Benjamin P. Saylor

	Sanofi Pasteur recently announced that it is discontinuing its BCG products TheraCys and ImmuCyst, prompting fears of a shortage of BCG for bladder cancer patients. In this interview, 

associate professor of urology at the University of Pittsburgh School of Medicine, discusses the implications of the announcement and what’s next for patients and clinicians.      

 What short-term and long-term implications does this announcement have for patients?   

I think in the short term, it’s a challenge to predict. We may well see a decrease in supply in the near term, although it’s a bit of a challenge to know if that’s true or not. I think long term, we’ll actually have a little bit easier time predicting that we’re going to have real supply difficulties with BCG. I think it’s fair to say that barring any change or any new announcement, that’s likely to happen. The reason I say that is because we know that Merck has had challenges in the past in increasing supply of the drug, and that was around 2012 into 2013. That’s probably a product of it being a challenging drug to make. You can imagine that this is not the type of drug where it’s chemical XYZ joins chemical ZYX in a pot and it’s spit out into pills. This is a biologic drug that has to grow under very careful medium conditions, and one mistake in temperature, one contamination into the growth medium, and the whole drug can be spoiled. That can mean up to 5,000 to 10,000 doses can go bad day to day. So it’s a challenging drug to make, and we know that it can be a challenge for one manufacturer to really hold the supply of America in good faith.   

	And I would say in Merck’s defense, it’s not really good for Merck to be the only supplier in America of a drug that’s very challenging to make. You can imagine from a market perspective that that’s not the way we want to be. We want to have multiple people making challenging drugs, biologics in general, because that way we know the drug will be available. If Merck’s one plant in North Carolina goes down, even for reasons of which it really has no ability to control, what do we do? It’s a real big problem. So I say in summary to that question, short term, we don’t know, we may be okay for the next few months, next 6 months. Long term, I think we have a serious problem.

Next: "I think at this point I would be surprised if we don’t have a severe problem."

How will this change how physicians treat non-muscle invasive bladder cancer?

	I don’t think it’s going to do anything for now; nothing will happen for now while the supply is being maintained by Merck. The challenge is that we don’t have assurance, or we have no reason to believe that Merck can always have a productive supply of drugs. In fact, we have the opposite; we know it cannot do it at all times, and potentially through no fault of its own. Look at what happened to Sanofi; it got into trouble making the drug with contamination issues in its Toronto facility. Then, only a few years later Merck had what we think is a similar problem at its facility. So now we have just one maker, Merck, making the drug. So I think the long term is going to be a big problem. Think about all the patients that we tell should be on maintenance therapy for BCG, which is basically the standard of care for high-risk patients with bladder cancer, localized non-muscle invasive bladder cancer. High-risk patients should be offered and explained what maintenance therapy is and that’s usually a year to 2 years of drug. So what I’m telling patients is that it may well be that we can’t give you the drug. And we’ll have to deal with the consequences as they come about.

	I should note, my discussions with both of these companies have been sort of tight-lipped. But I have talked to both companies. The discussions with Merck were kind of upbeat and I was happy that they were upbeat. They claim that we’re not going to see a disruption in the network of BCG. They claim that Sanofi really hasn’t been supplying that much drug in the past few years and Merck has been able to do fine. I’ll be happy to be wrong, although I’m quite sure that I won’t be. That’s because we have a track record of them not being able to do that and they haven’t changed the production amount, at least according to them. I’m happy to be disproved, but I think at this point I would be surprised if we don’t have a severe problem.

Do you expect the FDA to take any action on the BCG situation or drug shortages in general? Ideally, what steps should the agency take?

	That’s a good question. There’s no agency power for this. We want the government to be proactive when we feel like it, but we have to give them the resources and the legislation to do so. We haven’t, so the FDA has no power to increase BCG supply. There’s no regulatory framework for that. But there is a very arcane regulatory framework for the FDA to intercede on behalf of the American public when they think a drug is being used inappropriately; kind of like an eminent domain issue. The FDA does have that regulatory power. To my knowledge, it has never used it. It would not use it in a situation where there’s no patent protection involved and it’s just simply a matter of money. So the short of it is, there’s no regulatory way that 

 the FDA can do anything about it other than to call and say, “You should be making more, Merck.” The FDA is aware of it. They know what’s going on. They’ve had discussions with Merck and Sanofi. It’s on their website. But there is nothing specific they can do.

