Optical coherence tomography is a simple, portable, promising modality for evaluation of bladder lesions and depth of tumor penetration. Further refinement of this technology may lead to the development of an optical surrogate for biopsy.

Photodynamic therapy (PDT) is an experimental cancer treatment modality that selectively destroys cancer cells by an interaction between absorbed light and a retained photosensitizing agent. This review discusses the basic components of photodynamic activity and examines the clinical applications of photodynamic therapy in cancer treatment. Treatment of superficial and early-stage malignancies is encouraging. Technologic advancement and further elucidation of the fundamental basis of photodynamic action should permit treatment of more advanced malignancies.

Objectives To evaluate the diagnostic and prognostic value of the nuclear matrix protein-22 (NMP22) and bladder tumour antigen (BTAstat) tests compared with voided urinary cytology (VUC) in detecting and following bladder cancer, assessing particularly the prognostic value of false-positive test results in patients followed up for bladder cancer. Patients and methods From 739 patients suspected of having bladder cancer, voided urine samples for the NMP22 and BTAstat tests, and for VUC and urine analysis, were collected before cystoscopy. All patients underwent transurethral resection of bladder lesions or mapping, and were followed for a mean (range) of 27.3 (3±65) months. Results In the 406 patients with bladder cancer, the overall sensitivity was 85% for NMP22, 70% for BTAstat and 62% for VUC. For histological grades 1±3 the sensitivity in detecting transitional cell carcinoma was 82%, 89% and 94% for NMP22, 53%, 76% and 90% for BTAstat, and 38%, 68% and 90% for VUC, respectively. Although the sensitivity in detecting invasive carcinoma was >85% for all the tests, NMP22 and BTAstat were statistically more sensitive than VUC for super®cial tumours. The optimal threshold value for NMP22, calculated using the receiver operating characteristics curve, was 8.25 U/mL. The speci®city was 68% for NMP22, 67% for BTAstat, and 96% for VUC. The speci®city of VUC remained >87% and was independent of benign histological ®ndings. In contrast, in patients with no apparent genitourinary disease on histology, NMP22 and BTAstat had signi®cantly higher speci®city (94% and 92%, respectively; P=0.003) than in the group with chronic cystitis (52% for both tests). Forty patients having no bladder cancer at biopsy had a recurrence after a mean (range) followup of 7.7 (3±15) months; all had a previous history of bladder cancer. According to subsequent recurrence, the prognostic positive and negative predictive values were 18% and 91% for NMP22, 13% and 88% for BTAstat, and 79% and 91% for VUC. Both falsepositive VUC and NMP22 tests predicted recurrence (log-rank test, P<0.001 and P=0.004, respectively), but the BTAstat test produced no similar correlation (P=0.778). Conclusion The NMP22 and BTAstat tests are better than VUC for detecting super®cial and low-grade bladder cancer but they have signi®cantly lower speci®city. After excluding diseases with the potential to interfere in these tests the overall speci®city of both tests is increased considerably. False-positive results from NMP22 and VUC but not from BTAstat in patients followed up for bladder cancer correlate with future recurrences.

ObjectiveTo investigate whether a fixed-dose combination (FDC) of 0.5 mg dutasteride and 0.4 mg tamsulosin is more effective than watchful waiting with protocol-defined initiation of tamsulosin therapy if symptoms did not improve (WW-All) in treatment-naïve men with moderately symptomatic benign prostatic hyperplasia (BPH) at risk of progression. Patients and MethodsThis was a multicentre, randomised, open-label, parallel-group study (NCT01294592) in 742 men with an International Prostate Symptom Score (IPSS) of 8-19, prostate volume ≥30 mL and total serum PSA level of ≥1.5 ng/mL. Patients were randomised to FDC (369 patients) or WW-All (373) and followed for 24 months. All patients were given lifestyle advice. The primary endpoint was symptomatic improvement from baseline to 24 months, measured by the IPSS. Secondary outcomes included BPH clinical progression, impact on quality of life (QoL), and safety. ResultsThe change in IPSS at 24 months was significantly greater for FDC than WW-All (-5.4 vs −3.6 points, P < 0.001). With FDC, the risk of BPH progression was reduced by 43.1% (P < 0.001); 29% and 18% of men in the WW-All and FDC groups had clinical progression, respectively, comprising symptomatic progression in most patients. Improvements in QoL (BPH Impact Index and question 8 of the IPSS) were seen in both groups but were significantly greater with FDC (P < 0.001). The safety profile of FDC was consistent with established profiles of dutasteride and tamsulosin. ConclusionFDC therapy with dutasteride and tamsulosin, plus lifestyle advice, resulted in rapid and sustained improvements in men with moderate BPH symptoms at risk of progression with significantly greater symptom and QoL improvements and a significantly reduced risk of BPH progression compared with WW plus initiation of tamsulosin as per protocol.Keywords benign prostatic hyperplasia, dutasteride, fixed-dose combination, lower urinary tract symptoms, tamsulosin, watchful waiting [Correction added on 13 February 2015 after first online publication: The trademark symbol for 'Duodart' has been changed to a registered symbol]

