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Techniques and Procedures for Use - Intermittent Catheters

Intermittent catheterization is the method of bladder management in patients with urinary retention caused by a neurogenic bladder.  Neurogenic bladder can be caused by 1) upper motor neuron disease (for example, central nervous system lesions, including stroke, Parkinson’s disease, and multiple sclerosis [MS]); 2) spinal cord injury, including MS of the cord, and cervical and thoracic disc disease; and 3) lower motor neuron disease (for example, pelvic nerve injury, peripheral neuropathy, diabetes mellitus). These conditions can cause bladder dysfunction necessitating the use of intermittent catheterization.
Written by: Diane K. Newman, DNP, ANP-BC, FAAN
References:
  1. Beauchemin, L. , Newman, D.K., Le Danseur, M., Jackson,A., &Ritmiller, M. (2018). Best practices for clean intermittent catheterization.  48(9): 49-54
  2. Bhatt, N. R., Davis, N. F., Thorman, H., Brierly, R., & Scopes, J. (2021). Knowledge, skills, and confidence among healthcare staff in urinary catheterization. Canadian Urological Association Journal, 15(9). https://doi.org/10.5489/cuaj.6986
  3. Goetz, L.L., Droste, L., Klausner, A.P., & Newman, D.K. (2018). Intermittent catheterization. In: D.K. Newman, E.S. Rovner, A.J. Wein, (Eds). Clinical Application of Urologic Catheters and Products. (pp. 47-77) Switzerland: Springer International Publishing. Moore, KN., Fader, M. & Getliffe, K. Long‐term bladder management by intermittent catheterisation in adults and children. Cochrane Database of Systematic Reviews4 (2007).
  4. Hakansson MA. (2014). Reuse versus single-use catheters for intermittent catheterization: what is safe and preferred? Review of current status. Spinal Cord. 52:511–6.
  5. Sun AJ, Comiter CV, Elliott CS. (2018). The cost of a catheter: an environ- mental perspective on single use clean intermittent catheterization. Neurourol Urodyn. 37:2204–8.
  6. van Doorn, T.Bertil F M Blok, BFM. (2020). Multiuse Catheters for Clean Intermittent Catheterization in Urinary Retention: Is There Evidence of Inferiority? Eur Urol Focus. 15;6(5):809-810. doi: 10.1016/j.euf.2019.09.018. 
  7. Walter, M, & Krassioukov, A.V. (2020). Single-use Versus Multi-use Catheters: Pro Single-use Catheters. Eur Urol Focus. 6(5):807-808. doi: 10.1016/j.euf.2019.10.001. 

The Role of Remote Interactions in Genitourinary Oncology: Implications for Practice Change in Light of the COVID-19 Pandemic

The rapid spread of Coronavirus Disease 2019 (COVID-19) caused by the novel severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) has dramatically reshaped the structure of Western society, including on health care delivery.1 While care for patients with cancer has been prioritized in nearly every guideline and recommendation, data suggest that among patients with COVID-19, those with a history of cancer have significantly increased risk of severe outcomes.2 Further, patients most at risk of a severe SARS-CoV-2 phenotype are men and those of advanced age or comorbidity,1,3-6 demographics which mirror the patient population with genitourinary cancers.
Written by: Zachary Klaassen, MD, MSc
References:
  1. Guan WJ, Ni ZY, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. The New England journal of medicine. 2020.
  2. Dai M, Liu D, Liu M, et al. Patients with cancer appear more vulnerable to SARS-COV-2: a multi-center study during the COVID-19 outbreak. Cancer Discov. 2020.
  3. Team CC-R. Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) - United States, February 12-March 16, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(12):343-346.
  4. Grasselli G, Zangrillo A, Zanella A, et al. Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy. JAMA : the journal of the American Medical Association. 2020.
  5. Myers LC, Parodi SM, Escobar GJ, Liu VX. Characteristics of Hospitalized Adults With COVID-19 in an Integrated Health Care System in California. JAMA : the journal of the American Medical Association. 2020.
  6. Richardson S, Hirsch JS, Narasimhan M, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA : the journal of the American Medical Association. 2020.
  7. Boehm K, Ziewers S, Brandt MP, et al. Telemedicine Online Visits in Urology During the COVID-19 Pandemic-Potential, Risk Factors, and Patients' Perspective. European urology. 2020;78(1):16-20.
  8. Castaneda P, Ellimoottil C. Current use of telehealth in urology: a review. World journal of urology. 2019.
  9. Medicaid CfM. MEDICARE TELEMEDICINE HEALTH CARE PROVIDER FACT SHEET. 2020; https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet. Accessed June 1, 2020.
  10. Schaffert R, Dahinden U, Hess T, et al. [Evaluation of a prostate cancer Ehealth tutorial : Development and testing of the website prostata-information.ch]. Urologe A. 2018;57(2):164-171.
  11. Berry DL, Hong F, Blonquist TM, et al. Decision Support with the Personal Patient Profile-Prostate: A Multicenter Randomized Trial. The Journal of urology. 2018;199(1):89-97.
  12. Parsons JK, Zahrieh D, Mohler JL, et al. Effect of a Behavioral Intervention to Increase Vegetable Consumption on Cancer Progression Among Men With Early-Stage Prostate Cancer: The MEAL Randomized Clinical Trial. JAMA : the journal of the American Medical Association. 2020;323(2):140-148.
  13. Skolarus TA, Metreger T, Wittmann D, et al. Self-Management in Long-Term Prostate Cancer Survivors: A Randomized, Controlled Trial. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2019;37(15):1326-1335.
  14. Viers BR, Lightner DJ, Rivera ME, et al. Efficiency, satisfaction, and costs for remote video visits following radical prostatectomy: a randomized controlled trial. European urology. 2015;68(4):729-735.
  15. Leahy M, Krishnasamy M, Herschtal A, et al. Satisfaction with nurse-led telephone follow up for low to intermediate risk prostate cancer patients treated with radical radiotherapy. A comparative study. Eur J Oncol Nurs. 2013;17(2):162-169.
  16. Belarmino A, Walsh R, Alshak M, Patel N, Wu R, Hu JC. Feasibility of a Mobile Health Application To Monitor Recovery and Patient-reported Outcomes after Robot-assisted Radical Prostatectomy. Eur Urol Oncol. 2019;2(4):425-428.
  17. Lange L, Fink J, Bleich C, Graefen M, Schulz H. Effectiveness, acceptance and satisfaction of guided chat groups in psychosocial aftercare for outpatients with prostate cancer after prostatectomy. Internet Interv. 2017;9:57-64.
  18. Trinh L, Arbour-Nicitopoulos KP, Sabiston CM, et al. RiseTx: testing the feasibility of a web application for reducing sedentary behavior among prostate cancer survivors receiving androgen deprivation therapy. Int J Behav Nutr Phys Act. 2018;15(1):49.
  19. Lee BJ, Park YH, Lee JY, Kim SJ, Jang Y, Lee JI. Smartphone Application Versus Pedometer to Promote Physical Activity in Prostate Cancer Patients. Telemed J E Health. 2019;25(12):1231-1236.
  20. Novara G, Checcucci E, Crestani A, et al. Telehealth in Urology: A Systematic Review of the Literature. How Much Can Telemedicine Be Useful During and After the COVID-19 Pandemic? European Urology (in press). 2020.
  21. Kontopantelis E, Roland M, Reeves D. Patient experience of access to primary care: identification of predictors in a national patient survey. BMC Fam Pract. 2010;11:61.
  22. Kane LT, Thakar O, Jamgochian G, et al. The role of telehealth as a platform for postoperative visits following rotator cuff repair: a prospective, randomized controlled trial. J Shoulder Elbow Surg. 2020;29(4):775-783.
  23. Wallis CJD, Morton G, Herschorn S, et al. The effect of selection and referral biases for the treatment of localised prostate cancer with surgery or radiation. British journal of cancer. 2018;118(10):1399-1405.
  24. Meti N, Rossos PG, Cheung MC, Singh S. Virtual Cancer Care During and Beyond the COVID-19 Pandemic: We Need to Get It Right. JCO Oncol Pract. 2020:OP2000281.
  25. Holstead RG, Robinson AG. Discussing Serious News Remotely: Navigating Difficult Conversations During a Pandemic. JCO Oncol Pract. 2020:OP2000269.
  26. Roberts ET, Mehrotra A. Assessment of Disparities in Digital Access Among Medicare Beneficiaries and Implications for Telemedicine. JAMA internal medicine. 2020.
  27. Lam K, Lu AD, Shi Y, Covinsky KE. Assessing Telemedicine Unreadiness Among Older Adults in the United States During the COVID-19 Pandemic. JAMA internal medicine. 2020.
  28. de la Torre-Diez I, Lopez-Coronado M, Vaca C, Aguado JS, de Castro C. Cost-utility and cost-effectiveness studies of telemedicine, electronic, and mobile health systems in the literature: a systematic review. Telemed J E Health. 2015;21(2):81-85.
  29. Jiang X, Ming WK, You JH. The Cost-Effectiveness of Digital Health Interventions on the Management of Cardiovascular Diseases: Systematic Review. J Med Internet Res. 2019;21(6):e13166.
  30. Shepperd S, Iliffe S. Hospital at home versus in-patient hospital care. Cochrane Database Syst Rev. 2001(3):CD000356.
  31. Qaddoura A, Yazdan-Ashoori P, Kabali C, et al. Efficacy of Hospital at Home in Patients with Heart Failure: A Systematic Review and Meta-Analysis. PloS one. 2015;10(6):e0129282.
  32. Caplan GA, Coconis J, Woods J. Effect of hospital in the home treatment on physical and cognitive function: a randomized controlled trial. The journals of gerontology Series A, Biological sciences and medical sciences. 2005;60(8):1035-1038.
  33. Raphael R, Yves D, Giselle C, Magali M, Odile CM. Cancer treatment at home or in the hospital: what are the costs for French public health insurance? Findings of a comprehensive-cancer centre. Health Policy. 2005;72(2):141-148.
  34. K. SR, Magee D, Hird AE, et al. Reoperation within 30 Days of Radical Cystectomy: Identifying High-Risk Patients and Complications Using ACS-NSQIP Database. Can Urol Assoc J (in press). 2020.
  35. Metcalf M, Glazyrine V, Glavin K, et al. The Feasibility of a Health Care Application in the Treatment of Patients Undergoing Radical Cystectomy. The Journal of urology. 2019;201(5):902-908.
  36. Catto JWF, Khetrapal P, Ambler G, et al. Multidomain Quantitative Recovery Following Radical Cystectomy for Patients Within the Robot-assisted Radical Cystectomy with Intracorporeal Urinary Diversion Versus Open Radical Cystectomy Randomised Controlled Trial: The First 30 Patients. European urology. 2018;74(4):531-534.
  37. van Hout L, Bokkerink WJV, Ibelings MS, Vriens P. Perioperative monitoring of inguinal hernia patients with a smartphone application. Hernia. 2020;24(1):179-185.
  38. Raja JM, Elsakr C, Roman S, et al. Apple Watch, Wearables, and Heart Rhythm: where do we stand? Ann Transl Med. 2019;7(17):417.
  39. Krishnan N, Li B, Jacobs BL, et al. The Fate of Radical Cystectomy Patients after Hospital Discharge: Understanding the Black Box of the Pre-readmission Interval. Eur Urol Focus. 2018;4(5):711-717.
  40. Krishnan N, Liu X, Lavieri MS, et al. A Model to Optimize Followup Care and Reduce Hospital Readmissions after Radical Cystectomy. The Journal of urology. 2016;195(5):1362-1367.
  41. Cai S, Grubbs A, Makineni R, Kinosian B, Phibbs CS, Intrator O. Evaluation of the Cincinnati Veterans Affairs Medical Center Hospital-in-Home Program. J Am Geriatr Soc. 2018;66(7):1392-1398.
  42. Richards SH, Coast J, Gunnell DJ, Peters TJ, Pounsford J, Darlow MA. Randomised controlled trial comparing effectiveness and acceptability of an early discharge, hospital at home scheme with acute hospital care. Bmj. 1998;316(7147):1796-1801.
  43. Ramkumar PN, Haeberle HS, Ramanathan D, et al. Remote Patient Monitoring Using Mobile Health for Total Knee Arthroplasty: Validation of a Wearable and Machine Learning-Based Surveillance Platform. J Arthroplasty. 2019;34(10):2253-2259.
  44. Breteler MJM, KleinJan E, Numan L, et al. Are current wireless monitoring systems capable of detecting adverse events in high-risk surgical patients? A descriptive study. Injury. 2019.
  45. Soukup T, Lamb BW, Arora S, Darzi A, Sevdalis N, Green JS. Successful strategies in implementing a multidisciplinary team working in the care of patients with cancer: an overview and synthesis of the available literature. J Multidiscip Healthc. 2018;11:49-61.
  46. Specchia ML, Frisicale EM, Carini E, et al. The impact of tumor board on cancer care: evidence from an umbrella review. BMC Health Serv Res. 2020;20(1):73.
  47. Charara RN, Kreidieh FY, Farhat RA, et al. Practice and Impact of Multidisciplinary Tumor Boards on Patient Management: A Prospective Study. J Glob Oncol. 2017;3(3):242-249.
  48. Salami AC, Barden GM, Castillo DL, et al. Establishment of a Regional Virtual Tumor Board Program to Improve the Process of Care for Patients With Hepatocellular Carcinoma. J Oncol Pract. 2015;11(1):e66-74.
  49. Lesslie M, Parikh JR. Implementing a Multidisciplinary Tumor Board in the Community Practice Setting. Diagnostics (Basel). 2017;7(4).
  50. McGeady JB, Blaschko SD, Brajtbord JS, Sewell JL, Chen AH, Breyer BN. Electronic Preconsultation as a Method of Quality Improvement for Urological Referrals. Urology Practice 2014;1:172-175.
  51. Chertack N, Lotan Y, Mayorga C, Mauck R. Implementation of a Urology E-Consult Service at a Safety Net County Hospital. Urology Practice.
  52. Witherspoon L, Liddy C, Afkham A, Keely E, Mahoney J. Improving access to urologists through an electronic consultation service. Can Urol Assoc J. 2017;11(8):270-274.
  53. Vimalananda VG, Gupte G, Seraj SM, et al. Electronic consultations (e-consults) to improve access to specialty care: a systematic review and narrative synthesis. J Telemed Telecare. 2015;21(6):323-330.
  54. Rosner BI, Gottlieb M, Anderson WN. Effectiveness of an Automated Digital Remote Guidance and Telemonitoring Platform on Costs, Readmissions, and Complications After Hip and Knee Arthroplasties. J Arthroplasty. 2018;33(4):988-996 e984.
  55. Balakrishnan AS, Nguyen HG, Shinohara K, Au Yeung R, Carroll PR, Odisho AY. A Mobile Health Intervention for Prostate Biopsy Patients Reduces Appointment Cancellations: Cohort Study. J Med Internet Res. 2019;21(6):e14094.
  56. Asch DA, Nicholson S, Berger ML. Toward Facilitated Self-Service in Health Care. The New England journal of medicine. 2019;380(20):1891-1893.

