Impact of adjuvant androgen deprivation therapy after radical prostatectomy on the survival of patients with pathological T3b prostate cancer

Study Type – Therapy (case series)
Level of Evidence 4 What’s known on the subject? and What does the study add? Adjuvant hormonal therapy is known to improve cancer specific survival in prostate cancer patients with lymph node positive disease. This study suggests that surgically treated prostate cancer patients with seminal vesical invasion (pT3b) may have improved cancer specific survival if treated with adjuvant androgen deprivation therapy, similar to lymph node positive patients.

OBJECTIVE

To determine the impact of adjuvant androgen deprivation therapy (ADT) on survival in patients with seminal vesicle invasion (pT3b) at radical prostatectomy.

PATIENTS AND METHODS

We reviewed 12 115 patients who underwent radical prostatectomy between 1987 and 2002 to identify patients with pT3bN0 prostate cancer who received adjuvant ADT (n= 191). These patients were matched by clinical and pathological variables to a group of patients with pT3b prostate cancer who did not receive adjuvant ADT. Median postoperative follow‐up was 10 years. Clinical endpoints included biochemical progression‐free survival (BPFS), local recurrence‐free survival (LRFS), systemic progression‐free survival (SPFS), cancer‐specific survival (CSS) and overall survival.

RESULTS

Patients who underwent adjuvant ADT experienced improved 10‐year BPFS (60% vs 16%, P < 0.001), LRFS (87% vs 76%, P= 0.002), SPFS (91% vs 78%, P= 0.004) and CSS (94% vs 87%, P= 0.037). Overall survival was not significantly different between groups (75% vs 69%, P= 0.12). Both luteinizing hormone‐releasing hormone agonists (hazard ratio, 0.26; 95% CI, 0.15–0.46; P < 0.001) and bilateral orchiectomy (hazard ratio, 0.13; 95% CI, 0.06–0.31; P < 0.001) improved BPFS. When stratified by type of ADT (hormonal therapy vs orchiectomy), there was no difference in survival outcomes.

CONCLUSIONS

Adjuvant ADT improves local, and systemic control after radical prostatectomy for pT3b prostate cancer. There is no difference in survival between patients receiving medical hormonal therapy vs patients undergoing orchiectomy. Given the lack of improvement in overall survival, continued investigation is needed to identify the cohort of pT3b patients at highest risk for cancer progression and therefore most likely to benefit from a multimodal treatment approach.     

The total scaphoid titanium arthroplasty: A 15-year experience

Scaphoid nonunion followed by necrosis of bone segments is a common pathologic condition for the hand surgeon, and the difficulty of its management is well known. The total titanium scaphoid replacement, although not well-described in the literature, in our experience represents a reasonable choice in the treatment of this condition. Strict patient selection is necessary to achieve good clinical results. The titanium avoids the silicone synovitis, a well-described complication of silastic implants. Furthermore, this technique permits other surgical steps in case of failure.     

Influence of scanning density on macular choroidal volume measurement using spectral-domain optical coherence tomography

Background

To evaluate the impact of scanning density on macular choroidal volume measurement using spectral-domain optical coherence tomography (SD-OCT).

Methods

Thirty eyes of normal subjects underwent consecutive raster choroidal scanning protocols using SD-OCT in enhanced-depth imaging mode. Manual choroidal segmentation was performed using the built-in automated retinal segmentation software to obtain five analyses with different inter-scan distances, including inter-scan distances of 30 μm, 60 μm, 120 μm, 240 μm, and 480 μm. The built-in software of the device automatically generated the choroidal thickness and volume map in the similar manner as for the retinal volume map, using the standardized Early Treatment Diabetic Retinopathy Study (ETDRS) grid. For each raster scan, mean absolute difference and relative difference of mean foveal choroidal thickness (FCT), foveal choroidal volume (FCV) and total macular choroidal volume (TCV) in comparison to “true value” (i.e., 30-μm inter-scan distance) were calculated.

Results

The maximum relative differences were 10 % and 16 % for TCV and FCV respectively. For mean FCT, the maximum absolute difference was 31 μm, and maximum relative difference was 12.7 %. No statistically significant differences were found in measurements of mean foveal choroidal thickness (p?=?0.912) and volume (p?=?0.944), as well as macular choroidal volume (p?=?0.912), with varying inter-scan distance.

Conclusions

Our study shows that approximately 16 scans over the macula with a inter-scan distance of 480 μm is sufficient to provide a clinically relevant and reliable choroidal thickness/volume map. This information could be useful in the design of choroidal scanning protocols for future clinical trials.     

