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            <channel>
                <title>European Urology - Current issue</title>
                <link>http://www.europeanurology.com</link>
                <description>European Urology RSS feed of the current issue. AIMS AND SCOPE Elsevier is the publisher of European Urology, the official journal of the European Association of Urology. European Urology publishes peer-reviewed original articles and topical reviews on a wide range of urological problems. Topics such as oncology, impotence, infertility, pediatrics, lithiasis and endourology, as well as recent advances in techniques, instrumentation, surgery and pediatric urology provide readers with a complete guide to international developments in urology. Published monthly, European Urology is an important journal for all clinicians and researchers in this field. All members of the EAU receive the journal as a benefit of their membership. For more information on the European Association of Urology, please go to: http://www.uroweb.org Supplements to European Urology are published under the title European Urology Supplements (ISSN 1569-9056). All subscribers to European Urology automatically receive this publication. You can also visit the EAU-EBU Update Series (ISSN 1871-2592). </description>
                <language>en-US</language>
                <copyright> © 2013 Published by Elsevier Inc. All rights reserved.</copyright>
                
                <item>
                    <title><![CDATA[Re: Do Adenocarcinomas of the Prostate with Gleason Score (GS) 6 Have the Potential to Metastasize to Lymph Nodes?]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(13)00126-7/abstract</link>
                    <description><![CDATA[]]></description>
                    <pubDate>Mon, 29 Apr 2013 14:27:41 GMT</pubDate>
                    <guid>S0302-2838(13)00126-7</guid>
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                <item>
                    <title><![CDATA[Re: Abiraterone in Metastatic Prostate Cancer Without Previous Chemotherapy]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(13)00127-9/abstract</link>
                    <description><![CDATA[]]></description>
                    <pubDate>Mon, 29 Apr 2013 14:27:40 GMT</pubDate>
                    <guid>S0302-2838(13)00127-9</guid>
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                <item>
                    <title><![CDATA[Re: Marital Status: A Gender-independent Risk Factor for Poorer Survival After Radical Cystectomy]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(13)00128-0/abstract</link>
                    <description><![CDATA[]]></description>
                    <pubDate>Mon, 29 Apr 2013 14:27:40 GMT</pubDate>
                    <guid>S0302-2838(13)00128-0</guid>
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                <item>
                    <title><![CDATA[Re: Population Based Study of Long-Term Rates of Surgery for Urinary Incontinence After Radical Prostatectomy for Prostate Cancer]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(13)00129-2/abstract</link>
                    <description><![CDATA[]]></description>
                    <pubDate>Mon, 29 Apr 2013 14:27:39 GMT</pubDate>
                    <guid>S0302-2838(13)00129-2</guid>
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                <item>
                    <title><![CDATA[Re: Objective Measures of Renal Mass Anatomic Complexity Predict Rates of Major Complications Following Partial Nephrectomy]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(13)00130-9/abstract</link>
                    <description><![CDATA[]]></description>
                    <pubDate>Mon, 29 Apr 2013 14:27:39 GMT</pubDate>
                    <guid>S0302-2838(13)00130-9</guid>
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                <item>
                    <title><![CDATA[Re: Precise Segmental Renal Artery Clamping Under the Guidance of Dual-source Computed Tomography Angiography During Laparoscopic Partial Nephrectomy]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(13)00131-0/abstract</link>
                    <description><![CDATA[]]></description>
                    <pubDate>Mon, 29 Apr 2013 14:27:38 GMT</pubDate>
                    <guid>S0302-2838(13)00131-0</guid>
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                <item>
                    <title><![CDATA[Congress Calendar]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(13)00195-4/abstract</link>
                    <description><![CDATA[]]></description>
                    <pubDate>Mon, 29 Apr 2013 14:27:26 GMT</pubDate>
                    <guid>S0302-2838(13)00195-4</guid>
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                <item>
                    <title><![CDATA[Award pages]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(13)00176-0/abstract</link>
                    <description><![CDATA[]]></description>
                    <pubDate>Mon, 29 Apr 2013 14:27:26 GMT</pubDate>
                    <guid>S0302-2838(13)00176-0</guid>
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                <item>
                    <title><![CDATA[Editorial Board]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(13)00175-9/abstract</link>
                    <description><![CDATA[]]></description>
                    <pubDate>Mon, 29 Apr 2013 14:27:24 GMT</pubDate>
                    <guid>S0302-2838(13)00175-9</guid>
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                <item>
                    <title><![CDATA[Contents]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(13)00178-4/abstract</link>
                    <description><![CDATA[]]></description>
                    <pubDate>Mon, 29 Apr 2013 14:27:24 GMT</pubDate>
                    <guid>S0302-2838(13)00178-4</guid>
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                <item>
                    <title><![CDATA[Reply from Authors re: Behfar Ehdaie, Karim A. Touijer. 5-Alpha Reductase Inhibitors in Prostate Cancer: From Clinical Trials to Clinical Practice. Eur Urol 2013;63:7889]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(13)00117-6/abstract</link>
                    <description><![CDATA[]]></description>
                    <pubDate>Mon, 18 Feb 2013 11:45:04 GMT</pubDate>
                    <guid>S0302-2838(13)00117-6</guid>
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                <item>
                    <title><![CDATA[Renal Cancer Therapy: Going Forward by Going Backward?]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(13)00118-8/abstract</link>
                    <description><![CDATA[]]></description>
                    <pubDate>Mon, 18 Feb 2013 10:25:01 GMT</pubDate>
                    <guid>S0302-2838(13)00118-8</guid>
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                <item>
                    <title><![CDATA[A System for Long-term Urodynamic Studies Without Catheters]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(13)00098-5/abstract</link>
                    <description><![CDATA[]]></description>
                    <pubDate>Mon, 18 Feb 2013 09:45:36 GMT</pubDate>
                    <guid>S0302-2838(13)00098-5</guid>
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                <item>
                    <title><![CDATA[To Transfuse or Not to Transfuse: Is It Really a Question?]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(13)00100-0/abstract</link>
                    <description><![CDATA[]]></description>
                    <pubDate>Mon, 18 Feb 2013 09:45:02 GMT</pubDate>
                    <guid>S0302-2838(13)00100-0</guid>
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                <item>
                    <title><![CDATA[Obesity, Nutrition, and Prostate Cancer: Insights and Issues]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(13)00102-4/abstract</link>
                    <description><![CDATA[]]></description>
                    <pubDate>Thu, 07 Feb 2013 17:25:03 GMT</pubDate>
                    <guid>S0302-2838(13)00102-4</guid>
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                <item>
                    <title><![CDATA[Comparative Effectiveness and Safety of Oral Phosphodiesterase Type 5 Inhibitors for Erectile Dysfunction: A Systematic Review and Network Meta-analysis]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(13)00024-9/abstract</link>
                    <description><![CDATA[Context:Phosphodiesterase type 5 inhibitors (PDE5-Is) are currently the first-line therapy for erectile dysfunction (ED), but available studies investigating the comparative effects of different PDE5-Is are limited.Objective:To compare the efficacy and safety of different classes of oral PDE5-Is for ED.Evidence acquisition:A systematic search was performed in PubMed, Cochrane Library, and Embase to identify randomized controlled trials that compared different PDE5-Is or PDE5-Is with a placebo for ED. The methodological quality of included studies was appraised with the Cochrane Collaboration bias appraisal tool, and the quality of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation system.Evidence synthesis:A total of 118 trials (31 195 individuals) were included. There was no major difference in the results between the traditional meta-analysis and the network meta-analysis. Network meta-analysis demonstrated that PDE5-Is were superior to placebo to improve erectile function. Compared with tadalafil (relative risk [RR]: 0.61; 95% confidence interval [CI], 0.33–0.90) and vardenafil (RR: 0.63; 95% CI, 0.35–0.92), avanafil was less effective on Global Assessment Questionnaire question 1. Tadalafil was more effective than vardenafil (mean difference [MD]: 1.49; 95% CI, 0.50–2.50) and udenafil (MD: −1.84; 95% CI, −3.31 to −0.33) as measured by the erectile function domain of the International Index of Erectile Function. For all efficacy outcomes, the absolute effects and the rank tests indicated that tadalafil and vardenafil were the most effective agents. After adjusting for dosage, the conclusion remained the same. Safety analysis showed there was no major difference among different agents.Conclusions:In recommended doses, oral PDE5-Is are more effective than placebo for ED, and tadalafil seems to be the most effective agent, followed by vardenafil. PDE5-Is are generally safe and well tolerated, and there is no major difference on the safety profile.This study indicates that oral phosphodiesterase type 5 inhibitors (PDE5-Is) are more effective than placebo, and tadalafil seems to be the most effective agent, followed by vardenafil. PDE5-Is are generally well tolerated, and there is no major difference on safety.]]></description>
                    <pubDate>Thu, 07 Feb 2013 17:15:04 GMT</pubDate>
                    <guid>S0302-2838(13)00024-9</guid>
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                <item>
                    <title><![CDATA[Reply from Authors re: Peter J. Gilling. Laser Enucleation Is Increasingly Becoming the Standard of Care for Treatment of Benign Prostatic Hyperplasia of All Sizes. Eur Urol 2013;63:8689]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(13)00093-6/abstract</link>
                    <description><![CDATA[]]></description>
                    <pubDate>Thu, 07 Feb 2013 17:15:01 GMT</pubDate>
                    <guid>S0302-2838(13)00093-6</guid>
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                <item>
                    <title><![CDATA[Re: Maxine Sun, Marco Bianchi, Jens Hansen, et al. Chronic Kidney Disease After Nephrectomy in Patients with Small Renal Masses: A Retrospective Observational Analysis. Eur Urol 2012;62:696703]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(13)00090-0/abstract</link>
                    <description><![CDATA[]]></description>
                    <pubDate>Thu, 07 Feb 2013 16:25:11 GMT</pubDate>
                    <guid>S0302-2838(13)00090-0</guid>
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                <item>
                    <title><![CDATA[Reply to Georgios Papadopoulos, Georgios Stathouros and Konstantinos Doumas Letter to the Editor re: Maxine Sun, Marco Bianchi, Jens Hansen, et al. Chronic Kidney Disease After Nephrectomy in Patients with Small Renal Masses: A Retrospective Observational Analysis. Eur Urol 2012;62:696703]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(13)00091-2/abstract</link>
                    <description><![CDATA[]]></description>
                    <pubDate>Thu, 07 Feb 2013 16:25:09 GMT</pubDate>
                    <guid>S0302-2838(13)00091-2</guid>
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                <item>
                    <title><![CDATA[TVT-O: A New Gold Standard Surgical Treatment of Female Stress Urinary Incontinence?]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(13)00029-8/abstract</link>
                    <description><![CDATA[]]></description>
                    <pubDate>Wed, 23 Jan 2013 14:15:06 GMT</pubDate>
                    <guid>S0302-2838(13)00029-8</guid>
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                <item>
                    <title><![CDATA[Radical Locoregional Therapy for Bladder Cancer: Underutilized, or Unsuitable in Many?]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(13)00002-X/abstract</link>
                    <description><![CDATA[]]></description>
                    <pubDate>Wed, 23 Jan 2013 11:55:04 GMT</pubDate>
                    <guid>S0302-2838(13)00002-X</guid>
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                <item>
                    <title><![CDATA[The Impact of Perioperative Blood Transfusion on Cancer Recurrence and Survival Following Radical Cystectomy]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(13)00007-9/abstract</link>
                    <description><![CDATA[Background:While the receipt of a perioperative blood transfusion (PBT) has been associated with an increased risk of mortality for a number of malignancies, the relationship between PBT and survival following radical cystectomy (RC) for bladder cancer (BCa) has not been well established.Objective:To evaluate the association of PBT with disease recurrence and mortality following RC.Design, setting, and participants:We identified 2060 patients who underwent RC at the Mayo Clinic between 1980 and 2005. PBT was defined as transfusion of allogenic red blood cells during RC or postoperative hospitalization.Outcome measurements and statistical analysis:Survival was estimated using the Kaplan-Meier method and was compared with the log-rank test. Cox proportional hazard regression models were used to evaluate the association of PBT with outcome, controlling for clinicopathologic variables.Results and limitations:A total of 1279 patients (62%) received PBT. The median number of units transfused was 2 (interquartile range [IQR]: 2–4). Patients receiving PBT were significantly older (median: 69 yr vs 66 yr; p Receipt of a perioperative blood transfusion is independently associated with an increased risk of cancer recurrence, bladder cancer death, and all-cause mortality following radical cystectomy (RC). Continued efforts to reduce the use of blood products in patients undergoing RC are warranted.]]></description>
                    <pubDate>Thu, 17 Jan 2013 13:55:02 GMT</pubDate>
                    <guid>S0302-2838(13)00007-9</guid>
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                <item>
                    <title><![CDATA[Laser Enucleation Is Increasingly Becoming the Standard of Care for Treatment of Benign Prostatic Hyperplasia of All Sizes]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(13)00004-3/abstract</link>
                    <description><![CDATA[]]></description>
                    <pubDate>Thu, 17 Jan 2013 13:35:08 GMT</pubDate>
                    <guid>S0302-2838(13)00004-3</guid>
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                <item>
                    <title><![CDATA[5-Alpha Reductase Inhibitors in Prostate Cancer: From Clinical Trials to Clinical Practice]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(12)01565-5/abstract</link>
                    <description><![CDATA[]]></description>
                    <pubDate>Tue, 08 Jan 2013 09:15:05 GMT</pubDate>
                    <guid>S0302-2838(12)01565-5</guid>
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                <item>
                    <title><![CDATA[TVT-O for the Treatment of Pure Urodynamic Stress Incontinence: Efficacy, Adverse Effects, and Prognostic Factors at 5-Year Follow-up]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(12)01491-1/abstract</link>
