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Update on Urologic Cancers

New Research Presented at the 105th Annual Scientific Meeting of the American Urological Association

The American Urological Association (AUA) Annual Meeting was held May 29 - June 3, 2010, in San Francisco, CA. The AUA, founded in 1902, is the premier professional association for the advancement of urologic patient care, and works to ensure that its more than 16,000 members are current on the latest research and practices in urology. The AUA also pursues its mission of fostering the highest standards of urologic care by providing a wide range of services—including publications, research, the Annual Meeting, continuing medical education (CME) and the formulation of health policy.

External Beam Radiation for Prostate Cancer Increases Risk of Hip Fracture
Men undergoing three dimensional external beam radiation therapy (3D-EBRT) for prostate cancer may be at an increased risk of hip fracture and could benefit from additional measures to improve bone health following treatment, according to a new study.

Fracture risk is a well-known concern in men with prostate cancer who undergo androgen suppression therapy, which is known to weaken bones. EBRT has been shown to increase hip-fracture risk in women. So for this study, researchers explored whether EBRT affected a man’s risk and, if so, whether this effect extended beyond the radiation field.

Researchers evaluated men with prostate cancer and compared hip fracture risk (inside the radiation field) with wrist fracture risk (outside the radiation field) in those who had undergone EBRT and those who had not. They determined that undergoing EBRT increased a man’s risk of hip fracture by 58 percent, without increasing the risk of wrist fracture.

Preoperative Mitomycin-C Instillation Decreases Risk of Non-Muscle Invasive Bladder Cancer
A single preoperative intravesical electromotive (EMDA) instillation of mitomycin-C (MMC) improves a person’s risk of non-muscle invasive bladder cancer recurrence more than a single post-operative intravesical passive instillation, according to new research. This preventive measure can also enhance a person’s disease-free interval.

“Catching bladder cancer before it invades the muscle is key to a patient’s survival,” said Kevin T. McVary, MD, the AUA spokesperson who moderated the briefing. “But even with early detection, this paper demonstrates that recurrence rates can be reduced by preoperative intravesical EMDA/MMC instillation. Knowing that a pre-operative dose of mitomycin-C can help improve that survival is extremely important.”

Nephron-Sparing Surgery Best Option for People with Common Risk Factors for Chronic Kidney Disease
Nephron-sparing surgery is the preferred treatment for people with Stage I kidney cancer, but this technique is not being used as frequently as it should be, particularly in people with diabetes and high blood pressure, new data suggests.

Kidney cancer is the most lethal urologic malignancy but, according to the “AUA Clinical Guideline for Management of the Clinical Stage I Renal Mass,” nephron-sparing treatments are viable options that can remove the tumor while at the same time minimizing the person’s risk of future kidney dysfunction and cardiovascular disease. The use of nephron-sparing surgery may, therefore, be even more important among people with existing risk factors for these conditions, such as diabetes or hypertension.

Using population-based data, a team of researchers evaluated whether nephron-sparing surgery was more commonly used in people with diabetes and/or hypertension than in those without these risk factors. Of the 894 people who were treated surgically for renal cell carcinoma, only 20 percent underwent nephron-sparing treatment. While people with both hypertension and diabetes were more likely to have received nephron-sparing treatment than those with neither risk factor, usage rates were similar for people who had only one risk factor compared with those having no risk factors.

“This study suggests that there is an opportunity to improve patient care by increasing use of this treatment for patients who may only have a single risk factor which might put the remaining kidney at risk” said Anthony Y. Smith, MD, a spokesman for the AUA. “Nephron-sparing surgery should really be considered for any patient with either diabetes mellitus or hypertension and not just for those patients who have both conditions.”

Active Surveillance a Viable Option for Men with Prostate Cancer
Active surveillance is a viable option for many men with low-risk disease, but more research is needed to determine the critical points at which active treatment should be recommended, according to two new studies. During active surveillance urologists monitor key factors for evidence of progression, such as PSA velocity (rate of change over time) and PSA doubling time, or disease progression on surveillance biopsy to determine if active treatment is necessary. At present, there is no universal standard for these triggers.

 
 

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