Jay Simhan

Partial nephrectomy for renal masses ≥ 7 cm: technical, oncological and functional outcomes.

Whats known on the subject? and What does the study add?

Prostate‐specific antigen changes and prostate cancer in hypogonadal men treated with testosterone replacement therapy

To retrospectively review hypogonadal men receiving testosterone replacement therapy (TRT), and evaluate the changes in prostate‐specific antigen (PSA) levels over an extended period, and thus evaluate the occurrence of prostate cancer, as a primary concern in treating late‐onset hypogonadism (LOH) is the potential increased risk of prostate cancer; we also recorded the cardiovascular effects of TRT.

Modulation of Akt/mTOR Signaling Overcomes Sunitinib Resistance in Renal and Prostate Cancer Cells

Tyrosine kinase inhibitors exhibit impressive activity against advanced renal cell carcinoma. However, recent clinical studies have shown an equivocal response to sunitinib in patients with castration-resistant prostate cancer. The tumor suppressor PTEN acts as a gatekeeper of the phosphoinositide 3-kinase (PI3K)/Akt/mTOR cell–survival pathway. Our experiments showed that PTEN expression inversely correlates with sunitinib resistance in renal and prostate cancer cells. Restoration of PTEN expression markedly increases sensitivity of tumor cells to sunitinib both in vitro and in vivo. In addition, pharmacologic manipulation of PI3K/Akt/mTOR signaling with PI3K/mTOR inhibitor, GDC-0980, mTOR inhibitor, temsirolimus, or pan-Akt inhibitor, GSK690693, was able to overcome sunitinib resistance in cancer cells. Our findings underscore the importance of PTEN expression in relation to sunitinib resistance and imply a direct cytotoxic effect by sunitinib on tumor cells in addition to its antiangiogenic actions. Mol Cancer Ther; 11(7); 1510–7. ©2012 AACR.

Nephron-sparing management vs radical nephroureterectomy for low- or moderate-grade, low-stage upper tract urothelial carcinoma

To compare overall and cancer‐specific outcomes between patients with upper tract urothelial carcinoma (UTUC) managed with either radical nephroureterectomy (RNU) or nephron‐sparing measures (NSM) using a large population‐based dataset.

Racial differences in hypogonadal improvement and prostate-specific antigen levels in hypogonadal men treated with testosterone replacement therapy

PURPOSE To observe hypogonadal men undergoing testosterone replacement therapy (TRT) and assess racial differences in hypogonadal improvement and prostate-specific antigen (PSA) levels. MATERIALS AND METHODS In a retrospective analysis, 75 hypogonadal men were followed for an average 34 months after initiating TRT. Total testosterone and PSA levels were assessed every 6 months, and patients diagnosed with prostatitis or prostate cancer during treatment were excluded. RESULTS For 16 African American men, the average age at diagnosis of hypogonadism was 53.5 years, compared with 57.8 years in 59 Caucasian men (p=NS). Pre- and post-treatment testosterone was 219 ng/dL and 310 ng/dL in African American men, and 247 ng/dL and 497 ng/dL in Caucasian men (p=NS). Symptomatic response was 81% in African American men and 93% in Caucasian men (p=NS). Baseline PSA level was 1.32 ng/mL in African American men and 1.27 ng/mL in Caucasian men, and there was no significant difference in PSA between racial groups at 6-month intervals, although there was a small decreasing trend in the PSA of African Americans compared with Caucasians. CONCLUSIONS Hypogonadal African American men have a similar normalization of testosterone and symptomatic response as hypogonadal Caucasian men, and PSA levels remain stable over time in both groups. In this hypogonadal cohort, in contrast to studies of eugonadal men, higher PSA levels in African Americans were not observed.

Progress towards the development of a 157-nm photoresist for carbon- dioxide-based lithography

Photolithography requires organic solvents and aqueous base in the spin-coating, development, and stripping of photoresists. Carbon dioxide, an inexpensive, plentiful, and environmentally sound solvent with tunable solvency, has been proposed as an environmentally friendly alternative to traditional solvents in the electronics industry. Replacing current solvents with CO2 stems from the inherently low viscosity and surface tension of CO2. These properties allow for development of sub 0.1 μm images without image collapse, a potential problem in aqueous development. Carbon dioxide has been utilized for the synthesis of fluoropolymers. Therefore, given the high solubility of amorphous fluoropolymers in CO2, and the necessity of fluoropolymers for the next generation of photolithography (157 nm), CO2 may be an environmentally sound solvent for the synthesis, application, development, and stripping of photoresists. To accomplish this goal, several fluorinated monomers (tetrafluoroethylene, chlorotrifluoroethylene, hexafluoropropylene and vinylidene difluoride) have been copolymerized in dense carbon dioxide with norbornene and norbornene analogs. The resulting polymers have been characterized to determine molecular weight, comonomer incorporation, Tg, CO2 solubility, and absorbance at 157 nm and 193 nm.

