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Droller MJ. A Guideline for Discussion and Some Thoughts. J Urol 2009; 181:1530-1. [DOI: 10.1016/j.juro.2009.01.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kakizoe T, Mucci LA, Albertsen PC, Droller MJ. Screening for bladder cancer: theoretical and practical issues in considering the treated and untreated natural history of the various forms of the disease. ACTA ACUST UNITED AC 2009:191-212. [PMID: 18815934 DOI: 10.1080/03008880802284936] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Screening is used to detect disease earlier in its course, allow earlier treatment, and presumably decrease morbidities and potential mortality associated with the later expression of more advanced disease and presumably more complex treatments consequently required. Judicious screening in bladder cancer depends on an understanding of how the different forms of bladder cancer express their biological potential, whether the tools available for screening have sufficient sensitivity and specificity to have accurate predictive value in accurately diagnosing and assessing each cancer diathesis earlier in its course, and how this may influence the morbidities and mortality associated with each. The principles of screening, potential biases that can affect their accuracy and the interpretation of outcomes, tools currently available for screening, their efficacies and pitfalls, and lessons learned from studies of the role of screening in prostate cancer will be reviewed to offer an understanding of the potential role that screening may play in the different forms of bladder cancer in the context of their preclinical and treated natural history.
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Droller MJ. Peer Review of Guidelines, Best Practice Statements and New Documents: What This Means for How We Use Them. J Urol 2008; 180:2297-8. [DOI: 10.1016/j.juro.2008.09.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Andersson L, Droller MJ, Adolfsson J, Månsson W, Kirkali Z, Boffetta P, Montironi R, Malmstrom PU, Tribukait B, Grossman HB. Chairmen's summary. SCANDINAVIAN JOURNAL OF UROLOGY AND NEPHROLOGY. SUPPLEMENTUM 2008; 42:7-11. [PMID: 18815912 DOI: 10.1080/03008880802399684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Abstract
Patient advocacy organizations play a critical role in increasing public awareness of a specific cancer and in demanding improvement in approaches to treatment. These organizations also can increase participation in clinical trials and help raise funds for research. But not all cancer patients are represented by advocacy organizations. Until the founding of the Bladder Cancer Advocacy Network in 2005, there was no patient advocacy group for bladder cancer despite the prevalence of the disease. Working with health care professionals, this new advocacy organization can facilitate further advances in research and treatment, leading possibly to a cure for bladder cancer.
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Droller MJ. Urologic cancer--when is less more? J Urol 2007; 178:1837-9. [PMID: 17869308 DOI: 10.1016/j.juro.2007.06.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Fradet Y, Grossman HB, Gomella L, Lerner S, Cookson M, Albala D, Droller MJ. A Comparison of Hexaminolevulinate Fluorescence Cystoscopy and White Light Cystoscopy for the Detection of Carcinoma In Situ in Patients With Bladder Cancer: A Phase III, Multicenter Study. J Urol 2007; 178:68-73; discussion 73. [PMID: 17499291 DOI: 10.1016/j.juro.2007.03.028] [Citation(s) in RCA: 173] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE We compared hexaminolevulinate (Hexvix) fluorescence cystoscopy with white light cystoscopy for detecting carcinoma in situ. MATERIALS AND METHODS In this multicenter study 298 patients with known or suspected bladder cancer underwent bladder instillation with 50 ml 8 mM hexaminolevulinate for 1 hour. Cystoscopy was then performed, first using standard white light and then hexaminolevulinate fluorescence cystoscopy. Lesions or suspicious areas identified under the 