Timothy J. Christmas

Characteristics of incidental prostatic adenocarcinoma in contemporary radical cystoprostatectomy specimens

To investigate the relationship between prostate‐specific antigen (PSA) level and tumour volume for incidental adenocarcinoma of the prostate found in cystoprostatectomy (CP) specimens, and to analyse the incidence of clinically significant prostate cancers in CP specimens and the biochemical recurrence of incidental prostate cancers on short‐term follow up.

Undetectable ultrasensitive PSA after radical prostatectomy for prostate cancer predicts relapse-free survival

Radical retropubic prostatectomy is considered by many centres to be the treatment of choice for men aged less than 70 years with localized prostate cancer. A rise in serum prostate-specific antigen after radical prostatectomy occurs in 10–40% of cases. This study evaluates the usefulness of novel ultrasensitive PSA assays in the early detection of biochemical relapse. 200 patients of mean age 61.2 years underwent radical retropubic prostatectomy. Levels ≤ 0.01 ng ml–1 were considered undetectable. Mean pre-operative prostate-specific antigen was 13.3 ng ml–1. Biochemical relapse was defined as 3 consecutive rises. The 2-year biochemical disease-free survival for the 134 patients with evaluable prostate-specific antigen nadir data was 61.1% (95% CI: 51.6–70.6%). Only 2 patients with an undetectable prostate-specific antigen after radical retropubic prostatectomy biochemically relapsed (3%), compared to 47 relapses out of 61 patients (75%) who did not reach this level. Cox multivariate analysis confirms prostate-specific antigen nadir ≤ 0.01 ng ml–1 to be a superb independent variable predicting a favourable biochemical disease-free survival (P < 0.0001). Early diagnosis of biochemical relapse is feasible with sensitive prostate-specific antigen assays. These assays more accurately measure the prostate-specific antigen nadir, which is an excellent predictor of biochemical disease-free survival. Thus, sensitive prostate-specific antigen assays offer accurate prognostic information and expedite decision-making regarding the use of salvage prostate-bed radiotherapy or hormone therapy.

Vascular interventions during post-chemotherapy retroperitoneal lymph-node dissection for metastatic testis cancer

AIMS Complete excision of nodal masses during post-chemotherapy retroperitoneal lymph-node dissection (RPLND) for metastatic non-seminomatous germ-cell tumours (NSGCT) of the testis often requires vascular surgical intervention. We report our experience of vascular interventions and complications in a large series of men undergoing postchemotherapy RPLND. METHODS A retrospective review of vascular interventions during post-chemotherapy RPLND in 98 patients was undertaken (103 procedures). RESULTS Macroscopic tumour clearance was complete in 95/98 men (97%). Vascular intervention was required in all cases. Major complications included acute tubular necrosis in one patient who had undergone left nephrectomy and extensive dissection around the right renal artery, progressive atrophy of the ipsilateral kidney in three men and a colonic stricture and associated colocutaneous fistula in one patient after division of the inferior mesenteric artery. Iliac and femoral venous thrombosis developed in both patients in whom the inferior vena cava (IVC) was excised and in one patient after partial IVC excision. Eight of the 98 patients have died. No late vascular complications have occurred to date. CONCLUSION Complete tumour clearance can be achieved in most post-chemotherapy RPLNDs but invariably involves vascular intervention. Metastatic NSGCT should be treated by surgeons with the ability to undertake the vascular procedures required.

Repeat retroperitoneal lymph-node dissection after chemotherapy for metastatic testicular germ cell tumour.

To examine the operative findings, histopathology and clinical outcome of patients undergoing repeat retroperitoneal lymph node dissection (RPLND) after initial chemotherapy and RPLND (PC‐RPLND) for metastatic testicular germ cell tumour (GCT), as a small proportion relapse or have residual disease after incomplete resection in the lung, retrocrural or pelvic nodes, and retroperitoneum.

