Management of Urologic Cancer

Managing urologic cancer by preserving, as opposed to removing, affected tissue, is rapidly becoming the favoured choice for urologists and oncologists. Discover all available options and how to achieve the best possible patient management with this expert guide to the area. The editor, Mark Schoenberg, is an internationally-renown expert in this exciting new area and has recruited an outstanding team featuring some of the leading urologists/oncologists in North America and Europe to assist him.

Immer mehr Urologen und Onkologen entscheiden sich beim Management urologischer Krebserkrankungen für den Erhalt und nicht die Entfernung des betroffenen Gewebes. Dieses Fachbuch erläutert alle verfügbaren Optionen und zeigt das bestmögliche Patientenmanagement. Herausgeber Mark Schoenberg ist ein international anerkannter Experte auf diesem neuen, aufregenden Gebiet und hat ein herausragendes Team zusammengestellt, zu dem einige der führenden Urologen und Onkologen aus Nordamerika und Europa gehören.

List of Contributors ix

Preface xiii

1 Cancer Genetics, Cancer Biology, and Tumor Growth and Metastasis: The Interaction of Cancer and Its Host Environment 1
Mark C. Markowski and Kenneth J. Pienta

Renal Cell Carcinoma 1

Bladder Cancer 3

Prostate Cancer 6

References 12

2 Pathological Basis of Tumor Characterization: Cytopathology, Surgical Pathology, and How Histo‐Morphology Informs Treatment Decision Making 19
Oleksandr N. Kryvenko and Fadi Brimo

The Prostate 19

The Kidney 23

The Urothelium 27

The Testis 29

References 30

3 The Immunobiology of Tumor Ablation 33
Rafi 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

4 Computed Tomography of Urologic Malignancies: The Role of MDCT in Renal Cell Carcinoma and Transitional Cell Carcinoma 41
Siva 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

5 MRI and Metabolic Imaging 59
Louise Dickinson, Francesco Fraioli, Athar Haroon, and Clare Allen

Magnetic Resonance Imaging 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

Renal Cancer 72

Clinical Applications of PET–CT for Bladder Cancer 73

Novel Advances in PET Imaging: PET–MRI 74

Summary 76

References 76

6 Biopsy Strategies in the Analysis of Urologic Neoplasia 83
Nabeel A. Shakir, Soroush Rais‐Bahrami, and Peter A. Pinto

Kidney 83

Penile 86

Prostate 89

Testis 94

Urothelium 95

References 100

7 Active Surveillance for Low‐Risk Prostate Cancer 113
Laurence 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

8 Tissue‐Preserving Surgical Approaches in Urologic Oncology: The Therapeutic Mechanism for Tumor Ablation 127
Ganesh Kartha and J. Stephen Jones

Introduction 127

Cryoablation: Extreme Cold for Tumor Necrosis 128

Conclusion 130

References 130

9 Focal Therapy for Prostate Cancer: An Evidence‐Based Approach to Tissue‐Preserving Strategies 133
Kara 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

10 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 151
Jeffrey 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

11 Bladder‐Preserving Strategies in the Treatment of Urothelial Cancer: The Disease Spectrum and the Dawn of Molecular Surgical Guidance 169
Stephan Kruck and Arnulf Stenzl

Augmented Cystoscopy 170

Fiber‐Optic Probe Technology 171

Conclusion 172

References 172

12 Image‐Guided Thermal Ablation of Adrenal Malignancies 175
Kyungmouk 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

13 Managing Penile Cancer: Integrating Tissue Preservation, Energy‐Based Therapeutics, and Surgical Reconstruction 185
Arthur L. Burnett

Introduction 185

Description 186

Diagnosis and Staging 186

Treatment 189

References 193

14 Testis Cancer: Testis‐Sparing Cancer Surgery 199
Nilay 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

15 Nanotechnology: An Evolution in Tissue Preservation and Focal‐Targeted Oncologic Therapy 213
Kara L. Watts and Joshua M. Stern

Introduction 213

Introduction to Nanotechnology 214

Nanotechnology in Prostate Cancer 219

Nanotechnology in Renal Cancer 223

Nanotechnology in Other Urologic Cancers 224

Limitations of Nanoparticles 224

Future Directions and Conclusions 225

References 226

16 Trial Design Issues in the Study of Focal Therapy in Prostate and Kidney Cancer 233
John 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 243

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

Preservation of functioning, non-malignant tissue has become a mainstay of modern oncologic surgery in the past 30 years. Refinements in axial imaging technology coupled with the development of minimally invasive techniques such as laparoscopy and robot-assisted surgery have ushered in an era characterized by the fundamental re-evaluation of the role of the surgeon in cancer care and the manner in which cancers should be treated.

Edited by Mark P. Schoenberg and Kara L. Watts, Management of Urologic Cancer: Focal Therapy and Tissue Preservation offers a unique overview of this exciting new area in the management of urologic malignancies. An international faculty of experts provide insights into the current state of tissue-preserving surgery on an organ-by-organ basis.

Providing a vital introduction to the growing discipline of tissue-preserving and image-guided therapy, Management of Urologic Cancer: Focal Therapy and Tissue Preservation is valuable reading for urologists, radiologists, oncologists and practitioners advising patients about the complex issues related to the treatment of urologic cancers.