Indication of Catheterization for Intermittent Catheters (IC)

Intermittent catheterization (IC) is the “gold standard” for individuals with bladder dysfunction caused by neurologic or non-neurologic causes, a significant and growing population in the United States.  Intermittent catheterization is the recommended method for individuals who are unable to void or completely empty the bladder.  According to the 6th International Consultation on Incontinence, IC has replaced long-term indwelling urinary catheterization for patients with neurogenic lower urinary tract dysfunction (NLUTD) resulting in incomplete bladder emptying as it is associated with less urologic and non-urologic complications.
Written by: Diane K. Newman, DNP, ANP-BC, FAAN
References:
  1. Apostolidis, A., Drake, M., Emmanuel, A., Gajewski, J., Heesakkers, J., Kessler, T., …..Wyndaele, J.J. (2017) Neurologic urinary and fecal urinary incontinence. In: P. Abrams P CL, L.Cardozo, A. Wagg, A.Wein (Eds). International Consultation on Incontinence 6th edition. (pp. 1093-1308).  Plymouth, UK: Health Publications Ltd.
  2. Averch, T.D., Stoffel, J., Goldman, H.B., Griebling, T., Lerner, L., Newman, D.K., Peterson, A.C. (2014) AUA White Paper on Catheter-Associated Urinary Tract Infections: Definitions and Significance in the Urologic Patient Workgroup, Retrieved from  https://www.sciencedirect.com/science/article/pii/S2352077915000308
  3. Blok B, J. P-F, Pannek J, Castro-Diaz D, Del Popolo G, Groen J, Hamid R, Karsenty G, Kessler TM (2018) Guidelines on Neuro-Urology. EAU European Association of Urology, Retrieved from  https://uroweb.org/wp-content/uploads/EAU-Guidelines-on-Neuro-Urology-2018-large-text.pdf
  4. Bladder management following spinal cord injury. Spinal cord injury rehabilitation evidence. 2014.  https://msktc.org/lib/docs/Factsheets/SCI_Bladder_Health.pdf Accessed March 18, 2021
  5. Cottenden, A., Fader, M., Beeckman, D., Buckley, B., Kitson-Reynolds, E., Moore, K…..Wilde, M. (2017) Management using continence products. In: P. Abrams P CL, L.Cardozo, A. Wagg, A.Wein (Eds). International Consultation on Incontinence 6th edition. (pp. 2303-2426). Plymouth, UK: Health Publications Ltd
  6. Gajewski, J.B., Schurch B, Hamid R, Averbeck, A., Sakakibara, R., Agro, E.F.,…Haylen, B.T. (2018). An International Continence Society (ICS) report on the terminology for adult neurogenic lower urinary tract dysfunction (ANLUTD). Neurourology and Urodynamics, 37:1152–1161.  https://doi.org/10.1002/nau.23397
  7. Gamé X, Phé V, Castel-Lacanal E, Forin V, de Sèze M, Lam O, Chartier-Kastler E, Keppenne V, Corcos J, Denys P, Caremel R, Loche CM, Scheiber-Nogueira MC, Karsenty G, Even A. (2020). Intermittent catheterization: Clinical practice guidelines from Association Française d'Urologie (AFU), Groupe de Neuro-urologie de Langue Française (GENULF), Société Française de Médecine Physique et de Réadaptation (SOFMER) and Société Interdisciplinaire Francophone d'UroDynamique et de Pelvi-Périnéologie (SIFUD-PP). Prog Urol. Mar 24. pii: S1166-7087(20)30054-3. doi: 10.1016/j.purol.2020.02.009
  8. Ginsberg D. (2013). The epidemiology and pathophysiology of neurogenic bladder. Am J Manag Care. 2013;19(10 suppl):s191-6. http://www.ncbi.nlm. nih.gov/pubmed/24495240
  9. Groen J, Pannek J, Castro Diaz D, Del Popolo G, Gross T, Hamid R, Karsenty G, Kessler TM, Schneider M, Hoen L, Blok B. (2016) Summary of European Association of Urology(EAU) Guidelines on Neuro-Urology. Eur Urol. 69(2):324-33. doi: 10.1016/j.eururo.2015.07.071
  10. Goetz, L.L., Droste, L., Klausner, A.P., & Newman, D.K. (2018). Intermittent catheterization. In: D.K. Newman, E.S. Rovner, A.J. Wein, (Eds). Clinical Application of Urologic Catheters and Products. (pp. 47-77) Switzerland: Springer International Publishing.
  11. Gould, C., Umscheid, C., Agarwal, R., et al.; Healthcare Infection Control Practices Advisory Committee (HICPAC). (2009). In Guideline for prevention of catheter-associated urinary tract infections. Atlanta, GA: Centers for Disease Control and Prevention (CDC). Retrieved from http://www.cdc.gov/hicpac/pdf/cauti/cautiguideline2009final.pdf
  12. Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA (2010) Guideline for prevention of catheter-associated urinary tract infections 2009. Infection control and hospital epidemiology : the official journal of the Society of Hospital Epidemiologists of America. 31(4):319-326. doi:10.1086/651091
  13. Kennelly M, Thiruchelvam N, Averbeck MA, Konstatinidis C, Chartier-Kastler E, Trøjgaard P, Vaabengaard R, Krassioukov A, Jakobsen BP. AdultNeurogenic LowerUrinary Tract Dysfunction and Intermittent Catheterisation in a Community Setting: Risk Factors Model for Urinary Tract Adv Urol. 2019 Apr 2;2019:2757862. doi: 10.1155/2019/2757862.
  14. Kinnear, N., Barnett, D., O'Callaghan, M., Horsell, K., Gani, J, Hennessey, D. (2020). The impact of catheter-based bladder drainage method on urinary tract infection risk in spinal cord injury and neurogenic bladder: A systematic review. Neurourol Urodyn. 39(2):854-862. doi: 10.1002/nau.24253
  15. Klausner, A.P., & Steers, W.D. (2011). The neurogenic bladder: an update with management strategies for primary care physicians. Med Clin North Am. 95(1):111-20. https://DOI: 10.1016/j.mcna.2010.08.027.
  16. Lavis T, Goetz LL. (2019) Comprehensive care for persons with spinal cord injury. Phys Med Rehabil Clin N Am. 30(1):55-72. doi:10.1016/j.pmr.2018.08.010
  17. Management of the neurogenic bladder for adults with spinal cord injuries. https://www.aci.health.nsw. gov.au/__data/assets/pdf_file/0010/155179/ Management-Neurogenic-Bladder.pdf Accessed March 20, 2021
  18. Milligan J, Goetz LL, Kennelly MJ. (2020). A Primary Care Provider's Guide to Management of Neurogenic Lower UrinaryTractDysfunction and Urinary Tract Infection After Spinal Cord Injury. Top Spinal Cord Inj Rehabil. Spring;26(2):108-115. doi: 10.46292/sci2602-108
  19. Newman, D.K. (2017). Devices, products, catheters, and catheter-associated urinary tract infections. In: D.K. Newman, J.F. Wyman, V.W. Welch (Eds). Core Curriculum for Urologic Nursing (pp. 429-466). Pitman, New Jersey: Society of Urologic Nurses and Associates, Inc.
  20. Newman, D.K., & Wein, A.J. (2009). Managing and treating urinary incontinence (2nd ed). Baltimore: Health Professions Press.
  21. Panicker JN. (2020) NeurogenicBladder: Epidemiology, Diagnosis, and Management. Semin Neurol. Oct;40(5):569-579. doi: 10.1055/s-0040-1713876.
  22. Tate DG, Wheeler T, Lane GI, Forchheimer M, Anderson KD, Biering-Sorensen F, Cameron AP, Santacruz BG, Jakeman LB, Kennelly MJ, Kirshblum S, Krassioukov A, Krogh K, Mulcahey MJ, Noonan VK, Rodriguez GM, Spungen AM, Tulsky D, Post MW. Recommendations for evaluation of neurogenicbladderand bowel dysfunction after spinal cord injury and/or disease. J Spinal Cord Med. 2020 Mar;43(2):141-164. doi: 10.1080/10790268.2019.1706033

Ethnic Variation in Prostate Cancer Detection: A Feasibility Study for Use of the Stockholm3 Test in a Multiethnic U.S. Cohort - Beyond the Abstract

African American men are known to have nearly twice the incidence of prostate cancer and more than double the risk of prostate cancer mortality compared to Caucasian men.  There are several possible mechanisms for this including risk factors such as lifestyle, diet, genetic risk, inequalities in access to high-quality care, or other socioeconomic factors, however, the contribution of biology in prostate cancer risk is not well understood in this population.
Written by: Hari T. Vigneswaran, Andrea Discacciati, Peter H. Gann, Henrik Grönberg, Martin Eklund, Michael R. Abern
References:
  1. Darst, B.F., et al., A Germline Variant at 8q24 Contributes to Familial Clustering of Prostate Cancer in Men of African Ancestry. Eur Urol, 2020.
  2. Haiman, C.A., et al., Characterizing genetic risk at known prostate cancer susceptibility loci in African Americans. PLoS Genet, 2011. 7(5): p. e1001387.
  3. Gronberg, H., et al., Prostate cancer screening in men aged 50-69 years (STHLM3): a prospective population-based diagnostic study. Lancet Oncol, 2015. 16(16): p. 1667-76.
  4. Vigneswaran, H.T., et al., Ethnic variation in prostate cancer detection: a feasibility study for use of the Stockholm3 test in a multiethnic U.S. cohort. Prostate Cancer Prostatic Dis, 2020.

