Hartmann I, Král M, Kudláčková Š. Obezita a její vliv na karcinom prostaty. Cíl: Obezita jako jedno z nejčastějších civilizačních onemocnění má obrovský vliv na celkový zdravotní stav populace. Zvýšená morbidita a mortalita obézních pacientů je dána obezitou samotnou a dále pak také zvýšeným výskytem onemocnění, které nejsou s obezitou spjaty přímočaře, a přesto je jejich výskyt u obézních častější. Naším cílem bylo prokázat tuto souvislost u obézních pacientů s karcinomem prostaty (KP), což by mohlo vést k úpravě doporučení ohledně časné diagnostiky KP. Soubor a metody: Vyhodnotili jsme soubor 200 pacientů, kteří u nás v období 12/2017 až 4/2019 podstoupili robotickou radikální prostatektomii pro biopticky potvrzený karcinom prostaty. U těchto pacientů byl vyhodnocen věk, předoperační PSA (prostatický specifický antigen), objem prostaty, BMI (body mass index), pozitivní rodinná anamnéza, pooperační stadium dle TNM klasifikace a rizikovost karcinomu prostaty dle ISUP (International Society of Urological Pathology) grade group. Výsledky: V našem souboru bylo 34 % pacientů s nadváhou (BMI 25-30) a 52 % pacientů obézních (BMI > 30). U pacientů s BMI nad 30 je objem prostaty statisticky významně větší než u skupiny s BMI pod 30 (p = 0,034). Nepotvrdili jsme vztah mezi hodnotou BMI a hladinou PSA (p = 0,944). Dále jsme hodnotili vztah mezi BMI a agresivitou karcinomu. Neprokázali jsme statisticky signifikantní rozdíl (p = 0,995) mezi BMI a agresivitou karcinomu prostaty. Při hodnocení pooperačního stagingu byl častější klinicky pokročilý KP (pT3) stadium u pacientů s BMI nad 30 (p = 0,100). Závěr: Ačkoliv v České rebublice je procento obézních pacientů nemalé, nepotvrdili jsme jasnou souvislost mezi agresivním karcinomem prostaty a obezitou.
Hartmann I, Král M, Kudláčková Š. Obesity and risk of prostate cancer. Aim: Obesity, as one of the most common diseases of civilization, which has a huge impact on the overall health status of the population. The increased morbidity and mortality of obese patienets is due to obesity itself and also due to the increased incidence of diseases that are not directly related to obesity, and yet their occurrence is more frequent in obese patients. Our aim was to demonstrate this association in obese patients with prostate cancer, which could lead tothe modification of recommendations regarding the early diagnosis of prostate cancer. Material and methods: we evaluated a set of 200 patients who underwent robotic radical prostatectomy for prostate cancer between December 2017 and April 2019. Age, preoperative PSA (prostatic specific antigen), prostate volume, BMI ( Body Mass Index ), positive family history, postoperative stage according to TNM classification, and risk of aggressive prostate cancer according to ISUP (International Society of Urological pathology) grade group were evaluated in these patients. Results: In our group, 34 % of patients were overweight (BMI 25-30) and 52 % of patients were obese (BMI > 30). In patients with BMI over 30, the volume of the prostate was statistically significantly greater than in the group with BMI <30 (p=0.034). We didn ́t confirm the relationship between BMI and PSA level (p=0.944). Furthermore, we evaluated the relationship between BMI and cancer aggressiveness. We didn ́t confirm a statistically significant difference (p=0,995) between BMI and aggressive prostate cancer. When evaluating postoperative staging, locally advanced prostate carcinoma (pT3 stage) was more common in patients with a BMI over 30 (p=0,100). Conclusion: Although the percentage of obese patients in the Czech Republic is considerable, we didn ́t confirm a clear connection between aggressive prostate cancer and obesity.
