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Directory of Authors from the Journal and their last article.

Sanford J SiegelView Articles
Sanoj PunnenView 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

Sara Babcock GilbertView Articles

Volume 17, Number 4Review Articles

Fertility Preservation Options for Men and Women With Cancer

Management Update

Malgorzata E Skaznik-WikielSara Babcock GilbertRandall B MeachamLaxmi A Kondapalli

Approximately 0.2% of Americans aged 20 to 39 years are childhood cancer survivors. Advances in cancer detection and therapy have greatly improved survival rates for young cancer patients; however, treatment of childhood cancers can adversely impact reproductive function. Many cancer patients report a strong desire to be informed of existing options for fertility preservation and future reproduction prior to initiation of gonadotoxic cancer therapies, including surgery, chemotherapy, and radiotherapy. This article discusses, in detail, the effects of cancer treatment on fertility in men and women, and outlines both current and experimental methods of fertility preservation among cancer patients. [Rev Urol. 2015;17(4):211-219 doi: 10.3909/riu0666] © 2016 MedReviews®, LLC

Fertility preservationChildhood cancerSperm cryopreservationTesticular tissue cryopreservationSpermatogonial stem cell cryopreservationEmbryo cryopreservationOocyte cryopreservationOvarian tissue cryopreservation

Sara MelegariView Articles

Volume 15, Number 4Review Articles

Intracavitary Immunotherapy and Chemotherapy for Upper Urinary Tract Cancer: Current Evidence

Systematic Review

Luca CarmignaniRoberto BianchiGabriele CozziNicola MacchioneCarlo MarenghiSara MelegariMarco RossoElena TondelliAugusto MaggioniAngelica Grasso

A review of the literature was performed to summarize current evidence regarding the efficacy of topical immunotherapy and chemotherapy for upper urinary tract urothelial cell carcinoma (UUT-UCC) in terms of post-treatment recurrence rates. A Medline database literature search was performed in March 2012 using the terms upper urinary tract, urothelial cancer, bacillus Calmette-Guérin (BCG), and mitomycin C. A total of 22 full-text articles were assessed for eligibility, and 19 studies reporting the outcomes of patients who underwent immunotherapy or chemotherapy with curative or adjuvant intent for UUT-UCC were chosen for quantitative analysis. Overall, the role of immunotherapy and chemotherapy for UUT-UCC is not firmly established. The most established practice is the treatment of carcinoma in situ (CIS) with BCG, even if a significant advantage has not yet been proven. The use of BCG as adjuvant therapy after complete resection of papillary UUT-UCC has been studied less extensively, even if recurrence rates are not significantly different than after the treatment of CIS. Only a few reports describe the use of mitomycin C, making it difficult to obtain significant evidence. [Rev Urol. 2013;15(4):145-153 doi: 10.3909/riu0579] © 2014 MedReviews®, LLC

ImmunotherapyChemotherapyBacillus Calmette-GuérinUpper urinary tractUrothelial cell carcinomaMitomycin C

Sarah ColemanView Articles

Volume 16, Number 4Case Review

Testicular Sclerosing Sertoli Cell Tumor: A Case Report and Review of the Literature

Edmund S SabaneghYagil BarazaniSarah ColemanAndres A Roma

Sertoli cell tumors are very rare testicular tumors, representing 0.4% to 1.5% of all testicular malignancies. They are subclassified as classic, large-cell calcifying, and sclerosing Sertoli cell tumors (SSCT) based on distinct clinical features. Only 42 cases of SSCTs have been reported in the literature. We present a case of a 23-year-old man diagnosed with SSCT. [Rev Urol. 2014;16(4):191-193 doi: 10.3909/riu0620] © 2014 MedReviews®, LLC

Testicular neoplasmSertoli cell tumorSclerosing Sertoli cell tumor

Sasha C DruskinView Articles

Volume 19, Number 3Meeting Reviews

Best of the 2017 AUA Annual Meeting

Benjamin M BruckerDean G AssimosEllen ShapiroAlan W PartinMichael B ChancellorJ Curtis NickelMaria J Arcila-RuizSasha C Druskin

[Rev Urol. 2017;19(3):169–179 doi: 10.3909/riu0763] © 2017 MedReviews®, LLC

Percutaneous nephrolithotomyDisorders of sexual developmentBladder exstrophyProstate-specific antigenBiomarkersMicrobiomeOnabotulinumtoxinABladder pain syndromeStem cell therapyInterstitial cystitisStress urinary incontinenceKallikreinZika virusReverse transcription loop-mediated isothermal amplificationRefractory overactive bladderMeshectomyPudendal neuromodulationMedical expulsive therapyGlans groove

