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Directory of Authors from the Journal and their last article.

Mary-Ellen TaplinView Articles
Marybeth McCallView Articles

Volume 18, Number 3Original Research

Health Economic Impact and Prospective Clinical Utility of Oncotype DX® Genomic Prostate Score

Michael J KemeterPhillip G FebboDavid AlbalaRuixiao LuVincy JohnDylan StoyBela DenesMarybeth McCallAlan W ShindelFrank Dubeck

Prostate cancer (CaP) will be diagnosed in approximately 181,000 American men in 2016. Despite the high number of deaths from CaP in the United States, the disease has a protracted natural history and many men diagnosed with CaP will not die of the disease regardless of treatment. Unfortunately, identification of men with truly indolent/nonaggressive CaP is challenging; limitations of conventional diagnostic modalities diminish the ability of physicians to accurately stage every case of CaP based on biopsy results alone. The resulting uncertainty in prognosis may prompt men with low-risk CaP to proceed to morbid and expensive treatments for an unclear survival benefit. Incorporation of the Genomic Prostate Score (GPS) as part of the decision algorithm for patients with National Comprehensive Cancer Network very low-risk and low-risk cancer led to a substantial increase in uptake of active surveillance and substantial cost savings. GPS provides physicians and patients with an additional tool in assessing personalized risk and helps guide individual decision making. [Rev Urol. 2016;18(3):123-132 doi: 10.3909/riu0725] © 2016 MedReviews®, LLC

Prostate cancerOncotype DX® GPSGenomic testingHealth economicsClinical utility

MASView Articles

Volume 17, Number 1Review Articles

Finding the Wolf in Sheep’s Clothing: The 4Kscore Is a Novel Blood Test That Can Accurately Identify the Risk of Aggressive Prostate Cancer

Diagnosis and Screening Update

Dipen J ParekhSanoj PunnenMASNicola Pavan

Better biomarkers that can discriminate between aggressive and indolent phenotypes of prostate cancer are urgently needed. In the first 20 years of the prostate-specific antigen (PSA) era, screening for prostate cancer has successfully reduced prostate cancer mortality, but has led to significant problems with overdiagnosis and overtreatment. As a result, many men are subjected to unnecessary prostate biopsies and overtreatment of indolent cancer in order to save one man from dying of prostate cancer. A novel blood test known as the 4Kscore® Test (OPKO Lab, Nashville, TN) incorporates a panel of four kallikrein protein biomarkers (total PSA, free PSA, intact PSA, and human kallikrein-related peptidase 2) and other clinical information in an algorithm that provides a percent risk for a high-grade (Gleason score ≥ 7) cancer on biopsy. In 10 peer-reviewed publications, the four kallikrein biomarkers and algorithm of the 4Kscore Test have been shown to improve the prediction not only of biopsy histopathology, but also surgical pathology and occurrence of aggressive, metastatic disease. Recently, a blinded prospective trial of the 4Kscore Test was conducted across the United States among 1012 men. The 4Kscore Test replicated previous European results showing accuracy in predicting biopsy outcome of Gleason score ≥ 7. In a recent case-control study nested within a population-based cohort from Västerbotten, Sweden, the four kallikrein biomarkers of the 4Kscore Test also predicted the risk for aggressive prostate cancer that metastasized within 20 years after the test was administered. These results indicate that men with an abnormal PSA or digital rectal examination result, and for whom an initial or repeat prostate biopsy is being considered, would benefit from a reflex 4Kscore Test to add important information to the clinical decision-making process. A high-risk 4Kscore Test result may be used to select men with a high probability of aggressive prostate cancer who would benefit from a biopsy of the prostate to prevent an adverse and potentially lethal outcome from prostate cancer. Men with a low 4Kscore Test result may safely defer biopsy. [Rev Urol. 2015;17(1):3-13 doi: 10.3909/riu0668] © 2015 MedReviews®, LLC

Prostate cancerBiomarkerScreeningHigh-grade prostate cancer

Mason HoltelView Articles

Volume 21, Number 1Case Review

Use of Spermatic Cord Block Systematically Identifies a Paraspinal Tumor as Source of Orchialgia

Mason HoltelRobert J Baranello JrAllyson HalePatrick Springhart

Orchialgia is a common urologic complaint with a myriad of etiologies. Workup for orchialgia requires a broad differential diagnosis and a thorough understanding of relevant anatomy. We report the case of a 43-year-old man who presented to a urologist with right testicular pain. Following a negative workup, the patient received a spermatic cord block for therapeutic and diagnostic purposes. Two months after the block, the patient returned with new complaints of ipsilateral inner thigh paresthesias, suggesting a pathologic process proximal to the genital branch of the genitofemoral nerve. A subsequent MRI of the lumbosacral spine revealed a paraspinal mass involving nerve roots at L1-2. We highlight the utility of the spermatic cord block and its role in the diagnosis of a paraspinal tumor as an uncommon cause of orchialgia. [Rev Urol. 2019;21(1):49–52] © 2019 MedReviews®, LLC

OrchialgiaNeuropathic painTesticular painSpermatic cord blockGenitofemoral nerveParaspinal tumor

