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Benign prostatic obstructionView Articles
Benign prostatic specific antigenView Articles

Volume 11, Number 2Meeting Reviews

Best of the 2009 AUA Annual Meeting

Highlights From the 2009 Annual Meeting of the American Urological Association, April 25-30, 2009, Chicago, IL

Dean G AssimosEllen ShapiroAlan W PartinMichael B ChancellorStacy LoebJ Curtis NickelClaus G RoehrbornMichael K BrawerNaoki YoshimuraArie S BelldegrunB ShuchF Pouliot

Prostate cancer screeningObesityBenign prostatic hyperplasiaLower urinary tract symptomsVesicoureteral refluxNephrolithiasisStress urinary incontinenceInflammationSilodosinHormonal therapyTumor markersTMPRSS2ERG4-Kallikrein panelBotulinum toxin type AMale voiding dysfunctionBenign prostatic specific antigenRoux-en-Y gastric bypass surgeryGenitourinary pain indexUPOINT clinical phenotype systemNephron-sparing surgeryWatchful waitingLaparoscopy for adrenal cortical carcinomaPartial adrenalectomyUrethral traumaPediatric urethral strictureEnteric urologic surgery

Benign prostatichyperplasiaView Articles
Benignprostatic hyperplasia (BPH)View Articles
BethanecholView Articles
BicalutamideView Articles

Volume 5, Number 2Meeting Reviews

Advances in the Medical Treatment of Prostate Cancer, Bladder Cancer, Renal Cell Cancer, and Benign Prostatic Hyperplasia

Highlights from the XVIIth Congress of the European Association of Urology, Birmingham, UK

Claus G RoehrbornBob DjavanMesut RemziChristian Seitz

Prostate cancerBenign prostatic hyperplasiaBladder cancerLower urinary tract symptomsProstate-specific antigenRadical prostatectomyRadical nephrectomyNomogramsTamsulosinAlfuzosinFinasterideDutasterideBicalutamideBacille Calmette-GuerinPermixonRenal cell cancerTransrectal ultrasound-guided biopsyVirtual cystoscopy

Bifid uretersView Articles

Volume 15, Number 3Case Review

Obstructed Bifid Uretereric System Causing Unilateral Hydronephrosis

Amyn BhamaniManoj Srivastava

Bifid ureters are a common malformation of the urinary system. In clinical practice, hydronephrosis resulting from obstruction of such a system is rare. The authors present a case involving an 88-year-old man admitted to the hospital with symptoms of renal failure, where bifid ureters were found incidentally in a hydronephrotic kidney during an emergency nephrostomy. This had been missed on a previous CT scan, resulting in a unique therapeutic dilemma. [ Rev Urol. 2013;15(3):131-134 doi: 10.3909/riu0578] © 2013 MedReviews®, LLC

Bifid uretersHydronephrosisNephrostomy

Biochemical disease-free outcomeView Articles
Biochemical failureView Articles

Volume 9, Number 2Review Articles

The Impact of Definitions of Failure on the Interpretation of Biochemical Recurrence Following Treatment of Clinically Localized Prostate Cancer

Diagnostic Update

Alan W PartinMatthew E Nielsen

Widespread early detection with prostate-specific antigen (PSA) has radically transformed the clinical management of prostate cancer. PSA has become valuable in the monitoring and risk stratification of recurrent disease following local therapy. In many ways, biochemical recurrence–free survival, or PSA outcome, has become a surrogate measure of treatment efficacy following primary local therapy. Given the inherent differences in PSA kinetics following these treatment approaches, the definition of biochemical success or failure is not uniform among therapies. An appreciation of the inherent strengths, limitations, and biases of the standard definitions of failure can provide a more meaningful context within which to interpret the reported outcomes of different treatment modalities. [Rev Urol. 2007;9(2):57-62]

Prostate-specific antigenRadiotherapyHormonal therapyProstate cancer recurrenceBiochemical failureBrachytherapy

Biochemical recurrenceView Articles
Biochemical relapseView Articles
BiofeedbackView Articles
Biological targetvolumesView Articles

