Recommendations on opioid prescribing after endourologic and minimally invasive urologic surgery from an expert panel should help urologists align individual prescribing habits with current evidence, reduce opioid overprescribing, and provide a framework for refining patient-centered guidelines for opioid stewardship in urology, said Kevin Koo, MD, MPH, MPhil.
A multicenter study in the United Kingdom found 5-year prostate cancer control rates following treatment with focal therapy are similar to those of patients who have undergone radical prostatectomy, even when accounting for variation in tumor location, size, and risk.
A simple intervention aiming to curb the contribution of postoperative pain medication prescribing to the opioid crisis was shown to reduce post-discharge opioid prescribing and use and increase opioid disposal without seeming to jeopardize pain control for patients who had undergone radical prostatectomy.
"It certainly looks like these new therapies will provide better results. From the research and literature, it looks like significant improvement," says one urologist.
Several decades of data show that Black men are less likely to be screened and treated for prostate cancer than their white counterparts. In this interview, Kelvin A. Moses, MD, PhD, of Vanderbilt University Medical Center, Nashville, TN discusses the reasons for these disparities and how practicing urologists can address them.
For this installment of “Speak Out,” urologists were asked to discuss recent studies indicating African-American men with prostate cancer may be put on active surveillance without suffering complications and that they respond to radiation and some chemotherapy better than Caucasian men.
“The results of our retrospective study support taking advantage of the Cxbladder test to identify patients who should be further evaluated for cancer and to spare those who likely do not have cancer from an unnecessary workup," says Badrinath Konety, MD, MBA.
“We’re in an era of more personalized or precision medicine, and the ability to target cancer treatment to a patient’s specific genetic mutation or biomarker is becoming the standard,” according to Richard Pazdur, MD.
"A more standardized protocol that is office based, reliable, and reproducible as well as cost- and time-efficient is required to entice more urologists to abandon the TRUS-BX approach," writes J. Brantley Thrasher, MD.
Reduced infection rate may drive increased use of the transperineal approach.
"Irrespective of treatment, fewer than half of men reported the ability to maintain erections sufficient for intercourse at 5 years," writes Badar M. Mian, MD.
A radiolabeled small molecule that binds to prostate-specific membrane antigen is continuing to show promise for treating progressive metastatic castrate-resistant prostate cancer, according to researchers at the University of California, Los Angeles.
Chronic opioid use is rare following radical prostatectomy in Europe. Slightly more than half of men undergoing RP in Sweden between 2007 and 2017 were found to have filled an opioid prescription, but the proportion who became chronic opioid users was less than 1%.
In a study of circulating tumor cells (CTCs) in metastatic genitourinary cancer patients, shorter survival was associated with high CTC counts at baseline and on therapy, specific CTC morphologic subtypes, PD-L1-positive CTCs, and low percent CD4 and percent CD8 T-cells. Heather Chalfin, MD, discusses the data and explains how CTCs may offer an advantage over other forms of liquid biopsy.
The FDA has approved the anti-PD-1 therapy pembrolizumab (KEYTRUDA) as monotherapy for the treatment of patients with Bacillus Calmette-Guerin-unresponsive, high-risk, nonmuscle-invasive bladder cancer with carcinoma in situ with or without papillary tumors who are ineligible for or have elected not to undergo cystectomy.
The FDA has granted accelerated approval to enfortumab vedotin-ejfv (PADCEV) for the treatment of adults with locally advanced or metastatic urothelial cancer who have previously received a PD-1/L1 inhibitor and a platinum-containing chemotherapy before or after surgery or in a locally advanced or metastatic setting.
"Even in this selected cohort of men with very low-risk features, stable MRI score was not protective against disease progression during surveillance," writes Badar M. Mian, MD.
The FDA has approved a supplemental New Drug Application or enzalutamide (XTANDI) for the treatment of patients with metastatic castration-sensitive prostate cancer.
The BCG shortage, overuse of cystoscopy, and hematuria evaluation approaches are among the topics of the most-read Urology Times articles from 2019 on bladder cancer.
Urologists, oncologists, and prostate cancer patients are entering a new era in prostate cancer therapy-one that is going to be genetically defined.
Urology Times asked Maha H. Hussain, MD: How will the advent of PARP inhibitors change the management of advanced prostate cancer?
Leonard G. Gomella, MD, Tanya Dorff, MD, Scott Eggener, MD, and Jorge Garcia, MD, all reflect on prostate cancer treatment in 2019.
"The relevant professional associations in the field of medicine and/or urology must do their part to inform and educate their members about the appropriate use of finasteride and PSA to eliminate avoidable morbidity and mortality from prostate cancer," writes Badar M. Mian, MD.
In this interview, Chandru P. Sundaram, MD, explains the important patient and tumor characteristics to consider in deciding between partial and radical nephrectomy.
A study investigating discharge destination and perioperative complications after radical cystectomy provides useful data for risk stratification and preoperative counseling of patients 80 years of age and older, said Hayden M. Hill, MD, who presented the research at the American College of Surgeons Clinical Congress in San Francisco.
