The combination of cystoscopy and immunocytology yielded 100% sensitivity, while combining cystoscopy and cytology only marginally improved the sensitivity of cystoscopy alone. Since sensitivity appears to be of key relevance in the assessment of patients with gross hematuria, the authors suggest the addition of a sensitive noninvasive test to the diagnostic armamentarium in this situation.

Die schmerzlose Makrohämaturie stellt ein beunruhigendes Symptom dar, insbesondere wegen der hohen Prävalenz eines Urothelkarzinoms. Im Rahmen einer prospektiven Studie wurde die Rolle der Immunzytologie bei Patienten mit schmerzloser Makrohämaturie untersucht.

Schlüsselproblem in der Abklärung der schmerzlosen Hämaturie bleibt die Diskriminierung zwischen Tumoren der ableitenden Harnwege und nicht-malignen Erkrankungen. Im Rahmen einer prospektiven Studie wurde die Rolle der Immunzytologie in der Abklärung der schmerzlosen Hämaturie untersucht.

You have accessJournal of UrologyPodium, Monday, May 22, 2006, 1:00 - 3:00 pm1 Apr 2006885: Immunocytology in the Assessment of Patients with Microhematuria Bernd J. Schmitz-Drager, Birgit Beiche, Lenuta-Ancuta Tirsar, Claudia Schmitz-Dräger, Ekkehardt Bismarck, and Thomas Ebert Bernd J. Schmitz-DragerBernd J. Schmitz-Drager More articles by this author , Birgit BeicheBirgit Beiche More articles by this author , Lenuta-Ancuta TirsarLenuta-Ancuta Tirsar More articles by this author , Claudia Schmitz-DrägerClaudia Schmitz-Dräger More articles by this author , Ekkehardt BismarckEkkehardt Bismarck More articles by this author , and Thomas EbertThomas Ebert More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)33121-5AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "885: Immunocytology in the Assessment of Patients with Microhematuria." The Journal of Urology, 175(4S), p. 286 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 175Issue 4SApril 2006Page: 286 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Bernd J. Schmitz-Drager More articles by this author Birgit Beiche More articles by this author Lenuta-Ancuta Tirsar More articles by this author Claudia Schmitz-Dräger More articles by this author Ekkehardt Bismarck More articles by this author Thomas Ebert More articles by this author Expand All Advertisement Loading ...

Bei zunehmend besser werdender Prognose maligner Erkrankungen wird der Einfluss der Ernährung, Lebensweise, sportlichen Aktivität sowie supportiver Maßnahmen unter und nach chemotherapeutischer Behandlung von immer größerer Bedeutung. Bei mehreren Tumorentitäten hat das Einstellen des Rauchens einen positiven Einfluss auf die Prognose der Erkrankung. Ebenso stellt die gesunde und ausgeglichene Ernährung einen vergleichbaren Faktor dar. Die regelmäßige sportliche Aktivität von Tumorpatienten führt einerseits zur besseren Verträglichkeit chemotherapeutischer Therapieregime und reduziert andererseits die Co-Morbiditäten der Patienten mit daraus resultierender Unabhängigkeit der Patienten.

With improvements in cancer survival rates, more patients with cancer are living longer and the influence of nutrition, lifestyle, physical activity as well as supportive care during and after chemotherapy is of increasing interest. In several malignancies smoking cessation increases cancer survival. Similar effects are expected by healthy nutrition. Regular physical activity of cancer patients reduces drug interactions of chemotherapy, decreases the number of comorbid conditions, and helps patients maintain independence as long as possible.For supportive care during chemotherapy the 5-HT3 receptor antagonists are more effective for the prevention of chemotherapy-induced nausea and vomiting. There are several colony-stimulating factors (e.g. GCSF, erythropoietin) for hematopoietic recovery post-chemotherapy. Altogether supportive care of chemotherapy reduces toxicity and increases efficacy.

