R. Hartung

Fluorine-18-Fluorodeoxyglucose Positron Emission Tomography Is Useless for the Detection of Local Recurrence after Radical Prostatectomy

Objective: After radical retropubic prostatectomy a rise of the prostate-specific antigen (PSA) indicates a local recurrent or metastatic disease. If the bone scan shows no apparent bone metastasis, morphological imaging methods like x-ray computed tomography, magnetic resonance imaging or transrectal ultrasound often cannot distinguish between postoperative scar and local recurrence. Therefore we investigated the feasibility of fluorine-18-fluorodeoxyglucose positron emission tomography (F-18 FDG PET) for metabolic characterization of prostatic cancer, especially for differentiation of scar or recurrent prostate cancer after radical prostatectomy. Methods: Dynamic PET with 370 MBq F-18 deoxyglucose (F-18 FDG) up to 60 min p.i. was performed in 2 patients with biopsy-proven benign prostatic hyperplasia, in 11 patients with a histologically proven prostate cancer prior to radical retropubic prostatectomy (RRP) and 7 patients with suspected local recurrence (with negative bone scan) after RRP prior to biopsy of anastomosis (3 local recurrence, 4 postoperative scar). Results: Prostate cancer showed a very low F-18 FDG uptake. The placement of regions of interest was only possible by the use of other imaging methods. There was not difference between the F-18 FDG uptake of benign prostate hyperplasia, prostate carcinoma, postoperative scar or local recurrence after radical prostatectomy. Conclusion: F-18 FDG seems not to be useful to distinguish between postoperative scar and local recurrence after radical prostatectomy.

The value of a second transurethral resection for T1 bladder cancer.

To evaluate a series of repeat transurethral resections (TURs) of tumour in patients with T1 bladder cancer, usually used to ensure a complete resection and to exclude the possibility muscle‐invasive disease.

Limited value of endorectal magnetic resonance imaging and transrectal ultrasonography in the staging of clinically localized prostate cancer.

Objective To examine the role of endorectal magnetic resonance imaging (eMRI) and transrectal ultrasonography (TRUS) for clinically localized prostate cancer and to assess interobserver agreement in interpreting MRI studies.

Alfuzosin 10 mg once daily improves sexual function in men with lower urinary tract symptoms and concomitant sexual dysfunction

Associate Editor

The role of inflammation and infection in the pathogenesis of prostate carcinoma.

Two of the mini reviews are about aspects of prostate cancer that are currently often discussed. The role of inflammation in the pathogenesis of prostate cancer is of great interest and has led to many important changes in our approaches to the subject of prostate cancer. Intermittent androgen deprivation has been an alternative therapeutic option for some time, but the absence of a large multicentre randomized controlled trial has delayed its general acceptance; this is discussed in detail in this section.

Significance of random bladder biopsies in superficial bladder cancer

OBJECTIVES We investigated to what extent biopsies of normal-appearing urothelium taken from patients with superficial bladder cancer (Ta, T1, Tis) showed malignant disease and whether those findings had impact on therapeutical decisions. PATIENTS AND METHODS 1033 consecutive patients presenting with Ta, T1 or Tis (carcinoma in situ) superficial bladder tumors at increased risk for recurrence underwent multiple random biopsies from normal-appearing urothelium during transurethral resection (TUR). Patients with small, primary, singular tumors (smaller or equal to 1cm) were excluded from random biopsies. RESULTS No tumor was found in the random biopsies of 905 patients (87.6%). 128 patients (12.4%) showed urothelial bladder cancer in their random biopsies (Tis: 74, Ta: 41, T1: 12, T2: 1). In 14 patients, where transurethral resection of the primary tumor revealed no signs of malignancy, urothelial bladder cancer was detected in the random biopsy material: Ta 8 patients, Tis 5 patients and T1 one patient. 21 patients with Ta tumors and 29 patients with T1 disease showed concomitant Tis. Upstaging of the primary, resected tumor by histological examination of the random biopsy material occurred in 75 patients (7%). Altogether, due to the random biopsy results therapy was altered in 70 patients (6.8%) of our series: It changed intravesical chemotherapy to BCG in 45, provoked a second TUR in 48 and cystectomy in 15 patients. CONCLUSIONS While the clinical significance of random biopsies is still controversial, random biopsy results had strong impact on therapeutical decisions in our series. Regarding random bladder biopsies a simple tool for the urologist to identify high risk groups of patients, we recommend them as part of the routine management of superficial bladder cancer.

Diagnosis and Monitoring of Urological Tumors Using Positron Emission Tomography

The pupose of this article was to critically review the diagnostic value of positron emission tomography (PET) in urological oncology. Urinary tract tumor assessment is hampered by the renal elimination of 18F–fluorodeoxyglucose (FDG), the most commonly used PET radiopharmaceutical. PET imaging offers no significant benefits over conventional imaging modalities for renal cell and bladder carcinomas. As a result of the low metabolic activity of prostate cancer, PET does not differentiate adequately between adenoma and carcinoma, nor detect local recurrence after radical prostatectomy with sufficient sensitivity. However, lymph node staging with FDG–PET, specifically in bladder cancer, has been shown to have a potential clinical benefit. Further studies are required to determine the clinical value of retroperitoneal lymph node staging and recurrent disease detection in germ cell tumors. Finally, encouraging early results exist for the use of serial PET measurements to predict and assess therapy response to chemotherapy which may also be valuable in urological oncology.

Alfuzosin 10 mg once daily for treating benign prostatic hyperplasia: a 3-year experience in real-life practice

To assess the 3‐year efficacy and safety of the selective α1‐blocker alfuzosin at 10 mg once daily in men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) in ‘real‐life practice’. The influence of treatment response on the risk of acute urinary retention (AUR) and BPH‐related surgery was also analysed.

Inhibition of the Multidrug-Resistant Phenotype by Targeting YB-1 with a Conditionally Oncolytic Adenovirus: Implications for Combinatorial Treatment Regimen with Chemotherapeutic Agents

Bearing in mind the limited success of available treatment modalities for the therapy of multidrug-resistant tumor cells, alternative and complementary strategies need to be developed. It is known that the transcriptional activation of genes, such as MDR1 and MRP1, which play a major role in the development of a multidrug-resistant phenotype in tumor cells, involves the Y-box protein YB-1. Thus, YB-1 is a promising target for new therapeutic approaches to defeat multidrug resistance. In addition, it has been reported previously that YB-1 is an important factor in adenoviral replication because it activates transcription from the adenoviral E2-late promoter. Here, we report that an oncolytic adenovirus, named Xvir03, expressing the viral proteins E1B55k and E4orf6, leads to nuclear translocation of YB-1 and in consequence to viral replication and cell lysis in vitro and in vivo. Moreover, we show that Xvir03 down-regulates the expression of MDR1 and MRP1, indicating that recruiting YB-1 to the adenoviral E2-late promoter for viral replication is responsible for this effect. Thus, nuclear translocation of YB-1 by Xvir03 leads to resensitization of tumor cells to cytotoxic drugs. These data reveal a link between chemotherapy and virotherapy based on the cellular transcription factor YB-1 and provide the basis for formulating a model for a novel combined therapy regimen named Mutually Synergistic Therapy.

Long-term efficacy and safety of alfuzosin 10 mg once daily: a 2-year experience in ‘real-life’ practice

To assess the 2‐year efficacy and safety of alfuzosin 10 mg once daily, a selective α1‐adrenoceptor antagonist, in men complaining of lower urinary tract symptoms (LUTS) suggestive of benign prostate hyperplasia (BPH), in ‘real life’ practice.