Východiska: Nádorová onemocnění močového měchýře se řadí na 11. místo v celosvětovém měřítku. Většina z nádorů se řadí k uroteliálním karcinomům, kdy méně běžné varianty (spinocelulární či adenokarcinomy) zahrnují zpravidla ≤ 10 % případů. Ostatní typy nádorů jsou výjimečné. Nález Ewingova sarkomu v močovém měchýři pak řadíme mezi raritní. Případ: Prezentujeme případ 54leté pacientky vyšetřené pro bezbolestnou hematurii. V rámci došetření byl zjištěn objemný tumor močového měchýře, ale s ohledem na rozsah tumoru byla možná pouze diagnostická transuretrální resekce. Stadium onemocnění bylo dle primárního stagingu již vstupně pokročilé s metastatickým rozsevem, anemií a již zjištěnou obstrukcí horních močových cest. Výsledky: Histologicky byl překvapivě v močovém měchýři prokázán Ewingův sarkom. Anemie způsobená hematurií a pokročilostí onemocnění byla korigována krevními převody a obstrukce pravé ledviny založením punkční nefrostomie. Navzdory velmi rychle stanovené diagnóze, dokončení stagingu a přípravě pacientky k další léčbě však pacientka umírá ještě před zahájením plánované systémové léčby. Závěr: Diagnostika Ewingova sarkomu v měchýři je identická jako v případě ostatních typů měchýřových nádorů, tj. transuretrální resekce tumoru. V případě potvrzení tohoto histologického typu je nezbytné doplnit stagingová vyšetření a pokračovat multimodální léčbou. Zde hraje klíčovou roli včasně zahájená systémová chemoterapie, při vyloučení generalizace léčba zahrnuje také radikální cystektomii či radioterapii. Cílem našeho sdělení je prezentovat raritní případ tohoto onemocnění a poukázat na diferenciální diagnostiku, principy a možnosti léčby.
Background: Bladder cancer is 11th most common cancer worldwide. Histologically, most of the tumors are classified as urothelial carcinomas. Less common variants (squamous cell or adenocarcinomas) usually comprise up to 10% of cases. Other types of tumors are exceptional. The finding of Ewing‘s sarcoma in the bladder is considered extremely rare. Case: We present the case of a 54-year-old female patient examined for painless hematuria. During the follow-up examination, a bulky tumor of the bladder was detected, but considering the extent of the bladder tumor, only a diagnostic transurethral resection was possible. According to the primary staging, the disease was already advanced at the time of admission with metastatic spread, anemia and present obstruction of the upper urinary tract. Results: Histologically, Ewing‘s sarcoma was surprisingly demonstrated in the urinary bladder. Anemia caused by hematuria and advanced disease was corrected by blood transfusions and obstruction of the right kidney by puncture nephrostomy. However, despite a very quick diagnosis, completion of staging and preparation of the patient for further treatment, the patient had died before the planned systemic treatment began. Conclusion: The diagnosis of Ewing‘s sarcoma is identical to that of the other bladder tumors, i.e. transurethral resection. In the case of confirmation of this histological type, it is necessary to complete staging examinations and start multimodal treatment. Early systemic chemotherapy plays a key role and if metastatic spread is excluded, radical cystectomy or radiotherapy are included, too. The aim of our communication is to present a rare case of this disease, discuss the differential diagnosis and point out the principles and possibilities of its treatment.
