Urological oncology

Urological Oncology Vinod H Nargund, Derek Raghavan, and Howard M Sandler (Eds) Urological Oncology Vinod H Nargund, PhD, FRCS (Urol), FEBU Chair, Uro-Oncology MDT and Consultant Urological Surgeon St Bartholomew’s and Homerton Hospitals Queen Mary Barts and the London School of Medicine and Dentistry University of London London, UK Derek Raghavan, MD, PhD, FACP, FRACP Chairman and Director Cleveland Clinic Taussig Cancer Center Cleveland, OH USA Howard M Sandler, MD Professor and Senior Associate Chair Department of Radiation Oncology University of Michigan Ann Arbor, MI USA British Library Cataloguing in Publication Data Urological oncology Urinary organs—Cancer Prostate—Cancer I Nargund, Vinod II Raghavan, Derek III Sandler, Howard M (Howard Mark), 1956– 616.9′9461 ISBN-13: 9781846283871 Library of Congress Control Number: 2007921871 ISBN: 978-1-84628-387-1 e-ISBN: 978-1-84628-738-1 Printed on acid-free paper © Springer-Verlag London Limited 2008 Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the Copyright, Designs and Patents Act 1988, this publication may only be reproduced, stored or transmitted, in any form or by any means, with the prior permission in writing of the publishers, or in the case of reprographic reproduction in accordance with the terms of licences issued by the Copyright Licensing Agency Enquiries concerning reproduction outside those terms should be sent to the publishers The use of registered names, trademarks, etc in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant laws and regulations and therefore free for general use Product liability: The publisher can give no guarantee for information about drug dosage and application thereof contained in this book In every individual case the respective user must check its accuracy by consulting other pharmaceutical literature Springer Science+Business Media springer.com To Patients and Teachers Foreword Urological oncology is a subject of enormous interest to large numbers of urologists throughout the world, particularly with our increasing understanding of the possible causes and pathogenesis of the condition As Editor-in-Chief of one of the urological journals, I can attest to this interest; the largest percentage of the papers I receive for review each year relate to either clinical or experimental urological oncology It used to be that the manuscripts concerned mainly surgical techniques, but now this has extended to new technologies, diagnostic methods, randomized pharmaceutical clinical trials, and thoughtful and complex experimental studies into the genesis of urological cancer This is all evidence of our increasing interest in the topic In addition to this, we have come to understand the management of urological cancer is not in the hands of a single discipline The advent of multidisciplinary team meetings has made us realize that there is a hugely significant role to be played by urologists, medical oncologists, radiation oncologists, pathologists, and radiologists This new dimension has been driven by the advent of new therapies and by closer interaction among all of these groups at academic meetings This is to be applauded and has inevitably lead to improvements in the management of our patients One thing is of note which perhaps detracts from our overall feeling of satisfaction at these improvements Although our understanding of the mechanisms of disease and of the pathogenesis and molecular pathways in urological cancer has increased exponentially, there is a slower rise in the advent of pharmaceutical agents which will, for example, reduce the need for surgical therapies which may be considered to have an associated morbidity Much of this is due to delays in the development of such drugs and can perhaps best be advanced by involving pharmaceutical companies earlier on in the investigational loop This book, edited by Vinod Nargund, Derek Raghavan, and Howard Sandler is a very timely and significant volume It contains the whole panoply of urological oncology from basic science through clinical investigations to clinical management of the various cancers Each chapter is written by an acknowledged expert in the field There is a widespread authorship from all parts of the world vii viii Foreword It is a pleasure to have been asked to introduce it and I congratulate the editors on having put together such an excellent book John Fitzpatrick MCh FRCSI FC Urol (SA) FRCSGlas FRCS University College Dublin School of Medicine and Medical Science Preface I keep six honest serving men (They taught me all I knew); Their names are What and Why and When And How and Where and Who —Rudyard Kipling (“The Elephant’s Child,” in The Just-So Stories, 1902) Clinical knowledge is based on three components: meticulous observation, detailed recording, and an understanding of basic science relevant to the clinical situation The first two come with apprenticeship and the last one with personal research or inquisitive reading It is the last component that is the basis for this book Although most general urology books contain a fair amount of urological oncology, most of them are written by urologists for urologists There is increasing realization, however, that a multidisciplinary approach is required