Management of Urologic Cancer

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

• List of Contributors ixPreface xiii1 Cancer Genetics, Cancer Biology, and Tumor Growth and Metastasis: The Interaction of Cancer and Its Host Environment 1Mark C. Markowski and Kenneth J. PientaRenal Cell Carcinoma 1Bladder Cancer 3Prostate Cancer 6References 122 Pathological Basis of Tumor Characterization: Cytopathology, Surgical Pathology, and How Histo‐Morphology Informs Treatment Decision Making 19Oleksandr N. Kryvenko and Fadi BrimoThe Prostate 19The Kidney 23The Urothelium 27The Testis 29References 303 The Immunobiology of Tumor Ablation 33Rafi Kabarriti and Chandan GuhaManipulating the Immune System to Fight Cancer 33Can We Take Advantage of Ablative Therapies to Activate the Immune System? 34Immunomodulatory Properties of HIFU 35Immunomodulatory Properties of Cryotherapy 36Immunomodulatory Properties of Radiation Therapy 37References 384 Computed Tomography of Urologic Malignancies: The Role of MDCT in Renal Cell Carcinoma and Transitional Cell Carcinoma 41Siva P. Raman and Elliot K. FishmanIntroduction 41MDCT Protocol Design 41Three‐Dimensional Reconstructions 44Neoplasms of the Intrarenal Collecting Systems, Ureters, and Bladder 45Solid Renal Parenchymal Lesions 49Conclusion 55References 555 MRI and Metabolic Imaging 59Louise Dickinson, Francesco Fraioli, Athar Haroon, and Clare AllenMagnetic Resonance Imaging 59Clinical Applications of MRI for Prostate Cancer 61Clinical Applications of MRI for Renal Cancer 63Clinical Applications of MRI for Bladder Cancer 64New Advances in MRI 65Metabolic Imaging 66Clinical Applications of PET–CT for Prostate Cancer 69Renal Cancer 72Clinical Applications of PET–CT for Bladder Cancer 73Novel Advances in PET Imaging: PET–MRI 74Summary 76References 766 Biopsy Strategies in the Analysis of Urologic Neoplasia 83Nabeel A. Shakir, Soroush Rais‐Bahrami, and Peter A. PintoKidney 83Penile 86Prostate 89Testis 94Urothelium 95References 1007 Active Surveillance for Low‐Risk Prostate Cancer 113Laurence KlotzIntroduction and Background 113Rationale 113Genetic Features of Low‐Grade Prostate Cancer 114Metastatic Potential 115Limitations of PSA Kinetics 116Role of MRI 116Implications for Patient Management 117Eligibility for Surveillance 118Outcome of Surveillance 119Modeling 119AS in Practice 121Conclusions 121References 1228 Tissue‐Preserving Surgical Approaches in Urologic Oncology: The Therapeutic Mechanism for Tumor Ablation 127Ganesh Kartha and J. Stephen JonesIntroduction 127Cryoablation: Extreme Cold for Tumor Necrosis 128Conclusion 130References 1309 Focal Therapy for Prostate Cancer: An Evidence‐Based Approach to Tissue‐Preserving Strategies 133Kara L. Watts, Yaalini Shanmugabavan, Victoria Chernyak, and Hashim Uddin AhmedIntroduction 133Key Concepts in FT for PCa 134Tissue‐Preserving FTs 135Cryotherapy 135HIFU 137Salvage Focal/Hemiablation HIFU 140IRE 141Radiation 142Additional Therapies 143Implications for Research 144Conclusions 144References 14510 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 151Jeffrey J. Tomaszewski, Robert G. Uzzo, and David Y.T. ChenIntroduction 151Principal Treatment Options for SRMs and the Basis for Nephron Preservation 152Comparative Effectiveness of Radical versus NSS 153Rationale for Ablative Therapies 154Treatment Trends for Stage I RCC 157The Role of RMB 158Challenges Posed by Intratumoral Heterogeneity 161Conclusions 161References 16211 Bladder‐Preserving Strategies in the Treatment of Urothelial Cancer: The Disease Spectrum and the Dawn of Molecular Surgical Guidance 169Stephan Kruck and Arnulf StenzlAugmented Cystoscopy 170Fiber‐Optic Probe Technology 171Conclusion 172References 17212 Image‐Guided Thermal Ablation of Adrenal Malignancies 175Kyungmouk Steve Lee, Bradley B. Pua, and Stephen B. SolomonIntroduction 175Clinical Results 175Preprocedural Evaluation 176Technical Considerations 178RFA 178Microwave Ablation 179Cryoablation 180Complications 180Follow‐up 181Conclusion 182References 18213 Managing Penile Cancer: Integrating Tissue Preservation, Energy‐Based Therapeutics, and Surgical Reconstruction 185Arthur L. BurnettIntroduction 185Description 186Diagnosis and Staging 186Treatment 189References 19314 Testis Cancer: Testis‐Sparing Cancer Surgery 199Nilay M. Gandhi and Pravin K. RaoIntroduction 199Imaging of Testicular Tumors 199Bilateral Tumors 201The Advent of Testis‐Sparing Surgery 201Concerns about TSS 201Indications for TSS 204Preoperative Considerations and Surgical Technique 204Postoperative Care and Follow‐Up 207Considerations Regarding Surgical Technique 207Outcomes of TSS 208Summary 209References 21015 Nanotechnology: An Evolution in Tissue Preservation and Focal‐Targeted Oncologic Therapy 213Kara L. Watts and Joshua M. SternIntroduction 213Introduction to Nanotechnology 214Nanotechnology in Prostate Cancer 219Nanotechnology in Renal Cancer 223Nanotechnology in Other Urologic Cancers 224Limitations of Nanoparticles 224Future Directions and Conclusions 225References 22616 Trial Design Issues in the Study of Focal Therapy in Prostate and Kidney Cancer 233John B. Eifler and David F. PensonIssues around Endpoints in Studies of Focal Therapy 234Issues around Defining the Study Population and the Control Arms of Comparative Studies in Focal Therapy 237Issues around Selecting the Optimal Study Design in Focal Therapy 238Conclusion 238References 239Index 243