Management of Urologic Cancer

MARK P. SCHOENBERG, MD, University Professor & Chair, Department of Urology, The Montefiore Medical Center and The Albert Einstein College of Medicine, Bronx, NY, USA

KARA L. WATTS, MD, Assistant Professor, Department of Urology, The Montefiore Medical Center and The Albert Einstein College of Medicine, Bronx, NY, USA

List of Contributors xiii
Preface xvii
Cancer Genetics, Cancer Biology, and Tumor Growth and Metastasis: The Interaction of Cancer and Its Host Environment 1Mark C. Markowski and Kenneth J. Pienta
Renal Cell Carcinoma 1
Bladder Cancer 3
Prostate Cancer 6
References 12
Pathological Basis of Tumor Characterization: Cytopathology, Surgical Pathology, and How Histo ]Morphology Informs Treatment Decision Making 19Oleksandr N. Kryvenko and Fadi Brimo
The Kidney 23
The Urothelium 27
The Testis 29
References 30
The Immunobiology of Tumor Ablation 33Rafi Kabarriti and Chandan Guha
Manipulating the Immune System to Fight Cancer 33
Can We Take Advantage of Ablative Therapies to Activate the Immune System? 34
Immunomodulatory Properties of HIFU 35
Immunomodulatory Properties of Cryotherapy 36
Immunomodulatory Properties of Radiation Therapy 37
References 38
Computed Tomography of Urologic Malignancies: The Role of MDCT in Renal Cell Carcinoma and Transitional Cell Carcinoma 41Siva P. Raman and Elliot K. Fishman
Introduction 41
MDCT Protocol Design 41
Three ]Dimensional Reconstructions 44
Neoplasms of the Intrarenal Collecting Systems, Ureters, and Bladder 45
Solid Renal Parenchymal Lesions 49
Conclusion 55
References 55
MRI and Metabolic Imaging 59Louise Dickinson, Francesco Fraioli, Athar Haroon, and Clare Allen
Magnetic Resonance Imaging 59
MRI Sequences 59
Clinical Applications of MRI for Prostate Cancer 61
Clinical Applications of MRI for Renal Cancer 63
Clinical Applications of MRI for Bladder Cancer 64
New Advances in MRI 65
Metabolic Imaging 66
Clinical Applications of PET CT for Prostate Cancer 69
Active Surveillance for Low ]Risk Prostate Cancer 113Laurence Klotz
Introduction and Background 113
Rationale 113
Genetic Features of Low ]Grade Prostate Cancer 114
Metastatic Potential 115
Limitations of PSA Kinetics 116
Role of MRI 116
Implications for Patient Management 117
Eligibility for Surveillance 118
Outcome of Surveillance 119
Modeling 119
AS in Practice 121
Conclusions 121
References 122
Tissue ]Preserving Surgical Approaches in Urologic Oncology: The Therapeutic Mechanism for Tumor Ablation 127Ganesh Kartha and J. Stephen Jones
Introduction 127
Cryoablation: Extreme Cold for Tumor Necrosis 128
Conclusion 130
References 130
Focal Therapy for Prostate Cancer: An Evidence ]Based Approach to Tissue ]Preserving Strategies 133Kara L. Watts, Yaalini Shanmugabavan, Victoria Chernyak, and Hashim Uddin Ahmed
Introduction 133
Key Concepts in FT for PCa 134
Tissue ]Preserving FTs 135
Cryotherapy 135
HIFU 137
Salvage Focal/Hemiablation HIFU 140
IRE 141
Radiation 142
Additional Therapies 143
Implications for Research 144
Conclusions 144
References 145
The Modern Basis for Nephron ]Sparing Surgery in Patients with Renal Cancer: Biologic Heterogeneity, the Significance of Tumor Biopsy, and the Changing Roles of Partial Nephrectomy and Tumor Ablation 151Jeffrey J. Tomaszewski, Robert G. Uzzo, and David Y.T. Chen
Introduction 151
Principal Treatment Options for SRMs and the Basis for Nephron Preservation 152
Comparative Effectiveness of Radical versus NSS 153
Rationale for Ablative Therapies 154
Treatment Trends for Stage I RCC 157
The Role of RMB 158
Challenges Posed by Intratumoral Heterogeneity 161
Conclusions 161
References 162
Bladder ]Preserving Strategies in the Treatment of Urothelial Cancer: The Disease Spectrum and the Dawn of Molecular Surgical Guidance 169Stephan Kruck and Arnulf Stenzl
Augmented Cystoscopy 170
Fiber ]Optic Probe Technology 171
Conclusion 172
References 172
Image ]Guided Thermal Ablation of Adrenal Malignancies 175Kyungmouk Steve Lee, Bradley B. Pua, and Stephen B. Solomon
Introduction 175
Clinical Results 175
Preprocedural Evaluation 176
Technical Considerations 178
RFA 178
Microwave Ablation 179
Cryoablation 180
Complications 180
Follow ]up 181
Conclusion 182
References 182
Managing Penile Cancer: Integrating Tissue Preservation, Energy ]Based Therapeutics, and Surgical Reconstruction 185Arthur L. Burnett
Introduction 185
Description 186
Diagnosis and Staging 186
Treatment 189
References 193
Testis Cancer: Testis ]Sparing Cancer Surgery 199Nilay M. Gandhi and Pravin K. Rao
Introduction 199
Imaging of Testicular Tumors 199
Bilateral Tumors 201
The Advent of Testis ]Sparing Surgery 201
Concerns about TSS 201
Indications for TSS 204
Preoperative Considerations and Surgical Technique 204
Postoperative Care and Follow ]Up 207
Considerations Regarding Surgical Technique 207
Outcomes of TSS 208
Summary 209
References 210
Nanotechnology: An Evolution in Tissue Preservation and Focal ]Targeted Oncologic Therapy 213Kara L. Watts and Joshua M. Stern
Introduction 213
Introduction to Nanotechnology 214
Types of Nanoparticles 214
Delivery and Use of Nanoparticles 217
Nanotechnology in Prostate Cancer 219
Imaging in Prostate Cancer 219
Therapeutics in Prostate Cancer 221
Nanotechnology in Renal Cancer 223
Nanotechnology in Other Urologic Cancers 224
Limitations of Nanoparticles 224
Future Directions and Conclusions 225
References 226
Trial Design Issues in the Study of Focal Therapy in Prostate and Kidney Cancer 233John B. Eifler and David F. Penson
Issues around Endpoints in Studies of Focal Therapy 234
Issues around Defining the Study Population and the Control Arms of Comparative Studies in Focal Therapy 237
Issues around Selecting the Optimal Study Design in Focal Therapy 238
Conclusion 238
References 239
Index 000