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Volume 19, Number 4

Review Articles

Active Surveillance Use Among a Low-risk Prostate Cancer Population in a Large US Payer System: 17-Gene Genomic Prostate Score Versus Other Risk Stratification Methods

Original Research

John Hornberger Steven Canfield Phillip G Febbo Michael J Kemeter

Many men with low-risk prostate cancer (PCa) receive definitive treatment despite recommendations that have been informed by two large, randomized trials encouraging active surveillance (AS). We conducted a retrospective cohort study using the Optum™ Research Database (Eden Prairie, MN) of electronic health records and administrative claims data to assess AS use for patients tested with a 17-gene Genomic Prostate Score™ (GPS; Genomic Health, Redwood City, CA) assay and/or prostate magnetic resonance imaging (MRI). De-identified records were extracted on health plan members enrolled from June 2013 to June 2016 who had ≥1 record of PCa (n = 291,876). Inclusion criteria included age ≥18 years, new diagnosis, American Urological Association low-risk PCa (stage T1-T2a, prostate-specific antigen ≥10 ng/mL, Gleason score = 6), and clinical activity for at least 12 months before and after diagnosis. Data included baseline characteristics, use of GPS testing and/or MRI, and definitive procedures. GPS or MRI testing was performed in 17% of men (GPS, n = 375, 4%; MRI, n = 1174, 13%). AS use varied from a low of 43% for men who only underwent MRI to 89% for GPS-tested men who did not undergo MRI (P<001). At 6-month follow-up, AS use was 31.0% higher (95% CI, 27.6%-34.5%; P<001) for men receiving the GPS test only versus men who did not undergo GPS testing or MRI; the difference was 30.5% at 12-month follow-up. In a large US payer system, the GPS assay was associated with significantly higher AS use at 6 and 12 months compared with men who had MRI only, or no GPS or MRI testing. [Rev Urol. 2017;19(4):203–212 doi: 10.3909/riu0786] © 2018 MedReviews®, LLC

Prostate cancer Active surveillance Evidence-based practice Comparative effectiveness research Genomic biomarker Magnetic resonance imaging

Review 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

David Albala Michael McDonald Darian Kameh Mark E Johnson Truls E Bjerklund Johansen Vladimir Mouraviev

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 infection Pyelonephritis Cystitis DNA next-generation sequencing

Review Articles

The Use of Biomarkers in Prostate Cancer Screening and Treatment

Treatment Update

Kamlesh K Yadav Ashley V Alford Joseph M Brito III Shalini S Yadav Ashutosh K Tewari Joseph Renzulli II

Prostate cancer screening and diagnosis has been guided by prostate-specific antigen levels for the past 25 years, but with the most recent US Preventive Services Task Force screening recommendations, as well as concerns regarding overdiagnosis and overtreatment, a new wave of prostate cancer biomarkers has recently emerged. These assays allow the testing of urine, serum, or prostate tissue for molecular signs of prostate cancer, and provide information regarding both diagnosis and prognosis. In this review, we discuss 12 commercially available biomarker assays approved for the diagnosis and treatment of prostate cancer. The results of clinical validation studies and clinical decision-making studies are presented. This information is designed to assist urologists in making clinical decisions with respect to ordering and interpreting these tests for different patients. There are numerous fluid and biopsy-based genomic tests available for prostate cancer patients that provide the physician and patient with different information about risk of future disease and treatment outcomes. It is important that providers be able to recommend the appropriate test for each individual patient; this decision is based on tissue availability and prognostic information desired. Future studies will continue to emphasize the important role of genomic biomarkers in making individualized treatment decisions for prostate cancer patients. [Rev Urol. 2017;19(4):221–234 doi: 10.3909/riu0772] © 2018 MedReviews®, LLC

Prostate cancer Biomarkers 4Kscore Prolaris PCA3 Prostate Health Index Apifiny Michigan Prostate Score SelectMDx ConfirmMDx ProMark PTEN/TMPRSS2:ERG Decipher

Are You Developing an ABC: Advanced Bladder Cancer Clinic?

[Rev Urol. 2017;19(4):246–247 doi: 10.3909/riu0777] © 2018 MedReviews®, LLC

Practice Profile

Successfully Integrating Radium Ra 223 Dichloride Injection Into a Urology Practice

Gregory C McMahon Gordon A Brown

[Rev Urol. 2017;19(4):248–251 doi: 10.3909/riu0782] © 2018 MedReviews®, LLC

Prostate Cancer Academy

Prostate Cancer Academy 2017 Summaries

[Rev Urol. 2017;19(4):252–260 doi: 10.3909/riu0783] © 2018 MedReviews®, LLC

NYU Case of the Month

Ureteropelvic Junction Obstruction in Adults

October 2017

[Rev Urol. 2017;19(4):261–264 doi: 10.3909/riu0781] © 2018 MedReviews®, LLC

NYU Case of the Month

Diagnosis and Treatment of Persistent Genital Arousal Disorder

November 2017

[Rev Urol. 2017;19(4):265–267 doi: 10.3909/riu0784] © 2018 MedReviews®, LLC

Irreversible Electroporation for Prostate Cancer as Salvage Treatment Following Prior Radiation and Cryotherapy

Katie S Murray Oguz Akin Jonathan A Coleman

Salvage treatment options after localized primary treatment failure of prostate cancer are limited and associated with risk for serious complications. We report on the management details of a 57-year-old African American man treated with partial-gland ablation using irreversible electroporation following local recurrence after brachytherapy and prior salvage cryoablation. Therapeutic and functional outcomes were assessed by conventional means, including serum prostate-specific antigen values and prostate biopsy results. [Rev Urol. 2017;19(4):268–272 doi: 10.3909/riu0755] © 2018 MedReviews®, LLC

Prostate cancer Focal therapy Irreversible electroporation Salvage therapy

Cycling Trauma as a Cause of Arterial Priapism in Children and Teenagers

Girolamo Mattioli Carlo Terrone Giovanni De Caro Hilgard Ackermann Alexander Szpytko Guglielmo Mantica Irene Paraboschi Aldo Franco De Rose

Bicycle riding has multiple beneficial cardiovascular effects; however, it is a well-documented source of significant urologic injuries. Priapism is a rare condition in children, and occurs primarily because of congenital hematologic diseases or adverse drug reactions. A pediatric clinical case and literature review of a high-flow priapism secondary to cycling trauma is described here to highlight their etiopathologic correlation. Bicycle riding trauma is a rare but possible cause of high-flow priapism in children, and a high index of suspicion should ensure appropriate management. [Rev Urol. 2017;19(4):273–277 doi: 10.3909/riu0768] © 2018 MedReviews®, LLC

Pediatric Trauma Priapism Cycling