Reviews in UrologyLetter From the President of LUGPAEvan R GoldfischerAs we approach the next election, it is of utmost importance that we, as one of the strongest voices for independent medicine, engage in political advocacy. Our mission is to ensure that the independent practice of urology endures while showcasing outstanding quality and value to our patients, vendors, payers, legislators, and regulatory agencies. To achieve this, we must actively preserve our autonomy and demonstrate the highest quality standards through evidence-based practices and effective communication.
LUGPA NewsLUGPA NewsCeleste KirschnerEvan R GoldfischerOn May 23, 2024, Dr Timothy Richardson, a member of LUGPA’s board of directors, testified before the US House Committee on Ways & Means’ Subcommittee on Health about the negative impacts of hospital acquisitions on independent physician practices.
Prostate CancerAdvances in Radical Prostatectomy: A Narrative ReviewAustin DryschKathryn E. FinkChalairat Suk-OuichaiMitchell M. HuangKent T. PerryHiten D. PatelAshley E. RossRadical prostatectomy (RP) is the mainstay surgical treatment for men with localized prostate cancer. The use of robot-assisted RP (RARP) has specifically allowed for the development of novel techniques to improve postoperative quality of life for patients.Prostatic neoplasmsProstatectomyRobotic-assisted surgeryrobotic surgical procedures
Prostate CancerDarolutamide for the Management of Metastatic Hormone-Sensitive Prostate Cancer: A Urologist-Oncologist PerspectivePaul DatoRana R. McKayMetastatic prostate cancer accounts for 8% of all prostate cancer cases in the United States and has an estimated 5-year survival rate of 34%. Androgen-deprivation therapy (ADT) is the cornerstone of treatment for men with metastatic hormone-sensitive prostate cancer (HSPC), but there has been a recent focus on early treatment intensification through dual- or triple-therapy approaches, which have shown substantial survival benefit compared with ADT alone. Darolutamide, a distinct androgen receptor inhibitor, is the latest treatment for men with metastatic HSPC. In the Darolutamide in Addition to Standard Androgen Deprivation Therapy and Docetaxel in Metastatic Hormone-Sensitive Prostate Cancer (ARASENS) trial (ClinicalTrials.gov identifier NCT02799602), darolutamide in combination with ADT and docetaxel reduced the risk of death by 32.5% (P < .001) compared with ADT plus docetaxel in men with metastatic HSPC. The most recent National Comprehensive Cancer Network guidelines (2023) support the use of triple-therapy regimens for men with high-volume metastatic HSPC, but concerns about the side effects of the short-term chemotherapy component of this regimen necessitate a comprehensive approach to providing supportive care to ensure that patients are willing to begin and remain on treatment. Effective management should involve a well-informed multidisciplinary team with patient education and support to ensure optimal treatment outcomes. Here, we review the results of the ARASENS trial and consider the implications for the management of metastatic HSPC. By showing a statistically significant reduction in risk of death, triple therapy combining darolutamide with ADT and docetaxel has emerged as a new treatment modality that may help men with metastatic HSPC achieve prolonged survival while maintaining an acceptable quality of life.Prostatic neoplasmsDrug therapyNeoplasm metastasisAndrogen receptor antagonists
Pediatric UrologyRecent Advances in Managing Pediatric Neurogenic Bladder due to Spina BifidaRachel VancavageAlexandra RehfussSpina bifida is the most prevalent permanently disabling birth defect in the world. It results in damage to nerve endings that negatively affect bladder function and can potentially lead to kidney failure. Management of spina bifida continues to evolve, however, improving outcomes for patients with this condition.Neurogenic bladderUrinary bladderSpinal dysraphismMyelomeningocele