Definition - Intermittent Catheters

What is an intermittent urinary catheter?

Intermittent catheterization (IC) is the insertion and removal of a catheter several times a day to empty the bladder. The purpose of catheterization is to drain urine from a bladder that is not emptying adequately or from a surgically created channel that connects the bladder with the abdominal surface (such as Mitrofanoff continent urinary diversion).

catheter

Intermittent catheterization is widely advocated as an effective bladder management strategy for patients with incomplete bladder emptying due to idiopathic or neurogenic detrusor (bladder) dysfunction (NDO).

Written by: Diane K. Newman, DNP, ANP-BC, FAAN
References:
  1. Averbeck MA, Krassioukov A, Thiruchelvam N, Madersbacher H, Bogelund M, Igawa Y. The impact of different scenarios for intermittent bladder catheterization on health state utilities: results from an internet-based time trade-off survey. J Med Econ. 2018:1-8.
  2. Avery M, Prieto J, Okamoto I, et al. Reuse of intermittent catheters: a qualitative study of IC users' perspectives. BMJ open. 2018;8(8):e021554
  3. Beauchemin L, Newman DK, Le Danseur M, Jackson A, Ritmiller M. Best practices for clean intermittent catheterization. Nursing. 2018;48(9):49-54.
  4. DeFoor W, Reddy P, Reed M, et al. Results of a prospective randomized control trial comparing hydrophilic to uncoated catheters in children with neurogenic bladder. J Pediatr Urol. 2017;13(4):373.e371–373.e375.
  5. Goetz LL, Droste L, Klausner AP, Newman DK. Catheters Used for Intermittent Catheterization. Clinical Application of Urologic Catheters, Devices and Products. Cham: Springer International Publishing; 2018:47-77.
  6. Heard, L. & Buhrer, R. How do we prevent UTI in people who perform intermittent catheterization? Rehabilitation Nursing, 2005: (30): p 44–45. 
    Krassioukov A, Cragg JJ, West C, Voss C, Krassioukov-Enns D. The good, the bad and the ugly of catheterization practices among elite athletes with spinal cord injury: a global perspective. Spinal Cord. 2015;53(1):78-82.
  7. Lapides, J., Diokno, A.C., Silber, S.J., & Lowe, B.S., Clean, intermittent self-catheterization in the treatment of urinary disease. 1972. Urology:107;  p458.
  8. Lapides, J., Diokno, A.C., Silber, S.M., & Lowe, B.S. Clean, intermittent self-catheterization in the treatment of urinary tract disease. 1972. Journal of Urology: 167; p1584–1586.
  9. Newman DK. (2017). Devices, products, catheters, and catheter-associated urinary tract infections. In: Newman DK, Wyman JF, Welch VW, editors. Core Curriculum for Urologic Nursing. 1st ed. Pitman (NJ): Society of Urologic Nurses and Associates, Inc; 439-66.
  10. Newman DK, Willson MM. Review of intermittent catheterization and current best practices. Urol Nurs. 2011 Jan-Feb;31(1):12-28, 48; quiz 29. PubMed PMID: 21542441
    11. Vahr S, Cobussen-Boekhorst H, Eikenboom J, et al. Evidence-based guideline for best practice in urological health care. Catheterization. Urethral intermittent in adults. Dilatation, urethral intermittent in adults. . EAUN guideline. 2013.

The Value of Multiparametric Magnetic Resonance Imaging Sequences to Assist in the Decision Making of Muscle-Invasive Bladder Cancer - Beyond the Abstract

Over the last few years, the landscape of bladder cancer (BC) management has profoundly changed, thanks to increased knowledge of disease biology and the identification of novel therapeutic approaches and biomarkers.1 No more than 5 years ago, the treatment-decision process for non muscle-invasive BC (NMIBC) or muscle-invasive BC (MIBC) was represented by radical surgery in most cases, with an opportunity for perioperative systemic therapy in a few cases. To date, the diagnostic and therapeutic armamentarium has been exceedingly enlarged for these patients.
Written by: Marco Bandini, and Andrea Necchi
References:
  1. Vetterlein MW, Witjes JA, Loriot Y, et al. Cutting-edge Management of Muscle-invasive Bladder Cancer in 2020 and a Glimpse into the Future. Eur Urol Oncol. Published online June 15, 2020. doi:10.1016/j.euo.2020.06.001
  2. Merck Sharp & Dohme Corp. A Phase II Clinical Trial to Study the Efficacy and Safety of Pembrolizumab (MK-3475) in Subjects With High Risk Non-Muscle Invasive Bladder Cancer (NMIBC) Unresponsive to Bacillus Calmette-Guerin (BCG) Therapy. clinicaltrials.gov; 2020. Accessed July 16, 2020. https://clinicaltrials.gov/ct2/show/NCT02625961
  3. Safety and efficacy of intravesical nadofaragene firadenovec for patients with high-grade, BCG unresponsive nonmuscle invasive bladder cancer (NMIBC): Results from a phase III trial. | Journal of Clinical Oncology. Accessed July 18, 2020. https://ascopubs.org/doi/abs/10.1200/jco.2020.38.6_suppl.442
  4. Powles T, Kockx M, Rodriguez-Vida A, et al. Clinical efficacy and biomarker analysis of neoadjuvant atezolizumab in operable urothelial carcinoma in the ABACUS trial. Nat Med. Published online November 4, 2019. doi:10.1038/s41591-019-0628-7
  5. Necchi A, Raggi D, Gallina A, et al. Updated Results of PURE-01 with Preliminary Activity of Neoadjuvant Pembrolizumab in Patients with Muscle-invasive Bladder Carcinoma with Variant Histologies. Eur Urol. 2020;77(4):439-446. doi:10.1016/j.eururo.2019.10.026
  6. ASCO GU 2020: Results from BLASST-1 - Nivolumab, Gemcitabine, and Cisplatin in Muscle Invasive Bladder Cancer (MIBC) Undergoing Cystectomy. Accessed July 18, 2020. https://www.urotoday.com/conference-highlights/asco-gu-2020/asco-gu-2020-bladder-cancer/119384-asco-gu-2020-results-from-blasst-1-bladder-cancer-signal-seeking-trial-of-nivolumab-gemcitabine-and-cisplatin-in-muscle-invasive-bladder-cancer-mibc-undergoing-cystectomy.html
  7. Tan TZ, Rouanne M, Tan KT, Huang RY-J, Thiery J-P. Molecular Subtypes of Urothelial Bladder Cancer: Results from a Meta-cohort Analysis of 2411 Tumors. Eur Urol. 2019;75(3):423-432. doi:10.1016/j.eururo.2018.08.027
  8. Necchi A, Raggi D, Gallina A, et al. Impact of Molecular Subtyping and Immune Infiltration on Pathological Response and Outcome Following Neoadjuvant Pembrolizumab in Muscle-invasive Bladder Cancer. Eur Urol. Published online March 9, 2020. doi:10.1016/j.eururo.2020.02.028
  9. Necchi A, Raggi D, Giannatempo P, et al. Can Patients with Muscle-invasive Bladder Cancer and Fibroblast Growth Factor Receptor-3 Alterations Still Be Considered for Neoadjuvant Pembrolizumab? A Comprehensive Assessment from the Updated Results of the PURE-01 Study. Eur Urol Oncol. Published online May 14, 2020. doi:10.1016/j.euo.2020.04.005
  10. Bandini M, Ross JS, Raggi D, et al. Predicting the pathologic complete response after neoadjuvant pembrolizumab in muscle-invasive bladder cancer. J Natl Cancer Inst. Published online June 9, 2020. doi:10.1093/jnci/djaa076
  11. Necchi A, Gallina A, Dyrskjøt L, et al. Converging Roads to Early Bladder Cancer. Eur Urol. Published online March 17, 2020. doi:10.1016/j.eururo.2020.02.031
  12. Panebianco V, Narumi Y, Altun E, et al. Multiparametric Magnetic Resonance Imaging for Bladder Cancer: Development of VI-RADS (Vesical Imaging-Reporting And Data System). Eur Urol. 2018;74(3):294-306. doi:10.1016/j.eururo.2018.04.029
  13. Necchi A, Bandini M, Calareso G, et al. Multiparametric Magnetic Resonance Imaging as a Noninvasive Assessment of Tumor Response to Neoadjuvant Pembrolizumab in Muscle-invasive Bladder Cancer: Preliminary Findings from the PURE-01 Study. Eur Urol. 2020;77(5):636-643. doi:10.1016/j.eururo.2019.12.016
  14. Bandini M, Calareso G, Raggi D, et al. The Value of Multiparametric Magnetic Resonance Imaging Sequences to Assist in the Decision Making of Muscle-invasive Bladder Cancer. Eur Urol Oncol. Published online June 27, 2020. doi:10.1016/j.euo.2020.06.004

Complications - Intermittent Catheters

Urethral Adverse Events  |  Scrotal Complications  |  Bladder-related Complications  |  Pain  | Urinary Tract Infections  |  Causes of IC-related UTIs  |  Video Lecture  |  References

Intermittent catheterization (IC) is the preferred procedure for individuals with incomplete bladder emptying from non-neurogenic or neurogenic lower urinary tract dysfunction (NLUTD). IC is now considered the gold standard for bladder emptying in individuals following spinal cord injury (SCI) who have sufficient manual dexterity (Groen et al., 2016; Wyndaele et al, 2012). Goals of bladder management in individuals with a SCI include prevention of infection, injuries or trauma, optimizing social continence and function, and preventing upper tract deterioration. Despite these recommendations, complications and adverse events can arise in both men and women but are seen especially in male patients performing intermittent self-catheterization (ISC) for long-term.