Retroperitoneal lymph node dissection after chemotherapy in patients with elevated tumour markers: indications, histopathology and outcome

To evaluate the factors affecting outcome and the pathological findings in patients who had retroperitoneal lymph node dissection (pcRPLND) after chemotherapy with elevated tumour markers, as such patients have an unfavourable prognosis, with further salvage chemotherapy being the usual treatment of choice.

Retroperitoneal anomalies in men with testicular germ cell tumours

To assess whether vascular and other retroperitoneal anomalies are more frequent during retroperitoneal lymph node dissection (RPLND) for metastatic testicular tumours (when retroperitoneal masses persist after chemotherapy) than would be expected, based on the initial observations from one centre with a large experience of RPLND in the UK.

Spread of silicone to inguinal lymph nodes from a leaking testicular prosthesis: a cause for chronic fatigue?

A 32-year-old man presented with symptoms of chronic lethargy typical of myalgic encephalitis (ME) [1]. He had undergone left orchidopexy when aged 9 years, followed by orchidectomy and insertion of a silicone prosthesis when aged 11 years. He had consulted the Internet and found that patients with silicone prostheses often complained of similar symptoms to his. He requested that his prosthesis be changed for a newer variety, as he was concerned that the silicone gel may have leaked. At surgery there were large ̄eshy inguinal nodes and a silicone testicular prosthesis surrounded by ®rm scar tissue. Silicone was detected histologically around the prosthesis and in the inguinal nodes (Fig. 1). X-ray microanalysis, carried out on de-waxed 30 mm paraf®n sections, con®rmed the presence of silicone in the scar tissue surrounding the prosthesis (Fig. 2).

Pathological findings after primary chemotherapy in patients undergoing simultaneous orchidectomy and retroperitoneal lymph node dissection for advanced germ cell tumours

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

Mixed germ cell tumour arising from abdominal testicular tissue after apparent orchidectomy

A 19-year-old man presented with a pain in the right iliac fossa, and a mass. He had a history of bilateral cryptorchidism and underwent laparotomy, left orchidopexy and right orchidectomy when 7 years old. On examination there was a large right iliac fossa mass, a small testis at the left super®cial ring and a prosthesis in the right side of the scrotum. CT con®rmed a large intra-abdominal mass of 18r17r8 cm (Fig. 1). There was no apparent disease elsewhere. A needle biopsy showed teratoma; his serum AFP and bhCG levels were 9757 kU/L and 1976 U/L, respectively. He received three cycles of chemotherapy (cisplatinum, vincristine, methotrexate, bleomycin/actinomycin-D, cyclophosphamide, etoposide), with a marked reduction in the size of the right abdominal mass. After chemotherapy his AFP and bhCG levels reduced to 33 kU/L and 53 U/L, respectively. At laparotomy a large mass (20r11.5r7.5 cm) was dissected from the ascending colon. The right gonadal vessels were attached to the mass (Fig. 2). A nerve-sparing retroperitoneal lymph node dissection was also undertaken. Histology showed a malignant teratoma intermediate (teratoma differentiated and malignant teratoma undifferentiated) with yolk sac tumour and a small focus of seminoma. There was no tumour in the resected lymph nodes. After surgery his AFP and bhCG levels decreased to 22 kU/L and 2 U/L, respectively. He restarted chemotherapy 6 weeks after surgery because of rising bhCG levels and the development of liver metastases. Both AFP and bhCG rose after the completing salvage chemotherapy. The patient died with disseminated chemotherapy-resistant disease 8 months later.

The treatment of bisphosphonate refractory hypercalcaemia in renal cell carcinoma with Sunitinib

∗ Corresponding author. Tel.: +44 20 8846 1766; fax: +44 02 8846 1757. E-mail addresses: rkavia@gmail.com (R. Kavia), onur.gilleard@imperial.nhs.uk (O. Gilleard), Philip.savage@imperial.nhs.uk (P. Savage), tim.christmas@rmh.nhs.uk (T. Christmas), martin.gore@rmh.nhs.uk (M. Gore). 1 Present address: Department of Urology, Charing Cross Hospital, Imperial College NHS Trust, Fulham Palace Road, London, W6 8RF, United Kingdom. c S a 2