Masood A KhanView Articles
Matthew A StanizziView Articles

Volume 9, Supplement 1Review Articles

Clinical Experience With Gene Therapy for the Treatment of Prostate Cancer

New Directions in the Management of Advanced Prostate Cancer

Simon J HallMatthew A Stanizzi

Localized prostate cancer can be treated effectively with radical prostatectomy or radiation therapy. The treatment options for metastatic prostate cancer are limited to hormonal therapy; hormone-refractory cancer is treated with taxane-based chemotherapy, which provides only a modest survival benefit. New treatments are needed. The gene for the initiation of prostate cancer has not been identified; however, gene therapy can involve tumor injection of a gene to kill cells, systemic gene delivery to target and kill metastases, or local gene expression intended to generate a systemic response. This review will provide an overview of the various strategies of cancer gene therapy, focusing on those that have gone to clinical trial, detailing clinical experience in prostate cancer patients. [Rev Urol. 2007;9(suppl 1):S20-S28]

Prostate cancerProstate-specific antigenGene therapy

Matthew B GretzerView 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

Matthew C FerroniView Articles

Volume 19, Number 2Review Articles

The Use of Intraoperative Cell Salvage in Urologic Oncology

Surgical Update

Andres F CorreaMatthew C FerroniTimothy D LyonBenjamin J DaviesMichael C Ost

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

Urologic oncologyCell salvagetransfusion

Matthew E HardeeView Articles

Volume 13, Number 1Case Review

Squamous Cell Carcinoma of the Prostate

Case Review

Samir S TanejaRena D MalikGeorge DakwarMatthew E HardeeNicholas SanfilippoAndrew B Rosenkrantz

"Squamous cell carcinoma of the prostate is a rare tumor, making up 0.5% to 1% of all prostate carcinomas. It is typically described as an aggressive cancer, with a median postdiagnosis survival of 14 months. Presented here is a case of primary squamous cell carcinoma of the prostate, with a complicated presentation of metastatic disease. Due to the extent of the patientís disease, he was treated with palliative radiation therapy using a four-field technique (AP/PA and left and right lateral fields) with 18 mV photons prescribed to the 100% isodose line. The prescription dose was 4000 cGy in 16 fractions of 250 cGy per fraction. No definitive treatment of squamous cell carcinoma of the prostate exists but varying approaches including surgical intervention, chemotherapy, and radiation therapy have been implemented without durable response. However, multimodal treatments appear to be the most promising with longer durations of survival. [Rev Urol. 2011;13(1):56-60 doi: 10.3909/riu0494]"

Squamous cell carcinomaProstate adenocarcinomaLower urinary tractsymptomsMultimodal treatments

Matthew E NielsenView 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

Matthew F BultitudeView Articles

Volume 13, Number 3Review Articles

Lower Urinary Tract Injuries Following Blunt Trauma: A Review of Contemporary Management

Management Review

Peter L RoyceMatthew F BultitudeJennifer KongRussell GruenAlex CatoNiall Corcoran

Lower urinary tract trauma, although relatively uncommon in blunt trauma, can lead to significant morbidity when diagnosed late or left untreated; urologists may only encounter a handful of these injuries in their career. This article reviews the literature and reports on the management of these injuries, highlighting the issues facing clinicians in this subspecialty. Also presented is a structured review detailing the mechanisms, classification, diagnosis, management, and complications of blunt trauma to the bladder and urethra. The prognosis for bladder rupture is excellent when treated. Significant intraperitoneal rupture or involvement of the bladder neck mandates surgical repair, whereas smaller extraperitoneal lacerations may be managed with catheterization alone. With the push for management of trauma patients in larger centers, urologists in these hospitals are seeing increasing numbers of lower urinary tract injuries. Prospective analysis may be achieved in these centers to address the current lack of Level 1 evidence.[Rev Urol. 2011;13(3):119-130 doi: 10.3909/riu0521] © 2011 MedReviews®, LLC

UrethraMultiple traumaRuptureUrinary bladderWounds

Matthew GlansView Articles

Volume 23, Number 4Editorial

2024 LUGPA Advocacy Year in Review: Confronting Challenges, Advancing Progress

Matthew Glans

In 2024, independent practices nationwide faced new and mounting challenges, including increasing and expanding regulatory obligations and growing patient demands against a background of rising input costs and financial pressures. Amid a shifting health care landscape, urologists were tasked with the pressing challenge of doing more with less.

