Claus G Roehrborn

University of Texas Southwestern Medical Center | UT Southwestern · Department of Urology

Background: Understanding the molecular pathogenesis of distinct phenotypes in human benign prostatic hyperplasia (BPH) is essential to improving therapeutic intervention. Current therapies target smooth muscle and luminal epithelia for relief of lower urinary tract symptoms (LUTS) due to BPH, but basal cell hyperplasia (BCH) remains untargeted. T...

Introduction: To report the five year results of a prospective, multi-center, randomized, blinded sham control trial of the Prostatic Urethral Lift (PUL) in men with bothersome lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). Materials and methods: At 19 centers in North America and Australia, 206 subjects ≥ 50 year...

Purpose: To investigate (in a post hoc analysis of the 2-year CONDUCT study) the characteristics and clinical outcomes of men with moderately symptomatic benign prostatic hyperplasia (BPH) at risk of progression who benefitted from lifestyle changes alone. Methods: Patients were given lifestyle advice and randomized to a fixed-dose combination (...

Background: We sought to determine whether formalin disinfection of prostate biopsy needles between cores reduces post-biopsy urinary tract infections (UTIs). Methods: We reviewed a single-surgeon experience of transrectal prostate biopsies from 2010 to 2014. Biopsies were performed in either an operative suite, where 10% formalin was used to di...

Background: Targeted prostate biopsies are changing the landscape of prostate cancer (PCa) diagnosis with the degree of suspicion on multiparametric magnetic resonance imaging (mpMRI) being a strong predictor of targeted biopsy outcome. Data regarding the rate and potential causes of false-negative magnetic resonance imaging-transrectal ultrasound...

Available α1-blockers (ABs) have different profiles of receptor selectivity. Silodosin exhibits the highest selectivity for the α1A adrenergic receptor. This pharmacological feature couples with a singular urodynamic and clinical profile. The magnitude of bladder outlet obstruction improvement in patients receiving silodosin is higher if compared t...

Introduction Lower urinary tract symptoms have multifactorial etiology, are common in men, and increase with age. In view of an unprecedented growth of the aging population worldwide and in the United States, an increase in the number of men with lower urinary tract symptoms is expected in the near future. In contrast, a decline in practicing urolo...

BACKGROUND Since the US Preventive Services Task Force (USPSTF) recommended against prostate‐specific antigen (PSA) screening, there have been conflicting reports regarding the impact on the behavior of providers. This study analyzed real‐world data on PSA ordering and referral practices in the years surrounding the recommendation. METHODS A whole...

Background Previous studies have suggested a greater benefit for various outcomes in men diagnosed with benign prostatic hyperplasia (BPH) who are treated with dutasteride than for men treated with finasteride. This study investigates whether the rates of BPH-related prostate surgery and acute urinary retention (AUR) differ between dutasteride and...

Prostate inflammation has been suggested as an etiology for benign prostatic hyperplasia (BPH). We show that decreased expression of the androgen receptor (AR) in luminal cells of human BPH specimens correlates with a higher degree of regional prostatic inflammation. However, the cause-and-effect relationship between the two events remains unclear....

The prostatic urethral lift (PUL) is a unique, nonthermal approach to treating lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). It can be conducted under local anesthesia in an outpatient setting. In published clinical studies, most voiding tested patients do not require a catheter. After PUL, patients experience...

Purpose: To compare a simplified intravoxel incoherent motion (sIVIM) model to commonly used monoexponential and biexponential models in the characterization of prostate cancer (PCa) and noncancerous prostate tissues, and to investigate combinations of diffusion-weighted imaging (DWI) measures with dynamic contrast-enhanced (DCE) magnetic resonanc...

Introduction: and Objectives: We evaluated associations between histological prostate inflammation and development and progression of BPH/LUTS in men randomized to placebo in the REDUCE study over a 4-year period. Methods: The association of acute and chronic inflammation detected on baseline biopsies and BPH related parameters (IPSS, prostate v...

Objectives: To evaluate the effects of testosterone-replacement therapy (TRT) on prostate health indicators in hypogonadal men, including rates of prostate cancer diagnoses, changes in prostate-specific antigen (PSA) levels and lower urinary tract symptoms (LUTS) over time. Patients and methods: The Registry of Hypogonadism in Men (RHYME) is a m...

