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Over the last 20 years, radical retropubic prostatectomy has evolvedto become the standard of care in men with localized prostate cancer. Becauseof the morbidity of this procedure, however, interest has grown in the developmentof non-surgical modalities. Unfortunately, many of these non-surgical approaches,such as monotherapy with radioactive seed implantation, have resulted indisappointing results or excessive morbidity, as in first-generation cryotherapy.

Be prepared for a short-term gain that may be a long-term pain. The AmericanMedical Association has claimed a major political victory with passage ofthe Medicare Prescription Drug Improvement and Modernization Act of 2003,and I certainly hope the AMA is correct. Certainly the pay increase overthe next 2 years is great. However, I have concerns about many of the otherissues addressed in the bill.

Winston-Salem, NC--Well over one-third of men with localized prostatecancer are opting for brachytherapy as their primary treatment, accordingto a recently published study. Past and current data indicate the proportionof prostate cancer patients choosing brachytherapy has grown from 1.4% in1992 to 3.0% in 1995 to 36% in 1999-the latest year for which comprehensivedata are available.

Montreal--Novel approaches to percutaneous nephrolithotomy, includinguse of a stent instead of a tube and using smaller tubes and stone "cones,"are helping to optimize this procedure. Researchers agree that improvingsafety and reducing morbidity are the goals of these new techniques.

Minneapolis--Surgeons and other physicians across the country continueto deal with the higher costs of practicing medicine in the face of decliningreimbursements. Those factors added up to lower profit margins for U.S.physician groups in 2002 and a continuing awareness of the need to pay attentionto all of the vagaries of the business of practicing medicine. For the mostpart, urologists showed little change in reimbursement.

Personal digital assistants, or PDAs, have now reached critical mass, and nearly 25% of physicians use them on a daily basis.

Montreal--Using a high-powered potassium titanyl phosphate (KTP) laser to vaporize prostate tissue is proving to be safe and effective as a treatment for urinary retention in men.

Waltham, MA-Praecis Pharmaceuticals has received FDA approval to market abarelix (Plenaxis) for men with advanced prostate cancer.

Patients with nephrolithiasis frequently have metabolic abnormalities that promote calculus formation and, when identified and corrected, may attenuate stone activity.

Chicago--Advances in technology and technique are allowing computed tomography to image lesions and tumors as small as 2 mm in diameter in the kidney, bladder, and urinary tract of high-risk patients, according to a study presented here at the annual meeting of the Radiological Society of North America.

The long-awaited results of the landmark Medical Therapy of Prostatic Symptoms (MTOPS) study have been published in The New England Journal of Medicine (2003; 349:2387-98).

Health and Human Services Secretary Tommy G. Thompson has named Dennis G. Smith as interim head of the Centers for Medicare & Medicaid Services.

Scientists say they have coaxed uncommitted mouse embryonic stem cells to grow into sperm cells in the laboratory.

The American Medical Association said it has amended its policy to address inequities in the size, composition, and distribution of the U.S. physician workforce that are limiting patient access to care.

The controversy over prostate cancer screening does not appear to be going away any time soon.

Tom Scully, administrator of the Centers for Medicare & Medicaid Services, will resign effective Dec. 15, following 3 years at the helm of two of the nation's largest domestic programs.

Among men undergoing cryotherapy for prostate cancer, 95% showed no biochemical evidence of cancer recurrence at a follow-up of 3.5 years in a small study presented at the Radiological Society of North America annual meeting.

A single 15-minute CT scan may be all that is needed to detect tiny cancers, stones, and other problems in the urinary tracts of high-risk patients, potentially saving them from additional tests and from delayed detection and treatment.

A new study has joined a host of others concluding that high-volume surgeons have better outcomes than surgeons who perform a procedure less often.

The FDA has approved what is said to be the first gonadotropin releasing hormone (GnRH) antagonist for prostate cancer available as a depot formulation. Abarelix (Plenaxis) is indicated for the palliative treatment of men with advanced symptomatic prostate cancer, in whom LHRH agonist therapy is not appropriate, who refuse surgical castration, and have one or more of the following: risk of neurologic compromise due to metastases; ureteral or bladder outlet obstruction due to local encroachment or metastatic disease; or severe bone pain from skeletal metastases persisting on narcotic analgesia.

Also, always use the ­59 modifier when inserting an indwelling stentduring ureteroscopy

Failure to have the proper licenses and permits on hand can cost youin the long run

In this month's issue of Urology Times, attention is given to evolvingmethods for treating renal masses in less invasive ways, including laparoscopicnephron-sparing surgery and cryosurgical ablation.

Overactive bladder patients respond favorably to botulinum injectionsin small studies

Portland, OR-Weekly preoperative chemotherapy with docetaxel (Taxotere)and mitoxantrone (Novantrone) reduced PSA levels and was associated witha high rate of negative surgical margins in a small preliminary clinicaltrial involving high-risk localized prostate cancer patients.

Report calls for more study of testosterone replacement; urologists saybenefits are knownWashington-Clinical studies on the use of testosterone replacementtherapy (TRT) in men over age 65 years should move forward to determinethe efficacy of testosterone therapy in older men and the nature and extentof the potential benefits, according to a report released last month byan expert committee of the Institute of Medicine (IOM). Initially, studiesshould include a limited number of participants and proceed in a stepwisefashion, the report said.

Jackson, MS-Magnetic resonance imaging offers a far better picture of both tumors and a growing ice ball, and these factors may contribute to the success seen in the University of Mississippi's percutaneous cryoablation procedure in treating renal cell carcinoma, according to W. Bruce Shingleton, MD, formerly at the University of Mississippi and currently associate professor of surgery and radiology, division of urologic surgery, University of Louisville (KY) School of Medicine.

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