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	<title>Health and Prostate</title>
	<link>http://healthandprostate.com</link>
	<description>Benign Prostatic Hyperplasia - Prostate Cancer - Prostatitis</description>
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		<title>Renal Cancer</title>
		<description><![CDATA[Renal cancer is a relatively rare cancer accounting for approximately 3% of all adult malignancies. There are more than 5000 new cases diagnosed per year in the UK and the incidence is increasing. It most commonly affects people in their fifth to seventh decades with a male-to-female ratio of approximately 2:1. Renal cell carcinoma (also known as clear cell carcinoma or hyper-nephroma) accounts for 80-85% of all kidney cancers. Papillary renal carcinoma constitutes approximately 10%, with the remainder including chromophobe and collecting duct carcinomas. Transitional cell carcinomas, squamous cell carcinomas and lymphomas can also arise in the kidney. Risk factors for the development of Renal cell carcinoma include smoking, obesity, adult polycystic kidney disease and long-term renal replacement therapy. Approximately 1% of RCCs are hereditary, the most commonly associated syndrome being the von Hippel-Lindau syndrome. It has recently been demonstrated that most cases of sporadic Renal cell carcinoma have mutations in the von Hippel-Lindau gene, located on the short arm of chromosome three, Read more [...]]]></description>
		<link>http://healthandprostate.com/urological-oncology/renal-cancer</link>
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		<title>Principles of therapy</title>
		<description><![CDATA[Chemotherapy Cytotoxic chemotherapy remains the mainstay of systemic treatment for most solid cancers. Renal cell carcinoma however is a characteristically unresponsive tumour and at present, these agents are not routinely used. A comprehensive review of chemotherapy in Renal cell carcinoma, performed by Yagoda etal., included 4093 patients in 83 trials between 1983 and 1993. The trials included every class of anticancer agent. The overall RR was 6% (1.3% complete response (CR); 4.7% partial response (PR)). Similarly, a review of published literature between 1990 and 1998 showed no survival benefit for any single-agent chemotherapy drug. Vinblastine is a cytotoxic drug with some activity in Renal cell carcinoma. For a time it was regarded as the best available agent. However, it is clear that response rates are low, typically between 2% and 7%, and Vinblastine is no longer routinely used in the treatment of Renal cell carcinoma. 5-Fluorouracil is a cytotoxic drug that has some single-agent activity (approximately 10% RR) in Renal cell carcinoma. Introduced in the 1950s, it represents Read more [...]]]></description>
		<link>http://healthandprostate.com/urological-oncology/principles-of-therapy-2</link>
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		<title>Drugs available</title>
		<description><![CDATA[Interferons Interferons are a heterogeneous group of glycoproteins produced by mammalian cells in response to viral infections or other inducers. Three major types have been identified - interferon-a, interferon-β (class I) and inter-feron-8 (class II). As well as helping to fight viruses, interferons have anti-tumour properties. These may be mediated through a direct cytotoxic effect on tumour cells or through augmentation of the immunogenicity of tumours by upregulation of histocompatibility and tumour-associated antigens, and/ or activation of macrophages, T lymphocytes and natural killer cells [14]. It is also thought that interferons possess anti-angiogenic properties. The anti-neoplastic activity of IFN-a was first shown in hairy cell leukaemia and Kaposi's sarcoma. Subsequent studies have documented its activity in chronic mylogenous leukaemia, B and T cell lymphomas and melanoma. IFN-a is the most extensively tested IFN in clinical studies of patients with mRCC. The use of IFN-a in Renal cell carcinoma first began in the 1980s. It is now widely accepted in the UK as first-line Read more [...]]]></description>
		<link>http://healthandprostate.com/urological-oncology/drugs-available</link>
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		<title>Future developments</title>
