Authors

Main Content

Top Content

Directory of Authors from the Journal and their last article.

Markus MargreiterView Articles

Volume 11, Number 3Review Articles

Screening for Prostate Cancer: A Review of the ERSPC and PLCO Trials

Management Update

Herbert LeporSamir S TanejaBob DjavanElisabeth EckersbergerJulia FinkelsteinHelen SadriMarkus Margreiter

The advent of prostate-specific antigen (PSA) testing in the early 1980srevolutionized the diagnosis of prostate cancer. As a result of PSA testing,there has been a surge in the number of prostate cancer diagnoses. Thisreview examines the results of 2 recent landmark trials that studied the effectof screening on prostate cancer mortality: the European Randomized Study ofScreening for Prostate Cancer (ERSPC) and the US-based Prostate, Lung,Colorectal, and Ovarian (PLCO) Cancer Screening Trial.[Rev Urol. 2009;11(3):127-133 doi: 10.3909/riu0474]

PSA screeningEuropean Randomized Study of Screening for Prostate Cancer(ERSPC)Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial

Marnique BastoView Articles
Martin E GleaveView Articles
Martin I ResnickView Articles
Martin MinerView Articles

Volume 16, Number 4Review Articles

Erectile Dysfunction and Essential Hypertension: The Same Aging-related Disorder?

Screening Update

Raul I ClavijoMartin MinerJacob Rajfe

An erection is a mechanical event dependent primarily on corporeal vascular dynamics wherein arterial inflow and storage of blood within the corpora is greater than the egress of blood from the corpora. The most common cause of erectile dysfunction (ED) is the inability of the corporal tissue to store the blood within the corporal sinusoids once inflow into the corpora begins. This failure to store is primarily due to a corporal smooth muscle dysfunction and, in most men, is most likely an aging-related occurrence. Because the corporal smooth muscle is embryologically and physiologically indistinguishable from the smooth muscle within our arterial system, the authors hypothesize that the aging-related dysfunction that occurs within the penis also occurs within the arterial system, and that this smooth muscle dysfunction within the arterial media is most likely the cause of what is called essential hypertension. This panvascular smooth muscle myopathy could explain why hypertension is the most common comorbidity associated with ED and appears to indicate that both ED and essential hypertension are the same disorder, albeit in two different organ systems. [Rev Urol. 2014;16(4):167-171 doi: 10.3909/riu0631] © 2014 MedReviews®, LLC

HypertensionErectionEndotheliumSmooth muscle

Martin NewmanView Articles
Martin SheriffView Articles

Volume 16, Number 2Review Articles

Solitary Renal Fossa Recurrence of Renal Cell Carcinoma After Nephrectomy

Treatment Review

Kamran AhmedJi-Jian ChowZahoor FaziliMohammed SheikhMartin Sheriff

Renal cell carcinoma without metastasis responds well to surgical excision but is known to recur postnephrectomy. In a small but significant number of patients this recurrence is not accompanied by metastasis, which is important as these people benefit from further surgery. We examined 20 articles from the current literature to ascertain how best to treat this condition. Surgical management renders better results than conservative or medical therapies. Readily available investigations such as blood tests and computed tomography can help determine the right patients for surgery in an evidence-based fashion. Current findings have allowed us to suggest a protocol for the treatment of solitary renal fossa recurrence of postnephrectomy renal cell carcinoma. There are further opportunities for study in validating our protocol, and in novel renal cell carcinoma treatment strategies that have not been tested on solitary renal fossa recurrences. [Rev Urol. 2014;16(2):76-82 doi: 10.3909/riu0598] © 2014 MedReviews®, LLC

ComplicationsManagementRenal cancerRecurrenceNephrectomy

Mary B AjadiView Articles

Volume 15, Number 3Review Articles

Prostate-Specific Antigen: Any Successor in Sight?