Written by: Diane K. Newman, DNP, ANP-BC, FAAN
References:

 

  1. Bailey, L. & Jaffe, W.I. (2017). Obstructuve uropathy. In: D.K. Newman, J.F. Wyman, V.W. Welch, (Eds). Core Curriculum for Urologic Nursing. (pp.405-421) Pitman, New Jersey: Society of Urologic Nurses and Associates, Inc.
  2. Casey, R.G., Cullen I.M., Crotty, T., & Quinlan, D.M.  (2009) Intermittent self-catheterization and the risk of squamous cell cancer of the bladder: An emerging clinical entity? Canadian Urological Association Journal, 3(5), E51-E54.
  3. Clarke, S.A., Samuel, M., & Boddy, S.A.  (2005). Are prophylactic antibiotics necessary with clean intermittent catheterization? A randomized controlled trial. Journal of Pediatric Surgery, 40, 568-571.
  4. Cornejo-Davila V, Duran-Ortiz S, Pacheco-Gahbler C. (2017). Incidence of urethral stricture in patients with spinal cord injury treated with clean intermittent self-catheterization. Urology. 99:260–4.
  5. Cortese YJ, Wagner VE, Tierney M, Scully D, Devine DM, Fogarty A. (2020). Pathogen displacement during intermittent catheter insertion: a novel in vitro urethra model. J Appl Microbiol. Apr;128(4):1191-1200. doi: 10.1111/jam.14533.
  6. Cox L, He C, Bevins J, Clemens JQ, Stoffel JT, Cameron AP. (2017). Gentamicin bladder instillations decrease symptomatic urinary tract infections in neurogenic bladder patients on intermittent catheterization. Can Urol Assoc J. Sep;11(9):E350-E354. doi: 10.5489/cuaj.4434
  7. de Avila MAG, Rabello T, de Araújo MPB, Amaro JL, Zornoff DCM, Ferreira ASSBS, de Oliveira AS. (2021). Development and Validation of an Age-Appropriate Website for Children Requiring Clean IntermittentCatheterization. Rehabil Nurs. 2021 Mar-Apr 01;46(2):65-72. doi: 10.1097/rnj.0000000000000253
  8. De Ridder, D. J. M. K., Everaert, K., Fernandez, L. G., et al. (2005). Intermittent catheterisation with hydrophilic-coated catheters (SpeediCath) reduces the risk of clinical urinary tract infection in spinal cord injured patients: A prospective randomized parallel comparative trial. European Urology, 48(6), 991–995
  9. Groen J, Pannek J, Castro Diaz D, Del Popolo G, Gross T, Hamid R, et al. (2016). Summary of European Association of Urology (EAU) Guidelines on Neuro-Urology. Eur Urol. 69:324–33.
  10. Kinnear, N., Barnett, D., O'Callaghan, M., Horsell, K., Gani, J, Hennessey, D. (2020). The impact of catheter-based bladder drainage method on urinary tract infection risk in spinal cord injury and neurogenic bladder: A systematic review. Neurourol Urodyn. 39(2):854-862. doi: 10.1002/nau.24253
  11. Marei MM, Jackson R, Keene DJB. (2021). Intravesical gentamicin instillation for the treatment and prevention of urinarytract infections in complex paediatric urology patients: evidence for safety and efficacy. J Pediatr Urol. 17(1):65.e1-65.e11. doi: 10.1016/j.jpurol.2020.08.007
  12. Mitchell BG, Prael G, Curryer C, Russo PL, Fasugba O, Lowthian J, Cheng AC, Archibold J, Robertson M, Kiernan M. (2021). The frequency of urinarytract infections and the value of antiseptics in community-dwelling people who undertake intermittent urinarycatheterization: A systematic review. Am J Infect Control. Jan 21:S0196-6553(21)00022-5. doi: 10.1016/j.ajic.2021.01.009
  13. Moussa M, Chakra MA, Papatsoris AG, Dellis A, Dabboucy B, Fares Y. (2021). Bladder irrigation with povidone-iodine prevent recurrent urinarytract infections in neurogenic bladder patients on clean intermittent catheterization. Neurourol Urodyn. Feb;40(2):672-679. doi: 10.1002/nau.24607. Epub 2021 Jan 21
  14. Newman, D.K., New, P.W., Heriseanu, R. Petronis, S., Håkansson, J., Håkansson, M.A., & Lee, B.B. (2020). Intermittent catheterization with single- or multiple-reuse catheters: clinical study on safety and impact on quality of life. Int Urol Nephrol. Aug;52(8):1443-1451. doi: 10.1007/s11255-020-02435-9. 
  15. Patel DP, Herrick JS, Stoffel JT, et al. (2020) Reasons for cessation of clean intermittent catheterization after spinal cord injury: Results from the Neurogenic Bladder Research Group spinal cord injury registry. Neurourology and Urodynamics. 39:211–https://doi.org/10.1002/nau.24172
  16. Stensballe, J., Loom, D., et al. (2005). Hydrophilic-coated catheters for intermittent catheterisation reduce urethral microtrauma: A prospective, randomised, participant blinded, crossover study of three different types of catheters. Eu Urol, 48, 978-983.
  17. Stillman MD, Hoffman JM, Barber JK, Williams SR, Burns SP. (2018). Urinary tract infections and bladder management over the first year after discharge from inpatient rehabilitation. Spinal Cord Ser Cases. Oct 19;4:92. doi: 10.1038/s41394-018-0125-0.
  18. Stohrer M, Blok B, Castro-Diaz D, Chartier-Kastler E, Del Popolo G, Kramer G, Pannek J, Radziszewski P, Wyndaele JJ. (2009). EAU guidelines on neurogenic lower urinary tract dysfunction. Eur Urol. 56:81--8. doi: 10.1016/j.eururo.2009.04.028.
  19. Vapnek, J.M., Maynard, F.M., & Kim, J.  (2003). A prospective randomized trial of the LoFric hydrophilic coated catheter versus conventional plastic catheter for clean intermittent catheterization. Journal of Urology.169, 994-998.
  20. Walter, M., Ruiz, I. Squair, JW., Rios, LAS., Averbeck, MA.,  Krassioukov, AV. (2020). Prevalence of self-reported complications associated with intermittent catheterization in wheelchair athletes with spinal cord injury. Spinal Cord. Oct 13. doi: 10.1038/s41393-020-00565-6. 
  21. Wyndaele JJ, Brauner A, Geerlings SE, Bela K, Peter T, Bjerklund-Johanson TE. (2012). Clean intermittent catheterization and urinary tract infection: review and guide for future research. BJU Int. 110:E910–7.
  22. Wyndaele, J.J.  (2002). Complications of intermittent catheterization: Their prevention and treatment. Spinal Cord, 40(10), 536-541.

PARP Inhibitors in Prostate Cancer

Prostate cancer is a clinically heterogeneous disease with many patients having an indolent course requiring no interventions and others who either present with or progress to metastasis. While underlying dominant driving mutations are not widespread, there have been a number of key genomic mutations that have been consistently identified in prostate cancer patients, across the disease spectrum including gene fusion/chromosomal rearrangements (TMPRSS2-ERG), androgen receptor (AR) amplification, inactivation of tumor suppressor genes (PTEN/PI3-K/AKT/mTOR, TP53, Rb1) and oncogene activation (c-MYC, RAS-RAF).1
Written by: Zachary Klaassen, MD, MSc
References:
  1. Rubin MA, Maher CA, Chinnaiyan AM. Common gene rearrangements in prostate cancer. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2011;29(27):3659-3668.
  2. Kunkel TA, Erie DA. DNA mismatch repair. Annu Rev Biochem. 2005;74:681-710.
  3. Pritchard CC, Mateo J, Walsh MF, et al. Inherited DNA-Repair Gene Mutations in Men with Metastatic Prostate Cancer. The New England journal of medicine. 2016;375(5):443-453.
  4. Castro E, Romero-Laorden N, Del Pozo A, et al. PROREPAIR-B: A Prospective Cohort Study of the Impact of Germline DNA Repair Mutations on the Outcomes of Patients With Metastatic Castration-Resistant Prostate Cancer. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2019;37(6):490-503.
  5. Nicolosi P, Ledet E, Yang S, et al. Prevalence of Germline Variants in Prostate Cancer and Implications for Current Genetic Testing Guidelines. JAMA Oncol. 2019;5(4):523-528.
  6. Dantzer F, de La Rubia G, Menissier-De Murcia J, Hostomsky Z, de Murcia G, Schreiber V. Base excision repair is impaired in mammalian cells lacking Poly(ADP-ribose) polymerase-1. Biochemistry. 2000;39(25):7559-7569.
  7. McCabe N, Turner NC, Lord CJ, et al. Deficiency in the repair of DNA damage by homologous recombination and sensitivity to poly(ADP-ribose) polymerase inhibition. Cancer Res. 2006;66(16):8109-8115.
  8. Gudmundsdottir K, Ashworth A. The roles of BRCA1 and BRCA2 and associated proteins in the maintenance of genomic stability. Oncogene. 2006;25(43):5864-5874.
  9. Farmer H, McCabe N, Lord CJ, et al. Targeting the DNA repair defect in BRCA mutant cells as a therapeutic strategy. Nature. 2005;434(7035):917-921.
  10. Ashworth A. A synthetic lethal therapeutic approach: poly(ADP) ribose polymerase inhibitors for the treatment of cancers deficient in DNA double-strand break repair. J Clin Oncol. 2008;26(22):3785-3790.
  11. Fong PC, Boss DS, Yap TA, et al. Inhibition of poly(ADP-ribose) polymerase in tumors from BRCA mutation carriers. N Engl J Med. 2009;361(2):123-134.
  12. Mateo J, Carreira S, Sandhu S, et al. DNA-Repair Defects and Olaparib in Metastatic Prostate Cancer. The New England journal of medicine. 2015;373(18):1697-1708.
  13. Mateo J, Porta N, McGovern U, et al. TOPARP-B: A phase II randomized trial of the poly(ADP)-ribose polymerase (PARP) inhibitor olaparib for metastatic castration resistant prostate cancers (mCRPC) with DNA damage repair (DDR) alterations. J Clin Oncol. 2019;37(15_suppl):5005.
  14. de Bono J, Mateo J, Fizazi K, et al. Olaparib for Metastatic Castration-Resistant Prostate Cancer. The New England journal of medicine. 2020.
  15. de Wit R, de Bono J, Sternberg CN, et al. Cabazitaxel versus Abiraterone or Enzalutamide in Metastatic Prostate Cancer. The New England journal of medicine. 2019;381(26):2506-2518.
  16. Clarke N, Wiechno P, Alekseev B, et al. Olaparib combined with abiraterone in patients with metastatic castration-resistant prostate cancer: a randomised, double-blind, placebo-controlled, phase 2 trial. The lancet oncology. 2018;19(7):975-986.
  17. Abida W, Bryce AH, Vogelzang N, et al. Preliminary Results From TRITON2: A Phase II Study of Rucaparib in Patients with mCRPC Associated with Homologous Recombination Repair Gene Alterations. Ann Oncol. 2018;29(suppl_8):viii271.
  18. Smith MR, Sandhu S, Kelly WK, et al. Phase II study of niraparib in patients with metastatic castration-resistant prostate cancer (mCRPC) and biallelic DNA-repair gene defects (DRD): Preliminary results of GALAHAD. J Clin Oncol. 2019;37(7_suppl):202.
  19. Hussain M, Daignault-Newton S, Twardowski PW, et al. Targeting Androgen Receptor and DNA Repair in Metastatic Castration-Resistant Prostate Cancer: Results From NCI 9012. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2018;36(10):991-999.
  20. Hussain M, Carducci MA, Slovin S, et al. Targeting DNA repair with combination veliparib (ABT-888) and temozolomide in patients with metastatic castration-resistant prostate cancer. Invest New Drugs. 2014;32(5):904-912.
  21. Yu EY, Massard C, Retz M, et al. Keynote-365 cohort a: Pembrolizumab (pembro) plus olaparib in docetaxel-pretreated patients (pts) with metastatic castrate-resistant prostate cancer (mCRPC). J Clin Oncol. 2019;37(7_suppl):145.

Best Practices for Management - Intermittent Catheters

Intermittent catheterization can have a significant physical and/or emotional impact on patients’ lives.Intermittent_Catheterization.png


Patients may be concerned about the discomfort associated with intermittent catheterization(IC), the need to maintain privacy, the fear of performing the catheterization, and the inability to find a clean and appropriate toilet or bathroom for catheterization when traveling outside their home. Clinicians need to consider these patient concerns in their teaching and recommend possible strategies.