Volume 8, Supplement 1Review Articles

Fused Radioimmunoscintigraphy for Treatment Planning

Prostate Cancer Imaging

Rodney J EllisDeborah A Kaminsky

Advances in imaging technologies, including computerized tomography (CT) and single-photon emission tomography (SPECT), are improving the role of imaging in prostate cancer diagnosis and treatment. Hybrid (SPECT/CT) imaging, in particular, shows an increased sensitivity for identification of prostate cancer. Published studies have also recently proposed a new paradigm in the administration of radiation therapy for prostate cancer, favoring doseescalation strategies to improve tumor control for localized disease. Conventional dose-escalation protocols have previously relied primarily on margin extension to the entire prostate gland to achieve dose-escalation; extending increased risk to radiosensitive normal structures. A newer strategy proposes use of advanced imaging to confine dose-escalation to biological target volumes identified on capromab pendetide SPECT/CT-fused image sets or imageguided radiation therapy (IGRT). This strategy defines a shift in radiation dosimetry and planning from uniform glandular prescription dosing with doseescalation applied generically to the peripheral regions and margin extension; to dose-escalation confinement to discrete regions of known disease as defined by focal uptake on radioimmunoscintigraphy fusion with anatomic image sets, with minimal margin extension. The introduction of advanced imaging for IGRT in prostate cancer has also introduced an improved capability for the early-identification of patients at risk for metastatic disease, where more aggressive therapeutic interventions may prove beneficial. [Rev Urol. 2006;8(suppl 1):S11-S19]

Prostate cancerRadiotherapyBrachytherapyProstaScintSPECT/CTBiological targetvolumesSurvival

BiomarkerView Articles

Volume 23, Number 3Prostate Cancer

Incorporation of IsoPSA Into Clinical Practice in the Management of Elevated Prostate-Specific Antigen Based on Current Guidelines

Aidan KennedyJason Hafron

Prostate 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

BiomarkersView Articles

Volume 23, Number 3Prostate Cancer

Incorporation of IsoPSA Into Clinical Practice in the Management of Elevated Prostate-Specific Antigen Based on Current Guidelines

Aidan KennedyJason Hafron

Prostate 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

BiopsyView Articles
Biopsy rateView Articles

Volume 17, Number 4Original Research

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

Jason HafronStephen M ZappalaDipen J ParekhDanielle OsterhoutJeffrey SchockRandy M ChudlerGregory M OldfordKenneth M KernenBadrinath R Konety

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 cancerProstate-specific antigen4KscoreGleason scoreDigital rectal examinationBiopsy rateProstate cancer prognosis

Biopsy, post-radiation prostateView Articles
Biopsychosocial treatment modelView Articles
BisphosphonatesView Articles

Volume 8, Supplement 2Review Articles

Treatment- and Disease-Related Complications of Prostate Cancer

16th International Prostate Cancer Update

Anne R Simoneau

One of the highlights of the 16th International Prostate Cancer Update was a session on treatment- and disease-related complications of prostate disease. It began with presentation of a challenging case of rising prostate-specific antigen levels after radical prostatectomy, followed by an overview of the use of zoledronic acid in prostate cancer, a review of side effects of complementary medicines, an overview of complications of cryotherapy, an assessment of complications of brachytherapy and external beam radiation therapy, and a comparison of laparoscopy versus open prostatectomy. [Rev Urol. 2006;8(suppl 2):S56-S67]