Objective To examine the association between decreased serum testosterone levels and artificial urinary sphincter (AUS) cuff erosion. Materials and Methods We evaluated serum testosterone levels in 53 consecutive patients. Low testosterone was defined as <280 ng/dL and found in 30/53 patients (56.6%). Chi-square and Student t tests, Kaplan-Meier a...

Background and objectives: Dutasteride is currently marketed by GlaxoSmithKline (GSK), either as monotherapy or as a fixed-dose combination with tamsulosin. As part of the project to develop the fixed-dose combination product, alternative formulations of dutasteride were prepared by GSK, and their pharmacokinetic properties were investigated. Met...

Objective: To determine the incremental diagnostic value of targeted biopsies added to an extended sextant biopsy scheme on a per-patient, risk-stratified basis in 2 academic centers using different multiparametric magnetic resonance imaging (MRI) protocols, a large group of radiologists, multiple biopsy systems, and different biopsy operators. M...

Objective: To assess the efficacy of Light reflectance spectroscopy (LRS) to detect positive surgical margins (PSM) on ex vivo radical prostatectomy specimens. Materials and methods: A prospective evaluation of ex vivo prostate specimens using LRS was performed at a single institution from June 2013 to September 2014. LRS measurements were perfo...

Introduction: Most surgical treatments for male lower urinary tract symptoms and benign prostatic hyperplasia affect erectile and ejaculatory functions negatively, leading to patient dissatisfaction. Aim: To determine whether water vapor thermal therapy, when conducted in a randomized controlled trial, would significantly improve lower urinary t...

Objectives: To compare the sensitivity of 2 different non-endorectal coil strategies vs. endorectal coil (ERC) magnetic resonance imaging (MRI) for detection of prostate cancer (PCa). Methods: In this prospective, single-center, paired-patient, paired-reader study, 49 men with a clinical indication for MRI underwent non-ERC (phased-array coil on...

Context Several preclinical reports, randomized controlled trials, systematic reviews, and posthoc analyses corroborate the role of phosphodiesterase type 5 inhibitors (PDE5-Is) in the treatment of men with lower urinary tract symptoms (LUTS) associated with benign prostatic enlargement (BPE). Objective Update of the latest evidence on the mechani...

Objective To analyse the proportion of men taking tadalafil 5 mg once daily who experience a combined improvement in symptoms of both erectile dysfunction (ED) and lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH). Materials and Methods The data from men aged ≥45 years randomized to tadalafil 5 mg once daily or p...

A rise in antimicrobial resistant uropathogens has generated a global increase in infections following transrectal ultrasound-guided prostate biopsy (TRUS-Bx). We performed a systematic search of Ovid MEDLINE® and PubMed to comprehensively review strategies to mitigate infections. Of 1664 articles retrieved, 62 were included. The data suggest that...

Background: It has been shown that increased prostate size is a risk factor for lower urinary tract symptom (LUTS) progression in men who currently have LUTS presumed due to benign prostatic hyperplasia (BPH). Objective: To determine if prostate size is a risk factor for incident LUTS in men with mild to no symptoms. Design, setting, and partic...

Prostate cancer recurrences are usually first detected by increased levels of prostate specific antigen (PSA), and systemic therapy is often initiated if distant metastasis is confirmed. However, low or nearly undetectable levels of PSA in the modern era of ultrasensitive PSA assay may be difficult to interpret in patients with a history of prostat...

Purpose: This report reveals results of a multicenter randomized-control study utilizing transurethral prostate convective water vapor thermal energy to treat lower urinary tract symptoms associated with benign prostatic hyperplasia (BPH). Materials and methods: Men 50 years old or greater with International Prostate Symptom Scores (IPSS) 13 or...

Objective: Robotic-assisted laparoscopic prostatectomy (RALP) with suprapubic tube (SPT), as compared to urethral catheter (UC) drainage, has been proposed to improve patient comfort and recovery. We sought to compare short-term outcomes for pain and morbidity after RALP with SPT versus UC drainage. Methods: Between August 2012 and 2014, 159 men...