                    <description><![CDATA[Background:Inside-out tension-free vaginal transobturator tape (TVT-O) is currently one of the most effective and popular procedures for the surgical treatment of female stress urinary incontinence (SUI), but data reporting long-term outcomes are scarce.Objective:To evaluate the efficacy and safety of TVT-O 5-yr implantation for management of pure SUI in women.Design, setting, and participants:A prospective observational study was conducted in four tertiary reference centers. Consecutive women presenting with urodynamically proven, pure SUI treated by TVT-O were included. Patients with mixed incontinence and/or anatomic evidence of pelvic organ prolapse were excluded.Intervention:TVT-O implantation without any associated procedure.Outcome measurements and statistical analysis:Data regarding subjective outcomes (International Consultation on Incontinence-Short Form [ICIQ-SF], Patient Global Impression of Improvement, patient satisfaction scores), objective cure (stress test) rates, and adverse events were collected during follow-up. Multivariable analyses were performed to investigate outcomes.Results and limitations:Of the 191 women included, 21 (11.0%) had previously undergone a failed anti-incontinence surgical procedure. Six (3.1%) patients were lost to follow-up. The 5-yr subjective and objective cure rates were 90.3% and 90.8%, respectively. De novo overactive bladder (OAB) was reported by 24.3% of patients at 5-yr follow-up. Median ICIQ-SF score significantly improved from 17 (interquartile range [IQR]:16–17) preoperatively to 0 (IQR: 0–2) (p Tension-free vaginal transobturator tape implantation is a highly effective option for the treatment of women with pure stress urinary incontinence, showing a very high cure rate and a low incidence of complications after 5-yr follow-up.]]></description>
                    <pubDate>Mon, 31 Dec 2012 11:45:01 GMT</pubDate>
                    <guid>S0302-2838(12)01491-1</guid>
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                <item>
                    <title><![CDATA[Complications and Early Postoperative Outcome in 1080 Patients After Thulium Vapoenucleation of the Prostate: Results at a Single Institution]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(12)01423-6/abstract</link>
                    <description><![CDATA[Background:Thulium vapoenucleation of the prostate (ThuVEP) has been introduced as a minimally invasive treatment for benign prostatic obstruction (BPO).Objective:To analyze immediate outcomes and the institutional learning curve of ThuVEP, and to report its standardized complication rates, using the modified Clavien classification system (CCS) to grade perioperative complication rates.Design, settings, and participants:A prospective evaluation of 1080 patients undergoing ThuVEP from January 2007 until May 2012 at our institution.Intervention:ThuVEP was performed using the 2-μm, continuous-wave, thulium:yttrium-aluminum-garnet laser.Outcome measurements and statistical analysis:Preoperative status, surgical details, and immediate outcome were recorded for each patient. Perioperative complications were classified according to the modified CCS.Results and limitations:Median prostate size was 51 ml (interquartile range [IQR]: 36–78.7). Median operation time was 56 min (IQR: 40–80), and median enucleation time was 32.5 min (IQR: 22-50). Median catheterization time was 2 d (IQR: 2–2); median length of hospital stay was 4 d (IQR: 3–5). Median resected tissue weight was 30 g (IQR: 16.00–51.25). Incidental carcinoma of the prostate was detected in 59 (5.5%) patients. Median maximum urinary flow rate (8.9 vs 18.4 ml/s) and postvoid residual urine volume (120 vs 20 ml) changed significantly (p Thulium vapoenucleation of the prostate (ThuVEP) has been introduced as a size-independent, minimally invasive treatment of benign prostatic obstruction (BPO). We report standardized perioperative complication rates using the modified Clavien classification system and early postoperative outcomes in 1080 patients undergoing ThuVEP due to BPO.]]></description>
                    <pubDate>Mon, 03 Dec 2012 09:25:14 GMT</pubDate>
                    <guid>S0302-2838(12)01423-6</guid>
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                <item>
                    <title><![CDATA[Reply from Author re: Maurizio Brausi, Salvatore Siracusano. Collateral Activity of Immunotherapy with Bacillus Calmette-Gurin for the Treatment of Nonmuscle-invasive Transitional Cell Carcinoma of the Bladder: New Insights. Eur Urol 2013;63:8367]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(12)01420-0/abstract</link>
                    <description><![CDATA[]]></description>
                    <pubDate>Mon, 03 Dec 2012 09:05:19 GMT</pubDate>
                    <guid>S0302-2838(12)01420-0</guid>
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                <item>
                    <title><![CDATA[Development of Accurate Models for Individualized Prediction of Survival After Cytoreductive Nephrectomy for Metastatic Renal Cell Carcinoma]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(12)01415-7/abstract</link>
                    <description><![CDATA[Background:There is limited evidence to guide patient selection for cytoreductive nephrectomy (CN) following the diagnosis of metastatic renal cell carcinoma (mRCC).Objective:Given the significant variability in oncologic outcomes following surgery, we sought to develop clinically relevant, individualized, multivariable models for the prediction of cancer-specific survival at 6 and 12 mo after CN. The development of this nomogram will better help clinicians select patients for cytoreductive surgery.Design, setting, and participants:We identified 601 consecutive patients who underwent CN for kidney cancer at a single tertiary cancer center.Intervention:CN for mRCC.Outcome measurements and statistical analysis:The development cohort was used to select predictive variables from a large group of candidate predictors. The discrimination, calibration, and decision curves were corrected for overfit using 10-fold crossvalidation that included stepwise variable selection.Results and limitations:With a median follow-up of 65 mo (range: 6–199) for the entire cohort, 110 and 215 patients died from kidney cancer at 6 and 12 mo after surgery, respectively. For the preoperative model, serum albumin and serum lactate dehydrogenase were included. Final pathologic primary tumor stage, nodal stage, and receipt of blood transfusion were added to the previously mentioned parameters for the postoperative model. Preoperative and postoperative nomograms demonstrated good discrimination of 0.76 and 0.74, respectively, when applied to the validation data set. Both models demonstrated excellent calibration and a good net benefit over large ranges of threshold probabilities. The retrospective study design is the major limitation of this study.Conclusions:We have developed models for accurate prediction of cancer-specific survival after CN, using either preoperative or postoperative variables. While these tools need validation in independent cohorts, our results suggest that the models are informative and can be used to aid in clinical decision making.Because of significant variability in oncologic outcomes following cytoreductive nephrectomy for renal cell carcinoma, the role of surgery remains controversial. To aid clinical decision making, we have developed and validated multivariable models for the prediction of cancer-specific survival at 6 mo and 12 mo after cytoreductive surgery.]]></description>
                    <pubDate>Tue, 27 Nov 2012 11:15:33 GMT</pubDate>
                    <guid>S0302-2838(12)01415-7</guid>
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                <item>
                    <title><![CDATA[Use of Potentially Curative Therapies for Muscle-invasive Bladder Cancer in the United States: Results from the National Cancer Data Base]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(12)01346-2/abstract</link>
                    <description><![CDATA[Background:Despite its lethal potential, many patients with muscle-invasive bladder cancer (MIBC) do not receive aggressive, potentially curative therapy consistent with established practice standards.Objective:To characterize the treatments received by patients with MIBC and analyze their use according to sociodemographic, clinical, pathologic, and facility measures.Design, setting, and participants:Using the National Cancer Data Base, we analyzed 28 691 patients with MIBC (stages II–IV) treated between 2004 and 2008, excluding those with cT4b tumors or distant metastases. Treatments included radical or partial cystectomy with or without chemotherapy (CT), chemoradiotherapy (CRT), radiation therapy (RT), or CT alone and observation following biopsy. Aggressive therapy (AT) was defined as radical or partial cystectomy or definitive RT/CRT (total dose ≥50 Gy).Outcome measurements and statistical analysis:AT use and correlating variables were assessed by multivariable, generalized estimating equation models adjusted for facility clustering.Results and limitations:According to the database, 52.5% of patients received AT; 44.9% were treated surgically, 7.6% received definitive CRT or RT, and 25.9% of patients received observation only. AT use decreased with advancing age (odds ratio [OR]: 0.34 for age 81–90 yr vs ≤50 yr; p Only 52.5% of US patients with muscle-invasive bladder cancer receive potentially curative therapy. Noncurative therapy is more commonly received by the elderly and those with poor socioeconomic status. Education of providers and policymakers could improve the treatment of these patients.]]></description>
                    <pubDate>Fri, 23 Nov 2012 10:35:06 GMT</pubDate>
                    <guid>S0302-2838(12)01346-2</guid>
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                <item>
                    <title><![CDATA[Dutasteride Treatment Over 2 Years Delays Prostate-specific Antigen Progression in Patients with Biochemical Failure After Radical Therapy for Prostate Cancer: Results from the Randomised, Placebo-controlled Avodart After Radical Therapy for Prostate Cancer Study (ARTS)]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(12)01337-1/abstract</link>
                    <description><![CDATA[Background:Rising prostate-specific antigen (PSA) levels after radical therapy are indicative of recurrent or residual prostate cancer (PCa). This biochemical recurrence typically predates clinically detectable metastatic disease by several years. Management of patients with biochemical recurrence is controversial.Objective:To assess the effect of dutasteride on progression of PCa in patients with biochemical failure after radical therapy.Design, setting, and participants:Randomised, double-blind, placebo-controlled trial in 294 men from 64 centres across 9 European countries.Intervention:The 5α-reductase inhibitor, dutasteride.Outcome measurements and statistical analysis:The primary end point was time to PSA doubling from start of randomised treatment, analysed by log-rank test stratified by previous therapy and investigative-site cluster. Secondary end points included time to disease progression and the proportion of subjects with disease progression.Results and limitations:Of the 294 subjects randomised (147 in each treatment group), 187 (64%) completed 24 mo of treatment and 107 discontinued treatment prematurely (71 [48%] of the placebo group, 36 [24%] of the dutasteride group). Dutasteride significantly delayed the time to PSA doubling compared with placebo after 24 mo of treatment (p Dutasteride delays biochemical progression of prostate cancer and may offer a treatment option for men with biochemical failure after radical therapy for clinically localised disease. A larger-scale study with longer follow-up is warranted based on these encouraging data.]]></description>
                    <pubDate>Fri, 23 Nov 2012 10:15:09 GMT</pubDate>
                    <guid>S0302-2838(12)01337-1</guid>
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                <item>
                    <title><![CDATA[Feasibility of Robotic Laparoendoscopic Single-Site Partial Nephrectomy for Renal Tumors >4cm]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(12)01406-6/abstract</link>
                    <description><![CDATA[Background:Laparoendoscopic single-site (LESS) urologic procedures have gained significant interest worldwide in an attempt to further reduce morbidity and minimize scarring associated with conventional laparoscopic surgery. The robotic technology has overcome some of the limitations of manual single-incision surgery relating to lack of triangulation, instrument collision, and surgical exposure. There are no data on robotic LESS partial nephrectomy (PN) for renal tumors >4 cm.Objectives:To evaluate the feasibility of robotic LESS PN for renal tumors >4 cm.Design, setting, and participants:Data from 67 consecutive patients who underwent robotic LESS PN were collected between May 2009 to January 2011.Outcome measurements and statistical analysis:Patients were stratified into two groups: 20 patients with renal tumors >4 cm (group 1) and 47 patients with renal tumors ≤4 cm (group 2). Perioperative data were recorded and comparisons between the two groups were analyzed using the Mann-Whitney U test for continuous variables and Fisher exact test for categorical variables.Results and limitations:No statistically significant differences were found between the two groups in demographic information, operative complications, pathologic characteristics, mean decline in estimated glomerular filtration rate, estimated blood loss, operative times, conversion rate, or positive surgical margins. However, group 1 had a higher mean nephrometry score (p 4 cm. Patients with tumors >4 cm had a statistically significant, higher mean nephrometry score, longer warm ischemia time, and longer length of stay, but there was no increased risk of adverse outcomes. A long-term study is needed to confirm the durable renal preservation and oncologic outcomes for patients with larger tumor burden.Patients who underwent robotic laparoendoscopic single-site partial nephrectomy for renal tumors >4 cm had a statistically significant, higher mean nephrometry score and longer warm ischemia time and length of hospital stay but no increased risk of adverse outcomes.]]></description>
                    <pubDate>Fri, 23 Nov 2012 10:05:09 GMT</pubDate>
                    <guid>S0302-2838(12)01406-6</guid>
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                <item>
                    <title><![CDATA[Collateral Activity of Immunotherapy with Bacillus Calmette-Gurin for the Treatment of Nonmuscle-invasive Transitional Cell Carcinoma of the Bladder: New Insights]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(12)01408-X/abstract</link>
                    <description><![CDATA[]]></description>
                    <pubDate>Fri, 23 Nov 2012 10:05:02 GMT</pubDate>
                    <guid>S0302-2838(12)01408-X</guid>
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                <item>
                    <title><![CDATA[The Relationship Between Nutrition and Prostate Cancer: Is More Always Better?]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(12)01343-7/abstract</link>
                    <description><![CDATA[Context:Prostate cancer (PCa) remains one of the most diagnosed malignancies in the world, correlating with regions where men consume more of a so-called Western-style diet. As such, there is much interest in understanding the role of lifestyle and diet on the incidence and progression of PCa.Objective:To provide a summary of published literature with regard to dietary macro- and micronutrients and PCa incidence and progression.Evidence acquisition:A literature search was completed using the PubMed database for all studies published on diet and PCa in June 2012 or earlier. Primary literature and meta-analyses were given preference over other review articles when possible.Evidence synthesis:The literature was reviewed on seven dietary components: carbohydrates, protein, fat and cholesterol, vegetables, vitamins and minerals, and phytochemicals. Current literature linking these nutrients to PCa is limited at best, but trends in the published data suggest consumption of carbohydrates, saturated and ω-6 fats, and certain vitamin supplements may promote PCa risk and progression. Conversely, consumption of many plant phytochemicals and ω-3 fatty acids seem to slow the risk and progression of the disease. All other nutrients seem to have no effect or data are inconclusive. A brief summary about the clinical implications of dietary interventions with respect to PCa prevention, treatment, and survivorship is provided.Conclusions:Due to the number and heterogeneity of published studies investigating diet and PCa, it is difficult to determine what nutrients make up the perfect diet for the primary and secondary prevention of PCa. Because diets are made of multiple macro- and micronutrients, further prospective studies are warranted, particularly those investigating the relationship between whole foods instead of a single nutritional component.Our understanding of how nutrition affects prostate cancer (PCa) is growing but still is not entirely clear. By knowing how consumption of certain nutrients can affect a person, we can learn how these nutrients can fundamentally affect PCa incidence and progression.]]></description>
                    <pubDate>Fri, 23 Nov 2012 09:55:21 GMT</pubDate>
                    <guid>S0302-2838(12)01343-7</guid>
                </item>
            