- MeSH
- diferenciální diagnóza MeSH
- Ewingův sarkom * diagnóza epidemiologie farmakoterapie patologie MeSH
- hematurie etiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- metastázy nádorů diagnóza MeSH
- močový měchýř diagnostické zobrazování patologie MeSH
- nádory močového měchýře diagnóza farmakoterapie klasifikace komplikace MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
During endoscopic procedures for suspected urothelial tumors of the upper urinary tract, radiographic imaging using an iodinated contrast medium is often required. However, following ureteropyelography, we detected changes in cytology characteristics not correlating with real cytology findings in naive urine. The aim of our study was to assess cytology changes between naive and postcontrast urine according to The Paris System of cytology classification. Methods: We prospectively assessed urine samples from 89 patients (23 patients with histologically proven urothelial cancer and 66 healthy volunteers). The absence of malignancy was demonstrated by CT urography and/or ureteroscopy. The study was single blind (expert cytopathologist) and naïve Paris system for urine cytology assessment was used. Furthermore, additional cytological parameters were analyzed (e.g., specimen cellularity, degree of cytolysis, cytoplasm and nucleus color, chromatin and nucleo-cytoplasmic ratio). Results: Our study showed statistically significant differences when comparing naïve and postcontrast urine in healthy volunteers (only 51 % concordance, p = 0.001) versus malignant urine specimens (82 % concordance). The most important differences were in the shift from The Paris System category 2 (negative) to 1 (non-diagnostic) and from category 2 (negative) to 3 (atypia). Other significant changes were found in the assessment of specimen cellularity (p = 0.0003), degree of cytolysis (p = 0.001), cytoplasm color (p = 0.003), hyperchromasia (p = 0.001), course chromatin (p = 0.002), nucleo-cytoplasmatic ratio (p = 0.001) and nuclear borders' irregularity (p = 0.01). Conclusion: Our unique study found crucial changes in the cytological assessment of naive and postcontrast urine and we confirm that postcontrast urine is more often assessed as abnormal, suspect or non-diagnostic. Therefore, before urine collection for cytology, the clinician should avoid administration of iodinated contrast into the urinary tract.
- Publikační typ
- časopisecké články MeSH
OBJECTIVE: Analysis of the effect of technical factors, i.e. the type of stone targeting and shock wave generator, on ESWL efficacy. Evaluation of secondary outcomes to determine an optimal strategy for performing the procedure. PATIENTS AND METHOD: In the period from 01/2016 to 07/2021, we analyzed data from patients indicated for ESWL for nephrolithiasis and proximal or distal ureterolithiasis. This was a tricenter retrospective study to evaluate stone-free rates (SFR) while taking into account the number of ESWL sessions in four selected groups of patients with comparable characteristics. A patient is considered stone-free in the absence of residual lithiasis or with an asymptomatic residue of up to 2 mm. The real-time ultrasound-guided (USG) arm consisted of a group of 120 patients on the electromagnetic STORZ SLK lithotripter in the period from 02/2017 to 02/2020. A total of three comparison arms with x-ray guidance were created: A: 68 patients between 01/2016 and 03/2017 on the Medilit 7 electrohydraulic lithotripter. B: 72 patients from 04/2017 to 10/2017 on the Sonolith i-sys electroconductive lithotripter (EDAP). C: 120 patients from 03/2018 to 07/2021 on the STORZ SLK electromagnetic lithotripter. By comparing the US and x-ray guidance using the STORZ SLK lithotripter, the effect of targeting when using an identical device (electromagnetic generator) was evaluated. By comparing the arms A, B, and C, the efficacy in different types of generators - electromagnetic, electroconductive, electrohydraulic - was assessed when the same type of targeting (fluoroscopy) was used. The secondary parameters that were monitored included: the rate of use of auxiliary techniques in stone management; radiation exposure for the patient and/or operator; analgesic consumption; and the time required to perform the procedure. RESULTS: When US versus x-ray guidance was compared in an electromagnetic lithotripter, SFRs of 90% vs. 85% (P=0.329), i.e. statistically comparable results, were obtained. By comparing electromagnetic, electroconductive, and electrohydraulic generators with fluoroscopy, SFRs of 85%, 88.9%, and 88.2% were obtained, respectively (P=0.727). When the degree of need for intraoperative analgesic administration was assessed, the electromagnetic generator was found to have a significantly lower consumption (20.8% vs. 30.6% vs. 48.5%) (P=0.0005). Values less than 1095 HU and 108.5 mm were shown to be optimal cut-off values for stone density and skin-to-stone distance, respectively. CONCLUSION: Based on our comparative analysis, the noninferiority of US stone targeting was demonstrated compared to fluoroscopic targeting. No significant differences in ESWL efficacy were found using electrohydraulic, electroconductive or electromagnetic shock wave generators. With the electromagnetic lithotripter, there was a significantly lower analgesic consumption than with the electrohydraulic type.
