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Directory of Authors from the Journal and their last article.

Kazumasa TorimotoView Articles

Volume 5, Number 3Meeting Reviews

Best of the 2003 AUA Annual Meeting

Highlights from the 2003 Annual Meeting of the American Urological Association, April 26-May 1, 2003

Dean G AssimosEllen ShapiroAlan W PartinMichael B ChancellorJ Curtis NickelJacob RajferClaus G RoehrbornMichael K BrawerRandall B MeachamBob DjavanArie S BelldegrunAllan J PantuckMesut RemziMichael DobrovitsMatthew B GretzerKazumasa Torimoto

Prostate cancerRenal cell carcinomaBenign prostatic hyperplasiaDepressionBladder cancerLower urinary tract symptomsUrinary tract infectionProstate-specific antigenNephrolithiasisOveractive bladderRadical prostatectomyPeyronie’s diseaseGleason scoreTransrectal ultrasoundErectile dysfunctionChronic prostatitis/chronic pelvic pain syndromeAcute urinary retentionInternational Prostate Symptom ScoreBacille Calmette-Guérin therapyChronic Prostatitis Symptom IndexMTOPS trialPLESS studyProstate tumor markersSELDI-TOF

Ke ShengView Articles

Volume 23, Number 4Prostate Cancer

Deep Learning for Magnetic Resonance Imaging–Based Radiation Therapy for Prostate Cancer: Current Status

Jessica E. ScholeyAbhejit RajagopalJulian HongPeder LarsonKe Sheng

Magnetic resonance imaging (MRI) is increasingly being used for external beam radiation therapy in the treatment of prostate cancer because of its excellent soft tissue contrast and ability to provide functional and physiologic information about tumor behavior. At the same time, deep learning has seen widespread applications in medical imaging, including for MRI-based classification and synthesis. Deep learning–based approaches are being incorporated into the MRI-guided clinical external beam radiation therapy workflow for patient simulation, contouring of targets and critical structures, treatment planning, and treatment delivery. In this review, we examine the current status of deep learning for MRI-guided prostate external beam radiation therapy.

Artificial intelligenceProstatic neoplasmsRadiotherapyMagnetic resonance imaging (MRI)Deep Learning

Ke-Hung TsuiView Articles
Kelly K BreeView Articles

Volume 22, Number 4Review Articles

Low Penetrance Germline Genetic Testing: Role for Risk Stratification in Prostate Cancer Screening and Examples From Clinical Practice

Management Update

Gerald L AndrioleFranklin GaylisKelly K BreePaul DatoChristopher J KaneA Karim Kader

Broad-based prostate-specific antigen (PSA) screening has saved lives but at a substantial human and financial cost. One way of mitigating this harm, while maintaining and possibly improving the benefit, is by focusing screening efforts on men at higher risk. With age, race, and family history as the only risk factors, many men lack any reliable data to inform their prostate cancer (PCa) screening decisions. Complexities including history of previous negative biopsies, interpretation of negative and/or equivocal mpMRI findings, and patient comorbidities further compound the already complicated decisions surrounding PCa screening and early detection. The authors present cases that provide real-world examples of how a single nucleotide polymorphism–based test can provide patients and providers with personalized PCa risk assessments and allow for development of improved risk-stratified screening regimens. [Rev Urol. 2020;22(4):152–158] © 2021 MedReviews®, LLC

Prostate cancer screeningRisk stratificationSomatic DNA testGermline DNA testsSingle nucleotide polymorphism DNA test

Ken-ryu HanView Articles
Kendall DupreeView Articles
Kenneth A. MitchellView Articles

Volume 23, Number 2Editorial

Advanced Practice Providers, Urology Workforce Challenges, and Reviews in Urology

Kenneth A. Mitchell

In 2015, the American Urological Association published the Consensus Statement on Advanced Practice Providers (APPs) with the goal of providing up-to-date information on the training of APPs, the scope of practice legislation, and examples of APPs in urologic practices.1 This statement was co-written by an experienced team of physicians and APPs whose purpose was to provide a unique and collaborative perspective on urology APPs. The paper was inspired by a report from an American Urological Association ad hoc committee assembled in 2008, which concluded that there were substantial workforce shortages in urology and that physician assistants and advanced practice registered nurses would provide the “best solution” for the declining urology workforce.2 In 2009, reports estimated that there were 3.1 urologists per 100 000 people in the United States and that urology was the second-oldest surgical subspecialty, with a workforce median age of 52.5 years.2 A published update in 2021, which used data from 2018, revealed that there were 3.89 urologists per 100 000 people in the United States, with 65% of urologists reporting that they were “interested” in the integration and use of APPs; 72.5% of urologists reported already incorporating an APP into their practice, accounting for nearly 41% of a physician (ie, MD or DO) full-time equivalent.2 More recent data showed the use of APPs was lowest in practices with the youngest and oldest subgroups of urologists and was highest in urban urology practices, which represent groups most likely to be affected initially due to the disproportionate geographical urology patient population density.