for the management of all cancers including urological cancers In particular, there is a need for surgeons and oncologists to have an integrated strategy for the management of complex cancer cases A multidisciplinary team will include anesthetists, radiologists, minimally invasive surgeons, intensivists, nutritionists, support and social work staff, in addition to the cancer clinicians We aim, in this book, to provide this integrated approach as it has contributions from specialists from these different disciplines All these specialists should have a role in the management of patients to provide them with the optimal chances of recovery They have also a key role in counseling patients in a coordinated way, for otherwise patients would gain piecemeal information of variable quality from a number of sources including the Internet The media and the Internet have increased cancer awareness among patients who demand more and more answers to questions such as: What caused my cancer? How can I prevent a recurrence? Will my children get it? How I get the best up-to-date treatment for my cancer? Patients have a greater understanding that there may be choices in the management of their condition, and oncologists, both surgical and medical, have to listen to and include the patient’s views in the decision-making process We hope this book will assist in both the management and the counseling of ix x Preface patients with urological cancer The book also includes chapters on basic science, research, and trials related to urological cancers, which will help those students with an interest in research Relevant surgical anatomy and other details of basic science are included wherever necessary Initially, this book was intended to be a pocket guide on adult urological cancer, but the book quickly metamorphosed into a mini-textbook The authorship is truly international and therefore reflects a consensus approach to investigation and treatment across the world The text is didactic and should provide the basis for further reading from journals or more detailed review papers The book is aimed at residents and urological specialists at all levels of training in urology and oncology Vinod H Nargund, London Derek Raghavan, Cleveland, Ohio Howard M Sandler, Ann Arbor, Michigan Acknowledgments The authors acknowledge Sohail Baithun, FRCPath, consultant and reader in histopathology, Royal London Hospital, Whitechapel, London, UK, for his assistance with histopathology, and Anju Sahadev, FRCR, consultant radiologist, St Bartholomew’s Hospital, London, UK, for her assistance with ultrasound and computed tomography Vinod H Nargund Derek Raghavan Howard M Sandler xi 620 Index Keyhole-limpet hemocyanin, 333 Kidney multicystic, 75 polycystic, 19 in dialysis patients, 243 solitary, 244 static imaging of, 130–131 Kinesin, Klinefelter’s syndrome, 17 Kreb’s cycle, L Lactic dehydrogenase, as testicular germ cell tumor marker, 414, 415, 417 Laparoscopy, in urological oncology, 158–178 of adrenal cancer, 159–160 of bladder cancer, 160, 161 of prostate cancer, 160–162 of renal cancer, 158–159 surgical technique in, 163–165 Laser ablation, of hemangiomas, 117–118 Left ventricular ejection fraction, effect of chemotherapy on, 129 Leiomyomata, 269 Leucovorin (folinic acid), 586 Leukemia, alkylating agents-related, 204 Leukoplakia, 392 Leydig cells, chemotherapy-related failure of, 435–436 Leydig-cell tumors, 438 Lichen sclerosis, 566 Lichen sclerosis et atrophicus, 392 Li-Fraumeni syndrome, 19 Linoleic acid, 251 Liposomes, as drug therapy vectors, 46 Liver function tests, preoperative, 146 Local anesthesia, 151–152 in percutaneous nephrostomy, 67 Log kill model, of tumor cell cycles, 196 Lung cancer, chemotherapy for, 208–209 Luteinizing hormone, 518 Luteinizing hormone-releasing hormone, 518, 523 Luteinizing hormone-releasing hormone agonists, 521, 522 Lycopene, 251, 457, 528–529 Lymphadenopathy computed tomography of, 86, 89 retroperitoneal, 89 testicular cancer-related, imaging of, 76 Lymphangioleiomyomatosis, 278 Lymph nodes computed tomography of, 85 in testicular drainage, 412–413 Lymphocele, 490 Lymphocytes, tumor-infiltrating, 51 Lymphoma, 587–593 of the bladder, 361, 589, 591 clinical presentation of, 588–589 colorectal, 583 diagnosis of, 588 etiology of, 587–588 follicular, 590 Hodgkin’s, 587–591, 592–593 incidence of, 587 metastatic, 588 non-Hodgkin’s, 587–592 management of, 591–592 pathology of, 588 prostatic, 458 renal, 589 staging of, 590 testicular, 438 Lynch syndromes I and II, 19, 339 Lysosomes, M Magnetic fluid hyperthermia (MFH), 561 Magnetic resonance angiography, 114 Magnetic resonance imaging (MRI), 93–103 of adrenal incidentalomas, 300 of adrenal lesions, 94, 96, 97, 101–103 of adrenocortical carcinoma, 304 advantages and disadvantages of, 93 basic principles of, 92–93 of bladder cancer/lesions, 97–98, 100, 325 in combination with ultrasound, 75 comparison with computed tomography, 93, 114 for hematuria evaluation, 114 of metastatic testicular cancer, 417 Index preparation of patients for, 93–94 of prostate cancer/lesions, 96, 98–100, 99, 101, 460, 477–478 of renal cell carcinoma, 271, 272 of renal lesions, 96, 97, 101–103, 114 safety considerations in, 95 technique in, 93–94 for tumor staging, 77, 96, 