Urological Cancers in Clinical Practice : Jonathan Waxman :
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They discuss alterations of these immune regulators, their clinical relevance and therapeutic targeting strategies. Review Article 21 August Intravesical chemotherapy is a mainstay of treatment for non-muscle-invasive bladder cancer; however, the biology of the bladder means that intravesical therapy is limited by washout of the agent during voiding and systemic effects caused by absorption through the bladder wall.
In this Review, the authors consider novel approaches to improving the pharmacokinetics of intravesical chemotherapy, such as chemohyperthermia, sustained release devices, and nanoparticle conjugation. Review Article 17 July In this Review, Stabile and colleagues describe the current status of the role of mpMRI in prostate cancer diagnosis, its clinical application and consider its future direction in this disease. Review Article 09 July In this Review, the authors discuss the molecular and histopathological evidence supporting pathology-driven therapy for advanced bladder cancer, including rare histological subtypes of urothelial carcinoma and non-urothelial carcinomas, and highlight novel molecular taxonomies, relevant biomarkers and promising future therapies.
Research Highlight 13 September Comment 13 September Cell lines are valuable tools for developing treatments to minimize disparities in prostate cancer outcomes. Nevertheless, limitations in their application, primarily from the inadequate use of ethnically diverse cell lines, continue to hinder the advance of drug leads that would equally benefit men from both African and European ancestry. However, in the present study, we observed great disparity between the proposed guidelines SBU, EAU and AUA 4 - 7 and the current practice of Brazilian urologists, according to the questionnaires answers.
A meta-analysis of 1. This practice is still controversial in literature, since meta-analysis showed benefits of BCG therapy in recurrence rates only for patients with high risk tumors 9.
However, this is not an absolute fact, since there are at least two other meta-analysis that showed superiority of BCG over Mitomicin C in all high risk groups 10 , This blurred fact may explain the high use of BCH for low risk patients in this study. Our study did not analyze patients with intermediate risk. Witjes et al.
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The treatment of high risk bladder tumors showed a good accordance to the guidelines: An North American study with questionnaires available showed a Another epidemiological study from Spain 16 analyzed 2. Anyway, Brazilian rates of compliance of guidelines are comparable to international series.
Isolated TUR was used by 10 participants 2. Our study detailed the regimen of BCG administration whenever indicated. There was a great variability regarding dose, application interval and total duration of treatment. According to the guidelines, until now, the evidences show that there is no ideal dose and a reduced one does not lower side effects.
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However, the distribution of doses probably is based on the concern regarding BCG side effects. The regimen of BCG use showed a great variation during induction and maintenance. Several regimens were cited by urologists, including never described regimens. However, it is possible to verify that the SWOG protocol was the most used for maintenance Guidelines vary in relation to the best regimen to be used; AUA guidelines suggest the use of a standard dose in SWOG regimen 17 for 3 years and EUA guidelines recommend maintenance for at least one year.
AUA guidelines are based on a trial with 1. BCG strains are different in relation to phenotype, antigenicity and immunogenic activity, that may influence toxicity, tumor action and clinical efficacy. There are only a few studies that compared effectiveness and collateral effects of different strains, but those used in Brazil are the most common used worldwide 20 - Rate of Re-TUR in our study were notably superior in relation to two major international studies 15 , 16 , where rates varied from We registered Following BCG failure, only Future studies should address criteria for recurrence, failure and intolerance of BCG.
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Among these, early failure during intravesical treatment reflects a more aggressive disease, justifying precocious cystectomy, while long term recurrence and intolerance are alternatively treated rather than with cystectomy, what could reflect our results. Our data have never been published and there are very few studies in Brazilian literature. The lack of compliance and use of different regimens other than the European and North American guidelines reaffirm the complexity and diversity of NMIBC treatment 12 , Limitations of the study include the number of urologists that refrained from answering the questionnaire and the fact that it was realized during the Brazilian Congress of Urology, with a potential bias of selection of professionals who tend to recycle and update their knowledge more frequently.
Further studies are necessary to fully understand the reasons for such discrepancy. The results are similar to those of Europe and USA, but with particular aspects.
Epidemiology and risk factors of urothelial bladder cancer. Eur Urol. Tobacco smoke and bladder cancer--in the European Prospective Investigation into Cancer and Nutrition. Urologic cancers include cancers of the bladder , kidney , prostate and testicles , all relatively common. Prostate cancer, for example, is the most common cancer in American men.
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One out of every 10 men will develop the disease at some time in his life — most often after age Bladder cancer is the fourth most common cancer among men and the ninth most common among women in the United States. Each year, more than 50, new cases of bladder cancer are diagnosed. Among American men age 15 to 44, testicular cancer is the most common.