Browse Health
Urologist
8 years of experience
Video profile
Accepting new patients

Education ?

Medical School Score Rankings
Temple University Physicians (2002)
  • Currently 3 of 4 apples
Top 50%

Awards & Distinctions ?

Awards  
Patients' Choice 5th Anniversary Award (2012 - 2013)
Patients' Choice Award (2008 - 2014)
Compassionate Doctor Award - 5 Year Honoree (2013)
Compassionate Doctor Recognition (2009 - 2013)
Top 10 Doctor - State (2014)
Pennsylvania
Urologist
Top 10 Doctor - City (2014)
Philadelphia, PA
Urologist
Top 10 Doctor - Metro Area (2014)
Delaware Valley
Urologist
On-Time Doctor Award (2009, 2014)
Appointments
Johns Hopkins Medical Center
Instructor of Urology
Associations
American Board of Urology
American Urological Association

Affiliations ?

Dr. Guzzo is affiliated with 8 hospitals.

Hospital Affilations

Score

Rankings

  • Pennsylvania Hospital University PA Health System
    Urology
    800 Spruce St, Philadelphia, PA 19107
    • Currently 4 of 4 crosses
    Top 25%
  • Hospital of the University of PA
    3400 Spruce St, Philadelphia, PA 19104
    • Currently 4 of 4 crosses
    Top 25%
  • University of PA Medical Center/Presbyterian
    Urology
    51 N 39th St, Philadelphia, PA 19104
    • Currently 3 of 4 crosses
    Top 50%
  • Graduate Hospital
    1800 Lombard St, Philadelphia, PA 19146
    • Currently 1 of 4 crosses
  • Clinical Practices of the University of Pennsylvania
  • University of Penn Med Center-Presb Med Group
  • Pennsylvania Hospital
  • Philadelphia Veterans Affairs Medical Center
    3900 Woodland Ave, Philadelphia, PA 19104
  • Publications & Research

    Dr. Guzzo has contributed to 29 publications.
    Title Repeat Prostate Biopsy and the Incremental Risk of Clinically Insignificant Prostate Cancer.
    Date May 2011
    Journal Urology
    Excerpt

    To determine the incremental risk of diagnosis of clinically insignificant prostate cancer with serial prostate biopsies.

    Title Longitudinal Evaluation of the Concordance and Prognostic Value of Lymphovascular Invasion in Transurethral Resection and Radical Cystectomy Specimens.
    Date February 2011
    Journal Bju International
    Excerpt

    To evaluate the concordance transurethral resection of bladder tumour (TURBT) and radical cystectomy (RC) specimens with regard to the presence of lymphovascular invasion (LVI). Additionally, to evaluate the prognostic value of LVI in the prediction of lymph node metastases, overall survival, disease-specific survival and recurrence-free survival following RC.

    Title The Impact of Preoperative Erectile Dysfunction on Survival After Radical Prostatectomy.
    Date January 2011
    Journal Bju International
    Excerpt

    Erectile dysfunction (ED) and cardiovascular disease (CVD) share etiology and pathophysiology. The underlying pathology for preoperative ED may adversely affect survival following radical prostatectomy (RP). We examined the association between preoperative ED and survival following RP.

    Title Long-term Survival After Radical Prostatectomy for Men with High Gleason Sum in Pathologic Specimen.
    Date October 2010
    Journal Urology
    Excerpt

    To evaluate the long-term outcomes of patients with high Gleason sum 8-10 at radical prostatectomy (RP) and to identify the predictors of prostate cancer-specific survival (CSS) in this cohort.

    Title Prediction of Mortality After Radical Prostatectomy by Charlson Comorbidity Index.
    Date October 2010
    Journal Urology
    Excerpt

    Prostate cancer treatment should depend on the characteristics of a patient's prostate cancer as well as overall health status. A possible adverse consequence of poor patient selection is a lack of benefit because of premature death from another cause. We evaluated the association between perioperative comorbidity and risk of death from causes other than prostate cancer in men who underwent radical prostatectomy (RP).

