Maciej Salagierski

Percutaneous ultrasound-guided radiofrequency ablation for kidney tumors in patients with surgical risk

Objective: The aim of this study was to describe our experience with percutaneous ultrasound‐guided radiofrequency ablation of kidney tumors.

Early experience in reconstruction of long ureteral strictures with allogenic amniotic membrane

Objective:  To present our experience with the application of human amniotic membrane for the reconstruction of extensive ureteral wall defects.

Radiofrequency ablation partial nephrectomy : A new method of nephron-sparing surgery in selected patients

Abstract  From July 2002 to April 2005, seven radiofrequency ablation partial nephrectomies have been carried out in seven selected patients. A cool‐tip Tyco radiofrequency device under intraoperative ultrasound guidance was used. After intervention, tumors were removed and their tissue with their margins were verified histopathologically. Procedure efficacy was assessed by multidetector computed tomography and by ultrasound. Complications included urine leakage in three cases. Histopathologically, in every case renal cell carcinoma was detected. There is no need for dialysis and there has been no tumor recurrence. No bleeding without clamping renal pedicle, easy tumor extraction and, we hope, reduced risk of recurrence are the major advantages of this intervention.

Radiofrequency ablation in kidney tumour management: A method of real-time monitoring

Abstract Objective. Radiofrequency ablation (RFA) is an alternative to surgery in kidney tumour management. The aim was to describe a method of real-time temperature monitoring during ultrasound-guided RFA and establish the related efficacy and safety. Material and methods. Over a 6-year period 110 radiofrequency ablations in patients with kidney tumours and in most cases contraindications to surgery were performed. For the real-time temperature-monitored intervention 42 larger renal lesions exceeding 30 mm (range 31–59 mm) were selected. The monopolar Cool-tip RFA system was applied. The procedure involved the placement of up to three single radiofrequency probes within the tumour before starting the ablation session. Then, while ablating a tumour with one of the probes the remaining non-active electrode(s) served as real-time thermometer(s) to monitor simultaneously the temperature within the ablation zone. The average ablation time was between 10 and 15 min. The absence of contrast enhancement on computed tomography (CT) was considered to be a successful treatment. Results. At a mean follow-up of 24 months (range 6–60 months), 38 tumours (90%) showed no contrast enhancement on CT. Four incompletely ablated tumours (10%) were successfully treated with the second ablation session. Two major and two minor complications occurred. At the time of writing, no local progression has been observed. Conclusion. RFA with the use of non-active probes as thermal probes to monitor the temperature within the tumour results in high efficacy and is associated with low complication rates.

PCA3 and TMPRSS2-ERG: Promising Biomarkers in Prostate Cancer Diagnosis

The search for the biomarkers to precisely and non-invasively characterize the biology of prostate cancer (PCa) is the focus of many laboratories across the world. Although prostate-specific antigen (PSA) remains the standard diagnostic tool for PCa, its low specificity leads to unnecessary biopsies in a substantial number of patients. More importantly, with the current status of knowledge, it is very difficult to early identify individuals with a life-threatening disease who require an immediate treatment. The significant advances in genetics and biotechnology in recent years has led to the discovery of new molecular markers including PCA3 and the TMPRSS2:ERG genomic fusion. Both PCA3 and TMPRSS2:ERG, compared to PSA, show an increased specificity in PCa detection. However, the quest for a single PCa marker that can fully satisfy urologists and their patients is still ongoing. The aim of this review is to present the recent findings on PCA3 and TMPRSS2:ERG and to describe their clinical implications and performance.

Resveratrol in prostate diseases.

