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PSA doubling time appears to be a reliable tool to distinguish which patients have prolonged innocuous PSA levels after therapy from those who are at great risk for disease recurrence and death from prostate cancer, according to researchers from the Mayo Clinic in Rochester, MN.

The American Society of Clinical Oncology has updated its 2004 clinical practice guidelines for the initial management of androgen-sensitive, metastatic, recurrent, or progressive prostate cancer.

Excerpts from Q&A sessions that followed the coding sessions at the Urology Congress

Advances in nephron-sparing procedures have given them clear advantages over radical nephrectomy for most small renal masses, according to Stephen E. Strup, MD, an associate professor of urology at the University of Kentucky.

Most penile implant surgeries produce a positive outcome. Even problem cases can have a successful outcome with careful planning.

Synthetic materials work much better than biological ones for surgical treatment of stress urinary incontinence, in the experience of Shlomo Raz, MD, professor of urology at the University of California, Los Angeles.

In an era when reimbursement for medical services is flat to declining, there is one sure-fire way to increase revenue: Better coding.

I commonly hear, "Doc, there's nothing wrong, but will Viagra make it better?"

Infection panelist Anthony J. Schaeffer, MD, of the Feinberg School of Medicine, Northwestern University, Chicago, said it is important to draw a distinction between the syndrome of prostatitis and inflammation in the literal sense.

The therapeutic revolution that began in 1997 when the first phosphodiesterase type-5 inhibitor was approved for erectile dysfunction is poised to expand. ED is just the first, most obvious use for PDE-5 inhibitors, said Culley Carson, MD, of the University of North Carolina, Chapel Hill.

Phosphodiesterase type-5 inhibitors are the first step in the treatment of erectile dysfunction. But about 30% of men fail to respond to PDE-5 inhibitors, noted Andrew McCullough, MD. Another 20% suffer significant side effects.

The launch of two targeted therapies in the past 15 months dramatically changed the landscape for renal cell carcinoma, improving the prospects for patients with this deadliest of urologic cancers. The advances in medical treatment for metastatic RCC are not over, however, as two additional targeted therapies have shown great promise in clinical trials and may soon earn FDA approval.

Fears that testosterone replacement therapy may induce or promote prostate cancer are overblown, according to one leading urologist. The reality is that TRT can be a safe and effective treatment for hypogonadal men.

Medical therapy has a long history as a first-line treatment for men with lower urinary tract symptoms, and recent data have brought into focus which drugs work best for which men, according to Claus G. Roehrborn, MD, of the University of Texas Southwestern Medical Center in Dallas. Combination therapy-not necessarily the combination that urologists are most familiar with-also plays an important role.

With seven approved drugs for overactive bladder already on the market, the potential for new treatments might seem to be limited. The reality is that OAB treatment is still not optimal.

What advice do you have for managing adults with complaints of nocturia?

What are your criteria for triggering intervention in prostate cancer patients undergoing surveillance?

What have we learned from the work of Dean Ornish, MD about the effect of diet on prostate cancer prevention?

Urologists currently have several minimally invasive surgical therapies (MIST) for the treatment of BPH, but each has advantages and disadvantages that must be considered before initiating treatment. Newer MIST modalities tend to fall somewhere between the old standby of transurethral resection of the prostate and medical therapy, according to presenter Kevin T. McVary, MD, of the Feinberg School of Medicine, Northwestern University, Chicago.

Antimuscarinic agents are the primary pharmacologic therapies for overactive bladder, and their ranks continue to grow. The agents in this class-oxybutynin (Ditropan), tolterodine (Detrol), trospium (Sanctura), solifenacin (Vesicare), and darifenacin (Enablex)-are similar in efficacy and side effects, but not identical.

Mounting evidence suggests that finasteride (Proscar) can prevent the clinical manifestation of prostate cancer. Whether eligible men should receive the drug routinely must be an individualized decision, said Eric Klein, MD, of the Cleveland Clinic Lerner College of Medicine.

Seven genetic risk factors (DNA sequences) that determine prostate cancer risk have been identified by researchers from the University of Southern California in Los Angeles and Harvard Medical School in Boston.

Surgery sans scars is the potential promise of a new technique under development by a collaboration of physicians at University of Texas Southwestern Medical Center, Dallas, and engineers at University of Texas Arlington.

A new, less-invasive treatment for female stress urinary incontinence has garnered clearance from the FDA.

Inflammation may strongly affect metastasis of prostate cancer, according to researchers from the University of California, San Diego. Their findings may result in development of new drugs to block prostate cancer metastasis.

A soy-rich diet offers mixed results on its impact on the risk of prostate cancer, according to a large study from the National Cancer Center in Japan.

Patients with prostate cancer who are being treated with androgen deprivation therapy (ADT) have three times the risk of periodontal disease as do patients who are not taking the therapy, according to a study published recently in the Journal of Urology (2007; 177:921-4).

Weekly oral treatment with the bisphosphonate alendronate (Fosamax) may prevent bone loss and bone turnover resulting from androgen deprivation therapy (ADT) in men with prostate cancer, researchers from the University of Pittsburgh Medical Center report.