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The Impact of Positron Emission Tomography with 18F-Fluciclovine on the Management of Patients with Biochemical Recurrence of Prostate Cancer: Results from the LOCATE Trial

The prospective, multicenter LOCATE trial assessed the impact of positron emission tomography/computed tomography (PET/CT) with 18F-fluciclovine on management plans for patients with biochemical recurrence (BCR) of prostate cancer after curative-intent primary therapy.
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Role of Stereotactic body radiation therapy in the management of oligometastatic renal cell carcinoma

Kidney cancer has been increasing by 1.7% annually. Renal cell carcinoma (RCC) is the most common kidney cancer, and can metastasize. Our aim is to analyze patients treated with Stereotactic Body Radiation Therapy (SBRT) on metastases from RCC.
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Coffee, Caffeine Metabolism Genotype, and Disease Progression in Localized Prostate Cancer Patients Managed with Active Surveillance

Active surveillance (AS) is increasingly used as a management strategy for localized prostate cancer. Coffee intake has been associated with lower prostate cancer incidence; and we assessed whether coffee was associated with disease progression in men on AS.
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Genomic Prostate Score, PI-RADSv2, and Progression in Men with Prostate Cancer on Active Surveillance

OncotypeDx Genomic Prostate Score (GPS) is a 17-gene RNA expression assay intended to help guide treatment decisions for men diagnosed with prostate cancer. The Prostate Imaging-Reporting and Data System version 2 (PI-RADSv2) was developed to standardize the risk stratification of lesions identified on multiparametric prostate MRI. We sought to determine whether these tests are associated with increased risk of biopsy upgrade in men on active surveillance (AS).
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Clinical and Radiographic Predictors of Great Vessel Resection or Reconstruction During Retroperitoneal Lymph Node Dissection for Testicular Cancer

Urology (Gold Journal) In Press - Sat, 09/01/2018 - 00:00
To evaluate whether specific clinical or radiographic factors predict inferior vena cava (IVC) or abdominal aortic (AA) resection or reconstruction (RoR) at the time of post-chemotherapy retroperitoneal lymph node dissection (RPLND) for germ cell tumors of the testicle.
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Reply by Authors

We are familiar with the anatomical dimensions of the prostate since the senior author was the first to describe them in The Journal of Urology in 1993 (reference 13 in article). We find that real-time intraoperative 3-dimensional guided MRI pelvic floor dissection is more valuable than static preoperative studies and better facilitates safe pelvic dissection, whichever type of repair is chosen at initial closure.1 Finally, because ours is a referral center and we have seen more than 25 young patients with loss of the glans, corpora or both with penile disassembly and radical soft tissue mobilization, we avoid these 2 procedures.
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Editorial Comment

This study offers unique observations on the anatomical dimensions of the prostate and the prostatic, periprostatic, pudendal and penile vasculature using MRI before surgical reconstruction in males with bladder exstrophy compared to normal controls. Awareness of the vascular anatomy in this region is intuitively paramount as any damage to these structures during surgery can cause significant morbidity, eg penile loss during radical soft tissue mobilization.1 Unfortunately the authors did not attempt to correlate the findings on preoperative MRI with the intraoperative findings, treatment choices, modifications of the anatomy postoperatively or outcome of the repair.
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Reply by Authors

The comment addresses the importance of having patients understand the implications of the choice of whether to leave the vagina intact. In this light we emphasize the value of shared decision making in this field.
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Editorial Comment

In this series the rate of fistula at the proximal urethral anastomosis (the connection of the native urethra to the urethroplasty portion of the urethra, which is made of tubularized paravaginal flaps) more than doubled from 21% to 48% when simultaneous vaginectomy was not performed. The reasons for this are clear. When the vagina is removed, several more layers can be added to this otherwise delicate urethral suture line. 1) The bulbospongiosus muscle, which in the natal female is splayed out rather than encircling the urethra as in the natal male, can be freed and used to cover the midline urethral suture lines.
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Editorial Comment

The PICTURE study (references 13 and 14 in article) and the companion PROMIS study (reference 1 in article), in which men being evaluated for prostate cancer underwent magnetic resonance imaging followed by a comprehensive mapping biopsy, are monumental contributions. The biopsy procedure involved transperineal template sampling of the prostate at 5 mm intervals and often more than 60 cores of tissue were obtained at 1 sitting. The work helped establish the value of MRI in men suspected of having prostate cancer.
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Editorial Comment

In this study a cost-effective analysis was done comparing the performance of TRUSB in all men with elevated PSA and the use of various biomarkers or magnetic resonance imaging first and only performing biopsy if the biomarker was positive. The study modeled biopsy outcomes and likely management strategies. All costs, utilities and other inputs that went into the model were ascertained from the literature.
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Reply by Authors

Patients in the study group had biopsy proved, high grade UTUC as well as a visible lesion on axial imaging and underwent neoadjuvant chemotherapy followed by RNU. By comparison, patients who had biopsy proved, high grade UTUC but no visible lesion on axial imaging underwent RNU alone. Neoadjuvant chemotherapy was not offered to patients with CIS on ureteroscopic biopsy only. Patients in our study group likely had increased rates of CIS on final surgical pathology because CIS is conventionally unresponsive to chemotherapy, and as a result CIS was the only residual disease in patients who responded effectively to neoadjuvant chemotherapy.
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Re: Comparison of Pathological Stage in Patients Treated with and without Neoadjuvant Chemotherapy for High Risk Upper Tract Urothelial Carcinoma

Liao et al report outcomes of patients with high risk upper tract urothelial carcinoma (UTUC) treated with or without neoadjuvant chemotherapy. The survival rate of patients with high risk UTUC is poor despite the fact that radical nephroureterectomy (RNU) has been the standard treatment for this condition. The authors suggest that patients treated with neoadjuvant chemotherapy before RNU had a reduction in pathological tumor stage and a decreased prevalence of pT2 or higher disease. Interestingly we noted that the prevalence of Tis was higher in patients who had undergone neoadjuvant chemotherapy than those who had not.
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How Would MRI-Targeted Prostate Biopsy Alter Radiation Therapy Approaches in Treating Prostate Cancer?

Urology (Gold Journal) In Press - Thu, 08/30/2018 - 00:00
To determine if MRI/ultrasound fusion-targeted prostate biopsy (TB) would lead to increased recommendations of aggressive radiotherapy treatments for higher risk prostate cancer compared to systematic biopsy (SB) results.
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