Teaching Catheterization:

Successful intermittent self-catheterization (ISC) requires education and support, particularly during initial teaching and follow up. Although long term ISC is safe and well accepted, an early dropout rate of about 20% has been described in children and adolescents (Pohl et al., 2002), so good support, professional instruction on catheterization technique and periodic follow-up is necessary to obtain and maintain patient compliance.  A knowledgeable and experienced clinician, in most cases a nurse, is an important component for successful self-catheterization teaching. The nurse should assess what the patient and/or the person performing the catheterization knows about the urinary tract and functions of the bladder. Providing an overview of anatomy with pictures or the use of an anatomic model of the perineum can be very helpful. Many catheter manufacturers have visual guides or videos that can be used when teaching patients and/or caregivers.

Other teaching components include how to handle the catheter, identifying the urinary meatus, and care of the catheter. It is important that patients and/or the person performing the catheterization demonstrate understanding and/or ability or perform catheterization under the supportive supervision of the nurse.

Teaching Environment:

Most adults learn best under low to moderate stress, so it is important to teach self-catheterization in a low stress setting. The nurse should also assess the patient’s ability to learn intermittent self-catheterization (ISC), motivation to continue long-term catheterization, awareness of problems associated with catheterization, and the understanding of how to avoid possible complications.  Other factors to consider are the patient’s bladder capacity (still voiding some amounts or complete retention), adequate bladder outlet resistance (absence of urethral scarring, strictures or enlarged prostate), absence of urethral sensitivity to pain with catheterization, and patient’s possible fear of catheterization.  Initially, many patients may be extremely reluctant to perform any procedure that involves the genitals, but this is basically a “fear of the unknown.” Determining acceptance of intermittent catheterization is vital because non-compliance is seen in many patients, particularly adolescents.

General Assessment:

Many clinicians are concerned about teaching an older patient ISC but age is not necessarily a determinant to the success of ISC.  Disabilities, such as poor eyesight or blindness, poor hand dexterity, lack of perineal sensation, tremor, mental disability, and paraplegia, do not necessarily preclude the ability to perform ISC. But these obstacles may be difficult to overcome in some patients and caregivers. Teaching a patient with a spinal cord injury maybe even more of a challenge because motor and sensory impairment may require changes to catheterization techniques. Impaired cognitive function can affect success in being able to carry out the procedure independently.

Important Medical History:

Any previous experience with catheterization (e.g indwelling or IC) should be determined prior to teaching a patient ISC as this will direct the teaching and should be considered when choosing a catheter.  In a male patient, a history of urethral strictures or scarring or enlarged prostate may indicate need for a Coudé tip catheter.  If a woman has pelvic organ prolapse, angling the catheter around the prolapse may be needed.

Choosing the catheter:

With advances in catheter technology, the number of catheter types and designs has increased, adding complexity to the catheterization process for both the nurse and the patient.  Catheter types are now gender specific, long length for males, shorter length for females. acknowledging the anatomical differences in urethral length between men and women.

Design changes include the integration of all needed equipment (such as catheter, water-based

lubricant, and drainage bag) into a compact and user friendly system.  These are referred to as “closed systems or kits”. But some patients with limited dexterity may find it difficult to advance a catheter through a collection bag.

Intermittent_Catheterization2.png

When recommending a catheter, consider the patient’s lifestyle including plans for catheter storage, carrying, and disposal.  Offering a selection of three to four types of catheter is recommended.

Catheterization Position:


IC teaching includes identifying the best position for performing catheterization and it should be individualized for each patient. Variables to consider when assessing a patient for the ideal position includes abnormally high body mass index and body hiatus (large pannus) as both could restrict perineal and urethral access.  Most patients tend to catheterize in their bathroom, sitting on or standing in front of a toilet.  For someone who is in a wheelchair most of the day, catheterizing while sitting in the chair is an option but maybe more difficult for women.  Women may choose to use a mirror to visualize the urethra is also an option.

position.png

Catheterization Schedule:


The frequency of catheterization depends on patient history and the clinical reasons for initiating an IC program: for example, the individual with reflux and symptomatic UTI will require more frequent catheterizations than the person who is using IC to manage leakage caused by incomplete emptying and who has no UTI symptoms. A catheterization schedule can be recommended based on frequency-volume records, functional bladder capacity based on urodynamics findings, ultrasound bladder scans for PVR, and the impact of catheterization on a patient’s quality of life.  As a general rule, bladder volume should not exceed 500 mLs, and some advocate not exceeding 400 mLs. Based on an individual’s average output, catheterization is usually performed four to six times during the day. Many patients, especially older patients, may need to catheterize at bedtime and during the night. The bladder should be emptied completely with each catheterization.  When starting intermittent catheterization, the patient and/or caregiver should record the amount of urine drained from the bladder. If the patient voids, catheterization should always be performed after voiding.

Catheter Use and Care:
As there are no clear guidelines about the length of time for catheter use if the patient is re-using an uncoated catheter, re-using the same catheter for multiple catheterizations is notCatheterization_Position3.png recommended.  The cleaning of the catheter between uses has no basis in research because there are no published randomized controlled clinical trials of cleaning methods. The comparative effectiveness of cleaning methods, therefore, is unknown.


Currently, catheter manufacturers do not provide instructions for catheter re-use or cleaning. So best practices do not support the re-use of single-use catheters at this time.

There are no set guidelines for monitoring patients performing ISC, although many urologists advocate regular urine cytology and cystoscopy with random or targeted bladder biopsies.

In reality, many patients performing intermittent catheterization are lost to urologic follow up.

March 2021
© 2021 Digital Science Press, Inc. and UroToday.com
Written by: Diane K. Newman, DNP, ANP-BC, FAAN
References:
  1. Beauchemin L, Newman DK, Le Danseur M, Jackson A, Ritmiller M. (2018). Best practices for clean intermittent catheterization. 48, 9(Sept 2018):49-54.
  2. Canadian Practice Recommendations For Nurses, Clean Intermittent Urethral Catheterization in Adults, (April, 2020), Retrieved from:  https://ipac-canada.org/photos/custom/Members/pdf/Clean-Intermittent-Urethral-Catheterization-Adults-for-Nurses-BPR-May2020.pdf
  3. Gray, M., Wasner, M., Nichols, T.J. (2019). NursingPractice Related to IntermittentCatheterization: A Cross-Sectional Survey. Wound Ostomy Continence Nurs. 46(5):418-423. doi: 10.1097/WON.0000000000000576.
  4. Goetz, L.L., Droste, L., Klausner, A.P., & Newman, D.K. (2018). Intermittent catheterization. In: D.K. Newman, E.S. Rovner, A.J. Wein, (Eds). Clinical Application of Urologic Catheters and Products. (pp. 47-77) Switzerland: Springer International Publishing.
  5. Hentzen, C., Haddad, R., Ismael, S.S., Peyronnet, B., Gamé, X., Denys, P., … GRAPPPA (Clinical research Group of perineal dysfunctions in older adults). (2018) Intermittent self-catheterization in older adults: predictors of success for technique learning. Int Neurourol J. 22(1):65‐  https://doi.org/10.5213/inj.1835008.504
  6. Logan, K. (2020). An exploration of men's experiences of learning intermittent self-catheterisation with a silicone catheter. Br J Nurs. 29(2):84-90. https:// doi: 10.12968/bjon.2020.29.2.84
  7. Logan, K. (2017). The female experience of ISC with a silicone catheter. Br J Nurs. 26(2):82-88. https://doi: 10.12968/bjon.2017.26.2.82.
  8. Logan, K. (2015). The male experience of ISC with a silicone catheter. Br J Nursing 24(9), S32–4. https://doi: 10.12968/bjon.2015.24.Sup9.S30.
  9. Mangnall, J. (2015) Managing and teaching intermittent catheterisation. Br J Community Nurs. 20(2):82. https://doi.org/10.12968/bjcn.2015.20.2.82
  10. Martins, G., Soler, Z.A., Batigalia, F., & Moore, K.N. (209). Clean intermittent catheterization: Educational booklet directed to caregivers of children with neurogenic bladder dysfunction. Journal Wound Ostomy Conti. N, 36(5), 545-549. 
  11. Newman DK. (2017). Devices, products, catheters, and catheter-associated urinary tract infections. In: Newman DK, Wyman JF, Welch VW, editors. Core Curriculum for Urologic Nursing. 1st Pitman (NJ): Society of Urologic Nurses and Associates, Inc; 439-66.
  12. Newman DK, Willson MM. (2011) Review of intermittent catheterization and current best practices. Urol Nurs. Jan-Feb;31(1):12-28, 48; quiz 29. PubMed PMID: 21542441
  13. Pohl, H.G., Bauer, S.B., Borer, J.G., Diamond, D.A., Kelly, M.D., Grant, R., ... Retik, A.B.. (2002). The outcome of voiding dysfunction managed with clean intermittent catheterization in neurologically and anatomically normal children. British Journal of Urology International, 89(9), 923-927.
  14. Vahr, S., Cobussen-Boekhorst, H., Eikenboom, J., Geng, V., Holroyd, S., Lester, M., … Vandewinkel, C. (2013). Evidence-based guidelines for best practice in urological health care catheterisation dilatation, urethral intermittent in adults. European Association of Urology Nurses. Retrieved from  http://nurses.uroweb.org/wpcontent/uploads/2013_EAUN_Guide line_Milan_2013-Lr_DEF.pdf
  15. Vahr, S., Cobussen-Boekhorst, H., Eikenboom, J., Geng, V., Holroyd, S., Lester, M., … Vandewinkel, C. members of the European Association of Urology Nurses Guidelines Office. An edited summary of the European Association of Urology Nurses evidence-based guideline on Intermittent Urethral Catheterisation in Adults – Evidence-based Guidelines for Best Practice in Urological Health Care. Edition presented at the 18th International EAUN Meeting, London 2017. ISBN 978-90-79754-92-2. Retrieved from  http://www.eaun.uroweb.org
  16. Woodbury M.G., Hayes K.C., & Askes H.K. (2008). Intermittent catheterization practices following spinal cord injury: A national survey. Canadian Journal Urology, 15(3), 4065-4071.

PARP Inhibitors, Prostate Cancer and a Promise Fulfilled

June 26, 2020, marked the 20th anniversary of the publication of the first working draft from the Human Genome Project. At a special White House event to commemorate the results of this 10-year public effort (it was really more like 50 years since the discovery of DNA, but I digress), then-President Bill Clinton called the project “the most wondrous map ever created by humankind”, and touted its promise to detect, prevent, and treat disease.  Obtaining that first sequence from one human cost about $2B and resulted from a massive global public/private partnership.

