Seminars in Urologic Oncology (Semin Urol Oncol)

Journal description

Seminars in Urologic Oncology presents the most current and complete information on the treatment of the urologic patient with cancer. Topics covered include diagnosis, staging, pathology, therapy, complications, follow-up and relevant new research. The information in each issue is related to a specific clinical case that clinicians see regularly in their practice.

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Website Seminars in Urologic Oncology website
Other titles Seminars in urologic oncology, Urologic oncology
ISSN 1081-0943
OCLC 31977822
Material type Periodical
Document type Journal / Magazine / Newspaper

Publications in this journal

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    ABSTRACT: Tremendous progress has been made in the treatment of testicular seminoma over the past 25 years. The advent of curative cytotoxic chemotherapy, even for patients with advanced metastatic disease, has led to a paradigm shift toward minimizing additional oncologic therapies and their potential side effects. Despite these advances, controversial issues still exist in managing patients with this disease. Patients with stage I disease can now be managed successfully with close surveillance or postoperative radiotherapy (RT). Although deemed safe, considerable debate persists about surveillance including issues of compliance, cost, and secondary effects of routine RT. Aside from RT, patients with stage I disease also can be managed with one- or 2-dose single-agent carboplatin. Although this appears safe and efficacious, an ongoing randomized study is underway to compare its effectiveness with that of RT. Residual mass after chemotherapy for seminoma is not uncommon and therapeutic options include observation, RT, or retroperitoneal lymphadenectomy. Although most agree that patients with small (<3 cm) or ill-defined masses can be observed, debate persists as to the optimal management of patients with well-defined masses greater than 3 cm. For many years, patients with bulky retroperitoneal disease (>5 cm) were treated with up-front radiotherapy and chemotherapy at relapse. The high failure rate outside the treatment field has now changed this paradigm to one of up-front chemotherapy.
    Seminars in Urologic Oncology 12/2002; 20(4):227-33. DOI:10.1053/suro.2002.36979
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    ABSTRACT: Adjunctive surgical resection of residual disease after chemotherapy is a critical part of the comprehensive management of patients with advanced nonseminomatous germ-cell tumor (NSGCT). Surgical resection is indicated in the presence of residual radiographic abnormalities and normal serum tumor markers. Necrosis, teratoma, and viable carcinoma can be found at any resected site. After induction chemotherapy, necrosis comprises approximately 50% of histologic findings, teratoma 40%, and viable GCT the remaining 10%. A number of investigators have attempted to predict the presence of necrosis in an effort to obviate surgery. A number of variables predictive of necrosis have been identified and tested prospectively, including: degree of tumor shrinkage, size of pre- and posttreatment mass(es), prechemotherapy markers, and teratomatous components in the orchiectomy specimen. However, the risk for a false-negative prediction remains approximately 20%. The most rigorous approach remains a retroperitoneal lymph node dissection (RPLND). Furthermore, the histologic discordance between different sites ranges from 29% to 46%; thus, all sites of residual disease should be resected. The patient's prognosis is influenced by: (1) completeness of resection, and (2) biology of the tumor (histology of residual mass(es), marker status at the time of RPLND, and prior burden of therapy). Surgical boundaries and completeness of dissection should not be compromised in an attempt to preserve ejaculation.
    Seminars in Urologic Oncology 12/2002; 20(4):262-71. DOI:10.1053/suro.2002.36977
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    ABSTRACT: Patients with good-risk germ-cell tumors have a high likelihood of cure with an approach that integrates cisplatin-based chemotherapy, surgery, radiation, and observation. This article addresses risk group allocation as well as the controversies regarding the composition, number of cycles, and dosages of chemotherapy regimens used in this population. Recent data from randomized trials demonstrate that carboplatin is inferior to cisplatin and that the dose of etoposide should be 500 mg/m(2) per course. Bleomycin remains controversial in good-risk germ-cell tumors, but the literature suggests that both E(500)P for four cycles or BE(500)P for three cycles may be considered standard.