Severe allergic blepharoconjunctivitis induced by a dye for eyelashes and eyebrows

Purpose: To report a case of severe allergic blepharoconjunctivitis induced by a dye for eyebrows and eyelashes. Methods: A 38-year-old healthy female was examined one day after dyeing her eyebrows and eyelashes with a black cream dye intended for this purpose (FDA-approved). The patient complained of severe eye itching, redness, and epiphora. Results: Vision was 20/40 in both eyes; a moderate edema of the eyebrows and eyelid margins was noted. The conjunctiva was severely hyperemic with papillary reaction and chemosis. The corneas, anterior chambers, irides, lenses, and posterior segments were normal. The patient was treated with Dexamethasone 0.1% and ocular lubrication. After five days of treatment, the ocular symptoms improved, her vision returned to 20/20 in both eyes, and the ocular examination was within normal limits. Conclusion: FDA-approved dyes for eyebrows and eyelashes can sometimes irritate the ocular surface.     

Extended surgical resection for xanthogranulomatous cholecystitis mimicking advanced gallbladder carcinoma： A case report and review of literature

Xanthogranulomatous cholecystitis (XGC) is a destructive inflammatory disease of the gallbladder, rarely involving adjacent organs and mimicking an advanced gallbladder carcinoma. The diagnosis is usually possible only after pathological examination. A 46 year-old woman was referred to our center for suspected gallbladder cancer involving the liver hilum, right liver lobe, right colonic flexure, and duodenum. Brushing cytology obtained by endoscopic retrograde cholangiography (ERC) showed high-grade dysplasia. The patient underwent an en-bloc resection of the mass, consisting of right lobectomy, right hemicolectomy, and a partial duodenal resection. Pathological examination unexpectedly revealed an XGC. Only six cases of extended surgical resections for XGC with direct involvement of adjacent organs have been reported so far. In these cases, given the possible coexistence of XGC with carcinoma, malignancy cannot be excluded, even after cytology and intraoperative frozen section investigation. In conclusion, due to the poor prognosis of gallbladder carcinoma on one side and possible complications deriving from highly aggressive inflammatory invasion of surrounding organs on the other side, it seems these cases should be treated as malignant tumors until proven otherwise. Clinicians should include XGC among the possible differential diagnoses of masses in liver hilum.     

Flow-dependent re-endothelialization of tissue-engineered heart valves

BACKGROUND AND AIM OF THE STUDY: The generation of a functional, non-immunogenic, non-thrombogenic construct based on autologous cells seeded onto an acellular extracellular matrix is the major goal in heart valve tissue engineering. The study aim was to identify culturing conditions required to achieve a stable endothelial cell (EC) layer under physiological flow conditions, a prerequisite for the requested characteristics. METHODS: Eleven detergent-decellularized ovine pulmonary valves (PVs) were statically reseeded in special bioreactors with ovine venous ECs (1.2x10(7) cells per valve). The dynamic culture was started with 0.1 l/min in eight bioreactors. In four bioreactors the initial flow rate was slow, and increased by 0.1 l/min twice each day until maximal flow was 0.5 l/min and pulsation rate (PR) was 20 beats/min; in four other bioreactors the flow was increased by 0.7 l/min/day and reached 2.0 l/min with a PR of 50 beats/min. The mean system pressure was maintained at 25 +/- 5 mmHg during the whole dynamic cultivation in both groups. Three statically reseeded valves served as baseline. After achieving maximal appointed flow, the valves were investigated morphologically (hematoxylin and eosin staining, electron microscopy, von Willebrand factor, endothelial nitric oxide synthase immunostaining) and for metabolic activity (MTS assay). RESULTS: After reseeding, the endothelium appeared on the luminal surface of the PV as a non-confluent monolayer. Moderate pulsatile circulation induced complete confluence of EC monolayers on both cusp sides and the pulmonary wall. A high flow rate led to a partial loss of cells on the wall surface with large defects, and to complete cell wash-off from cusps. Cusp and wall metabolic activity was significantly higher after culture under moderate flow (p < 0.001) than in other groups, and was absent from cusps in high-flow bioreactors. CONCLUSION: Moderate pulsatile flow with small increments stimulates EC proliferation on the ovine decellularized valve scaffold. A rapid increase in bioreactor flow to physiological levels leads to significant damage of the reseeded endothelium and complete loss of cusp cellularity. This effect may be responsible for the in-vivo failure of static reseeded tissue-engineered valves exposed to physiological hemodynamic forces.