                <item>
                    <title><![CDATA[Obesity and Prostate Cancer: Weighing the Evidence]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(12)01344-9/abstract</link>
                    <description><![CDATA[Context:Obesity and prostate cancer (PCa) affect substantial proportions of Western society. Mounting evidence, both epidemiologic and mechanistic, for an association between the two is of public health interest. An improved understanding of the role of this modifiable risk factor in PCa etiology is imperative to optimize screening, treatment, and prevention.Objective:To consolidate and evaluate the evidence for an epidemiologic link between obesity and PCa, in addition to examining the proposed underlying molecular mechanisms.Evidence acquisition:A PubMed search for relevant articles published between 1991 and July 2012 was performed by combining the following terms: obesity, BMI, body mass index and prostate cancer risk, prostate cancer incidence, prostate cancer mortality, radical prostatectomy, androgen-deprivation therapy, external-beam radiation, brachytherapy, prostate cancer and quality of life, prostate cancer and active surveillance, in addition to obesity, BMI, body mass index and prostate cancer and insulin, insulin-like growth factor, androgen, estradiol, leptin, adiponectin, and IL-6. Articles were selected based on content, date of publication, and relevancy, and their references were also searched for relevant articles.Evidence synthesis:Increasing evidence suggests obesity is associated with elevated incidence of aggressive PCa, increased risk of biochemical failure following radical prostatectomy and external-beam radiotherapy, higher frequency of complications following androgen-deprivation therapy, and increased PCa-specific mortality, although perhaps a lower overall PCa incidence. These results may in part relate to difficulties in detecting and treating obese men. However, multiple molecular mechanisms could explain these associations as well. Weight loss slows PCa in animal models but has yet to be fully tested in human trials.Conclusions:Obesity appears to be linked with aggressive PCa. We suggest clinical tips to better diagnose and treat obese men with PCa. Whether reversing obesity slows PCa growth is currently unknown, although it is an active area of research.Obesity appears to be linked with aggressive prostate cancer (PCa). Small tips can be used to better diagnose and treat obese men with PCa. Whether reversing obesity slows PCa growth is currently unknown, although this area of research is active.]]></description>
                    <pubDate>Fri, 23 Nov 2012 09:55:12 GMT</pubDate>
                    <guid>S0302-2838(12)01344-9</guid>
                </item>
            