- MeSH
- analgetika MeSH
- ledvinové kameny * terapie MeSH
- lidé MeSH
- litotripse * metody MeSH
- retrospektivní studie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Toll-like receptor 3 (TLR3) is an endosomal receptor expressed in several immune and epithelial cells. Recent studies have highlighted its expression also in solid tumors, including prostate cancer (PCa), and have described its role primarily in the proinflammatory response and induction of apoptosis. It is up-regulated in some castration-resistant prostate cancers. However, the role of TLR3 in prostate cancer progression remains largely unknown. The current study experimentally demonstrated that exogenous TLR3 activation in PCa cell lines leads to a significant induction of secretion of the cytokines IL-6, IL-8, and interferon-β, depending on the model and chemoresistance status. Transcriptomic analysis of TLR3-overexpressing cells revealed a functional program that is enriched for genes involved in the regulation of cell motility, migration, and tumor invasiveness. Increased motility, migration, and invasion in TLR3-overexpressing cell line were confirmed by several in vitro assays and using an orthotopic prostate xenograft model in vivo. Furthermore, TLR3-ligand induced apoptosis via cleavage of caspase-3/7 and poly (ADP-ribose) polymerase, predominantly in TLR3-overexpressing cells. These results indicate that TLR3 may be involved in prostate cancer progression and metastasis; however, it might also represent an Achilles heel of PCa, which can be exploited for targeted therapy.
- MeSH
- apoptóza MeSH
- lidé MeSH
- nádorové buněčné linie MeSH
- nádory prostaty * patologie MeSH
- poly I-C farmakologie MeSH
- prostata patologie MeSH
- toll-like receptor 3 * genetika metabolismus MeSH
- zvířata MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
AIMS: With the introduction of magnetic resonance imaging in the diagnosis of prostate cancer and its use in targeted prostate biopsy, an increased incidence of anterior-predominant prostate cancer (APC) has been observed. METHODS: We enrolled 200 patients who underwent radical prostatectomy at our department between 12/2017 and 04/2019. We evaluated tumour location in the individual segments of the prostate, index tumour location and volume, and compared the postoperative stage, Gleason score, grade group (GG), and the presence of extraprostatic extension (EPE) in APC and posterior prostate cancer (PPC). We assessed the rate of MRI scans prior to prostate surgery as well as the influence of family history and PSA on the presence of APC. RESULTS: We found a significantly higher rate of anterior tumours than previously reported (37%) and confirmed that these tumours are diagnosed with a significantly larger index tumour volume (P=0.003). We also showed that a mere 6.76% of APCs were low-risk tumours not requiring radical treatment. Furthermore, anterior tumours were found significantly more often (P=0.001) in patients who underwent preoperative MRI. No differences were observed between PSA values, family history, presence of EPE, or locally advanced disease in APC vs. PPC. CONCLUSIONS: The frequency of anterior tumours is higher than previously thought, and they include tumours requiring radical treatment. When these tumours are neglected, it may lead to patient undertreatment with impact on their life prognosis. Thus, we consider the use of MRI-targeted prostate biopsy to be a necessity both for ruling out APC in the case of repeatedly negative prostate biopsies and, in particular, before patient inclusion in active surveillance.
