The Role of Salvage Radical Prostatectomy in Patients with Radiation-Resistant Prostate Cancer

There are multiple treatment strategies for patients with localized prostate adenocarcinoma. In intermediate- and high-risk patients, external beam radiation therapy demonstrates effective long-term cancer control rates comparable to radical prostatectomy. In patients who opt for initial radiotherapy but have a local recurrence of their cancer, there is no unanimity on the optimal salvage approach. The lack of randomized trials comparing surgery to other local salvage therapy or observation makes it difficult to ascertain the ideal management. A narrative review of existing prospective and retrospective data related to salvage radical prostatectomy after radiation therapy was undertaken. Based on retrospective and prospective data, post-radiation salvage radical prostatectomy confers oncologic benefits, with overall survival ranging from 84 to 95% at 5 years and from 52 to 77% at 10 years. Functional morbidity after salvage prostatectomy remains high, with rates of post-surgical incontinence and erectile dysfunction ranging from 21 to 93% and 28 to 100%, respectively. Factors associated with poor outcomes after post-radiation salvage prostatectomy include preoperative PSA, the Gleason score, post-prostatectomy staging, and nodal involvement. Salvage radical prostatectomy represents an effective treatment option for patients with biochemical recurrence after radiotherapy, although careful patient selection is important to optimize oncologic and functional outcomes

Clearing up Clear Cell: Clarifying the Immuno-Oncology Treatment Landscape for Metastatic Clear Cell RCC

Patients with advanced or malignant renal cell carcinoma at the time of diagnosis have historically had a poor prognosis. Immunonologic agents have significantly altered the therapeutic landscape and clinical outcomes of these patients. In this review, we highlight recent and upcoming clinical trials investigating the role of immunotherapies in clear cell RCC. In particular, we emphasize immunotherapy-based combinations, including immune checkpoint inhibitor (ICI) combinations, neoadjuvant, and adjuvant ICI, and ICI agents combined with anti-VEGF therapy

Top Ten Tips Palliative Care Clinicians Should Know About Urological Care

Patients receiving palliative care (PC) can present with or develop a host of urological needs or complications. These needs can include attention to sexual health, urinary incontinence, genitourinary bleeding, and urinary tract obstruction by benign, malignant, or urinary stone diseases. These varied conditions require that PC clinicians understand invasive and noninvasive medical, surgical, and radiation options for treatment. This article, written by a team of urologists, geriatricians, and PC specialists, offers information and guidance to PC teams in an accessible "Top Ten Tips" format to increase comfort with and skills around assessment, evaluation, and specialist referral for urological conditions common in the PC setting. Keywords: dignity; fatigue; hematuria; individualized decision making; palliative urological care; quality of life; sexual intimacy; ureteral obstruction; urinary catheter; urinary incontinenc

Transforming Infrastructure: Frameworks for Bringing the Fourth Industrial Revolution to Infrastructure

The technological advances of the Fourth Industrial Revolution have fundamentally altered society in ways both seen and unseen. This digital transformation has changed how people live and work, and everything in between. One area of daily life, however, seems to be largely missing out on this revolution: infrastructure. It remains one of the least digitally transformed sectors of the economy. While individual examples of highly advanced infrastructure systems exist, the sector at large lags behind others in innovation, a fact made all the more apparent by infrastructure’s ubiquity. When the World Economic Forum Global Future Council on Infrastructure gathered for its annual meeting in Dubai in November 2018, it sought to understand why. As it began to think through solutions, the Council found a situation full of opportunity. Infrastructure is far from being a staid industry devoid of innovation – indeed, new technologies and ideas are flourishing. Integrating these innovations, which could change the way infrastructure is designed, developed and delivered, requires aligning stakeholders, implementing effective strategies and creating fertile enabling environments. This will allow existing innovation into the space and provide opportunities for new ideas. The Council thus decided to create a guidebook, contained here, that explores major questions about how to bring the Fourth Industrial Revolution to infrastructure