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Directory of Authors from the Journal and their last article.

Firas AbdollahView Articles

Volume 18, Number 1Review Articles

Contemporary Role of the Decipher® Test in Prostate Cancer Management: Current Practice and Future Perspectives

Management Update

Deepansh DalelaBjörn LöppenbergAkshay SoodJesse SammonFiras Abdollah

We performed a systematic literature search to identify original articles and editorials about the Decipher® Prostate Cancer Test (GenomeDx Biosciences, San Diego, CA) to provide an overview of the current literature and its present role in urologic clinical practice. The Decipher test, which uses the expression of 22 selected RNA markers (from a total of over 1.4 million), showed a very high discrimination in predicting clinical metastasis (0.75-0.83) and cancer-specific mortality (0.78) in external validation studies, outperforming all routinely available clinicopathologic characteristics. Further, the timing of postoperative radiotherapy (adjuvant vs salvage) may be guided based on Decipher scores. The Decipher test was also the only independent predictor of clinical metastasis in patients with biochemical recurrence after surgery. The Decipher Genomic Resource Information Database (GRID) is a novel research tool that captures 1.4 million marker expressions per patient and may facilitate precision-guided, individualized care to patients with prostate cancer. In this era of precision medicine, Decipher, along with the Decipher GRID platform, is a promising genomic tool that may aid in managing prostate cancer patients throughout the continuum of care and delivering appropriate treatment at an individualized level. [Rev Urol. 2016;18(1):1-9 doi: 10.3909/riu0706] © 2016 MedReviews®, LLC

Prostate cancerDecipher® Prostate Cancer TestGenomic classifierNeoplasm recurrenceLocal/surgeryTreatment outcome

Fouad AounView Articles

Volume 17, Number 2Review Articles

Penile Rehabilitation Strategies Among Prostate Cancer Survivors

Treatment Update

Fouad AounAlexandre PeltierRoland van Velthoven

Despite advances in technical and surgical approaches, erectile dysfunction (ED) remains the most common complication among prostate cancer survivors, adversely impacting quality of life. This article analyzes the concept and rationale of ED rehabilitation programs in prostate cancer patients. Emphasis is placed on the pathophysiology of ED after diagnosis and treatment of prostate cancer to understand the efficacy of rehabilitation programs in clinical practice. Available evidence shows that ED is a transient complication following prostate biopsy and cancer diagnosis, with no evidence to support rehabilitation programs in these patients. A small increase in ED and in the use of phosphodiesterase type 5 (PDE5) inhibitors was reported in patients under active surveillance. Patients should be advised that active surveillance is unlikely to severely affect erectile function, but clinically significant changes in sexual function are possible. Focal therapy could be an intermediate option for patients demanding treatment/refusing active surveillance and invested in maintaining sexual activity. Unlike radical prostatectomy, there is no support for PDE5 inhibitor use to prevent ED after highly conformal external radiotherapy or low-dose rate brachytherapy. Despite progress in the understanding of the pathophysiologic mechanisms responsible for ED in prostate cancer patients, the success rates of rehabilitation programs remain low in clinical practice. Alternative strategies to prevent ED appear warranted, with attention toward neuromodulation, nerve grafting, nerve preservation, stem cell therapy, investigation of neuroprotective interventions, and further refinements of radiotherapy dosing and delivery methods. [Rev Urol. 2015;17(2):58-68 doi: 10.3909/riu0652] © 2015 MedReviews®, LLC

Prostate cancerErectile dysfunctionPenile rehabilitationPhosphodiesterase type 5 inhibitorProstaglandin E

Francesca SurianoView Articles

Volume 15, Number 3Review Articles

Bladder Cancer After Radiotherapy for Prostate Cancer

Systematic Review

Francesca SurianoEmanuela AltobelliFederico SergiMaurizio Buscarini

External beam radiotherapy (EBRT) is frequently used in the management of prostate cancer (PCa) as definitive, postoperative, or salvage local treatment. Although EBRT plays a central role in the management of PCa, complications remain a troubling by-product. Several studies have demonstrated an association between radiotherapy and elevated risk of acute and late toxicities. A secondary malignancy induced by initial therapy represents one of the most serious complications related to definitive cancer treatment. The radiation-related secondary primary malignancy risk increases with increasing survival time. Transitional cell carcinoma of the bladder is the most frequent secondary primary malignancy occurring after radiotherapy and is described as more aggressive; it may be diagnosed later because some radiation oncologists believe that the hematuria that occurs after prostate EBRT is normal. Some patients treated for localized PCa will subsequently develop invasive bladder cancer requiring surgical intervention. Patients with PCa treated with EBRT should be monitored closely for the presence of bladder cancer. [Rev Urol. 2013;15(3):108-112 doi: 10.3909/riu0577] © 2013 MedReviews®, LLC

Prostate cancerBladder cancerRadiotherapyExternal beam radiotherapy

Francesco Paolo SelvaggiView Articles
Frank A LiporaceView Articles

Volume 19, Number 1Review Articles

Revisiting the Role of Testosterone: Are We Missing Something?

