Siberyn T. Nuijens

Objectives: To evaluate the effect of metformin on non‐muscle‐invasive bladder cancer (NMIBC) marker lesions. Patients and methods: A phase II, open‐label, multicentre, marker lesion trial using oral metformin in patients with primary or recurrent, multiple, low‐grade Ta‐T1 NMIBC was conducted. After transurethral resection for histological confirmation, leaving one tumour as a marker lesion, 11 patients were treated with oral metformin up to 3000 mg per day for 3 months. Reported outcomes included response of the marker lesion, safety of metformin, quality of life and pharmacological and immunohistochemical examinations of the mechanism of action of metformin. Results: One complete response and one partial response were observed. In the other nine patients, the marker lesion remained, while five of these patients also developed new Ta low‐grade lesions. Diarrhoea grade ≤ 2 was the most common adverse event (AE), observed in nine out of 11 patients. No serious AEs related to study treatment occurred. Metformin concentrations in the urine were significantly higher than metformin levels in the blood. Immunohistochemical analysis before and after treatment showed no difference in expression of markers associated with the mechanism of metformin. Conclusion: We did not find conclusive evidence for the hypothesis of an antitumour effect of metformin in bladder cancer.

Objectives: To evaluate the impact of treatment for localised muscle‐invasive bladder cancer (MIBC) during the first 2 years after diagnosis. Patients and Methods: A prospective cohort study was conducted including patients diagnosed with non‐metastatic (cM0) MIBC between November 2017 and November 2019 in the Netherlands. Health‐related quality of life (HRQoL) was measured using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ‐C30) as well as the MIBC‐specific QLQ‐BLM30 module. Questionnaires were administered at baseline (pre‐treatment) and at 6, 12 and 24 months after diagnosis. Patients were grouped by treatment: neoadjuvant chemotherapy (NAC) and radical cystectomy (RC), upfront RC, chemoradiation, and radiotherapy. Linear mixed models were used to assess HRQoL changes over time per treatment group. Results: A total of 518 patients participated in quality of life measurements (46% response rate). After excluding 14 patients who did not complete the EORTC QLQ‐C30 and 114 for baseline completion after start of treatment, a total of 390 patients were included of whom 105 underwent NAC and RC, 148 underwent upfront RC, 58 underwent chemoradiation, and 79 underwent radiotherapy alone. Over time, clinically relevant improvements in emotional functioning and future perspective were observed across all treatment groups. However, a temporary worsening in physical functioning was observed at 6 months. Patients treated with RC (with or without NAC) experienced persistent deteriorations in body image and sexual functioning up to at least 2 years after diagnosis, although urostomy‐related outcomes improved. Patients undergoing chemoradiation showed improvements in urinary symptoms, while those receiving radiotherapy reported significant worsening of dyspnoea over time. Conclusion: In this largest population‐based study to date on HRQoL in MIBC, HRQoL largely recovered to baseline levels during the first 2 years after diagnosis. However, persistent deteriorations in physical and cognitive functioning, body image, and sexual function were observed, particularly in patients treated with RC (with or without NAC).

Samenvatting: Dit case report betreft een patiënt met hematurie ten gevolge van een kiemceltumor van de linker testis, welke doorgroeide in de blaaswand. Mannen met een niet-ingedaalde testis hebben een verhoogde kans op het ontwikkelen van een testiculaire kiemceltumor. Bij de 67-jarige patiënt in deze casus werd tijdens cystoscopie een tumor in de blaas gevonden. De patiënt onderging een diagnostische transurethrale resectie van de tumor, laboratoriumonderzoek en een CT-scan, op grond waarvan een stadium 2‑good-risk seminoom van de testis werd gediagnosticeerd. De patiënt werd behandeld met vier cycli van etoposide en cisplatine met nadien een open chirurgische resectie van de restlaesie. Het herstel verliep ongecompliceerd. Bij beeldvorming na zes maanden waren er geen tekenen van een recidief.

Samenvatting: Het doel van deze studie was de oncologische en functionele uitkomsten van salvage cryochirurgie (sCC) te beoordelen bij lokaal recidief prostaatcarcinoom na radiotherapie (rrPCA). De studie werd uitgevoerd bij 169 patiënten. Er vond retrospectieve analyse plaats van recidiefvrije overleving (BRFS), algehele overleving, metastasevrije overleving, androgeendeprivatietherapie (ADT)-vrije overleving, functionele uitkomsten en complicaties. De mediane follow-up was 36 maanden (IQR = 18–66). BRFS na vijf en acht jaar was 52% (95%-BI = 43–62) en 45% (95%-BI = 35–57), respectievelijk. PSA bij initiële diagnose, de initiële behandeling, het interval tussen de primaire behandeling en SCS, leeftijd bij SCS en post-SCS PSA-nadir waren significante voorspellers van BRFS. De vijf-jaars ADT-vrije overleving was 70% (95%-BI = 62–79). Complicaties van graad III of hoger traden op bij 1,2% van de patiënten. Bij 19% en 92% van de patiënten trad new onset urine-incontinentie respectievelijk erectiele disfunctie op, bij 6,5% persisterende urinaire fistels en bij 12% desobstructie. SCS heeft aanvaardbare oncologische resultaten, maar kan gepaard gaan met ernstige complicaties (urine-incontinentie, stenose en fistels).

Purpose of review: To study the recent literature on health-related quality of life (HRQOL) in patients after radical cystectomy followed by urinary diversion. Recent findings: General consensus regarding, which urinary diversion is superior in terms of HRQOL has not been reached. Although there is an increase in studies favoring the orthotopic neobladder, overall quality of these studies is poor. Other studies suggest that HRQOL outcomes in different types of urinary diversions is similar and that other factors, such as age, comorbidities and sex are more important instead. Patient choice, in consultation with the treating surgeon should be the determinant of which urinary diversion is performed. Furthermore, sexual function can play an important role in HRQOL. However, practice shows that counselling on the option of sexual-preserving techniques is still not implemented in routine clinical practice. Furthermore, studies regarding differences in HRQOL after urinary diversion between male and female individuals are lacking. Summary: Thorough preoperative counselling on the different types of urinary diversion and options for sexual-preserving techniques decreases decision regret and increases HRQOL in patients after radical cystectomy.