Volume 23, Number 3Prostate 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
Volume 23, Number 2Bladder CancerIntegrating JELMYTO (Mitomycin) for Pyelocalyceal Solution Into Community Practice: Practical Tips for the UrologistMichael J. ShannonSandip M. PrasadTreatment options for upper-tract urothelial carcinoma are based on whether the patient has high-risk or low-risk disease. Low-grade tumors can be managed with nephron-sparing approaches, including ureteroscopic resection and ablation, although most patients undergoing endoscopic treatment of upper-tract urothelial cancers face a risk of recurrence. Mitomycin gel for pyelocalyceal solution provides an effective alternative therapy. In OLYMPUS, a phase 3, single-arm, open-label study, 58% of patients with low-grade disease experienced a complete response to induction therapy at 3 months. Kaplan-Meier analysis revealed an estimated 12-month durable response rate of 82%. The most common treatment-emergent adverse events were ureteric stenosis, urinary tract infection, hematuria, and flank pain (grade <3). Mitomycin gel offers a novel, kidney-sparing, nonoperative approach to managing low-grade upper-tract urothelial carcinoma.MitomycinUrologyDrug therapyUrinary tractCarcinomaUrologic neoplasmsurinary bladder neoplasms
Volume 11, Number 3Review ArticlesMale Urinary Incontinence: Prevalence, Risk Factors, and Preventive InterventionsSystematic ReviewTatyana A ShamliyanJean F WymanRyan PingTimothy J WiltRobert L KaneUrinary incontinence (UI) in community-dwelling men affects quality of lifeand increases the risk of institutionalization. Observational studies and randomized,controlled trials published in English from 1990 to November 2007on the epidemiology and prevention of UI were identified in several databasesto abstract rates and adjusted odds ratios (OR) of incontinence, calculateabsolute risk difference (ARD) after clinical interventions, and synthesizeevidence with random-effects models. Of 1083 articles identified, 126 wereeligible for analysis. Pooled prevalence of UI increased with age to 21% to32% in elderly men. Poor general health, comorbidities, severe physicallimitations, cognitive impairment, stroke (pooled OR 1.54; 95% confidenceinterval [CI], 1.14-2.1), urinary tract infections (pooled OR 3.49; 95%CI, 2.33-5.23), prostate diseases, and diabetes (pooled OR 1.36; 95% CI,1.14-1.61) were associated with UI. Treatment with tolterodine alone (ARD0.17; 95% CI, 0.02-0.32) or combined with tamsulosin (ARD 0.17; 95% CI,0.08-0.25) resulted in greater self-reported benefit compared with placebo.Radical prostatectomy or radiotherapy for prostate cancer compared withwatchful waiting increased UI. Short-term prevention of UI with pelvic floormuscle rehabilitation after prostatectomy was not consistently seen acrossrandomized, controlled trials. The prevalence of incontinence increased with ageand functional dependency. Stroke, diabetes, poor general health, radiation, andsurgery for prostate cancer were associated with UI in community-dwellingmen. Men reported overall benefit from drug treatments. Limited evidence ofpreventive effects of pelvic floor rehabilitation requires future investigation.[Rev Urol. 2009;11(3):145-165 doi:10.3909/riu0416]© 2009 MedReviews, LLCRisk factorsUrinary incontinenceRehabilitationDrug therapy