Joseph R. Sterbis

Prospective quality‐of‐life outcomes for low‐risk prostate cancer: Active surveillance versus radical prostatectomy

For patients with low‐risk prostate cancer (PCa), active surveillance (AS) may produce oncologic outcomes comparable to those achieved with radical prostatectomy (RP). Health‐related quality‐of‐life (HRQoL) outcomes are important to consider, yet few studies have examined HRQoL among patients with PCa who were managed with AS. In this study, the authors compared longitudinal HRQoL in a prospective, racially diverse, and contemporary cohort of patients who underwent RP or AS for low‐risk PCa.

Prostate Cancer Nomograms: A Review of Their Use in Cancer Detection and Treatment

As prostate cancer treatment discussions have grown more complex, increasing numbers of nomograms to guide decision-making have been found in the literature. Such nomograms can influence every step in the prostate cancer therapeutic process, from determining the need for biopsy to the need for adjuvant therapy. With a properly counseled patient who is aware of the limitations of nomograms, such tools assist in the shared decision-making that characterizes modern informed consent.

Preoperative Albumin Is Predictive of Early Postoperative Morbidity and Mortality in Common Urologic Oncologic Surgeries.

Micro‐Abstract Using the American College of Surgeons National Surgical Quality Improvement Program database, we explored the relationship between preoperative albumin status and postoperative outcomes in cystectomies, nephrectomies, partial nephrectomies, prostatectomies, and transurethral resection of bladder tumors. Hypoalbuminemia correlated with increased morbidity and mortality, not only in large cases such as cystectomies, but in smaller cases such as transurethral resection of bladder tumors. These findings will assist with preoperative planning and counseling. Introduction: Multiple studies have linked preoperative nutrition status to postoperative outcomes. This relationship has been little studied in urology. We used a standardized, national, risk‐adjusted surgical database to evaluate 30‐day outcomes of patients undergoing common urologic oncologic procedures as they related to preoperative albumin. Methods: The American College of Surgeons National Surgical Quality Improvement Program is a risk‐adjusted dataset analyzing preoperative risk factors, demographics, and 30‐day outcomes. From 2005 through 2012, we identified a total of 17,805 patients who underwent prostatectomy, nephrectomy, partial nephrectomy, cystectomy, or transurethral resection of bladder tumor (TURBT). Hypoalbuminemic patients were compared with those with normal preoperative albumin, and 30‐day outcomes were evaluated. Logistic regression analyses were used to estimate odds ratios for mortality and complication rates. Results: Evaluation of the cohort noted significantly increased overall morbidity, serious morbidity, and mortality in the hypoalbuminemic group (P < .01 for all procedures). Hypoalbuminemia was associated with a significantly higher 30‐day mortality in major procedures such as cystectomy, and in smaller procedures such as TURBT (P < .01). Hypoalbuminemia was associated with a 6.4% 30‐day mortality in the TURBT group compared with 0.6% in those with normal albumin (P < .0001). These findings remained significant after adjustment for other risk factors. Conclusions: The large sample size, standardized data definitions, and quality control measures of the American College of Surgeons National Surgical Quality Improvement Program database allow for in‐depth analysis of subtle but significant differences in outcomes between groups. Serum albumin is a strong predictor of short‐term postoperative complications in the urologic oncology patient.

Intravesical ALT-803 for BCG-unresponsive Bladder Cancer – A Case Report

The administration of intravesical chemotherapy or BCG often can prolong the progression-free interval after initial transurethral resection in select bladder cancer (BCa) patients. However, 60% of these patients will recur and up to 30% of patients with recurrent BCa will progress and succumb to their disease over a 15 year period, while another 50% will cystectomy in an attempt to control their disease. Thus better therapeutic strategies are needed for patients who have failed intravesical therapy. In this article, we report the treatment of a 91-year-old man with NMIBC with high-risk features that had failed multiple intravesical therapies.

A prospective study of health-related quality-of-life outcomes for patients with low-risk prostate cancer managed by active surveillance or radiation therapy.