2 illumination conditions were mapped and biopsied for histological examination. In addition, 1 directed biopsy was obtained from an area appearing to be normal. RESULTS Of 196 evaluable patients 29.6% (58 of 196) had carcinoma in situ, including 18 with carcinoma in situ alone, and 35 with carcinoma in situ and concomitant papillary disease, which was only detected on random biopsy in 5. Of the 18 patients with no concomitant papillary disease carcinoma in situ was detected only by hexaminolevulinate fluorescence in 4 and only by white light in 4. In the group with concomitant papillary disease carcinoma in situ was found only by hexaminolevulinate fluorescence in 5 patients and only by white light in 3. The proportion of patients in whom 1 or more carcinoma in situ lesions were found only by hexaminolevulinate cystoscopy was greater than the hypothesized 5% (p=0.0022). Overall more carcinoma in situ lesions were found by hexaminolevulinate than by white light cystoscopy in 22 of 58 patients (41.5%), while the converse occurred in 8 of 58 (15.1%). Biopsy results confirmed cystoscopy findings. Of a total of 113 carcinoma in situ lesions in 58 patients 104 (92%) were detected by hexaminolevulinate cystoscopy and 77 (68%) were detected by white light cystoscopy, while 5 were detected only on directed visually normal mucosal biopsy. Hexaminolevulinate instillation was well tolerated with no local or systemic side effects. CONCLUSIONS In patients with bladder cancer hexaminolevulinate fluorescence cystoscopy with blue light can diagnose carcinoma in situ that may be missed with white light cystoscopy. Hexaminolevulinate fluorescence cystoscopy can be used in conjunction with white light cystoscopy to aid in the diagnosis of this form of bladder cancer.
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Grossman HB, Gomella L, Fradet Y, Morales A, Presti J, Ritenour C, Nseyo U, Droller MJ. A phase III, multicenter comparison of hexaminolevulinate fluorescence cystoscopy and white light cystoscopy for the detection of superficial papillary lesions in patients with bladder cancer. J Urol 2007; 178:62-7. [PMID: 17499283 DOI: 10.1016/j.juro.2007.03.034] [Citation(s) in RCA: 219] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2006] [Indexed: 11/17/2022]
Abstract
PURPOSE We compared hexaminolevulinate fluorescence cystoscopy with white light cystoscopy for detecting Ta and T1 papillary lesions in patients with bladder cancer. MATERIALS AND METHODS A total of 311 patients with known or suspected bladder cancer underwent bladder instillation with 50 ml 8 mM HAL for 1 hour. The bladder was inspected using white light cystoscopy, followed by blue light (fluorescence) cystoscopy. Papillary lesions were mapped and resected for histological examination. RESULTS Noninvasive pTa tumors were found in 108 of 196 evaluable patients (55.1%). In 31 patients (29%) at least 1 more tumor was detected by HAL than by white light cystoscopy (p<0.05). Six of these patients had no lesions detected by white light, 12 had 1 lesion detected by white light and more than 1 by HAL, and 13 had multiple Ta lesions detected by the 2 methods. Conversely at least 1 more tumor was detected by white light cystoscopy than by HAL cystoscopy in 10 patients (9%, 95% CI 5-16). Tumors invading the lamina propria (T1) were found in 20 patients (10.2%). At least 1 additional T1 tumor was detected by HAL but not by white light cystoscopy in 3 of these patients (15%), while at least 1 more T1 tumor was detected by white light cystoscopy than by HAL cystoscopy in 1 patient (5%, 95% CI 0-25). Detection rates for Ta tumors were 95% for HAL cystoscopy and 83% for white light cystoscopy (p=0.0001). Detection rates were 95% and 86%, respectively, for T1 tumors (p=0.3). HAL instillation was well tolerated with few local or systemic side effects. CONCLUSIONS HAL fluorescence cystoscopy detected at least 1 more Ta and T1 papillary tumor than white light cystoscopy in approximately a third of the patients with such tumors. Whether this would translate to improved patient outcomes has yet to be determined.