    Title Defining Pathological Variables to Predict Biochemical Failure in Patients with Positive Surgical Margins at Radical Prostatectomy: Implications for Adjuvant Radiotherapy.
    Date June 2010
    Journal Bju International
    Excerpt

    To evaluate the utility of estimated tumour volume, number of positive surgical margins (PSMs), and margin location for predicting biochemical failure in patients with PSM, in an attempt to better risk-stratify the heterogeneous group of patients at high risk of biochemical failure after radical prostatectomy (RP) for prostate cancer.

    Title Synchronous Metastatic Renal Cell Carcinoma to the Genitourinary Tract: Two Rare Case Reports and a Review of the Literature.
    Date May 2009
    Journal The Canadian Journal of Urology
    Excerpt

    Synchronous metastasis of renal cell carcinoma (RCC) to the ureter or the bladder represents an extremely rare event. We report one case of synchronous metastasis of RCC to the ipsilateral ureter and one case of solitary synchronous metastasis of RCC to the urinary bladder. We review the literature and discuss possible mechanisms of dissemination. We discuss the surgical management of metastases from RCC as well as the surgical options in the treatment of these rare occurrences.

    Title Does Race Affect Postoperative Outcomes in Patients with Low-risk Prostate Cancer Who Undergo Radical Prostatectomy?
    Date April 2009
    Journal Urology
    Excerpt

    To assess the magnitude of racial disparities in prostate cancer outcomes following radical prostatectomy for low-risk prostate cancer.

    Title Laparoscopic Radical Nephroureterectomy with En-bloc Distal Ureteral and Bladder Cuff Excision Using a Single Position Pneumovesicum Method.
    Date November 2008
    Journal Urology
    Excerpt

    We describe a completely laparoscopic approach for en-bloc dissection of the distal ureter and bladder cuff during nephroureterectomy using a pneumovesicum approach and with the need for intraoperative patient repositioning. This technique is efficient, technically feasible and adheres to the oncologic principles of radical nephroureterectomy.

    Title Hydronephrosis is an Independent Predictor of Poor Clinical Outcome in Patients Treated for Muscle-invasive Transitional Cell Carcinoma with Radical Cystectomy.
    Date September 2008
    Journal Urology
    Excerpt

    OBJECTIVES: The purpose of this study was to assess the prognostic significance of hydronephrosis on pathologic and clinical outcomes in muscle-invasive bladder cancer. METHODS: We performed a retrospective evaluation of a prospectively maintained cystectomy database and identified patients with hydronephrosis on preoperative imaging. Of a total of 306 patients, 57 (19%) had unilateral hydronephrosis and 17 (6%) had bilateral hydronephrosis. We constructed multivariate Cox regression analysis and Kaplan Meier tables to evaluate the association between preoperative hydronephrosis and clinical outcomes. RESULTS: In patients without hydronephrosis, 41.4% had extravesical disease compared with 56.1% and 64.7% in patients with unilateral or bilateral hydronephrosis, respectively. Mean overall survival (OS) among patients without hydronephrosis, with unilateral hydronephrosis, and with bilateral hydronephrosis was 55.5, 42.1, and 22.2 months, respectively. Five-year OS and disease-specific survival (DSS) was 46%, 35%, and 22% (P = .001) and 68%, 54%, and 35% (P = .002), respectively. Multivariate analysis demonstrated that both unilateral and bilateral hydronephrosis are significant independent risk factors for DSS and OS. Bilateral hydronephrosis was found to have a hazard ratio of 3.87 (95% confidence interval [CI] = 1.71-8.78, P = .001) and 2.75 (95% CI = 1.45-5.18, P = .002) for DSS and OS, respectively. The hazard ratios for unilateral hydronephrosis were 1.7 (95% CI = 1.05-2.87, P = .03) and 1.5 (95% CI = 1.03-2.23, P = .04) for DSS and OS, respectively. CONCLUSIONS: Preoperative hydronephrosis is associated with a significantly poorer prognosis in patients with muscle-invasive bladder cancer. These patients should be appropriately counseled with regard to overall prognosis and the potential benefit of neoadjuvant chemotherapy.