		<description><![CDATA[Anti-angiogenesis agents Angiogenesis refers to the formation of new blood vessels and is an important step in tumour growth. It is estimated that most tumours need to trigger angiogenesis in order to grow beyond 2 mm in diameter. The initiation and promotion of angiogenesis is under the control of a variety of cytokines and hormones, termed angiogenic factors, and include vascular endothelial growth factor, basic fibroblast growth factor, IL-8 and a tumour necrosis factor. Renal tumours are highly vascular and this makes them an attractive target for inhibitors of angiogenesis. The development of anti-angiogenesis agents is the focus of much research, both in Renal cell carcinoma and in other solid malignancies. These novel approaches have burgeoned over recent years. Two such agents are discussed below. Thalidomide is infamous as a drug that was prescribed to pregnant women in the late 1950s to combat morning sickness, which resulted in birth defects in thousands of children. We now know that thalidomide possesses anti-angiogenic properties and in utero this impaired limb development, with Read more [...]]]></description>
		<link>http://healthandprostate.com/urological-oncology/future-developments-2</link>
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		<title>Testicular Cancer</title>
		<description><![CDATA[A germ cell tumour of the testis is a rare disease although it is the most common tumour in men aged 20-35 years. The incidence of testicular cancer is about 4-5 per 100000 men per year, but there is a geographical and racial variation. Most patients present themselves with a painless lump in the testicle. Sometimes the first symptoms are related to retroperitoneal lymph node metastasis (back pain) or to lung metastasis (haemoptysis or breathlessness). A few patients present with gynaecomastia as a result of an elevated level of the tumour marker human chorionic gonadotrophin. The diagnosis is established after an inguinal orchiectomy, and germ cell tumours are distinguished into seminomas and non-seminomas, each accounting for about 50% of the total. Staging includes, next to physical examination, computed tomographic scanning of the chest, the abdomen and the pelvis and determination of the serum levels of lactodehydrogenase, alpha-fetoprotein and human chorionic gonadotrophin. The Royal Marsden staging system is widely used [1]. In stage I there is no evidence of metastatic disease and the Read more [...]]]></description>
		<link>http://healthandprostate.com/urological-oncology/testicular-cancer</link>
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		<title>Non-seminoma stage I</title>
		<description><![CDATA[The cure rate for patients with non-seminomatous tumours in clinical stage I exceeds 95%. About 20% of patients with stage I disease without lymphatic or vascular invasion or without invasion into the tunica albuginea, spermatic cord or scrotum are discovered to have regional lymph node metastases at surgery. Nerve-sparing retroperitoneal lymph node dissection and surveillance are both standard treatment options. Nerve-sparing retroperitoneal lymph node dissection A primary retroperitoneal lymph node dissection after orchiectomy allows careful pathological staging, while at the same time offering a therapeutic benefit if the retroperitoneal lymph nodes are positive. A nerve-sparing retroperitoneal lymphadenectomy that preserves ejaculation in virtually every clinical stage I patient appears to be as effective as the standard retroperitoneal lymphadenectomy. Despite the improved accuracy of clinical staging methods about 20% of patients with clinical stage I have pathological stage II disease at retroperitoneal lymphadenectomy. Many of these patients are cured surgically without subsequent chemotherapy. Read more [...]]]></description>
		<link>http://healthandprostate.com/urological-oncology/non-seminoma-stage-i</link>
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		<title>Non-seminoma stage II-Intravenous</title>
		<description><![CDATA[Disseminated non-seminoma is highly curable. In most patients, an orchiectomy  is   performed   before   starting  chemotherapy.   However,   if  the diagnosis has been made by biopsy of a metastatic site and chemotherapy initiated, subsequent orchiectomy is generally performed due to the fact that chemotherapy may not eradicate the primary cancer. This is illustrated by case reports in which viable tumour was found on postche-motherapy orchiectomy despite complete response of metastatic lesions. After the introduction of cisplatin, vinblastine and bleomycin (PVB) combination chemotherapy, consisting of a remission-induction part and a maintenance part, the strategy for treatment outcome improvement had focused on less toxicity with similar efficacy. It was shown that the dosage of vinblastine could be reduced (0.3 mg/kg vs 0.4 mg/kg) and that maintenance chemotherapy does not prevent relapses but adds significantly to the toxicity. Later on vinblastine has been replaced by etoposide; based on the efficacy of etoposide in salvage therapy, and based on the results of a randomized Read more [...]]]></description>
