Intermittent hydronephrosis represents a well-defined proportion among cases operated for hydronephrosis. The delay in diagnosis led to the loss of the kidney in one third of the patients, and this finding urges for the awareness of health professionals for this phenomenon. In case of recurrent abdominal pain of unknown etiology one must suspect a urological origin, even if a previous abdominal ultrasound showed normal kidneys.
Background:The prognosis of castration resistant metastatic prostate cancer has been improved by several recently introduced therapeutic options, among others the second line antihormonal agents. Still, several questions related to the optimal use of these new drugs have remained open. The following ones were addressed in this paper. (1) Is the use of abiraterone + hydrocortisone inferior to abiraterone + prednisone in terms of overall survival? (2) Is the treatment up to prostate specific antigen (PSA) progression inferior to the treatment up to radiological progression in terms of overall survival? (3) Does the level of initial PSA decrease have a predictive value for the duration of response? Methods: As part of our self-assessment the dataset of 62 patients with castration resistant metastatic prostate cancer who started second line antihormonal therapy at our outpatient clinic before 31st of December 2019 was analysed. Results: 35 patients received abiraterone with prednisone substitution, 12 patients received abireterone with hydrocortisone substitution and 15 patients received enzalutamide. 39 patients were treated until clinical or radiological progression and 23 patients were treated until biological progression. (1) Median overall survival of patients substituted with hydrocortisone was not inferior as compared to patients substituted with prednisone (31 months vs. 17 months). ( 2) Median overall survival of patients treated until PSA progression was not inferior as compared to patients treated until radiological progression (32 months vs. 17 months). ( 3) Median overall survival of patients whose first control PSA level was below the normal value was 50% higher than median survival of patients whose first control PSA level was over the normal value (25 months vs. 17 months). Median overall survival of patients treated with abiraterone or enzalutamide was similar (21 months vs. 24 months). Conclusions: The combination of abiraterone + hydrocortisone is not inferior to the combination of abiraterone + prednisone and the treatment up to PSA progression is not inferior to the treatment up to radiological progression in terms of overall survival for patients with castration resistant metastatic prostate cancer.
Background:The sensitivity and specificity of bone scintigraphy and thoraco-abdominopelvic CT scans traditionally used for the staging of prostate cancer don't meet clinical requirements. In 2020 18 F-JK-PSMA-7 positron emission tomography-computed tomography (PET-CT) became available in our country for routine clinical diagnostics.Methods: As part of our self-assessment, we retrospectively analysed the results of 24 PSMA PET-CTs realised for our patients up to 31 December 2020. Results:The indication of the examination was biochemical recurrence after radical prostatectomy (prostate specific antigen (PSA) >0.2 ng/mL) for 16 patients and primary staging (PSA range: 5.2-70 ng/mL) for 8 patients. Biochemical recurrence was related to local relapse in 2 cases, regional lymph node involvement in 5 cases, oligo-and multi-metastatic spread in 1 and 3 cases respectively. 5 patients had no detectable lesion. Patients with PSA <1 ng/mL showed no extrapelvic enhancement. At primary staging 3 patients presented distant metastases. There was no correlation between PSA level and disease extent. In total PSMA PET-CT results changed the treatment strategy for 7 patients.Conclusions: 18 F-JK-PSMA-7 PET-CT is a useful diagnostic tool. The examination can lead to change the treatment decision at primary staging as well as at biochemical recurrence. The results of this pilot study may support the strategy that patients with biochemical recurrence following radical prostatectomy receive salvage radiotherapy to the prostate bed and the pelvic lymphatic regions without any imaging examination when PSA <1 ng/mL.
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