OBJECTIVE: To determine the efficacy of sequential intravesical Gemcitabine and Docetaxel (siGD) in patients with non-muscle invasive bladder cancer (NMIBC) in preventing disease recurrence after transurethral resection, as an alternative to BCG-naïve patients or to failed intravesical BCG therapy. METHODS: An extensive literature search on the use of siGD for BCG-naïve or BCG-refractory NMIBC was done using the following terms: non-muscle invasive bladder cancer, intravesical Gemcitabine and Docetaxel. Search results were filtered to include all retrospective studies and randomized controlled trials reporting the oncological outcomes of siGD published over the last 5 years from the conception of this study. Information on the safety profile and adverse events related to therapy were also reported, if available. RESULTS: The authors’ search yielded 8 retrospective articles describing the efficacy of siGD for NMIBC, 5 of which had complete and accessible English manuscripts. A total of 476 low to high-risk NMIBC patients were included in the 5 eligible studies, 31 (6.5%) of which were BCG-naïve, while the rest failed BCG therapy. The reported one and two-year success rates were 54-69% and 34-55%, respectively. The recurrence-free survival rates at 1 and 2 years were 49-60% and 29-46%, respectively. Bladder cancer-specific mortality at 1 and 2-years were 1-3% and 4-11%, respectively. Treatment-related adverse reactions were mostly mild, the most common of which were urinary frequency, urgency, hematuria, and dysuria. CONCLUSION Sequential intravesical Gemcitabine and Docetaxel is a feasible alternative for BCG-naïve and BCG-refractory NMIBC patients. Oncological outcomes are comparable to BCG therapy with less adverse effects.

The decision to proceed with radical prostatectomy has to be supported with biopsy-proven prostate cancer. However, when a patient has persistently multiple negative prostate biopsies and a high PSA, a serious diagnostic and therapeutic dilemma arises. The PIRADS score generated by the multiparametric-MRI of the prostate provides a guide for a template biopsy using MRI-ultrasound fusion technology, with the hope of minimizing a false negative result. Fluorine-18 Prostate-Specific Membrane Antigen (18F-PSMA) PET CT scan, on the other hand, is used mainly for staging prostate cancer after biochemical recurrence. The use of 18F-PSMA PET CT in the primary clinical diagnosis of prostate cancer has never been reported.The authors performed radical prostatectomy on a 66-year-old HIV-positive male with suspicious lesion on 18F-PSMA, PIRADS 5 on mp-MRI, and a persistently elevated PSA >100 despite multiple negative biopsies. The final histopathological analysis confirmed the presence of adenocarcinoma of the prostate, Gleason 7 (3+4), with negative margins. There were no intraoperative complications, and the patient was discharged in good condition. On follow-up, he had a nadir PSA of 0.058 ng/ml, has partial incontinence, and decreased erectile function and was advised phosphodiesterase inhibitors. 18F-PSMA may be utilized in the decision process for patients who are highly suspected with malignancy but have no preoperatively biopsy-proven cancer after multiple negative biopsies.

OBJECTIVE: To determine the validity of NMP-22 (Bladder Check Protein Test Pack Kit) in the diagnosis of bladder cancer.

MATERIALS: From May 1, 2009 to October 31, 2009 all patients with bladder mass by ultrasound, IVP or CT scan from three different urology training institutions were enrolled in this prospective study. These patients underwent urine cytology and NMP-22 qualitative assay. The diagnosis determined from the cytoscopic and histopathologic findings from CTURBT was accepted as the gold standard.

RESULTS: Thirty nine subjects were enrolled in this study, whom of 31 patients were diagnosed of malignancy and 8 were benign in pathology. The sensitivity of urine cytology, NMP-22 assay and cytoscopy was 34.6%, 96.8% and 92.3% respectively and the specificity was 37.5% for NMP-22 and 66.1% for the cytoscopy.

CONCLUSION: The result of this study suggests that NMP-22 is a very sensitive test, however is less specific in identifying bladder cancer.

Human ; Male ; Female ; Middle Aged ; Neoplasms ; Urologic Neoplasms ; Urinary Bladder Neoplasms-cytology, diagnosis, pathology ; nuclear matrix protein 22 ; ultrasonography ; Tomography Scanners, X-Ray Computed ; ;