Abstract: Many studies have indicated that nuclear DNA content evaluation can be used to
predict biological behavior of transitional cell carcinoma (TCC) of the bladder.
Some authors also indicated that static cytometry is more useful in DNA content
analysis than flow cytometry. The aim of the present study was to evaluate the
prognostic significance of DNA ploidy in TCC of the bladder, performed by using
static cytometry with an image analyzer, and monitoring patients at 10 years
follow-up. Thirty-one consecutive patients underwent transurethral or open
surgery for bladder tumors, and neoplastic tissue samples taken from each patient
were imprinted on glass slides and sent for histopathological and DNA content
evaluation. DNA ploidy evaluation was performed using a CAS 200 image analyzer.
Nuclear DNA content evaluation was compared to patient follow-up on recurrence,
progression or survival performed 10 years after surgery. Pathological evaluation
demonstrated the presence of superficial TCC in 23 patients, while 8 had an
invasive bladder tumor. Twenty-nine tumor samples were adequate for DNA content
measurement, with 13 showing diploid DNA content and 16 with aneuploid DNA
content. At 10 years follow-up, all patients with aneuploid DNA content
demonstrated a lower survival time (p=0.049) and higher recurrence rate
(p=0.0346). A log-rank test demonstrated that stage, grade and nuclear DNA
content are the most useful prognostic parameters for predicting the biological
behavior of TCC of the bladder. These results confirm that static cytometry is a
good and reliable method to evaluate DNA tumor content and considered a useful
prognostic parameter for predicting recurrence rate, disease progression or
survival in patients affected by bladder tumors.
Abstract: PURPOSE: Several urinary markers have been recently introduced in clinical practice for improving the noninvasive diagnosis of transitional cell carcinoma. Although microsatellite analysis must be considered the best method in terms of results, its cost and method time are unacceptable for daily use. We validated a more rapid and inexpensive method of determination using rapid DNA extraction and automatic multiplex polymerase chain reaction amplification. MATERIALS AND METHODS: A total of 120 patients who presented consecutively to a urological office, including 73 with transitional cell carcinoma and 43 who served as controls, were selected for study. Microsatellite analysis was performed in the blood/urine pair using 3 multiplex polymerase chain reactions per patient. Urine sediment inflammatory cells were assessed by urine dipstick test. Ten microsatellite loci were investigated. Numerical data collected during electrophoresis of the amplified segment in an ABI Prism 310 Genetic Analyzer were used to calculate the cutoff for allelic imbalance. Method sensitivity, specificity, and positive and negative predictive values were calculated. RESULTS: A total of 66 patients had microsatellite analysis alterations in urine sediment, of whom 59 had transitional cell carcinoma, while 7 had other urological diseases. Test sensitivity and specificity were 80.8% and 85.1%, respectively. Statistical analysis did not indicate any significant influence of inflammatory status on microsatellite analysis diagnostic performance. In the control group the allelic imbalance on chromosome 9 was significantly lower than on other chromosomes (p = 0.0143). This could confirm that chromosome 9 has a specific role in transitional cell carcinoma. The multiplex microsatellite analysis method was low cost and not time-consuming. CONCLUSIONS: Multiplex microsatellite analysis is a noninvasive, rapid, inexpensive and reproducible method for screening for and monitoring superficial transitional cell carcinoma. It should be considered an alternative method to urinary cytology and it should also be considered in the presence of urine sediment inflammatory cells.
Abstract: A giant stone in enterocystoplasty is a very rare condition; only 5 cases have been reported in the literature. A 50-year-old female with an enterocystoplasty due to congenital myelomeningocele presented at our institution for an asymptomatic 10-cm bladder stone, incidentally detected during an imaging procedure for uterine fibroma. The patient was treated with a laparoscopic hysterectomy with bilateral annexectomy, neocystotomy and stone removal under general anesthesia. The case report and an accurate literature review are reported. The incidence, risk factors, pathophysiology and treatment options are analyzed.
