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Atlanta-Using extracorporeal shockwave therapy (ESWT) to reduce pain and to correct some deviation in Peyronie's disease is a relatively new concept whose application appears to be more extensive in Europe than in the United States. The majority of European studies on this topic involve small cohorts of 30 or fewer patients, and although several have included control groups who did not undergo treatment, none of these trials included sham treatment to define the strength of the placebo effect.

Atlanta-A study presented at the AUA annual meeting by researchers from Columbia University in New York asked the provocative question, Are physicians overusing intravesical therapy in patients with T1 bladder cancer?

Atlanta-A calculator that can instantly predict short-and long-term risks of recurrence and progression in patients with stage Ta/T1 bladder cancer is a few clicks away.

Atlanta-How many significant clinical advances began like this?

Atlanta-Up to half of all bladder cancer patients receiving Bacillus Calmette-Gu?rin (BCG [TheraCys, TICE BCG]) therapy will fail to respond or relapse within 5 years, but those who make it through the first year have a better chance at responding to subsequent therapy than those who fail sooner. The response rate of those who fail after a year is similar to the response rate of patients who have yet to receive their first treatment, according to a University of Iowa study presented at the AUA annual meeting.

Atlanta-Conducting a second transurethral resection to restage bladder cancer should be a routine practice, according to Harry Herr, MD, attending physician at Memorial Sloan-Kettering Cancer Center, New York. The results are diagnostic, therapeutic, and invaluably prognostic, he said.

Dallas-A new study shows that screening high-risk populations for bladder cancer may save both lives and money. That conclusion stands in sharp contrast to screening programs for other cancers, which save lives but increase costs.

Atlanta-Sometimes studies are more notable for the questions they raise than for the ones they answer. Kevin T. McVary, MD, professor of urology at Northwestern University Feinberg School of Medicine, Chicago, presented a study at the AUA annual meeting showing that the phosphodiesterase type-5 inhibitor sildenafil citrate (Viagra) improves both erectile function and lower urinary tract symptoms, but has no apparent effect on flow rates.

Atlanta-Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) has a huge impact on men's sexuality, but a combination of pelvic muscle trigger point release physiotherapy and relaxation training can go a long way toward improving sexual dysfunction in these men, said Rodney U. Anderson, MD, professor of urology, Stanford University School of Medicine, Stanford, CA.

Atlanta-Direct medical costs are nearly twice as much for men with chronic prostatitis as men without, and those costs are definitely because of the disease, an analysis of an HMO's cost data showed.

Atlanta-Bisphosphonates have already been shown to reduce loss of bone mineral density (BMD) in men undergoing androgen deprivation therapy and to reduce skeletal events and markers of bone turnover in men with metastatic prostate cancer. However, the drugs carry risks and can be expensive. That's why Dror Michaelson, MD, PhD, an assistant in medicine at Massachusetts General Hospital and instructor at Harvard Medical School, Boston, examined the effects of zoledronic acid (Zometa) in a once-annual dosing schedule that is much reduced compared with that used in past trials.

Atlanta-Based on the landmark TAX-327 study, which showed a survival benefit of treatment every 3 weeks with docetaxel (Taxotere)/prednisone over mitoxantrone hydrochloride/prednisone, the every-3-weeks docetaxel regimen has now become a standard of care for men with metastatic hormone-refractory prostate cancer.

Atlanta-Like intermittent androgen deprivation, could intermittent chemotherapy give men with prostate cancer welcome treatment holidays and still control cancer?

Atlanta-Initial results with neoadjuvant celecoxib (Celebrex) strongly suggest that this may be a promising agent in the management of patients with early localized prostate cancer, British researchers reported at the American Society of Clinical Oncology annual meeting.

Atlanta-A trial of drug regimens in hormone-refractory prostate cancer came up with only modest results, but it did take an important first step: It is one of the first prospective trials conducted in taxane-refractory disease.

Atlanta-Neoadjuvant docetaxel added to androgen suppression therapy and radiation therapy appears to be safe and active in patients with high-risk localized prostate cancer, according to findings of a new phase II study from Canada reported here at the American Society of Clinical Oncology annual meeting.

Atlanta-PSA doubling time (PSADT) appears to have limitations as a predictor of treatment outcome, according to results of a phase II, placebo-controlled trial of atrasentan (Xinlay) in patients with early-stage, hormone-naive prostate cancer. Researchers found that both placebo and drug recipients showed an extended PSADT of similar length.

Atlanta-The ability to detect lymph node invasion (LNI) in men undergoing radical prostatectomy relates directly to the extensiveness of pelvic lymph node dissection (PLND), a review of a large clinical series suggests.

Atlanta-The prostate cancer staging benefits of an extensive pelvic lymph node dissection (PLND) come at a price of a significantly increased risk of complications and a significantly longer hospitalization.

Atlanta-Positive surgical margin rates decrease as experience with robot-assisted laparoscopic prostatectomy (RALP) increases. In addition, formal laparoscopic training may not be necessary for optimizing some outcomes with the robotic procedure, according to the findings of two new studies presented here at the AUA annual meeting.

Atlanta-Results from the Prostate Cancer Prevention Trial (PCPT) showing treatment with the type 2-specific 5-alpha-reductase inhibitor finasteride (Proscar) reduced the incidence of prostate cancer, but was associated with increased detection of high-grade cancers has prompted additional research on the association among prostate cancer detection, cancer grade, and prostate volume.

Atlanta-Men with smaller prostate glands appear to be more likely to develop prostate cancer and have higher Gleason sum disease than are men with larger prostates, according to the results of a new prospective analysis.

Research has begun to examine a range of novel treatment modalities, some with quite promising results.

Atlanta-Are nanobacteria involved in prostate disease? That question hasn't been settled, but evidence of these controversial organisms has been found in the prostates and serum of men with prostatic inflammation.

Atlanta-Because prostatitis in African-American men is not well studied, University of Michigan researchers examined the prevalence and risk factors in African-American men in Genessee County, MI, with a surprising result. On the whole, the risk factors matched those reported for Caucasian populations, but men who were physically active had significantly decreased odds of having prostatitis in a study presented at the AUA annual meeting.

Within the past year, enormous strides have been made in the treatment of renal cell carcinoma, particularly in the pharmacotherapeutic arena. To date, two new drugs have received FDA approval, and other promising agents are in development. As research provides new insights into the nature of RCC and its treatment, the role of the urologist in patient management is evolving quickly.

Surgery has greater impact on urinary function;......radiation therapy, on bowel function

These simple pointers can help keep your patients happy and, consequently, healthy