Written by: Charles Ryan, MD
References: 1. McKie, Robin. ‘The wondrous map’: how unlocking human DNA changed the course of science. The Guardian. June 21, 2020. Retrieved from: https://www.theguardian.com/science/2020/jun/21/human-genome-project-unlocking-dna-covid-19-cystic-fibrosis-molecular-scientists

Intermittent Catheter Types

The number of catheter types and designs has increased with the advancement of new technology. This has added complexity to the catheterization process for both the nurse and the patient.
Written by: Diane K. Newman, DNP, ANP-BC, FAAN
References:
  1. Chartier-Kastler E, Amarenco G, Lindbo L, et al. (2013). A prospective, randomized, crossover, multicenter study comparing quality of life using compact versus standard catheters for intermittent self-catheterization. J Urol. 190(3):942-947.
  2. Cardenas, D. D., Moore, K. N., Dannels-McClure, A., et al. (2011). Intermittent catheterization with a hydrophilic-coated catheter delays urinary tract infections in acute spinal injury: A prospective randomised, multicenter trial. Physical Medicine and Rehabilitation, 3(5), 408–417.
  3. Christnsen, J., Ostri, P., Frimodt-moller, C., et al. (1987). Intravesical pressure changes during bladder drainage in patients with acute urinary retention. Urologia Internationalis, 42(3), 181–184.
  4. Christison K, Walter M, Wyndaele JJM, et al. (2018). Intermittent catheterization: The devil is in the details. J Neurotrauma. Feb 1. doi: 10.1089/neu.2017.5413doi
  5. DeFoor W, Reddy P, Reed M, et al. (2017). Results of a prospective randomized control trial comparing hydrophilic to uncoated catheters in children with neurogenic bladder. J Pediatr Urol. Aug;13(4):373.e1-373.e5. doi: 10.1016/j.jpurol.2017.06.003. 
  6. Goetz LL, Droste L, Klausner AP, Newman DK. (2018). Intermittent catheterization. In: D.K. Newman, E.S. Rovner, A.J. Wein, (Eds). Clinical Application of Urologic Catheters and Products. (pp. 47-77) Switzerland: Springer International Publishing
  7. Håkansson MA. (2014). Reuse versus single-use catheters for intermittent catheterization: what is safe and preferred? Review of current status. Spinal Cord. 52(7):511-516.
  8. Newman, D.K., New, P.W., Heriseanu, R. Petronis, S., Håkansson, J., Håkansson, M.A., & Lee, B.B. (2020). Intermittent catheterization with single- or multiple-reuse catheters: clinical study on safety and impact on quality of life. Int Urol Nephrol. Aug;52(8):1443-1451. doi: 10.1007/s11255-020-02435-9. 
  9. Newman DK. (2017). Devices, products, catheters, and catheter-associated urinary tract infections. In: Newman DK, Wyman JF, Welch VW, editors. Core Curriculum for Urologic Nursing. 1st Pitman (NJ): Society of Urologic Nurses and Associates, Inc; 2017. p.439-66.
  10. Newman DK, Willson MM. (2011). Review of intermittent catheterization and current best practices. Urol Nurs. Jan-Feb;31(1):12-28, 48; quiz 29. PubMed PMID: 21542441
  11. Rognoni C, Tarricone R. (2017). Intermittent catheterization with hydrophilic and non-hydrophilic urinary catheters: systematic literature review and meta-analyses. BMC Urol. 17(1):4.
  12. Shamout S, Biardeau X, Corcos J, Campeau L. (2017). Outcome comparison of different approaches to self-intermittent catheterization in neurogenic patients: a systematic review. Spinal Cord. 55(7):629-643.
  13. Sun AJ, Comiter CV, Elliott CS. (2018). The cost of a catheter: An environmental perspective on single-use clean intermittent catheterization. Neurourol Urodyn. 37(7):2204-2208.

Germline Testing for DNA Repair Mutations in Prostate Cancer: Who, When and How?

Germline testing indications for prostate cancer (PCa) have rapidly expanded and have been catapulted by precision medicine and precision management.1,2 In particular, testing for mutations in DNA repair genes such as in BRCA2, BRCA1, ATM, and other DNA repair genes, has taken front-stage due to the clinical activity of poly (ADP-ribose) polymerase (PARP) inhibitors in metastatic, castration-resistant prostate cancer (mCRPC).3-7 Phase II trial data supported the U.S. Federal Drug Administration (FDA) designations for olaparib, rucaparib, and niraparib due to demonstrated response rates particularly among men with BRCA2 mutations along with other DNA repair genes.5-7 Excitingly, the FDA has recently approved two PARP inhibitors for mCRPC. Rucaparib was granted accelerated approval for BRCA1/2-mutated mCRPC with prior treatment with androgen receptor-directed therapy and taxane-based chemotherapy based on TRITON2.5 Olaparib was FDA-approved for the treatment of mCRPC in men with deleterious or suspected deleterious germline or somatic homologous recombination repair gene mutations who have progressed following prior treatment with enzalutamide or abiraterone based on PROfound.4 These approvals provide exciting therapeutic options for men with mCRPC and will increase the role of germline testing for DNA repair mutations. Furthermore, the National Comprehensive Cancer Network (NCCN) guidelines recommend germline testing for DNA repair mutations in all men with mCRPC, with additional testing criteria proposed.8,9 The international Philadelphia Prostate Cancer Consensus Conference 2019 has provided significant multidisciplinary guidance regarding germline testing for DNA repair mutations across the stage spectrum, along with strategies for implementation of genetic counseling and germline testing.1 Therefore, understanding the role of germline testing in PCa is now critical to urologic and oncology practice for this disease. Here, we will address who should be considered for germline testing, when germline testing may influence treatment and management, and how to implement germline testing involving provider practices and genetic counseling.

Written by: Veda N. Giri, MD
References: 1. Giri, Veda N., Karen E. Knudsen, William K. Kelly, Heather H. Cheng, Kathleen A. Cooney, Michael S. Cookson, William Dahut et al. "Implementation of Germline Testing for Prostate Cancer: Philadelphia Prostate Cancer Consensus Conference 2019." Journal of Clinical Oncology (2020): JCO-20.
2. Cheng, Heather H., Alexandra O. Sokolova, Edward M. Schaeffer, Eric J. Small, and Celestia S. Higano. "Germline and somatic mutations in prostate cancer for the clinician." Journal of the National Comprehensive Cancer Network 17, no. 5 (2019): 515-521.
3. Mateo, Joaquin, Suzanne Carreira, Shahneen Sandhu, Susana Miranda, Helen Mossop, Raquel Perez-Lopez, Daniel Nava Rodrigues et al. "DNA-repair defects and olaparib in metastatic prostate cancer." New England Journal of Medicine 373, no. 18 (2015): 1697-1708.
4. de Bono, Johann, Joaquin Mateo, Karim Fizazi, Fred Saad, Neal Shore, Shahneen Sandhu, Kim N. Chi et al. "Olaparib for metastatic castration-resistant prostate cancer." New England Journal of Medicine 382, no. 22 (2020): 2091-2102.
5. Abida, Wassim, David Campbell, Akash Patnaik, Jeremy D. Shapiro, Brieuc Sautois, Nicholas J. Vogelzang, Eric G. Voog et al. "Non-BRCA DNA damage repair gene alterations and response to the PARP inhibitor rucaparib in metastatic castration-resistant prostate cancer: Analysis From the Phase II TRITON2 Study." Clinical Cancer Research 26, no. 11 (2020): 2487-2496.
6. Mateo, Joaquin, Nuria Porta, Diletta Bianchini, Ursula McGovern, Tony Elliott, Robert Jones, Isabel Syndikus et al. "Olaparib in patients with metastatic castration-resistant prostate cancer with DNA repair gene aberrations (TOPARP-B): a multicentre, open-label, randomised, phase 2 trial." The Lancet Oncology 21, no. 1 (2020): 162-174.
7. Smith, M. R., S. K. Sandhu, W. K. Kelly, H. I. Scher, E. Efstathiou, P. N. Lara, E. Y. Yu et al. "LBA50 Pre-specified interim analysis of GALAHAD: A phase II study of niraparib in patients (pts) with metastatic castration-resistant prostate cancer (mCRPC) and biallelic DNA-repair gene defects (DRD)." Annals of Oncology 30, no. Supplement_5 (2019): mdz394-043.
8. National Comprehensive Cancer Network Clinical Guidelines in Oncology (NCCN Guidelines®): Prostate Cancer (Version 4.2019). Accessed June 6, 2020. Available at NCCN.org.
9. National Comprehensive Cancer Network Clinical Guidelines in Oncology (NCCN Guidelines®): Genetic/Familial High-Risk Assessment: Breast, Ovarian, and Pancreatic (Version 1.2020). Accessed June 6, 2020. Available at NCCN.org.
10. Carter, H. Ballentine, Brian Helfand, Mufaddal Mamawala, Yishuo Wu, Patricia Landis, Hongjie Yu, Kathleen Wiley et al. "Germline mutations in ATM and BRCA1/2 are associated with grade reclassification in men on active surveillance for prostate cancer." European urology 75, no. 5 (2019): 743-749.
11. National Comprehensive Cancer Network Clinical Guidelines in Oncology (NCCN Guidelines®): Prostate Cancer Early Detection (Version 2.2019). Accessed June 6, 2020. Available at NCCN.org.
12. National Cancer Institute Genetics of Prostate Cancer (PDQ®)–Health Professional Version. Accessed June 9, 2020. Available at: https://www.cancer.gov

Will Immunotherapy Work as Salvage Therapy for Patients with Testicular Germ Cell Tumors?

It’s now been 3.5 years since I last wrote anything about testicular germ cell tumors and ongoing clinical trials.1  Although we still cure most men afflicted with this disease, we have not made any major new therapeutic advancements since I wrote that last article.  Approximately, 15-20% of patients with metastatic germ cell tumors will relapse following initial chemotherapy.  Even in this situation, approximately 50% can still be cured with salvage treatments, either with more conventional cisplatin-based chemotherapy or with high-dose chemotherapy and autologous stem cell rescue.2-4

