Prostate cancer is the most common cancer in men. Diagnosis of prostate cancer poses a significant challenge, due to several different key parameters that need to be evaluated, such as age, history ...of prostate specific antigen (PSA), clinical examination and more recently magnetic resonance imaging (MRI). The current diagnostic pathway for prostate cancer has resulted in overdiagnosis and overtreatment as well as underdiagnosis and missed diagnoses in many men. Multiparametric MRI (mp-MRI) of the prostate has been identified as a test that could alleviate these diagnostic errors. Before prostate cancer treatment pathological confirmation is mandatory. Prostate biopsy is an invasive procedure with rare but not negligible potential complications. There are several methods of prostate biopsy of which most common are systemic or planar prostate biopsy and cognitive or targeted MRI-guided prostate biopsy. Multiparametric MRI has demonstrated better accuracy and reproducibility in detecting, locating and evaluating prostate cancer and also sparing some men unnecessary biopsies. Recent studies have shown a mpMRI benefit for better procedure planning regarding prostate cancer location, extent of disease and length of the urethra. There are still some challenges ahead, such as ensuring high-quality execution and reporting of mpMRI and ensuring that this diagnostic pathway is cost-effective. According to the latest urological clinical guidelines mpMRI became fundamental tool in management of prostate cancer. The aim of this study is to give a brief insight in use of mpMRI in prostate cancer diagnosis and treatment.
All malignancies, including prostate cancer, require accurate diagnosing and staging before making a treatment decision. The introduction of targeted biopsies based on prostate MRI findings has ...raised prostate biopsy accuracy. Guided biopsies target the tumor itself during the biopsy instead of the most common tumor sites as is the case with a systemic biopsy. Some studies report that targeted biopsies should lower prostate cancer biopsy undergrading and overgrading.
To determine the incidence of prostate cancer biopsy undergrading in patients who underwent a classic systemic biopsy compared to patients who underwent a mpMRI cognitive targeted biopsy.
We identified the patients from our database who underwent a radical prostatectomy at our institution from January 1st, 2021, to June 30th, 2021.There were 112 patients identified. Patients were stratified into two groups based on the type of biopsy that confirmed prostate cancer. The mpMRI (N=50) group had a mpMRI cognitive guided transrectal ultrasound (TRUS) prostate biopsy performed, and the non-mpMRI group (N=62) received a classic, systemic TRUS biopsy. We compared the biopsy results with the final pathological results, and searched for undergrading or overgrading in the biopsies compared to the final histological report.
The undergrading was found in 17,7% (N=11) cases in the non-mpMRI group and in 12,0% (N=6) of cases in the mpMRI group (p=0,02, Mann-Whitney U test). No overgrading was found in our cohort. All cases of undergrading had Grade Group 1 in the biopsy report and Grade Group 2 in the final specimen report. The charasteristics of patients are listed in Table 1.
In our cohort, the patients who underwent a mpMRI targeted biopsy had a lower undergrading incidence. During a systemic TRUS biopsy, the urologist targets the areas of the prostate where cancer is most commonly located, which is usually the peripheral zone of the prostate. Since different areas of the tumor have different areas of differentiation, only a low-grade part of the tumor is sometimes biopsied, which results in a sampling error. Once the prostate is removed, the whole tumor is analyzed, so the obtained pathological results related to the removed prostate are far more accurate than the analysis of prostate cores obtained by biopsy.
Andrija Štampar je putem svojih načela uspostavio temelje javnoga zdravstva i socijalne medicine. Provedbom svojih ideja promijenio je paradigmu postojećih medicinskih stavova, stavljajući fokus ...prema preventivnoj medicini. Kao okvir za djelovanje po takvim medicinskim tendencijama, arhitektura je shvaćena kao područje velike važnosti. Radom kroz Školu narodnoga zdravlja, Štampar je uspostavio odjel zdravstvene arhitekture kao mjesto gdje se načela socijalne medicine isprepleću s konceptima novoga prostornog planiranja. Unutar ovoga odjela radila je i arhitektica Zoja Dumengjić, čiji se rad snažno utemeljio na socijalnim postavkama Andrije Štampara. Zoja Dumengjić je značajna osobnost hrvatske arhitekture dvadesetoga stoljeća, koja je ostavila opsežan i značajan doprinos upravo u specijaliziranom području arhitekture zdravstvene namjere. Temeljem postojeće literature, predstavljen je kratak pregled raznovrsnosti i opsega njezina rada i života. Njezin opus obuhvaća projekte različite tipologije, uključujući domove zdravlja, dispanzere, medicinske centre i velike bolničke sklopove. Posebno je značajno pridonijela području arhitekture lječilišta za tuberkulozu u našoj zemlji. U okviru ovoga rada dodatno su istaknuta najznačajnija arhitektonska ostvarenja, posebice ona koja u značajnoj mjeri reflektiraju principe Štamparove ideologije. Rad Zoje Dumengjić u području zdravstvene arhitekture ukorijenjen je u modernizmu i predstavlja idealan primjer kako je arhitektura uspjela odražavati nove humanističke vrijednosti i pristupiti prostoru kao instrumentu za poboljšanje kvalitete života i zdravlja.
