Renal & Urology News - October 2016 issue

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O C T O B E R 2016

VOLUME 15, ISSUE NUMBER 8

ADT Failure Tied to Genetic Variant

Disease progression linked to HSD3B1 (1245C) allele

www.renalandurologynews.com

DECREASED PROGRESSION-FREE SURVIVAL Prostate cancer patients who receive ADT for disease recurrence following radical prostatectomy have shorter median progression-free survival if they are heterozygous or homozygous for the variant gene HSD3B1 (1245C).* 6.6 years

*Data are from the study’s primary cohort.

4.1 years

BY JODY A. CHARNOW PROSTATE CANCER (PCa) patients with a certain variant genotype are more likely to experience resistance to androgen-deprivation therapy (ADT) following disease recurrence after radical prostatectomy, new study findings suggest. The genotype, HSD3B1 (1245C), could potentially be a powerful genetic biomarker for distinguishing PCa patients who will respond favorably to ADT from those who have cancer that is more likely to behave aggressively, investigators concluded.

IN THIS ISSUE 7

Adding folic acid to enalapril may lower CKD progression risk

10

Staghorn stones predict a higher infection risk after PCNL

11

Serious side effects uncommon with sacral neuromodulation

20

Ultrasonography alone suboptimal for detecting kidney stones

22

Prostate cancer treatment may relieve pre-existing LUTS New equations may improve MRI/US fusion prostate biopsy PAGE 16

The HSD3B1 (1245C) allele encodes an altered enzyme that augments dihydrotestosterone synthesis from nongonadal precursors. “Overall, these data suggest that there may be a genetically defined subgroup of patients with prostate cancer who might benefit from upfront treatment with a next-generation antiandrogen along with standard medical or surgical castration,” principal investigator Nima Sharifi, MD, of the Glickman Urological and Kidney Institute at Cleveland Clinic, told Renal & Urology News.

Biomarkers Predict AKI Progression THREE URINARY biomarkers measured at the time of acute kidney injury (AKI) diagnosis in patients with acute cardiorenal syndrome (CRS) may help to identify those at highest risk for adverse outcomes, investigators concluded. In a prospective study of 213 with acute CRS and stage 1 or 2 AKI at diagnosis, the highest tertiles of urinary angiotensinogen (uAGT), urinary neutrophil gelatinase-associated lipocalin (uNGAL), and urinary interleukin-18 (uIL-18) were associated, respectively, with a significant 10.8-, 4.7-, and 3.6fold increased risk of AKI progression, continued on page 11

2.5 years

Homozygous wild-type

Heterozygous variant

Homozygous variant

Source: Hearn JWD et al. HSD3B1 and resistance to androgen-deprivation therapy in prostate cancer: a retrospective, multicohort study. Lancet Oncol. 2016; published online ahead of print.

Dr Sharifi and his colleagues genotyped 443 PCa patients who received ADT for biochemical failure after radical prostatectomy (RP), then correlated genotype with long-term clinical outcomes. Of these, 118 were

in the primary cohort (those who underwent RP), 137 were in a post-RP validation cohort, and 188 were in a metastatic validation cohort. The primary endpoint was progression-free continued on page 11

BCG Alone Best for Bladder CIS BACILLUS Calmette-Guérin (BCG) monotherapy is associated with better long-term efficacy than alternating therapy with mitomycin C (MMC) and BCG in patients with carcinoma in situ of the bladder, according to a new study. The finding is from a study of 321 CIS patients from Finland, Norway, and Sweden enrolled in a prospective multicenter trial and randomized to receive either BCG monotherapy or alternating MMC/BCG therapy. After a median follow-up of 9.9 years (maximum 19.9 years) in the BCG monotherapy arm and 8.9 years (maximum 20.3 years) in the alternating treatment arm, investigators found that the risk

of disease recurrence was significantly lower in the BCG monotherapy arm than the alternating treatment arm (49% vs. 59%) at 15 years). This difference in recurrence rates corresponded to a significant 26% decreased risk of recurrence, investigators led by Eero Kaasinen, MD, of Helsinki University Hospital in Helsinki, Finland, reported in the Scandinavian Journal of Urology (2016;50:360-368). The researchers observed no significant difference in progression risk and disease-specific and overall mortality between the groups. Patients who experienced disease progression after 2 years compared continued on page 11

A PROMISING TREATMENT ALTERNATIVE FOR BPH

Encouraging results reported for prostate artery embolization PAGE 19


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