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Droller MJ. Note by Editor. J Urol 2007. [DOI: 10.1016/j.juro.2006.08.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Droller MJ. Re: Surveillance for Recurrent Bladder Cancer Using a Point-of-Care Proteomic Assay. Eur Urol 2006; 50:1119-20. [DOI: 10.1016/j.eururo.2006.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Droller MJ. Editorial Comment. J Urol 2006. [DOI: 10.1016/j.juro.2006.06.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Droller MJ. We Need to Lead and Not Be Led. J Urol 2006; 176:861-2. [PMID: 16890638 DOI: 10.1016/j.juro.2006.06.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Droller MJ. Message from the Editor. Urol Oncol 2006. [DOI: 10.1016/j.urolonc.2006.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Lokeshwar VB, Habuchi T, Grossman HB, Murphy WM, Hautmann SH, Hemstreet GP, Bono AV, Getzenberg RH, Goebell P, Schmitz-Dräger BJ, Schalken JA, Fradet Y, Marberger M, Messing E, Droller MJ. Bladder tumor markers beyond cytology: International Consensus Panel on bladder tumor markers. Urology 2006; 66:35-63. [PMID: 16399415 DOI: 10.1016/j.urology.2005.08.064] [Citation(s) in RCA: 295] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2005] [Accepted: 08/08/2005] [Indexed: 12/27/2022]
Abstract
This is the first of 2 articles that summarize the findings of the International Consensus Panel on cytology and bladder tumor markers. The objectives of our panel were to reach a consensus on the areas where markers are needed, to define the attributes of an ideal tumor marker, and to identify which marker(s) would be suitable for diagnosis and/or surveillance of bladder cancer. Our panel consisted of urologists and researchers from Europe, Asia, and the United States who reviewed original articles, reviews, and book chapters on individual bladder tumor markers published in the English language mainly using the PubMed search engine. Panel members also met during 3 international meetings to write recommendations regarding bladder tumor markers. The panel found that the most practical use of noninvasive tests is to monitor bladder cancer recurrence, thereby reducing the number of surveillance cystoscopies performed each year. Markers also may be useful in the screening of high-risk individuals for early detection of bladder cancer. However, more prospective studies are needed to strengthen this argument. Case-control and cohort studies show that several markers have a higher sensitivity to detect bladder cancer. However, cytology is the superior marker in terms of specificity, although some markers in limited numbers of studies have shown specificity equivalent to that of cytology. Our panel believes that several bladder tumor markers are more accurate in detecting bladder cancer than prostate-specific antigen (PSA) is in detecting prostate cancer. However, bladder tumor markers are held to a higher standard than PSA. Therefore, use of bladder tumor markers in the management of patients with bladder cancer will require the willingness of both urologists and clinicians to accept them.
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Habuchi T, Marberger M, Droller MJ, Hemstreet GP, Grossman HB, Schalken JA, Schmitz-Dräger BJ, Murphy WM, Bono AV, Goebell P, Getzenberg RH, Hautmann SH, Messing E, Fradet Y, Lokeshwar VB. Prognostic markers for bladder cancer: International Consensus Panel on bladder tumor markers. Urology 2005; 66:64-74. [PMID: 16399416 DOI: 10.1016/j.urology.2005.08.065] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2005] [Accepted: 08/08/2005] [Indexed: 10/25/2022]
Abstract
The International Consensus Panel on cytology and bladder tumor markers evaluated markers that have the ability to predict tumor recurrence, progression, development of metastases, or response to therapy or patient survival. This article summarizes those findings. The panel mainly reviewed articles listed in PubMed on various prognostic indicators for bladder cancer. Based on these studies, most of which were case-control retrospective studies, various prognostic indicators were classified into 6 groups: (1) microsatellite-associated markers, (2) proto-oncogenes/oncogenes, (3) tumor suppressor genes, (4) cell cycle regulators, (5) angiogenesis-related factors, and (6) extracellular matrix adhesion molecules. The panel concluded that although certain markers, such as Ki-67 and p53, appear to be promising in predicting recurrence and progression of bladder cancer, the data are still heterogeneous. The panel recommends that identifying definitive criteria for test positivity, a clearly defined patient population, standardization of techniques used to evaluate markers, and clearly specified endpoints and statistical methods will help to bring accurate independent prognostic indicators into the clinical management of patients with bladder cancer.
