High-risk non-muscle invasive bladder cancer (NMIBC) progresses to metastatic disease in 10-15% of cases, suggesting that micrometastases may be present at first diagnosis. The prediction of risks of progression relies upon EORTC scoring systems, based on clinical and pathological parameters, which do not accurately identify which patients will progress. Aim of the study was to investigate whether the presence of CTC may improve prognostication in a large population of patients with Stage I bladder cancer who were all candidate to conservative surgery. A prospective single center trial was designed to correlate the presence of CTC to local recurrence and progression of disease in high-risk T1G3 bladder cancer. One hundred two patients were found eligible, all candidate to transurethral resection of the tumor followed by endovesical adjuvant immunotherapy with BCG. Median follow-up was 24.3 months (minimum-maximum: 4-36). The FDA-approved CellSearch System was used to enumerate CTC. Kaplan-Meier methods, log-rank test and multivariable Cox proportional hazard analysis was applied to establish the association of circulating tumor cells with time to first recurrence (TFR) and progression-free survival. CTC were detected in 20% of patients and predicted both decreased TFR (log-rank p < 0.001; multivariable adjusted hazard ratio [HR] 2.92 [95% confidence interval: 1.38-6.18], p 5 0.005), and time to progression (log-rank p < 0.001; HR 7.17 [1.89-27.21], p 5 0.004). The present findings provide evidence that CTC analyses can identify patients with Stage I bladder cancer who have already a systemic disease at diagnosis and might, therefore, potentially benefit from systemic treatment.High-risk, non-muscle invasive bladder cancer (NMIBC) is defined as any transitional cell carcinoma (TCC) of the bladder that is high-grade, whether it is primary or recurrent. This high-risk group includes patients with high-grade papillary Stage Ta or T1 tumors and any patient with carcinoma in situ (CIS). 1 Following transurethral resection bladder (TURB) of the initial tumor with no additional therapy, there is a recurrence rate of 50-70% and a progression rate of 25-50%, leading to cancer death after bladder-sparing treatment within 5 years in about 16-23% of cases. 2 To date, the European Organization for Research and Treatment of Cancer (EORTC) risk tables is the best-established predictive tools to help decision making for patients with NMIBC. These tables group patients by risk (low, intermediate and high) with the sums of factors (number of tumors, tumor size, prior recurrence rate, T category, presence of CIS and grade) to enable easy prediction of the recurrence and progression of NMIBC. 3 CUETO tables were developed with a similar structure to the EORTC tables but were adapted for patients treated with Bacillus Calmette Guerin (BCG). 4 Nevertheless, recent studies underline that both EORTC and CUETO risk tables have a low positive predictive value (PPV), thus not able to identify patients with higher risk to progress. 5 Circ...

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Study Type - Clinical (prospective trial) Level of Evidence 2b What's known on the subject? and What does the study add? In clinical practice, we know that it is necessary to identify new biomarkers that can better detect prostate cancer (PC), at the same time as reducing the number of unnecessary biopsies. Recently, studies have suggested that the most relevant clinical scenario in which the prostate cancer antigen 3 (PCA3) score could be used comprises patients with a previous negative prostate biopsy and persistently elevated PSA levels. At the same time, although multiparametric MRI is not currently used as a first approach for diagnosing PC, it can be useful for directing targeted biopsies, especially in those patients with elevated PSA levels and a previous negative TRUS-guided biopsy. Considering all of these aspects, the present study aimed to evaluate the role of multiparametric MRI as an additional diagnostic tool for improving the accuracy of the urinary PCA3 test in patients with increased PSA levels and a previous negative prostate biopsy. Our hypothesis is that the potential value of the PCA3 test as a biomarker for PC diagnosis could be improved by the use of multiparametric MRI in directing prostate biopsy. In the present study, we show that, in cases with a previous negative biopsy and persistently elevated PSA levels submitted to multiparametric MRI to direct biopsies, the sensitivity of the PCA3 test significantly improved (79% vs 68%). However, further larger randomized studies on this combination using a new biomarker and a new imaging modality for PC diagnosis are expected. OBJECTIVE To evaluate the role of multiparametric magnetic resonance imaging (MRI) as an additional diagnostic tool for improving the accuracy of the urinary prostate cancer antigen 3 (PCA3) test in patients with an increase in prostate-specific antigen (PSA) levels and a previous negative prostate biopsy. PATIENTS AND METHODS The present study comprised a prospective randomized study on patients with a previous negative transrectal ultrasonography (TRUS)-guided prostate biopsy and elevated PSA levels. In total, 180 cases were analyzed, and all were submitted to PCA3 assay. Patients in group A were submitted to a second random TRUS-guided prostate biopsy, whereas patients in group B were submitted to a multiparametric MRI examination and then to a second TRUS-guided prostate biopsy. RESULTS At the second biopsy, a histological diagnosis of prostate cancer was found in 26 of 84 cases (30.9%) in group A and in 29 of 84 cases (34.5%) in group B. In group A, the sensitivity and specificity of the PCA3 score were 68.0% and 74.5% respectively (positive predictive value of 53.1%, negative predictive value of 84.6% and accuracy of 72.6%). In group B, the sensitivity and specificity of the PCA3 score were 79.3% and 72.7%, respectively (positive predictive value of 60.5%, negative predictive value of 86.9% and accuracy of 75.0%). For the PCA3 score, the area under the receiver-operator characteristic curve was 0.825 (95% confidence...

Bladder hemorrhage following radiation therapy is a serious complication in patients undergoing this treatment. Several methods have been proposed to control this particular situation; however, results have been far from satisfactory, with the exception of drastic measures such as hypogastric artery ligation and radical cystectomy. We recently used a method of superselective embolization of the bladder arteries which enabled us to control severe intractable bleeding in a patient submitted to bladder irradiation for a transitional cell infiltrating carcinoma. Compared to selective embolization and other methods, the advantages of superselective embolization are a lower recurrence rate concerning bleeding, fewer side-effects and the possibility of using adaptable embospheres (150-1000 micron) which, on account of their marked plasticity, offer better occlusion of the vessels. For these reasons, superselective embolization of the bladder arteries should be considered as the treatment of choice in intractable bladder hemorrhage.