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Year : 2015  |  Volume : 7  |  Issue : 5  |  Page : 50-54  

Onco-urology Abstracts

Date of Web Publication20-Mar-2015

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How to cite this article:
. Onco-urology Abstracts. Urol Ann 2015;7, Suppl S1:50-4

How to cite this URL:
. Onco-urology Abstracts. Urol Ann [serial online] 2015 [cited 2020 Jan 18];7, Suppl S1:50-4. Available from: http://www.urologyannals.com/text.asp?2015/7/5/50/153740

Bank of biological samples and related information intended for uro-oncological (biobank) research purposes

Danny M. Rabah, Osman Zin Al-Abdin

Department of Surgery, Division of Urology, King Khaled University Hospital, Riyadh 11472, Kingdom of Saudi Arabia

Methods: We evaluated the feasibility of establishing a prostate cancer biobank in Saudi Arabia. We have outlined the ethical, methodological and technical issues of the biobank establishment process, focusing particularly on prostate cancer biobank. As a result, we have aligned with Procure Biobank of Canada to adapt Procure's SOPs and eliminate the numerous variables that can emerge around the process of collecting surgical tissues for research.

Results: The aim of the Procure Alliance Biobank is to provide research groups biological samples in conjunction with essential medical, biological, and socio-demographic information to properly interpret research data and ultimately promote the advancement of prostate cancer research. Access to the biological samples and all information associated with it will be restricted to investigators whose projects have been approved by their respective institution's ethics committee and by the Biobank Allocation Committee. On January 2011, we have established a bank of fresh frozen prostate tissue taken from radical prostatectomy specimens at King Khaled University hospital in Riyadh. Since then, 28 patients have contributed their biological samples to the biobank. In addition to banking fresh frozen prostate tissue from both cancer and benign areas, the bank contains blood from which was also derived serum, plasma, the buffy coat layer, RNA, DNA along with clarified urine. The methods, in which the fresh prostate tissue is harvested for biobanking and in which the prostate is sampled for histological assessment, correlates with the strict policies, procedures and appropriate controls that are adapted according to Procure best practices.

Conclusion: A well developed biobank is a critical prerequisite for high-quality research. This review provides an outline of certain critical elements that would need careful attention as a prostate cancer biobank is developed.

Epidemiology profile of renal cell carcinoma: A 10 year patients' experience at King Abdulaziz Medical City NGHA, Saudi Arabia

Sarah Mahasin, Nourah Aloudah, Khaled Al-Surimi, Sultan Alkhateeb

King Abdulaziz Medical City NGHA, Saudi Arabia

Purpose: To describe the epidemiological profile, histo-pathological features, and outcomes of patients diagnosed with RCC in a tertiary referral center over 10 years.

Methods: This is a retrospective cohort of 219 Saudi patients diagnosed with RCC between June 2003 and May 2013. The variables collected included the socio-demographic details and clinical presentation. The histopathological features investigated include the tumor's histological subtype, nuclear grade, pTNM descriptors, and lymph-vascular invasion. Patients were followed until May 2013. Bivariables analysis were calculated using chi-square test, with level of significance set at P < 0.05. Kaplan-Meier estimate was used to calculate the survival rate.

Results: The median age of patients was 57.18 (΁14.68 SD). The trend of patients diagnosed with RCC over the last 10 years was higher among males than females (60.27% versus 39.73%). The majority (68.5%) of patients were from Riyadh. Noticeably, more than half (57.58%) were diagnosed incidentally. The most common histological subtype was clear cell (conventional) RCC (70.44%). Patients were usually diagnosed at the pT1 stage (48.1%).

The statistically significant features associated with worse patient outcome were type of surgery (P ≤ 0.0001), stage of the primary tumor (P = 0.01) and lymph-vascular invasion (P = 0.003). The overall mean survival rate was 2.03 years.

Conclusion: In the last ten years, there are more patients diagnosed incidentally with RCC, which is in line with the global trend. Patients were more likely to be male and middle aged. We recommend further population-based studies in this area to establish a national epidemiological data for this common type of cancer.