Abstract: It has recently been shown that allelic abnormalities, detected by microsatellite analysis of the DNA extracted from urine sediment, can be successfully used for the detection of transitional cell carcinoma (TCC) of the bladder. The diagnostic accuracy of urinary cytology, urinary bladder cancer (UBC) marker, bladder tumor antigen (BTA) and microsatellite sequence alterations was compared in 42 patients who were recruited for the study. Of them, 30 had been diagnosed with TCC at cystoscopy plus biopsy (group A). Seven patients without any apparent lesions after trans-urethral resection (TUR) and 6 subsequent weeks of endovesical administration of bacillus Calmette-Guerin (BCG), had irritative symptoms. None of them had positive cytology or TCC bladder mucosa biopsies (group B). In the control group were 5 other subjects who were affected by benign prostatic hypertrophy and candidates for prostatectomy (group C). Urine and blood samples were obtained from all of the patients before surgery. Tumor tissue and normal mucosa samples were taken from groups A and C during surgery. Different urinary sediment analyses were performed by using both nuclear medicine and molecular tests. UBC and BTA-t analyses were carried out using monoclonal antibody tests while microsatellite analyses were performed using extracted DNA and electrophoresis of polymerase chain reaction (PCR) products on 13 different primers. Urinary cytological examinations were carried out using the Autocyte Preparation System(R). Urinary cytology confirmed the presence of TCC in 13.3% of patients. The BTA-t marker allowed the identification of 73.3% of cancers with 50% specificity; the UBC marker identified 63.3% of the cases with 41.6% specificity. Microsatellite analysis permitted the identification of 83.3% of the tumors with 100% specificity. DNA analysis demonstrated high sensitivity in patients affected by superficial (81.4%) or G1 (80%) tumors, even when cytological studies demonstrated little or no sensitivity. Microsatellite analysis is a highly-sensitive and specific marker for TCC diagnosis and its monitoring, especially in patients with low-stage and low-grade tumors. Other testing procedures failed to increase urinary cytological diagnostic significance.
Abstract: OBJECTIVES: To validate an Italian version of the University of California-Los
Angeles Prostate Cancer Index (UCLA-PCI). METHODS: Men with prostate cancer
treated with radical retropubic prostatectomy (RRP) or external beam radiation
(EBR) were retrospectively selected. Each subject was asked to complete the
UCLA-PCI short form and the 36-item short-form health survey (SF-36)
questionnaires (principal sample); a subgroup completed both questionnaires twice
(retest sample). A linguistic translation and validation was performed.
Psychometric properties were analyzed. RESULTS: A total of 595 men were included
in the study: 394 from the Department of Urology (treated with RRP) and 201 from
the Department of Radiotherapy (treated with EBR). Of these, 75 patients (50 from
the RRP group and 25 from the EBR group) were selected as the retest cohort.
Internal consistency reliability of the SF-36 and UCLA-PCI for the primary sample
of the surgery and radiotherapy populations ranged from 0.82 to 0.94; the mean
values of sexual function were superior in the principal urology group, whereas
the principal radiotherapy group demonstrated superior mean values of urinary
function and urinary bother. A strong correlation between urinary function and
sexual and bowel function, and between urinary function and all bother scales,
was reported only for patients treated with RRP. The expected correlation between
sexual function and sexual bother was reported for the EBR group but not for the
RRP group. CONCLUSIONS: Our study demonstrated the excellent psychometric
properties of the Italian version of the UCLA-PCI; the Italian version of the
UCLA-PCI questionnaire will allow cross-cultural comparative studies in men with
prostate cancer.
Abstract: Many authors have shown that tumor hypoxia exerts its own influence on malignant progression by inducing angiogenetic factors and new blood vessels inside and around the tumor. This event usually suggests a poor prognosis and/or aggressive tumor behavior. The objective of the present study is to compare molecular analysis of angiogenetic factors with microvessel density (MVD) in bladder carcinoma. Twenty-nine consecutive patients underwent transurethral or open surgery for bladder tumors. Neoplastic tissue samples, normal-appearing bladder mucosa and blood samples were taken from each patient. All the tissues underwent mRNA extraction and Northern blot analysis, marked with specific probes for inducible nitric oxide sinthase (iNOS), cyclo-oxygenase-2 (cox-2), vascular endothelial growth factor (VEGF) and were evaluated by gel-electrophoresis. Microvessel density, a quantitative analysis for neoangiogenesis, was also evaluated by using CD31 immunohistochemical assay and compared with both molecular analysis and patient follow-up. Two follow-up for recurrence and/or progression were performed at 74 months and 10 years from surgery respectively. Pathological evaluation demonstrated the presence of superficial transitional cell carcinoma (sTCC) in 15 patients, while 14 had an invasive bladder tumor (iBT). At both 74 months and 10 years follow-up, all patients with lower MVD had a shorter survival time. No significant results were obtained by comparing disease progression or survival rate with VEGF, iNOS and COX-2 levels. A proportional increase of VEGF expression and MVD compared with poor prognosis was the expected outcome of our study. These results were disregarded at both the 1st and the 2nd follow-up. A strong association between MVD>20 and survival rate was noted both in sTCC (p=0.024) and iBT (p>0.001) patients. These results confirm that MVD could be considered a good prognostic factor. The angiogenetic cytokines overexpression found in control tissue samples of sTCC could have clinical significance, either as a macroscopically unidentified diffuse carcinogenetic process or the presence of a systemic immune-response against tumor cells.