INTRODUCTION Patients with low-risk prostate cancer (PCa) often have excellent oncologic outcomes. However, treatment with curative intent can lead to decrements in health-related quality of life (HRQoL). Patients treated with radical prostatectomy have been shown to suffer declines in urinary and sexual HRQoL as compared to those managed with active surveillance (AS). Similarly, patients treated with external-beam radiation therapy (EBRT) are hypothesized to experience greater declines in bowel HRQoL. As health-related quality-of-life (HRQoL) concerns are paramount when selecting among treatment options for low-risk PCa, this study examined HRQoL outcomes in men undergoing EBRT as compared to AS in a prospective, racially diverse cohort. METHODS A prospective study of HRQoL in patients with PCa enrolled in the Center for Prostate Disease Research (CPDR) Multicenter National Database was initiated in 2007. The current study included patients diagnosed through April 2014. HRQoL was assessed with the Expanded Prostate Cancer Index Composite (EPIC) and the Medical Outcomes Study Short Form (SF-36). Temporal changes in HRQoL were compared for patients with low-risk PCa managed on AS vs. EBRT at baseline, 1-, 2-, and 3 years post-PCa diagnosis. Longitudinal patterns were modeled using linear regression models fitted with generalized estimating equations (GEE), adjusting for baseline HRQoL, demographic, and clinical patient characteristics. RESULTS Of the 499 eligible patients with low-risk PCa, 103 (21%) selected AS and 60 (12%) were treated with EBRT. Demographic characteristics of the treatment groups were similar, though a greater proportion of patients in the EBRT group were African American (P = 0.0003). At baseline, both treatment groups reported comparable HRQoL. EBRT patients experienced significantly worse bowel function and bother at 1 year (adjusted mean score: 87 vs. 95, P = 0.001 and 89 vs. 95, P = 0.008, respectively) and 2 years (87 vs. 93, P = 0.007 and 87 vs. 96, P = 0.002, respectively) compared to patients managed on AS. In contrast to those on AS, more than half the number of patients who received EBRT experienced a decline in bowel function (52% vs. 17%, p=0.003) and bother (52% vs. 15%, P = 0.002) from baseline to 1 year. Patients who received EBRT were significantly more likely to experience a decrease in more than one functional domain (urinary, sexual, bowel, or hormonal) at 1 year when compared with those on AS (60% vs. 28%, P = 0.004). CONCLUSIONS Patients receiving EBRT for low-risk prostate cancer suffer declines in bowel HRQoL. These declines are not experienced by patients on AS, suggesting that management of low-risk prostate cancer with AS may offer a means for preserving HRQoL following prostate cancer diagnosis.

Leydig cell hyperplasia in the setting of Klinefelter syndrome

A man in his 20s with Klinefelter syndrome presented to the urology clinic with a recent history of left-sided orchalgia. Ultrasound evaluation demonstrated multiple small hypoechoic lesions bilaterally, with the largest lesion measured at 5 mm×6 mm×8 mm. Testis cancer tumour markers, chest radiographs and abdominal CT imaging were negative. A partial orchiectomy was performed on the largest lesion, demonstrating the presence of Leydig cell hyperplasia.

Penile Squamous Cell Carcinoma After a Childhood Hypospadias Repair With Bladder Mucosa Graft.

Bladder mucosa grafts were historically used for hypospadias surgical repairs, when preputial or penile skin was unavailable and in cases of prior failed hypospadias repairs. We present a case of advanced penile squamous cell carcinoma diagnosed 22 years after a childhood hypospadias repair with a free bladder mucosa graft.

Postcoital Hemorrhage of a Recurrent Seminal Vesicle Cyst Requiring Embolization

Herein is a case of a 23-year-old man with recurrence of a seminal vesicle cyst after percutaneous drainage and laparoscopic excision complicated by hemorrhage requiring embolization. He presented to the emergency department for pain after ejaculation. Computed tomographic scan of his pelvis revealed extravasation of contrast near his cyst and pelvic fluid collection suspicious for a hematoma. The patient had steadily decreasing hemoglobin and hematocrit levels. An interventional radiologist performed an embolization of the left seminal vesicle cystic arteries. Hemoglobin and hematocrit values improved and he was discharged. Hemorrhage resolved with embolization procedure and pain dissipated over the course of follow up care.

A case of scrotal venous malformation mimicking a failed varicocelectomy

A 21-year-old man presented to interventional radiology department with several years of left scrotal pain, which exacerbated by prolonged standing and walking. The patient had undergone a left varicocelectomy at the age of 10, after which he had a persistent scrotal mass. As he grew older, the left scrotal mass continued to increase in size, and symptoms progressively worsened. Physical examination revealed a non-tender, firm left scrotal mass which remained unchanged in size after Valsalva manoeuvres. Initial ultrasound examination revealed an extratesticular, intrascrotal mass with minimal internal flow. MRI revealed a heterogeneously enhancing, low-flow venous malformation centred in the midscrotum involving multiple tissue planes. Two sessions of percutaneous sclerotherapy failed to relieve his pain. Three months after the second sclerotherapy, the patient underwent surgical resection. At the time of his postoperative visit, his left scrotal pain had significantly improved and pain with prolonged standing and walking had resolved completely.