Thereapeutic Update

Vineet TyagiMichael ScordoRichard S YoonFrank A LiporaceLoren Wissner Greene

Testosterone is a pleiotropic hormone that plays an important role in the human body. Classically, testosterone was thought to be predominantly involved in androgenesis and physiology in boys and men. Through its conversion to estrogen, testosterone affects bone health, including bone density. Recently, there has been a renewed interest in the systemic role of testosterone in pain, well-being, and cardiovascular function in women and men alike. In this review, we discuss the historic significance of testosterone, its traditionally known physiology, and its molecular and cellular effects. We also discuss evidence for testosterone’s lesser known effects, including its role in women’s health. We suggest a need to revisit the clinical role of testosterone given its potential for applications to treat mood, cognitive health, and other illnesses, and its anabolic role in bone and muscle; we also suggest consideration of the current debate on risks of its use. [Rev Urol. 2017;19(1):16-24 doi: 10.3909/riu0716] © 2017 MedReviews®, LLC

Coronary heart diseaseTestosterone replacement therapyTestosterone

Frank CostaView Articles
Frank D GrecoView Articles
Frank DubeckView Articles

Volume 18, Number 3Original Research

Health Economic Impact and Prospective Clinical Utility of Oncotype DX® Genomic Prostate Score

Michael J KemeterPhillip G FebboDavid AlbalaRuixiao LuVincy JohnDylan StoyBela DenesMarybeth McCallAlan W ShindelFrank Dubeck

Prostate cancer (CaP) will be diagnosed in approximately 181,000 American men in 2016. Despite the high number of deaths from CaP in the United States, the disease has a protracted natural history and many men diagnosed with CaP will not die of the disease regardless of treatment. Unfortunately, identification of men with truly indolent/nonaggressive CaP is challenging; limitations of conventional diagnostic modalities diminish the ability of physicians to accurately stage every case of CaP based on biopsy results alone. The resulting uncertainty in prognosis may prompt men with low-risk CaP to proceed to morbid and expensive treatments for an unclear survival benefit. Incorporation of the Genomic Prostate Score (GPS) as part of the decision algorithm for patients with National Comprehensive Cancer Network very low-risk and low-risk cancer led to a substantial increase in uptake of active surveillance and substantial cost savings. GPS provides physicians and patients with an additional tool in assessing personalized risk and helps guide individual decision making. [Rev Urol. 2016;18(3):123-132 doi: 10.3909/riu0725] © 2016 MedReviews®, LLC

Prostate cancerOncotype DX® GPSGenomic testingHealth economicsClinical utility

Franklin C LoweView Articles
Franklin E KuehhasView Articles
Franklin GaylisView Articles

Volume 22, Number 4Review Articles

Low Penetrance Germline Genetic Testing: Role for Risk Stratification in Prostate Cancer Screening and Examples From Clinical Practice

Management Update

Gerald L AndrioleFranklin GaylisKelly K BreePaul DatoChristopher J KaneA Karim Kader

Broad-based prostate-specific antigen (PSA) screening has saved lives but at a substantial human and financial cost. One way of mitigating this harm, while maintaining and possibly improving the benefit, is by focusing screening efforts on men at higher risk. With age, race, and family history as the only risk factors, many men lack any reliable data to inform their prostate cancer (PCa) screening decisions. Complexities including history of previous negative biopsies, interpretation of negative and/or equivocal mpMRI findings, and patient comorbidities further compound the already complicated decisions surrounding PCa screening and early detection. The authors present cases that provide real-world examples of how a single nucleotide polymorphism–based test can provide patients and providers with personalized PCa risk assessments and allow for development of improved risk-stratified screening regimens. [Rev Urol. 2020;22(4):152–158] © 2021 MedReviews®, LLC

Prostate cancer screeningRisk stratificationSomatic DNA testGermline DNA testsSingle nucleotide polymorphism DNA test

Frans M DebruyneView Articles
Frederic KinkeadView Articles

Volume 23, Number 2Prostate Cancer

Real-World Comparison of Deep Prostate-Specific Antigen Response in Patients With Metastatic Castration-Sensitive Prostate Cancer Treated With Apalutamide or Enzalutamide

Benjamin H. LowentrittIbrahim KhilfehDominic PilonShawn DuCarmine RossiFrederic KinkeadLilian DiazJill KorsiakPatrick LefebvreGordon A Brown

Deep prostate-specific antigen reduction of at least 90% (PSA90 response) after androgen receptor pathway inhibitor initiation to treat metastatic castration-sensitive prostate cancer (mCSPC) is associated with longer survival. This real-world study evaluated the proportion of androgen receptor pathway inhibitor–naive patients with mCSPC who achieved PSA90 response 6 months after initiating apalutamide or enzalutamide.