Little is known about how total testosterone and estradiol-17β influence lower urinary tract symptoms (LUTS) in men with benign prostatic hypertrophy (BPH). We analyzed data from a subset of men aged ≥18 years randomized to tadalafil 5 mg once-daily or placebo who had ≥6 month history of LUTS and an International Prostate Symptom Score (IPSS)≥13 en...

Objectives: Intraoperative frozen section analysis is not routinely performed to determine positive surgical margins (PSM) at radical prostatectomy (RP) due to time requirement and unproven clinical utility. Light reflectance spectroscopy (LRS) measures light intensity reflected or backscattered from tissues and can be used to differentiate malign...

Purpose: To determine if men with self-reported lower urinary tract symptoms (LUTS) can make a correct decision to use an over-the-counter (OTC) alpha-1 blocker. Further, to assess the frequency of medically significant conditions (MSCs) presenting with urinary symptoms in these consumers. Materials and methods: Subjects reviewed a mock-up of th...

PURPOSE: To assess the performance of prospectively assigned MRI-based Likert scale scores for detection of clinically significant prostate cancer and to analyze the pre-biopsy imaging variables associated with increased cancer detection using targeted MRI-TRUS fusion biopsy. MATERIALS AND METHODS: In this retrospective review of prospectively gene...

To assess the performance of prospectively assigned MRI-based Likert scale scores for detection of clinically significant prostate cancer and to analyze the pre-biopsy imaging variables associated with increased cancer detection using targeted MRI-TRUS fusion biopsy. In this retrospective review of prospectively generated data including men with ab...

Salvage radiation therapy (SRT) is an effective treatment for recurrent prostate cancer (PCa) after radical prostatectomy. We report the long-term outcome of men who developed biochemical recurrence (BCR) after SRT and were treated >14 years ago. In total, 61 patients treated with SRT from 1992 to 2000 at our institution were identified. Survival w...

To report the three year results of a multi-center, randomized, patient and outcome assessor blinded trial of the Prostatic Urethral Lift (PUL) in men with bothersome lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). At 19 centers in North America and Australia, 206 subjects = 50 years old with International Prostate Sy...

We compared cost of multiparametric magnetic resonance imaging (MP-MRI) vs. repeat biopsy in detection of prostate cancer (PCa) in men with prior negative findings on biopsy. A decision tree model compared the strategy of office-based transrectal ultrasound-guided biopsy (TRUS) for men with prior negative findings on biopsy with a strategy of initi...

Cancer of the prostate gland is a common but heterogeneous disease requiring individualized risk stratification for optimal clinical management. However, transrectal ultrasonography (US)-guided biopsy-the standard of care for diagnosis of prostate cancer-frequently fails to detect aggressive tumors or provide reliable parameters for pretreatment ri...

Objectives To report the secondary analyses of treatment satisfaction and clinically meaningful improvements in a randomized study comparing coadministration of tadalafil 5 mg with finasteride 5 mg versus finasteride alone in men with prostatic enlargement secondary to benign prostatic hyperplasia.Methods An international, randomized, double-blind,...

We evaluated the risk of histologic upgrading and upstaging in patients who met strict active surveillance (AS) criteria on saturation biopsy and elected to undergo radical prostatectomy. A retrospective review was conducted of 362 consecutive, individual patients who underwent transrectal ultrasound guided saturation biopsy (32 cores) between 2006...

Objective To investigate whether a fixed‐dose combination (FDC) of 0.5 mg dutasteride and 0.4 mg tamsulosin is more effective than watchful waiting with protocol‐defined initiation of tamsulosin therapy if symptoms did not improve (WW‐All) in treatment‐naïve men with moderately symptomatic benign prostatic hyperplasia (BPH) at risk of progression....

Background: To assess the efficacy and safety of LY500307, a selective estrogen receptor beta agonist, on lower urinary tract symptoms (LUTS) in patients with enlarged prostate secondary to BPH. Methods: In a randomized, double-blind, placebo-controlled, parallel phase 2, efficacy and safety study, eligible patients with moderate to severe LUTS...

Introduction: Tadalafil (TAD) 5 mg coadministered with finasteride (FIN) 5 mg significantly improves lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH) and prostatic enlargement. However, its effects on erectile/sexual function have yet to be fully described. Aim: Assess the effects of TAD/FIN coadministration (co...

