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Volume 17, Number 4

Review Articles

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

Treatment Update

Dimitrios Telonis Vladimir Mouraviev David Albala Christopher M Pieczonka

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

Immunotherapy Metastatic castrate-resistant prostate cancer Sipuleucel-T Clinical

Review Articles

Fertility Preservation Options for Men and Women With Cancer

Management Update

Malgorzata E Skaznik-Wikiel Sara Babcock Gilbert Randall B Meacham Laxmi A Kondapalli

Approximately 0.2% of Americans aged 20 to 39 years are childhood cancer survivors. Advances in cancer detection and therapy have greatly improved survival rates for young cancer patients; however, treatment of childhood cancers can adversely impact reproductive function. Many cancer patients report a strong desire to be informed of existing options for fertility preservation and future reproduction prior to initiation of gonadotoxic cancer therapies, including surgery, chemotherapy, and radiotherapy. This article discusses, in detail, the effects of cancer treatment on fertility in men and women, and outlines both current and experimental methods of fertility preservation among cancer patients. [Rev Urol. 2015;17(4):211-219 doi: 10.3909/riu0666] © 2016 MedReviews®, LLC

Fertility preservation Childhood cancer Sperm cryopreservation Testicular tissue cryopreservation Spermatogonial stem cell cryopreservation Embryo cryopreservation Oocyte cryopreservation Ovarian tissue cryopreservation

Smoking: Its Impact on Urologic Health

Management Update

Neil Baum David Mobley

Tobacco use remains the single largest preventable cause of disease and premature death in the United States, and smoking is a leading cause of cancer and death from cancer. There is also evidence that smoking is associated with several urologic diseases. Urologists have a unique opportunity to help our patients lead healthy lifestyles, which includes ending their dependence on nicotine and tobacco. This article points out the various urologic conditions associated with smoking and tobacco use with the intention of providing physicians and patients with knowledge and education regarding this connection. [Rev Urol. 2015;17(4):220-225 doi: 10.3909/riu0684] © 2016 MedReviews®, LLC

Prostate cancer Bladder cancer Kidney cancer Interstitial cystitis Smoking Erectile dysfunction

Review Articles

Can Serum Testosterone Be Used as a Marker of Overall Health?

Health Screening Update

Michael A Mederos Aaron M Bernie Jason M Scovell Ranjith Ramasamy

Low serum testosterone has been associated with obesity, type 2 diabetes, metabolic syndrome, and atherosclerosis. Individuals with these comorbidities are at increased risk of premature death and other adverse health effects. Clinical data portend low testosterone as a risk factor for developing these conditions which are supported by the hypogonadal-obesity-adipocytokine hypothesis. The authors support comprehensive evaluation for these comorbid conditions in men found to have low serum testosterone. [Rev Urol. 2015;17(4):226-230 doi: 10.3909/riu0674] © 2016 MedReviews®, LLC

Diabetes Androgen deficiency Aging male Comorbidities Cardiovascular disease

Original Research

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

Randy M Chudler Danielle Osterhout Jeffrey Schock Gregory M Oldford Kenneth M Kernen Badrinath R Konety Jason Hafron Stephen M Zappala Dipen J Parekh

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 cancer Prostate-specific antigen 4Kscore Gleason score Digital rectal examination Biopsy rate Prostate cancer prognosis

Effectiveness of Antegrade Access in Bladder Tumors With Inaccessible Urethra

Sajad Maik Javaid Magray Ashiq Bhat Arif Hameed Bhat MohdSaleem Wani Baldev Singh Wazir Tanveer Iqbal Dar Abdul Rouf Khawaja

Inaccessible urethra with no retrograde endoscopic access due to multiple/diffuse strictures or multiple urethrocutaneous fistulas with acute urinary retention due to posturethral instrumentation (transurethral resection of bladder tumor [TURBT], or TURBT with transurethral resection of the prostate [TURP]), is a rare entity. Management of such a case with a bladder tumor for TURBT/surveillance cystoscopy poses a great challenge. The authors present 12 cases of bladder tumor with inaccessible urethra, 10 cases due to multiple strictures (post-TURBT and/or TURP), and 2 cases due to urethrocutaneous fistulas (post-TURBT), who presented to our emergency department with acute urinary retention. Emergent suprapubic catheterization was used as a temporary treatment method. [Rev Urol. 2015;17(4):241-245 doi: 10.3909/riu0677] © 2016 MedReviews®, LLC

Bladder tumors Suprapubic cystostomy Inaccessible urethra Tract seedling

Acromegaly Presenting as Erectile Dysfunction: Case Reports and Review of the Literature

Jerry A Raju Kate E Shipman John A Inglis Rousseau Gama

Erectile dysfunction (ED) is a common yet complex condition. The authors report two cases of acromegaly presenting with ED and hypogonadotropic hypogonadism. Surgical cure of the acromegaly was associated with either an improvement or resolution of hypogonadotropic hypogonadism-associated ED. Active acromegaly should be considered in the differential diagnosis of ED presenting with supporting clinical features, particularly hypogonadotropic hypogonadism. [Rev Urol. 2015;17(4):246-249 doi: 10.3909/riu0676] © 2016 MedReviews®, LLC

Erectile dysfunction Endocrine dysfunction Endocrinology Acromegaly Growth hormone

Sorafenib-induced Scrotal Eczema

Selahattin Caliskan

Sorafenib is an orally active, small-molecule multikinase inhibitor that blocks tumor cell proliferation and angiogenesis. Studies have shown that it is a highly potent, selective inhibitor of vascular endothelial growth factor receptors 2 and 3, platelet-derived growth factor-β, RAF, FLT-3, and c-Kit. This drug was recently approved for the treatment of metastatic renal cell carcinoma and hepatocellular carcinoma. We report a case of a patient treated with sorafenib for metastatic renal cell carcinoma who developed scrotal eczema. [Rev Urol. 2015;17(4):250-251 doi: 10.3909/riu0648] © 2016 MedReviews®, LLC

Sorafenib Scrotal eczema Hand-foot skin reaction