Painless hematuria has remained a diagnostic challenge in daily urological practice. Key problem in the assessment of these patients is the discrimination between malignant and non-malignant conditions. In this prospective study the role of immunocytology in the evaluation of patients with hematuria was investigated. Ucyt® is a commercially available immunocytological assay based upon microscopical detection of tumor-associated antigens on the membrane of urothelial cells by immunofluorescence. Between October 2000 and July 2007, 301 consecutive patients with a first episode of painless hematuria without prior transitional cell carcinoma were included. Urine samples were obtained from all patients and examined cytologically and immunocytologically. Clinical assessment by physical examination, laboratory tests, endoscopy and imaging in 228 cases with microhematuria and 66 cases with gross hematuria yielded bladder cancer in 10 (4.6%) and 17 (27%) patients, respectively. Clinical workup demonstrated that composition of both groups was entirely different. Sensitivity of cystoscopy and immunocytology was similar in both groups. Furthermore, a negative finding in cystoscopy and immunocytology virtually excluded the presence of urothelial cancer. However, while predictive values of immunocytology were clearly superior to cytology in gross hematuria, cytology performed better in the microhematuria cohort. Combination of cystoscopy and immunocytology yield 100% sensitivity in the assessment of patients with painless hematuria. Based upon performance characteristics the authors recommend to replace urine cytology by a more sensitive marker like immunocytology in gross hematuria. In patients with microhematuria immunocytology could be used to select for patients at risk for urothelial cancer and thus spare negative patients from further examinations.

Diagnosis of tumor recurrence and of therapy-related side effects as well as psychological support are the main goals of a surveillance program of cancer patients. While the latter may represent a time-consuming effort, most diagnostic procedures are expensive. Whether we can efficiently detect tumor recurrence in renal cell carcinoma depends on various parameters of the recurrent disease (e.g., frequency, localization, or therapeutic options). Available data lend support to "lean" follow-up strategies in patients with renal cell carcinoma.

Die Hauptaufgaben einer Tumornachsorge umfassen sowohl die Diagnose des Tumorrezidivs und möglicher Spätkomplikationen der Tumortherapie als auch die Betreuung des Patienten bei psychologischen und sozialen Problemen. Während letzteres vornehmlich Zeit erfordert, kommen für die erstgenannten Aufgaben in der Regel teuere Untersuchungsmaßnahmen zum Einsatz. Ob ihr Einsatz in der Nachsorge des Nierenzellkarzinoms (NZK) sinnvoll ist, hängt von verschiedenen Parametern (z. B. Häufigkeit, Lokalisation oder Therapiefähigkeit des Rezidivs) ab. Die vorliegenden Daten sprechen für eine „schlanke“ Tumornachsorge bei Patienten mit NZK.

Die Lymphknotendissektion bei Patienten mit Nierenzellkarzinom ist seit Jahrzehnten ein kontrovers diskutiertes Thema. Für die einzige prospektiv randomisierte Studie (EORTC 30881) liegt eine Endauswertung nicht vor. Retrospektive Analysen lassen sowohl diagnostisch als auch therapeutisch keinen Nutzen einer systematischen ausgiebigen Lymphknotendissektion vermuten. In der Bildgebung oder intraoperativ palpatorisch auffällige Lymphknoten sollten bei der Nephrektomie entfernt werden.

For over 50 years, testosterone therapy has been used for the treatment of hypogonadism. In recent years, there has been an increase in the use of testosterone therapy for men with late-onset hypogonadism, as more convenient and effective modes of application are developed. Testosterone therapy in these men can significantly improve their sense of well-being, and lead to increases in muscle and bone mass, upper body strength, virility and libido [Gruenewald, Matsumoto. J Am Geriatr Soc 2003;51:101; Morales. Aging Male 2004; in press].

Diagnosis of tumor recurrence and of therapy-related side effects as well as psychological support are the main goals of a surveillance program of cancer patients. While the latter may represent a time-consuming effort, most diagnostic procedures are expensive. Whether we can efficiently detect tumor recurrence in renal cell carcinoma depends on various parameters of the recurrent disease (e.g., frequency, localization, or therapeutic options). Available data lend support to "lean" follow-up strategies in patients with renal cell carcinoma.

The role of lymph node dissection in renal cell carcinoma has been controversial for decades. However, the results of the only prospective randomised study concerning this issue (EORTC 30881) are preliminary. Retrospective analyses were not able to demonstrate a diagnostic or therapeutic benefit of an extended lymph node dissection. Suspicious lymph nodes (imaging, palpation) should be excised during nephrectomy.

