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Urology

Volume 19, Number 2 - 2017

Volume 19, Number 2 - 2017

Table of Contents

Active Surveillance of Prostate Cancer: Current State of Practice and Utility of Multiparametric Magnetic Resonance Imaging Practice Update
Active surveillance (AS) is an alternative to immediate intervention in patients with very low- and low-risk prostate cancer. Ongoing reports from multiple AS programs have consistently demonstrated a very low rate of metastasis and prostate cancer-specific mortality in appropriately selected patients. Accordingly, AS has been adopted by major clinical organizations as a safe and effective management strategy. Clinical focus has now shifted to identifying the optimal approach to selecting and monitoring patients. Multiparametric magnetic resonance imaging (mpMRI) has emerged as one potentially helpful tool in the AS setting. The utility of mpMRI has been well demonstrated in the setting of screening and diagnosis, but its role in AS remains unclear. We summarize the published experience with AS and review pertinent, contemporary data on the use of mpMRI in the setting of AS. [Rev Urol. 2017;19(2):77–88 doi: 10.3909/riu0757] © 2017 MedReviews®, LLC
The Use of Intraoperative Cell Salvage in Urologic Oncology Surgical Update
Intraoperative cell salvage (IOCS) has been used in urologic surgery for over 20 years to manage intraoperative blood loss and effectively minimize the need for allogenic blood transfusion. Concerns about viability of transfused erythrocytes and potential dissemination of malignant cells have been addressed in the urologic literature. We present a comprehensive review of the use of IOCS in urologic oncologic surgery. IOCS has been shown to preserve the integrity of erythrocytes during processing and effectively provides cell filtration to mitigate the risk of tumor dissemination. Its use is associated with reduction in the overall need for allogenic blood transfusion, which clinically reduces the risk of hypersensitivity reactions and disease transmission, and may have important implications on overall oncologic outcomes. In the context of a variety of urologic malignancies, including prostate, urothelial, and renal cancer, the use of IOCS appears to be safe, without risk of tumor spread leading to metastatic disease or differences in cancer-specific and overall survival. IOCS has been shown to be an effective intraoperative blood management strategy that appears safe for use in urologic oncology surgery. The ability to reduce the need for additional allogenic blood transfusion may have significant impact on immune-mediated oncologic outcomes. [Rev Urol. 2017;19(2):89–96 doi: 10.3909/riu0721] © 2017 MedReviews®, LLC
Utilization of Individualized Prostate Cancer and Genomic Biomarkers for the Practicing Urologist Management Update
Prostate cancer encompasses a complex heterogeneous disease spectrum. Physicians and patients are faced with the ambiguity of who should be screened, biopsied, rebiopsied, treated, or provided with adjuvant therapy. Personalized outcomes and treatments are especially important given the varied nature of the disease, plethora of treatment options, risks of morbidity, and quality of life. Today’s practicing urologist has a multitude of tests from which to choose, creating the difficult task of appropriate use. This review focuses on two blood-, one urine-, and five genomic-based tests, which, when used in the appropriate clinical setting, can facilitate the patient-physician decision-making process. [Rev Urol. 2017;19(2):97–105 doi:10.3909/riu0730] © 2017 MedReviews®, LLC
The American Urological Association’s Prostate Cancer Screening Guideline: Which Cancers Will Be Missed in Average-risk Men Aged 40 to 54 Years? Cancer Screening Update
