CT. Currently, more than a third of renal tumours are discovered incidentally [1]. The mainstay of diagnosis for renal tumours is cross-sectional imaging, but a group of solid and complex cystic lesions cannot be differentiated as definitely malignant or benign. In essence, many radiologists label such a renal mass as ‘indeterminate’ in contemporary practice, especially small lesions [2]. The dilemma for urologists then is how to manage this subgroup of patients.

Gonadotropins and Prostate Cancer – Revisited

Luteinizing hormone and follicle-stimulating hormone are called gonadotropins, because they stimulate the gonads – in males the testes and in females the ovaries. They are not necessary for life, but are essential for reproduction. In addition, the association of these hormones with prostate cancer has been the interest of many researchers. Their detection in the human prostate has been investigated using different methods, including immunologic and RT-PCR techniques. In addition, the increasing evidence of paracrine/autocrine functions of the gonadotropic glycoprotein hormones, their allocation to the superfamily of cystine knot growth factors, and luteinizing hormone/chorionic gonadotropin receptor gene expression in non-gonadal tissues led many researchers to investigate intraprostatic glycoprotein hormones and their receptor gene expression. We aim in this review to shed light on the physiology of the gonadotropins and their association with prostate cancer and highlight the future possibilities of their use as targets in treating this disease.

Nonmyeloablative Allogeneic Stem-Cell Transplantation for Metastatic Renal Cell Cancer: A Review and Update

Metastatic renal cell carcinoma (RCC) is resistant to conventional chemotherapy and radiotherapy. However, immunotherapy appears to be effective in 15—20% of cases, with interleukin-2 becoming the standard therapy for this disease. As a consequence of the immune susceptibility of RCC, other avenues of immunotherapy are being explored, such as nonmyeloablative allogeneic stem cell transplantation (NST). A number of trials have shown NST to be effective in varying degrees, causing partial or complete regression. Although nonmyeloablative conditioning is safer than myeloablative conditioning, its role has yet to be clearly proven as many studies have shown variable effect. Alongside this limitation, transplant-related toxicity also forms obstacles. Regardless of the limitation of NST, further refinement of the technique, with appropriate patient selection, may lead to this being an effective therapeutic choice for a significant number of individuals.

High-intensity focused ultrasound: a potential salvage treatment for recurrent prostate cancer following radiotherapy

“The developments of treatment protocols and safety features have led to reduced side effects, making highintensity focused ultrasound an attractive proposition for men who desire cure following radiotherapy failure without surgery” PL Acher, A Thwaini, IS Shergill and JM Barua Author for correspondence Harold Wood Hospital and Bart’s and the London Hospitals NHS Trust, London, UK Tel.: +44 797 694 6282 Fax: +44 208 502 1762 super_iqi@yahoo.co.uk Expert Rev. Anticancer Ther. 6(7), 969–970 (2006)

Radiommunotherapy and prostate cancer: a promising new therapy in the management of metastatic disease.

The mainstay of treatment for metastatic prostate cancer is androgen deprivation, but unfortunately all patients eventually become resistant to this treatment, developing androgen-independent cancer, with a median time to death of ≈1 year. In addition, taxanebased chemotherapy has met with limited success and is usually associated with significant toxicity. Recent research has suggested that radioimmunotherapy (RIT) using radiolabelled monoclonal antibodies (mAbs) could emerge as a novel and potentially successful treatment for metastatic prostate cancer.

Medical Therapy in Urology

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Therapies in bladder cancer: intravesical mitomycin-C

‘Various studies have found intravesical chemotherapy with mitomycin-C to be an effective treatment in preventing the recurrence rate of superficial bladder cancer.’ The use of intravesical therapy for the treatment of superficial bladder cancer aims to reduce morbidity and mortality by eradicating existing disease, preventing tumor recurrence and attempting to halt tumor progression. Mitomycin-C is a commonly used intravesical treatment option for superficial bladder cancer and was used for the first time by Shida and colleagues in 1967 [1]. It is an antitumor antibiotic with a molecular weight of 334.3 and is soluble in water and organic solvents. Mitomycin-C is usually minimally absorbed on intravesical instillation due to its high molecular weight and hydrophobic nature. The use of an instillate at the lowest achievable osmotic strength appears to be optimal for the intravesical instillation of the drug and, hence, sterile water is preferred over saline. Its dose is typically 40 mg per instillation – this regimen has been shown to exhibit a longer time-torecurrence and less recurrence compared with the standard regimen (20 mg) in patients with Stage Ta and grade 1–2 bladder cancer [2].

Dutasteride: 21st Century medical therapy for symptomatic benign prostatic hyperplasia

Dutasteride is the latest addition to medical therapy for symptomatic benign prostatic hyperplasia. The safety and efficacy of dutasteride has been firmly established in high-quality, randomized, clinical trials, and in this article we discuss these key studies, along with current thoughts on its use in combination with other benign prostatic hyperplasia drugs. The role of dutasteride in chemoprevention of prostate cancer will also be discussed.