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Directory of Authors from the Journal and their last article.

Daniel RicchiutiView Articles

Volume 19, Number 1Case Review

Bladder Cancer That Metastasized to the Skin: A Unique Presentation That Signifies Poor Prognosis

Tal CohenMark MemoDaniel Ricchiuti

In the United States in 2015, an estimated 74,000 new cases of bladder cancer were diagnosed and approximately 16,000 deaths were due to bladder cancer. We present a rare case of a patient with aggressive bladder cancer who presented with multiple inguinal and scrotal skin lesions that were proven to be metastatic urothelial malignancy. Bladder malignancy can involve the skin by direct tumor invasion, hematogenous routes, lymphatic spread, and direct seeding due to iatrogenic implantation. The cutaneous lesions have an extremely variable appearance, are resistant to therapies, and signify a dismal prognosis. [Rev Urol. 2017;19(1):68-71 doi: 10.3909/riu0740] © 2017 MedReviews®, LLC

Bladder cancerCutaneous metastasisUrothelial malignancy

Daniel ShoskesView Articles
Daniel W ChanView Articles
Daniel WollinView Articles
Daniela V. CastroView Articles

Volume 23, Number 3Kidney Cancer

Response to Targeted Therapy and Checkpoint Inhibition in a Patient With Mucinous Tubular and Spindle Cell Carcinoma: A Case Report and Literature Review

Ruchi AgarwalDaniela V. CastroYu Jun LiJaya GoudSalvador Jaime-Casas

Mucinous tubular and spindle cell carcinoma (MTSCC) is a form of renal cell carcinoma characterized by its tubular structure, mucinous stroma, and spindle-shaped cells. It makes up less than 1% of all renal cell carcinoma cases and has been classically described as indolent, although the disease course varies. Here we analyze the case of a 67-year-old woman with metastatic MTSCC with a sarcomatoid component. The course of treatment was extensive and included targeted therapy and immunotherapy. Thus, this case review offers insight into the heterogeneous clinical course of MTSCC and potential therapeutic options for these patients.

Immunotherapyimmune checkpoint inhibitorsCarcinoma, renal cellCarcinomaneoplasms, squamous, mucinous, and serouscarcinoma, tubular

Danielle D SweeneyView Articles
Danielle OsterhoutView Articles

Volume 17, Number 4Original Research

The 4Kscore® Test Reduces Prostate Biopsy Rates in Community and Academic Urology Practices

Jason HafronStephen M ZappalaDipen J ParekhDanielle OsterhoutJeffrey SchockRandy M ChudlerGregory M OldfordKenneth M KernenBadrinath R Konety

There is significant concern regarding prostate cancer screening because of the potential for overdiagnosis and overtreatment of men who are discovered to have abnormal prostate specific antigen (PSA) levels and/or digital rectal examination (DRE) results. The 4Kscore® Test (OPKO Diagnostics, LLC) is a blood test that utilizes four kallikrein levels plus clinical information in an algorithm to calculate an individual’s percentage risk (< 1% to > 95%) for aggressive prostate cancer (Gleason score ≥ 7) on prostate biopsy. The 4Kscore Test, as a follow-up test after abnormal PSA and/or DRE test results, has been shown to improve the specificity for predicting the risk of aggressive prostate cancer and reduce unnecessary prostate biopsies. A clinical utility study was conducted to assess the influence of the 4Kscore Test on the decision to perform prostate biopsies in men referred to urologists for abnormal PSA and/or DRE results. The study population included 611 patients seen by 35 academic and community urologists in the United States. Urologists ordered the 4Kscore Test as part of their assessment of men referred for abnormal PSA and/or DRE test results. Results for the patients were stratified into low risk (< 7.5%), intermediate risk (7.5%-19.9%), and high risk (≥ 20%) for aggressive prostate cancer. The 4Kscore Test results influenced biopsy decisions in 88.7% of the men. Performing the 4Kscore Test resulted in a 64.6% reduction in prostate biopsies in patients; the actual percentage of cases not proceeding to biopsy were 94.0%, 52.9%, and 19.0% for men who had low-, intermediate-, and high-risk 4Kscore Test results, respectively. A higher 4Kscore Test was associated with greater likelihood of having a prostate biopsy (P < 0.001). Among the 171 patients who had a biopsy, the 4Kscore risk category is strongly associated with biopsy pathology. The 4Kscore Test, as a follow-up test for an abnormal PSA and/or DRE results, significantly influenced the physician and patient shared decision in clinical practice, which led to a reduction in prostate biopsies while increasing the probability of detecting aggressive cancer. [Rev Urol. 2015;17(4):231-240 doi: 10.3909/riu0699] © 2016 MedReviews®, LLC

Prostate cancerProstate-specific antigen4KscoreGleason scoreDigital rectal examinationBiopsy rateProstate cancer prognosis