Sarcomatoid Squamous Cell Carcinoma of the Renal Pelvis Masquerading as Emphysematous Pyelonephritis with Staghorn Calculus

Abstract Background: Staghorn calculi are well-established risk factors for recurrent urinary tract infections (UTIs) and subsequent renal deterioration. Less commonly, long-term urothelial irritation from a calculus may also pose a risk of malignant transformation. Case Presentation: A 77-year-old male with multiple medical comorbidities presented with a chronic right renal pelvic staghorn calculus and findings concerning for emphysematous pyelonephritis. He was subsequently taken to the operating room for a planned laparoscopic right nephrectomy. Final pathology analysis revealed sarcomatoid squamous cell carcinoma (SCC) of the renal pelvis with superimposed pyelonephritis and renal abscesses. Preoperative imaging was not suggestive of malignancy. Conclusion: Although SCC of the urothelium can be caused by chronic irritation, its presentation is usually isolated to the lower urinary tract and is rarely encountered in the renal pelvis. Our patients presentation with sarcomatoid SCC is an even rarer entity. Chronic staghorn calculi must be considered as a potential risk factor for the development of both UTI and malignant urothelial transformation.

442 REGIONALIZATION OF RADICAL CYSTECTOMY: TRENDS BY HOSPITAL VOLUME 1996–2009 USING STATE DISCHARGE DATA

INTRODUCTION AND OBJECTIVES: Centralization of complex urologic oncology procedures to high volume centers has been proposed as a means of improving surgical quality of care. We hypothesized that performance of radical cystectomy has become increasingly regionalized to very high volume hospitals resulting in improved short term clinical and mortality outcomes. METHODS: Using 1996 to 2009 hospital discharge data from NY, NJ, and PA provided by Databay Resources, all patients 18 years with transitional cell carcinoma undergoing cystectomy were identified using ICD-9 coding. We assigned hospital volume status by quintiles based on relative proportions of radical cystectomies performed on a per hospital basis in 1996; very low volume hospital: 0–2 (VLVH), low: 3–4 (LVH), moderate: 5–8 (MVH), high: 9–31 (HVH) and very high: 32 (VHVH). Changes in the relative proportion of procedures performed by hospital volume status were assessed over time, and patient characteristics were compared between groups. Outcome variables including discharge status, inpatient mortality, and hospital length of stay (HLOS) were examined by hospital volume status using logistic regression models. RESULTS: 14,404 patients undergoing cystectomy were included for analysis. From 1996 to 2009, there was a significant shift towards regionalization of care to VHVHs (21 to 38%, p 0.02) and away from VLVHs (20 to 9%, p 0.001). For each year increase (1996–2009), the odds of having surgery performed at a VHVH increased by 16% (OR 1.16 [CI 1.03, 1.31]). Stratified by hospital volume status, there were significant differences between groups in patient age (p 0.0001), race (p 0.0001), gender (p 0.0001), geographic location (p 0.0001), and payer group (p 0.0001). Independent of year treated, patients undergoing surgery at a VHVH were less likely to be African American (OR 0.50 [CI 0.32–0.79]) or insured through Medicaid (OR 0.67 [CI 0.47–0.95]) or Medicare (OR 0.84 [CI 0.76–0.95]). Controlling for year treated, median LOS was shorter (median difference 1.1 days [CI 1.12 to 1.06]) and patients were less likely to die during their hospital stay if treated at a VHVH compared to a VLVH (OR 0.30 [CI 0.17–0.52]). CONCLUSIONS: Since 1996, these data demonstrate that there has been extensive centralization of radical cystectomy to VHVHs, which has resulted in significant reductions in inpatient mortality rates and HLOS over time. Nevertheless, insurer and racial disparities preclude optimal access to care and these discrepancies must still be addressed.