Through his principles, Andrija Štampar established the foundations of public health and social medicine. By implementing his ideas, he changed the paradigm of existing medical opinions, focusing on preventive medicine. As a framework for acting on such medical tendencies, architecture was understood as an area of great importance. Working through the School of Public Health, Štampar established the Department of Healthcare Architecture as a space where the principles of social medicine are intertwined with the concepts of new spatial planning. Architect Zoja Dumenjgić also worked within this department, and her work was strongly based on Andrija Štampar’s social principles. Zoja Dumenjgić is a significant personality of Croatian 20th-century architecture, who left an extensive and significant contribution precisely in the specialised field of healthcare architecture. A brief overview of the diversity and scope of her work and life is presented, based on existing literature. Her portfolio includes projects of various typologies, including medical centers, dispensaries, and large hospital complexes. She made a particularly significant contribution to the architecture of tuberculosis sanatoriums in Croatia. Her most significant architectural accomplishments are additionally highlighted, especially those that reflect the principles of Štampar’s ideology to a significant extent. Her work in the field of healthcare architecture is rooted in modernism and represents an ideal example of how architecture managed to reflect new humanistic values and approach space as an instrument for improving the quality of life and health.
Through his principles, Andrija Štampar established the foundations of public health and social medicine. By implementing his ideas, he changed the paradigm of existing medical opinions, focusing on ...preventive medicine. As a framework for acting on such medical tendencies, architecture was understood as an area of great importance. Working through the School of Public Health, Štampar established the Department of Healthcare Architecture as a space where the principles of social medicine are intertwined with the concepts of new spatial planning. Architect Zoja Dumenjgić also worked within this department, and her work was strongly based on Andrija Štampar’s social principles. Zoja Dumenjgić is a significant personality of Croatian 20th-century architecture, who left an extensive and significant contribution precisely in the specialised field of healthcare architecture. A brief overview of the diversity and scope of her work and life is presented, based on existing literature. Her portfolio includes projects of various typologies, including medical centers, dispensaries, and large hospital complexes. She made a particularly significant contribution to the architecture of tuberculosis sanatoriums in Croatia. Her most significant architectural accomplishments are additionally highlighted, especially those that reflect the principles of Štampar’s ideology to a significant extent. Her work in the field of healthcare architecture is rooted in modernism and represents an ideal example of how architecture managed to reflect new humanistic values and approach space as an instrument for improving the quality of life and health.
Although collecting duct carcinoma is a subtype of renal cell carcinoma, several studies implicate association with urothelial carcinoma. The coexistence of collecting duct carcinoma and another ...renal neoplasm is rare. Endemic nephropathy is a renal disease causing chronic renal failure. It is highly associated with urothelial neoplasm and occurs in endemic villages in Bosnia, Croatia, Bulgaria, Romania and Serbia. Recent studies have confirmed the important role of exposure to aristolochic acid as an etiologic factor. We present three cases of collecting duct carcinoma with literature overview. In one case, we describe collecting duct carcinoma with metachronous urothelial carcinoma of the pyelon and urinary bladder in an endemic nephropathy patient. To our knowledge, this is the first case report describing this coexistence. Certain similarities between collecting duct carcinoma and urothelial carcinoma were found, e.g., higher incidence in female compared to male, higher mean age, and multifocal and multicentric occurrence of the tumor. Our observations support the hypothesis that collecting duct carcinoma and urothelial carcinoma could be connected.
The aim of this study was to determine the incidence of incidental prostate cancer and its clinical significance among patients who underwent transurethral prostate resection or transvesical ...adenomectomy for benign prostate hyperplasia at the Department of Urology in Sestre milosrdnice University Hospital Center from January 1997 to December 2017. A total of 277/4,372 (6.34%) patients from our cohort were diagnosed with incidental prostate cancer (mean age 74.5 years). Due to incomplete data, 12 patents were excluded from further analysis. 44.91% (119/265 patents) of our cohort were stage T1a and 55.09% (146/265) were stage T1b. Clinically significant prostate cancer was found in 168/265 patients (63.40%). When divided into two groups, Gleason score ≤6 (mean age 73.58 years) and Gleason score ≥7 (mean age 75.77 years), the results showed that Gleason score ≥7 patients were significantly older (p=0.0104) and that the tumor extent among patients in this group (mean = 34.58%) was higher than that in Gleason score ≤6 group (mean = 11.11%) (p=0.0169). More than a half of patients in our cohort had T1b stage prostate cancer. We found that 63.4% of carcinomas were clinically significant, with 52/265 (19,62%) patients affected by ISUP grade 4 and 5 cancers. Based on our research, we cannot give any recommendations regarding incidental prostate cancer treatment due to lacking preoperative (PSA, DRE) and follow-up data.
