From the Desk of the Editor: Volume 4, Issue 1

Welcome to the current issue of Everyday Urology – Oncology Insights. We begin this issue with our cover story: “Optimizing TURBT and Optical Diagnostics in Bladder Cancer,” authored by Ashish Kamat, MD. Dr. Kamat discusses the crucial importance of performing the optimal TURBT. This is the essential first step in managing newly diagnosed and recurrent bladder cancer, ultimately impacting potential multidisciplinary therapies, for both advanced disease and high risk NMIBC. While transurethral resection of the bladder tumor (TURBT) remains the gold standard ‘first step’ in bladder cancer management (both diagnosis and tumor removal), there can be a high rate of residual tumor left behind after TURBT. He details tips to optimize TURBT as well as a checklist of processes for consideration of prognostic factors. In addition, Dr. Kamat reviews state of the art methods for enhancing cystoscopic evaluation of malignant urothelium, the most recent AUA bladder management guidelines (2016) and reimbursement considerations. Our understanding of the complexity of bladder cancer management is expanding, and thus an optimally performed TURBT not only provides the accuracy for a correct diagnosis but may also prevent or delay recurrence as well as progression of bladder malignancy.

In this issue’s Expert Perspective, Noah Hahn, MD, has authored: “Immuno-Oncology: The Urologist’s Role” in which he reviews the efficacy of immuno-oncologic agents in advanced urothelial cancer with an assessment of the importance of urologic involvement. Dr. Hahn describes the trial landscape whereby the efficacy and administration of immuno-oncologic agents in advanced urothelial cancer may lead to their potential use in earlier-stage bladder cancer, which augurs the potential promise of the shift of immuno-oncologic therapy to earlier-stage use. Practice changing studies evaluating the safety and efficacy of apalutamide and enzalutamide in men with high-risk nonmetastatic castration-resistant prostate cancer have resulted in U.S. FDA approvals for both of these drugs for this indication. At the 2019 Genitourinary Cancers Symposium Karim Fizazi presented the first efficacy and safety results from the ARAMIS trial. The Efficacy and Safety Study of Darolutamide (ODM-201) in Men With High-Risk Nonmetastatic Castration-resistant Prostate Cancer (ARAMIS) achieved its primary endpoint: improving metastasis-free survival (MFS) while offering a favorable safety and toxicity profile. Pending U.S. FDA regulatory approval, darolutamide will be the third drug to having an indication for the treatment of men with nmCRPC. A full summary of the ARAMIS presentation, as well as a summary of the presentation, results from ARCHES - A Study of Enzalutamide Plus Androgen Deprivation Therapy (ADT) Versus Placebo Plus ADT in Patients With Metastatic Hormone Sensitive Prostate Cancer (mHSPC) and other highlights from presentations from this same meeting in bladder cancer, kidney cancer and others in men with prostate cancer can be found in this issue’s Spotlight. Thank you for reading these state-of-the-art discussions, as well as for your continued support.

Written by: Neal Shore, MD, FACS, is an internationally recognized expert in systemic therapies for patients with advanced urologic cancers and innovative therapies to treat patients suffering from prostate enlargement symptoms. Dr. Shore was recently appointed President-Elect of the Large Urology Group Practice Association (LUGPA), which seeks to provide urologists with all the tools they need to effectively care for patients. Neal D. Shore, MD, FACS, is the Medical Director of the Carolina Urologic Research Center. He practices with Atlantic Urology Clinics in Myrtle Beach, South Carolina. Dr. Shore has conducted more than 100 clinical trials, focusing mainly on prostate and bladder disease.

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