    Title A Case of Synchronous Bilateral Testicular Seminoma.
    Date August 2008
    Journal Nature Clinical Practice. Urology
    Excerpt

    BACKGROUND: A previously healthy 51-year-old man with two children sustained a minor testicular trauma and subsequently sought medical care for persistent discomfort. INVESTIGATIONS: Physical examination, scrotal ultrasonography, Doppler ultrasound evaluation of testicular blood flow, scrotal MRI, measurement of serum tumor markers and testosterone levels, CT of the chest, abdomen and pelvis, intraoperative frozen section analysis and final pathologic analysis. DIAGNOSIS: Bilateral testicular seminoma (clinical stage I). MANAGEMENT: The patient initially underwent radical left orchiectomy with intraoperative frozen section analysis, which returned equivocal results. Final pathologic analysis revealed a 2.5 cm left testicular seminoma without vascular invasion. After careful discussion, he ultimately underwent radical right orchiectomy; pathologic analysis revealed a 2.7 cm right seminoma with vascular invasion. Testosterone replacement therapy was initiated. After further discussion, the patient elected to undergo adjuvant abdominal radiotherapy to a total of 25 Gy. The patient showed no evidence of disease over a post-treatment follow-up period of 24 months.

    Title Re: Guzzo Tj, Vira Ma, Neway W, Et Al: Minimal Tumor Volume May Provide Additional Prognostic Information in Good Performance Patients After Radical Prostatectomy. Urology 69: 1147-1151, 2007.
    Date July 2008
    Journal Urology
    Title Relationship of Biochemical Outcome to Percentage of Positive Biopsies in Men with Clinically Localized Prostate Cancer Treated with Permanent Interstitial Brachytherapy.
    Date May 2008
    Journal Urology
    Excerpt

    OBJECTIVES: Recent studies have demonstrated that the percentage of positive prostate needle biopsies (PPBs) is an independent predictor of biochemical failure (BF) after radical prostatectomy and external beam radiotherapy. Few studies have confirmed this phenomenon in patients treated with permanent interstitial brachytherapy. We conducted an analysis to determine the clinical utility of the PPBs in predicting BF after permanent interstitial brachytherapy for patients with clinically localized prostate cancer. METHODS: The clinical and pathologic data from 245 hormone-naive patients with clinical Stage T1c-T2cNxM0 prostate cancer who had undergone permanent prostate brachytherapy from 1992 to 2002 at our institution were retrospectively evaluated. The PPBs, preimplant prostate-specific antigen, and biopsy Gleason score were evaluated as predictors of BF after brachytherapy. The risk of BF was calculated using logistic regression models. The time to BF was assessed using Cox proportional hazard models and Kaplan-Meier estimates. RESULTS: The median PPBs in our study cohort was 27%. The risk of BF was 10.9% for those with a PPBs less than the median versus 26.2% for those with a PPBs greater than the median. A PPBs greater than the median was an independent predictor of BF on multivariate analysis (relative risk 2.3, 95% confidence interval 1.21 to 4.39, P = 0.011). In the time-to-failure models, the PPBs, prostate-specific antigen level, and Gleason score were significantly associated with BF. CONCLUSIONS: Our data suggest that the PPBs is significantly associated with BF in patients undergoing permanent interstitial brachytherapy. The PPBs, along with the pretreatment prostate-specific antigen level and Gleason biopsy score, is a useful preoperative parameter in predicting for BF and the time to failure for patients treated with interstitial brachytherapy.

    Title Modern Management of Pheochromocytoma.
    Date December 2007
    Journal Nature Clinical Practice. Urology
    Excerpt

    BACKGROUND: A 55-year-old male with poorly controlled hypertension and a history of coronary artery disease presented with a large adrenal mass. The patient also reported a long-standing history of profuse sweating, tinnitus, vomiting and headaches. INVESTIGATIONS: Physical examination, 24-hour urine metanephrine level, CT, MRI and bone scan. DIAGNOSIS: Pheochromocytoma of the left adrenal gland. MANAGEMENT: Preoperative alpha-blockade therapy with phenoxybenzamine followed by open left adrenalectomy.