The vast majority of bladder cancers originate within 600 microm of the tissue surface, making optical coherence tomography (OCT) a potentially powerful tool for recognizing cancers that are not easily visible with current techniques. OCT is a new technology, however, and surgeons are not familiar with the resulting images. Technology able to analyze and provide diagnoses based on OCT images would improve the clinical utility of OCT systems. We present an automated algorithm that uses texture analysis to detect bladder cancer from OCT images. Our algorithm was applied to 182 OCT images of bladder tissue, taken from 68 distinct areas and 21 patients, to classify the images as noncancerous, dysplasia, carcinoma in situ (CIS), or papillary lesions, and to determine tumor invasion. The results, when compared with the corresponding pathology, indicate that the algorithm is effective at differentiating cancerous from noncancerous tissue with a sensitivity of 92% and a specificity of 62%. With further research to improve discrimination between cancer types and recognition of false positives, it may be possible to use OCT to guide endoscopic biopsies toward tissue likely to contain cancer and to avoid unnecessary biopsies of normal tissue.

ObjectiveTo prospectively assess the impact of the fixed-dose combination (FDC) of the 5a-reductase inhibitor (5ARI), dutasteride 0.5 mg and the a 1 -adrenoceptor antagonist, tamsulosin 0.4 mg (DUT-TAM FDC) therapy on sexual function domain scores in sexually active men with lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH), using the Men's Sexual Health Questionnaire (MSHQ). Patients and MethodsThis European and Australian double-blind, placebocontrolled, parallel-group study was conducted at 51 centres. Inclusion criteria: age ≥50 years, International Prostate Symptom Score ≥12, prostate volume ≥30 cc, prostate-specific antigen 1.5-10 ng/mL. Patients were randomised 1:1 to DUT-TAM FDC therapy or placebo for 12 months. The change from baseline to Month 12 on the total MSHQ (primary endpoint) and MSHQ erection, ejaculation and satisfaction domains (secondary outcome) was assessed, using a mixed model repeated measures analysis. Safety was evaluated. ResultsThe intention-to-treat population included 489 patients (243 DUT-TAM FDC therapy; 246 placebo). A significant decrease (worsening) was observed with DUT-TAM FDC therapy versus placebo on the total MSHQ score (À8.7 vs À0.7; standard error [SE]: 0.81, 0.78; P < 0.001), and the ejaculation (À7.5 vs À0.6; SE: 0.56, 0.55; P < 0.001) and satisfaction (À0.6 vs +0.3; SE: 0.3, 0.29, P = 0.047) domains, but not the erection domain (À1.0 vs À0.5; SE: 0.19, 0.19, P = 0.091). ConclusionThis is the first domain-specific quantitative evaluation of DUT-TAM FDC therapy on sexual function in men with LUTS secondary to BPH. The observed changes in the MSHQ with DUT-TAM FDC therapy were mainly driven by changes in the ejaculation domain. These findings will help give context to erectile and ejaculatory dysfunction AEs reported spontaneously in earlier 5ARI studies.

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The provision of accurate prognostic information is a long-standing goal for effective management of prostate adenocarcinoma. Nontargeted imaging modalities are less efficient at detecting slow-growing prostate cancers. Prostate-specific membrane antigen has emerged as a superior biomarker, especially for the evaluation of metastatic spread. Advances in imaging technology have focused clinical interest on indium-111 capromab ((111)In capromab) pendetide, a radioimmunoconjugate that detects prostate-specific membrane antigen expression in vivo. Single-photon emission computed tomography capromab pendetide images, fused with those generated by computed tomography or magnetic resonance, have engendered improvements in localization accuracy by correlating high signal intensity with anatomic structures. In long-term outcomes studies, fused (111)In capromab pendetide scans have delivered significant benefits for patient selection and improved treatment of prostate cancer.