Resveratrol (trans-3, 49, 5-trihydroxys-tilbene) is a polyphenolic antioxidant found in peanuts, grapes and red wine. Preclinical studies indicate that the consumption of food containing resveratrol leads to significant health benefits including possible action of the compound in treating and/or even preventing cancer. One of the long-term epidemiologic studies demonstrated a greater than 50% reduction in breast cancer risk in women taking resveratrol [1]. Furthermore, several in vitro studies and experimental cancer models have shown that resveratrol has a potential to suppress the initiation, promotion, and progression of tumors. Jasinski and co-authors reasonably point out that ‘long latency time, make prostate cancer (PCa) an attractive target for chemopreventive interventions [2]. According to Klempner et al., despite only modest clinical evidence of efficacy, complementary and alternative medicine use is common among adults, and recent reports suggest that 25%-50% of PCa patients use at least one of these modalities (mainly: herbal preparations and vitamins) [3]. Therefore, it is necessary to more rigorously evaluate the anticancer properties of the natural compounds. As described by Jasinski et al., the possible relationship of resveratrol with PCa might be associated with its interactions with androgen regulation. Resveratrol was shown to down-regulate the androgen receptor (AR). Kai and co-authors demonstrated that the combination of resveratrol and the antiandrogen, flutamide, has a synergistic effect on AR inhibition in prostate cancer cells [4]. With the current status of knowledge, the inhibition of the function of the AR seems to be one of the key mechanisms in PCa treatment. According to Iguchi et al., the hydroxyl groups in resveratrol play a key role in their antiandrogenic effect by modulating AR transcriptional activity [5]. However, we should not be that surprised, as suggest Jasinski et al., by the small number of clinical trials with resveratrol. It is quite natural to do many laboratory experiments before commencing human trials. Moreover, there are many more chemical compounds with well-documented anticancer activity awaiting clinical trials. To my knowledge, several phase I and phase II clinical trials are currently underway for resveratrol. I think it is also quite a simplistic approach to explain the French paradox by resveratrol consumption. Firstly, apparently red wine contains very little of resveratrol (inadequate to permit biologic activity in humans) [6]. Secondly, based on the personal observation, I think the French lifestyle together with the healthcare system is much more likely related to the longevity of the French population. In the review, Jasinski et al., raised one of the most important issues, i.e., the bioavailable amount of resveratrol in humans. Frequently, the concentrations of different agents used in in vitro experiments are very different from that achievable in serum. Unfortunately, despite quoting a huge number of articles, Jasinski et al. do not spend much time on the explanation of the plausible anticancer mechanism of resveratrol. In one of the mentioned publications, Sheth et al. showed that resveratrol reduced the expression of various prostatetumor associated microRNAs (miRs) including miR-21 in androgen-receptor negative and highly aggressive human prostate cancer cells, PC-3M-MM2 [7]. Additionally, resveratrol increased the expression of tumor suppressors, PDCD4 and maspin. According to Sheth and his colleagues, resveratrols anti-tumor actions in PCa could be explained, at least in part, through inhibition of the Akt/miR-21 signaling pathway. In my opinion, a key issue is to reveal the predominant in vitro mechanism responsible for the anticancer activity of resveratrol. Although the results of many studies are very encouraging, the way from bench to bedside is often very long. While resveratrol has shown anticancer potential in many experimental studies, it is difficult not to agree with Jasinski et al., that that there is so far insufficient evidence to support the use of the compound for the treatment of PCa patients outside of a clinical trial. There is also not enough clinical data to justify a recommendation for the prophylactic administration of resveratrol.

How accurate is our prediction of biopsy outcome? PCA3-based nomograms in personalized diagnosis of prostate cancer.

Purpose The sensitivity and specificity of prostate-specific antigen (PSA) alone to select men for prostate biopsy remain suboptimal. This review aims at presenting a review of current prostate cancer (PCa) nomograms that incorporate Prostate Cancer Gene 3 (PCA3), which was designed to outperform PSA at predicting biopsy outcome. Materials and methods The PubMed database and current literature search was conducted for reports on PCA3-based nomograms and tools for examining the risk of a positive prostate biopsy in a man without a known PCa diagnosis. Results and conclusions The introduction of PCA3 into clinical practice has led to the development of a set of PCA3-based nomograms to predict biopsy outcome. Combining PCA3 results with established PCa risk factors has produced significant improvements over PSA alone in predicting the risk of a positive prostate biopsy for cancer.

Radiofrequency ablation: a minimally invasive approach in kidney tumor management.

The management and diagnosis of renal tumors have changed significantly over the last decade. Due to advances in imaging techniques, more than 50% of kidney tumors are discovered incidentally and many of them represent an early stage lesion. This has stimulated the development of nephron-sparing surgery and of the minimally invasive treatment options including ablative techniques, i.e., radiofrequency ablation (RFA) and cryoablation. The objective of the minimally invasive approach is to preserve the renal function and to lower the perioperative morbidity. RFA involves inducing the coagulative necrosis of tumor tissue. Being probably one of the least invasive procedures in kidney tumor management, RFA may be performed percutaneously under ultrasound (US), computed tomography (CT) or magnetic resonance (MR) guidance. Most of the studies show that the RFA procedure is efficient, safe and has a low complication rate. Due to the still limited data on the oncological outcome of RFA, the indication for this intervention remains limited to selected patients with small organ-confined renal tumors and contraindication to surgery or who have a solitary kidney. The aim of our study is to review the literature on RFA of kidney tumors.