98–103 of upper urinary tract transitional cell carcinoma, 341 of urethral cancer, 394 for urological lesion characterization, 95–96 Magnetic resonance spectroscopy, prostatic, 100, 460, 477–478 Magnetic resonance urography, 66, 114 Malaria, as hematuria cause, 109 Malnutrition, in cancer patients, 254, 255 Mammography, sensitivity of, 454 Mass spectrometry, 31 Mass spectroscopy, 42 Matrix-assisted laser desorption/ ionization (MALDI), 42 Medical Research Council, 521 Meiosis, 16–17 Melanoma, 419 of the bladder, 320–321, 361 scrotal, 572 urethral, 392 Memorial Sloan-Kettering Cancer Center, 364, 365, 366 Metabolic syndrome, 298 Metabolomics, 31 Metallothionein, 365 Metaplasia, keratinizing squamous, 317, 321 Metastases See also specific types of metastatic cancer computed tomography of, 85–86 Metformin, discontinuation prior to intravenous urography, 113 Methicillin, as hematuria cause, 109 Methotrexate, 205 renal toxicity of, 246 Methotrexate, vinblastine, adriamycin, and cisplatin (MVAC) therapy for metastatic bladder cancer, 371, 377–382 621 in combined modality treatment, 369–370 of transitional cell cancer, 377–379, 380, 381, 383 resistance to, 365–366 Metyrapone, 305 Microarrays, 30–31, 41–42 Microsatellite instability, 27 Microscopy, for hematuria diagnosis, 111–112 Microtubule-associated proteins, Microtubules, 3, Mineral supplements, 250 Minichromosome maintenance protein-5 (Mcm-5) immunoassay, 324 Mitochondria, 12–13 cancer-related mutations in, structure and function of, Mitogen-activated protein (MAP) kinase, Mitogen-associated protein kinase, 55 Mitomycin, 206 Mitomycin C, 329, 331, 344, 540 Mitosis, 12, 194–195 Mitotane, 305 Mitoxantrone, 525, 526, 538, 540, 541 Modification of Diet in Renal Disease (MDRD), 237 Molecular cell biology, techniques in, 29–32 Monoclonal antibodies, 29 in immunotherapy, 47 against epidermal growth factor receptors, 208–209, 382 Monosomy, 16–17 Mosaicism, chromosomal, 17 Multiple endocrine neoplasia (MEN), 26, 303 Muscle wasting, androgen deprivation therapy-related, 522–523 Mutations, 18 in cancer cells, 20, 21 point, 18 splicing-type, 18–19 termination-type, 19 Mycophenolate mofetil, 242 Myeloma, 29, 61 Myelosuppression, chemotherapy-related, 434 622 Index Myocardial infarction, 436 Myocardial perfusion, assessment of, 129 Myosin, N National Bladder Cancer Collaborative Group (NBCCG), 325–326 National Cancer Institute, 528, 537 National Prostate Cancer Project (NPCP), 537 Natural killer cells, lymphokine-activated, 51 Nausea, chemotherapy-related, 434 Neck, preoperative auscultation of, 144 Necrosis, 215–216 Neobladders, 353–357, 367 ileal, 351 orthotopic, 353, 355 rectal/sigmoid, 357–358 Nephrectomy debulking, 281–282 impact on renal function, 238 partial laparoscopic, 159 retroperitoneal, 167–168 transperitoneal, 165–167 radical, 274, 275–276, 277 in dialysis patients, 244 perioperative management in, 240 radical laparoscopic, 158–159 of renal cell carcinoma, 70 retroperitoneal, 164–165 transperitoneal, 165 residual renal function after, 131 Nephritis, radiation therapy-related, 593 Nephron-sparing surgery, 79, 91, 269, 274–275 in dialysis patients, 244 impact on renal function, 238 perioperative management in, 240–242 Nephropathy analgesic, 243 Balkan, 339 Nephrostomy, percutaneous, 66–68 Nephrotic syndrome, 589 Nephroureterectomy in dialysis patients, 244 laparoscopic, 162 laparoscopic radical, 175–176 as transitional cell carcinoma treatment, 342–343, 346 Neutropenic diet, 254 Nevi, multiple atypical, 404 Nitrosureas, 204 NMP-22 immunoassay, 324 Nomograms, 487, 600–602 Nonsteroidal anti-inflammatory drugs cyclooxygenase-inhibiting, 529 as hematuria cause, 109 as postoperative pain treatment, 155 renal toxicity of, 245 Norton-Simon regression hypothesis, of cell cycles in tumors, 197 Nuclear medicine, in urological cancer, 122–140 applications of antibody imaging, 138 antibody therapy, 138–139 bone scintigraphy, 132–136 cardiac assessment, 129 renal function assessment, 128 renography, 129–130 sentinel lymph node drainage, 138 static renal imaging, 130–131 ureteric obstruction assessment, 130 imaging devices in computed tomography, 127 gamma cameras, 122, 123–124, 125, 126 positron emission tomography, 127, 137–138 single-photon emission tomography, 127 principles of atomic structure and radioactivity, 122–123 tracer principle, 123–128 radiation exposure in, 127 radiopharmaceuticals in for glomerular filtration rate measurement, 125, 128 iodine131, 123–124 positron emitters, 125 radionuclides, 122–124 technetium 99m, 123, 124, 128 therapy isotopes, 126, 137 Nucleotides, 10–11, 13 Index Nucleus, cellular, 3–4 Nutritional Prevention Cancer Trial, 457 Nutritional therapy, in cancer patients, 254–256 O Obesity as cancer risk factor, 250–251, 264 effect on chemotherapy pharmacokinetics, 199 in surgical patients, 144–145 Occupational factors in bladder cancer, 318 in scrotal cancer, 571 Oligospermia, 435–436 Omega-3 fatty acids, 252 Oncocytoma adrenal, 305–306 renal, 278 Oncogenes in aging-related carcinogenesis, 55 in cell-cycle control, 23–25 definition of, 21 examples of, 24 as gene therapy targets, 43, 45 Oncogenesis, process of, 20–29 Opioids, 143, 155 Orchidopexy, 404 Orchiectomy, 415 as azoospermia cause, 436 bilateral subscapular, 492 