Volume 24, Number 1

Reviews in Urology

Letter From the President of LUGPA

Scott B Sellinger

As we begin 2025, LUGPA remains firm in its mission to advance policies that support independent urology practices and protect patient access to high-quality care. The US Congress’s continuing resolution last year averted a government shutdown but left critical health care reforms unresolved, including a much-needed fix for Medicare payment cuts.

LUGPA News

LUGPA News

Celeste Kirschner

LUGPA’s first Global Prostate Cancer Congress took place January 18-21, 2025, at the Sun Valley Resort in Sun Valley, Idaho. More than 170 people attended.

Reviews in Urology

Underused Potential: Real-World Insights on Abiraterone Acetate in High-Risk Localized Prostate Cancer

Zachariah D. TaylorKayla G. MeyerKathryn DohertyGregory C McMahon

We sought to examine real-world data to evaluate the use of abiraterone acetate in men with very high-risk prostate cancer.

abiraterone acetatemedical oncologyProstatic neoplasms

Prostate Cancer

Real-World Outcomes for Patients With Metastatic Castration-Resistant Prostate Cancer Within a US Community Urology Network

Emily N. SmythSam WhippleNicholas LazarouKatie GrantArpit KashyapZhanglin L. CuiNadine HaddadArjun V. BalarNeal D Shore

The role of novel hormonal agents (NHAs) for advanced prostate cancer (PCa) has expanded over time to include treatment of metastatic and nonmetastatic disease. Additionally, in the last 5 years, select poly(ADP-ribose) polymerase (PARP) inhibitors have been FDA-approved and incorporated into treatment guidelines for homologous recombination repair and BRCA mutant metastatic castration-resistant prostate cancer (mCRPC). To understand the evolving treatment landscape and unmet medical needs in mCRPC, treatment patterns, patient characteristics, and outcomes within a large community urology network were evaluated.

medical oncologyprostatic neoplasms, castration-resistantUrology

Meet The Expert

Meet the Experts: Wanda Wilt, RN, BSN, and Gordon A. Brown, DO, FACOS

Neal D Shore

Thank you so much for joining us today for our first Meet the Expert of the year with our very special guests, Dr Gordon Brown of New Jersey Urology and Wanda Wilt from Specialty Networks. Dr Brown is associate professor at Thomas Jefferson University School of Medicine in Pennsylvania. He is also the medical director for the New Jersey Urology Center for Advanced Therapeutics. And Wanda Wilt is the executive vice president of provider solutions for Specialty Networks, a Cardinal Health Company. I’m Neal Shore. I’m the medical director of Carolina Urologic Research Center, practicing with AUC Urology Specialists in Myrtle Beach, South Carolina. So this is really a great opportunity, and we’re privileged to speak with you today. Just published last month in Urology, what is oftentimes called the Gold Journal, February 2025 edition, the 3 of us, along with our colleagues Ben Lowentritt, Lorraine O’Donnell, Sabree Burbage, Ibrahim Khilfeh, and Franklin Gaylis.

Prostate Cancer

Use of Radium-223 in Advanced Prostate Cancer

Soumyajit RoyAngela Y. JiaPedro C. BarataDaniel E. Spratt

Radium-223 dichloride (Ra-223) is a life-prolonging therapeutic option for castration-resistant prostate cancer with symptomatic bone metastases. As an α-emitting osteotropic radiopharmaceutical, Ra-223 selectively targets areas of increased bone turnover. Recent evidence from the PEACE III randomized trial demonstrated a radiographic progression-free survival and overall survival benefit with a combination of Ra-223 and enzalutamide, provided appropriate bone health measures are in place. There is also a growing body of evidence on the use of Ra-223 in metastatic hormone-sensitive prostate cancer. Robust phase 3 data, however, are needed to define its optimal integration into the current standard of care for these patients.