PARP Inhibitors - A Breakthrough in Targeted Therapies for Prostate Cancer

PARP inhibition has become a key therapeutic option for a genomically-defined subset of patients with metastatic prostate cancer. Further clinical trial work may expand both the number and setting of PARP inhibitor therapies. In this review, we will summarize the current indications for PARP inhibitor monotherapies and combination(s), review data from clinical trials in prostate cancer, discuss management of commonly encountered side effects, and highlight exciting clinical research on expanding the role of PARP inhibitors in prostate cancer.
Written by: Arpit Rao, MBBS and Charles Ryan, MD
References: 1. Clark, J. B., G. M. Ferris, and S. Pinder. "Inhibition of nuclear NAD nucleosidase and poly ADP-ribose polymerase activity from rat liver by nicotinamide and 5′-methyl nicotinamide." Biochimica et Biophysica Acta (BBA)-Nucleic Acids and Protein Synthesis 238, no. 1 (1971): 82-85.
2. Tentori, Lucio, Ilaria Portarena, and Grazia Graziani. "Potential clinical applications of poly (ADP-ribose) polymerase (PARP) inhibitors." Pharmacological research 45, no. 2 (2002): 73-85.
3. Farmer, H., N. McCabe, C. J. Lord, and A. N. Tutt. "Johnso n DA, Richardson TB, Santarosa M, Dillon KJ, Hickson I, Knights C, Martin NM, Jackson SP, Smith GC and Ashworth A. Targeting the DN A repair defect in BRCA mutant cells as a therapeutic strategy." Nature 434 (2005): 917-921.
4. Bryant, Helen E., Niklas Schultz, Huw D. Thomas, Kayan M. Parker, Dan Flower, Elena Lopez, Suzanne Kyle, Mark Meuth, Nicola J. Curtin, and Thomas Helleday. "Specific killing of BRCA2-deficient tumours with inhibitors of poly (ADP-ribose) polymerase." Nature 434, no. 7035 (2005): 913-917.
5. “Drugs@FDA: FDA-Approved Drugs.” Accessed June 14, 2020. https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=reportsSearch.process.
6. U.S. Food and Drug Administration - Full prescribing information for Lynparza (olaparib). U.S. Food and Drug Administration - Full prescribing information for Lynparza (olaparib). Accessed June 14, 2020. https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/208558s013lbl.pdf
7. U.S. Food and Drug Administration - Full prescribing information for Rubraca (rucaparib). U.S. Food and Drug Administration - Full prescribing information for Rubraca (rucaparib). Accessed June 14, 2020. https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/209115s004lbl.pdf
8. U.S. Food and Drug Administration - Full prescribing information for Zejula (niraparib). U.S. Food and Drug Administration - Full prescribing information for Zejula (niraparib). Accessed June 14, 2020.https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/208447s015s017lbledt.pdf
9. U.S. Food and Drug Administration - Full prescribing information for Talzenna (talazoparib). U.S. Food and Drug Administration - Full prescribing information for Talzenna (talazoparib). Accessed June 14, 2020. https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/211651s005lbl.pdf
10. Mateo, Joaquin, Suzanne Carreira, Shahneen Sandhu, Susana Miranda, Helen Mossop, Raquel Perez-Lopez, Daniel Nava Rodrigues et al. "DNA-repair defects and olaparib in metastatic prostate cancer." New England Journal of Medicine 373, no. 18 (2015): 1697-1708.
11. Mateo, Joaquin, Nuria Porta, Diletta Bianchini, Ursula McGovern, Tony Elliott, Robert Jones, Isabel Syndikus et al. "Olaparib in patients with metastatic castration-resistant prostate cancer with DNA repair gene aberrations (TOPARP-B): a multicentre, open-label, randomised, phase 2 trial." The Lancet Oncology 21, no. 1 (2020): 162-174.
12. de Bono, Johann, Joaquin Mateo, Karim Fizazi, Fred Saad, Neal Shore, Shahneen Sandhu, Kim N. Chi et al. "Olaparib for metastatic castration-resistant prostate cancer." New England Journal of Medicine 382, no. 22 (2020): 2091-2102.
13. Abida, W., D. Campbell, A. Patnaik, B. Sautois, J. Shapiro, N. J. Vogelzang, A. H. Bryce et al. "Preliminary results from the TRITON2 study of rucaparib in patients (pts) with DNA damage repair (DDR)-deficient metastatic castration-resistant prostate cancer (mCRPC): Updated analyses." Annals of Oncology 30 (2019): v327-v328.
14. Smith, Matthew Raymond, Shahneen Kaur Sandhu, William Kevin Kelly, Howard I. Scher, Eleni Efstathiou, Primo Lara, Evan Y. Yu et al. "Phase II study of niraparib in patients with metastatic castration-resistant prostate cancer (mCRPC) and biallelic DNA-repair gene defects (DRD): preliminary results of GALAHAD." (2019): 202-202.
15. De Bono, Johann S., Niven Mehra, Celestia S. Higano, Fred Saad, Consuelo Buttigliero, Marielena Mata, Hsiang-Chun Chen et al. "TALAPRO-1: A phase II study of talazoparib (TALA) in men with DNA damage repair mutations (DDRmut) and metastatic castration-resistant prostate cancer (mCRPC)—First interim analysis (IA)." (2020): 119-119.
16. LaFargue, Christopher J., Graziela Z. Dal Molin, Anil K. Sood, and Robert L. Coleman. "Exploring and comparing adverse events between PARP inhibitors." The Lancet Oncology 20, no. 1 (2019): e15-e28.
17. Sandhu, Shahneen K., William R. Schelman, George Wilding, Victor Moreno, Richard D. Baird, Susana Miranda, Lucy Hylands et al. "The poly (ADP-ribose) polymerase inhibitor niraparib (MK4827) in BRCA mutation carriers and patients with sporadic cancer: a phase 1 dose-escalation trial." The lancet oncology 14, no. 9 (2013): 882-892.
18. Francica, Paola, and Sven Rottenberg. "Mechanisms of PARP inhibitor resistance in cancer and insights into the DNA damage response." Genome medicine 10, no. 1 (2018): 1-3.
19. Brenner, J. Chad, Bushra Ateeq, Yong Li, Anastasia K. Yocum, Qi Cao, Irfan A. Asangani, Sonam Patel et al. "Mechanistic rationale for inhibition of poly (ADP-ribose) polymerase in ETS gene fusion-positive prostate cancer." Cancer cell 19, no. 5 (2011): 664-678.
20. Asim, Mohammad, Firas Tarish, Heather I. Zecchini, Kumar Sanjiv, Eleni Gelali, Charles E. Massie, Ajoeb Baridi et al. "Synthetic lethality between androgen receptor signaling and the PARP pathway in prostate cancer." Nature communications 8, no. 1 (2017): 1-10.
21. Clarke, Noel, Pawel Wiechno, Boris Alekseev, Nuria Sala, Robert Jones, Ivo Kocak, Vincenzo Emanuele Chiuri et al. "Olaparib combined with abiraterone in patients with metastatic castration-resistant prostate cancer: a randomised, double-blind, placebo-controlled, phase 2 trial." The Lancet Oncology 19, no. 7 (2018): 975-986.

Bladder Tumor Subtype Commitment Occurs in Carcinoma In-Situ Driven by Key Signaling Pathways Including ECM Remodeling - Beyond the Abstract

It is profound that despite years of intensive therapeutic efforts, a staggering 50-60% of patients with muscle-invasive urothelial bladder cancer will have a local or distant disease recurrence within five years with only limited therapeutic options. Therefore, it is imperative to understand how these tumors develop and continue efforts to identify new therapeutic targets. Because basal and luminal tumor subtypes of invasive bladder tumors have significant prognostic and predictive impacts for patients we sought to answer the question: When does subtype commitment occur and which signaling gene pathways are important during the process of tumorigenesis?
Written by: Markus Eckstein, MD, Institute of Pathology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
References: 1. Wullweber, Adrian, Reiner Strick, Fabienne Lange, Danijel Sikic, Helge Taubert, Sven Wach, Bernd Wullich et al. "Bladder tumor subtype commitment occurs in carcinoma in-situ driven by key signaling pathways including ECM remodeling." Cancer Research (2021).

What Are the Most Common Genomic Aberrations Seen in DNA Damage Response (DDR) Pathways in Advanced Prostate Cancer?

What are the most common genomic aberrations seen in DNA damage response (DDR) pathways in advanced prostate cancer?