		<link>http://healthandprostate.com/urological-oncology/non-seminoma-stage-ii-intravenous</link>
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		<title>Treatment of recurrent disease</title>
		<description><![CDATA[Deciding on further treatment in case of recurrent testicular cancer depends on many factors, including the histology, prior treatment, site of recurrence, as well as individual patient considerations. Salvage regimens consisting of ifosfamide, cisplatin and either etoposide or vinblastine can induce long-term complete responses in about one quarter of patients with disease that has persisted or recurred following first-line cisplatin-based regimens. Patients who have had an initial complete response to first-line chemotherapy and those without extensive disease have the most favourable outcome. The VIP regimen is now the standard initial salvage regimen. However, few, if any, patients with recurrent NSGCTs of an extragonadal origin achieve long-term disease-free survival using VIP if their disease recurs. High-dose chemotherapy with autologous stem cell transplantation has also been used with some success in the setting of refractory disease. Durable complete remissions may be achievable in 10-20% of patients. The durable complete remission rate may even exceed 50% in selected patients if high-dose Read more [...]]]></description>
		<link>http://healthandprostate.com/urological-oncology/treatment-of-recurrent-disease</link>
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		<title>Systemic Therapy for Bladder Cancer</title>
		<description><![CDATA[Despite radical treatments with curative intent, the chance of long-term survival for patients with muscle-invasive bladder cancer remains disappointing. In a large series of more than 1000 patients with apparently organ-confined disease, 5-year overall survival was only 47% for all muscle-invasive tumours, ranging from 72% for T2 tumours to only 33% for T4 disease. Death from bladder cancer following radical primary treatment is largely due to occult systemic disease, present at the time of surgery, which is below the limits of resolution of currently available cross-sectional imaging. This post reviews systemic therapy for muscle-invasive cancer of the urothelium and describes the common drugs that are used, the various clinical scenarios when they may be indicated and the selection of patients for treatment. Drugs in use Orthodox cytotoxic agents Transitional cell carcinoma (transitional cell carcinoma) is sensitive to a variety of drugs as shown by complete or partial response in patients with measurable metastatic or locally advanced disease. Of the older cytotoxic drugs, Read more [...]]]></description>
		<link>http://healthandprostate.com/urological-oncology/systemic-therapy-for-bladder-cancer</link>
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		<title>Comparison of well-known combination regimens</title>
		<description><![CDATA[CMV and MVAC The CMV regimen  is a combination of cisplatin, methotrexate and, vinblastine. In the context of a randomized controlled phase III clinical trial, treatment with CMV resulted in an objective response rate of 46%, with a median survival of 7 months. MVAC combines cisplatin with methotrexate, vinblastine and doxorubicin (Adriamycin®). In randomized controlled trials, this regimen has been found superior to single-agent cisplatin, combination chemotherapy with cisplatin, cyclophosphamide and doxorubicin (CISCA) and also methotrexate, carboplatin and vinblastine (MCAVI). For these phase III studies, overall response rates have varied between 39% and 65%, with median survivals up to 16 months. Dose escalation of MVAC has been attempted using recombinant haematopoietic growth factors. Better objective response rates have been reported with the more dose-intense regimen; this did not translate into improved time to disease progression or overall survival in a large randomized controlled trial. However, toxicity was significantly less in the accelerated arm, suggesting that the accelerated Read more [...]]]></description>
		<link>http://healthandprostate.com/urological-oncology/comparison-of-well-known-combination-regimens</link>
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