    Seminars in Urologic Oncology 12/2002; 20(4):244-50. DOI:10.1053/suro.2002.37208
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    ABSTRACT: Following orchiectomy in patients with stage 1 nonseminomatous germ-cell tumors (NSGCT), there are three treatment options. Retroperitoneal lymph-node dissection (RPLND) is currently the treatment of choice in the United States and can be both diagnostic and therapeutic but is associated with surgical morbidities. Surveillance is the least invasive but carries the highest potential for relapse and can be timely and costly for both patient and physician. Primary chemotherapy avoids the morbidity of surgery while achieving similar survival rates, albeit with potentially significant side effects. The advantages and disadvantages of each treatment modality are discussed.
    Seminars in Urologic Oncology 12/2002; 20(4):220-6. DOI:10.1053/suro.2002.36976
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    ABSTRACT: About 5% of all patients with unilateral testis cancer harbor testicular intraepithelial neoplasia (TIN) in their contralateral testicle, which will progress into an invasive germ-cell tumor over time. Accurate diagnosis of TIN by a random surgical testis biopsy examination and effective therapy by local radiation has led to the concept of a contralateral screening biopsy procedure in all testis cancer patients. Screening and preventive treatment, however, only are indicated if (1) therapeutic outcome of the screened population is improved and (2) physiologic function of the affected organ might be maintained. Based on a critical review of the literature, some drawbacks of this policy have to be considered and the routine indication for contralateral testis biopsy procedure has to be questioned: (1) all TIN-negative patients still have to undergo meticulous follow-up evaluation for metachronous testis cancer owing to a false-negative biopsy diagnosis rate of 0.3%; (2) testis biopsy procedure is associated with a 15% to 20% complication rate, which might a negative impact on endocrine and exocrine testicular function; (3) local radiation of TIN results in irreversible infertility owing to eradication of spermatogenesis; (4) local radiation of TIN results in an impairment of endocrine Leydig cell function in 25% of patients; (5) therapeutic outcome and prognosis will not be improved in irradiated patients as compared with patients on surveillance; (6) local tumor resection for the management of metachronous testicular cancer represents an effective and viable option. The current literature does not support the strategy to perform contralateral testis biopsy procedures in all patients with unilateral testicular germ-cell tumors. Testis biopsy procedures might, however, be offered to high-risk (34%) patients for contralateral TIN with a testicular volume less than 12 mL, a history of cryptorchidism, and an age less than 30 years.
    Seminars in Urologic Oncology 12/2002; 20(4):234-8. DOI:10.1053/suro.2002.36980
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    ABSTRACT: The prognostic classification developed by the International Germ Cell Consensus group (IGCCC) enables appropriate choice of initial treatment, and provides consistent eligibility criteria for clinical trials and more accurate assessment of published results. The standard therapy for IGCCC poor- and intermediate-prognosis germ-cell tumors is 4 cycles of bleomycin, etoposide, and cisplatin chemotherapy followed by surgical resection of residual masses, if the serum tumor markers have returned to normal. Improved outcomes are achieved by centers that treat a larger number of cases. The unsatisfactory results achieved with current therapy warrant entry of these patients into appropriate clinical trials. Future improvements in therapy are likely to require a better understanding of the molecular mechanisms of resistance and the development of novel therapeutic approaches that target these mechanisms.
    Seminars in Urologic Oncology 12/2002; 20(4):251-61. DOI:10.1053/suro.2002.36978
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    ABSTRACT: Management of carcinoma of the prostate has traditionally been guided by digital rectal examination, and by laboratory data such as serum prostate-specific antigen (PSA) level and histopathologic tumor grade. The introduction of the endorectal coil has improved the ability of magnetic resonance imaging (MRI) to contribute to staging and treatment planning of prostate cancer, especially in cases of confined or locally invasive disease. Exciting research in the fields of magnetic resonance spectroscopy (MRS) and MR-guided intervention of the prostate may soon expand the role of MRI in the diagnosis and treatment of prostate cancer. This article reviews current MRI techniques, the MRI features of prostate cancer, the role and efficacy of MRI in prostate carcinoma staging, and the current and future uses of MR spectroscopy and MR-guided prostate brachytherapy.
