Issues

Can Urinary Nerve Growth Factor Be a Biomarker for Overactive Bladder?

Diagnostic Update

Michael B ChancellorHann-Chorng KuoHsin-Tzu Liu

The clinical diagnosis of overactive bladder (OAB) greatly varies and is based on subjective symptoms. A more objective method to diagnose and assess therapeutic outcome in OAB patients, especially for health care providers not trained in urology, needs to be found. Evidence has shown that urinary proteins such as nerve growth factor (NGF) and prostaglandin E2 levels increase in patients with OAB, bladder outlet obstruction, and detrusor overactivity. Urinary NGF level increases physiologically in normal subjects at urge to void, but increases pathologically in OAB patients at a small bladder volume and with a sensation of urgency. Recent studies have shown that patients with OAB dry and OAB wet have significantly higher urinary NGF levels compared with control groups and patients with increased bladder sensation. Urinary NGF levels decrease after antimuscarinic therapy and further decrease after detrusor botulinum toxin injections in refractory OAB. Urinary NGF level could be a potential biomarker for diagnosis of OAB and assessment of the therapeutic effect of antimuscarinic therapy. The latest medical advances in this field are reviewed herein. [Rev Urol. 2010;12(2/3):e69-e77 doi: 10.3909/riu0432]

Intermittent Androgen Deprivation Therapy: Redefining the Standard of Care?

Management Update

Neal D ShoreE David Crawford

As a clinical strategy, intermittent androgen deprivation therapy (IADT) has the potential to minimize adverse events associated with continuous androgen deprivation therapy while providing comparable efficacy for patients with advanced prostate cancer. Because most studies supporting IADT to date have been somewhat small and underpowered, additional large, randomized, controlled trials are needed before this strategy becomes the standard of care.However, the potential advantages of IADT, which include improved quality of life, the theoretical possibility of delaying hormone resistance, and possible reduction in expenses to the patient and health care payers, suggest it is a strategy worth further exploration.[Rev Urol. 2010;12(1):1-11 doi: 10.3909/riu0490]

Advances in the Medical Treatment of Benign Prostatic Hyperplasia

Herbert Lepor

In this KOL (key opinion leader) interview, Herbert Lepor, MD, co–Medical Editor of Reviews in Urology, discusses the medical treatment of benign prostatic hyperplasia (BPH).[Rev Urol. 2009;11(4):181-184 doi: 10.3909/riu0477]© 2009 MedReviews®, LLC

Predictive Models for Newly Diagnosed Prostate Cancer Patients

Management Update

Peter T ScardinoWilliam T Lowrance

[Rev Urol.2009;11(3):117-126 doi: 10.3909/riu0456]2009 MedReviews®, LLC©Accurate risk assessment is of paramount importance to newly diagnosedprostate cancer patients and their physicians. Risk prediction models helpidentify those at high (or low) risk of disease progression and guide discussionsabout prognosis and treatment. Widely used, well-validated predictiontools are based on standard, readily available clinical and pathologic parameters,but do not include biomarkers, some of which may have an importantrole in predicting prognosis or determining therapeutic options. A newapproach, known as systems pathology, may improve the accuracy of traditionalprediction methods and provide patients with a more personalized riskassessment of clinically relevant outcomes. The ultimate goal of predictionmodels is to improve medical decision making.

Will the Evolution of Overactive Bladder Delivery Systems Increase Patient Compliance?