Prostate cancerBisphosphonatesCryotherapyComplementary medicine

Black menView Articles

Volume 22, Number 3Review Articles

A Trend Toward Aggressive Prostate Cancer

Original Research

Navin ShahVladimir Ioffe

To compare prostate biopsy (Pbx) characteristics before and after the 2012 United States Preventive Services Task Force (USPSTF) prostate cancer (PCa) screening guidelines, we completed a retrospective comparative analysis of 1703 sequential patients that had a Pbx in 2010 to 2012 (3 years) with 383 patients biopsied in 2018 and 310 patients biopsied in 2019. Data was collected on patient age, race, serum prostate specific antigen (PSA) level, digital rectal examination (DRE) results, total number of biopsies performed, and Gleason sum score (GSS). Data were analyzed to determine whether the 2012 USPSTF screening recommendations against PCa screening may have affected PCa characteristics. Three study groups were defined as Group A, Group B, and Group C. Group A represents Pbx prior to the 2012 USPSTF screening guidelines (2010-2012), Group B represents Pbx in 2018, and Group C represents Pbx in 2019. The patient population consisted of 73% Black men, 16% White men, and 11% men of other races. The number of patients that had a biopsy in Groups A through C, respectively, were 567 patients/year, 383 patients/year, and 310 patients/year. The annual positive Pbx rate for Group A through C was 134/year, 175/year, and 201/year, respectively. High-grade PCa (GSS 7-10) in Groups A through C was 51.5%, 60.5%, and 60.0%. The proportion of patients with a serum PSA level 10 ng/mL or greater in Groups A through C was 25.4%, 29.3%, and 33%. For patients age 70 to 80 years, there was an increasing trend for serum PSA levels 10 ng/mL and higher: 31%, 38%, and 39%, respectively. In this age group, high-grade tumors (GSS 7-10) occurred in 61%, 65%, and 68%, respectively. In 2019, Grade Group 3, 4, and 5 was present in 37.7% of 70- to 80-year-old men and 34.6% of Black men. More than 50% positive biopsy cores were present in 46.3% of 70- to 80-year-old men and 36.6% of Black men. Our data through 2019 continued to show that after the 2012 USPSTF recommendations against PCa screening, PCa screening has decreased. We found decreased Pbx, increased PCa diagnosis, and increased high-grade PCa (GSS 7-10). As our patient population consisted of 73% Black patients and 33% of men age 70 to 80 years, our results support aggressive PCa screening for high-risk patients, which include Black men, men with a family history of PCa, and healthy men age 70 to 80 years. [Rev Urol. 2020;22(3):102-109] © 2020 MedReviews®, LLC

Prostate cancerElderly menUnited States Preventive Services Task ForceProstate-specific antigen screeningBlack men

BladderView Articles
Bladder and bowel dysfunctionView Articles
Bladder augmentation and diversionView Articles
Bladder cancerView Articles
Bladder carcinomaView Articles

Volume 16, Number 4Case Review

The Use of Botulinum Neurotoxin Type A in a Patient With Refractory Urge Incontinence to Facilitate the Intravesical Treatment of Bladder Carcinoma

Mina FamPatricia Gilhooly

Intravesical Bacillus Calmette-Guérin (BCG) has become the preferred initial treatment after resection of high-grade T1 urothelial carcinoma and carcinoma in situ (CIS). We report the case of a patient with high-grade T1 urothelial carcinoma and CIS who was treated with intravesical BCG. Due to the patient’s severe urge incontinence, however, the BCG solution leaked from the bladder immediately upon instillation. We describe our experience of using botulinum neurotoxin A intradetrusor injections to facilitate successful intravesical therapy by increasing bladder capacity to enable the BCG to remain in the patient’s bladder for the appropriate treatment duration. [Rev Urol. 2014;16(4):194-197 doi: 10.3909/riu0621] This article is a US Government work, and, as such, is in the public domain in the United States of America. Published by MedReviews®, LLC.

Bacillus Calmette-GuérinBladder carcinomaBotulinum neurotoxinGemcitabine

Bladder diseasesView Articles
Bladder diverticulumView Articles

Volume 18, Number 2Case Review

Endoscopic Management of Bladder Diverticula

Claudio JeldresKhanh N PhamThomas HeftyJohn M Corman

A 50-year-old man with benign prostatic hyperplasia and urinary retention had a very large diverticulum on the posterior wall of the bladder. The patient was managed with transurethral resection of the prostate and endoscopic fulguration of the bladder diverticulum mucosa using the Orandi technique. There was near-complete resolution of the bladder diverticulum following endoscopic management, obviating the need for bladder diverticulectomy. The patient now empties his bladder, with a postvoid residual ­ 50 mL and the absence of urinary tract infection after 6-month follow-up. We report the successful treatment of a large bladder diverticulum with endoscopic fulguration to near-complete resolution. This minimally invasive technique is a useful alternative in patients unfit for a more extensive surgical approach. [Rev Urol. 2016;18(2):114-117 doi: 10.3909/riu0701] © 2016 MedReviews®, LLC

Bladder diverticulumEndoscopicFulguration

Bladder dysfunctionView Articles
Bladder epitheliumView Articles