To validate the biological and prognostic value of tertiary Gleason pattern 5 (TGP5) in patients with Gleason score 7 (GS 7) prostate cancer (PCa) and to develop a prognostic model to identify the high-risk group of patients with TGP5. We retrospectively reviewed the data from 4,146 patients with localized (pT2-3 N0 M0) GS 7 PCa treated by radical...

Background The international prostate symptom score (IPSS) evaluates lower urinary tract symptoms (LUTS) in men with suspected benign prostatic hyperplasia (BPH); the total score does not differentiate between storage and voiding and is unevenly weighted (four questions [57%] on voiding, three questions [43%] on storage). Objective To evaluate the...

There are clearly defined mechanisms of action for alpha adrenergic receptor blockers (AARB), 5 alpha reductase inhibitors (5ARI), antimuscarinics, and, to a lesser degree, phosphodiesterase type 5 inhibitors (PDE5i) in the management of men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH). Taking advantage of the...

Purpose: We analyzed our initial 100-case experience with the 3.5 cm artificial urinary sphincter cuff to identify risk factors for cuff erosion. Materials and methods: We reviewed the records of a single surgeon, consecutive series of patients treated with 3.5 cm artificial urinary sphincter cuff placement from September 2009 to August 2013. Ea...

The heterogeneity and largely indolent nature of prostate cancer require better tools to avoid overdetection of low-risk disease and improve diagnostic accuracy in high-risk patients. During the last 3 decades, magnetic resonance imaging (MRI) has evolved to become the most accurate imaging technique for prostate cancer detection and staging, with...

Introduction and Objective: Robot-assisted laparoscopic prostatectomy (RALP) with suprapubic tube (SPT), compared to urethral catheter (UC) drainage, has been proposed to improve patient's comfort and recovery. We sought to compare short- and intermediate-term outcomes for pain and satisfaction after RALP with SPT versus UC drainage. Materials and...

Purpose To assess the efficacy and tolerability of 200U onabotulinumtoxinA versus placebo to treat lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH) in men previously treated with oral BPH medication in a 24 week, phase 2, multicenter, double-blind, randomized, placebo-controlled, parallel-group trial. Materials and Methods Pati...

Objective: To compare the outcomes of robotic-assisted laparoscopic prostatectomy (RALP) using a dual versus single-console system in a resident training program using intraoperative, perioperative and postoperative measures. Methods: Patients with PCa who underwent RALP prior to and after implementing a dual-console system at an academic instit...

Purpose To assess the impact of dutasteride compared with placebo on nocturia in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia, using pooled data from dutasteride phase III studies. Methods Nocturia was assessed using Question 7 of the International Prostate Symptom Score questionnaire. Efficacy measures includ...

The purpose of the study was to assess the impact of dutasteride plus tamsulosin combination therapy, compared with dutasteride or tamsulosin monotherapy, on nocturia in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) using data from the 4-year CombAT study. Nocturia was assessed using Question 7 of the I...

Objective To investigate the natural history of urologic symptom progression and remission by means of cluster analysis in a large, well-characterized cohort of men and women. Methods Cluster analysis was used to assign men and women to symptom clusters on the basis of the prevalence of 14 self-reported urologic symptoms. Data were analyzed from t...

This study was conducted to evaluate the capability of detecting prostate cancer (PCa) using auto-fluorescence lifetime spectroscopy (AFLS) and light reflectance spectroscopy (LRS). AFLS used excitation at 447 nm with four emission wavelengths (532, 562, 632, and 684 nm), where their lifetimes and weights were analyzed using a double exponent model...

Purpose: High-risk prostate cancer (PC) has poor outcomes due to therapeutic resistance to conventional treatments, which include prostatectomy, radiation, and hormone therapy. Previous studies suggest that anticoagulant (AC) use may improve treatment outcomes in PC patients. We hypothesized that AC therapy confers a freedom from biochemical failu...

Introduction For a therapy to become an important part of a provider armamentarium it must be safer or better than existing therapies and be durable. The prostatic urethral lift offers rapid improvement in lower urinary tract symptoms associated with benign prostatic hyperplasia with minimal side effects. We report 2-year results of a multicenter,...

We employed light reflectance spectroscopy to quantify light scattering of prostate cancer on the gland capsules from ex-vivo human prostates. Results confirmed that light scattering is distinct between cancerous and benign prostate tissue.