                <item>
                    <title><![CDATA[National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) Symptom Evaluation in Multinational Cohorts of Patients with Chronic Prostatitis/Chronic Pelvic Pain Syndrome]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(12)01273-0/abstract</link>
                    <description><![CDATA[Background:The assessment of patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) in everyday practice and clinical studies relies on National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) scores for symptom appraisal, inclusion criteria for clinical trials, follow-up, and response evaluation.Objective:We investigated multiple databases of CP/CPPS patients to determine the prevalence and impact of pain locations and types to improve our strategy of individualized phenotypically guided treatment.Design, setting, and participants:Four major databases with CPSI scores for nonselected CP/CPPS clinic patients from Canada, Germany, Italy, and the United States.Outcome measurements and statistical analysis:Individual question scores and subtotal and total scores of CPSI were described and correlated with each other. Ordinal regression analysis was performed to define pain severity categories.Results and limitations:A total of 1563 CP/CPPS patients were included. Perineal pain/discomfort was the most prevalent pain symptom (63%) followed by testicular pain (58%), pain in the pubic area (42%) and penis (32%); reports of pain during ejaculation and voiding were 45% and 43%, respectively. European patients had a significantly higher number of pain localizations and symptoms compared with North American patients (p The National Institutes of Health Chronic Prostatitis Symptom Index is an accepted tool in the assessment and follow-up of patients with chronic prostatitis/chronic pelvic pain syndrome that has not been validated in nonselected patients. This large multinational population-based cohort study showed that pain, especially pain intensity, has the most important impact on quality of life, and this has importance in the light of phenotype-directed treatment. Cut-off levels for pain and disease severity categories have also been defined. Clinical trial patients can now be compared with this unbiased patient population.]]></description>
                    <pubDate>Fri, 02 Nov 2012 03:46:40 GMT</pubDate>
                    <guid>S0302-2838(12)01273-0</guid>
                </item>
            