Due to a decrease in Leydig cell function, a considerable proportion of men over 50 years of age will develop hypogonadism. Consequently, loss of libido and several other testosterone-dependent symptoms may become evident. When decreased levels of biologically available testosterone are found, and corresponding symptoms are present, these men could be eligible for testosterone substitution therapy. Testosterone treatment in testosterone-deprived men has been shown to improve general well-being, osteoporosis, muscle atrophy, libido and - if present - anemia. Despite these positive effects, testosterone treatment has to be performed with caution. Although it has not been proven that elevation of the serum testosterone level to the normal range results in a greater risk of developing prostate cancer, the effects of testosterone on a prostate cancer already present are well established. Several studies have demonstrated that testosterone treatment does not result in a significant increase in serum levels of prostate-specific antigen (PSA) or prostate volume. The long-term effects, however, are currently unknown. For these reasons, testosterone treatment should be performed only when the presence of prostate cancer is unlikely; i.e. when PSA levels are within normal limits and digital rectal examination does not reveal any suspicious findings. These examinations may still miss some small prostate cancers that could be promoted by testosterone treatment. The determination of PSA levels under testosterone treatment is necessary every 3 months, at least for the first year. Steadily rising PSA levels require immediate cessation of testosterone administration and the initiation of further diagnostic procedures (prostate biopsy), to rule out prostate cancer.

Offensichtlich ist die Ernährung ein wesentlicher Risikofaktor für das Entstehen und Fortschreiten des Prostatakarzinoms. In experimentellen Untersuchungen und epidemiologischen Studien konnten bis heute eine Reihe verschiedener Nahrungsbestandteile identifiziert werden, für die ein Zusammenhang mit dem Prostatakarzinom wahrscheinlich ist. Zu diesen Substanzen zählen v. a. sekundäre Pflanzenstoffe wie Flavone, Isoflavone und Lykopin aber auch Selen und Vitamin D. Vor allem Raucher scheinen von der präventiven Einnahme von Vitamin E zu profitieren.

Nutrition is apparently a major risk factor for the development and progression of prostate cancer. Based on experimental studies and epidemiologic data mainly from case-control studies or cohort studies, there is strong evidence that reduction of the total energy consumption, a diet comprising less than 30% fat, and increased intake of phytoestrogens, vitamins D and E and selenium could yield a decreased prostate cancer incidence. Furthermore, some of these measures appear to have antitumoral capacity even in the presence of the disease. These observations have provided a rationale to forward large prospective trials on dietary interventions to prove the efficacy of the concept and further delineate the correlation between nutritional compounds and prostate cancer risk. These chemoprevention trials are either aiming a reduction prostate cancer incidence or a decrease in tumor progression. Depending on the study design, large numbers of individuals need to be enrolled and long follow-up intervals are required thus making such trials highly complex and cost-intensive. However, regarding the potential relevance of chemoprevention on public health, further efforts to identify nutritional factors affecting prostate cancer growth are warranted.

OBJECTIVES:Anomalies of the p53 tumor suppressor gene have been reported for a variety of different tumor types. Also in urothelial cancer accumulation of the P53 protein has been linked with an unfavorable prognosis of the patients. Despite the growing number of publications confusion remains because key questions regarding p53 accumulation in bladder cancer are still unanswered. The objective of this manuscript was to review all published literature on the association of p53 accumulation and prognosis of patients with bladder cancer. Furthermore, putative reasons for the conflicting results should be defined as a basis for future research. METHODS:The entry criteria for the analysis were met by 43 trials comprising 3,764 patients out of 138 publications found through Medline search. RESULTS:Comparison between the trials yielded considerable differences obviously due to technical aspects, e.g. the selection of the antibody and the use of different cut-off values, study design and patient selection. CONCLUSIONS:From this analysis it becomes evident that further retrospective investigations will not contribute to the solution of the problem and thus are obsolete. There is an obvious need for standardization of the assay procedure and the assessment of the specimens as well as for the initiation of a prospective multicenter trial to provide definite answers.

BACKGROUND:Human renal cell carcinogenesis is associated with loss of expression of tissue-specific genes and loss of function of tissue-specific transcription factors such as HNF(hepatic nuclear factor)1 alpha.MATERIALS AND METHODS:In this study HNF1 alpha DNA-binding activities and protein amounts were determined by gel retardation assay and Western blot analysis, respectively, in 42 non-metastasized renal cell carcinomas and paired normal tissues.RESULTS:36 tumors out of 42 (86%) showed diminished binding activity of HNF1 alpha. In most cases (26 out of 42) this appeared to be due to decreased amounts of HNF1 alpha protein, but 10 tumors contained equal or even higher amounts of HNF1 alpha, in spite of reduced binding to DNA. Only 6 tumors out of 42 had unaltered HNF1 alpha binding activity. A clinical follow-up was obtained for 40 patients. Over an average follow-up period of 39 months no significant differences in the survival rate were observed between patients having lost or retained HNF1 alpha function. However, since most of the patients with retained function are still alive, long-term follow-up might be warranted.CONCLUSIONS:The very high incidence of loss of HNF1 alpha function indicates the important biological role of this change in renal cell carcinoma.