    Seminars in Urologic Oncology 09/2002; 20(3):192-210. DOI:10.1053/suro.2002.35333
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    ABSTRACT: In the 60 years since Huggins first demonstrated the hormone dependency of prostate cancer, the introduction of various means of hormonal manipulation has resulted in modest achievements. Orchiectomy reduced testosterone but was irreversible and associated with reduced quality of life. Diethylstilbestrol (DES) represented the first alternative to surgical castration. However, cardiovascular adverse events severely limited its use. The luteinizing hormone-releasing hormone (LHRH) agonists offered true medical castration but suffered from problems of testosterone surge and tumor flare. The introduction of antiandrogens in combination with LHRH agonists appears on meta-analysis not to have improved survival and has implications for the cost and convenience of therapy, as well as added toxicity. Gonadotropin-releasing hormone (GnRH) antagonists offer for the first time a truly rapid medical means of reducing testosterone and also suppress follicle-stimulating hormone (FSH). However, the clinical benefit of this new class of drugs remains to be evaluated.
    Seminars in Urologic Oncology 09/2002; 20(3 Suppl 1):4-9. DOI:10.1053/suro.2002.35051
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    ABSTRACT: Monoclonal antibodies (mAbs) to prostate-specific antigens, such as PSMA, have great potential as diagnostic and therapeutic tools in the management of advanced prostate cancer. PSMA is a very attractive target for mAb-based imaging. It is expressed by virtually all prostate cancers and its expression is further increased in poorly differentiated, metastatic, and hormone-refractory carcinomas. The ProstaScint scan (Cytogen, Princeton, NJ), based on the mAb 7E11-C5.3, is currently approved for the imaging of prostate cancer in soft tissue but is not approved for imaging bone metastases. It appears superior to conventional imaging studies for soft-tissue disease but has limitations attributed to its intracellular binding site on PSMA. Overcoming this limitation, new mAbs to the extracellular domain of PSMA have been developed. The radioisotopes, (111)Indium, (90)Yttrium, and (177)Lutetium have been conjugated to one such mAb, J591. Radioimmunoscintigraphy with this immunoconjugate has demonstrated excellent tumor targeting of prostate cancer sites not only in soft tissue but also in bone.
    Seminars in Urologic Oncology 09/2002; 20(3):211-8. DOI:10.1053/suro.2002.36250
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    ABSTRACT: Prostate cancer is the second leading cause of cancer mortality among men in Western countries. The initial treatment of advanced prostate cancer is suppression of testicular androgen production by medical or surgical castration, but nearly all men with metastases will develop disease progression. Patients with hormone-resistant prostate cancer (HRPC) have a median survival of approximately 18 months, and no therapy has yet demonstrated a definitive survival advantage. However, in the past several years, a number of promising new treatment strategies have emerged. One of the most important new treatment strategies involves secondary hormonal manipulation after the failure of primary androgen deprivation. This approach is predicated on the recognition that HRPC is a heterogeneous disease, and some patients may respond to alternative hormonal interventions despite the presence of castrate levels of testosterone.
    Seminars in Urologic Oncology 09/2002; 20(3 Suppl 1):24-30. DOI:10.1053/suro.2002.35054
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    ABSTRACT: Nephron-sparing surgery is more technically demanding than conventional nephrectomy. The urologist can benefit from modern radiological methods to plan and monitor surgery and to provide post-surgical surveillance. This article describes how 3D volume renderings of CT and MRI data can be useful in planning nephron-sparing surgery, how intraoperative imaging can guide surgery and tumor ablation, and how CT and MRI can be used to monitor for recurrent disease and postoperative complications.
    Seminars in Urologic Oncology 09/2002; 20(3):180-91. DOI:10.1053/suro.2002.35330
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    ABSTRACT: With the introduction of helical CT and its ability to acquire images very rapidly, new problems are being encountered, which can profoundly affect the quality of CT examinations performed for evaluation of known or suspected renal masses. In this article, these problems are summarized and recommendations made for CT techniques that will maximize sensitivity and specificity in renal mass detection, accuracy in renal mass characterization, and accuracy in staging of renal cancer.
    Seminars in Urologic Oncology 09/2002; 20(3):166-73. DOI:10.1053/suro.2002.35332
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    ABSTRACT: In the past few years, radiologists have begun to design a single imaging test to thoroughly evaluate the urinary tract. Multidetector computed tomography urography (MDCTU) is a novel imaging technique that provides high-resolution images of the entire renal collecting system in a single helical run. This technique lends itself to creating detailed 3-dimensional urograms. Combining the known strengths of CT axial data and the 3-dimensional urograms can provide a comprehensive evaluation of the genitourinary tract.