International prostate symptom score improves in all men following robotic prostatectomy even in those with mild baseline lower urinary tract symptoms, 2 years postoperatively

Anwar Alesawi, Malek Meskawi, Nawar Hanna, Thierry Lebeau, Serge Benayoun, Kevin Zorn,

Assaad El-Hakim

University of Montreal, Canada

Introduction and Objective: Many reports suggest that men with moderate or severe lower urinary tract symptoms (LUTS) experience significant symptom improvement after open radical prostatectomy, whereas patients with mild LUTS do not seem to derive a significant benefit. LUTS have not been well studied after robot-assisted radical prostatectomy (RARP), particularly beyond one year postoperatively. We report the natural history of LUTS in men who underwent RARP as assessed by international prostate symptom score (IPSS) for 2 years postoperatively.

Methods: We reviewed charts of 678 patients who underwent RARP between 2006 and 2014. Data was collected prospectively and IPSS questionnaire was completed at baseline and at 1, 3, 6, 9, 12, 18 and 24 months postoperatively. Patients were grouped according to preoperative IPSS as having mild (0-7), moderate (8-19) or severe (20-35) LUTS. Paired two sample t-tests were used to compare change in IPSS for each group at 6, 12, and 24 months.

Results: Baseline LUTS were mild (group 1), moderate (group 2) and severe (group 3) in 397 (58.6%), 236 (34.8%) and 45 (6.6%) patients, respectively. Patients in group 3 were older, had higher baseline PSA and larger prostates, had more median lodes, and lower baseline SHIM scores (P < 0.05). Other clinical and pathological parameters were not statistically different. Median IPSS scores (IQR) at baseline, 6, 12, and 24 months for group 1 were 3 (2-5), 3 (2-4), 2 (2-4), 2 (2-3.5), respectively (P = 0.02, between baseline and 24 months). For group 2 results were 11 (9-14), 3 (2-4), 3 (2-5), and 3 (2-7), respectively (P < 0.001, between baseline and each time point). For group 3 scores were 24 (21-26), 2.5 (2-4.7), 3 (3-5), and 3 (2-6.5), respectively (P < 0.001, between baseline and each time point).

Conclusions: All men experienced a statistically significant improvement of LUTS post RARP 2 years after surgery. However, only men with moderate and severe symptoms had a clinically significant improvement that was sustained from 6, 12 to 24 months postoperatively. This benefit of surgical therapy should be considered when patients are weighing risks and benefits of various treatment options for localized prostate cancer.

Intravescial tumor recurrence after surgical management of upper tract urothelial carcinoma:

A single center experience with long-term follow-up

Mohammed Elawdy

Ministry of Health, Sultanate of Oman

Introduction: Bladder cancer recurrence after the management of upper tract Urothelial Carcinoma (UTUC) is a common disease. We aim to review the incidence, predictors and impact of this pathology.

Methods: From 1983 to 2009, a retrospective study was conducted on 168 patients diagnosed with UTUC. The mean age of our study population was 53 years (28-81) with median follow-up of 42 months (6-290). Thirty-two (19%) had a history of bladder tumors while concomitant bladder tumors were diagnosed in 47 (28%) of the patients. Risk factors and the impact of developing recurrent bladder tumors were judged utilizing appropriate statistical methodology.

Results: Recurrent bladder tumors occurred in 79 patients (47%). The mean time for recurrence after surgery was 21 months (range: 2-216). Neither sex, past history of bladder tumors, concomitant bladder tumor, surgical approaches, the size of the tumor, UTUT stage, grade, presence of CIS or multi-centricity at the time of diagnosis of UTUC were significant predictors of Intravesical Tumor recurrence. Ureteric tumors (P < 0.02) were the only identified risk factor. Post treatment bladder recurrence was a significant predictor of later urethral recurrence (P < 0.05).

Conclusion: Bladder cancer recurrence is anticipated in half the number of patients after management of UTUC with Ureteric Tumors being the only identified risk factor. The development of effective Intravesical Therapy should be more investigated for those patients to reduce such recurrence.

Predictors of positive surgical margin following robotic assisted radical prostatectomy: Results from the largest Canadian prospective cohort

Anwar Alesawi

University of Montreal, Canada

Introduction and Objective: PSM is strongly associated with biochemical recurrence (BCR). We though to identify preoperative predictors of PSM in patients treated with RARP for localized prostate cancer.

Methods: 1000 patients underwent RARP between 2006 and 2014. 748 patients had complete data. Preoperative clinical characteristics were collected, included age, BMI, PSA, Gleason sum, clinical stage and TRUS prostate volume. Groups were compared using two-sided t-test. 5-year. Kaplan-Meier BCR-free survival curves were derived. Multivariate logistic regression analyses were performed to assess various preoperative predictors of PSM status.