Diagnostic Review

Aniebietabasi S ObortMary B AjadiOluyemi Akinloye

Prostate cancer (PCa) is the most frequently diagnosed malignancy and the second leading cause of cancer death in men in the United States and other parts of the world. The lifetime risk of being diagnosed with PCa is approximately 16%. At present, the only widely accepted screening tools for PCa are prostate-specific antigen (PSA) and digital rectal examination. PSA is known to be prostate specific, but not PCa specific, and hence lacks the sensitivity to detect a large number of tumors, especially during the early stages. The PSA level is also known to be affected by many factors, such as medication, inflammation (benign prostatic hyperplasia and prostatitis), and urologic manipulation; hence, the controversy regarding the appropriate level of serum PSA that should trigger a biopsy or have clinical relevance to prostate metastases. Attempts to determine the level of prostate cells in peripheral blood by reverse transcriptase polymerase chain reaction did not significantly improve cancer diagnosis or predict postoperative failure. Therefore, the search continues for a novel biomarker or a panel of markers as well as other possible interventions to improve the use of PSA. This article reviews several possibilities. [Rev Urol. 2013;15(3):97-107 doi 10.3909/riu0567] © 2013 MedReviews®, LLC

Prostate-specific antigenProstate carcinomaProstate diagnostic or screening test

Mary M SmithView Articles

Volume 22, Number 2Review Articles

Implementation of a Centralized, Cost-effective Call Center in a Large Urology Community Practice

Original Research

Gary M KirshStephen F KappaChris McClainKrista WallacePaul CinquinaDon LawsonMary M SmithEarl WalzBrooke Edwards

Call centers provide front-line care and service to patients. This study compared call-answering efficiency and costs between the implementation of an internal, centralized call center (January to July 2019) and previously outsourced call-center services (January to July 2018) for a large urology community practice. Retrospective review of call metrics and cost data was performed. Internal call-center leadership, training, and culture was examined through survey of staff and management. A total of 299,028 calls with an average of 5751 calls per week were answered during the study periods. The Average Speed of Answer (ASA) was 1:42 (min:s) for the outsourced call center and 0:14 for the internal call center (P < 0.001), with 70% of outsourced calls answered under 2 minutes compared with 99% of calls for the internal call center (P < 0.001). The Average Handle Time (AHT) for each outsourced call was 5:32 versus 3:41 for the internal call center (P < 0.001). The total operating expenses were 7.7% lower for the internal call center. Surveys revealed the importance of engaged leadership and staff training with feedback, simplified work algorithms, and expanded clinical roles. We found that internal, centralized call centers may provide a call-answering solution with greater efficiency and lower total operating expense versus an outsourced call center for large surgical practices. A culture that emphasizes continuous improvement and empowers call-center staff with expanded clinical roles may ultimately enhance patient communication and service. [Rev Urol. 2020;22(2):67–74] © 2020 MedReviews®, LLC

Cost effectivenessCall centerTelehealthOrganizational efficiency

Mary McNaughton CollinsView Articles
Mary-Ellen TaplinView Articles
Marybeth McCallView 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

MASView Articles

Volume 17, Number 1Review Articles

Finding the Wolf in Sheep’s Clothing: The 4Kscore Is a Novel Blood Test That Can Accurately Identify the Risk of Aggressive Prostate Cancer

Diagnosis and Screening Update

Dipen J ParekhSanoj PunnenMASNicola Pavan

Better biomarkers that can discriminate between aggressive and indolent phenotypes of prostate cancer are urgently needed. In the first 20 years of the prostate-specific antigen (PSA) era, screening for prostate cancer has successfully reduced prostate cancer mortality, but has led to significant problems with overdiagnosis and overtreatment. As a result, many men are subjected to unnecessary prostate biopsies and overtreatment of indolent cancer in order to save one man from dying of prostate cancer. A novel blood test known as the 4Kscore® Test (OPKO Lab, Nashville, TN) incorporates a panel of four kallikrein protein biomarkers (total PSA, free PSA, intact PSA, and human kallikrein-related peptidase 2) and other clinical information in an algorithm that provides a percent risk for a high-grade (Gleason score &ge; 7) cancer on biopsy. In 10 peer-reviewed publications, the four kallikrein biomarkers and algorithm of the 4Kscore Test have been shown to improve the prediction not only of biopsy histopathology, but also surgical pathology and occurrence of aggressive, metastatic disease. Recently, a blinded prospective trial of the 4Kscore Test was conducted across the United States among 1012 men. The 4Kscore Test replicated previous European results showing accuracy in predicting biopsy outcome of Gleason score &ge; 7. In a recent case-control study nested within a population-based cohort from V&auml;sterbotten, Sweden, the four kallikrein biomarkers of the 4Kscore Test also predicted the risk for aggressive prostate cancer that metastasized within 20 years after the test was administered. These results indicate that men with an abnormal PSA or digital rectal examination result, and for whom an initial or repeat prostate biopsy is being considered, would benefit from a reflex 4Kscore Test to add important information to the clinical decision-making process. A high-risk 4Kscore Test result may be used to select men with a high probability of aggressive prostate cancer who would benefit from a biopsy of the prostate to prevent an adverse and potentially lethal outcome from prostate cancer. Men with a low 4Kscore Test result may safely defer biopsy. [Rev Urol. 2015;17(1):3-13 doi: 10.3909/riu0668] © 2015 MedReviews®, LLC

