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Abiraterone plus prednisone in metastatic, castration-sensitive prostate cancer
Abiraterone acetate, the prodrug of abiraterone, blocks endogenous androgen synthesis by inhibiting cytochrome p-450c17, a critical enzyme in androgen biosynthesis. Its active D4A metabolite also has anti-tumour effects through possibly multiple mechanisms. 3-5% of men diagnosed with prostate cancer in...
Anti-VEGF and PD-1 combinations in renal cell carcinoma
Over the past decade, vascular endothelial growth factor (VEGF) tyrosine kinase inhibitors (TKIs) have been central to treating renal cell carcinoma (RCC), with oncologists refining dosing strategies to balance treatment efficacy with quality of life (QoL). Recently, the introduction of...Clinical trials 1
Clinical Trials 2 is available here. Case 1 1. What are the levels of clinical evidence based on the 2009 definitions from the ‘Oxford CEBM’? 2. What is the null hypothesis? 3. What are type 1 and type 2 errors?...Trials offering cytoreductive surgery for men with de novo synchronous metastatic prostate cancer
Life expectancy in men diagnosed with de novo synchronous metastatic hormone-sensitive prostate cancer (mHSPC) has risen to a median of 4.8 years with upfront systemic agents (such as docetaxel) in addition to standard androgen deprivation therapy (ADT) [1-3]. Within this...What is the role of evidence-based medicine in urology?
The concept of ‘evidence-based medicine’ (EBM) was first developed in the early 1990s and was described as “the conscientious, explicit and judicious use of the current best evidence in making decisions about the care of individual patients” by the recently...
Testosterone and erectile function – the debate goes on!
The most common causes of erectile dysfunction (ED) as per European Association of Urology (EAU) guidelines are: psychogenic, vasculogenic, neurogenic and hormonal. The EAU 2017 guidelines recommend measuring total testosterone (TS) level. This study is a meta-analysis of 14 randomised...
Intravesical instillation of chemotherapy before radical surgery for upper UTUC
Upper urinary tract urothelial carcinoma (UTUC) is a rare but increasingly prevalent form of urothelial cancer, accounting for 5–10% of cases, with an annual incidence of two to three cases per 100,000 individuals in Western Europe. Radical nephroureterectomy (RNU) with...Clinical Trials 2 – key papers
Clinical Trials 1 is available here. Case 1 This British study on haematuria clinic diagnostic yield was published in the British Journal of Urology International in 2006. The results are often asked in examinations! Edwards TJ, et al. A prospective...Focal therapies in prostate cancer
The standard of care in the management of prostate cancer has, to date, always been to treat the whole gland. This has ranged from surveillance, surgical excision / prostatectomy or external beam radiotherapy / whole gland brachytherapy. With the evolution...
Reliability of grading of VUR and other findings on VCUG
The gold standard for diagnosing VUR is still the voiding cycstogram (VCUG). These authors looked at the inter observer variability of grading of vesicoureteral reflux (VUR) using a VCUG and highlight the implications for treatment and prognosis as a results....
Mindfulness-based stress reduction as a novel treatment for IC/PBS
Interstitial cystitis / painful bladder syndrome (IC / PBS) is not fully understood and is associated with significant morbidity. The objective of this study was to provide initial data to evaluate mindfulness-based stress reduction (MBSR) as a treatment for IC...