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Droller MJ. Biological considerations in the assessment of urothelial cancer: A retrospective. Urology 2005; 66:66-75. [PMID: 16194710 DOI: 10.1016/j.urology.2005.06.128] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2005] [Accepted: 06/20/2005] [Indexed: 10/25/2022]
Abstract
In bladder cancer, variations in clinical course and treatment outcomes support the concept that the condition may comprise a compendium of different types of tumor diathesis with unique, albeit interrelated, pathways of development. This concept and the schema of developmental pathways of bladder cancer derived from it are intended to complement the traditional classification used to stage bladder cancer, providing a perspective on the potential evolution of a particular malignancy over time. The schema represents the intrinsic biologic potential of various types of bladder cancer. It also indicates a given tumor's likely behavior as can be predicted by its histopathologic appearance at a given point in time, what may be expected through specific interventions, how approaches to treatment may need to be adjusted in considering the pathway a specific tumor may follow, as well as how the disease course may reflect genetic changes associated with the generation of a specific malignant diathesis. These considerations and the concept of specific but interrelated pathways of development in bladder cancer are presented in their historical context and current clinical use.
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Lehrer S, Diamond EJ, Mamkine B, Droller MJ, Stone NN, Stock RG. C-reactive protein is significantly associated with prostate-specific antigen and metastatic disease in prostate cancer. BJU Int 2005; 95:961-2. [PMID: 15839913 DOI: 10.1111/j.1464-410x.2005.05447.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To further analyse the relationship of c-reactive protein (CRP) levels to prostate cancer, by measuring CRP in men with prostate cancer and benign prostatic hypertrophy (BPH), as chronic inflammation has long been linked to cancers with an infectious cause and CRP is a nonspecific marker for inflammation, associated with prostate cancer incidence and progression. PATIENTS AND METHODS Data from 114 men, most of whom had had radioactive seeds implanted, were evaluated from November 1990 to April 2002. In addition, 27 men were included who had biopsy-confirmed BPH. CRP was assessed with an automated chemiluminometric high-sensitivity assay kit. RESULTS There was no significant difference in CRP levels in men with localized prostate cancer or BPH but levels were significantly higher in men with bone metastases. There was also a significant correlation of CRP level with prostate-specific antigen (PSA) in those with cancer. Because PSA is correlated with disease stage, multiple linear regression was used with CRP as the dependent variable, and PSA and disease stage as independent variables. The regression was significant overall (P < 0.001) and the effect of disease stage on CRP (P < 0.001) was independent of the effect of PSA level (P = 0.001). CONCLUSION The strong association of CRP with PSA, independent of tumour stage, suggests that inflammation might be fundamental in prostate cancer, and that chronic inflammation may be a legitimate target for prostate cancer chemoprevention and treatment.
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Droller MJ. A Model for 3-Dimensional Growth of Bladder Cancers to Investigate Cell-Matrix Interactions. J Urol 2004. [DOI: 10.1016/s0022-5347(05)60946-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Droller MJ. DD23 Biomarker. A Prospective Clinical Assessment in Routine Urinary Cytology Specimens From Patients Being Monitored for TCC. J Urol 2004. [DOI: 10.1016/s0022-5347(05)60947-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Droller MJ. Comparison of Telomerase Activity and Matrix Metalloproteinase-9 in Voided Urine and Bladder Wash Samples as a Useful Diagnostic Tool for Bladder Cancer. J Urol 2004. [DOI: 10.1016/s0022-5347(05)60942-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Droller MJ. WHEN IS A CANCER A MALIGNANCY? J Urol 2004; 172:1771-2. [PMID: 15540717 DOI: 10.1097/01.ju.0000142450.27180.5c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Droller MJ. FGFR3 and P53 Characterize Alternative Genetic Pathways in the Pathogenesis of Urothelial Cell Carcinoma. J Urol 2004. [DOI: 10.1016/s0022-5347(05)60945-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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