What ' s known on the subject? and What does the study add? Staging of patients with prostate cancer is the cornerstone of treatment. However, after curative intended therapy a high portion of patients relapse with local and/or distant recurrence. Therefore, one may question whether surgical lymph node dissection (LND) is suffi ciently reliable for staging of these patients.Several imaging methods for primary LN staging of patients with prostate cancer have been tested. Acceptable detection rates have not been achieved by CT or MRI or for that matter with PET/CT using the most common tracer fl uoromethylcholine (FCH). Other more recent metabolic tracers like acetate and choline seem to be more sensitive for assessment of LNs in both primary staging and re-staging. However, previous studies were small. Therefore, we assessed the value of [18 F ] FCH PET/CT for primary LN staging in a prospective study of a larger sample and with a ' blinded ' review. After a study period of 3 years and > 200 included patients, we concluded that [18 F ] FCH PET/CT did not reach an optimal detection rate compared with LND, and, therefore, it cannot replace this procedure. However, we did detect several bone metastases with [18 F ] FCH PET/CT that the normal bone scans had missed, and this might be worth pursuing. OBJECTIVES• To assess the value of [ 18 F ] fl uoromethylcholine (FCH) positron emission tomography/computed tomography (PET/CT) for lymph node (LN) staging of prostate cancer.• To evaluate if FCH PET/CT can replace LN dissection (LND) for LN staging of prostate cancer, as about one-third of patients with prostate cancer who receive intended curative therapy will have recurrence, one reason being undetected LN involvement. PATIENTS AND METHODS• From January 2008 to December 2010, 210 intermediate-or high-risk patients had a FCH PET/CT scan before regional LND.• After dissection, the result of histological examination of the LNs (gold standard) was compared with the result of FCH PET/CT obtained by ' blinded review ' .• Sensitivity, specifi city, positive (PPV), and negative predictive values (NPV) of FCH PET/CT were measured for detection of LNe metastases. RESULTS• Of the 210 patients, 76 (36.2%) were in the intermediate-risk group and 134 (63.8%) were in the high-risk group. A medium (range) of 5 (1 -28) LNs were removed per patient.• Histological examination of removed LNs showed metastases in 41 patients. Sensitivity, specifi city, PPV, and NPV of FCH PET/CT for patient-based LN staging were 73.2%, 87.6%, 58.8% and 93.1%, respectively.• Corresponding values for LN-based analyses were 56.2%, 94.0%, 40.2%, and 96.8%, respectively.• The mean diameter of the true positive LN metastases was signifi cantly larger than that of the false negative LNs (10.3 vs 4.6 mm; P < 0.001).• In addition, FCH PET/CT detected a high focal bone uptake, consistent with bone metastases, in 18 patients, 12 of which had histologically benign LNs. CONCLUSIONS• Due to a relatively low sensitivity and a correspondingly rather low PPV, FCH PET/ CT i...

scanned before lymphadenectomy. Each patient was assessed twice with imaging, at 15 and 60 min after the injection with FCH. Images were compared with the results of histopathological examination of the surgically removed lymph nodes. Maximum standardized uptake values (SUV max ) at 15 and 60 min were also compared. RESULTSHistopathologically, metastases were present in removed lymph nodes from three patients. FCH PET/CT showed a high radiotracer uptake in four patients, the former three and a fourth. The sensitivity, specificity, positive and negative predictive value of FCH PET/CT for patient based lymph node staging of prostate cancer were 100%, 95%, 75% and 100%, respectively; the corresponding 95% confidence intervals were 29.2-100%, 77.2-99.9%, 19.4-99.4% and 83.9-100%, respectively. Values of SUV max at early and late imaging were not significantly different. CONCLUSIONSThis small series supports the use of FCH PET/ CT as a tool for lymph node staging of patients with prostate cancer. Values of SUV max at early and late imaging did not differ. However, larger prospective studies are needed to validate these findings.

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The long-term results of simple high-pressure balloon dilation in the treatment of ureteropelvic junction obstruction (UPJO) and ureteral strictures were evaluated. A total of 77 consecutive patients were treated: 40 had UPJO and 37 ureteral strictures. The etiology of the obstruction included congenital UPJO, previous stones, sequelae of endoscopic and open surgery, radiotherapy, and urinary tract reconstruction. A retrograde ureteroscopic approach was used. Evaluation included clinical and radiographic examinations and renal scintigraphy with diuretic wash-out. The procedure was repeated in 21 cases. The median follow-up was 29 months. The procedure was considered successful if it left the patient asymptomatic and with improved renographic function and drainage. The overall success rate was 70%. The best results were obtained in strictures secondary to stones, with a success rate of 94%, and in strictures secondary to reconstructive and ureteroscopic surgery, with a success rate of 91%. In congenital UPJO, the results were less encouraging: in patients with a symptom debut after the age of 18 years, balloon dilation was successful in 57% of cases; in patients with symptom debut before the age of 18 years, success was achieved in only 25% of cases. There were no major complications. It was concluded that simple high-pressure balloon dilation is a safe and reasonably effective technique for the management of most ureteral strictures and congenital UPJO with symptom debut in adult life. Balloon dilation seems to have no place in the treatment of primary congenital UPJO in children.

Two hundred and fifteen consecutive patients admitted to our department between 1978 and 1988 were included in a retrospective study. Entrance criteria were transitional cell carcinoma of the bladder T1-4, Grade III-IV. Status of nodes and metastases were not recorded. Initially all patients had a macroscopically radical transurethral resection (TUR). Patients were followed with cystoscopies. Recurrent tumours were treated with repeated TUR (RE-TUR). In cases of progression to a higher T-stage or recurrences with multiple papillomas (> 10), adjuvant therapy was recommended. The patients were retrospectively allocated to three different groups. Group 1 had TUR only, Group 2 had TUR + adjuvant irradiation, and Group 3 had TUR and various adjuvant therapies (Table I). Median crude actuarial overall survival was 29 months. In Groups 1, 2 and 3, median crude survival was 37, 13 and 32 months, respectively. In the analysis, most emphasis was put on Group 1. For stages T1-4 in this group, the median survivals was 67, 19, 9 and 2 months, respectively. Differences were statistically significant (p < 0.05). T1 tumour stage seemed to predict a reduced risk of progression compared with the higher tumour stages (p = 0.05, Fisher's test). There was a tendency for females to progress less often than men, but the difference was not statistically significant. In conclusion, macroscopically radical TUR does not seem to offer the same cure rates as radical cystectomy. However, in a selected group of patients with a troublesome medical history, or for patients wishing minimal risk treatment, TUR might be a reasonable treatment modality.