The objective of this study was to determine differential expression of TFF1, TFF2 and TFF3 genes and proteins in breast tumor subtypes. In addition, we investigated the correlation between TFF genes ...within tumor subgroups, and TFF genes with clinical and pathologic characteristics of the tumor. Study group included 122 patients with surgically removed breast tumors. Samples were investigated using qRT-PCR and immunohistochemistry. TFF1 and TFF3 genes and proteins were expressed in breast tumors, while the levels of TFF2 gene and protein expression were very low or undetectable. TFF1 was significantly more expressed in benign tumors, while TFF3 was more expressed in malignant tumors. Gene and protein expression of both TFF1 and TFF3 was greater in lymph node-negative tumors, hormone positive tumors, tumors with moderate levels of Ki67 expression, and in grade II tumors. A strong positive correlation was found between TFF1 and TFF3 genes, and the expression of both negatively correlated with Ki67 and the level of tumor histologic differentiation. Our results suggest that TFF1 and TFF3, but not TFF2, may have a role in breast tumor pathogenesis and could be used in the assessment of tumor differentiation and malignancy.
Multiparametric magnetic resonance is assuming an increasingly important role in the diagnosis, initial assessment and monitoring of patients with prostate cancer. This paper offers a more complex ...insight into the application of magnetic resonance imaging with prostate cancer, with a current literature overview. The focus is on the problem of initial prostate cancer evaluation which strongly affects further decision-making and therapeutic interventions. Clinical suggestions based on the current guidelines are also offered.
The aim of this prospective clinical study was to determine the detection rate of prostate cancers by multiparametric magnetic resonance and transrectal ultrasound (mpMRI-TRUS) cognitive fusion ...biopsies in patients with a previously negative TRUS-guided biopsy. Between 1 October 2016 and 1 July 2017, in 101 consecutive patients with elevated antigen (PSA) and/or positive digital rectal examination and after a negative first TRUS biopsy, a second, repeated prostate biopsy was performed. In 24 patients, cognitive fusion mpMRI-TRUS biopsy of the prostate with 8-10 system cores and 1-3 target biopsies was performed, in line with the European Association of Urology guidelines. In 77 patients, only a classic, repeated TRUS guided biopsy was performed. In patients with mpMRI, the detection rate according to PIRADS-v2 reporting system was: PIRADS 1, n = 0; PIRADS 2, n = 0; PIRADS 3, n = 0; PIRADS 4, n = 6/8 (75%); and PIRADS 5, n = 2/3 (67%). In the group of patients with MR-TRUS cognitive fusion biopsy, the prostate cancer detection rate was 8/24 (33%), while in the control group the detection rate was 12/77 (16%), which was statistically significant (t test, p = 0.037, CI 95% is 0.01 to 0.37). Patients with PIRADS ≤ 3 (54%) could have avoided the biopsy.
One of the main reasons for the introduction of a new grading system was Gleason sum 7, which differed significantly in the prognosis of the disease depending on the primary Gleason. The aim of this ...study was to compare grade group 2 and grade group 3, and the impact of cancer percentages in final pathology reports after radical prostatectomy on the occurrence of T3 stage of the disease after radical prostatectomy of clinically localized prostate cancer. The study covered 365 patients with clinically localized prostate cancer who underwent radical retropubic prostatectomy (RRP) over the period of two years. The average percentage of carcinomas found in pathology reports after RRP was 20.1%. With the increase in the grade group, the average percentage of carcinomas in pathology reports increased significantly, p <0.001. With regard to grade groups 2 and 3, irrespective of cancer percentages in pathology reports, more cases of T3 stage were found in grade group 3 when compared to grade group 2, which was statistically significant (p <0.001). However, grade group 2 and grade group 3 patients with ≤10% cancer occurrences in final pathology reports after RRP did not show any statistical significance in the occurrence of T3 stage, p=0.96. Prognostic differences in grade group 2 and grade group 3 patients after RRP are significant, but not in all cases, because of their dependence on the percentage of cancer in the final pathology report after RRP of clinically localized prostate cancer.
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