Results: Of 748 patients, 196 (26%) had PSM. Patients with PSM had higher median PSA (6.9 vs. 5.2; P < 0.001), smaller TRUS prostate volume (34 vs. 37 g; P = 0.02), higher clinical stage (P < 0.001) and biopsy Gleason score (G7-10: 73.9% vs. 60.9%; P < 0.001). For pathological characteristics, patients with PSM harbored more advanced pathological stage (P < 0.001) as well as higher Gleeson score (G8-10: 18.4% vs. 6%; P < 0.001). The 5-years freedom from BCR was 75% for patients with PSM compared to 95% for negative margins (P < 0.001). In multivariate logistic regression analyses, higher PSA (OR: 1.06; P = 0.004), clinical stage ≥ T2a (OR: 3.01; P = 0.01), biopsy Gleason sum 7 (4 + 3) (OR: 2.1; P = 0.02) and Gleason 8-10 (OR: 2.5; P = 0.01) were independent predictors of PSM. Conversely, larger TRUS prostate volume was protective against PSM (OR: 0.98; P = 0.007).

Conclusions: In our series of RARP, PSA, TRUS prostate volume, biopsy Gleason sum and clinical stage are predictors of PSM following RARP.

Keywords: Robotic assisted radical prostatectomy, robotic radical prostatectomy, surgical margin

The prevalence of urinary tract infection/urosepsis following transrectal ultrasound- guided prostate biopsy in a subset of saudi population and patterns of susceptibility to flouroquinolones

Sultan S. AlKhateeb, Nayf A. AlShammari, Rakan M. AlDarrab, Mohand A. AlZughaibi

Medical City NGHA, Saudi Arabia

Introduction and Aim: Transrectal prostate biopsy (TRUS) is a commonly preformed procedure to diagnose prostate cancer. It is associated with certain morbidities some of which are serious like urinary tract infection (UTI) leading to urosepsis. We aim to study the prevalence of these complications, the pathogens involved and patterns of antibiotic resistance.

Methodology: This is a descriptive study of patient who underwent elective TRUS biopsy at our hospital utilizing the routinely recommended prophylactic antibiotics. Variable included were patients demographics, prostate specific antigen levels (PSA), type of antibiotic prophylaxis, results of biopsy, the rate of UTI and urosepsis with the type of pathogen(s) involved and its/their antimicrobial sensitivity.

Results: A total of 139 consecutive Patients were reviewed, UTI was observed in 11(7.79%) and urosepsis requiring hospital admission in 7 (5%). The most common pathogens were E-coli (90.1%) and staphylococcus aureus (9.1%). Resistance to the routinely utilized antibiotic prophylaxis ciprofloxacin was observed in 10 patients (90.9%).

There is an increasing rate of infectious complications of TRUS biopsy and increasing resistance to routinely utilized prophylaxis antibiotics as observed in many parts of the world. Therefore, we should consider this in counseling patients for TRUS AND IN revising the prophylaxis antibiotics that we use.

Inflammatory pseudo-tumor of the urinary bladder: A case series among more Than 5,000 bladder tumor cases at a tertiary urology center

Mohammed Elawdy

Ministry of Health, Sultanate of Oman

Introduction: Benign tumors of the urinary bladder (UB) may mimic cancer during a clinical diagnosis. Once mistaken for cancer, the patient may be subjected to unnecessary cancer management. Inflammatory Pseudo-tumor has been reported infrequently in the medical journals. Urologists need to report their findings from the more than 5,000 bladder tumor cases.

Materials and Methods: From January 2000 to December 2009, a retrospective analysis was conducted on 5,150 patients who had been diagnosed with bladder tumors. All pathological reports were reviewed to identify any patients with inflammatory pseudo-tumor. Data, including demographics, past history, presentation at diagnosis, radiologic and cystoscopic findings, were collected for the targeted patients.

Results : Six patients, with a median age of 31 years (range: 18-58), presented with Irritative LUTS, three with hematuria. Three patients had Cystoscopic-guided bladder biopsies and one patient had TURBT a few months prior to the presentation. One female patient had an IUD inserted years before her presentation. Another patient had a negative surgical history. The median tumor size was 3.5 cm (range 3-8 cm). With high suspicions of malignancy, three consecutive bladder biopsies were taken before receiving a benign confirmation. After a complete resection of the tumor and median follow up of 6 years (range 5-10 years), no recurrence has been observed.