                <item>
                    <title><![CDATA[Occlusion Angiography Using Intraoperative Contrast-enhanced Ultrasound Scan (CEUS): A Novel Technique Demonstrating Segmental Renal Blood Supply to Assist Zero-ischaemia Robot-assisted Partial Nephrectomy]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(12)01253-5/abstract</link>
                    <description><![CDATA[Background:Recent innovations in technology and operative techniques have enabled safe performance of robot-assisted zero-ischaemia partial nephrectomy (PN), thus preventing the deleterious effect of warm ischaemia time.Objective:To describe a novel technique of occlusion angiography using intraoperative contrast-enhanced ultrasound scan (CEUS) for zero-ischaemia robot-assisted PN (RAPN).Design, setting, and participants:We used a prospective cohort evaluation of five patients who had imaging suspicious of renal cell carcinoma (RCC) treated at a single centre.Surgical procedure:We used computed tomography with three-dimensional reconstruction to identify renal arterial anatomy and its relationship to the tumour. Then, RAPN was performed with selective clamping and demonstration of a nonperfused segment of kidney (occlusion angiography) using intraoperative CEUS.Outcome measurements and statistical analysis:We prospectively collected data on baseline, perioperative, and postoperative parameters.Results and limitations:We describe the effects seen on ultrasound contrast administration. Contrast flare is seen in the segment of the kidney that is perfused. When selective clamping is performed, a watershed (line of demarcation) between the perfused and nonperfused segments of the kidney is clearly seen, allowing excision of the tumour in a relatively avascular plane and ensuring an adequate oncologic margin, when feasible. The mean age was 68.2 yr of age (range: 36–85), and the mean tumour size was 29.6 mm (range: 20–42). The mean intraparenchymal extension of the tumour was 22.6 mm (range: 12–30). Three tumours were located on the right kidney and two on the left. The mean blood loss was 420 ml (range: 200–1000). The histology revealed clear cell RCC in two patients, oncocytoma in two patients, and type 1 papillary RCC in one patient. All the surgical specimens had negative surgical margins. The mean decrease in glomerular filtration rate was 8.4 ml (range: 0–24). The mean follow-up was 6.4 mo (range: 5–8), with no evidence of recurrence in any patient. The only limitation in adopting this technique is the need for an intraoperative ultrasound probe with a CEUS mode. However, most specialists who perform minimally invasive surgery for small renal tumours believe that intraoperative ultrasound scan imaging is essential to achieving adequate resection margins.Conclusions:Intraoperative CEUS can be a useful adjunct in determining whether zero-ischaemia RAPN is feasible by delineating the area of nonperfusion. This technique has several advantages over the currently available techniques, such as indigo carmine green and Doppler probes.Robot-assisted partial nephrectomy with zero-ischaemia utilising intraoperative contrast-enhanced ultrasound scan–guided surgery is technically feasible. This new technique preserves the maximum renal function by avoiding the deleterious effects of prolonged global warm ischaemia time.]]></description>
                    <pubDate>Wed, 24 Oct 2012 06:05:02 GMT</pubDate>
                    <guid>S0302-2838(12)01253-5</guid>
                </item>
            