Sashi S KommuView Articles

Volume 17, Number 3Review Articles

Current Status of Hemostatic Agents and Sealants in Urologic Surgical Practice

Management Update

Sashi S KommuRobert McArthurAmr M EmaraUtsav D ReddyChristopher J AndersonNeil J BarberRaj A PersadChristopher G Eden

There has been a recent and near exponential increase in the use of hemostatic agents and sealants to supplement the rapidly evolving methods in the surgical management of urologic patients. This article reviews the use of hemostatic agents and sealants in current urologic practice. [Rev Urol. 2015;17(3):150-159 doi: 10.3909/riu0673] © 2015 MedReviews®, LLC

HemostasisTissue adhesionUrologic surgery

Savvas E MendrinosView Articles

Volume 15, Number 4Original Research

Utilization Trends and Positive Biopsy Rates for Prostate Biopsies in the United States: 2005 to 2011

Deepak A KapoorAnn E AndersonCarl A OlssonSavvas E MendrinosDavid G Bostwick

This article assesses the positive biopsy rate and core sampling pattern in patients undergoing needle biopsy of the prostate in the United States at a national reference laboratory (NRL) and anatomic pathology laboratories integrated into urology group practices, and analyzes the relationship between positive biopsy rates and the number of specimen vials per biopsy. For the years 2005 to 2011 we collected pathology data from an NRL, including number of urologists and urology practices referring samples, total specimen vials submitted for prostate biopsies, and final pathologic diagnosis for each case. The diagnoses were categorized as benign, malignant, prostatic intraepithelial neoplasia, or atypical small acinar proliferation. Over the same period, similar data were gathered from urology practices with in-house laboratories performing global pathology services (urology practice laboratories; UPLs) as identified by a survey of members of the Large Urology Group Practice Association. For each year studied, positive biopsy rate and number of specimen vials per biopsy were calculated in aggregate and separately for each site of service. From 2005 to 2011, 437,937 biopsies were submitted in . 4.23 million vials (9.4 specimen vials/biopsy); overall positive biopsy rate was 40.3%—this was identical at both the NRL and UPL (P 5 .97). Nationally, the number of specimen vials per biopsy increased sharply from a mean of 8.8 during 2005 to 2008 to a mean of 10.3 from 2009 to 2011 (difference, 1.5 specimen vials/biopsy; P 5 .03). For the most recent 3-year period (2009-2011), the difference of 0.6 specimen vials per biopsy between the NRL (10.0) and UPL (10.6) was not significant (P 5 0.08). Positive biopsy rate correlated strongly (P , .01) with number of specimen vials per biopsy. The positive prostate biopsy rate is 40.3% and is identical across sites of service. Although there was a national trend toward increased specimen vials per biopsy from 2005 to 2011, from 2009 to 2011 there was no significant difference in specimen vials per biopsy across sites of service. Increased cancer detection rate correlated significantly with increased number of specimens examined. Segregation of prostate biopsy cores into 10 to 12 unique specimen vials has been widely adopted by urologists across sites of service. [Rev Urol. 2013;15(4):137-144 doi: 10.3909/riu0600] © 2014 MedReviews®, LLC

Prostate cancerProstate biopsyUtilization trendsNational reference laboratory

Scott B SellingerView Articles
Scott B ShappellView Articles

Volume 10, Number 1Review Articles

Clinical Utility of Prostate Carcinoma Molecular Diagnostic Tests

Diagnostic Update

Scott B Shappell

Instead of relying on serum prostate-specific antigen (PSA) to identify patients for prostate biopsy, new laboratory tests are needed that have improved specificity for prostate carcinoma (CaP), allow accurate classification of clinically insignificant CaPs, allow for detection of clinically significant CaP in patients without elevated serum PSA, and allow for identification of aggressive forms of CaP, which may warrant adjunctive or even molecularly targeted therapy in the future. Over the last several years, highthroughput gene expression profiling and proteinomics have led to the identification of genes and proteins that are specifically overexpressed in CaP. Molecular diagnostic techniques readily translated to the clinical laboratory have been incorporated into the development of new tests based on these novel molecular alterations in CaP. Some of these tests already have well-documented clinical utility, such as in facilitating prostate biopsy decisions, and are routinely available. The current review focuses on the biological, clinical, and laboratory aspects of the most promising of these current and nearfuture molecular CaP tests. [Rev Urol. 2008;10(1):44-69]

Molecular diagnosticsProstate carcinomaProstate cancer antigen 3Alpha-methylacyl-CoA racemaseEarly prostate cancer antigenTransmembrane protease,serine 2ERGDNARNA

