The superior doctor prevents sickness; The mediocre doctor attends to impending sickness; The inferior doctor treats actual sickness.
Doctors will have more lives to answer for in the next world than even we generals.
Doctors are men who prescribe medicines of which they know little, to cure diseases of which they know less, in human beings of whom they know nothing.
The doctor should be opaque to his patients and, like a mirror, should show them nothing but what is shown to him.
Wednesday, April 30, 2014
The effect of estrogen on the sexual interest of castrated males: Implicationsto prostate cancer patients on androgen-deprivation therapy
Effect of abiraterone acetate treatment on the quality of life of patients with metastatic castration-resistant prostate cancer after failure of docetaxel chemotherapy
Taxanes in the management of metastatic castration-resistant prostate cancer: Efficacy and management of toxicity
Prevention of Bone Metastases in Patients with High-risk Nonmetastatic Prostate Cancer Treated with Zoledronic Acid:Efficacy and Safety Results of the Zometa European Study (ZEUS)
Sunday, April 27, 2014
Wednesday, April 23, 2014
وهى أفضل إسطواناته على الإطلاق
لأنها الوحيدة التى يستخدم فيها مؤشر
والأفضل جودة و الأطول وقتا
وتصلح لجميع الكليات
طلاب الفرقة الثالثة و طلاب الماجيستر
Tuesday, April 22, 2014
Friday, April 18, 2014
See that outside urology: Download Your Free Black Holes eBook Now from Sky & Telescope Magazine! - See more at: http://www.skyandtelescope.com/black-holes-free-ebook/thanks-download#sthash.YFUyttRJ.dpuf
Thursday, April 17, 2014
EAU 2014 - Active surveillance in 853 men with low and intermediate risk prostate cancer - Session Highlights Published on 14 April 2014
Tuesday, April 15, 2014
The 2014 Genitourinary Cancers Symposium (GU-ASCO 2014)
provided an opportunity for researchers from around the world to
present their research in a variety of fields, including prostate, renal
cell, penile, urethral and testicular cancers. Over the symposium’s 3
days, Canadian researchers were well-represented, with a number of
oral abstract podium presentations and many more research posters.
The following section provides brief summaries of some of the most
interesting work involving Canadians presented at GU-ASCO 2014 and
a listing of all the studies that included contributions from Canadian
The Phase 3 Randomized Sequential Open-Label Study to
Evaluate the Efficacy and Safety of Sorafenib Followed by
Sunitinib Versus Sunitinib Followed by Sorafenib in the
Treatment of First-Line Advanced/Metastatic Renal Cell
Carcinoma (SWITCH) trial was the first study to prospectively
evaluate whether there or not there is an advantage to the
sequence of sorafenib followed by sunitinib (SO/SU) compared
to sunitinib followed by sorafenib (SU/SO). The primary results
of this study were presented at GU-ASCO 2014.1
The study, initiated in 2008, enrolled a total of 365 patients
with metastatic RCC (mRCC) who had not previously received
systemic therapy and were deemed to be unsuitable for cytokine
therapy. Patients were randomized 1:1 to receive sunitinib or
sorafenib. Patients were switched to the other therapy if they
experienced disease progression or intolerable toxicity. The
primary end point was the total progression-free survival (T-PFS)
from the time of initial randomization to confirmed progression
or death during second-line therapy. There were a number
of secondary end points presented as well, including overall
survival (OS), PFS in first-line treatment, PFS in second-line
treatment and objective response rate. Safety and tolerability
were also assessed.
At baseline, the 2 arms were well-balanced in terms of
demographics and disease characteristics, with no statistically
significant differences between treatment arms. At time of final
T-PFS analysis, there was no statistically significant difference
in T-PFS between treatment arms. The median T-PFS was 14.9
months for SU/SO and 12.5 months for SO/SU (hazard ratio
[HR] 1.01, p = 0.54). There was also no significant difference
between arms for OS (median 31.5 months for SO/SU and
30.2 months for SU/SO; HR 1.00, p = 0.49) (Fig. 1). However,
more patients in the SO/SU arm reached second-line therapy
compared to those in the SU/SO arm (57% vs. 42%, p < 0.01)
and the second-line PFS was significantly longer for the SO/
SU arm (median 5.4 months) compared to the SU/SO arm (2.8
months). The authors stressed that these results must be interpreted
with caution, however, due to the imbalance between
arms for patients initiating protocol-defined second-line therapy
and the fact that there was no randomization immediately
prior to the second line. There were also some differences in
tolerability profiles, with diarrhea and hand-foot skin reaction
being considerably higher in the SO/SU arm, while nausea and
stomatitis were more common in the SU/SO arm.