Telemedicinehealth care costsinsurance, healthhealth services accessibility

Matthew GretzerView Articles

Volume 16, Number 2Case Review

Immunoglobulin G4–related Retroperitoneal Fibrosis of the Pelvis

Anthony DyerPeter M SadowErika BracamonteMatthew Gretzer

Retroperitoneal fibrosis (RPF) is a rare disease characterized by the replacement of normal tissue with fibrosis and/or inflammation. In this case, a 68-year-old man presented with RPF in the pelvis, a rare location for this disease. Biopsies were performed, which showed elevated levels of C-reactive protein, erythrocyte sedimentation rate, and, most importantly, immunoglobulin G4 (IgG4). It has been postulated that IgG4-related sclerosing disease is a systemic disease. Treatment has been successful with systemic corticosteroids. [Rev Urol. 2014;16(2):92-94 doi: 10.3909/riu0594] © 2014 MedReviews®, LLC

Retroperitoneal fibrosisSerum immunoglobulin G4

Matthew HT BuiView Articles
Matthew J WhitfieldView Articles

Volume 22, Number 4Review Articles

Application of Artificial Intelligence/Machine Vision & Learning for the Development of a Live Single-cell Phenotypic Biomarker Test to Predict Prostate Cancer Tumor Aggressiveness

Original Research

David M. AlbalaGrannum R SantJonathan S VarsanikMichael S ManakMatthew J WhitfieldBrad J HoganWendell R SuCJ JiangAshok C Chander

To assess the usefulness and applications of machine vision (MV) and machine learning (ML) techniques that have been used to develop a single cell–based phenotypic (live and fixed biomarkers) platform that correlates with tumor biological aggressiveness and risk stratification, 100 fresh prostate samples were acquired, and areas of prostate cancer were determined by post-surgery pathology reports logged by an independent pathologist. The prostate samples were dissociated into single-cell suspensions in the presence of an extracellular matrix formulation. These samples were analyzed via live-cell microscopy. Dynamic and fixed phenotypic biomarkers per cell were quantified using objective MV software and ML algorithms. The predictive nature of the ML algorithms was developed in two stages. First, random forest (RF) algorithms were developed using 70% of the samples. The developed algorithms were then tested for their predictive performance using the blinded test dataset that contained 30% of the samples in the second stage. Based on the ROC (receiver operating characteristic) curve analysis, thresholds were set to maximize both sensitivity and specificity. We determined the sensitivity and specificity of the assay by comparing the algorithm-generated predictions with adverse pathologic features in the radical prostatectomy (RP) specimens. Using MV and ML algorithms, the biomarkers predictive of adverse pathology at RP were ranked and a prostate cancer patient risk stratification test was developed that distinguishes patients based on surgical adverse pathology features. The ability to identify and track large numbers of individual cells over the length of the microscopy experimental monitoring cycles, in an automated way, created a large biomarker dataset of primary biomarkers. This biomarker dataset was then interrogated with ML algorithms used to correlate with post-surgical adverse pathology findings. Algorithms were generated that predicted adverse pathology with >0.85 sensitivity and specificity and an AUC (area under the curve) of >0.85. Phenotypic biomarkers provide cellular and molecular details that are informative for predicting post-surgical adverse pathologies when considering tumor biopsy samples. Artificial intelligence ML-based approaches for cancer risk stratification are emerging as important and powerful tools to compliment current measures of risk stratification. These techniques have capabilities to address tumor heterogeneity and the molecular complexity of prostate cancer. Specifically, the phenotypic test is a novel example of leveraging biomarkers and advances in MV and ML for developing a powerful prognostic and risk-stratification tool for prostate cancer patients. [Rev Urol. 2020;22(4):159–167] © 2021 MedReviews®, LLC

Prostate cancerArtificial intelligencePhenotypic biomarkersMachine visionMachine learning

Matthew J ZiegelmannView Articles

Volume 21, Number 2Review Articles

Evaluation and Management of Chronic Scrotal Content Pain—A Common Yet Poorly Understood Condition

Management Review

Matthew J ZiegelmannRyan FarrellLaurence A Levine

Chronic scrotal content pain (CSCP) refers to bothersome pain localized to structures within the scrotum that has been present for ≥ 3 months. Etiologies include infection, trauma, and referred pain from the spine, abdomen, and retroperitoneum. However, in many patients there is no obvious identifiable cause. The initial evaluation should include a thorough history and physical examination with adjunctive imaging and laboratory tests as indicated. Treatments vary based on the underlying etiology and include both nonsurgical and surgical options with high levels of success when selectively utilized. The spermatic cord block with local anesthetic is an important tool that helps identify those patients who may benefit from surgery such as microscopic denervation of the spermatic cord. Other treatments including pelvic floor physical therapy may also be indicated in specific circumstances. Using a thoughtful and thorough approach to evaluation and treatment of CSCP, urologists can work with patients to achieve significant improvements in quality of life. [Rev Urol. 2019;21(2/3):74–84] © 2019 MedReviews®, LLC

OrchialgiaTesticlePain inguinalDenervation

Matthew J. JonesView Articles

Volume 23, Number 1Literature Reviews

Comparison of Methods for Ureteral Patency Visualization

Michelle BoytimMatthew J. JonesAlex S. BartPavel Svintozelskiy

The most common cause of ureteral trauma occurs during open, laparoscopic, or endoscopic procedures across multiple specialties. Ureteral injuries are often unrecognized or mismanaged. Early recognition of ureteral injuries by cystoscopy allows for prompt intervention. Visualization can be enhanced using agents that color or improve the contrast of ureteral flow.

Cystoscopydiagnostic imagingindigo carminemethylene bluefluorescein

Matthew O FraserView Articles
Matthew P LierzView 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

Matthew R SmithView Articles