Prostate CancerIncorporation of IsoPSA Into Clinical Practice in the Management of Elevated Prostate-Specific Antigen Based on Current GuidelinesAidan KennedyJason HafronProstate cancer is a highly prevalent malignancy among men worldwide. Optimal management depends on early detection and accurate surveillance. Several screening and surveillance tools are available to men with prostate cancer, including prostate-specific antigen (PSA) testing, digital rectal examination, prostate biopsy, imaging modalities, and a plethora of biomarkers. Prostate-specific antigen, though widespread in its use, is limited in its specificity. Many adjunctive tests to PSA have been developed. One such test is IsoPSA (Cleveland Diagnostics), a novel PSA assay that focuses on structural differences among PSA isoforms to aid in detecting clinically significant prostate cancer. With an improved understanding of the capability and uses of IsoPSA, physicians can enhance patient outcomes through more accurate risk assessment and save costs by reducing the number of unnecessary prostate biopsies and imaging generated resulting from a nonspecific elevation in serum PSA. This review describes the performance and use of IsoPSA.Prostatic neoplasmsBiomarkerProstate-specific antigen (PSA)Prostate-specific antigenBiomarkers
Kidney CancerResponse to Targeted Therapy and Checkpoint Inhibition in a Patient With Mucinous Tubular and Spindle Cell Carcinoma: A Case Report and Literature ReviewRuchi AgarwalDaniela V. CastroYu Jun LiJaya GoudSalvador Jaime-CasasMucinous 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
Bladder CancerImmune Checkpoint Inhibitors for the Treatment of Non–Muscle-Invasive Bladder Cancer: An Overview of Ongoing Clinical TrialsNeal D ShoreTreatment of non–muscle-invasive bladder cancer (NMIBC) is evolving, seeking new treatments to overcome the limitations of bacille Calmette-Guérin therapy and alternatives to radical cystectomy. Studies are currently evaluating the safety and efficacy of immune checkpoint inhibitors in combination with bacille Calmette-Guérin vs bacille Calmette-Guérin monotherapy for patients with high-risk NMIBC that is bacille Calmette-Guérin naive or recurrent after bacille Calmette-Guérin induction. We briefly summarize 4 studies that are evaluating intravenous immune checkpoint inhibitors (atezolizumab, durvalumab, and pembrolizumab) and 1 subcutaneous immune checkpoint inhibitor (sasanlimab). These studies may substantially change standard-of-care treatment for patients with high-risk NMIBC.immune checkpoint inhibitorsMonoclonal antibodiesClinical trialsnon-muscle invasive bladder neoplasms
Business of UrologyThe Business of Independent Urologic Medicine: Caring for Patients While Operating a Business in a Post–COVID-19 Era of Private PracticeNathan P. DillerMara HoltonPrimum non nocere—“First, do no harm.” Independent medicine is challenged not only to achieve outcomes that patients value but also not to intentionally harm their business in the process. The COVID-19 pandemic and postpandemic regulatory environment have added new limitations on and restrictions to independent practices’ ability to innovate, grow, and provide stable access to meet their communities’ urologic needs. In the face of these challenges, independent medicine is at its strongest when it continues to press toward meeting its social contract with its community. Conversely, but just as importantly, society needs to be mindful of its social contract with the health care workforce.UrologyPrivate practiceCOVID-19
EditorialThe Specialty Networks Localized to High-Risk Biochemically Recurrent Prostate Cancer Patient PlaybookGautam JayramKatie GrantJayme NalleyNicole SmithProstate cancer (PCa) is the second-leading cause of cancer death among men in the United States. The American Cancer Society estimates that more than 299 010 men will be diagnosed with PCa in 2024, with more than 35 250 PCa-associated deaths.1 It is estimated that of those patients treated for localized PCa, 30% to 35% will experience biochemical recurrence (BCR), which further increases the risk of PCa death. Although multiple definitions have been proposed, BCR is generally present when a man has a persistently rising prostate-specific antigen (PSA) value after definitive local therapy (Table 1) in the absence of radiographic evidence of metastatic disease. This definition has evolved and will continue to develop, with advances in genomics, next-generation sequencing, and digital pathology.
Meet The ExpertMeet the Expert: Shelby Moneer, MS, CHES, from ZERO Prostate CancerBenjamin H. LowentrittThank you for joining us today for our third “Meet the Expert” session with our special guest Shelby Moneer. Shelby is vice president of patient programs and education at ZERO Prostate Cancer. I’m your moderator for today, Benjamin Lowentritt. I’m the medical director of the prostate cancer program at Chesapeake Urology, and I am fortunate enough to be one of the medical advisors for ZERO, as well. Today’s “Meet the Expert” is sponsored by Cipla. For more information about Cipla, please visit their website at www.cipla.com.Prostatic neoplasmspatient advocacy