This study concludes that both sequences achieved comparable
PFS and OS with similar toxicity safety profiles, and further
illustrates the ongoing need to determine the best sequencing
strategies to optimize outcomes for mRCC patients.
One of the major areas of research presented at the 2014 Genitourinary
Cancers Symposium (GU-ASCO 2014) pertained to the management
of renal cell cancer (RCC).
A pivotal study presented at GU-ASCO 2014 was the
Multinational Phase 3, Randomized, Double-Blind, Placebo-
Controlled Efficacy and Safety Study of Oral MDV3100 in
Chemotherapy-Naive Patients With Progressive Metastatic
Prostate Cancer Who Have Failed Androgen Deprivation
Therapy (PREVAIL) study investigating the utility of enzalutamide
in chemotherapy-naïve patients with CRPC.1 The study
population included a total of 1717 men, enrolled in 22 countries,
including Canada. The subjects were randomized 1:1
to enzalutamide capsules 160 mg/day (n = 872) or placebo
(n = 845). Concomitant steroids were allowed, but were not
required. The co-primary efficacy endpoints were overall survival
(OS) and radiographic progression-free survival (rPFS).
The trial was intended to continue until there were 765 deaths,
with a pre-planned interim analysis planned at 516 deaths (twothirds
of the final number of events).
The baseline characteristics were well-balanced in the 2
groups. Median age was 71 years in the placebo group and 72
in the enzalutamide group. Approximately two-thirds of patients
in each group were either asymptomatic or mildly symptomatic
at initial diagnosis and approximately two-thirds of each group
had an Eastern Cooperative Oncology Group (ECOG) performance
score of 0. Approximately 4% of each group were taking
corticosteroids at baseline.
At the time of the interim analysis, the Data Monitoring
Committee reported statistically significant benefits in both OS
and rPFS in favour of the enzalutamide arm. Because of these
findings, the trial was halted and unblinded at that time; the
planned interim analysis therefore became the trial’s final analysis.
Patients from the placebo arm were subsequently offered
treatment with enzalutamide.
The median duration of treatment among patients in the
enzalutamide arm was 16.6 months, almost 4 times higher than
that of the placebo group (4.6 months). At the time of the trial’s
discontinuation, 42.1% of enzalutamide patients remained on
treatment, as did 7.2% of those in the placebo arm.
Figures 1a and 1b show the curves for the 2 co-primary endpoints.
For OS, enzalutamide significantly reduced the risk by
29% (hazard ratio [HR] 0.706, 95% confidence interval [CI] 0.60
to 0.84, p < 0.0001). Enzalutamide also prolonged mean rPFS,
with an HR of 0.186 (95% CI 0.15 to 0.23, p < 0.0001). The
estimated mean rPFS was 3.9 months with placebo (95% CI 3.7
to 5.4) and was not yet reached (NYR) with enzalutamide (95%
CI 13.8 to NYR). For both co-primary endpoints, the results were
consistent across pre-specified subgroups (e.g., ECOG 0 or 1, age
above or below 75 years, presence or absence of visceral disease
and geographic regions). Overall, the subgroup analyses were
consistent with the benefit observed for the primary analysis of
OS and PFS. Subsequent therapies were used less frequently in
the enzalutamide arm than in the placebo arm: 56.7% of the placebo
group was subsequently treated with docetaxel and 45.6%
with abiraterone. In the enzalutamide group, 32.8% went on to
receive docetaxel and 20.5% received abiraterone.
Objective response rates (complete response [CR] plus partial
response [PR], defined as per RECIST 1.1 criteria) were 58.8%
(19.7% + 39.1%) for enzalutamide and 4.9% (1% and 3.9%) for
placebo (p < 0.0001). Enzalutamide delayed the median time to
chemotherapy by 17 months relative to placebo (p < 0.0001).
Serious adverse events (SAEs) were experienced by 32.0% of
patients in the enzalutamide group and 26.8% of the placebo
group. Discontinuations due to adverse events (AEs) were 5.6%
of the enzalutamide group and 6.0% of the placebo group. AEs
leading to death occurred in 4.2% of the enzalutamide group
and 3.8% of the placebo group. The most common AEs in both
groups were fatigue, back pain, constipation and arthralgia.