high inguinal, 415–416 as prostate cancer treatment, 518 radical as seminoma treatment, 420–421 as testicular cancer treatment, 230–231 as testicular germ cell tumor treatment, 423–424 as testicular carcinoma in situ treatment, 420 as testicular germ cell tumor treatment, 421–422, 423 Organ transplant patients, 149, 242 Osteoarthropathy, hypertrophic pulmonary (HPOA), 136 Osteoporosis, 522–523 Ovarian cancer, 19, 321 623 Overactive bladder syndrome, 324 Oxaliplatin, 586 Oxygen administration, postoperative, 155 P Pacemakers, in surgical patients, 147–148 Paclitaxel, 207 as hormone-refractory prostate cancer treatment, 540, 541 as metastatic bladder transitional cell cancer treatment, 379, 380, 382 p53 gene mutations and, 365–366 as testicular germ cell tumor treatment, 430–431 Paget’s disease, 134 Pain management postoperative, 153–155 with radiopharmaceuticals, 137 during transrectal ultrasound-guided prostate biopsy, 475 Palliative therapy for cervical cancer, 580, 581 for colorectal cancer, 586 for rectal cancer, 587 Paracetamol, 155 Paraganglioma, 306–307, 308 Parenteral nutrition, 254 Partin’s tables, 487, 600–602 Patient-controlled analgesia (PCA), 154, 155 PC-SPES, 525 Penectomy, as urethral cancer treatment, 395 Penicillin, as hematuria cause, 109 Penile cancer, 566–571 clinical features of, 568 etiology of, 566–567 management of, 569–571 metastatic, 567, 568, 569, 570–571 pathology of, 567 prognostic factors in, 567 staging of, 567, 569 Perioperative management, of genitourinary cancer patients, 148–152 Peritoneal dialysis, 242 continuous ambulatory, 244 624 Index p53 gene, 10 expression of, 25 mutations of, 214–215, 363, 364–365 viral inactivation of, 25–26 p53 gene therapy, 43 p53 protein, 24–25, 201 Pharmacology, of chemotherapeutic agents, 197–200 pharmacodynamics, 199–200 pharmacokinetics, 198–199 Phenacetin, as urothelial cancer cause, 317, 339 Pheochromocytoma, 306–310 benign, 310 clinically silent, 301 differential diagnosis of, 83 laparoscopic adrenalectomy of, 160–161 malignant, 308, 310 von Hippel-Lindau disease-related, 269 Phimosis, 566 Phosphorylation, of proteins, Phosphorylation, oxidative, 12–13 Placebo effect, 184–185 Placental alkaline phosphatase, 414, 415, 417 Plasma membrane, Platelet-derived growth factor, 285, 286, 287, 289 Platinol See Cisplatin Pneumoretroperitoneum, carbon dioxideinduced, 164 Point mutations, 18 Polyacrylamide gel electrophoresis (PAGE), 42 Polycystic kidney disease, 19, 243 Polycythemia, 243–244 Polymerase chain reaction (PCR)-based techniques, 30, 40 methylation-specific, 40 Polymorphisms, genetic, as bladder cancer risk factor, 318 Polypeptides, synthesis of, 13 Polyphosphinositide (PIP2), Polyps, urethral, 340, 390, 392 Positron emission tomography (PET) of adrenal incidentalomas, 300 of prostate cancer, 478 of testicular germ cell tumors, 417 tracers in, 138–139 Postoperative care, for genitourinary cancer patients, 153–156 computed tomograpy in, 91 Prednisolone, 149 Prednisone, 591 Preoperative management, of genitourinary cancer patients, 141–148 Priapism, malignant, 231–232 Prodrugs, 43, 45, 201 Progeria, 12 Pronuclear microinjection, 37 Prostate cancer age factors in, 54 androgen deprivation therapy for, 510–511, 518–535 after radical prostatectomy, 519 antiandrogen monotherapy, 522 complications of, 522–524 early versus delayed, 521–522 intermittent, 522 for localized cancer, 526–527 with maximum androgen blockade, 521–522 neoadjuvant, 519–527 prior to cryotherapy, 519 prior to radical prostatectomy, 519–520 androgen-independent/hormone-refractory androgen deprivation therapy for, 518–519, 524–525 chemotherapy for, 525–526, 536–543 definition of, 524 prostate-specific antigen levels in, 524–525 quality-of-life assessment in, 538, 540 second-line hormonal therapy for, 524–525 stage migration in, 538–539 surrogate markers of response in, 537–538 xenograft models of, 37 angiogenic factors in, 28 animal models of, 37–38 bilateral subscapular orchiectomy of, 492 Index biopsy of, image-guided, 69, 77, 472–477 bone scans of, 222 brachytherapy for, 221–222 after radiation therapy, 521 in combination with androgen deprivation therapy, 519, 527 chemoprevention of, 528–530 chemotherapy response markers in, 537–538 clinical features of, 470–471 computed tomography of, 460, 477, 478 diagnostic, 81 for local assessment, 85–86 for metastases evaluation, 86 in recurrent prostate cancer, 520 cystoscopy and JJ stenting of, 492 diagnosis of, 471–477 with computed tomography, 81 with ultrasound, 74, 77 dietary factors in, 251–252, 457, 502–503, 528 etiology of, 455–458 expectant management of, 497–504 as active surveillance, 499–501 prostate-specific antigen screening in, 498, 499, 500, 501, 502 as “watchful waiting,” 497–499 external beam radiation therapy for, 505–515 as adjuvant therapy, 515 as combined modality therapy, 510–515, 519, 527 effect on prostate-specific antigen levels, 520 as intensity-modulated radiation therapy, 509 as monotherapy, 507–510 postprostatectomy, 514–515 as salvage therapy, 515 genetic factors in, 26, 52, 464–465 Gleason grading of, 458, 459, 461, 470, 477 in androgen-independent cancer, 524–525 in metastatic disease, 483 heat shock protein expression in, as hematospermia cause, 119–120 incidence and epidemiology