Treatment Review

Nirit Rosenblum

The negative impact of overactive bladder (OAB) on daily quality of life drives the large market of pharmacotherapy targeted at symptoms of urinary frequency and urgency, with or without urinary urge incontinence. Currently, the primary pharmacologic treatment modality is aimed at modulation of the efferent muscarinic receptors (M2 and M3) predominant in detrusor smooth muscle and responsible for involuntary or unwanted bladder contractions. However, due to drug effects in the muscarinic receptors of the salivary glands and intestinal smooth muscle, as well as extensive first-pass metabolism in the liver and intestinal tract yielding parent drug metabolites, adverse side effects are common and can be quite bothersome. These issues, encountered with many of the oral antimuscarinic formulations, limit their tolerability and affect long-term patient compliance and satisfaction. Thus, the benefit of pharmacotherapy for OAB must be a balance between efficacy and tolerability, also known as therapeutic index. This article reviews the current pharmacologic delivery systems available for the treatment of OAB, patient compliance, and reasons for discontinuation of medication.[Rev Urol. 2009;11(2):45-51]

Efficacy of a-Adrenergic Receptor Blockers in the Treatment of Male Lower Urinary Tract Symptoms

Advances in the Pharmacologic Treatment of BPH

Claus G Roehrborn

Male lower urinary tract symptoms (LUTS) are one of the most common causes for a consultation with a health care provider, and one of the most common causes of male LUTS is benign prostatic hyperplasia (BPH). In recent decades, medical therapy has established itself as viable and cost effective for the majority of men. For the treatment of male LUTS in the United States, the 5 currently available α-adrenergic receptor blockers are alfuzosin, doxazosin, silodosin, terazosin, and tamsulosin. α-Blockers remain one of the mainstays in the treatment of male LUTS and clinical BPH. They exhibit an early onset of efficacy (within less than 1 week) with regard to both symptoms and flow rate improvement, maintain such improvements in open-label and controlled trials for up to 5 years, and have been shown to prevent symptomatic progression.[Rev Urol. 2009;11(suppl 1):S1–S8 doi: 10.3909/riu11S1S0003]© 2009 MedReviews®, LLC

The Evolution of Transdermal/Topical Overactive Bladder Therapy and Its Benefits Over Oral Therapy

Treatment Update

Scott MacDiarmid

Multiple antimuscarinic agents are available for the treatment of overactive bladder. Many of the agents have undergone reformulation in an attempt to improve patient adherence and drug tolerability. Oxybutynin evolved from an immediate-release pill to a once-daily oral preparation, and is now available as a transdermal patch and gel. This article discusses the clinical impact of oxybutynin reformulation and reviews the evolution and benefits of transdermal therapy.[Rev Urol. 2009;11(1):1-6]

Renewing Intimacy: Advances in Treating Erectile Dysfunction Postprostatectomy

Expert Commentary

Herbert LeporAndrew R McCulloughJason D Engel

Erectile dysfunction following prostatectomy is almost universal. Herbert Lepor, MD, Professor and Martin Spatz Chairperson of Urology and Professor of Pharmacology at New York University School of Medicine and cofounder of Reviews in Urology; Andrew McCullough, MD, Director of the Sexual Health and Male Fertility and Microsurgery Programs at New York University School of Medicine; and Jason D. Engel, MD, Vice Chairman of Urology and Director of Urologic Robotic Surgery at George Washington University Hospital, discuss treatment options for erectile dysfunction postprostatectomy. [Rev Urol. 2008;10(4):245-253]

Prostate Cancer Specificity of PCA3 Gene Testing: Examples from Clinical Practice

Diagnostic Update

David G BostwickLeonard S Marks

A specific marker for early prostate cancer would fill an important void. In initial evaluations of the prostate cancer antigen 3 (PCA3) gene vis-à-vis serum prostate-specific antigen (PSA) levels, the gene offers great promise. At the cellular level, PCA3 specificity for cancer is nearly perfect because of the gross overexpression of the gene by cancer cells. As a clinical test for early prostate cancer, heightened specificity is also seen in urine containing prostate cells from men with the disease. PCA3 gene testing holds valuable potential in PSA quandary situations: (1) men with elevated PSA levels but no cancer on initial biopsy; (2) men found to have cancer despite normal levels of PSA; (3) men with PSA elevations associated with varying degrees of prostatitis; and (4) men undergoing active surveillance for presumed microfocal disease. [Rev Urol. 2008;10(3):175-181]

John P. Stein, MD, FACS 1962-2008

In Memoriam