Search

In the pregnant patient with urinary calculi, the benefits of various diagnostic and treatment strategies must be weighed against the risks to the mother and the fitus. [ABSTRACT FROM AUTHOR]

Open RPLND has been the standard for staging and treating patients with clinical stage 1 NSGCTs. Is laparoscopic RPLND merely an 'expensive staging tool' or can it deliver comparable cancer control to the open procedure? Experts from Indiana University and the University of Chicago discuss and debate the advantages and disadvantages of these surgical approaches. [ABSTRACT FROM AUTHOR]

Six controversial questions confront every urologist who cares for a patient with penile carcinoma. New findings are helping to clarify the answers. The goal in each case should be cancer cure and functional preservation. [ABSTRACT FROM AUTHOR]

Two experts debate the pros and cons of this controversial topic--and ultimately reach an intriguing consensus. [ABSTRACT FROM AUTHOR]

While retropubic prostatectomy has been the unchallenged standard of care for the treatment of localized prostate cancer for more than a decade, the perineal approach is undergoing a resurgence in popularity and supporters of robot-assisted prostatectomy are growing. The authors debate the advantages and disadvantages of these 3 approaches. [ABSTRACT FROM AUTHOR]

While subspecialty certification for pediatric urologists would bring a host of benefits to urologists who specialize in this area, it might also carry with it a multitude of risks to the field of urology as a whole. In this installment of Point and Counterpoint, George W. Kaplan, MD, and H. Logan Holtgrewe, MD, discuss whether the benefits outweigh the risks and debate the pros and cons of subspecialty certification for pediatric urologists. [ABSTRACT FROM AUTHOR]

Competing Interests: Declaration of Competing Interest The author has no conflict of interest to declare.

Competing Interests: Declaration of competing interest The author declare no conflicts of interest.

Vivien Thomas was born into humble beginnings in Iberia, Louisiana in 1910. The circumstances of that era prevented him from achieving his goal of attending medical school. He became a surgical research technician at Vanderbilt Medical School. While at Vanderbilt, he began working under Alfred Blalock, one of the famous surgeons of that era. When Blalock left Vanderbilt, he asked Thomas to come with him. At Hopkins, the surgical procedure known as the Blalock-Taussig Shunt was developed to treat a serious congenital heart defect known as Tetralogy of Fallot. Vivien Thomas was instrumental in the development of that procedure., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Paraneoplastic syndromes can occur in 8% to 20% of individuals with malignancies. They can occur in a variety of cancers that include breast, gastric, leukemia, lung, ovarian, pancreatic, prostate, testicular, as well as kidney. The classic presentation of the triad of mass, hematuria, and flank pain occurs in less than 15% of patients with renal cancer. Because of the protean presentations of renal cell cancer, it has been referred to as the internist's tumor or the great masquerader. This article will provide a review of the causes of these symptoms., (Copyright © 2023 Elsevier Inc. All rights reserved.)

The history of prostate cancer treatment is filled with progress over the past 120 years. The understanding of the role of testosterone in the genesis of prostate cancer continues to evolve. Diagnostic testing and the treatment of localized and metastatic prostate cancer have undergone major changes over recent decades and have transformed the outlook for patients with prostate cancer. This article reviews the major milestones of prostate cancer research and its impact on clinical care., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Aside from nonmelanoma skin cancer, prostate cancer is the most common cancer among men in the United States, and benign prostatic hyperplasia is the most common benign tumor found in men. Until recently, its endocrine functions and possible influence on the hypothalamic-pituitary axis have been relatively understudied. This review summarizes the current understanding of the potential endocrine functions of prostate cancer and benign prostate tissue., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Major changes in the field of prostate cancer over the last 25 years include the implementation of prostate specific antigen screening and the recognition that BRCA confers hereditary risk of prostate cancer. Quality of life and survivorship have driven risk stratification for localized prostate cancer, facilitated by molecular signatures and leading to increased acceptance of active surveillance as a mainstream treatment option. Advances in technology have improved efficacy and reduced toxicity in both radical prostatectomy and radiation therapy for localized prostate cancer. Improved understanding of the androgen receptor has yielded substantially more effective therapies. Future growth areas include personalized treatment based on genomic and genetic information, theranostics radiopharmaceuticals, and more aggressive treatment of metastatic disease to include focal therapy. Multidisciplinary management between specialized urologists, radiation oncologists, and medical oncologists remains central to maximizing patient outcomes., (Copyright © 2021 Elsevier Inc. All rights reserved.)

