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The effectiveness of the Bosniak classification system for complex renal cysts was high in categories II, IIF and IV, but low in category III, and 49% of Bosniak III cysts was overtreated because of a benign outcome. This surgical overtreatment combined with the excellent outcome for Bosniak III cysts may suggest that surveillance is a rational alternative to surgery. This will require further study to assess whether surveillance of Bosniak III cysts will prove safe.

Background Many trials are evaluating therapies for men with metastatic hormone-sensitive prostate cancer (mHSPC). Objective To systematically review trials of prostate radiotherapy. Design, setting, and participants Using a prospective framework (framework for adaptive meta-analysis [FAME]), we prespecified methods before any trial results were known. We searched extensively for eligible trials and asked investigators when results would be available. We could then anticipate that a definitive meta-analysis of the effects of prostate radiotherapy was possible. We obtained prepublication, unpublished, and harmonised results from investigators. Intervention We included trials that randomised men to prostate radiotherapy and androgen deprivation therapy (ADT) or ADT only. Outcome measurements and statistical analysis Hazard ratios (HRs) for the effects of prostate radiotherapy on survival, progression-free survival (PFS), failure-free survival (FFS), biochemical progression, and subgroup interactions were combined using fixed-effect meta-analysis. Results and limitations We identified one ongoing (PEACE-1) and two completed (HORRAD and STAMPEDE) eligible trials. Pooled results of the latter (2126 men; 90% of those eligible) showed no overall improvement in survival (HR = 0.92, 95% confidence interval [CI] 0.81–1.04, p = 0.195) or PFS (HR = 0.94, 95% CI 0.84–1.05, p = 0.238) with prostate radiotherapy. There was an overall improvement in biochemical progression (HR = 0.74, 95% CI 0.67–0.82, p = 0.94 × 10 −8 ) and FFS (HR = 0.76, 95% CI 0.69–0.84, p = 0.64 × 10 −7 ), equivalent to ∼10% benefit at 3 yr. The effect of prostate radiotherapy varied by metastatic burden—a pattern consistent across trials and outcome measures, including survival (<5, ≥5; interaction HR = 1.47, 95% CI 1.11–1.94, p = 0.007). There was 7% improvement in 3-yr survival in men with fewer than five bone metastases. Conclusions Prostate radiotherapy should be considered for men with mHSPC with a low metastatic burden. Patient summary Prostate cancer that has spread to other parts of the body (metastases) is usually treated with hormone therapy. In men with fewer than five bone metastases, addition of prostate radiotherapy helped them live longer and should be considered.

Purpose: To gain insight in the mechanism and clinical relevance of TMPRSS2-ERG expression in prostate cancer, we determined the specific characteristics of fusion transcripts starting at TMPRSS2 exon 1 and at a more upstream and less characterized exon 0. Experimental Design: We used quantitative PCR analysis to investigate expression of wild-type TMPRSS2(exon 0) and TMPRSS2(exon 1) and of ERG fusion transcripts. Expression was tested in normal tissue samples, in prostate cancer cell lines and xenografts, and in fresh-frozen clinical prostate cancer samples (primary tumors and recurrences). Expression in clinical samples was correlated with disease progression. Results: TMPRSS2(exon 0) and TMPRSS2(exon 1) transcripts were similarly androgen regulated in prostate cancer cell lines, but the expression levels of TMPRSS2(exon 1) were much higher. Comparison of expression in different tissues showed TMPRSS2(exon 0) expression to be much more prostate specific. In androgen receptor-positive prostate cancer xenografts, TMPRSS2(exon 1) transcripts were expressed at similar levels, but TMPRSS2(exon 0) transcripts were expressed at very variable levels. The same phenomenon was observed for TMPRSS2-ERG fusion transcripts. In clinical prostate cancers, the expression of TMPRSS2(exon 0)-ERG was even more variable. Expression of TMPRSS2 (exon 0)-ERG transcripts was detected in 55% (24 of 44) of gene fusion-positive primary tumors but only in 15% (4 of 27) of gene fusion-positive recurrences and at much lower levels. Furthermore, in primary tumors, expression of TMPRSS2(exon 0)-ERG transcripts was an independent predictor of biochemical progression-free survival. Recently, recurrent fusions of prostate-specific and androgenregulated TMPRSS2 to the ETS genes ERG, ETV1, ETV4, and ETV5 have been reported as the most frequent genetic alterations in clinical prostate cancer (1-7). TMPRSS2-ERG fusion is detected in 40% to 70% of clinical prostate cancers. Fusion of ETV1, ETV4, and ETV5 to TMPRSS2 are much less frequent, but ETV1, ETV4, and ETV5 have multiple fusion partners. Expression of most of these partner genes is prostate specific and androgen regulated (1-5). Some clinical studies have shown TMPRSS2-ERG to be associated with a more aggressive prostate cancer phenotype (8-12). However, other studies did not find an association with outcome in patients treated by radical prostatectomy (13, 14) or even described TMPRSS2-ERG to be correlated with a more favorable outcome (15,16).TMPRSS2 has more than one first exon. 3 Not only fusion transcripts starting at the well-known TMPRSS2 exon 1 but also transcripts that start from a more upstream and less characterized alternative first exon, here denoted exon 0, have been identified (14). 4 In the present study, we determined the specific characteristics of TMPRSS2 transcripts starting at exons 1 and 0 in benign prostatic tissue and in prostate cancer. Moreover, we investigated clinical prostate cancer samples (primary tumors and recurrences) for expression of TMPRSS2(exon 0)-...

Triple-bolus multidetector CT urography is a dose-efficient protocol acquiring corticomedullary-nephrographic-excretory and vascular enhancement phases in a single acquisition and provides sufficient opacification and distention of the UUT. Simultaneously, adequate image quality of renal parenchyma and vascular anatomy is achieved.

largest metastasis and extranodal extension (ENE). The lymph node metastases were graded according to the Gleason system. These variables were correlated with CSS. RESULTSThe mean age of the patients was 62.4 years and the mean preoperative prostate-specific antigen level was 40.2 ng/mL. The median follow-up was 77.5 months, and the median overall and CSS were 91 and 112 months, respectively. On univariable analysis the following variables correlated with poor CSS: a nodal Gleason score of > 7 (hazard ratio 2.4, P < 0.001), a diameter of the largest metastasis of > 3 mm (2.2, P = 0.025), more than two lymph node metastases (2.0, P = 0.003), and ENE in more than one lymph node (1.9, P = 0.014). Multivariable analysis showed only the nodal Gleason score and the diameter of the largest metastasis to be independent predictors of CSS (1.8, P = 0.021, and 2.2, P = 0.046, respectively). CONCLUSIONThe histopathological characteristics of lymph node metastases in prostate cancer have predictive value for the clinical outcome. The nodal Gleason score and the diameter of the largest metastasis are independent predictors of survival. KEYWORDSlymph node metastases, mortality, prognosis, prostate cancer Study Type -Prognosis (case series) Level of Evidence 4

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