Danielo G FrietasView Articles
Danil V MakarovView Articles
Dara LundonView Articles
Darian KamehView Articles

Volume 19, Number 4Review Articles

A Head-to-Head Comparative Phase II Study of Standard Urine Culture and Sensitivity Versus DNA Next-generation Sequencing Testing for Urinary Tract Infections

Original Research

Vladimir MouravievDavid AlbalaMichael McDonaldDarian KamehMark E JohnsonTruls E Bjerklund Johansen

Many studies have discussed clinical practice guidelines for the treatment of cystitis and pyelonephritis. Treatment of uncomplicated urinary tract infections (UTIs) can be based on empiric antibiotic therapy. For complicated or recurrent UTIs, therapy can be based on laboratory-controlled culture and sensitivity (C&S) reports. The diagnosis of UTI by clinical criteria alone has an error rate of up to 33%. In addition, positive laboratory culture results do not always indicate a diagnosis of UTI. Comparison of urine in a conventional culture model versus DNA next-generation sequencing (NGS) to accurately identify and provide information on resistance factors (mobile genetic elements) is warranted. Our study was a head-to-head comparative phase II study of standard urine C&S versus DNA NGS testing for the diagnosis and treatment efficacy in patients with symptoms of acute cystitis based on short-term outcomes. [Rev Urol. 2017;19(4):213–220 doi: 10.3909/riu0780] © 2018 MedReviews®, LLC

Urinary tract infectionPyelonephritisCystitisDNA next-generation sequencing

Darius A PaduchView Articles
Darshan ShahView Articles
David A GoldfarbView Articles
David AlbalaView Articles

Volume 17, Number 4Review Articles

Sipuleucel-T for the Treatment of Patients With Metastatic Castrate-resistant Prostate Cancer: Considerations for Clinical Practice

Treatment Update

Christopher M PieczonkaVladimir MouravievDavid AlbalaDimitrios Telonis

Sipuleucel-T treatment is associated with a significant and consistent survival benefit in patients with metastatic castrate-resistant prostate cancer. Most adverse events are infusion related, manageable, and of short duration. Early screening and diagnosis of metastatic disease is important, as the greatest survival benefit may occur in patients with a lower disease burden. The short duration of sipuleucel-T treatment facilitates the use of subsequent therapies. Sipuleucel-T is now being used in the clinic for patients with a lower disease burden. We present our own experience with the use of sipuleucel-T in the setting of a large urology practice. [Rev Urol. 2015;17(4):203-210 doi: 10.3909/riu0671] © 2016 MedReviews®, LLC

ImmunotherapyMetastatic castrate-resistant prostate cancerSipuleucel-TClinical

David C BeyerView Articles
David C BoschView Articles

Volume 16, Number 2Review Articles

Treating Interstitial Cystitis/Bladder Pain Syndrome as a Chronic Disease

Management Review

Philip C BoschDavid C Bosch

The management of interstitial cystitis/bladder pain syndrome (IC/BPS) is both frustrating and difficult. The etiology is uncertain and there is no definitive treatment. Consequently, both patients and doctors tend to be unhappy and unsatisfied with the quality of care. The American Urological Association (AUA) provides a guideline for the diagnosis and treatment of IC/BPS. Recommended first-line treatments include patient education, self-care practices, behavior modifications, and stress management. Management of IC/BPS may be also improved if both patients and doctors treat this condition as a chronic disease. This article reviews the AUA first-line treatments for IC/BPS and considers the benefits of treating this condition as a chronic disease. [Rev Urol. 2014;16(2):83-87 doi: 10.3909/riu0603] © 2014 MedReviews®, LLC

Bladder pain syndromeInterstitial cystitisChronic diseaseAutoimmune diseases

David C ChaikinView Articles
David D WatsonView Articles

Volume 22, Number 3Case Review

From Radical to Partial Nephrectomy in the Setting of Solitary Functioning Kidney: Neoadjuvant Treatment of Renal Cell Carcinoma

David D WatsonNicole G FarhaK James KallailShaker DakhilA J Farha

Immunotherapy has revolutionized the treatment of metastatic renal cell carcinoma (RCC). This case evaluates the use of neoadjuvant immunotherapy for localized RCC in a patient with solitary functioning kidney. A retrospective chart review was conducted between September 2019 and January 2020 on a single patient. Before treatment, the tumor was 7 cm × 8 cm × 8.5 cm. The patient trialed nivolumab + ipilimumab then cabozantinib. The tumor shrunk to 6.3 cm × 5.5 cm and was removed via partial nephrectomy. This case demonstrates the efficacy of immunotherapy in neoadjuvant treatment of RCC. Expansion of guidelines could allow for patients with RCC to undergo partial nephrectomy. [Rev Urol. 2020;22(3):126-129] © 2020 MedReviews®, LLC

Renal cell carcinomaImmunotherapyNeoadjuvant immunotherapySolitary kidney

David F PensonView Articles