Radioisotopesprostatic neoplasms, castration-resistantmetastatic hormone-sensitive prostate cancerProstatic neoplasms

Prostate Cancer

Darolutamide for Metastatic Hormone-Sensitive Prostate Cancer: An Overview of Meta-Analyses and Indirect Treatment Comparisons

Neal D ShoreAlicia K. MorgansNoman ParachaSarah HodgkinsonChristian S. EichingerCraig MillarStephanie ChenHoward ThomMartin Boegemann

We evaluated the numerous published indirect treatment comparisons (ITCs) and meta-analyses of the efficacy and safety of treatments in metastatic hormone-sensitive prostate cancer (mHSPC), which include the ARASENS study of darolutamide triple therapy, to identify limitations of the evidence and to suggest methodological improvements.

network meta-analysisoverall survivaladverse eventsProstatic neoplasms

Prostate Cancer

Advanced Tools for Risk Stratification in Prostate Cancer: A Contemporary Review of Commercially Available Molecular Genomic and Digital Histopathology Tests

Ryan J. Hutten

Traditional risk stratification in localized prostate cancer provides broad treatment guidance but lacks the preci­sion necessary for individualized care. Commercially available biomarkers, including Decipher (Veracyte), Prolaris (Myriad Genetics, Inc), Genomic Prostate Score (mdxhealth), and ArteraAI, have recently demonstrated improved prognostic and predictive capabilities. These tools can assist clinical decision-making in key scenarios, including active surveil­lance, intensification of treatment with definitive radiation, and postoperative management. This review synthesizes the current evidence supporting these biomarkers, emphasizing their validation, clinical utility, and potential to refine prostate cancer management. Understanding the development and limitations of these biomarkers is crucial for their appropriate integration into patient care.

precision medicineProstatic neoplasmsBiomarkers

Bladder Cancer

The Role of TURBT in Bladder Cancer: Standardizing Surgical Approaches and Future Directions to Improve Patient Outcomes

Benjamin FinkYoung SonThomas MuellerGordon A Brown

Bladder cancer is one of the most commonly diagnosed cancers in the United States. Transurethral resection of a bladder tumor (TURBT) is a fundamental aspect of bladder cancer treatment. Standardizing TURBT is essential to optimize patient outcomes and reproduce results. There are many ways to standardize care. New technologies, from blue-light cystoscopy to magnetic resonance imaging and artificial intelligence, are enhancing treatment effectiveness in patients with bladder cancer. Providing maximal TURBT is an acceptable alternative to patients with muscle-invasive disease, especially patients who are medically frail and could not tolerate radical cystectomy.

Artificial intelligenceBladder cancerCystectomyCystoscopy

Reviews in Urology

Evaluating the Analytical Validity and Clinical Utility and Validity of Polymerase Chain Reaction Diagnostics vs Culture and Sensitivity Methods in Complicated Urinary Tract Infection Management

A Comprehensive Review of Real-World Evidence, Clinical Trials, and MetaAnalyses Concerning Molecular Diagnostic Services Program Coverage Criteria

Michael E. AbergerBradley A. WilsonRoel ChavezFrank L. SpanglerItoe P. PriestlyLauren Y. ParkMoustafa Kardjadj

Polymerase chain reaction (PCR)–based diagnostics are increasingly used for complicated urinary tract infections, offering faster and more sensitive detection of pathogens than conventional culture and sensitivity methods. This review assessed the clinical validity, utility, and alignment of PCR-based diagnostics with the Molecular Diagnostic Services Program’s (MolDX) Medicare coverage and reimbursement criteria.

Polymerase chain reactionmicrobial sensitivity testsvalidation studyinsurance health reimbursementUrinary tract infections

Coding Corner

Office or Other Outpatient Evaluation and Management Visit Complexity Code: Early Experience in Community Urology Practice

Robert A. DowlingMark PainterEvan R Goldfischer

In January 2024 the Centers for Medicare & Medicaid Services began reimbursement for a Healthcare Common Procedure Coding System add-on complexity code (G2211) applied to eligible evaluation and management visits. This study examines the use of and reimbursement for this code in urology practices in the first 6 months of 2024.

Ambulatory care facilitiesclinical codingurologic diseasesambulatory care

Prostate Cancer

Prostate Cancer Metastatic to Testicle Discovered on PSMA PET Scan

Taylor P. SeitzCurtis J. Dunshee

Prostate cancer is one of the most commonly diagnosed carcinomas in men in the United States. Although advanced disease often metastasizes to the bones and nodes, occurrences of metastasis to other sites are rare. With the newer availability of prostate-specific membrane antigen positron emission tomography scan technology, it has become increasingly feasible to detect the recurrence and spread of prostate cancer. We present the case of a 54-year-old man with high-volume metastatic prostate cancer at diagnosis who was found 19 months later to have asymptomatic and nonpalpable prostatic adenocarcinoma in the right testis, detected by a prostate-specific membrane antigen positron emission tomography scan.

PET scanProstate cancerMetastasis