Do you think Merck will be able to meet demand for BCG after Sanofi exits the market?

	I hope so. I have no faith that they will be able to given their track record. Merck claims the past 2 years that basically Sanofi exited the market and basically their announcement was ex post facto; that it was an announcement of fact but the fact had already happened 2 years ago. It’s unclear that’s true because I know that there are VA hospitals which were getting Sanofi’s product, and I don’t feel comfortable saying that Merck will be able to meet the market, to be honest.

Is there anything that urologists can do to help ensure that they’ll have an adequate supply of BCG going forward?

	After I wrote an article on this topic for Forbes, people emailed me and called asking if I had any suggestions. I said, look I’m not the national expert on BCG therapy. We have people in our field who are much better positioned to answer that question. And it’s been answered. It’s not like I’m coming up with the answer here by myself. The things we can do are simple. First of all, I wouldn’t do anything for now. We don’t have a shortage as of present. Nothing would change as of today. If and when I suspect that we do get notice that we have supply challenges, I would treat patients the following way. First of all, I would stop maintenance therapy for patients because while maintenance therapy does change recurrence rates in randomized controlled studies, I think it’s more important to give patients the proper induction therapy.

	I would consider also halving doses of BCG to sort of get more bang for your buck. There are quite a few studies showing half-dose BCG or even one-third dose BCG is as good as full-dose or close to as good. The third thing I would consider if we really get a shortage is giving patients four doses of BCG or even three doses as induction therapy. I’m not advocating that as an approach, but there are some studies looking at three doses, four doses, or six doses, and while six doses does seem to be the most efficient and the best, it’s not like you don’t get any effect if you give three or four doses. So if we’re stuck in a world where we have two patients who need induction therapy, I’d rather give three and three rather than give one six and the other none. There are strategies that we can use. They’re all kind of horrible strategies, but they will give us something.

	I’m hopeful that Merck will be able to increase their capacity. I have no reason to doubt them when they tell me they will be able to meet the demand. What I’m fearful of is in the same way sort of if you think about the food supply, you don’t want to have one producer of lettuce. You know, when you have one producer of lettuce in California and they get an 

 contamination, we all lose lettuce and we all get 

, right? You don’t want to have a situation in a market where you’re reliant on one agency to provide you an essential drug because all that has to happen is for Merck to have a contamination, which they’ve had before, and we don’t have the drug. That is my cautionary tale here and that’s my worry is that we get a sort of 

 infection of the BCG supply, and there’s nothing else. We have no other choice, we have nothing.

	The AUA or the international community has to come up with a good plan here to get other pharmaceuticals interested in developing their BCG drugs. The only way I can think of is from a free market perspective would be to increase the reimbursement to the pharmaceutical biologic agencies to increase prices for BCG. If that’s not going to happen, and it may well not given the current environment, then I think we need to have government control in production for non-patent protected drugs. That’s my sort of socialist Bernie Sanders hat, but if the free market as we have now isn’t going to work for patients, I don’t know what else we do except have the government make it work. People may not like that; they may think it’s anti-American and not market minded, but I would remind those people that right now we have an unacceptable situation where we’re relying on the good graces of Merck, which doesn’t have a great history, and we have no other method of making the drug. None. So we’re in a really scary situation. I’m not trying to be scary, but it is a scary situation. If you’re a patient with bladder cancer, it’s potentially a disaster. We have to make it better.

	To get weekly news from the leading news source for urologists, 

Articles

Sanofi Pasteur recently announced that it is discontinuing its BCG products TheraCys and ImmuCyst, prompting fears of a shortage of BCG for bladder cancer patients. In this interview, Dr. Benjamin J. Davies, associate professor of urology at the University of Pittsburgh School of Medicine, discusses the implications of the announcement and what’s next for patients and clinicians.

How Sanofi’s discontinuation of BCG affects patients, clinicians

	Perioperative blood transfusion for patients undergoing radical prostatectomy is associated with increased short-term morbidity, according to a recent study presented at the AUA annual meeting in San Diego. 

Study finds prostate Ca clones trackable by fusion biopsy

	“Blood transfusion in the perioperative period, either immediately after surgery or during surgery, has been associated with worse overall survival for several malignancies, including 

 It has been suggested that the allogeneic blood stimulates an inflammatory response that may promote tumor growth. Keeping this in mind, we hypothesized that the use of perioperative blood transfusion during radical prostatectomy may be associated with increased short-term morbidity,” explained first author Justin T. Matulay, MD, of Columbia University Medical Center, New York.  