of, 53, 458 625 incidental finding of, 470 investigational therapies for, 544–565 cryotherapy, 521, 526–527, 554, 556–558 gene therapy, 544–548 high-intensity focused ultrasound, 551–554, 555 magnetic fluid hyperthermia, 561 radiofrequency treatment, 559–560 vaccine therapy, 548–551 magnetic resonance imaging of, 98–100, 101 metastatic, 471 to the bladder, 321 to bone, 132–136 to lymph nodes, 488–489 risk of, 477 as spinal cord compression cause, 230 systemic radiation therapy for, 222–223 mitochondrial mutations in, 4, 13 molecular epidemiology of, 529–530 as mortality cause, 525 mortality rate in, 452, 453 natural history of, 454–455 nutrition-based prevention of, 251–252, 457, 528 overdetection of, 454 paraneoplastic syndromes of, 471 pathogenesis of, 457–458 pathology of, 458 prevalence of, 458 prostatectomy for with androgen deprivation therapy, 525 laparoscopic, 160–162 as salvage therapy, 492, 521 radiation therapy for as brachytherapy, 511–514 for clinically-localized cancer, 505–517 complications of, 491 hyperfractionated, 218–219 hypofractionated, 218–219 prostatic biopsy after, 473 randomized clinical trials of, 505–517 systemic, 222–223 626 Index Prostate cancer (cont.) radical prostatectomy for, 482–496, 505 complications of, 490–492 decision-making process for, 485–487 effectiveness of, 454 effect on prostate-specific antigen levels, 520–521 laparoscopic, 160–162, 489–490 nomograms and, 487 open versus laparoscopic, 489–490 pelvic lymph node dissection in, 488–489, 490 perineal, 489 predictive factors in, 484, 485 preoperative considerations in, 483–489 retropubic, 489 surgical anatomy in, 482–483 techniques of, 489–490 recurrent, 520–521 relapse risk in, 183 risk factors for, 455–458 racial/ethnic factors, 52–53, 452, 456 salvage therapy for, 492, 521, 526–527 screening for, 453–455 staging of, 76–77, 77, 96, 99, 100, 459–461, 477–478 telomerase activity in, 12 as urinary retention cause, 226 Prostate cancer cell lines, 37 Prostate Cancer Intervention Versus Observation Trial (PIVOT), 501–502 Prostate Cancer Prevention Trial, 472, 527–528 Prostatectomy laparoscopic radical, 160–162 radical, 461, 482–496 complications of, 490–492 decision-making process for, 485–487 effectiveness of, 454 effect on prostate-specific antigen levels, 520–521 laparoscopic, 173–175 nomograms and, 487 open versus laparoscopic, 489–490 pelvic lymph node dissection in, 488–489, 490 perineal, 489 predictive factors in, 484, 485 preoperative considerations in, 483–489 prostatic fossa biopsy after, 473 retropubic, 489 surgical anatomy in, 482–483 techniques of, 489–490 salvage, 492, 521 Prostate gland anatomy of, 99, 451, 452, 475–476 magnetic resonance imaging of, 99 ultrasound imaging of, 72, 77 Prostate-specific antigen (PSA) as benign prostatic hyperplasia indicator, 463 monoclonal antibodies against, 139, 520 as prostate cancer indicator, 76, 113, 452, 454, 461–464, 471–472 after radiation therapy, 506 age-related levels in, 462–463 in anuric patients, 244 as chemotherapy response indicator, 537, 538, 539, 541 correlation with digital rectal examination findings, 459–460 correlation with prostate biopsy findings, 453 definition of, 461 density of, 462 doubling time of, 464, 550 in expectant management, 498, 499, 500, 501, 502 as indication for prostate biopsy, 472, 473, 474 isoforms of, 463 lead-time bias in, 455 in metastatic disease, 484 prior to radical prostatectomy, 483, 484 in prostate cancer screening, 40, 461, 477, 498, 499, 500, 501, 502, 544 in prostate cancer staging, 461, 477 as prostate cancer vaccine target, 550–551 Index racial factors in, 462 randomized trials of, 455 sensitivity of, 454 velocity of, 462 Prostate-specific membrane antigen (PSMA), 478 monoclonal antibodies against, 138, 520 ProtecT study, 502 Protein kinase, Protein phosphorylation, Proteomics, 31, 42 Proto-oncogenes, 16, 21, 26 Pseudohematuria, 108 p16INK4a protein, 363 p21 gene, expression in bladder cancer, 363 Pyelography, retrograde, 64–66 Q Quality-of-life assessment, 538, 540 R Radiation exposure as cell death cause, 216 environmental, 127 nuclear medicine-related, 127 Radiation therapy See also under specific types of cancer action mechanism of, 214–216 adverse effects of, 447 biologically equivalent doses (BEDs) of, 218 as bladder cancer risk factor, 317 complications of, 218, 317, 582, 587 daily localization technique in, 221 definition of, 213 as DNA damage cause, 221 effect on tumor cell cycles, 195–196 R’s of, 217 as hemorrhagic cystitis cause, 225, 226 hyperfractionated, 218 hypofractionated, 218–219 intensity-modulated (IMRT), 91–92, 219, 220, 221 new technologies and equipment in, 219–222 nutritional effects of, 253 627 nutritional requirements during, 254–255 postchemotherapy, 447 principles of, 213–223 radiation dosage in, 213 simulation process in, 214 skin-sparing, 214 three-dimensional, 219, 220 tumor sensitivity to, 216 tumor volume measurement in, 91–92 Radiation Therapy Oncology Group (RTOG), 369, 370, 527 Radiofrequency ablation in dialysis patients, 244 image-guided, 70–71 radiofrequency interstitial tumor ablation (RITA), 559–560 of renal cell carcinoma, 276 Radiological investigations, in genitourinary cancer, 61–106 See also Computed tomography (CT); Magnetic resonance imaging (MRI); Ultrasound interventional radiology, 66–71 noninterventional radiology, 61–66 ras oncogenes, 52, 290 Ras proteins, Raynaud’s phenomenon, 436 RB genes, viral inactivation of, 25–26 RB proteins, 24, 25, 26 Reactive oxygen species (ROS), 9, 12–13 Receptors, cellular, Rectal cancer imaging of, 584 management of, 586–587 metastatic to the bladder, 321 morbidity/mortality rates in, 583 radiation therapy-related, 510 Rectum, prostatectomy-related injury to, 490 Red blood cells, in urine, 111–112 5α-Reductase inhibitors, 528 Reed-Sternberg cells, 588 Renal cancer animal models of, 39 biopsy of, 68–70 cystic, surgical resection of, 68 in dialysis patients, 243 heat shock protein expression in, 628 Index Renal cancer (cont.) hereditary papillary, 26 laparoscopic partial nephrectomy of, 158–159 retroperitoneal, 167–168 transperitoneal, 165–167 laparoscopic radical nephrectomy of, 158–159 retroperitoneal, 164–165 transperitoneal, 165 lymphoma, 589 magnetic resonance imaging of, 95–96 Renal cell carcinoma, 263–280 angiogenic factors in, 28 biomolecular markers for, 274 in children, 263, 265 chromophobe, 267, 268, 273 clear-cell (granular-cell), 267, 273 clinical features of, 270 collecting duct (Bellini’s duct), 267, 268 cystic Bosniak classification of, 74–75, 82–83, 96 differentiated from benign/simple cysts, 82–83 imaging of, 74–75, 82, 96 diagnostic investigations of, 270–274 with computed tomography, 81, 82 with magnetic resonance imaging, 95 with molecular biology techniques, 40 with ultrasound imaging, 73–75 dietary factors in, 253, 264 differentiated from transitional cell carcinoma, 270 Furhman grading of, 273 hereditary, 263–264, 268–269 imaging of, 131, 271, 272 with computed tomography, 78, 79, 84, 86, 87 immunotherapy for, 47 management of, 274–278 in localized carcinoma, 274–277 in locally advanced carcinoma, 277–278 metastatic, 160, 270, 273, 274 to bone, 132, 136 to the central nervous system, 291–292 cytokine therapy for, 282–285, 292–293 debulking nephrectomy of, 281–282 immunotherapy for, 51 intracaval, 72, 73, 75 nonsurgical management of, 281–297 surgical management of, 277–278 ultrasound imaging of, 72, 73 vascular endothelial growth factortargeted therapy for, 285–291, 293 microvascular invasive, 274 mitochondrial DNA mutations in, 4, 13 natural history and pathology of, 265–269 papillary (chromophilic), 267–268, 273, 279 paraneoplastic syndromes of, 270 preoperative embolization of, 70 preoperative surgical planning in, 78 prevention of, 265 prognostic factors in, 272–274 radical nephrectomy of, 70 radiofrequency ablation of, 70–71 risk factors for, 263–265 environmental factors, 264 obesity, 251 occupational exposure, 264 screening for, 265 as spinal cord compression cause, 229 staging of, 79, 81, 84, 86, 101–103, 271–273 supportive care for, 291–292 tumor diameter in, 273–274 vaccination against, 52 von Hippel-Lindau syndrome-related, 70–71, 95, 285–287, 293 whole-brain radiation therapy for, 291–292 Renal dysfunction, in genitourinary cancer patients, 235–249 assessment of, 235–238 as intravenous urography contraindication, 61–62 postoperative, 238 Index Renal failure, 243 acute, 244–246 chronic, 264 cisplatin-related, 582 end-stage, 239, 243–244 urinary diversion-related, 353 Renal insufficiency, implication for bladder substitution, 354 Renal masses computed tomography of, 114 differential diagnosis of, 272 magnetic resonance imaging of, 95–96 Renal pelvis, urothelial tumors of, 339, 342–344 Renal transplantation, 243, 264, 276 Renal vein, tumor extension into, 72, 75, 82, 87 RENCA (murine renal adenocarcinoma system), 39 Renography, 129–130 of adrenocortical carcinoma, 304 Retroperitoneal cancer, image-guided biopsy of, 69 Retroperitoneal lymph node dissection (RLND), 417, 419, 421–422 laparoscopic, 419 postchemotherapy, 427–428 of seminoma, 421 of testicular germ cell tumors, 422, 425–428 Rhabdosarcoma, 27 Ribonucleic acid (RNA), 3–4, 13 expression (microarray) gene chip analysis of, 30–31 RNASEL gene, 529 S Samarium, 137, 223 Sarcoma of the bladder, 320–321, 361 colorectal, 583 prostatic, 458 radiation therapy-related, 510 urethral, 392 Scandinavian Prostate Cancer Group Study, 498, 499 Schistosomiasis, as bladder cancer cause, 317, 321 629 Scrotal cancer, 571–572 See also Testicular cancer Scrotectomy, 572 Selectins, Selenium, 251, 252, 457, 528 Semen, analysis and cryopreservation of, 415, 416, 420 Seminoma classification of, 409–410 genetic factors in, 406 imaging of, 72, 138 metastatic, 423 radiation therapy for, 216, 445–447 radiosensitivity of, 216 relapsed, 433–434 risk factors for, 402, 403, 404 treatment for, 420–421 tumor markers for, 410 Senescence, premature, 55 Sentinel lymph node biopsy, 419, 570 Sentinel lymph node drainage, 138 Sertoli cell tumors, 438 Sex chromosomes, nondisjunction of, 17 Sex hormone-binding globulin, 529 Sex hormones abnormalities of, 411 as testicular cancer risk factor, 403–404 Sexual dysfunction See also Erectile dysfunction androgen deprivation therapy-related, 524 Shock, hematuria-related, 224 Sickle cell disease, 61, 109, 146–147 Signaling pathways, cellular, Single-gene diseases, 19–20 Single nucleotide polymorphisms (SNPs), 11 Single-photon emission computed tomography (SPECT), renal, 131 Small bowel cancer, genetic