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Thomas E. Keane
Canadian Journal of Urology, Vol.14, Suppl.6, pp. 1-1, 2007
Abstract This article has no abstract. More >

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Gary W. Bong, Thomas E. Keane
Canadian Journal of Urology, Vol.14, Suppl.6, pp. 2-9, 2007
Abstract Despite excellent success rates with radical prostatectomy and radiotherapy for the treatment of prostate cancer, a significant number of patients will experience a rise in their serum prostate specific antigen (PSA) level. A variety of salvage options in this scenario have been investigated and the choice to pursue surveillance, single therapy or combination therapy depends on clinical assessment of risk and location of tumor recurrence. After radical prostatectomy, for example, patients with low risk local disease may not require secondary therapy or may benefit from salvage radiotherapy. Those with higher risk disease, based on PSA More >

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Michelle L. Ramirez¹, Thomas E. Keane², Christopher P. Evans¹
Canadian Journal of Urology, Vol.14, Suppl.6, pp. 10-18, 2007
Abstract Androgen deprivation therapy has been the mainstay of treatment for men with metastatic prostate cancer and now plays a more active role in the management of less advanced cancers as neoadjuvant and adjuvant treatment. Investigative uses include primary therapy for patients unsuitable for definitive therapy and as a complement to ablative procedures, brachytherapy, and chemotherapy. Intermittent androgen deprivation therapy is being considered as an alternative to continuous therapy and further evaluated as triple 10 androgen blockade in conjunction with finasteride. Many accepted and potential management schemes incorporating hormonal therapy are increasingly employed despite indeterminate indications More >

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Thomas J. Eichler
Canadian Journal of Urology, Vol.14, Suppl.6, pp. 19-23, 2007
Abstract Over 200000 cases of prostate cancer will be diagnosed in the United States in 2007. Management of this common malignancy is controversial with essentially equal long-term survival and local control with either surgery or radiation therapy stage for stage in the setting of localized disease. Factors that can affect treatment recommendations include stage and grade of disease, the pre-treatment PSA, physician bias and patient choice. This paper examines several of the radiotherapeutic options for the treatment of prostate cancer, and will also discuss evolving modalities that may offer additional treatment choices in the future. More >

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Harry S. Clarke Jr, Matthew R. Eskridge, Ahmed M. El-Zawahry, Thomas E. Keane
Canadian Journal of Urology, Vol.14, Suppl.6, pp. 24-27, 2007
Abstract Purpose: We assessed the efficacy, complications and technical advancements in salvage cryosurgical ablation of the prostate for recurrent prostate cancer after radiation therapy.
Methods: A total of 58 patients were evaluated for salvage cryosurgery using an algorithm of capromab pendetide scan and prostate biopsy from January 2003 to July 2007. Forty-seven patients underwent salvage cryosurgery and biochemical recurrence-free survival and complications were retrospectively reviewed. Mean follow-up was 24 months.
Results: Seventy percent of patients achieved a nadir PSA < 0.5 ng/ml. Overall, 51% of patients achieved a durable PSA response with a pre-salvage serum PSA < 10 predictive More >

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David T. Marshall
Canadian Journal of Urology, Vol.14, Suppl.6, pp. 28-31, 2007
Abstract Permanent interstitial brachytherapy with I-125 or Pd- 103 seeds is a well-established approach as single modality for low-risk prostate cancer patients and as part of a multi-modality program for intermediate- and high-risk patients. There are multiple approaches that have been developed to deliver high-quality implants, including pre-planned and real-time intra-operative techniques. In the hands of experienced users, either approach can provide consistently excellent outcomes. We believe that the combination of real-time intra-operative dosimetry and connected seeds may provide for improved consistency due to decreased seed migration. More >

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Michael J. Manyak
Canadian Journal of Urology, Vol.14, Suppl.6, pp. 32-38, 2007
Abstract Rapid advances in imaging technology have whetted our collective appetites for practical clinical applications to assist the physician and patient in therapeutic decisions. Current limitations of imaging technology are being addressed by the convergence of technology in materials science, the computer industry, and biology which have led to improvements of diagnostic imaging. Refinements in image acquisition, fusion of images, and outcomes data now suggest use for image-guided therapy. Novel imaging agents and technologies appear to provide improved capabilities to detect malignant lymph nodes. Future applications of optical coherence tomography, electron paramagnetic resonance imaging, nanotechnology, and More >

