Vaičiūnas, Kęstutis

Testicular metastasis from prostate cancer is extremely rare, and on conventional radiological imaging, features can be non-specific, making diagnosis challenging. We report a case of a 63-year-old man with locally advanced prostate adenocarcinoma initially treated with radiotherapy and a 3-year course of androgen deprivation therapy. During follow-up, a rising PSA level prompted further evaluation. Conventional imaging revealed a heterogeneous lesion in the left testis. The patient underwent a left radical orchiectomy. Histological and immunohistochemical analysis confirmed a high-grade metastatic prostate adenocarcinoma. Postoperatively, the PSA level decreased to 0.04 ng/ml and remained stable for at least 2 years under active surveillance with PSA monitoring. This case demonstrates the potential of radical orchiectomy as a metastasis-directed approach for isolated testicular metastasis from castration-sensitive prostate cancer, delaying the need for systemic treatment. Further studies are needed to clarify its place in clinical practice.

Introduction & Objectives: Multiparametric magnetic resonance imaging (MRI), with or without MRI-targeted biopsy, is getting the important role as an alternative test to systematic transrectal ultrasonography-guided biopsy in men suspected of prostate cancer. Cognitive fusion biopsy method is underrated and we need more detailed evidence-based decision-making on which investigation to use for diagnosing prostate cancer. Objectives: This study aims to evaluate the improvement in concordance of prostatectomy specimens with prostate biopsy (PB) histopathology obtained using the cognitive MRI-fusion approach compared with the 10-core transrectal systemic biopsy and determining the influencing factors. Materials & Methods: A single-centre prospective study included 351 men scheduled for initial prostate biopsy between January 2021 and July 2025 due to elevated total PSA levels or abnormal digital rectal examination (DRE). Biopsies were performed based on multiparametric magnetic resonance imaging (mpMRI) findings. 76 patients underwent radical prostatectomy. The patients were divided into groups based on the biopsy method: 69 patients underwent only systemic transrectal biopsy and 282 patients underwent transrectal systemic and targeted biopsy. The histopathological grading of these biopsy specimens was compared with that of radical prostatectomy specimens. Multivariate logistic regression analyses were conducted to evaluate the impact of various criteria on histopathological concordance. Results: Cognitive MRI-fusion PB had a significantly higher upgrading of prostatectomy histopathology than systemic PB in all Gleason grade categories. Systemic PB showed significantly better concordance with prostatectomy histopathology than MRI-fusion PB (100 % vs. 64,79 %, p < 0.01), but the sample of patients with systemic PB was too small. PI-RADS score is an independent predictor for concordance (OR = 1,72, 95%CI = 1,27 – 2,32, p = 0.01) and downgrading (OR = 0.18, 95%CI = 0.05-0.61, p = 0.01). In biopsy specimens detected clinically significant prostate cancer showed ability to predict concordance (OR = 4.74, 95%CI = 1.27 – 17.64, p = 0.02) and upgrading (OR = 0.1, 95%CI = 0.02 – 0.49, p = 0.01) with the prostatectomy histopathological results. Conclusions: Performed MRI and PI-RADS score are independent predictors of the concordance between biopsy and final histopathology after prostatectomy and post-prostatectomy histopathology downgrading. Detected clinically significant prostate cancer leads to the expectation of better histological concordance and lower upgrading. Despite limitations, these findings underscore the potential of systemic and cognitive targeted PB for detecting prostate cancer more accurately in clinical practice, advocating for larger cohorts to validate these results.