predisposition to, 19 Small cell carcinoma of the bladder, 361 prostatic, 458 Smoking as bladder cancer risk factor, 54, 252, 263, 317–318, 390 as genital squamous cell carcinoma risk factor, 567 630 Index Smoking (cont.) as lung cancer risk factor, 263 as renal cell carcinoma risk factor, 263, 265 Smoking history, 143 Southern hybridization, 29 Southwest Oncology Group (SWOG), 332, 522, 525, 526, 538, 541 Soy, 252, 528 Spermatocele, 412 Sperm banking, 420, 427 Sphincters, artificial urinary, 491 Spinal anesthesia, 151–152 Spinal cord compression, 226, 230 Squamous cell carcinoma of the bladder, 53–54, 317, 320, 361, 363 genital, 567 penile, 566, 567, 572 scrotal, 572 urethral, 390, 392 vulvar, 566 Stauffer’s syndrome, 270 Stem cells/stem cell transplantation, 12, 37, 52, 202–203, 431, 433 Stents, ureteric, 66–67, 130, 582 Steroid replacement therapy, perioperative, 149 Stomach cancer, genetic predisposition to, 19 Stress testing, preoperative, 147 Stromal cells, senescent, 55 Strontium 89 isotope, 137, 222–223 Sturge-Weber syndrome, 307 SU11248, 290 Superoxide dismutases, Surface-enhanced laser desorption/ ionization, 42 Sympathetic nervous system, lumbar, 425–426 Systemic lupus erythematosus, 109 T Tacrolimus, 242 Taxanes, 206 as apoptosis cause, 10 tumor resistance to, 200–201 Teletherapy, definition of, 213 Telomerase, 12, 113 Telomeres, 11, 12, 529–530 age-related shortening of, 55 Temozolamide, 204 Teratocarcinoma, 410, 411, 414 Teratoma, 410, 411 Tesmilifene, 541 Testes atrophy of, 402–403, 412, 415 congenital abnormalities of, 404 lymphatic drainage of, 412–413 undescended, 404 Testes-preserving surgery, 416 Testicular cancer acute symptoms of, 230–231 computed tomography of diagnostic, 81, 82 for metastases evaluation, 86 for staging, 88, 90 cure rate in, 401 genetic factors in, 404 of germ cell origin See Germ cell tumors, testicular imaging-based diagnosis of with computed tomography, 81, 82 with positron emission tomography, 138 with ultrasound, 74, 76, 77 imaging-guided biopsy of, 68, 69 incidence of, 401 metastatic, 86, 136, 230–231 risk factors for, 401 as spinal cord compression cause, 229 staging of, 76, 88, 89 tumor markers for, 230 Testicular carcinoma in situ, 403, 408, 416 treatment for, 419–420 Testicular dysgenesis syndrome, 404 Testicular sperm extraction (TSE), 420 Testicular torsion, 412 Testosterone, procarcinogenic activity of, 529 Testosterone deprivation therapy See Androgen deprivation therapy Thalassemia, 18 Thalidomide, 51 Thermoablation, of prostate cancer, 559–560, 561 Thrombosis, deep venous, prophylaxis against, 151 Index Thrombospondin-1, 363–364 Ticlopidine, discontinuation prior to surgery, 142–143, 146 Topoisomerase inhibitors, 206, 207, 208 tumor resistance to, 200–201 Topotecan, 208 Toremifene citrate, 529 Toroids, 46 Traits, inheritance of, 20 Transcription factors, 15–16 Transferrin receptors, 363 Transitional cell carcinoma of the bladder bacille Calmette-Guérin therapy for, 330–332, 334 computed tomography of, 80, 87–88, 89 as contraindication to suprapubic catheters, 227 cystoscopy of, 327–328 diagnosis of, 112, 113 as hematuria cause, 75 imaging of, 76, 80, 87–88, 89, 113 metastatic, 361 molecular and genetic basis for, 318, 319–320 muscle-invasive, 327 natural history of, 319 new chemotherapeutic regimes for, 379–381 pathology of, 320–321 preoperative embolization of, 70 progression of, 325–326 prostate transitional cell carcinomaassociated, 327 risk factors for, 317, 318 staging and grading of, 87–88, 89, 321–323 upper-tract transitional cell carcinoma-associated, 339, 340, 342, 346 urine cytology of, 112 metastatic bladder, 377–389 management of, 377–389 MVAC therapy for, 377–379, 380, 381, 383 new treatment approaches to, 382–382 631 postchemotherapy surgical treatment for, 382 prognostic factors in, 381 second-line therapy for, 384 prostatic, 458 bladder transitional cell cancerassociated, 327 renal, 270 differentiated from renal cell carcinoma, 270 as spinal cord compression cause, 229 upper urinary tract, 339–347 bladder cancer associated with, 324–325 clinical features of, 341 conservative resection of, 343–344 diagnostic investigations of, 341–342 epidemiology and etiology of, 339 management of, 66–67, 162, 342–346 pathology of, 340 prognostic factors in, 340 radiation therapy for, 345 staging of, 88, 90, 340–342 systemic chemotherapy for, 345 topical therapy for, 344–345 ureteric, intravenous urogram of, 62, 64 urethral, 390, 392, 393 Translocations, chromosomal, 17 fluorescent tagging analysis of, 18 Transurethral resection of bladder tumors (TURBT), 149, 328 bladder cancer diagnosis after, 325 in diabetic patients, 151 multiple/periodic, 148, 368 Transurethral resection of the prostate (TURP), 453, 470, 492 Trastuzumab, 209, 382 Trauma, testicular, 412 Trisomy, 16–17 Tubulin targeting agents, 206, 207 Tumor cells See Cancer cells Tumor growth factors affecting, 196 models of, 196, 197 Tumor lysis syndrome, 245, 592–593 Tumor necrosis factor receptors, in apoptosis, 22, 23 632 Index Tumors responsiveness to chemotherapy, 200–201 volume measurement of, 92 Tumor suppressor genes, 24 cell-cycle control function of, 24–25, 26 definition of, 21 as gene therapy targets, 43 inactivation of, 16, 25–26 Turner’s syndrome, 17 U Ultrasound, 