Prostatic neoplasmsProstate-specific antigen (PSA)Prostate-specific antigenProstate-specific antigensCastrationAndrogen receptorAndrogen receptor antagoniststreatment effectiveness

Frederick A GulmiView Articles
Frederick D TaylorView Articles

Volume 14, Number 3Case Review

Two Separate Synchronous Primary Genitourinary Tumors

Matthew T SmithFrederick D TaylorWilliam P GianakopoulusRoy R Brown

A 54-year-old man presented to the office with gross painless hematuria, dysuria, and urinary frequency. He was diagnosed with renal cell carcinoma of the kidney and transitional cell carcinoma of the bladder. The article reviews the presentation, radiology, pathology, and intervention of an uncommon case of synchronous primary carcinomas, and aims to show the importance of continued clinical suspicion for multiple genitourinary primary neoplasms. [Rev Urol. 2012;14(3/4):104-107 doi: 10.3909/riu0555] © 2013 MedReviews®, LLC

HematuriaGenitourinary tumorDysuriaNeoplasmUrinary frequency

Fritz H SchroederView Articles
Gabriela De AngelisView Articles

Volume 9, Number 3Review Articles

Twenty Years of PSA: From Prostate Antigen to Tumor Marker

Diagnostic Update

Gabriela De AngelisStephen D MikolajczykHarry G RittenhouseAxel SemjonowL Blair Shamel

The measurement of prostate-specific antigen in serum is credited with dramatic advances in the early detection of men with prostatic carcinoma. This report summarizes the history of biochemical research and the current understanding and application of prostate-specific antigen in prostate cancer diagnostics. [Rev Urol. 2007;9(3):113-123]

Prostate cancerProstate-specific antigenHuman kallikrein

Gabriele CozziView Articles

Volume 15, Number 4Review Articles

Intracavitary Immunotherapy and Chemotherapy for Upper Urinary Tract Cancer: Current Evidence

Systematic Review

Luca CarmignaniRoberto BianchiGabriele CozziNicola MacchioneCarlo MarenghiSara MelegariMarco RossoElena TondelliAugusto MaggioniAngelica Grasso

A review of the literature was performed to summarize current evidence regarding the efficacy of topical immunotherapy and chemotherapy for upper urinary tract urothelial cell carcinoma (UUT-UCC) in terms of post-treatment recurrence rates. A Medline database literature search was performed in March 2012 using the terms upper urinary tract, urothelial cancer, bacillus Calmette-Guérin (BCG), and mitomycin C. A total of 22 full-text articles were assessed for eligibility, and 19 studies reporting the outcomes of patients who underwent immunotherapy or chemotherapy with curative or adjuvant intent for UUT-UCC were chosen for quantitative analysis. Overall, the role of immunotherapy and chemotherapy for UUT-UCC is not firmly established. The most established practice is the treatment of carcinoma in situ (CIS) with BCG, even if a significant advantage has not yet been proven. The use of BCG as adjuvant therapy after complete resection of papillary UUT-UCC has been studied less extensively, even if recurrence rates are not significantly different than after the treatment of CIS. Only a few reports describe the use of mitomycin C, making it difficult to obtain significant evidence. [Rev Urol. 2013;15(4):145-153 doi: 10.3909/riu0579] © 2014 MedReviews®, LLC

ImmunotherapyChemotherapyBacillus Calmette-GuérinUpper urinary tractUrothelial cell carcinomaMitomycin C

Ganesh K KarthaView Articles

Volume 17, Number 2Case Review

Long-term Survival From Muscle-invasive Bladder Cancer With Initial Presentation of Symptomatic Cerebellar Lesion: The Role of Selective Surgical Extirpation of the Primary and Metastatic Lesion

Ganesh K KarthaJoseph SanfrancescoEsther UdojiHemant Chaparala (4)Donna HanselJ Stephen Jones

A 59-year-old man was diagnosed with urothelial carcinoma involving an isolated cerebellar metastasis after presenting to the emergency department for headache complaints. After selective surgical excision of the symptomatic brain lesion and delayed cystectomy due to intractable hematuria, he survived 11 years without evidence of recurrence or subsequent systemic chemotherapy. He eventually expired after delayed recurrence in the lung, supraclavicular lymph node, and brain. To our knowledge, this is the only case of prolonged survival from urothelial carcinoma after selective surgical extirpation of the primary and metastatic lesion without subsequent systemic chemotherapy. [Rev Urol. 2015;17(2):106-109 doi: 10.3909/riu0643] © 2015 MedReviews®, LLC

Urothelial carcinomaBladder cancerMetastasisCystectomy

Ganesh S PalapattuView Articles