                <item>
                    <title><![CDATA[Contemporary Grading for Prostate Cancer: Implications for Patient Care]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(12)01234-1/abstract</link>
                    <description><![CDATA[Context:The Gleason grading system is one of the most powerful predictors of outcome in prostate cancer and a cornerstone in counseling and treating patients. Since its inception, it has undergone several modifications triggered by a change in clinical practice and a better understanding of the cancer's histologic spectrum and variants and their prognostic significance.Objective:To provide an overview of the implementation and the impact of the Gleason system as a predictive and prognostic tool in all available treatment modalities, and to compare the original and modified Gleason systems in major pathologic and clinical outcome data sets.Evidence acquisition:A comprehensive nonsystematic Medline search was performed using multiple Medical Subject Headings such as Gleason, modified, system, outcome, biopsy, prostatectomy, recurrence, prognosis, radiotherapy, and focal therapy, with restriction to the English language and a preference for publications within the last 10 yr. All Gleason grade–related studies in the last 3 yr were reviewed. For studies before this date, we relied on prior culling of the literature for various recent books, chapters, and original articles on this topic.Evidence synthesis:Using the modified grading system resulted in disease upgrading with more cancers assigned a Gleason score ≥7 than in the past. It also resulted in a more homogeneous Gleason score 6, which has an excellent prognosis when the disease is organ confined. The vast majority of studies using both systems showed that Gleason grading of adenocarcinomas on needle biopsies and radical prostatectomies was strongly associated with pathologic stage, status of surgical margins, metastatic disease, biochemical recurrence, and cancer-specific survival, with the modified system outperforming the original one in some large series. A description of the continuous incorporation of this parameter in the clinical decision making for treating prostate cancer using all currently used treatment modalities is presented, and the findings of studies before and after the inception of the modified grading system, if available, are compared. The proposed contemporary grading prognostic categories are 3 + 3, 3 + 4, 4 + 3, 8, and 9–10.Conclusions:The Gleason score is one of the most critical predictive factors of prostate cancer regardless of the therapy used. Modernization of the Gleason grading system has resulted in a more accurate grading system for radical prostatectomy (RP) but has complicated the comparison of data before and after the updating. A better prognostication with the updated Gleason grading system for patients treated with modalities other than surgery can only be postulated at this time because there are limited conflicting data on radiation and no studies on other treatment modalities. Its greatest impact is the uniformly excellent prognosis associated with Gleason score 6 in RPs.Modernization of the Gleason grading system has resulted in a more accurate grading system for radical prostatectomy (RP) but has complicated the comparison of data before and after updating. The greatest impact of using the modified system is the uniformly excellent prognosis associated with a more strictly defined Gleason score 6 in RPs.]]></description>
                    <pubDate>Thu, 18 Oct 2012 02:35:01 GMT</pubDate>
                    <guid>S0302-2838(12)01234-1</guid>
                </item>
            
                <item>
                    <title><![CDATA[Novel Immunotherapeutic Strategies in Development for Renal Cell Carcinoma]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(12)01225-0/abstract</link>
                    <description><![CDATA[Context:The purpose of this report is to review immunotherapies under investigation for patients with renal cell carcinoma (RCC), the most common form of kidney cancer, for which the incidence and mortality rate continue to increase.Objective:To summarize and evaluate current data on immunotherapies for RCC and discuss issues to be resolved before integration into the RCC treatment paradigm.Evidence acquisition:A search of Medline, clinicaltrials.gov, and congress abstracts/treatment guidelines was performed in May 2012 using the following terms (and variations): metastatic renal cell carcinoma, practice guidelines, response/resistance to current treatments, immunotherapy, novel immunotherapeutic strategies, T-cell modulation, immune priming, innate immunity, and combination therapy.Evidence synthesis:Prior to the advent of novel agents targeting the vascular endothelial growth factor and mechanistic target of rapamycin pathways, interleukin-2 (IL-2) and interferon-α were the mainstays of RCC treatment. IL-2 remains one of the only treatments capable of curing advanced RCC, albeit in few patients. Despite recent advances, unmet need still exists for patients in the adjuvant setting, those with poor prognostic factors, and those who have progressed on prior targeted therapies. Improved understanding of host–tumor immune interactions has led to development of novel immunotherapeutic agents, including antibodies against immune checkpoint proteins (eg, programmed death-1 and cytotoxic T-lymphocyte antigen-4), and various vaccines. Because many of these compounds are in development, clinical experience with them is limited, although some have demonstrated activity in preliminary studies.Conclusions:It is not yet clear where these new immunotherapies will fit into RCC treatment paradigms, but they may provide new options for patients whose current choices are limited. Furthermore, predictive biomarkers are needed to identify patients who will derive the greatest benefit from immunotherapy.Many new immunotherapies in development for patients with kidney cancer may serve as new options to improve patient outcomes. Predictive biomarkers that will identify patients who are most likely to benefit from treatment are needed.]]></description>
                    <pubDate>Sat, 13 Oct 2012 02:37:16 GMT</pubDate>
                    <guid>S0302-2838(12)01225-0</guid>
                </item>
            
                <item>
                    <title><![CDATA[Reply from Authors re: James W.F. Catto, Shahrokh F. Shariat. The Changing Face of Renal Cell Carcinoma: The Impact of Systematic Genetic Sequencing on Our Understanding of This Tumor's Biology. Eur Urol 2013;63:8557]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(12)01142-6/abstract</link>
                    <description><![CDATA[]]></description>
                    <pubDate>Tue, 02 Oct 2012 02:45:02 GMT</pubDate>
                    <guid>S0302-2838(12)01142-6</guid>
                </item>
            
                <item>
                    <title><![CDATA[Clinical and Pathologic Impact of Select Chromatin-modulating Tumor Suppressors in Clear Cell Renal Cell Carcinoma]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(12)01028-7/abstract</link>
                    <description><![CDATA[Background:Historically, VHL was the only frequently mutated gene in clear cell renal cell carcinoma (ccRCC), with conflicting clinical relevance. Recent sequencing efforts have identified several novel frequent mutations of histone modifying and chromatin remodeling genes in ccRCC including PBRM1, SETD2, BAP1, and KDM5C. PBRM1, SETD2, and BAP1 are located in close proximity to VHL within a commonly lost (approximately 90%) 3p locus. To date, the clinical and pathologic significance of mutations in these novel candidate tumor suppressors is unknown.Objective:To determine the frequency of and render the first clinical and pathologic outcome associated with mutations of these novel candidate tumor suppressors in ccRCC.Design, setting, and participants:Targeted sequencing was performed in 185 ccRCCs and matched normal tissues from a single institution. Pathologic features, baseline patient characteristics, and follow-up data were recorded.Outcome measurements and statistical analysis:The linkage between mutations and clinical and pathologic outcomes was interrogated with the Fisher exact test (for stage and Fuhrman nuclear grade) and the permutation log-rank test (for cancer-specific survival [CSS]).Results and limitations:PBRM1, BAP1, SETD2, and KDM5C are mutated at 29%, 6%, 8%, and 8%, respectively. Tumors with mutations in PBRM1 or any of BAP1, SETD2, or KDM5C (19%) are more likely to present with stage III disease or higher (p = 0.01 and p = 0.001, respectively). Small tumors (This study demonstrates that mutations of a new class of tumor suppressors, chromatin modulators, in clear cell renal cell carcinoma are associated with advanced and metastatic diseases, and it highlights the clinical potential to focus on pathways regulated by these genes for developing novel therapeutics.]]></description>
                    <pubDate>Thu, 27 Sep 2012 02:36:11 GMT</pubDate>
                    <guid>S0302-2838(12)01028-7</guid>
                </item>
            