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Michelle L. Ramírez, Christopher P. Evans
Canadian Journal of Urology, Vol.14, Suppl.6, pp. 39-47, 2007
Abstract The incidence of small renal masses (< 4 cm) is increasing due to the widespread use of imaging studies. Many of these incidental lesions may remain asymptomatic or in fact be benign, and recent insight into their natural course has contributed to modifications in management. With improvements in biopsy technique and minimally invasive technologies, appropriate diagnosis and treatment of these masses are further being evaluated. Other contemporary approaches, including surveillance, laparoscopic partial nephrectomy, enucleation, ablative procedures, and high-intensity focused ultrasound, are weighed against open nephron-sparing surgery, the current gold standard for treatment. Here, we review More >

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Sam D. Graham, Jr.^1,2, Mary Elizabeth Warden¹, Jeffrey Lou^1,3
Canadian Journal of Urology, Vol.14, Suppl.6, pp. 48-52, 2007
Abstract New advances in technology to directly target specific molecular events in the proliferation of cancer have led to promising results in renal cell carcinoma. Response rates in excess of 70% and complete responses in advanced (metastatic) renal cell carcinoma have caused a change in the paradigm of treatment from immunotherapy. Toxicities are significant, but manageable and pushing the toxicity to tolerability may increase the response rate. More >

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Jeffrey W. Nix, Culley C. Carson
Canadian Journal of Urology, Vol.14, Suppl.6, pp. 53-57, 2007
Abstract Benign prostatic hyperplasia (BPH) is a common condition of the aging male. The bladder outlet obstruction caused by this condition occurs despite variations in prostate size. Symptoms of BPH include the irritative and obstructive voiding symptoms termed lower urinary tract symptoms (LUTS). While transurethral surgery has long been the gold standard for treatment of LUTS, medical treatment has emerged as the first line of treatment for those men who fail expectant or watchful waiting treatment. Medical options include: alpha blockers, 5α-reductase inhibitors and newly identified PDE 5 inhibitors, drugs for erectile dysfunction that have a… More >

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E. Ann Gormley
Canadian Journal of Urology, Vol.14, Suppl.6, pp. 58-62, 2007
Abstract The incontinent patient is evaluated in order to make a presumptive diagnosis so that treatment can be offered. The evaluation begins with a history and a physical examination. The history focuses on the description of the patient’s incontinence. Assessing the patient’s bother and determining their expectations of treatment may further guide how aggressive one needs to be both with the evaluation and the presentation of treatment options. The important parts of the physical exam are an examination of the abdomen and pelvis including a provocative stress test. A urinalysis and a post-void residual (PVR) should… More >

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Mathew C. Raynor¹, Culley C. Carson², Matthew D. Pearson², Jeffrey W. Nix²
Canadian Journal of Urology, Vol.14, Suppl.6, pp. 63-68, 2007
Abstract A steady decline in androgen levels occurs in males as they age. Evidence suggests that this decline may be at least partially responsible for a variety of physical and mental changes associated with the aging process. For instance, abnormally low levels of androgens can lead to profound changes in bone density, body composition, as well as sexual and cognitive function. Testosterone replacement has been shown to produce improvements in many of these areas. However, this practice is not without risks, both proven and theoretic. Also, the diagnosis of androgen deficiency and the decision to treat More >

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Gerald H. Jordan
Canadian Journal of Urology, Vol.14, Suppl.6, pp. 69-74, 2007
Abstract Peyronie's disease is a scarring phenomenon of the penis causing various deformities; initially pain with erection, and in most patients is associated with some element of erectile dysfunction. Studies of the natural history of the disease show that Peyronie's disease is a self-limited condition. In its stable and quiescent phase, patients have stable deformity, and in some cases that deformity then requires surgery.
For the most part, pharmacologic therapy is confined to the immature or active phase of the disease. Pharmacotherapy is aimed at trying to adjust or interfere with the scarring process, so that the… More >

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