    Title Minimal Tumor Volume May Provide Additional Prognostic Information in Good Performance Patients After Radical Prostatectomy.
    Date August 2007
    Journal Urology
    Excerpt

    OBJECTIVES: The significance of tumor volume (TV) as a predictor of biochemical failure after radical prostatectomy (RP) remains debatable. TV determinants can also entail significant time and cost. Estimating TVs using an asymmetric categorical classification system provides an economical alternative to determining this parameter. We evaluated the prognostic value of an estimated TV in patients undergoing RP in predicting for prostate-specific antigen (PSA) failure. METHODS: We retrospectively reviewed the clinical and pathologic features of 865 patients who underwent RP at our institution from 1991 to 1999. The TV, PSA level, final Gleason score, percentage of positive biopsy cores, and clinical stage were evaluated using univariate and multivariate analysis to determine their association with biochemical failure. Patients were also stratified according to PSA level (less than versus greater than 10 ng/mL), Gleason score (less than versus greater than 7), and clinical T stage (Stage T1c or better versus worse than Stage T1c) to analyze the prognostic significance of TV in this subpopulation of patients. RESULTS: Of our 865 evaluable patients, 124 (14.3%) had progression to biochemical failure at a mean follow-up of 60 months. The TV was significantly associated with biochemical failure on univariate analysis (P = 0.024). In the low-risk patients (PSA level less than 10 ng/mL, Gleason score less than 7, and clinical Stage T1c or better), a minimal TV was associated with a lower risk of biochemical failure on multivariate analysis (hazard ratio 2.0, 95% confidence interval 1.09 to 3.68, P = 0.025). CONCLUSIONS: In RP patients with favorable clinical and pathologic characteristics, a minimal TV was associated with a decreased risk of biochemical failure. In carefully selected patients, the estimated TV might provide additional prognostic information for risk stratification for PSA progression and biochemical failure.

    Title Initial Experience with Laparoscopic Transvesical Ureteral Reimplantation at the Children's Hospital of Philadelphia.
    Date January 2007
    Journal The Journal of Urology
    Excerpt

    PURPOSE: Laparoscopic transvesical ureteral reimplantation with or without robotic assisted surgical devices is being developed as an alternative to open surgery. We review our experience with laparoscopic transvesical ureteral reimplantation. MATERIALS AND METHODS: A total of 32 patients underwent laparoscopic transvesical reimplantation by the same surgeon. Of the patients 5 had primary obstructing megaureters and 27 had vesicoureteral reflux. Transvesical laparoscopic cross-trigonal ureteral reimplantation was performed in patients with reflux, and a Glenn-Anderson reimplantation was used in patients with a primary obstructing megaureter. A pure laparoscopic approach using two 3 mm working ports and a 5 mm camera port was used. RESULTS: The operative success rates were 92.6% and 80% for vesicoureteral reflux and primary obstructing megaureter cases, respectively. Complications included a postoperative urinary leak in 4 patients (12.5%) and ureteral stricture at the neoureterovesical anastomosis in 2 (6.3%). All but 1 complication occurred in patients 2 years or younger with bladder capacity less than 130 cc. CONCLUSIONS: Laparoscopic intravesical reimplantation is in its infancy and appears to have higher complication rates in young patients with small bladder capacity.

    Title Clinical Approach to the Prostate: an Update.
    Date December 2006
    Journal Radiologic Clinics of North America
    Excerpt

    Prostatic disease continues to present clinicians with challenges. Although giant strides have been made in the medical and surgical management of benign prostatic hyperplasia, many fundamental questions about its pathogenesis, progression, and treatment efficacy remain unanswered. Prostate cancer also continues to be an area in which progress is needed despite major recent advancements. Numerous debates that include the value of prostate-specific antigen screening and appropriate roles for each of the numerous therapeutic modalities await resolution. For millions of patients who suffer from prostatitis, a major breakthrough is yet to come. Current treatment regimens for prostatitis remain ineffective at best. Contemporary approaches to the pathogenesis, diagnosis, and treatment of benign prostatic hyperplasia, prostate cancer, and prostatitis are discussed in this review.