	Dr. Matulay presented findings from a retrospective analysis of 30-day postoperative outcomes in men undergoing radical prostatectomy from 2005 to 2013 using the National Surgical Quality Improvement (NSQIP) database. The primary outcome was 30-day postoperative morbidity, and secondary outcomes were 30-day mortality, readmission, length of stay, infectious complications, and pulmonary complications.

Data offer new insight on HIFU’s use in low-risk PCa

	The authors found that of the 21,293 radical prostatectomies performed during the period covered, 810 patients (3.9%) received a perioperative blood transfusion. Perioperative blood transfusion was associated with increased 30-day morbidity, readmission, pulmonary complications, and surgical site infections, they reported.

	Transfusion was more common in patients with higher body mass index, lower functional status, and longer operative times. When controlling for comorbidities, having a blood transfusion remained an independent predictor of short-term morbidity and infectious and pulmonary complications, a finding that surprised the authors.

AS success rate strong in appropriate PCa patients

	“You would expect to find that patients who receive a blood transfusion would be more apt to have a complication. Those patients are generally sicker… but when controlling for many of those factors, we were still able to find significance,” said Dr. Matulay, working with G. Joel DeCastro, MD, MPH, and colleagues.

	Dr. Matulay did mention the caveat that the NSQIP database does not contain disease characteristics such as T staging, clinical staging, and pathologic staging, “so we can’t account for the fact that maybe these patients were more complex… had worse disease, or maybe there was something technical in the surgery that made them at higher risk for complications,” he said.

that the sheer volume of patients included was a particular strength of the study.

	“I don’t think at an institutional level you’d be able to do this kind of analysis on blood transfusion,” he said.

	Asked about clinical implications of the research, Dr. Matulay said, “I think that this would be a starting-off point to investigate our use of allogeneic blood transfusion, knowing that just like any other donor tissue, blood is going to stimulate an inflammatory response.”

	The findings should also make urologists “conscientious” about performing blood transfusions, he said.

A retrospective analysis looks at the short-term morbidity associated with transfusion among patients in the National Surgical Quality Improvement database.

Peri-op transfusion raises short-term morbidity risk

	The month of May is fast approaching, and with it the AUA annual meeting, which returns to San Diego after a recent visit in 2014.

	As ever, this massive meeting offers a robust scientific program of presentations on a variety of clinical topics, a wide selection of offerings on health policy, and plenty of sessions and courses to help you run your practice.

	To guide you through the event and help maximize your time, 

 editorial board has reviewed the program to identify the key trends and noteworthy research at this year’s meeting.  

Interstitial Cystitis/Bladder Pain Syndrome

Dr. KaufmanThis year’s AUA annual meeting will feature a wide selection of sessions and courses focused on current topics in health care policy, socioeconomic issues, and practice management, according to Jeffrey E. Kaufman, MD, a urologist in private practice in Santa Ana, CA.

	“It wasn’t long ago that the AUA was extremely resistant to suggestions to add health policy content to the annual meeting. How times have changed,” Dr. Kaufman told 

 “Reviewing the 2016 agenda reflects the enormous interest resulting from the Affordable Care Act and last year’s Medicare Access and CHIP Reauthorization Act (MACRA). Even topics that narrowly focus on the science, technique, or technology of urology often include a value dimension related to cost or quality.”

	Some of the meeting’s highlights in health policy and practice management, according to Dr. Kaufman, include the following:

		The 2-day Practice Management Conference (separate registration) offered Thursday, May 5, and Friday, May 6, discusses adapting new business models (accountable care organizations, surgical medical homes, registries, and implications of MACRA on quality reporting and reimbursement).

		Thomas Stringer, MD, will direct a presentation on physician contract negotiations on Saturday, May 7.

		Many new models emphasize integration of non-physician providers, and a course addressing that topic will be led by Claus G. Roehrborn, MD, on Saturday from 1-3 p.m.

		Coding trends and updates will be covered on Monday, May 9 in a course directed by Ronald Kaufman, Jr., MD.