Cieľ: Porovnanie efektivity ESWL pri zemeriavaní konkrementov výhradne ultrasonografickom (USG) alebo flouroskopickom (RTG). Preukázenie minimálne ekvivalencie oboch modalít. Poukázanie na výhody ultrasonografického prístupu za účelom jeho širšieho a pružnejšieho využitia. Súbor pacientov a metóda: Retrospektívna bicentrická štúdia porovnáva stone free rates (SFRs) u troch selektovaných skupín pacientov s porovnateľnými charakteristikami, pričom ESWL bola prvou intervenciou k riešeniu nefrolitiázy, proximálnej alebo prevesikálnej ureterolitiázy. Za "stone free" je považovaný pacient s absenciu residuálnej litiázy alebo s asymptomatickým reziduom do 2 mm. Rameno s real time USG fokusáciou tvorí skupina 120 pacientov za obdobie 02/2017–02/2020 na elektromagnetickom litotryptore STORZ SLK. Do ramena s RTG zameriavaním spadajú dve skupiny: 72 pacientov v období 04/2017–10/2017 na elektrokonduktívnom litotryptore Sonolith-i-sys (EDAP) a 68 pacientov medzi 01/16–03/2017 na elektrohydraulickom litotryptore Medilit 7. Po pritom sledujeme nutnosť využitia auxiliárnych postupov a počet intervencí ESWL nutných pre kompletnú sanáciu konkrementu. Výsledky: Pri USG zameriavaní bola SFR na úrovni 90%. Primerný počet intervencí 1,3. RTG‑ -fokusácia: kumulatívne skupina Sonolith-i-sys plus Medilit 7: bola zistená hodnota SFR 90% pri 1,5 dobách. Signifikantný rozdiel v počte ESWL tak nebol zistený α = 0,105. Rovnaká situácia nastala pri porovnaní frekvencie prevedenia auxiliárneho postupu – zavedenia stentu alebo ureterorenoskopie α = 0,453, zatiaľ čo pri kumulatívnej radiačej záťaži je rozdiel signifikantný, podobne ako v prípade potreby analgetika bola taktiež signifikanatne nižšia (α < 0,001) u USG fokusácie. Miera prezencie operatéra pri intervencii bola signifikantne väčšia u USG ramena . Záver: Výsledky našej štúdie deklarujú rovnocennost' oboch zobrazovacích modalít z hľadiska efektivity. USG navigácia by mala byť predovšetkým s ohľadom na odbúranie radiačnej záťaže pre pacienta preferovanou formou zameriavania konkrementov pri realizácii ESWL.
Aim: Efficacy comparison of two localization techniques using ESWL – exclusively real time ultrasound or fluoroscopy. Demonstration of at least equivalence of both techniques. To publisize the advantages of real-time ultrasound guidance to encourage more departments in develop of this modality. Methods: This bicentric retrospective study compares stone free rates (SFRs) in three selected groups of patients with similar characteristics. Inclusion criteria: ESWL as primary intervention for nephrolithiasis, proximal or prevesical uretherolithiasis. The definition of stone free was a patient without any residual stone or the absence of fragments ≥ 2 mm. The arm with exclusively real-time USG targeting of urolithiasis contains a group of 120 patients, using electromagnetic lithotripter – STORZ SLK between 02/2017–02/2020. The fluroscopy- arm includes two groups: 72 patients, using electroconductive lithotripters: Sonolith-i-sys (EDAP) between 04–10/2017 and 68 patients, by using electrohydraulic lithotripter Medilit 7 between 01/2016–03/2017. Simultaneus evaluation of requisite for auxiliary techniques and number of sessions for complete stone-desintegration. Results: SFR was 90% in the USG-guided group. The avarage number of ESWL sessions was 1,3. SFR in the fluoroscopic arm: the group-Sonolith-i-sys plus the group Medilit 7 was 90%. The avarage number of ESWL sessions was 1,5. These results were not significantly different α = 0,105. The same result is shown on comparson of frequency of requirement for auxiliary techniques – DJ-stent insertion/ureterorenoscopy α = 0,453. Radiation exposure was the biggest difference between techniques, as well as analgesics requirement which were significantly lower in USG arm ( α < 0,001). The operator presence-time was significantly longer in USG – guided ESWL. Conclusion: Our study shows efficacy equivalence of outcomes of both localization modalities. Real-time USG guidance should be primarily used to reduce radation exposure for patients undergoing ESWL.