    Title Preoperative Parameters, Including Percent Positive Biopsy, in Predicting Seminal Vesicle Involvement in Patients with Prostate Cancer.
    Date February 2006
    Journal The Journal of Urology
    Excerpt

    PURPOSE: Complete dissection of the SVs during RP can contribute to increased morbidity including erectile dysfunction and incontinence. Therefore we evaluated the clinical parameters associated with a positive SV finding on final pathology and identified those patients with a minimal risk of SV involvement for potential SV sparing surgery. MATERIALS AND METHODS: We retrospectively reviewed our RP database from 1991 to 1999 to evaluate the incidence and clinical correlates of SV invasion. Variables studied included preoperative total serum PSA, percent positive biopsy cores, DRE and biopsy Gleason score. Statistical analysis included univariate, multivariate regression analysis and ROC curves. RESULTS: Of our 1,056 patients 79 (7.4%) had SV involvement. Of the 356 patients with less than 17% positive biopsies, only 2 (0.5%) had SV involvement on final pathology. Preoperative PSA, biopsy Gleason score and percent positive biopsies were all highly predictive of SV invasion on multivariate analysis. Percent positive biopsy was found to be the single best predictor of seminal vesicle invasion (p <0.0001). CONCLUSIONS: In our series percent positive biopsy was the single best predictor of SV invasion at the time of RP. An analysis of preoperative parameters including percent positive biopsy, biopsy Gleason score and preoperative PSA may define a subset of patients in which prospective studies could be used to determine the value and safety of SV sparing surgery.

    Title Impact of Multiple Biopsy Cores on Predicting Final Tumor Volume in Prostate Cancer Detected by a Single Microscopic Focus of Cancer on Biopsy.
    Date November 2005
    Journal Urology
    Excerpt

    OBJECTIVES: To compare the impact that the number of biopsy cores have on final pathologic findings when minimal disease is detected at biopsy. Discordance has been noted between transrectal ultrasound-guided biopsy results and tumor volume even when minimal amounts of tumor are found on biopsy. METHODS: We identified patients who had undergone radical retropubic prostatectomy for a single microscopic focus of adenocarcinoma from a prospectively maintained surgical database. Patients were stratified into two groups: those with six biopsies or less and those with seven or more. The Gleason score, margin status, presence of extracapsular extension, and percentage of tumor volume were compared. RESULTS: A total of 102 patients in our database had a single microscopic focus of adenocarcinoma detected by needle biopsy. Of these patients, 65 underwent six or fewer biopsies and 37 underwent seven or more at transrectal ultrasonography. Of the 37 patients in group 2, 27 (73%) had a final tumor volume of less than 5% compared with 24 (37%) of 65 patients in group 1 (P = 0.002). Of the group 2 patients, 15 (75%) with Stage T1c had an estimated tumor volume of less than 5% compared with only 11 (34%) in group 1 (P = 0.01). No statistically significant difference was noted between the two groups for margin status, presence of extracapsular extension, or Gleason score. CONCLUSIONS: A single microscopic focus of cancer obtained after multiple cores predicts for a significantly lower tumor volume on final pathologic examination across clinical stages. In the context of greater tissue sampling, the minimal disease designation may carry more predictive value and be a useful parameter in stratifying patients with Stage T1c and other good-risk factors with regard to surgical outcome.

    Title Enucleation of Renal Cell Carcinoma with Ablation of the Tumour Base.
    Date
    Journal Bju International
    Excerpt

    OBJECTIVE: To retrospectively assess the effectiveness of cancer control with enucleation of renal cell carcinoma (RCC), which is surgically expedient, allows preservation of maximal renal parenchyma, and makes intraoperative renal ischaemia unnecessary, by two surgeons routinely enucleating renal tumours and ablating the tumour bed with argon beam and the Nd-YAG laser. PATIENTS AND METHODS: Between 1996 and 2006 at our institution, 97 patients had RCC enucleated, with ablation of the tumour base. Patients with lesions other than RCC and those with von Hippel-Lindau disease or Birt-Hogg-Dube syndrome were excluded from the study. The mean follow-up was 24.9 months. Patients were evaluated for RCC recurrence with cross-sectional imaging at least every 6 months for the first 2 years and then annually thereafter. RESULTS: The mean (median, range) tumour size was 2.8 (2.5, 0.8-7.0) cm. Of the 97 patients only one had disease progression after a mean follow-up of 24.9 months. This patient presented with a solitary grade 2 clear cell RCC and had a local recurrence 30 months after original surgery. CONCLUSIONS: The present series and other available clinical data suggest that enucleation with cavity ablation is an oncologically sound approach that is simple, versatile and obviates the need for renal ischaemia.

