Treatments for bladder and prostate Ca, stones, and BPH highlight presentations this week

New research on both current and promising new treatments for bladder and prostate cancer, stone disease, and BPH are making headlines at this week's AUA annual meeting. While robotics and other newer technologies took center stage last year, the emphasis at this year's meeting is on comparisons of existing techniques and outcomes data.J. Brantley Thrasher, MD, chair of AUA's Public Media Committee, briefed a group of editors and reporters yesterday on the hot topics to expect over the course of this week's meeting. Among the 1,700 abstracts being presented, these were among the highlights discussed by Dr. Thrasher:

Bladder cancer/TCC

• Although patients who usually receive Bacillus Calmette-Guerin prior to radical cystectomy have a low risk of immediate death from bladder cancer, those who do require a cystectomy have a 5-year disease-specific survival of 69%. University of Miami researchers say the data suggest that it is difficult to determine which patients with superficial TCC should be treated with a trial of BCG and which should have an early cystectomy."Maybe we need to be careful about those patients we're pushing into first, second, and even third BCG treatments rather than taking them to cystectomy," Dr. Thrasher said of the data. "This, I'm sure, will generate a lot of conversation and a lot of provocative discussion."

• Do married patients with bladder cancer fare better than their non-married counterparts? The authors of a study of nearly 6,000 patients who had undergone radical cystectomy suggest the answer is yes, as married patients showed a significant survival advantage over single or widowed patients.

• Patients with pT0N0 disease following radical cystectomy may not all be out of the woods. Although the majority of patients were found to have excellent clinical outcomes, not all patients who were pT0 in the cystectomy were cured, according to findings from one study.

• Two sources of pollution, namely leaking underground storage tanks and incineration sites, appear to increase the risk of bladder cancer, particularly in older people, according to University of Michigan researchers.

• A study of bladder cancer patients has shown that lymph node involvement, regardless of number or density, is a poor prognostic indicator and is a marker for disseminated disease.

Prostate cancer

• Bilateral nerve preservation during retropubic radical prostatectomy provides some advantage over unilateral preservation in terms of health-related quality of life, but the differences are not statistically significant, report Johns Hopkins researchers. Overall, declines in sexual quality of life are common post-RP.

• More than one-third of radical prostatectomy patients having insignificant volume of prostate cancer actually have a clinically significant cancer, extraprostatic extension, or bladder neck involvement, Cleveland Clinic researchers have found.

• Patients receiving neoadjuvant hormone therapy experience a significant impairment in sexual and hormonal/vitality health-related quality of life, according to researchers who suggest that the modest gains in survivorship associated with NHT must be weighed against its impact on quality of life. Look for more on this research in Tuesday's edition of UT E-news Daily Meeting Report.

• Data from the CaPSURE database show that prostate cancer patients with less than a high school diploma reported lower health-related quality of life at baseline, a steeper decline at 6 months post-treatment that remained significantly lower after 12 months than their counterparts with some college education.

Stone disease

• The prevalence of stone disease is changing by gender, according to Duke University researchers, who found a 15.6% increase in the rate of females discharged for the condition in recent years. Watch for a more detailed report in Wednesday's edition.

• In a study comparing ureteroscopy and extracorporeal shock wave lithotripsy for proximal ureteral calculi, ureteroscopy came out on top in terms of time to achieve a stone-free rate.

BPH

• Botulinum toxin A (Botox) has made its way into urology as a treatment for refractory overactive bladder, and now researchers say it may have a role in BPH. Results with intraprostatic botulinum injections in 16 men with severe BPH and severe voiding dysfunction were promising enough that the study's authors said the injections were a mutually exclusive alternative to surgery in this population.

In other topics . . .

• Pediatric urologists may be interested in a report on how they can become more aware of child sexual abuse. History is the most important aspect of evaluating children for abuse. "I think this will get a lot of press, for good reason," Dr. Thrasher said. "This abstract leads us to believe that the best way to find out whether this is going on is to ask the appropriate questions."

• Major surgical care for the three major urologic cancers (prostate, bladder, and kidney) is increasingly being transferred to high-volume hospitals, research shows, while nonsurgical care is delivered through low- and moderate-volume hospitals.

• In a study that will likely surprise few urologists, a survey of AUA members found that with pretrial financial settlements and time spent defending a case, the medical liability crisis is having a profound effect on practicing urologists.