Physician assistantsnurse practitionershealth workforce

Kenneth E SchmankeView Articles

Volume 22, Number 2Review Articles

The Role of Multiparametric MRI and MRI-targeted Biopsy in Detecting Clinically Significant Prostate Cancer in the Community Setting: A Retrospective Study

Original Research

Kenneth E SchmankeJordan J StiversonRosalee E ZackulaSerge G SrourMatthew P LierzFadi N Joudi

Multiparametric MRI and the Prostate Imaging-Reporting and Data System (PI-RADS) have emerged as tools to reveal suspicious prostate lesions and MRI-targeted biopsy has shown potential to avoid repeat prostate biopsies and miss fewer significant cancers. This retrospective study sought to assess the differences in diagnostic yield and sampling efficiency between MRI-targeted and standard biopsies in a community urology practice. We concluded that MRI-targeted biopsy was more efficient than a standard biopsy, although neither technique achieved a superior diagnostic yield of clinically significant cancer in our community setting. We recommend that a standard biopsy be performed alongside targeted biopsy. [Rev Urol. 2020;22(2):57–66] © 2020 MedReviews®, LLC

Health services researchProstatic neoplasmsImage-guided biopsyMultiparametric MRIAmbulatory care facilities

Kenneth J PientaView Articles
Kenneth M KernenView 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

Kenneth M PetersView Articles
Kenneth WooView Articles
Kent E WallnerView Articles

Volume 15, Number 3Review Articles

The Case for Hypofractionation of Localized Prostate Cancer

Systematic Review

Winnifred M WongKent E Wallner

An optimal treatment regimen for localized prostate cancer (PCa) is yet to be determined. Increasing evidence reveals a lower a/b ratio for PCa with hypofractionated radiation therapy (HFRT) regimens introduced to exploit this change in therapeutic ratio. HFRT also results in shortened overall treatment times of 4 to 5 weeks, thus reducing staffing and machine burden, and, more importantly, patient stress. This review evaluates pretreatment characteristics, outcomes, and toxicity for 15 HFRT studies on localized PCa. HFRT results in comparable or better biochemical relapse-free survival and toxicity and is a viable option for localized PCa. [Rev Urol. 2013;15(3):113-117 doi: 10.3909/riu0582] © 2013 MedReviews®, LLC

Localized prostate cancerHypofractionationShort-course radiotherapyDose escalation

Kent PerryView Articles
Kent T. PerryView Articles

Volume 23, Number 3Prostate Cancer

Advances in Radical Prostatectomy: A Narrative Review

Austin DryschKathryn E. FinkChalairat Suk-OuichaiMitchell M. HuangKent T. PerryHiten D. PatelAshley E. Ross

Radical prostatectomy (RP) is the mainstay surgical treatment for men with localized prostate cancer. The use of robot-assisted RP (RARP) has specifically allowed for the development of novel techniques to improve postoperative quality of life for patients.

Prostatic neoplasmsProstatectomyRobotic-assisted surgeryrobotic surgical procedures

Kevin M SlawinView Articles
Kevin R RiceView Articles

Volume 12, Number 3Review Articles

Venous Thromboembolism in Urologic Surgery: Prophylaxis, Diagnosis, and Treatment

Treatment Update

Kevin R RiceStephen A BrassellDavid G McLeod

Venous thromboembolism (VTE) represents one of the most common and potentially devastating complications of urologic surgery. With VTE’s rapid onset of symptoms, association with a precipitous clinical course, and high mortality rate, all urologists should be well versed in appropriate prophylaxis, prompt diagnosis, and expeditious treatment. A MEDLINE® search was performed for articles that examined the incidence, diagnosis, and treatment of VTE in urologic surgery. Additional articles were reviewed based on cited references. There is a paucity of prospective studies on VTE in the urologic literature with most recommendations for urologic surgery patients being extrapolated from other surgical disciplines. Retrospective studies place VTE incidence rates in major urologic surgeries among the highest reported—highlighting the importance of thromboprophylaxis. Conversely, VTE was rarely reported in association with endoscopic and laparoscopic procedures making mechanical thromboprophylaxis sufficient. Recent literature reveals delayed VTE occurring after hospital discharge to be a persistent threat despite inpatient preoperative prophylaxis. Computed tomographic angiography has emerged as the test of choice for diagnosing pulmonary embolism, whereas lower extremity duplex sonography is recommended for diagnosing deep venous thrombosis. Traditional angiography is rarely used. Treatment of VTE involves therapeutic anticoagulation for various lengths of time based on presence and reversibility of patient risk factors as well as number of events. Perioperative thromboprophylaxis should be considered in all major urologic surgeries. Urologists should be familiar with incidence rates, recommended prophylaxis, appropriate diagnosis, and treatment recommendations for VTE to minimize morbidity and mortality. The limited number of prospective, randomized, controlled trials evaluating the use of thromboprophylaxis in urologic surgery demonstrates the need for further research. [Rev Urol. 2010;12(2/3):e111-e124 doi: 10.3909/riu0472]

Kevin T McVaryView Articles
Keyur ChavdaView Articles

Volume 17, Number 1Case Review

En Bloc Robot-assisted Laparoscopic Partial Cystectomy, Urachal Resection, and Pelvic Lymphadenectomy for Urachal Adenocarcinoma

Christopher R WilliamsKeyur ChavdaPaul Abrams

Primary adenocarcinomas of the bladder and urachus are extremely rare, accounting for 0.5% to 2.0% of all bladder malignancies. During fetal development, the urachus develops into the median umbilical ligament that stretches from the umbilicus to the bladder. Adenocarcinoma accounts for 90% of all cases of urachal carcinoma. There is no consensus regarding the management of urachal carcinoma. Although the preferred treatment is wide local excision with partial or radical cystectomy, bladder-sparing management is increasing. We report a case of robot-assisted laparoscopic partial cystectomy with en bloc resection of the urachus and bilateral pelvic lymphadenectomy for urachal carcinoma. The robot-assisted laparoscopic approach allowed us to minimize surgical morbidity, postoperative pain, and convalescent time while maintaining the oncologic principle of wide local excision. [Rev Urol. 2015;17(1):46-49 doi: 10.3909/riu0630] © 2015 MedReviews®, LLC

Urachal adenocarcinomaRobotic partial cystectomyPelvic lymphadenectomy

Khaled A ImamView Articles