Introduction & Objectives: The aim of this study was to evaluate whether MSKCC pre-radical prostatectomy prostate cancer nomograms are a reliable method for predicting prostate cancer (PCa) recurrence-free survival (RFS) after I-125 seeds brachytherapy. Objectives: a) To calculate 5- and 10-year biochemical recurrence-free survival (RFS) probabilities using MSKCC nomograms in patients treated with I-125 brachytherapy. b) To compare nomogram-predicted and actual recurrence free PCa outcomes. c) To evaluate the impact of tumor extension parameters (extracapsular extension (ECE) seminal vesicle invasion (SVI), lymph node invasion (LNI)) on PCa recurrence risk. Materials & Methods: Patients diagnosed with PCa and treated with LDR brachytherapy between the years 2007 and 2024 in the Hospital of Lithuanian University of Health Sciences, Kaunas Clinics, were included into this retrospective study. Medical records of 645 patients were analyzed, collecting demographic and clinical data including age, prostate-specific antigen (PSA) levels, biopsy results, Gleason score, and biochemical recurrence. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 30.0. Results: The mean patient age was 63±7 years (range 39–88). During a mean follow-up of 10±5.4 years, 34 patients developed recurrence and 19 died from PCa. In our study PCa recurrence-free survival was 96% at 5 years and 94% at 10 years. MSKCC nomogram calculated predictions were 86±11% for 5 years and 77±14% for 10-years PCa recurrence-free survival; predicted probabilities were related to actual outcomes (p<0.001) but underestimated real results of our study. Calculated ECE probability was higher in patients with PCa recurrence group compared to PCa recurrence-free patients (49±20% vs 33±16%, p<0.001). In univariate analysis, ECE, SVI, and LNI were significant predictors of PCa recurrence (p<0.001), but in multivariate analysis only ECE remained significant: each 1% increase was associated with a 5% higher recurrence risk (HR 1.05, p<0.001). Patient age was not a significant predictor. Conclusions: Observed 5- and 10-year PCa recurrence-free survival rates after LDR brachytherapy were 96% and 94%, respectively. MSKCC nomogram predicted the probability of PCa progression-free survival after I-125 seeds brachytherapy but their prognosis was worse than our study data. Among tumor extension parameters, ECE probability was an independent predictor of PCa recurrence, whereas seminal vesicle invasion and lymph node invasion were not significant in multivariate analysis. These findings suggest that more precise prediction models are needed for patients treated with LDR brachytherapy.

Introduction Testicular metastasis from prostate cancer (PCa) is an extremely rare phenomenon mostly observed in patients with high-grade disease. It occurs in approximately 0.5% of patients with metastatic disease. Case Presentation We present a 63-year-old man with a history of locally advanced PCa (cT3bN1M0) characterized by pure adenocarcinoma, ISUP Grade Group 3, and an initial PSA of 11.8 ng/mL. The patient underwent external beam radiation therapy (50 Gy /25 fr), high-dose-rate brachytherapy (9 Gy/2 fr) and ADT with a PSA nadir of 0.07 ng/mL. Five months after completing ADT, the PSA level began to rise to 3.28 ng/ml. CT and prostate MRI revealed a heterogeneous contrast-enhancing mass within the left testis, resembling a primary testicular tumor. Testicular cancer tumor markers were normal. The patient underwent left radical orchofuniculectomy. Histopathological and immunohistochemical analysis confirmed a highgrade metastatic prostate adenocarcinoma with cribriform growth pattern (ISUP Grade Group 5). Following the surgery, PSA level dropped to 0.04 ng/mL and remained stable for nearly two years, with a recent slight rise to 0.38 ng/mL. CT, MRI and bone scintigraphy have shown no evidence of recurrence. ADT is planned if PSA rises. Discussion Testicular metastasis in PCa may present either as an isolated lesion or as a part of widespread metastatic involvement. The interval between definitive treatment and the development of testicular metastasis can vary widely, ranging from several months up to 22 years. Clinically, testicular involvement may be asymptomatic or manifest as a painful palpable mass, swelling, or even mimic orchitis. The introduction of PSMA/PET-CT has proven particularly valuable in such cases, demonstrating high sensitivity in detecting metastatic lesions even at rare sites. The primary management approach is radical orchiectomy, with most reported cases of isolated testicular metastasis subsequently managed with ADT. However, in our case, ADT was not initiated immediately; instead, the patient was placed under close biochemical surveillance, potentially avoiding or delaying the systemic therapy and its adverse effects. Conclusions This case highlights the rarity of testicular metastasis from PCa and suggests that vigilant monitoring of PSA level may be a suitable alternative to immediate systemic therapy in selected patients.