    Seminars in Urologic Oncology 09/2002; 20(3):174-9. DOI:10.1053/suro.2002.35331
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    ABSTRACT: Although definitive therapy with either radical prostatectomy or radiation therapy can be effective, the optimal treatment for prostatic adenocarcinoma remains controversial. Patients may be at significant risk for primary treatment failure even with apparent clinically localized disease. Thus, there has been increased interest in initial multimodal therapy in order to maximize the potential for cure. Neoadjuvant hormonal therapy prior to radical prostatectomy has been used for several decades and a large body of literature discusses its use; nevertheless, the current data suggest that it only decreases rates of positive surgical margins without improving prostate-specific antigen (PSA)-free or disease-free survival. Novel neoadjuvant hormonal and chemotherapeutic regimens are under investigation and may improve outcomes for patients undergoing radical prostatectomy.
    Seminars in Urologic Oncology 09/2002; 20(3 Suppl 1):10-8. DOI:10.1053/suro.2002.35055
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    ABSTRACT: The management of patients with high-risk, early-stage, prostate cancer represents a major challenge to all disciplines involved in the treatment of this common malignant neoplasm. Definition of the natural history of this disease, including the identification of key prognostic factors, in addition to the availability of active systemic therapeutic modalities for patients with advanced disease, are among the basic requirements that allow for early intervention in high-risk patients. Emerging new antiprogression approaches, targeted at various known stages of the metastatic cascade with the potential benefit of altering the natural history of early prostate cancer are attractive alternatives for early interventions with innovative programs. Studies on the natural history of patients with evidence of biochemical relapse following local treatment provide the basis for appropriate estimation of the risk ratio for development of clinical metastasis and selection of candidates for aggressive implementation of early treatment. The study of new candidate biomarkers of disease activity should be included in the context of clinical trials. Genotypic and phenotypic characterization of patients in clinical trials may enhance future therapeutic prospects in this disease.
    Seminars in Urologic Oncology 09/2002; 20(3 Suppl 1):19-23. DOI:10.1053/suro.2002.35049

  • Seminars in Urologic Oncology 09/2002; 20(3 Suppl 1):1-3. DOI:10.1053/suro.2002.35050
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    ABSTRACT: Estimating prognosis with patients with metastatic disease is important for patient counseling, guiding treatment selection, and assessing treatment outcomes. For patients with noncastrate metastatic disease, androgen ablation is considered first-line therapy, with upward of 80% of patients showing clinical benefit. For these patients, information about duration of response to hormones and overall survival is important. Most patients eventually relapse, at which point the mortality from cancer greatly exceeds that from other causes. This article focuses on prognostic models for patients with progressive noncastrate and castrate metastatic prostate cancer.
    Seminars in Urologic Oncology 06/2002; 20(2):155-63. DOI:10.1053/suro.2002.32938
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    ABSTRACT: Nomograms are valuable tools for estimating the likelihood of cancer being diagnosed, the pathologic features of a localized cancer, and the prognosis of a patient after treatment. Although the available nomograms are reasonably accurate, better predictive factors including additional clinical factors and new molecular analyses are needed to improve the accuracy or predictions. Nomogram performance will also be enhanced with larger datasets of patients and longer follow-up. We review the concepts of risk stratification and the development and use of nomograms as predictive tools.
    Seminars in Urologic Oncology 06/2002; 20(2):108-15. DOI:10.1053/suro.2002.32936
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    ABSTRACT: Patients with newly diagnosed, clinically localized prostate cancer need information concerning long-term outcomes to make informed decisions regarding treatment options. Several nomograms have been developed that can help in this decision process. By using a nomogram originally published in 1998, patients and clinicians can predict the 15-year clinical outcomes in the absence of aggressive treatment based on age and Gleason score at diagnosis. These predictions are based on patients diagnosed and treated before the routine use of PSA that has accelerated the diagnosis of prostate cancer by at least 5 years. Longer follow-up of contemporary patients will determine whether this nomogram remains accurate in the prostate-specific antigen (PSA) era. In view of the lead-time bias resulting from PSA testing, the outcomes of contemporary patients are likely to be better rather than worse than the results shown.
    Seminars in Urologic Oncology 06/2002; 20(2):140-5. DOI:10.1053/suro.2002.32495