Preoperative serum prostate specific antigen remains a significant prognostic variable in predicting biochemical failure after radical prostatectomy.

Purpose: Multiple investigators have argued that PSA may no longer be an accurate marker of prostate cancer biology. We determined whether the impact of PSA in predicting biochemical failure after radical prostatectomy has changed since the beginning of the PSA era.

Materials And Methods: A total of 1,246 patients were identified from the Columbia University Comprehensive Urological Oncology Database who underwent radical prostatectomy by 1 of 3 surgeons between 1988 and 2003.

Does year of radical prostatectomy independently predict outcome in prostate cancer?

Objectives: To examine how the biochemical outcomes after radical prostatectomy (RP) have changed in the prostate-specific antigen (PSA) era when controlling for the effects of other prognostic variables. Since the beginning of the PSA era, the presentation, treatment, and therapeutic outcomes of prostate cancer have evolved.

Methods: We reviewed the Columbia University Comprehensive Urologic Oncology Database and identified 1319 patients who had undergone RP without adjuvant therapy, performed by three surgeons, between 1988 and 2003 (minimal follow-up of 12 months).

Partial nephrectomy and radical nephrectomy offer similar cancer outcomes in renal cortical tumors 4 cm or larger.

Objectives: To determine whether the type of surgery (partial nephrectomy [PN] versus radical nephrectomy [RN]) has any effect on cancer outcome for renal cortical tumors 4 cm or larger. PN outcomes for large renal cortical tumors have been shown to be worse than outcomes for smaller tumors, but the upper limit of tumor diameter amenable to PN remains controversial.

Methods: We identified 33 patients from the Columbia University Comprehensive Urologic Oncology Database who underwent PN between 1988 and 2004 for renal cortical tumors 4 cm or larger.

Rationale for zoledronic acid therapy in men with hormone-sensitive prostate cancer with or without bone metastasis.

Men with prostate cancer are at risk for bone loss and skeletal complications throughout the course of their disease. Bone loss is prevalent in many men with prostate cancer at initial diagnosis, and initiating androgen deprivation therapy results in accelerated bone resorption, leading to bone loss and an increased risk of fracture. These men are also at high risk for disease progression and bone metastases that can result in significant skeletal morbidity, including pathologic fracture, spinal cord compression, and debilitating bone pain requiring additional therapy.

Treatment of nonretroperitoneal residual germ cell tumor masses.

The appropriate treatment of residual disease outside the retroperitoneum after chemotherapy is a crucial component of the comprehensive approach to treating advanced testicular germ cell tumors (GCT). Residual nonretroperitoneal disease is most commonly found in the thorax but can also be identified in other sites, including the neck, liver, and brain. Although some data suggest that certain variables such as retroperitoneal lymph node dissection histology can accurately predict nonretroperitoneal histology, a multitude of studies show significant histologic discordance among different sites.

The cost of treatment of skeletal-related events in patients with bone metastases from lung cancer.

Purpose: Patients with bone metastases from lung cancer often experience skeletal-related events (SREs) including pathological fracture, spinal cord compression, hypercalcemia or pain requiring surgery, radiotherapy or opioid analgesics. These complications result in impaired mobility and reduced quality of life and have a significant negative impact on survival. The economic consequences of SREs in patients with lung cancer have not been examined.

Re-evaluation of the Tumour-Node-Metastasis staging of locally advanced renal cortical tumours: absolute size (T2) is more significant than renal capsular invasion (T3a).

Unlabelled: Authors from Iowa City report on the incidence of RCC; they compared the rate of these tumours at autopsy and felt that the decrease found was a result of better antemortem detection, and an increase with time in the frequency of clinically detected renal cancer. A study from New York attempted to determine whether size, or transcapsular extension irrespective of size, was more likely to produce an adverse outcome. They analysed their database of 717 such tumours between 1988 and 2002, and found that absolute tumour size was the more significant of the two findings.

A postoperative prognostic nomogram predicting recurrence for patients with conventional clear cell renal cell carcinoma.

Purpose: Few published studies have simultaneously analyzed multiple prognostic factors to predict recurrence after surgery for conventional clear cell renal cortical carcinomas. We developed and performed external validation of a postoperative nomogram for this purpose. We used a prospectively updated database of more than 1,400 patients treated at a single institution.

Epidemiology of male osteoporosis and prostate cancer.

Purpose Of Review: In this review, we will discuss the increasing importance of male osteoporosis, risk factors for the disease, its relationship to prostate cancer and androgen deprivation treatment modalities for prostate cancer, and recent trials describing therapeutic intervention.

Recent Findings: Osteoporosis has become an increasingly important problem in men's health, accounting for significant morbidity in the aging United States male population. Hypogonadism is a major risk factor.

Controversies in prostate cancer screening.

Purpose: Prostate cancer is the most common cancer in men and the second most common cause of cancer death in men, and yet controversy continues to surround the practice of prostate cancer screening. Despite recent studies that have cast doubt over the true efficacy of breast cancer screening programs, the National Cancer Institute continues to support breast cancer screening and it has withheld endorsement of widespread prostate cancer screening. Criticisms of prostate cancer screening include the financial burden of screening, the morbidity of prostate biopsy, the low positive predictive value of screening, the over treatment of an indolent disease and the lack of evidence demonstrating a mortality benefit due to screening.

Novel therapeutics in the treatment of bladder cancer.

Purpose Of Review: The successful treatment of bladder cancer remains a challenge for urologists and oncologists. There have been substantial changes in the therapeutic options for the management of both superficial and muscle-invasive bladder cancer in the last 5 years. Here we review the preclinical and clinical developments over the last year in bladder cancer therapeutics.

A contemporary evaluation of cytoreductive nephrectomy with tumor thrombus: Morbidity and long-term survival.

