Nephrectomy Followed by Interferon Alfa-2b Compared With Interferon Alfa-2b Alone for Metastatic Renal Cell Cancer

This chapter summarizes the findings of a landmark trial of cytoreductive nephrectomy in patients with metastatic renal cell carcinoma performed in the interferon era. All enrolled patients had a good performance status. It found overall survival extended by about 3 months in the cytoreductive-nephrectomy-plus-interferon arm versus the interferon-only arm.

A Prospective Study of Dietary Calcium and Other Nutrients and the Risk of Symptomatic Kidney Stones

This chapter reviews the results of an important observational study seeking to establish how, in individuals without a history of nephrolithiasis, dietary calcium intake is associated with the risk of symptomatic stone disease. The study found that the mean daily dietary calcium intake was lower in the group who formed stones compared to those who did not and that, after adjusting for covariates, high daily dietary calcium intake was strongly associated with decreased risk of stones.

The Influence of Finasteride on the Development of Prostate Cancer

This chapter describes the design, main findings, relevance, and limitations of the landmark Prostate Cancer Prevention Trial (PCPT), which randomized men to finasteride versus placebo and followed them for 7 years. It found a major reduction in prostate cancer incidence but also a higher proportion of high-risk cancer in men diagnosed with prostate cancer. The study did not address the more important oncological outcomes of disease-specific and overall survival. Secondary analyses of PCPT outcomes favored the finasteride arm and suggested that the risk of high-risk cancer is not increased. Linkage analysis of participants from PCPT to Medicare claims data suggested no adverse long-term cardiac, endocrine, or sexual effects.

Treatment of Men With Erectile Dysfunction With Transurethral Alprostadil

This chapter summarizes the results of an important trial comparing transurethral alprostadil to placebo in men with erectile dysfunction. Sexual intercourse was reported as having occurred more often in the alprostadil group, and more men in the group experienced orgasm. Penile pain was reported by approximately one-third of men during clinic testing. This study described the initial experience with transurethral alprostadil and identified the effectiveness of patient-specific doses.

Oral Sildenafil in the Treatment of Erectile Dysfunction

This chapter summarizes the results of a landmark trial comparing different doses of oral sildenafil versus placebo to treat erectile dysfunction. Patients received either an identical placebo or 25- mg, 50-mg, or 100-mg tablets of sildenafil to be taken approximately one hour before planned sexual activity (but not more than once daily) for 24 weeks. Higher doses of sildenafil resulted in higher mean score for frequency of penetration and maintenance of erection, which were also consistently better than placebo. The most common side effects were headaches, flushing, dyspepsia, rhinitis, and visual disturbances. This study established sildenafil as an effective, reasonably well-tolerated treatment for men with erectile dysfunction of varying etiologies.

Burch Colposuspension Versus Fascial Sling to Reduce Urinary Stress Incontinence

This chapter summarizes the results of the Stress Incontinence Surgical Treatment Efficacy (SISTEr) trial, which randomized women with stress urinary incontinence to an autologous sling procedure versus a Burch colposuspension. Overall treatment success favored the fascial sling over the Burch procedure group, as did the stress incontinence–specific success rate at 24 months. Postoperative voiding dysfunction and urge incontinence were more common in the sling group than the Burch group. These findings supported the historical shift toward slings (autologous and synthetic) versus Burch colposuspension procedures in clinical practice.

Radical Prostatectomy Versus Observation in Early Prostate Cancer

This chapter provides a summary of the landmark Scandinavian Prostate Cancer Group Study Number 4 trial of men with clinically localized prostate cancer from the pre–prostate-specific antigen (PSA) era who were randomized to radical prostatectomy versus watchful waiting and were followed long term. With follow-up of more than 20 years, the results favored surgery with regard to prostate cancer mortality.

Neoadjuvant Chemotherapy Plus Cystectomy Compared With Cystectomy Alone for Locally Advanced Bladder Cancer

This study summarizes a landmark study on the role of neoadjuvant chemotherapy with methotrexate, vinblastine, doxorubicin, and cisplatin (M-VAC) in patients with muscle-invasive bladder cancer. This randomized study of M-VAC plus cystectomy versus cystectomy alone suggested improved overall survival in patients receiving neoadjuvant therapy. Severe granulocytopenia was a common adverse effect in the chemotherapy group, but no deaths were attributed to chemotherapy.

Bilateral Orchiectomy With or Without Flutamide for Metastatic Prostate Cancer

This chapter summarizes the findings of a landmark randomized trial comparing total androgen deprivation in the form of bilateral orchiectomy plus the antiandrogen flutamide to bilateral orchiectomy alone. The study found no survival benefit but did find increased side effects from the addition of an antiandrogen.

A Randomized Comparison of Cisplatin Alone or in Combination With Methotrexate, Vinblastine, and Doxorubicin in Patients With Metastatic Urothelial Carcinoma

This chapter reviews the landmark trial in patients with advanced urothelial carcinoma of the bladder assessing how the addition of methotrexate, vinblastine, and doxorubicin to cisplatin (M-VAC) compared to cisplatin alone. The study found improved overall survival and progression-free survival in the M-VAC group, but at the expense of increased toxicity and more drug-related deaths.