                <item>
                    <title><![CDATA[The Changing Face of Renal Cell Carcinoma: The Impact of Systematic Genetic Sequencing on Our Understanding of This Tumor's Biology]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(12)01117-7/abstract</link>
                    <description><![CDATA[]]></description>
                    <pubDate>Thu, 27 Sep 2012 02:36:04 GMT</pubDate>
                    <guid>S0302-2838(12)01117-7</guid>
                </item>
            
                <item>
                    <title><![CDATA[A Phase 3, Double-blind, Randomised, Parallel-group, Placebo-controlled Study of Oral Weekly Alendronate for the Prevention of Androgen Deprivation Bone Loss in Nonmetastatic Prostate Cancer: The Cancer and Osteoporosis Research with Alendronate and Leuprolide (CORAL) Study]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(12)01030-5/abstract</link>
                    <description><![CDATA[Background:Androgen-deprivation therapy (ADT) induces loss of bone mineral density (BMD) and increases the risk of fractures in patients with prostate cancer (PCa). We sought to determine whether a weekly dose of alendronate, an oral bisphosphonate, could reduce this unwanted side-effect.Objective:To assess whether once-weekly oral alendronate therapy would maintain or improve BMD in men initiating ADT for localised PCa.Design, setting, and participants:A multicentre, double-blind, randomised, placebo-controlled study, we included hormonally naïve PCa patients initiating ADT with leuprolide acetate 30 mg intramuscularly every 4 mo.Intervention:Patients were randomised to receive either oral alendronate 70 mg once weekly or placebo for 1 yr. Both groups received daily calcium 1 g and vitamin D 400 international units.Outcome measurements and statistical analysis:Changes in BMD (at the lumbar spine [LS] and total hip [TH]) and bone markers.Results and limitations:One hundred ninety-one subjects were enrolled, and 186 were randomised between alendronate (n = 84) and placebo (n = 102). The alendronate group demonstrated a mean spine BMD increase of 1.7% compared with −1.9% in the placebo group (p In this multicentre, double-blind, randomised, placebo-controlled study in prostate cancer patients initiating androgen-deprivation therapy, patients were randomised between alendronate 70 mg/wk or placebo for 1 yr. Alendronate increased bone mass and decreased bone turnover with few related side-effects.]]></description>
                    <pubDate>Wed, 12 Sep 2012 02:35:47 GMT</pubDate>
                    <guid>S0302-2838(12)01030-5</guid>
                </item>
            
                <item>
                    <title><![CDATA[The Promise of Choline-PET/CT in the Detection of Recurrent Prostate Cancer: What Are the Limits of Our Investigation?]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(12)01024-X/abstract</link>
                    <description><![CDATA[]]></description>
                    <pubDate>Tue, 11 Sep 2012 02:45:46 GMT</pubDate>
                    <guid>S0302-2838(12)01024-X</guid>
                </item>
            
                <item>
                    <title><![CDATA[Targeted Next-generation Sequencing of Advanced Prostate Cancer Identifies Potential Therapeutic Targets and Disease Heterogeneity]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(12)01006-8/abstract</link>
                    <description><![CDATA[Background:Most personalized cancer care strategies involving DNA sequencing are highly reliant on acquiring sufficient fresh or frozen tissue. It has been challenging to comprehensively evaluate the genome of advanced prostate cancer (PCa) because of limited access to metastatic tissue.Objective:To demonstrate the feasibility of a novel next-generation sequencing (NGS)–based platform that can be used with archival formalin-fixed paraffin-embedded (FFPE) biopsy tissue to evaluate the spectrum of DNA alterations seen in advanced PCa.Design, setting, and participants:FFPE samples (including archival prostatectomies and prostate needle biopsies) were obtained from 45 patients representing the spectrum of disease: localized PCa, metastatic hormone-naive PCa, and metastatic castration-resistant PCa (CRPC). We also assessed paired primaries and metastases to understand disease heterogeneity and disease progression.Intervention:At least 50 ng of tumor DNA was extracted from FFPE samples and used for hybridization capture and NGS using the Illumina HiSeq 2000 platform.Outcome measurements and statistical analysis:A total of 3320 exons of 182 cancer-associated genes and 37 introns of 14 commonly rearranged genes were evaluated for genomic alterations.Results and limitations:We obtained an average sequencing depth of >900X. Overall, 44% of CRPCs harbored genomic alterations involving the androgen receptor gene (AR), including AR copy number gain (24% of CRPCs) or AR point mutation (20% of CRPCs). Other recurrent mutations included transmembrane protease, serine 2 gene (TMPRSS2):v-ets erythroblastosis virus E26 oncogene homolog (avian) gene (ERG) fusion (44%); phosphatase and tensin homolog gene (PTEN) loss (44%); tumor protein p53 gene (TP53) mutation (40%); retinoblastoma gene (RB) loss (28%); v-myc myelocytomatosis viral oncogene homolog (avian) gene (MYC) gain (12%); and phosphatidylinositol-4,5-bisphosphate 3-kinase, catalytic subunit α gene (PIK3CA) mutation (4%). There was a high incidence of genomic alterations involving key genes important for DNA repair, including breast cancer 2, early onset gene (BRCA2) loss (12%) and ataxia telangiectasia mutated gene (ATM) mutations (8%); these alterations are potentially targetable with poly(adenosine diphosphate-ribose)polymerase inhibitors. A novel and actionable rearrangement involving the v-raf murine sarcoma viral oncogene homolog B1 gene (BRAF) was also detected.Conclusions:This first-in-principle study demonstrates the feasibility of performing in-depth DNA analyses using FFPE tissue and brings new insight toward understanding the genomic landscape within advanced PCa.We describe and validate an approach for performing next-generation sequencing at >900X coverage that is amenable to formalin-fixed paraffin-embedded biopsy material. This work identifies novel targetable alterations in advanced prostate cancer and mutations associated with disease progression and tumor resistance.]]></description>
                    <pubDate>Thu, 06 Sep 2012 02:55:12 GMT</pubDate>
                    <guid>S0302-2838(12)01006-8</guid>
                </item>
            