		“Male Health: Strategies for Managing Lifelong Wellness” is a Sunday afternoon course directed by Richard Pelman, MD. It will emphasize prevention in men’s health, as urologists transition from treating disease to preserving wellness.

		Several presentations on medicolegal litigation will be held on Saturday, Sunday, and Monday.

		Finally, the AUA/American Association of Clinical Urologists-sponsored Health Policy Forum on Sunday from 1-3 p.m. will explore physician response to narrow networks as well as the Kaiser experience with bundled, comprehensive population health management.

Next: Prostate Cancer Markers/Surveillance

Dr. LoebThe changing landscape of prostate cancer diagnosis and management continues to be a major theme, according to Stacy Loeb, MD, MSc.

	The 2012 U.S. Preventive Services Task Force recommendation against PSA-based prostate cancer screening and increasing use of active surveillance have led to a shift in the composition of patients undergoing radical prostatectomy, Dr. Loeb said.

	“Not surprisingly, active surveillance continues to be a hot topic at this year’s meeting. As more data continue to accrue showing the long-term safety of this management option, there are multiple studies looking into expanding the eligibility criteria. Look out for studies on expanding use of active surveillance in young men and using MRI-targeted biopsy to confirm eligibility,” said Dr. Loeb, assistant professor of urology and population health at New York University School of Medicine, New York.

	“There are also several studies on monitoring during active surveillance, including the utility of noninvasive biomarkers and multiparametric MRI,” she added.

	New biomarker findings will be another major theme at this year’s meeting.

	“Look out for new data on commercially available markers, as well as some new marker tests in the pipeline,” Dr. Loeb said.

	Dr. Loeb singled out the following abstracts from this year's meeting:

 Prediction of the cancer state to inform a personalized management program for prostate cancer
	Rebecca Coley

 Molecular Progression of Gleason 6 Prostate Cancer: Tracking of Specific Clones by Image-Guided Biopsy
	Ganesh Palapattu

 Validation of a genomic risk classifier to predict prostate cancer death in high risk patients
	R. Jeffrey Karnes

 Abdominal obesity, altered adipokynes and elevated C-peptide levels are associated with high Gleason score in patients undergoing diagnostic prostate biopsy: Data from prospective registry
	Jehonathan H Pinthus

	Dr. Loeb also highlighted these abstracts, from 

Prostate Cancer: Localized: Active Surveillance II:

	MP15-02: The Effect of Radical Prostatectomy, External Beam Radiation Therapy, and Active Surveillance on Life Insurance Premiums in Patients with Prostate Cancer
	Mark Biebel

	MP15-04: Variation in active surveillance follow-up over two years in diverse urology practices
	Amy Luckenbaugh MD

	MP15-15: A Retrospective Review of a Large Active Surveillance Cohort in Patients with Prostate Cancer at the Cleveland Clinic
	Yaw A. Nyame

	MP15-18: Multiparametric MRI outperforms PSA Velocity for Pathologic Progression in Men on Active Surveillance for Prostate Cancer
	Michael Kongnyuy

Dr. GomellaLeonard G. Gomella, MD, reviewed abstracts on prostate cancer treatment and identified several key themes, including research examining the perennial debate over robotic versus open radical prostatectomy.

	“The AUA abstracts relating to localized prostate cancer continue to identify improvements in outcomes with robotic vs. open radical prostatectomy. Although the absolute differences are often small, the statistical analyses do typically favor the robotic techniques,” said Dr. Gomella, professor and chairman of urology at Thomas Jefferson University, Philadelphia.

	Also watch for new findings on focal and whole-gland ablation.

	“With the approval in the U.S. of high-intensity focused ultrasound for the ablation of prostate tissue, there will be much interest in the abstracts that address focal and whole-gland ablation in prostate cancer, with the data suggesting encouraging outcomes,” Dr. Gomella said.

	Other themes Dr. Gomella pointed to include:

		Several papers suggest that many men with high-risk prostate cancer treated by radical prostatectomy with persistent PSA elevation may not develop metastasis over the long term.

		Several European studies of extended lymph node dissections continue to demonstrate a positive impact on long-term disease control. “However, the data to be presented by several groups indicate that ‘super-extended LND’ may actually be detrimental,” Dr. Gomella said.

		Several papers will question the utility of multiparametric magnetic resonance imaging in the setting of radical prostatectomy.