- MeSH
- lidé MeSH
- litotripse * metody MeSH
- radiační expozice MeSH
- retrospektivní studie MeSH
- ultrasonografie * MeSH
- urolitiáza terapie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
Prostate cancer (PCa) is the second leading cause of cancer-related deaths in men in Western countries, and there is still an urgent need for a better understanding of PCa progression to inspire new treatment strategies. Skp2 is a substrate-recruiting component of the E3 ubiquitin ligase complex, whose activity is regulated through neddylation. Slug is a transcriptional repressor involved in the epithelial-to-mesenchymal transition, which may contribute to therapy resistance. Although Skp2 has previously been associated with a mesenchymal phenotype and prostate cancer progression, the relationship with Slug deserves further elucidation. We have previously shown that a high Gleason score (≥8) is associated with higher Skp2 and lower E-cadherin expression. In this study, significantly increased expression of Skp2, AR, and Slug, along with E-cadherin downregulation, was observed in primary prostate cancer in patients who already had lymph node metastases. Skp2 was slightly correlated with Slug and AR in the whole cohort (Rs 0.32 and 0.37, respectively), which was enhanced for both proteins in patients with high Gleason scores (Rs 0.56 and 0.53, respectively) and, in the case of Slug, also in patients with metastasis to lymph nodes (Rs 0.56). Coexpression of Skp2 and Slug was confirmed in prostate cancer tissues by multiplex immunohistochemistry and confocal microscopy. The same relationship between these two proteins was observed in three sets of prostate epithelial cell lines (PC3, DU145, and E2) and their mesenchymal counterparts. Chemical inhibition of Skp2, but not RNA interference, modestly decreased Slug protein in PC3 and its docetaxel-resistant subline PC3 DR12. Importantly, chemical inhibition of Skp2 by MLN4924 upregulated p27 and decreased Slug expression in PC3, PC3 DR12, and LAPC4 cells. Novel treatment strategies targeting Skp2 and Slug by the neddylation blockade may be promising in advanced prostate cancer, as recently documented for other aggressive solid tumors.
- MeSH
- androgenní receptory genetika metabolismus MeSH
- antitumorózní látky farmakologie MeSH
- buňky PC-3 MeSH
- CD antigeny genetika metabolismus MeSH
- cyklopentany farmakologie MeSH
- docetaxel farmakologie MeSH
- epitelo-mezenchymální tranzice genetika MeSH
- inhibitor p27 cyklin-dependentní kinasy genetika metabolismus MeSH
- kadheriny genetika metabolismus MeSH
- lidé MeSH
- lymfatické metastázy MeSH
- malá interferující RNA genetika metabolismus MeSH
- nádorové buněčné linie MeSH
- nádory prostaty genetika metabolismus patologie MeSH
- posttranslační úpravy proteinů * MeSH
- prostata metabolismus patologie MeSH
- protein NEDD8 genetika metabolismus MeSH
- proteiny asociované s kinázou S-fáze antagonisté a inhibitory genetika metabolismus MeSH
- pyrimidiny farmakologie MeSH
- regulace genové exprese u nádorů MeSH
- rodina transkripčních faktorů Snail genetika metabolismus MeSH
- stupeň nádoru MeSH
- viabilita buněk účinky léků MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Publikační typ
- abstrakt z konference MeSH
- MeSH
- dospělí MeSH
- lidé MeSH
- lymfangiom cystický * chirurgie diagnostické zobrazování patologie MeSH
- magnetická rezonanční tomografie metody MeSH
- nádory nadledvin * chirurgie diagnostické zobrazování patologie MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