One seizure was reported in the placebo group, and 1 seizure
event was subsequently reported in the enzalutamide arm after
the date of data cut-off.
Overall, enzalutamide was well-tolerated compared to placebo;
it demonstrated minimal side effects, with an impressive
29% improvement in OS, and reduced the risk of rPFS by 81%
in those patients who have not received chemotherapy.
Another study of interest with enzalutamide presented at
GU-ASCO 2014 was the data from the extended follow-up
at 49 weeks of the open-label, single-arm, Phase 2 study in
67 patients with histologically-confirmed hormone-naive prostate
cancer requiring hormonal treatment and presenting with
non-castrate testosterone levels (>230 ng/dL), prostate-specific
antigen (PSA) >2 ng/mL, ECOG performance status of 0, and
life expectancy greater than 12 months.2 Enzalutamide was
associated with large reductions in PSA levels, which were
maintained over the duration of the 49-week analysis period
in this study. At week 49, the PSA response rate for all
patients entering the study was 80.6% (54/67) achieving a PSA
decrease of 80% or greater from baseline. Outcomes for all
endpoints at 40 weeks were consistent with those reported at 25
weeks, and no new safety signals were observed.
At GU-ASCO 2014, there was a significant body of research
presented involving several novel therapies targeting the androgen pathway for the treatment of castration-resistant prostate cancer (CRPC). This included several important studies involving two approved agents, the androgen-synthesis inhibitor abiraterone and the androgen-receptor antagonist enzalutamide.
Cite as: Can Urol Assoc J 2014;8(3-4Suppl2):S8-12. http://dx.doi.org/10.5489/cuaj.2013
Published online April 14, 2014.
At the 2014 Genitourinary Cancers Symposium (GU-ASCO 2014),
international researchers presented an extensive array of research in
the field of prostate cancer treatment. The following pages provide a
summary of some of the most compelling results presented during the
Cost analysis of fixed-dose combination of dutasteride and tamsulosin compared with concomitant dutasteride and tamsulosin monotherapy in patients with benign prostatic hyperplasia in Canada
Canadian clinical guidelines recommend the use of the combination of tamsulosin and dutasteride for men with moderate/severe symptoms associated with BPH and enlarged prostate volume. This analysis, using a representational patient group, suggests that the FDC is a more cost-effective treatment option for BPH.
Monday, April 14, 2014
Cell & Gene Therapy
October 27-29, 2014 Embassy Suites Las Vegas, USA
Sunday, April 13, 2014
Saturday, April 12, 2014
A.L. Burnett: We shouldn't stop looking for better options, just because we can use PDE5 inhibitors 12 Apr 2014
In this informative AUA lecture, Prof. Burnett addresses some of the most important concequences of urological surgery.
In the session about radical cystectomy, Prof. Richard Gaston (Bordeaux, FR) showed that robot-assisted radical cystectomy (RARC) can be performed safely because there is a lower risk of complications and patients generally have less blood loss. He further pointed out that the expertise of the surgical team is of utmost importance in any surgery.
In this interview EORTC's current president talks about the current developments in the field of onco-urological trials. He stresses the need for a qualitative change in the way trials are designed to atteact practicing urologists to participate and offers examples of how this is already being done.
A quarter of men drop out of prostate cancer monitoring, casting doubt on safety of "active surveillance" 12 Apr 2014
As lead researcher Dr Lukas Hefermehl said:
“The limitation of this study is that this is not a huge sample, but nevertheless it is one of the best “real-world” samples we have with long-term data. I strongly believe that active surveillance is a good option for men who follow the recommended controls. But from our results it looks like there must be a significant number of men lost to follow up who will eventually develop a progressive disease; many of these men may even eventually die of prostate cancer. As Urologists we still remain responsible for these patients”.
We don’t know exactly what the reasons are. It may be that once the patient was told that this cancer is probably “not immediately threatening“ , he might downplay the importance of another test. On the other hand some men might have real concerns about the risk of there being a more severe cancer. Or it may be to do with the risk of incontinence or impotence after treatment, the idea of having cancer, a sense that nothing will really happen to them or it may be due to another reason which we just don’t know about”.
Commenting, Professor Manfred Wirth (Technical University of Dresden), Treasurer and Executive Member, Communication, of the European Association of Urology said:
Download the complete Guidelines 2014 edition as a single PDF-file
Download the complete Pocket Guidelines 2014 edition as a single PDF-file