    Title Application of Evicel to Cavernous Nerves of the Rat Does Not Influence Erectile Function In Vivo.
    Date
    Journal Urology
    Excerpt

    OBJECTIVES: To evaluate the effect of the fibrin sealant, Evicel, on the neuroregulatory control of penile erections in an experimental rat model. METHODS: Two groups of rats were used: sham-operated rats with exposure of the bilateral cavernous nerves (CNs) and application of saline vehicle (500 muL), and rats treated with direct application of Evicel (500 muL) bilaterally to the CNs. At 14 and 45 days after application of Evicel to the CNs, the CNs were stimulated to measure the in vivo erectile responses. Additionally, we evaluated the neuronal nitric oxide synthase immunoreactivity in the dorsal CNs of the penis and changes in the smooth muscle and collagen deposition in the penis using a trichrome stain. RESULTS: Evicel application to the CNs did not have any detrimental effect on the neurogenic erectile responses in vivo at 14 or 45 days after application. The neuronal nitric oxide synthase expression in the dorsal CNs of the penis was unchanged after Evicel application at all points studied, and we saw no change in the histomorphometric analysis findings of smooth muscle and collagen deposition in the penis. CONCLUSION: These data suggest that the hemostatic agent, Evicel, is safe in an experimental rat model of erection physiology, with no detrimental effects on neuroregulatory control of erection.

    Title The Clinical and Pathological History of Prostate Cancer Progression in Men with a Prior History of High Grade Prostatic Intraepithelial Neoplasia.
    Date
    Journal The Canadian Journal of Urology
    Excerpt

    OBJECTIVES: The natural history of high grade prostatic intraepithelial neoplasia (HGPIN) is incompletely understood limiting evidence based recommendations regarding screening and repeat biopsy intervals. Our objective was to evaluate the natural history of HGPIN to better assess the time frame to disease progression and the pathological findings at the time of progression to cancer. METHODS AND MATERIALS: We retrospectively reviewed 74 consecutive patients with an initial diagnosis of HGPIN. The number and timing of all biopsies leading to the diagnosis of cancer were assessed. Clinical and pathological features of those patients with eventual disease progression were evaluated. RESULTS: The mean number of biopsies performed before subsequent cancer diagnosis was 5 (range: 3-13). The mean time to the diagnosis of cancer was 29 months (range: 7-83). Men with a history of HGPIN had lower percent positive biopsies at the time of cancer diagnosis (p < 0.001) and smaller volume tumors on final pathology (p = 0.041) compared to men without a history of HGPIN. CONCLUSIONS: Patients with an initial diagnosis of HGPIN on transrectal ultrasound (TRUS) guided biopsy progressed to cancer at a mean of 29 months. The vast majority of patients that progressed to prostate cancer had low volume disease at the time of diagnosis and definitive treatment. Our data indicate the importance of re-evaluation in HGPIN patients and suggest a trend toward low volume disease in carefully followed patients. Prospective data is warranted to adequately define an evidence based biopsy regimen in men with HGPIN.

    Title Outcomes of Patients After Aborted Radical Cystectomy for Intraoperative Findings of Metastatic Disease.
    Date
    Journal Bju International
    Excerpt

    OBJECTIVES To assess the clinical outcome of patients with bladder cancer who underwent attempted radical cystectomy (RC) with curative intent, but whose procedures were aborted due to intraoperative findings of metastatic disease, as the presence of metastatic disease at RC is associated with a poor prognosis and there are no data on the optimum management strategy in this situation. PATIENTS AND METHODS In all, 248 consecutive patients with bladder cancer had attempted RC at one academic institution between 1994 and 2003. We retrospectively reviewed the records of 35 patients who had an aborted RC due to intraoperative findings of metastatic disease. The pathological characteristics, time to recurrence, overall survival, disease-specific survival, and suitability for adjuvant or salvage therapies were examined. RESULTS Of the 35 patients who had an aborted RC for metastatic disease, 21 (60%) died from the disease within the study period (median time to cancer-specific death 26.4 months), 11 (31%) are alive with evidence of persistent disease or progression, and three (9%) are alive with no evidence of recurrence or progression. Seven patients had a salvage RC after successful adjuvant treatment, of whom three died from recurrent disease (at a mean of 46.5 months after initial exploration, 31.9 months after salvage RC), one is alive with bladder cancer recurrence to the rectum 10 months after salvage cystectomy, and three have no evidence of disease progression at a mean of 10 months after salvage RC. CONCLUSIONS The prognosis of patients who undergo an aborted attempt at curative RC due to intraoperative findings of metastatic disease is poor. Although a few patients might subsequently have salvage RC, many of these patients still have poor outcomes even if adjuvant treatments are used. When metastatic disease is discovered at RC, completing the cystectomy should be considered, although further studies are needed to show a clinical benefit.