Both obesity and chronic kidney disease (CKD) are increasingly recognized as global epidemics. Their escalating incidence and far-reaching health implications highlight the urgent need for comprehensive prevention and management strategies. This review aims to clarify how obesity interacts with end-stage kidney disease (ESKD) and how to improve the management of obese patients receiving kidney replacement therapy. It also explores underlying mechanisms, current treatments, future directions, and ongoing controversies. By highlighting this intricate relationship, the review seeks to enhance clinical practice and promote further research toward more personalized care for this vulnerable population. Obesity is frequent in dialysis patients and creates challenges related to body composition, metabolism, and treatment. While higher body mass index (BMI) may appear to improve survival, this paradox does not offset the cardiovascular and functional risks of visceral and sarcopenic obesity. Obesity also increases post-transplant complications and can limit access to transplantation. Lifestyle changes rarely achieve lasting weight loss, whereas bariatric surgery—especially sleeve gastrectomy—can improve transplant eligibility with fewer complications. Weight-loss medications may be used before transplantation but remain insufficiently studied in ESKD. After transplantation, weight-reduction efforts should continue, with pharmacotherapy preferred over bariatric surgery. Comprehensive assessment strategies and individualized management approaches in ESKD patients are essential to optimize outcomes in this growing patient population.

Introduction Papillary transitional cell carcinoma (TCC) is the most common type of bladder cancer, accounting for 84.32% of cases. The presence of tumors in various parts of the urinary tract is a known feature of TCC, often due to intraluminal seeding. This report discusses a rare case of non-invasive TCC affecting three distinct sites in the urinary system due to COVID-19 crisis [1,2]. Case Presentation A 62-year-old man presented with hematuria. Cystoscopy revealed urinary bladder carcinoma staged as pT2G3, confirmed by transurethral resection. During follow-up, ureterocystoscopy showed altered mucosal appearance; a biopsy confirmed pT1G2 TCC. Bacillus Calmette-Guérin therapy was initiated. Follow-up revealed bladder neck elevation and prostate enlargement, preventing ureterocystoscopy. The patient developed a severe COVID-19 infection, causing missed treatment appointments. Resection of the prostatic urethra and bladder neck was performed, with histology confirming pT4aG2 TCC. A CT scan showed no metastasis, and neoadjuvant chemotherapy began. Further treatment included radical cystoprostatectomy, lymph node dissection, and appendectomy. A Wallace ureteroenteric anastomosis and urostomy were performed. Later, CT revealed right hydronephrosis due to a ureteral stricture. Further evaluation showed ureteral obstruction by a tumor with a cystic abscess and pyelonephritis. Antibiotics and nephrostomy were administered. Right ureter resection with Bricker anastomosis was performed. The patient continues treatment and follow-up. Discussion Papillary transitional cell carcinoma (TCC) presents a significant challenge due to its multifocality and recurrence. Surgery remains the primary treatment, with radiotherapy and chemotherapy for high-grade cases. In March 2020, Lithuania’s COVID-19 emergency led to outpatient closures, reducing cancer care by 16.8% that year [4–6]. Conclusions COVID-19-related disruptions contributed to TCC in the bladder, ureter, and prostate, complicating treatment. Further research into multifocal TCC’s genetic and molecular characteristics may improve targeted therapies. Globally, recurrences increased as patients delayed seeking care due to widespread facility closures.

Introduction Radical nephroureterectomy (RNU) represents the gold standard of care for managing upper tract urothelial carcinoma (UTUC) [1]. Recently, kidney-sparing surgery (KSS) – distal ureterectomy (DU) has emerged as a viable alternative, by removing only the affected portion of the ureter and allowing it to preserve kidney function [2]. Case presentation Six months ago, a 74-year-old female patient underwent treatment for pyelonephritis and sepsis. A CT scan was performed which revealed a nonspecific structure in the distal 1/3 of the left ureter. Therefore, cystourethroscopy and a biopsy were performed, which detected infiltrative papillary UTUC. A few months later, the patient was admitted to the urology department with complaints of macrohematuria and left-side pain. An RNU was scheduled, however, dynamic scintigraphy showed an impaired function of the right kidney. It was decided to perform a leftside DU, a pelvic lymphadenectomy, and a ureterocystoneostomy. Surgical procedures and recovery proceeded without any complications. Histological examination confirmed infiltrative papillary UTUC pT2N0R0G2. [...].