Prostate cancerBiomarkerScreeningHigh-grade prostate cancer

Mason HoltelView Articles

Volume 21, Number 1Case Review

Use of Spermatic Cord Block Systematically Identifies a Paraspinal Tumor as Source of Orchialgia

Mason HoltelRobert J Baranello JrAllyson HalePatrick Springhart

Orchialgia is a common urologic complaint with a myriad of etiologies. Workup for orchialgia requires a broad differential diagnosis and a thorough understanding of relevant anatomy. We report the case of a 43-year-old man who presented to a urologist with right testicular pain. Following a negative workup, the patient received a spermatic cord block for therapeutic and diagnostic purposes. Two months after the block, the patient returned with new complaints of ipsilateral inner thigh paresthesias, suggesting a pathologic process proximal to the genital branch of the genitofemoral nerve. A subsequent MRI of the lumbosacral spine revealed a paraspinal mass involving nerve roots at L1-2. We highlight the utility of the spermatic cord block and its role in the diagnosis of a paraspinal tumor as an uncommon cause of orchialgia. [Rev Urol. 2019;21(1):49–52] © 2019 MedReviews®, LLC

OrchialgiaNeuropathic painTesticular painSpermatic cord blockGenitofemoral nerveParaspinal tumor

Masood A KhanView Articles
Matthew A StanizziView Articles

Volume 9, Supplement 1Review Articles

Clinical Experience With Gene Therapy for the Treatment of Prostate Cancer

New Directions in the Management of Advanced Prostate Cancer

Simon J HallMatthew A Stanizzi

Localized prostate cancer can be treated effectively with radical prostatectomy or radiation therapy. The treatment options for metastatic prostate cancer are limited to hormonal therapy; hormone-refractory cancer is treated with taxane-based chemotherapy, which provides only a modest survival benefit. New treatments are needed. The gene for the initiation of prostate cancer has not been identified; however, gene therapy can involve tumor injection of a gene to kill cells, systemic gene delivery to target and kill metastases, or local gene expression intended to generate a systemic response. This review will provide an overview of the various strategies of cancer gene therapy, focusing on those that have gone to clinical trial, detailing clinical experience in prostate cancer patients. [Rev Urol. 2007;9(suppl 1):S20-S28]

Prostate cancerProstate-specific antigenGene therapy

Matthew B GretzerView Articles

Volume 5, Number 3Meeting Reviews

Best of the 2003 AUA Annual Meeting

Highlights from the 2003 Annual Meeting of the American Urological Association, April 26-May 1, 2003

Dean G AssimosEllen ShapiroAlan W PartinMichael B ChancellorJ Curtis NickelJacob RajferClaus G RoehrbornMichael K BrawerRandall B MeachamBob DjavanArie S BelldegrunAllan J PantuckMesut RemziMichael DobrovitsMatthew B GretzerKazumasa Torimoto

Prostate cancerRenal cell carcinomaBenign prostatic hyperplasiaDepressionBladder cancerLower urinary tract symptomsUrinary tract infectionProstate-specific antigenNephrolithiasisOveractive bladderRadical prostatectomyPeyronie’s diseaseGleason scoreTransrectal ultrasoundErectile dysfunctionChronic prostatitis/chronic pelvic pain syndromeAcute urinary retentionInternational Prostate Symptom ScoreBacille Calmette-Guérin therapyChronic Prostatitis Symptom IndexMTOPS trialPLESS studyProstate tumor markersSELDI-TOF