To determine the impact of the American Urological Association’s (AUA) guideline for early detection of prostate cancer that recommends against routine screening in men aged 40 to 54 years at average risk (eg, white men without a family history of prostate cancer), we undertook a study of 973 men who previously underwent a prostate biopsy at Urology Centers of Alabama (UCA) over the 5-year period from 2010 to 2014. We retrospectively reviewed the results of the prostate biopsies performed by urologists at UCA—and, where applicable, the final surgical pathology results and compared the results by race and family history. In white men with a family history of prostate cancer, 47% had cancer and 30% had Gleason score (GS) ≥ 7 disease. In white men without a family history of prostate cancer, 32% had cancer and 23% had GS ≥ 7 disease. By comparison, in African American men with a family history of prostate cancer, 56% had cancer and 42% had GS ≥ 7 disease. In African American men without a family history, 42% had cancer and 29% had GS ≥ 7 disease. In our study, 144 of 456 (32%) of the group of average-risk men had cancer and 105 of 456 (23%) had GS ≥ 7 cancer. Had the AUA guidelines been followed, these cancers would have been missed or the diagnoses delayed. [Rev Urol. 2017;19(2):106–112 doi: 10.3909/riu0748] © 2017 MedReviews®, LLC
The Association Between Hypertension and Prostate Cancer Disease State Review
A 2016 meta-analysis documented a possible association between hypertension and prostate cancer. We retrospectively reviewed our 3200 prostate cancer patients that were aged 51 to 76 years to determine the frequency of hypertension. Data was gathered on age, race (African American and white), hypertension, diabetes, and body mass index (BMI). Patients were subdivided into three groups: age 51 to 60 years, age 61 to 70 years, and age 71 to 76 years. Our study population consisted of 1388 (43%) African American patients and 1812 (57%) white patients. Hypertension was found in 1013 (73%) of African American patients and 1290 (72%) of white patients. Diabetes was found in 35% of African American patients and 24% of white patients. BMI over 30 kg/m2 (obesity) was found in 47% of African American patients and 45% of white patients. We found the frequency of hypertension to be 73% in African American and 72% in white patients, 18% and 44% relatively higher in African American vs white patients, respectively, compared with the general population (62% in African American vs 50% in white patients). The study also found a similar frequency of hypertension among African American and white prostate cancer patients, despite an approximate 12% difference in the general population. Based on these findings, we suggest that prostate cancer and hypertension share a common androgen-mediated mechanism and further prospective studies are recommended to confirm that hypertension is a risk factor for prostate cancer. [Rev Urol. 2017;19(2):113–118 doi: 10.3909/riu0758] © 2017 MedReviews®, LLC
LUGPA News News in Urology
[Rev Urol. 2017;19(2):119–121 doi: 10.3909/riu0761] © 2017 MedReviews®, LLC
The Society of Urologic Oncology Clinical Trials Consortium: A Brief History and Overview News in Urology
[Rev Urol. 2017;19(2):122–124 doi: 10.3909/riu0760] © 2017 MedReviews®, LLC
A Discussion on the AUA Castrate-resistant Prostate Cancer Guidelines
[Rev Urol. 2017;19(2):125-128 doi: 10.3909/riu0765] © 2017 MedReviews®, LLC
ICD-10-CM Changes for October 1, 2017
[Rev Urol. 2017;19(2):129–130 doi: 10.3909/riu0766] © 2017 MedReviews®, LLC
Pelvic Organ Prolapse: Considerations in Surgical Management April 2017
[Rev Urol. 2017;19(2):134–137 doi: 10.3909/riu0759] © 2017 MedReviews®, LLC
Antenatal Hydronephrosis: Here Today, Gone Tomorrow—One Way or Another May 2017
[Rev Urol. 2017;19(2):138–141 doi: 10.3909/riu0762] © 2017 MedReviews®, LLC
Proper Diagnosis and Management of Nonobstructive Azoospermia June 2017
[Rev Urol. 2017;19(2):142–144 doi: 10.3909/riu0764] © 2017 MedReviews®, LLC
Transitional Cell Carcinoma of the Renal Pelvis With Venous Tumor Thrombus
Renal cell carcinoma (RCC) is the most common malignancy that results in venous tumor thrombosis. Transitional cell carcinoma of the renal pelvis with renal or vena cava thrombus is extremely rare. Fewer than 40 cases have been reported. We report a similar case of a patient who underwent radical nephrectomy with a preoperative diagnosis of RCC. [Rev Urol. 2017;19(2):145–148 doi: 10.3909/riu0743] © 2017 MedReviews®, LLC