Background and Objectives: Early improvements to graft function are crucial for good outcomes in kidney transplantation (kTx). Various factors can influence early graft function. This study aimed to evaluate the pre- and post-transplant hydration statuses of kTx recipients using bioimpedance analysis (BIA) and lung ultrasonography (LUS) and to investigate the hydration status’ relationship with the function of the transplanted kidney during the first year after transplantation. Materials and Methods: This observational prospective cohort study included deceased kidney recipients transplanted in the Hospital of the Lithuanian University of Health Sciences between September 2016 and January 2023. BIA and LUS were performed before transplantation, on days 3 and 7, and at discharge. Data on recipient and donor clinical characteristics were collected. Graft function was evaluated according to the serum creatinine reduction ratio and the need for dialysis. Hydration status was evaluated by calculating B-lines (BL) on LUS and the ratio of extracellular/total body water on BIA. Results: Ninety-eight kTx recipients were included in the study. Patients with immediate graft function (IGF) were compared to those with slow or delayed graft function (SGF + DGF). Recipients in the SGF + DGF group had a higher sum of BL on LUS before transplantation. After transplantation in early postoperative follow-up, both groups showed hyperhydration as determined by BIA and LUS. After one year, recipients with no BL before transplantation had better graft function than those with BL. Logistic regression analysis showed that having more than one BL in LUS was associated with a 2.5 times higher risk of SGF or DGF after transplantation. Conclusions: This study found that lung congestion detected by LUS before kTx was associated with slower graft recovery and worse kidney function after 1 year. Meanwhile, the hyperhydration status detected by BIA analysis did not correlate with the function of the transplanted kidney.

Background: The study aimed to assess predictors and to identify patients at increased risk of prostate-cancer-specific mortality (CSM) after radical prostatectomy (RP). Methods: A total of 2421 men with localized and locally advanced PCa who underwent RP in 2001–2017 were included in the study. CSM predictors were assessed using multivariate competing risk analysis. Death from other causes was considered a competing event. Cumulative CSM and other-cause mortality (OCM) were calculated in various combinations of predictors. Results: During the median 8 years (interquartile range 4.4–11.7) follow-up, 56 (2.3%) of registered deaths were due to PCa. Cumulative 10 years CSM and OCM was 3.6% (95% CI 2.7–4.7) and 15.9% (95% CI 14.2–17.9), respectively. The strongest predictors of CSM were Grade Group 5 (GG5) (hazard ratio (HR) 19.9, p < 0.0001), lymph node invasion (HR 3.4, p = 0.001), stage pT3b-4 (HR 3.1, p = 0.009), and age (HR 1.1, p = 0.0007). In groups created regarding age, stage, and GG, cumulative 10 years CSM ranged from 0.4–84.9%, whereas OCM varied from 0–43.2%. Conclusions: CSM after RP is related to GGs, pathological stage, age, and combinations of these factors, whereas other-cause mortality is only associated with age. Created CSM and OCM plots can help clinicians identify patients with the most aggressive PCa who could benefit from more intensive or novel multimodal treatment strategies.

Prediabetas yra angliavandenių apykaitos sutrikimas, pagrįstas glikemijos rodikliais, viršijančiais normą, tačiau nesiekiančiais cukrinio diabeto ribų. Jis dar vadinamas tarpine hiperglikemija ir siejamas su makrokraujagysline ateroskleroze bei su tuo susijusiomis širdies ir kraujagyslių ligomis, didina diabetinės retinopatijos ir nefropatijos riziką. Pastaraisiais dešimtmečiais prediabeto paplitimas pasaulyje didėja, tačiau tikslūs globalaus prediabeto plitimo duomenys nėra žinomi. Prognozuojama, kad 2030 m. juo gali sirgti daugiau 470 milijonų žmonių. LSMU Endokrinologijos instituto mokslininkų tyrimo duomenimis, viename Lietuvos rajone prediabetas diagnozuotas daugiau nei 32 proc. populiacijos. Tarptautinės diabeto federacijos 2019 m. duomenimis, gliukozės tolerancijos sutrikimas nustatomas 7,5 proc. 18-99 metų amžiaus žmonių, ir apie pusę jų jaunesni nei 50 metų. Leidinyje pateikiama prediabeto patofiziologija, rizikos veiksniai, diagnostika, aptariamos prediabeto sąsajos su periferine nervų sistema, mikro- ir makrokraujagyslių pokyčiais, hipertenzija, širdies nepakankamumu, akių ir inkstų ligomis, aprašomas prediabetas ir hemostazė, vyrų lytinių hormonų pusiausvyros ir erekcijos trikimai prediabeto atvejais, prediabeto problemos vaikų amžiuje, pateikiama duomenų apie pirminę diabeto sukeltą komplikacijų prevenciją ir kt. klausimai.