                <item>
                    <title><![CDATA[Intravesical Bacille Calmette-Gurin Eradicates Bacteriuria in Antibiotic-nave Bladder Cancer Patients]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(12)00948-7/abstract</link>
                    <description><![CDATA[Background:Intravesical bacille Calmette-Guérin (BCG) therapy is safe and effective in bladder cancer patients who have asymptomatic bacteriuria. BCG induces robust immune responses in the bladder that are responsible for its antitumor effect. We hypothesize that BCG-induced inflammation may eradicate bacterial infection.Objective:To investigate whether intravesical BCG therapy alone can eradicate bacterial infection in antibiotic-naïve bladder tumor patients who have asymptomatic bacteriuria.Design, setting, and participants:A single-institution prospective cohort study of bacteriuric adults with non–muscle-invasive bladder tumors who underwent outpatient BCG therapy or surveillance cystoscopy.Intervention:Ninety high-risk patients received induction intravesical BCG without maintenance BCG, and 95 low-risk patients who had not received BCG underwent outpatient surveillance cystoscopy. Each patient had significant bacteriuria on urine culture, and none received routine antibiotics before, during, or after procedures.Outcome measurements and statistical analysis:Urine cultures were repeated after 3, 6, and 12 mo. All patients had follow-up cystoscopy every 3 mo and were followed for a minimum of 1 yr. The end point was number of BCG-treated and cystoscopy patients who became bacteria free at 3, 6, and 12 mo.Results and limitations:Two BCG-treated patients (2.2%) and six patients after cystoscopy (6%) developed febrile urinary tract infection (p = 0.21). All resolved with antibiotics. No patient was admitted for sepsis. Of 88 infected patients who received BCG without routine antibiotics, 58 (66%) were continuously bacteria free at 1 yr compared with 16 of 89 cystoscopy patients (18%; p = 0.001). The prospective observational study design prohibits causal inference of antibacterial effects attributed to BCG over cystoscopy.Conclusions:Intravesical BCG therapy is associated with clearance of uropathogens in bladder cancer patients, possibly due to augmented innate host immunity.Intravesical bacille Calmette-Guérin therapy may eradicate chronic bacteriuria in antibiotic-naïve bladder cancer patients, indicating a secondary benefit of the immune response to tumor and further support to avoid antibiotics in asymptomatic infected patients.]]></description>
                    <pubDate>Tue, 21 Aug 2012 02:45:01 GMT</pubDate>
                    <guid>S0302-2838(12)00948-7</guid>
                </item>
            
                <item>
                    <title><![CDATA[18F-Fluoroethylcholine PET/CT Identifies Lymph Node Metastasis in Patients with Prostate-Specific Antigen Failure After Radical Prostatectomy but Underestimates Its Extent]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(12)00927-X/abstract</link>
                    <description><![CDATA[Background:The detection of lymph node metastases (LNMs) is one of the biggest challenges in imaging in urology.Objective:To evaluate the accuracy of combined 18F–fluoroethylcholine (FEC) positron emission tomography (PET)/computed tomography (CT) in the detection of LNMs in prostate cancer (PCa) patients with rising prostate-specific antigen (PSA) level after radical prostatectomy.Design, settings, and participants:From June 2005 until November 2011, 56 PCa patients with biochemical recurrence after radical prostatectomy underwent bilateral pelvic and/or retroperitoneal lymphadenectomy based on a positive 18F-FEC PET/CT scan.Outcome measurements and statistical analysis:The findings of PET/CT were compared with the histologic results.Results and limitations:Median PSA value at the time of 18F-FEC PET/CT analysis was 6.0 ng/ml (interquartile range: 1.7–9.4 ng/ml). In 48 of 56 (85.7%) patients with positive 18F-FEC PET/CT findings, histologic examination confirmed the presence of PCa LNMs. Of 1149 lymph nodes that were removed and histologically evaluated, 282 (24.5%) harbored metastasis. The mean number of lymph nodes removed per surgical procedure was 21 (standard deviation: ±18.3). A lesion-based analysis yielded 18F-FEC PET/CT sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 39.7%, 95.8%, 75.7%, and 83.0%, respectively.A site-based analysis yielded sensitivity, specificity, PPV, and NPV of 68.4%, 73.3%, 81.3%, and 57.9%, respectively. Patients with negative PET/CT did not undergo surgery, thus sensitivity, specificity, and negative predictive value on a patient basis could not be calculated.Conclusions:A positive 18F-FEC PET/CT result correctly predicted the presence of LNM in the majority of PCa patients with biochemical failure after radical prostatectomy but did not allow for localization of all metastatic lymph nodes and therefore was not adequately accurate for the precise estimation of extent of nodal recurrence in these patients.Although a positive 18F-fluoroethylcholine positron emission tomography/computed tomography scan did not aid in precise localization of all positive lymph nodes, it correctly predicted the presence of lymph node metastasis in the majority of patients with prostate-specific antigen failure after radical prostatectomy.]]></description>
                    <pubDate>Fri, 10 Aug 2012 02:35:14 GMT</pubDate>
                    <guid>S0302-2838(12)00927-X</guid>
                </item>
            
                <item>
                    <title><![CDATA[Reflex ImmunoCyt Testing for the Diagnosis of Bladder Cancer in Patients with Atypical Urine Cytology]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(12)00485-X/abstract</link>
                    <description><![CDATA[Background:ImmunoCyt/uCyt (Scimedx, Denville, NJ, USA) is a well-established urinary marker assay with high sensitivity for the diagnosis of urothelial carcinoma (UC) and can function as a second-level test to arbitrate atypical reads of urine cytology.Objective:To determine the utility of uCyt as a reflex test for atypical cytology in patients undergoing a hematuria evaluation or surveillance with a history of UC.Design, setting, and participants:The uCyt assay was performed as a second-level reflex test on all voided urine cytology tests read as atypical between January 2007 and June 2010 in an academic medical center. Records were retrospectively reviewed. Three hundred twenty-four patients underwent a total of 506 uCyt assays.Intervention:Reflex uCyt assay on atypical urine cytology.Outcome measurements and statistical analysis:The uCyt test characteristics include sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV).Results and limitations:Reflex uCyt was performed on 506 atypical voided urine samples that were followed by cystoscopy within 90 d. Reflex uCyt with a history of UC showed a sensitivity of 73%, a specificity of 49%, and an NPV of 80%. In those with a history of low-grade UC, reflex uCyt had a sensitivity of 75%, a specificity of 50%, and an NPV of 82%, while in those with a history of high-grade UC, it had a sensitivity of 74%, a specificity of 44%, and an NPV of 79%. Without prior history of UC, reflex uCyt had a sensitivity of 85%, a specificity of 59%, and an NPV of 94%. This study's limitations include its retrospective design and interobserver variability inherent to cystoscopy, which was used as the reference test.Conclusions:When used as a reflex test on atypical urine cytology, negative uCyt may predict a negative cystoscopy in select patients and modulate the urgency and further work-up in those with no prior history or low-grade disease.When used as a reflex test on atypical urine cytology in evaluating urothelial carcinoma, a negative ImmunoCyt assay can effectively predict a negative cystoscopy and may obviate the need for cystoscopy in those with prior low-grade disease.]]></description>
                    <pubDate>Sat, 14 Apr 2012 02:45:33 GMT</pubDate>
                    <guid>S0302-2838(12)00485-X</guid>
                </item>
            
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