    Title The Presence of Circulating Tumor Cells Does Not Predict Extravesical Disease in Bladder Cancer Patients Prior to Radical Cystectomy.
    Date
    Journal Urologic Oncology
    Excerpt

    OBJECTIVE: Due to imprecise clinical staging, the finding of extravesical and node-positive disease at the time of radical cystectomy (RC) for patients with clinically localized bladder cancer is not uncommon. Circulating tumor cells (CTCs) have been shown to be present in the peripheral blood of patients with metastatic urothelial carcinoma. The object of this study was to evaluate the ability of CTCs to predict extravesical disease in bladder cancer patients prior to RC. MATERIALS AND METHODS: Peripheral blood samples from 43 patients with bladder cancer were evaluated using the CellSearch (Veridex, LLC, Raritan, NJ) CTC assay prior to RC. The sensitivity, specificity, and positive predictive value (PPV) of CTC status in predicting extravesical disease was calculated. Receiver operating characteristic (ROC) curves were generated to quantify the ability of CTCs to predict extravesical and node-positive disease. RESULTS: CTCs were detected in 9 (21%) patients prior to RC. The sensitivity, specificity, and PPV of CTC status in predicting extravesical disease were 27%, 88% and 78%, respectively. The accuracy of CTC status in predicting extravesical (>/=pT3 or node-positive) disease for the entire cohort was 0.576. In a model incorporating preoperative hydronephrosis, CTC status did not improve the predictive accuracy for extravesical disease (0.576 vs. 0.585, P = 0.915). CONCLUSION: CTCs were detected in low numbers in a small percentage (21%) of patients prior to undergoing RC at our institution. CTC status was not a robust predictor of extravesical or node-positive disease in this cohort. CTC status is not likely to be a clinically useful parameter for directing therapeutic decisions in patients with </=cT2 bladder cancer.

    Title Impact of Surgical Technique (open Vs Laparoscopic Vs Robotic-assisted) on Pathological and Biochemical Outcomes Following Radical Prostatectomy: an Analysis Using Propensity Score Matching.
    Date
    Journal Bju International
    Excerpt

    Study Type - Therapy (case series)
Level of Evidence 4 OBJECTIVES: To investigate a single institution experience with radical retropubic prostatectomy (RRP), laparoscopic radical prostatectomy (LRP) and robot-assisted radical prostatectomy (RARP) with respect to pathological and biochemical outcomes. SUBJECTS AND METHODS: A group of 522 consecutive patients who underwent RARP between 2003 and 2008 were matched by propensity scoring on the basis of patient age, race, preoperative prostate-specific antigen (PSA), biopsy Gleason score and clinical stage with an equal number of patients who underwent LRP and RRP at our institution. Pathological and biochemical outcomes of the three cohorts were examined. RESULTS: Overall positive surgical margin rates were lower among patients who underwent RRP (14.4%) and LRP (13.0%) compared to patients who underwent RARP (19.5%) (P= 0.010). There were no statistically significant differences in positive margin rates between the three surgical techniques for pT2 disease (P= 0.264). In multivariate logistic regression analysis, surgical technique (P= 0.016), biopsy Gleason score (P < 0.001) and preoperative PSA (P < 0.001) were predictors of positive surgical margins. Kaplan-Meier analysis did not show any statistically significant differences with respect to biochemical recurrence for the three surgical groups. CONCLUSIONS: RRP, LRP and RARP represent effective surgical approaches for the treatment for clinically localized prostate cancer. A higher overall positive SM rate was observed for the RARP group compared to RRP and LRP; however, there was no difference with respect to biochemical recurrence-free survival between groups. Further prospective studies are warranted to determine whether any particular technique is superior with regard to long-term clinical outcomes.