Inflammatory Pseudo-tumor is a rare disease of the UB and should b regarded with a high degree of suspicion, especially if the tumor appears after recent bladder instrumentation. Although the definite diagnosis may need an extensive work-up, but it deserves as patients may be subjected to non indicated cancer management with its deleterious consequences.

Seminoma in a live kidney transplant recipient: Case report and review of urogenital malignancies complicating kidney transplantation

Abdulsamad Al-Harbi, Magdy El-Bahnasawy, Mahmoud Zakeria, Mohammed Abdulfattah, Hossam S. El-Tholoth, Mohammed Aljohani, Anas abo alhassan

Armed Forces Hospital, Tabuk, Saudi Arabia

Patients on renal replacement therapy have an increased cancer risk. Tumor development after Rena Transplantation (RT) is believed in some cancers to depend on the duration and type of immunosuppression or association with viral infections, while other cancers such as kidney or urinary tract cancers are linked to end stage kidney disease. Malignancies are diagnosed at younger age and at higher stages compared to patients without transplantation, and are associated with worse outcomes. Due to the increase in donor age and graft survival a significant increase in the number of genitourinary post-transplant malignancies after RT can be expected in the future. Herein we present a case of 37 years old male patient who had ESRD managed by live kidney transplantation 7 years ago. He is on tacrolimus and mycophenolate mofetil and prednisolone immunosuppressive regimen. He presented to Urology clinic with painless left testicular mass of 4 months duration. It was not associated with history of trauma, fever or UTI. On examination its size was about 5 cm Χ 7 cm with solid consistency and free overlying intact skin and cord. Scrotal US showed that the left testis was replaced with solid heterogenous mass with increase vascularity. Tumor markers were within normal. CT abdomen and chest were free of any metastatic lesions as well as any significant lymphadenopathy. Left high inguinal orchiectomy was performed and definitive histopathology was classic seminoma. Patient was referred to oncology department for further management. This case highlights the necessity of long life follow-up of these patients putting a high index of malignancy suspicion.

The aggressive behavior of genitourinary rhabdomyosarcoma in adolescents: Report of 3 cases

Ammar B. Al Shaikh, Mohamed A. Gomha

King Fahad Specialist Hospital, Dammam, Saudi Arabia

Purpose: Genitourinary rhabdomyosarcoma (GRMS) is a rare tumor. Age is an independent prognostic factor with aggressive behavior in adolescents. Here, we report 3 cases of GRMS in adolescents.

Three adolescent patients with GRMS were identified in our records. Their medical records were reviewed as regards to clinical presentation, diagnostic methods, management and outcomes.

Results: The 3 patients with GRMS were males with a median age of 19 years (range: 17-19), 2 with paratesticular RMS (PTRMS) and 1 with a pelvic RMS (PVRMS). The two with PTRMS presented with scrotal swelling while the one with PVRMS presented with big pelvic mass causing intestinal obstruction and urinary retention. Imaging studies confirm the presence of a solid mass in the scrotum of the 2 patients with PRMS with no metastasis but indicated possible origin of the PVRMS with hepatic and pulmonary metastasis. Histopathology showed embryonal RMS in the 2 patients with PTRMS following initial management by radical orchidectomy while it showed undifferentiated RMS in the patient with PVRMS following pelvic mass biopsy. 1 patient of the 2 with PTRMS had rapid local recurrence after 3 months from orchidectomy that was locally resected and then received chemotherapy and local radiotherapy but tumor continued to recur locally and later patients developed pulmonary metastases and finally died 2 years from time of presentation. The other patient with PTRMS received chemotherapy for 1 year following left orchidectomy but he developed big retroperitoneal metastases 9 months after discontinuation of chemotherapy. Patien received second line chemotherapy and the mass decreased in size and then he underwent retroperitoneal lymph node dissection with the histopathology showing no residual tumor. Follow-up CT showed no recurrence 3 months after resection. The patient with PVRMS deteriorated despite multiple lines of chemotherapy and finally died 1 year from time of presentation.

Conclusion: The GRMS in adolescents has aggressive behavior. While some patients can be cured with multi-modal therapy others succumb early to their disease.


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