	Here are Dr. Gomella's selections from this year's poster and podium sessions:

 EFFICACY OF HIGH INTENSITY FOCUSED ULTRASOUND (HIFU) AS A PRIMARY MONOTHERAPY FOR LOW RISK LOCALIZED PROSTATE CANCER: OUTCOMES FROM THE ENLIGHT TRIAL
	Cary Robertson

 Assessing the role of time from prostate cancer diagnosis to radical prostatectomy: can surgery be postponed safely?
	Vito Cucchiara

 Prognostic factors for biochemical recurrence more than ten years after radical prostatectomy
	Kathleen Herkommer

 Is a negative mpMRI really able to rule out significant prostate cancer?
	Nicolas Branger

 The impact of infectious complications after prostate biopsy on radical prostatectomy surgical outcomes: A population-based analysis
	Daniel Olvera-Posada

 The Effect of Smoking on 30-Day Morbidity Following Malignancy-Related Prostatectomy.
	David Byun

 Long-term oncological outcomes in patients with biochemical recurrence after radical prostatectomy
	Raisa Pompe

 Functional outcomes after extended vs. super-extended pelvic lymph node dissection for intermediate and high-risk localized prostate cancer.
	Steven Joniau

 Impact of weekday on radical prostatectomy outcomes
	Julian Hanske

 MRI Prior to Prostatectomy Does Not Improve Surgical Outcomes
	Eric Kim

To guide you through the 2016 AUA annual meeting and help maximize your time, Urology Times’ editorial board has reviewed the program to identify the key trends and noteworthy research at this year’s meeting.

AUA 2016: Experts offer guidance on the meeting

Trial launched for drugs’ use in metastatic, hormone-sensitive PCa

	Astellas Pharma Inc. and Medivation, Inc. recently announced the launch of the ARCHES (AR Inhibition with ChemoHormonal Therapy in Men with MEtastatic Castrate Sensitive Prostate Cancer) phase III registrational trial. The study, which will evaluate the efficacy and safety of enzalutamide (XTANDI) with androgen deprivation therapy (ADT) versus placebo with ADT in metastatic hormone-sensitive prostate cancer (mHSPC) patients, has been initiated and the first patient has been randomized. The global, randomized, double-blind, placebo-controlled study, which is being led by Astellas, will enroll approximately 1,100 patients with mHSPC at approximately 250 centers globally. The primary endpoint is radiographic progression-free survival, defined as the time from randomization to the first objective evidence of radiographic disease progression as assessed by central review or death, whichever occurs first.

Agreement reached to investigate efficacy of PCa detection cameras

	Aytu BioScience, Inc. has entered into a study agreement with Hybridyne Imaging Technologies to investigate the efficacy of Hybridyne’s ProxiScan compact gamma cameras to detect local prostate cancer using ProstaScint, Aytu’s imaging agent. The study is being conducted at The Princess Margaret Cancer Centre in Toronto, and supported by Hybridyne. As part of the agreement, Hybridyne will purchase ProstaScint for the study.

Next: Data for novel oral TRT agent presented at scientific meeting

Data for novel oral TRT agent presented at scientific meeting

	Clinical data for LPCN 1021, an oral testosterone replacement therapy product candidate being developed for adult males with hypogonadism, were presented at the American Society of Andrology annual meeting in New Orleans. LPCN 1021 is a novel twice-a-day oral testosterone replacement therapy product candidate that is designed to help restore normal testosterone levels in hypogonadal men. The agent demonstrated positive efficacy and safety results in phase III testing and has a new drug application under review with the FDA, according to developer Lipocine Inc.

Patient enrollment begins for phase II trial of prostate cancer treatment

	Arno Therapeutics has enrolled the first patient in the second stage of its phase I/II clinical trial evaluating onapristone in men with advanced castration-resistant prostate cancer (CRPC) after failure of abiraterone (ZYTIGA) or enzalutamide (XTANDI). The phase II portion of this study will evaluate onapristone in combination with abiraterone in patients with CRPC. Stage 2 of the study also includes a phase II cohort of patients with CRPC who will receive single-agent onapristone. Onapristone is an oral, anti-progestin hormone blocker that has been shown in previous phase II clinical trials (not sponsored by Arno) to exhibit anti-tumor activity in patients with breast cancer, according to the company.