    Title Is Prostate-specific Antigen Surveillance Necessary in Men with Benign Prostate Pathology Following Radical Cystoprostatectomy for Bladder Cancer?
    Date
    Journal Urologia Internationalis
    Excerpt

    Radical cystoprostatectomy (RCP) remains the gold standard for the treatment of muscle-invasive bladder cancer. There are limited data regarding the clinical impact and detection of PSA following complete prostatectomy or the need to monitor serum PSA in patients with benign prostate pathology at time of RCP. The purpose of our study was to analyze the postoperative PSA characteristics of men without prostate cancer who underwent a RCP for bladder cancer.

    Title Impact of Adjuvant Chemotherapy on Patients with Lymph Node Metastasis at the Time of Radical Cystectomy.
    Date
    Journal The Canadian Journal of Urology
    Excerpt

    Radical cystectomy (RC) remains the gold standard treatment for patients with muscle-invasive bladder cancer. Unfortunately, a significant proportion of patients will have lymph node involvement at the time of RC. We set out to determine the impact of adjuvant cisplatin-based chemotherapy (AC) in a cohort of lymph node positive patients following RC.

    Title Increased Ezh2 Protein Expression is Associated with Invasive Urothelial Carcinoma of the Bladder.
    Date
    Journal Urologic Oncology
    Excerpt

    OBJECTIVES:: Elevated polycomb group protein Enhancer of Zest Homolog 2 (EZH2) expression has been associated with progression to more advanced disease in a variety of malignancies. We examined EZH2 protein expression levels in bladder tissue specimens from patients with urothelial carcinoma (UC) and investigated the relationship between EZH2 protein expression and clinical outcomes. MATERIALS AND METHODS:: Tissue microarrays (TMAs) were constructed using bladder tissue specimens from radical cystectomies performed for UC at our institution between 1994 and 2002. EZH2 expression was measured by immunohistochemistry and scoring was based on percentage and intensity of positive nuclear staining. A receiver operating curve (ROC) was generated to differentiate cancerous from benign lesions using EZH2 protein scores. Recurrence-free survival was estimated using the Kaplan-Meier approach with log-rank test. A multivariate Cox proportional hazards model was used to assess independent contributions. RESULTS:: A total of 454 TMA specimen spots from 81 patients were evaluated. EZH2 protein levels in invasive high grade UC were significantly elevated compared with adjacent benign urothelium, noninvasive low grade UC, and CIS. EZH2 protein levels were also significantly increased in CIS and noninvasive low grade UC compared with adjacent benign urothelium. We found no association between EZH2 protein expression and clinical outcomes following radical cystectomy in our cohort of patients. CONCLUSION:: EZH2 overexpression is a common event in UC of the bladder. Elevated EZH2 protein levels are associated with more aggressive bladder cancer, including invasive UC. EZH2 may therefore serve as a useful biomarker for UC.

    Title Endorectal T2-weighted Mri Does Not Differentiate Between Favorable and Adverse Pathologic Features in Men with Prostate Cancer Who Would Qualify for Active Surveillance.
    Date
    Journal Urologic Oncology
    Excerpt

    With the increased diagnosis of low grade, low volume, potentially non-lethal disease, active surveillance (AS) has become an increasingly popular alternative for select men with low-risk prostate cancer. The absence of precise clinical staging modalities currently makes it difficult to predict which patients are most appropriate for AS. The goal of our study was to evaluate the ability of endorectal MRI (eMRI) to predict adverse pathologic features in patients who would otherwise qualify for an AS program.

    Similar doctors nearby

    Dr. Keith Van Arsdalen

    Urology
    33 years experience
    Philadelphia, PA

    Dr. Andrew Axilrod

    Urology
    28 years experience
    Philadelphia, PA

    Dr. Philip Hanno

    Urology
    37 years experience
    Philadelphia, PA

    Dr. Stanley Malkowicz

    Urology
    29 years experience
    Philadelphia, PA

    Dr. Michael Carr

    Urology
    25 years experience
    Philadelphia, PA

    Dr. Tara Frenkl

    Urology
    14 years experience
    Philadelphia, PA
    Search All Similar Doctors