Background: Metastatic renal cell carcinoma (RCC) is an aggressive entity that frequently invades the venous system. We evaluated the morbidity and survival of patients with tumor thrombus who undergo cytoreductive nephrectomy.

Materials And Methods: We identified 56 patients from our institution's database who had a primary renal tumor in place and documented metastases at the time of surgery.

Role of promoter hypermethylation in Cisplatin treatment response of male germ cell tumors.

Background: Male germ cell tumor (GCT) is a highly curable malignancy, which exhibits exquisite sensitivity to cisplatin treatment. The genetic pathway(s) that determine the chemotherapy sensitivity in GCT remain largely unknown.

Results: We studied epigenetic changes in relation to cisplatin response by examining promoter hypermethylation in a cohort of resistant and sensitive GCTs.

Prognostic indicators for long term outcome following radical retropubic prostatectomy for prostate cancer involving the seminal vesicles.

Seminal vesicle involvement at the time of radical prostatectomy (RP) for prostate cancer has been equated with metastatic disease. We review our biochemical freedom from disease results following RP in patients with seminal vesicle involvement with particular attention to identifying variables that may be predictive of disease recurrence. We retrospectively reviewed our surgical database and identified patients with pT3b (2002 AJCC) prostate cancer at RP [corrected].

Predicting the clinical course of prostate cancer.

Risk stratification in prostate cancer remains a significant clinical challenge. A study in this issue of the JCI describes an exciting application of high-throughput functional genomic technology to further refine our understanding of treatment failure risk in prostate cancer patients.

Shifting gene expression profiles during ex vivo culture of renal tumor cells: implications for cancer immunotherapy.

The use of cultured tumor cells rather than original tumor tissue for the preparation of therapeutic cancer vaccines represents an obvious solution to the problem of availability of adequate quantities of autologous tumor. In this study we investigated possible changes in gene expression accompanying the transition of renal cell carcinoma cells from the original tissue to cell populations in culture. In our study we employed cDNA microarray technology to compare the gene expression pattern of ex vivo cultured renal carcinoma cells to that of the original solid tumor tissue from which the cells were derived.

Natural history and clinical outcome of sporadic renal cortical tumors diagnosed in the young adult.

Objectives: To determine the natural history of patients younger than 40 years (young patient [YP] group) who are diagnosed with a sporadic renal cortical tumor (RCT) and to compare the natural history of these patients with the more typical older patient (OP) with RCT.

Methods: We reviewed our database and identified 34 patients (younger than 40 years old, median age 35) who underwent surgery for a sporadic RCT. The YP group outcomes were compared with 100 patients between 41 and 85 years (median 65).

Management of recurrence and follow-up strategies for patients with nonseminoma testis cancer.

This review serves as an outline of the clinical features and management options for the majority of recurrence situations in NSGCTs. The combination of reliable serum tumor markers, improved imaging techniques, effective cisplatin chemotherapy regimens, and application of meticulous surgical techniques has resulted in dramatic improvements in cure rates in NSGCT. These factors have caused the incidence of recurrent NSGCT to decline substantially in the past 20 years.

Reoperative retroperitoneal surgery for nonseminomatous germ cell tumor: clinical presentation, patterns of recurrence, and outcome.

Objectives: To describe the clinical characteristics and outcome of patients with metastatic nonseminomatous germ cell tumor requiring reoperative retroperitoneal surgery at the Memorial Sloan-Kettering Cancer Center, because such patients are poorly characterized.

Methods: The Memorial Sloan-Kettering Cancer Center germ cell tumor surgical database was reviewed from January 1989 through April 2001, and the clinical characteristics of patients undergoing reoperative retroperitoneal surgery for nonseminomatous germ cell tumor were identified. The initial presentation, histologic findings, morbidity, and survival were analyzed.

Incidence and clinical outcome of patients with teratoma in the retroperitoneum following primary retroperitoneal lymph node dissection for clinical stages I and IIA nonseminomatous germ cell tumors.

Purpose: We determined the incidence and clinical outcome of patients with clinical stages I and IIA nonseminomatous germ cell tumors (NSGCT), and teratoma in the retroperitoneum following primary retroperitoneal lymph node dissection (RPLND).

Materials And Methods: Between January 1989 and February 1998, 294 patients with clinical stages I (209) and IIA (85) underwent primary RPLND at our institution. The primary tumor had teratomatous elements in 179 (61%) cases.

Seminal vesicle involvement after radical prostatectomy: predicting risk factors for progression.

Objectives: To evaluate and study the factors for progression after radical prostatectomy with seminal vesicle invasion in a cohort of European and American patients.

Methods: The data of 137 patients with isolated seminal vesicle invasion who underwent radical retropubic prostatectomy between 1988 and 2001 were analyzed. The Gleason score of the specimen, presence of capsular invasion, and surgical margin status were noted.

The evolving role of partial nephrectomy in the management of renal cell carcinoma.

The surgical management of renal cell carcinoma has undergone critical review over the past decade. Initially treated with radical nephrectomy, renal cell carcinoma is now approached with nephron-sparing surgical techniques. Improved imaging modalities have substantially increased the number of incidental renal tumors detected, and with the increasing number of incidentally detected kidney tumors, a size and stage migration has occurred in renal cell carcinoma.

Transitional cell carcinoma of the urinary bladder metastatic to the orbit.

We report a rare case of transitional cell carcinoma of the urinary bladder metastatic to the orbit, review the histopathology, and highlight characteristics of the few previously reported cases. A 68-year-old man with a remote history of transitional cell carcinoma of the urinary bladder presented with decreased visual acuity, afferent pupillary defect, and limited extraocular motility OS. Computed tomography scan of the orbits showed a diffuse infiltrate surrounding the left globe and optic nerve.