Next: Bladder control system shows efficacy at 6 months

Bladder control system shows efficacy at 6 months

	Stefan De Wachter, MD, PhD, recently presented 6-month data from a trial of the Vesair Bladder Control Baloon during the European Association of Urology annual congress in Munich, Germany. The poster presentation included 6-month data from the SOLECT Trial that had been collected from ongoing follow-up of patients enrolled in Solace Therapeutics, Inc.’s second randomized controlled trial of the Vesair system. The results demonstrate that patients continue to experience clinically relevant efficacy in the reduction of urine leakage, episode frequency, and improved quality of life 6 months after receiving the balloon, according to Solace Therapeutics.

Breakthrough therapy designation granted for bladder cancer Tx

	The FDA has granted breakthrough therapy designation for durvalumab (MEDI4736), an investigational human monoclonal antibody directed against programmed death ligand-1 (PD-L1), for the treatment of patients with PD-L1-positive inoperable or metastatic urothelial bladder cancer whose tumor has progressed during or after one standard platinum-based regimen, according to AstraZeneca and MedImmune, its global biologics research and development arm. The designation for durvalumab was granted by the FDA on the basis of early clinical data from a phase I trial (Study 1108) in patients with advanced metastatic urothelial bladder cancer whose tumor has progressed during or after one standard platinum-based regimen.

Next: Phase II results announced for localized prostate cancer agent

Phase II results announced for localized prostate cancer agent

	Nymox Pharmaceutical Corp. recently announced results from the completion of the company’s U.S. 40-month (18-month outcomes) localized prostate cancer phase II NX03-0040 clinical trial of fexapotide triflutate (NX-1207). The study successfully met its pre-determined endpoints. Cancer progression clinical outcomes were significantly improved in the fexapotide-treated patient groups, Nymox reported.

Phase III efficacy, safety results announced for T injection

	Antares Pharma, Inc. announced 12-week efficacy and 52-week safety results from the phase III clinical study (QST-13-003) evaluating testosterone enanthate administered once-weekly by subcutaneous injection using the QuickShot (QS) auto injector in testosterone-deficient adult males. In the overall analysis for efficacy, the primary endpoint of the population that received one or more doses of QS T was met by 139 out of 150 patients, equating to 92.7% with a 95% confidence interval of 87.3% to 96.3%. Among the 137 patients that completed all 12 weeks of dosing and PK sampling, 98.5% were within the pre-defined range.

Next: Trial to evaluate agent in obese hypogonadal males

Trial to evaluate agent in obese hypogonadal males

	Repros Therapeutics Inc. has fully randomized a phase II double-blind placebo-controlled proof of concept study of enclomiphene in conjunction with rigorous diet and exercise in the treatment of obese secondary hypogonadal men. In the ongoing double-blind placebo-controlled proof-of-concept study, rigorous diet and exercise with or without enclomiphene will be evaluated to determine how quickly obese men can achieve sustainable improvements in metabolic parameters. The study will be 15 months in length and consist of three phases.

Enrollment stopped for monotherapy arm of bladder cancer agent

	Heat Biologics, Inc. has announced that it will no longer enroll new patients in its phase II monotherapy trial arm evaluating HS-410 alone for the treatment of nonmuscle-invasive bladder cancer. Heat Biologics added the monotherapy trial arm in response to the intermittent global shortage of standard of care bacillus Calmette-Guérin (TheraCys, TICE BCG) in early 2015. The shortage has since then been resolved and as such, Heat Biologics will no longer enroll new patients in this trial arm based on discussions with the FDA. The decision does not relate to concerns regarding the safety profile of HS-410. Heat Biologics said it anticipates reporting topline 6-month data from these 16 patients in the fourth quarter of 2016, contemporaneous with reporting data from the company’s BCG combination cohorts.

Single-payer proposals crop up at state, federal level

Placement of a hydrogel rectal spacer before RT for prostate Ca

What overpayments rule means for your practice

 to get monthly news from the leading news source for urologists.

A novel oral TRT agent, bladder control system, and localized prostate cancer agent are among other treatments in the pipeline discussed in this round-up.

Author | Benjamin P. Saylor

Articles

How Sanofi’s discontinuation of BCG affects patients, clinicians

Peri-op transfusion raises short-term morbidity risk

AUA 2016: Experts offer guidance on the meeting

Uro Pipeline: Trial launched for drugs' use in metastatic, hormone-sensitive PCa