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Orlando, FL-In a finding that will likely change the way physicianstreat patients with benign prostatic hyperplasia, the combination of twocommonly used drugs was shown to slow progression of the disease significantlybetter than placebo or either drug alone. In fact, treatment with the combinationof finasteride (Proscar) and doxazosin (Cardura) lowers the risk of BPHprogression by as much as 67% and the risk of urinary retention by as muchas 79%.

Ex-urologists say they wanted to escape reimbursement woes, pursue morefulfilling careersMedicine is a commitment. Pre-med, medical school, internship, residency,and building a reputation in academia or in community practice adds up toa self-imposed promissory note that can take a decade, perhaps two, to payoff. This is why it is unusual when an established physician opts to changecareers.

The most preferred benefit program may be the least expensive for yourpracticeThe difficulty in recent years of attracting and retaining employeeshas eased somewhat, largely because of the state of the economy. Many ofthe problems faced by urologists in finding and keeping good, qualifiedworkers remain, however, especially for many small, understaffed, or financiallytroubled practices.

New technologies, procedures, and human-interest stories appeal to audiencesIn Hollywood, you may hear that "there's no such thing as bad publicity."That theory certainly does not apply to the field of medicine, but thereis an upside to gaining the attention of the media. Appear on local or networktelevision, and you will instantly enhance your image.

Orlando, FL-Hydrodistention has little therapeutic value in the managementof interstitial cystitis, according to the results of a retrospective investigationpresented at the AUA annual meeting. Researchers from Stanford University, CA, reported the outcomes froma chart review study identifying 63 patients in whom they had performedcystoscopy/hydrodistention since January 2000.

Orlando, FL-Conformal radiotherapy to the prostate with isocenterdoses of 78 Gy lowers biochemical failure by at least 6% at 6 years, andby as much as 19% for men at higher risk of cancer relapse. But the costis a 14% increase in mild to moderate risk of rectal toxicity, accordingto two reports presented at the American Society of Clinical Oncology annualmeeting.

Orlando, FL-Most long-term survivors of metastatic renal cellcarcinoma do not achieve a response to cytokine treatment, according toresults of a pooled analysis by French researchers. Their findings suggesta lack of association between initial tumor regression on cytokine treatmentand long-term survival, except for the few patients who achieve completeregression.

Orlando, FL-After 7 years follow-up, researchers from the UnitedKingdom report that a landmark clinical trial in bladder cancer now showsa significant reduction in mortality if patients underwent 3 months of neoadjuvantchemotherapy prior to definitive surgery or radiation for muscle-invasivebladder cancer.

In this issue of Urology Times, we see interviews with several urologistswho have chosen to change paths in mid-career (see article, page 1). Havinggone through many of these issues myself, a few words of caution are inorder. Everyone goes through a period when they at least consider major changes,either because they have "been there, done that" and want somethingnew, or perhaps changes are forced upon them for personal or health reasons.Most of us have gone through the medical tract in life on somewhat of astraightaway. We go from high school to college, from college to medicalschool, from medical school to surgical and urology training, and embarkon our career. After several years of practice, looking at other fieldsand endeavors may be a natural progression for many of us.

Presented by Richard A. Santucci, MD, Wayne State University School of Medicine, Detroit.

Presented by H. Barton Grossman, MD, University of Texas M.D.Anderson Cancer Center, Houston.

Presented by Randall G. Rowland, MD, University of Kentucky, Lexington.

Presented by Deborah R. Erickson, MD, Pennsylvania State UniversityCollege of Medicine, Hershey.

Presented by Louis R. Kavoussi, MD, Johns Hopkins, Baltimore.

Presented by Joachim W. Thuroff, MD, Johannes-Gutenberg UniversityMedical School, Mainz, Germany.

Presented by Daniel Shoskes, MD, Cleveland Clinic Florida, FortLauderdale.

Presented by Dean G. Assimos, MD, Wake Forest University School of Medicine, Winston-Salem, NC.

Presented by Ralph Buttyan, PhD, Columbia-Presbyterian MedicalCenter, New York.

Presented by Edward Kim, MD, University of Tennessee School ofMedicine, Knoxville.

Presented by John N. Krieger, MD, University of Washington School ofMedicine, Seattle.

Presented by Ricardo Gonzalez, MD, University of Miami Schoolof Medicine.

Presented by Michael B. Siroky, MD, Boston University.

Presented by Dominick J. Carbone, Jr, MD, Wake Forest University,Winston-Salem, NC.

Presented by Mostafa M. Elhilali, MD, University of Montreal.

Presented by John Trachtenberg, MD, University of Toronto.

Presented by Martin G. Sanda, MD, University of Michigan, Ann Arbor.

New Products as presented in the August 1, 2002 issue of Urology Times

Orlando FL-Measuring complexed PSA (cPSA) may provide improved specificity over total PSA (tPSA), according to the results of a multicenter trial. In their study, researchers from Innsbruck, Austria; Houston; New York; Cheyenne, WY; Stanford, CA; Baltimore; and Seattle compared the clinical performance of a cPSA test (Bayer Diagnostics, Tarrytown, NY) versus a standard tPSA test and PSA ratios (percent-free PSA and percent cPSA) as a first-line test for detecting prostate cancer.

Advances in ureteroscope design and instrumentation, along with the ready availability and technical simplicity of shock wave lithotripsy, have made the treatment of ureteral calculi simpler, more available, and more successful than ever. Indeed, the need for salvage open or laparoscopic treatment of ureteral calculi is exceptionally rare.

Minneapolis-For decades, the Gleason grading system has been the de facto standard used to characterize prostatic tumors. Now, with the help of Donald F. Gleason, MD, himself, researchers from the University of Minnesota have found a way to make the system even more useful to clinicians.