Guideline for the Management of Clinically Localized Prostate Cancer: 2007 Update

Neoadjuvant chemotherapy in invasive bladder cancer: Update of a systematic review and meta-analysis of individual patient data

The aim of this paper was to conduct a critical systematic review of the available literature on the clinical and economic burden of bladder cancer in developed countries, with a focus on the cost effectiveness of interventions aimed at reducing that burden.Forty-four economic studies were included in the review. Because of long- term survival and the need for lifelong routine monitoring and treatment, the cost per patient of bladder cancer from diagnosis to death is the highest of all cancers, ranging from 96000-187000 US dollars (2001 values) in the US. Overall, bladder cancer is the fifth most expensive cancer in terms of total medical care expenditures, accounting for almost 3.7 billion US dollars (2001 values) in direct costs in the US. Screening for bladder cancer in the general population is currently not recommended. The economic value of relatively new and less expensive urine assays and molecular urinary tumour markers has not been assessed. However, the literature suggests that screening patients suspected of having bladder cancer and using less invasive diagnostic procedures is cost effective. Very few cost-effectiveness studies have evaluated intravesical therapies such as bacillus Calmette-Guerin and mitomycin in the management of superficial disease and no robust recommendations can be drawn. Economic analyses suggest that non-surgical treatment strategies for the management of invasive disease aiming at bladder preservation may not be cost effective, because they have not consistently demonstrated survival benefits and do not eliminate the need for subsequent radical cystectomy. The literature suggests that the current conventional frequent follow-up and monitoring of patients can be cost effectively replaced by less frequent and less invasive monitoring, and should rely more heavily on intravesical chemotherapy to reduce the need for cystoscopies. Bladder cancer is a fairly common and costly malignancy. Nevertheless, the existing literature only contributes marginally to our knowledge concerning the burden of bladder cancer and the economic value of various interventions. The limited value of the literature in this area may be attributed to (i) being published as abstracts rather than full peer-reviewed evaluations; (ii) employing questionable methodologies; and (iii) being in many cases nearly obsolete, rendering them less relevant to, if not in conflict with, current clinical practice. Consequently, opportunities exist to conduct meaningful economic research in all areas of the management of bladder cancer, including screening, diagnosis, follow-up and treatment, especially with respect to new and innovative pharmaceutical and other technologies.

The health economics of bladder cancer: a comprehensive review of the published literature

Neoadjuvant chemotherapy in invasive bladder cancer: a systematic review and meta-analysis

Objective
Bladder cancer (BC) has the highest lifetime treatment costs per patient of all cancers. The high recurrence rate and ongoing invasive monitoring requirement are the key contributors to the economic and human toll of this disease. The purpose of this paper was to utilize the recent literature to identify opportunities for improving the benefits and costs of BC care.

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Economic aspects of bladder cancer: what are the benefits and costs?

Low dose bacillus Calmette-Guerin for carcinoma in situ of the bladder: long-term results.

Sperm antibodies and infertility in patients with testicular cancer.

Neoadjuvant m-vac chemotherapy of invasive bladder cancer: results of a multicenter phase iii trial

Low Dose Pasteur Bacillus Calmette-Guerin Regimen in Stage T1, Grade 3 Bladder Cancer Therapy

Zusammenfassung

Immunologische und klinische Untersuchungen bei Patienten nach Samenstrangtorsion



Es wurden 25 Patienten untersucht, bei denen postpubertar eine Samenstrangtorsion aufgetreten war. Der Zeitraum zwischen aufgetretenen Symptomen und Untersuchung lag zwischen 6 Monaten und 7 Jahren. Bei der Untersuchung des Spermas dieser Patienten stellte sich heraus, das die Spermatozoenzahl bei Patienten mit atrophischen Hoden (13 Patienten) geringer war als bei Patienten mit normalen Hoden oder bei Zustand nach Orchidektomie. Weiter war die Spermatozoendichte vermindert bei Patienten, bei denen die Torsion langer als 2 Jahre zurucklag (12 Patienten) gegenuber denen, bei denen sie erst kurzlich aufgetreten war (13 Patienten).



Agglutinationsantikorper wurden bei 20 % der Patienten gefunden; sie wiesen allerdings keine Korrelation mit Fertilitat bzw. Sterilitat auf.



Immunfluoreszenzantikorper waren ebenfalls nicht mit Veranderungen der Spermaqualitat korreliert. Bei Patienten mit zum Untersuchungszeitpunkt normalen Hoden waren sie nicht vorhanden.



Auf der anderen Seite bestand ein eindeutiger Bezug zwischen Immobilisationsantikorpern und Sterilitat, insbesondere mit Beeintrachtigung der Motilitat.



Diese Befunde legen nahe, das Sterilitat nach Samenstrangtorsion mit einem Autoimmungeschehen einhergeht. Moglicherweise tritt dieses besonders bei Patienten mit atrophischen Hoden auf und bildet sich erst im Laufe von mehr als 2 Jahren vollstandig heraus.

A. Lembo

Papers

Low dose bacillus Calmette-Guerin for carcinoma in situ of the bladder: long-term results.

Sperm antibodies and infertility in patients with testicular cancer.

Neoadjuvant m-vac chemotherapy of invasive bladder cancer: results of a multicenter phase iii trial

Low Dose Pasteur Bacillus Calmette-Guerin Regimen in Stage T1, Grade 3 Bladder Cancer Therapy

Immunological and Clinical Study in Patients after Spermatic Cord Torsion