The complexity of health care today along with the drive towards value-based care are strong forces in support of growing and expanding the physician leadership workforce. Physician led organizations are associated with improved physician engagement, quality of care and cost efficiency. Physicians would benefit from more formal leadership training which incorporates a structed leadership curriculum, mentorship and on the job progressive leadership experience. Special attention must be placed on increasing the diversity of our physician leaders. There are many important characteristics to look for in our physician leaders including emotional intelligence, integrity, visioning, humility, persuasion and the ability to listen., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2021 Elsevier Inc. All rights reserved.)

INTRODUCTION Five-alpha reductase (5-AR) deficiency was first identified by Imperato-McGinley and Walsh as the cause of pseudohermaphroditism in two separate studies. The discoveries led to the development of finasteride (inhibitor of type 2 isoenzyme of 5-AR) and dutasteride (inhibitor of type 1 and type 2 isoenzymes of 5-AR. Both drugs have been proven effective for the treatment of benign prostatic hyperplasia and improve voiding symptoms, reduce the risk of urinary retention and the need for prostate surgery. Five-alpha reductase inhibitors 5-ARIs have been demonstrated to be chemopreventive agents and reduce the risk of prostate cancer, although the risk of selecting out or mediating higher grade prostate cancer remains uncertain. A lower dose of finasteride has been shown to be effective in the treatment of male pattern baldness., Materials and Methods: A Medline search was performed using mesh terms, benign prostatic hypertrophy, prostate cancer, male pattern baldness, female and 5-AR., Results: The Prostate Long Term Efficacy and Safety Study (PLESS) was a randomized double-blind study that established that finasteride resulted in a 22% increase in maximum flow rate and a 19% decrease in prostate volume. Further studies demonstrated that finasteride caused a significant reduction in the risk of the need for surgery and urinary retention in a 4 year period. Additional studies showed similar beneficial results with dutasteride. The potential benefits of 5-ARIs as chemopreventive agents were examined in the Prostate Cancer Prevention Trial (PCPT) and the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) studies. In the 7 year PCPT trial, 18.4% of the finasteride group developed prostate cancer compared to 24.4% in the placebo group. In the 4 year REDUCE trial, there was a 22.8% reduction of prostate cancer at the conclusion of the study. Despite the reduction of prostate cancer in both the PCPT and REDUCE trials, each study showed an increased risk of prostate cancer in the treatment arms. The explanation for these observations remains an area of investigation. Low dose finasteride has also been used successfully for the treatment of male pattern baldness., Conclusions: The use of 5-ARIs has been a major advance in urologic clinical practice. Urologists should be familiar with the underlying pharmacology of 5-ARIs as well as the clinical indications for their use.

In recent years, immunotherapy has been the focus of great interest to researchers, clinicians, and the general public. Traditionally cancer therapy has been thought to be limited to surgery, radiation therapy, or chemotherapy. Some clinicians have considered it the so-called fifth pillar of cancer therapy, following surgery, cytotoxic chemotherapy, radiation, and targeted therapy. However, the origins of immunotherapy in cancer treatment reach back at least into the nineteenth century. This article reviews the origins, development, and future of immunotherapy., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Purpose: Germline testing (GT) is a central feature of prostate cancer (PCA) treatment, management, and hereditary cancer assessment. Critical needs include optimized multigene testing strategies that incorporate evolving genetic data, consistency in GT indications and management, and alternate genetic evaluation models that address the rising demand for genetic services., Methods: A multidisciplinary consensus conference that included experts, stakeholders, and national organization leaders was convened in response to current practice challenges and to develop a genetic implementation framework. Evidence review informed questions using the modified Delphi model. The final framework included criteria with strong (> 75%) agreement (Recommend) or moderate (50% to 74%) agreement (Consider)., Results: Large germline panels and somatic testing were recommended for metastatic PCA. Reflex testing-initial testing of priority genes followed by expanded testing-was suggested for multiple scenarios. Metastatic disease or family history suggestive of hereditary PCA was recommended for GT. Additional family history and pathologic criteria garnered moderate consensus. Priority genes to test for metastatic disease treatment included BRCA2, BRCA1, and mismatch repair genes, with broader testing, such as ATM , for clinical trial eligibility. BRCA2 was recommended for active surveillance discussions. Screening starting at age 40 years or 10 years before the youngest PCA diagnosis in a family was recommended for BRCA2 carriers, with consideration in HOXB13, BRCA1, ATM , and mismatch repair carriers. Collaborative (point-of-care) evaluation models between health care and genetic providers was endorsed to address the genetic counseling shortage. The genetic evaluation framework included optimal pretest informed consent, post-test discussion, cascade testing, and technology-based approaches., Conclusion: This multidisciplinary, consensus-driven PCA genetic implementation framework provides novel guidance to clinicians and patients tailored to the precision era. Multiple research, education, and policy needs remain of importance.