Matthew C FerroniView Articles

Volume 19, Number 2Review Articles

The Use of Intraoperative Cell Salvage in Urologic Oncology

Surgical Update

Andres F CorreaMatthew C FerroniTimothy D LyonBenjamin J DaviesMichael C Ost

Intraoperative cell salvage (IOCS) has been used in urologic surgery for over 20 years to manage intraoperative blood loss and effectively minimize the need for allogenic blood transfusion. Concerns about viability of transfused erythrocytes and potential dissemination of malignant cells have been addressed in the urologic literature. We present a comprehensive review of the use of IOCS in urologic oncologic surgery. IOCS has been shown to preserve the integrity of erythrocytes during processing and effectively provides cell filtration to mitigate the risk of tumor dissemination. Its use is associated with reduction in the overall need for allogenic blood transfusion, which clinically reduces the risk of hypersensitivity reactions and disease transmission, and may have important implications on overall oncologic outcomes. In the context of a variety of urologic malignancies, including prostate, urothelial, and renal cancer, the use of IOCS appears to be safe, without risk of tumor spread leading to metastatic disease or differences in cancer-specific and overall survival. IOCS has been shown to be an effective intraoperative blood management strategy that appears safe for use in urologic oncology surgery. The ability to reduce the need for additional allogenic blood transfusion may have significant impact on immune-mediated oncologic outcomes. [Rev Urol. 2017;19(2):89–96 doi: 10.3909/riu0721] © 2017 MedReviews®, LLC

Urologic oncologyCell salvagetransfusion

Matthew E HardeeView Articles

Volume 13, Number 1Case Review

Squamous Cell Carcinoma of the Prostate

Case Review

Samir S TanejaRena D MalikGeorge DakwarMatthew E HardeeNicholas SanfilippoAndrew B Rosenkrantz

"Squamous cell carcinoma of the prostate is a rare tumor, making up 0.5% to 1% of all prostate carcinomas. It is typically described as an aggressive cancer, with a median postdiagnosis survival of 14 months. Presented here is a case of primary squamous cell carcinoma of the prostate, with a complicated presentation of metastatic disease. Due to the extent of the patientís disease, he was treated with palliative radiation therapy using a four-field technique (AP/PA and left and right lateral fields) with 18 mV photons prescribed to the 100% isodose line. The prescription dose was 4000 cGy in 16 fractions of 250 cGy per fraction. No definitive treatment of squamous cell carcinoma of the prostate exists but varying approaches including surgical intervention, chemotherapy, and radiation therapy have been implemented without durable response. However, multimodal treatments appear to be the most promising with longer durations of survival. [Rev Urol. 2011;13(1):56-60 doi: 10.3909/riu0494]"

Squamous cell carcinomaProstate adenocarcinomaLower urinary tractsymptomsMultimodal treatments

Matthew E NielsenView Articles

Volume 9, Number 2Review Articles

The Impact of Definitions of Failure on the Interpretation of Biochemical Recurrence Following Treatment of Clinically Localized Prostate Cancer

Diagnostic Update

Alan W PartinMatthew E Nielsen

Widespread early detection with prostate-specific antigen (PSA) has radically transformed the clinical management of prostate cancer. PSA has become valuable in the monitoring and risk stratification of recurrent disease following local therapy. In many ways, biochemical recurrence–free survival, or PSA outcome, has become a surrogate measure of treatment efficacy following primary local therapy. Given the inherent differences in PSA kinetics following these treatment approaches, the definition of biochemical success or failure is not uniform among therapies. An appreciation of the inherent strengths, limitations, and biases of the standard definitions of failure can provide a more meaningful context within which to interpret the reported outcomes of different treatment modalities. [Rev Urol. 2007;9(2):57-62]

Prostate-specific antigenRadiotherapyHormonal therapyProstate cancer recurrenceBiochemical failureBrachytherapy