71–77 of adrenal lesions, 75, 76, 300 advantages and disadvantages of, 72–73, 74 in combination with computed tomography, 75 magnetic resonance imaging, 75 contrast-enhanced, 77 Doppler, 72 contrast-enhanced, 77 of prostate cancer, 76 of urothelial cancer, 75 general principles of, 71–72 for hematuria evaluation, 76, 113–114, 116–117 high-intensity focused (HIFU), 224, 276–277, 551–554, 555 of prostate cancer, 77 of renal cell carcinoma, 271, 276–277 of renal masses, 72–75, 113–114 testicular, 76–77, 413–414, 416–417 transrectal (TRUS), 471–477 contraindication in prostate cancer screening, 454 for hematospermia evaluation, 120, 121 for prostate cancer diagnosis, 454, 477, 478 for prostate cancer staging, 460 with transrectal transducers, 77 of urothelial tumors, 76 use in cryosurgery, 556, 557 transvaginal, 578 of urothelial tumors, 76 Ultrasound-guided biopsy, 69 Urate crystals, as hematuria indicator, 112 Ureteral cancer, trisomy-related, 16–17 Ureteric stents, 66–67, 130, 582 Ureteropyelography, retrograde, 115 Ureterorenoscopy for hematuria evaluation, 115, 117 virtual, 115 Ureterosigmoidostomy, 358 Ureters obstruction/stenosis of, 582 as anuria cause, 228–229 bilateral, 492 diagnosis of, 324–325 renographic assessment of, 129–130 strictures of, dilatation of, 66–67, 68 Urethra abscess of, 393 anatomy of, 391–392 stenosis of, 582 strictures of, 393 as hematuria cause, 110 radiation therapy-related, 510 as urinary retention cause, 226 Urethral cancer, 390–398 anatomical factors in, 391–392 in bulbomembranous urethra, 395 clinical presentation of, 393 diagnostic investigations of, 394 epidemiology of, 390 in females, 390, 392 in males, 390, 391, 392 metastatic, 393, 394 pathology of, 392 prognostic factors in, 393, 396 risk factors for, 390 staging of, 393, 394 transitional cell, 396 in association with bladder cancer, 396 treatment for, 394–396 Urethrectomy with radical cystoprostectomy, 348 as urethral cancer treatment, 396 Urethrocystoscopy, rigid, 394 Urinalysis See also Cytological analysis, of urine for hematuria diagnosis, 111–113 Index Urinary diversion, 352–354 Urinary incontinence, 491, 512 Urinary leaks, 68, 490 Urinary retention, 226–228, 512 Urinary tract See also Bladder; Ureters; Urethra nonurological cancers affecting, 576–595 colorectal cancer, 582–587 endometrial and cervical cancers, 576–582 lymphoma, 587–593 Urinary tract cancer See also Bladder cancer; Urethral cancer genetic predisposition to, 19 Urinary tract infections colony-forming units in, 112 recurrent, 253 Urine output, following nephron-sparing surgery, 241–242 Urography computed tomographic, 64–66 intravenous (excretory), 61–64 alternatives to, 64–66 of bladder cancer, 324–325 diagnostic value of, 63–64 for hematuria evaluation, 76, 113, 116–117 of renal cell carcinoma, 271 technique of, 62–63 of upper-tract transitional cell carcinoma, 341 magnetic resonance, 66, 114 Urological cancer, risk factors for, 117 Uropathy, obstructive, 235, 247 Urothelial cancer as hematuria cause, 75 laparoscopic nephroureterectomy of, 162 ultrasound imaging of, 76 Uterus cancer, metastatic to the bladder, 321 V Vaccine therapy, 47, 49, 52 antigen vaccines, 551 dendritic cell-based vaccines, 49, 52, 550–551 633 DNA vaccines, 49, 551 for prostate cancer, 548–551 whole-cell vaccines, 549–550 Vascular endothelial growth factor, 28 Vascular endothelial growth factortargeted therapy, 45, 209, 285–291, 293, 382–383 Vascularity, of tumors, ultrasound evaluation of, 71–77 VEGF See Vascular endothelial growth factor VHL gene, mutations in, 4–5, 28, 269 Vinblastine, 207, 429–430, 592 Vinca alkaloids, 206 tumor resistance to, 200–201 Vincristine, 207 adverse effects of, 593 as lymphoma treatment, 591 Virilization, adrenocortical carcinomarelated, 304 Virtual endoscopy, 114–115 Virtual ureterorenoscopy, 115 Viruses as gene therapy vectors, 43, 44 tumor suppressor gene-inactivating activity of, 25–26 Vitamin C, Vitamin D, 251, 528 Vitamin D deficiency, 53, 457 Vitamin E, 9, 457, 528 Vitamin supplements, 250 Vomiting, chemotherapy-related, 434 von Hippel-Lindau disease, 4–5, 71, 75, 95, 268–269, 307 von Hippel-Lindau (VHL) gene, mutations in, 4–5, 28, 269 W Warfarin, discontinuation prior to surgery, 142–143, 146 White blood cells, in urine, 112 Wilms’ tumor, 17, 27 Wunderlich syndrome, 278 X X-rays of chest preoperative, 147, 416–417 634 Index X-rays (cont.) prior to orchiectomy, 416–417 for renal cell carcinoma evaluation, 271–272 for testicular cancer evaluation, 414, 416–417 discovery of, 213 Y Yeast artificial chromosome (YAC) clonal probes, 17 Yolk sac tumors, 410–411, 414 Z Zinc, prostate gland content of, 457 Zoledronic acid, 292, 523 .. .Urological Oncology Vinod H Nargund, Derek Raghavan, and Howard M Sandler (Eds) Urological Oncology Vinod H Nargund, PhD, FRCS (Urol), FEBU Chair, Uro -Oncology MDT and Consultant Urological. .. Senior Associate Chair Department of Radiation Oncology University of Michigan Ann Arbor, MI USA British Library Cataloguing in Publication Data Urological oncology Urinary organs—Cancer Prostate—Cancer... one of the urological journals, I can attest to this interest; the largest percentage of the papers I receive for review each year relate to either clinical or experimental urological oncology