Scott E EggenerView Articles
Scott EggenerView Articles

Volume 20, Number 2Original Research

Effectiveness of Subcutaneously Administered Leuprolide Acetate to Achieve Low Nadir Testosterone in Prostate Cancer Patients

Scott EggenerChristopher M PieczonkaJason HafronJoseph Renzulli IIPrzemyslaw TwardowskimDeborah M Boldt-HouleStuart Atkinson

Evidence suggests lower nadir testosterone levels during the first year of androgen deprivation therapy improve advanced prostate cancer clinical outcomes. We evaluated pivotal trials for subcutaneously administered leuprolide acetate (1-, 3-, 4-, and 6-month doses) to determine nadir testosterone levels. Pooled analysis showed 99%, 97%, and 91% of patients reached nadir testosterone ≤20, ≤10, and ≤5 ng/dL respectively (median ≤3 ng/dL). Across all available categories, ≥88% of patients reached nadir testosterone ≤5 ng/dL, and <3% experienced a microsurge. Achievement and maintenance of low nadir testosterone levels may improve progression-free survival and time to onset of castrate-resistant prostate cancer. [Rev Urol. 2018;20(2):63–68 doi: 10.3909/riu0798] © 2018 MedReviews®, LLC

Prostate cancerAndrogen deprivation therapyLHRH agonistsLeuprolide acetateNadir testosterone

Scott HalperinView Articles

Volume 20, Number 2Case Review

Clinical Relevance of Petit’s Triangle: A Forgotten Landmark

Scott HalperinJulian SpectorDavid PennBarry Zisholtz

This rare case details a right-sided hydronephrotic kidney herniated through Petit’s triangle. Petit’s triangle is an anatomical landmark that is usually not clinically significant and only alluded to during multiple-choice examinations. This case describes the clinical ramification of this area of weakness and allows us to revisit and relearn the anatomy, and its relevance in clinical practice. [Rev Urol. 2018;20(2):112–114 doi: 10.3909/riu0796] © 2018 MedReviews®, LLC

HerniaPetit’s triangleHydronephrotic kidney

Scott I ZeitlinView Articles
Scott M LuciaView Articles
Scott MacDiarmidView Articles
Scott Tully JrView Articles

Volume 19, Number 2Review Articles

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

Thomas E MoodyCurtis L SpraitzarElizabeth EisenhartScott Tully Jr

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

Prostate cancerProstate-specific antigenAUA screening guidelineAverage-risk men

Seamus TeahanView Articles
Sean P StroupView Articles

Volume 9, Number 4Case Review

Bilateral Testicular Infarction and Orchiectomy as a Complication of Polyarteritis Nodosa

Case Review

Donald S CrainShannon R HerreraSean P Stroup

We report an unusual case of a 28-year-old male with constitutional symptoms and bilateral testicular pain. After diagnosis of cytomegalovirus (CMV) hepatitis, his constitutional symptoms and testicular pain worsened despite treatment for epididymoorchitis. Ultrasound was concerning for infarction. Exploration in the operating room revealed bilateral testicular infarction requiring bilateral orchiectomy with subsequent androgen hormone replacement. Pathologic diagnosis was polyarteritis nodosa (PAN). PAN is a rare systemic vasculitis that affects multiple organs. There are no previous reports of PAN-induced vasculitis leading to bilateral testicular infarction and bilateral orchiectomy. [Rev Urol. 2007;9(4):235-238]

Testicular infarctionPolyarteritis nodosaAndrogen replacement therapy

Selahattin ÇalIiskanView Articles

Volume 17, Number 3Case Review

Retroperitoneal Ancient Schwannoma: A Case Report

Selahattin ÇalIiskanGülistan GümrükçüCevdet Kaya

Schwannomas are extremely rare tumors that are composed of Schwann cells. Retroperitoneal localization comprises 0.7% to 2.6% of all schwannomas. Patients usually present with nonspecific symptoms. There are no pathognomonic features on radiologic evaluation. Preoperative biopsy is not recommended because of complication risks; however, surgery is necessary for diagnosis and treatment. Although most schwannomas are benign tumors, those that are associated with von Recklinghausen disease are malignant. Schwannomas exhibit regions of high and low cellularity, termed Antoni A and Antoni B areas, with a diffuse positivity of S100 protein on pathologic evaluation. If there are degenerative changes, such as cyst formation, hemorrhage, calcification, and hyalinization, these tumors are termed ancient schwannomas. We present a case of retroperitoneal ancient schwannoma. [Rev Urol. 2015;17(3):190-193 doi: 10.3909/riu0638] © 2015 MedReviews®, LLC

Retroperitoneal schwannomaNeurilemmomaSchwannomaRetroperitoneal tumor