Men with advanced prostate cancer have a 10-15% risk of carrying a hereditary, or germline, variant in a DNA damage response (DDR) gene, as previously discussed. Pathogenic or deleterious variants in these same DDR genes can also be found at the somatic, or tumor-associated level, in up to 25% of metastatic castrate-resistant prostate cancer.1 Precision medicine currently centers mostly on discovering these somatic aberrations through DNA sequencing to then guide targeted treatment selection for patients with advanced cancer. Compared to other solid tumors such as melanoma or urothelial cancers, advanced prostate cancer overall displays relatively low tumor mutational burden (TMB), with rare exceptions including those tumors with mismatch repair (MMR) deficiency and/or subsequent high microsatellite instability (MSI-H). Defective MMR genes and/or MSI-H are seen in ~3-8% of prostate cancer, with the majority being of sporadic origin and with Lynch syndrome not displaying high penetrance in prostate cancer.2-4 The remainder of DDR defects seen in prostate cancer center mostly around the DNA double-strand break repair, replication stress signaling, and cell cycle regulation pathways. DDR gene alterations occur in ~25% of metastatic castration-resistant prostate cancer (mCRPC), with BRCA2 being by far the most frequently altered gene in this pathway, followed by ATM, and then to a lesser degree BRCA1 and CDK12, with more rare deleterious variants found in multiple other homologous recombination repair (HRR) and cell cycle genes.1 Alterations in BRCA2 are found significantly greater in advanced prostate cancer compared to primary disease, and certain histologic subtypes like ductal and cribriform disease are enriched for deleterious variants in DDR genes.5
Written by: Patrick G. Pilié, MD
References: 1. Robinson, Dan, Eliezer M. Van Allen, Yi-Mi Wu, Nikolaus Schultz, Robert J. Lonigro, Juan-Miguel Mosquera, Bruce Montgomery et al. "Integrative clinical genomics of advanced prostate cancer." Cell 161, no. 5 (2015): 1215-1228.
2. Rodrigues, Daniel Nava, Pasquale Rescigno, David Liu, Wei Yuan, Suzanne Carreira, Maryou B. Lambros, George Seed et al. "Immunogenomic analyses associate immunological alterations with mismatch repair defects in prostate cancer." The Journal of clinical investigation 128, no. 10 (2018): 4441-4453.
3. Bauer, Christina M., Anna M. Ray, Bronwen A. Halstead-Nussloch, Robert G. Dekker, Victoria M. Raymond, Stephen B. Gruber, and Kathleen A. Cooney. "Hereditary prostate cancer as a feature of Lynch syndrome." Familial cancer 10, no. 1 (2011): 37-42.
4. Abida, Wassim, Michael L. Cheng, Joshua Armenia, Sumit Middha, Karen A. Autio, Hebert Alberto Vargas, Dana Rathkopf et al. "Analysis of the prevalence of microsatellite instability in prostate cancer and response to immune checkpoint blockade." JAMA oncology 5, no. 4 (2019): 471-478.
5. Schweizer, Michael T., Emmanuel S. Antonarakis, Tarek A. Bismar, Liana B. Guedes, Heather H. Cheng, Maria S. Tretiakova, Funda Vakar-Lopez et al. "Genomic characterization of prostatic ductal adenocarcinoma identifies a high prevalence of DNA repair gene mutations." JCO precision oncology 3 (2019): 1-9.
6. Gundem, Gunes, Peter Van Loo, Barbara Kremeyer, Ludmil B. Alexandrov, Jose MC Tubio, Elli Papaemmanuil, Daniel S. Brewer et al. "The evolutionary history of lethal metastatic prostate cancer." Nature 520, no. 7547 (2015): 353-357.
7. Wyatt, Alexander W., Matti Annala, Rahul Aggarwal, Kevin Beja, Felix Feng, Jack Youngren, Adam Foye et al. "Concordance of circulating tumor DNA and matched metastatic tissue biopsy in prostate cancer." JNCI: Journal of the National Cancer Institute 109, no. 12 (2017).
8. Li, Marilyn M., Michael Datto, Eric J. Duncavage, Shashikant Kulkarni, Neal I. Lindeman, Somak Roy, Apostolia M. Tsimberidou et al. "Standards and guidelines for the interpretation and reporting of sequence variants in cancer: a joint consensus recommendation of the Association for Molecular Pathology, American Society of Clinical Oncology, and College of American Pathologists." The Journal of molecular diagnostics 19, no. 1 (2017): 4-23.
9. Ng, Patrick Kwok-Shing, Jun Li, Kang Jin Jeong, Shan Shao, Hu Chen, Yiu Huen Tsang, Sohini Sengupta et al. "Systematic functional annotation of somatic mutations in cancer." Cancer Cell 33, no. 3 (2018): 450-462.
10. Yi, Song, Shengda Lin, Yongsheng Li, Wei Zhao, Gordon B. Mills, and Nidhi Sahni. "Functional variomics and network perturbation: connecting genotype to phenotype in cancer." Nature Reviews Genetics 18, no. 7 (2017): 395.
11. Johnson, Amber, Jia Zeng, Ann M. Bailey, Vijaykumar Holla, Beate Litzenburger, Humberto Lara-Guerra, Gordon B. Mills, John Mendelsohn, Kenna R. Shaw, and Funda Meric-Bernstam. "The right drugs at the right time for the right patient: the MD Anderson precision oncology decision support platform." Drug discovery today 20, no. 12 (2015): 1433-1438.
12. Li, Quan, and Kai Wang. "InterVar: clinical interpretation of genetic variants by the 2015 ACMG-AMP guidelines." The American Journal of Human Genetics 100, no. 2 (2017): 267-280.
13. Kurnit, Katherine C., Ecaterina E. Ileana Dumbrava, Beate Litzenburger, Yekaterina B. Khotskaya, Amber M. Johnson, Timothy A. Yap, Jordi Rodon et al. "Precision oncology decision support: current approaches and strategies for the future." Clinical Cancer Research 24, no. 12 (2018): 2719-2731.
14. Cheng, Heather H., Alexandra O. Sokolova, Edward M. Schaeffer, Eric J. Small, and Celestia S. Higano. "Germline and somatic mutations in prostate cancer for the clinician." Journal of the National Comprehensive Cancer Network 17, no. 5 (2019): 515-521.
15. Le, Dung T., Jennifer N. Uram, Hao Wang, Bjarne R. Bartlett, Holly Kemberling, Aleksandra D. Eyring, Andrew D. Skora et al. "PD-1 blockade in tumors with mismatch-repair deficiency." New England Journal of Medicine 372, no. 26 (2015): 2509-2520.
16. Marcus, Leigh, Steven J. Lemery, Patricia Keegan, and Richard Pazdur. "FDA approval summary: pembrolizumab for the treatment of microsatellite instability-high solid tumors." Clinical Cancer Research 25, no. 13 (2019): 3753-3758.
17. Center for Drug Evaluation and Research. “FDA Grants Accelerated Approval to Rucaparib for BRCA-Mutated Metastatic Castration-Resistant Prostate Cancer.” U.S. Food and Drug Administration, FDA, www.fda.gov/drugs/fda-grants-accelerated-approval-rucaparib-brca-mutated-metastatic-castration-resistant-prostate.
18. Center for Drug Evaluation and Research. “FDA Approves Olaparib for HRR Gene-Mutated Metastatic Castration-Resistant Prostate Cancer.” U.S. Food and Drug Administration, FDA, https://www.fda.gov/drugs/drug-approvals-and-databases/fda-approves-olaparib-hrr-gene-mutated-metastatic-castration-resistant-prostate-cancer.
19. de Bono, Johann, Joaquin Mateo, Karim Fizazi, Fred Saad, Neal Shore, Shahneen Sandhu, Kim N. Chi et al. "Olaparib for metastatic castration-resistant prostate cancer." New England Journal of Medicine 382, no. 22 (2020): 2091-2102.
20. Dubbury, Sara J., Paul L. Boutz, and Phillip A. Sharp. "CDK12 regulates DNA repair genes by suppressing intronic polyadenylation." Nature 564, no. 7734 (2018): 141-145.
21. Wu, Yi-Mi, Marcin Cieślik, Robert J. Lonigro, Pankaj Vats, Melissa A. Reimers, Xuhong Cao, Yu Ning et al. "Inactivation of CDK12 delineates a distinct immunogenic class of advanced prostate cancer." Cell 173, no. 7 (2018): 1770-1782.
22. Antonarakis, Emmanuel S., Pedro Isaacsson Velho, Wei Fu, Hao Wang, Neeraj Agarwal, Victor Sacristan Santos, Benjamin L. Maughan et al. "CDK12-altered prostate cancer: clinical features and therapeutic outcomes to standard systemic therapies, poly (ADP-ribose) polymerase inhibitors, and PD-1 inhibitors." JCO Precision Oncology 4 (2020): 370-381.
23. Nguyen, Bastien, Jose Mauricio Mota, Subhiksha Nandakumar, Konrad H. Stopsack, Emily Weg, Dana Rathkopf, Michael J. Morris et al. "Pan-cancer Analysis of CDK12 Alterations Identifies a Subset of Prostate Cancers with Distinct Genomic and Clinical Characteristics." European Urology (2020).
24. Abida, Wassim, David Campbell, Akash Patnaik, Jeremy D. Shapiro, Brieuc Sautois, Nicholas J. Vogelzang, Eric G. Voog et al. "Non-BRCA DNA damage repair gene alterations and response to the PARP inhibitor rucaparib in metastatic castration-resistant prostate cancer: Analysis From the Phase II TRITON2 Study." Clinical Cancer Research 26, no. 11 (2020): 2487-2496.
25. Jonsson, Philip, Chaitanya Bandlamudi, Michael L. Cheng, Preethi Srinivasan, Shweta S. Chavan, Noah D. Friedman, Ezra Y. Rosen et al. "Tumour lineage shapes BRCA-mediated phenotypes." Nature 571, no. 7766 (2019): 576-579.
26. Pilié, Patrick G., Carl M. Gay, Lauren A. Byers, Mark J. O'Connor, and Timothy A. Yap. "PARP inhibitors: extending benefit beyond BRCA-mutant cancers." Clinical Cancer Research 25, no. 13 (2019): 3759-3771.
27. Leo, Elisabetta, Jeffrey Johannes, Giuditta Illuzzi, Andrew Zhang, Paul Hemsley, Michal J. Bista, Jonathan P. Orme et al. "Abstract LB-273: A head-to-head comparison of the properties of five clinical PARP inhibitors identifies new insights that can explain both the observed clinical efficacy and safety profiles." (2018): LB-273.
28. De Bono, Johann S., Niven Mehra, Celestia S. Higano, Fred Saad, Consuelo Buttigliero, Marielena Mata, Hsiang-Chun Chen et al. "TALAPRO-1: A phase II study of talazoparib (TALA) in men with DNA damage repair mutations (DDRmut) and metastatic castration-resistant prostate cancer (mCRPC)—First interim analysis (IA)." (2020): 119-119.
29. Gershenson, David Marc, A. Miller, W. Brady, J. Paul, K. Carty, W. Rodgers, D. Millan et al. "LBA61 A randomized phase II/III study to assess the efficacy of trametinib in patients with recurrent or progressive low-grade serous ovarian or peritoneal cancer." Annals of Oncology 30, no. Supplement_5 (2019): mdz394-058.
30. Antonarakis, Emmanuel S. "Olaparib for DNA repair-deficient prostate cancer—one for all, or all for one?." Nature Reviews Clinical Oncology (2020): 1-2.
31. Pilié, Patrick G., Chad Tang, Gordon B. Mills, and Timothy A. Yap. "State-of-the-art strategies for targeting the DNA damage response in cancer." Nature Reviews Clinical Oncology 16, no. 2 (2019): 81-104.
32. Clarke, Noel, Pawel Wiechno, Boris Alekseev, Nuria Sala, Robert Jones, Ivo Kocak, Vincenzo Emanuele Chiuri et al. "Olaparib combined with abiraterone in patients with metastatic castration-resistant prostate cancer: a randomised, double-blind, placebo-controlled, phase 2 trial." The Lancet Oncology 19, no. 7 (2018): 975-986.

Improving Prostate Cancer Early Detection with Biomarkers in Primary Care

The COVID-19 pandemic has resulted in numerous physical and psychological adjustments for clinicians, patients, and their families—wearing personal protective equipment, adopting telemedicine, adjusting clinic workflow, etc. The ensuing uncertainty and attendant anxiety from the fluidity of information and healthcare policy debate has augmented the need for enhanced communication and thoughtfulness for healthcare providers.  For urologic patient care, we strive to surmount the ever-evolving challenges of the COVID-19 pandemic by incorporating strategies to avoid the infection while protecting and prioritizing patient care. Specifically, as we assess the optimization of prostate cancer detection and diagnosis, we should identify men at risk for clinically significant cancer who mainly first present within the primary care setting.
Written by: Neal D. Shore, MD, FACS, and Michael S. Cookson, MD, MMHC

Biomarker Strategies for Prostate Cancer Care During COVID-19

Despite the recent disruptions in health care delivery due to the COVID-19 pandemic, patients at risk for developing prostate cancer as well as those diagnosed with prostate cancer still deserve timely and optimal decision making. Unfortunately, the uncertainty of the pandemic requires urologists to adopt innovative strategies in order to prioritize patient care while being mindful to mitigate the potential infectious risks of COVID-19 to their patients as well as to their healthcare team.
Written by: Neal D. Shore, MD, FACS, and Michael S. Cookson, MD, MMHC
References: 1. Hayes, Julia H., Daniel A. Ollendorf, Steven D. Pearson, Michael J. Barry, Philip W. Kantoff, Susan T. Stewart, Vibha Bhatnagar, Christopher J. Sweeney, James E. Stahl, and Pamela M. McMahon. "Active surveillance compared with initial treatment for men with low-risk prostate cancer: a decision analysis." Jama 304, no. 21 (2010): 2373-2380.

Association Between Novel Anti-Androgens and Overall Survival in Non-Metastatic Castration-Resistant Prostate Cancer

Background

While there have been dramatic changes in treatment options for patients with advanced prostate cancer over the past 5 years, perhaps the greatest change has been for patients with non-metastatic castration-resistant prostate cancer (nmCRPC). Prior to February 14, 2018, there were no agents approved by the United States Food and Drug Administration (FDA) for men with nmCRPC. Since then, three agents have been approved (apalutamide, enzalutamide, and darolutamide, in chronologic sequence of approval). While approval was initially based on improvements in metastasis-free survival, the seminal phase III trials for each of these agents have now reported overall survival data.
Written by: Zachary Klaassen, MD, MSc
References:
  1. Huggins C, Hodges CV. Studies on prostatic cancer: I. The effect of castration, of estrogen and of androgen injection on serum phosphatases in metastatic carcinoma of the prostate. Cancer research. 1941;1(4):293-297.

  2. Scher HI, Morris MJ, Stadler WM, et al. Trial Design and Objectives for Castration-Resistant Prostate Cancer: Updated Recommendations From the Prostate Cancer Clinical Trials Working Group 3. J Clin Oncol. 2016;34(12):1402-1418.

  3. Fizazi K, Shore N, Tammela TL, et al. Darolutamide in Nonmetastatic, Castration-Resistant Prostate Cancer. N Engl J Med. 2019.

  4. Hussain M, Fizazi K, Saad F, et al. PROSPER: A phase 3, randomized, double-blind, placebo (PBO)-controlled study of enzalutamide (ENZA) in men with nonmetastatic castration-resistant prostate cancer (M0 CRPC). Journal of Clinical Oncology. 2018;36(Suppl 6S):abstract 3.

  5. Smith MR, Saad F, Chowdhury S, et al. Apalutamide Treatment and Metastasis-free Survival in Prostate Cancer. N Engl J Med. 2018;378(15):1408-1418.

  6. Xie W, Regan MM, Buyse M, et al. Metastasis-Free Survival Is a Strong Surrogate of Overall Survival in Localized Prostate Cancer. J Clin Oncol. 2017;35(27):3097-3104.

  7. Hird AE, Magee DE, Bhindi B, et al. A Systematic Review and Network Meta-analysis of Novel Androgen Receptor Inhibitors in Non-metastatic Castration-resistant Prostate Cancer. Clin Genitourin Cancer. 2020.

  8. Small EJ, Saad F, Chowdhury S, et al. Apalutamide and overall survival in non-metastatic castration-resistant prostate cancer. Annals of oncology : official journal of the European Society for Medical Oncology / ESMO. 2019;30(11):1813-1820.

  9. Sternberg CN, Fizazi K, Saad F, et al. Enzalutamide and Survival in Nonmetastatic, Castration-Resistant Prostate Cancer. The New England journal of medicine. 2020;382(23):2197-2206.

  10. Smith MR, Saad F, Chowdhury S, et al. Apalutamide and Overall Survival in Prostate Cancer. European urology. 2020.

  11. Fizazi K, Shore N, Tammela TL, et al. Nonmetastatic, Castration-Resistant Prostate Cancer and Survival with Darolutamide. The New England journal of medicine. 2020;383(11):1040-1049.

PARP Inhibitors in Prostate Cancer: PROfound and Beyond

Prostate cancer is a clinically heterogeneous disease with many patients having an indolent course requiring no interventions and others who either present with or progress to metastasis. While underlying dominant driving mutations are not widespread, there have been a number of key genomic mutations that have been consistently identified in prostate cancer patients, across the disease spectrum including gene fusion/chromosomal

Written by: Zachary Klaassen, MD, MSc
References:
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