Purpose Extraprostatic disease will be manifest in one third of men after radical prostatectomy. We present long-term followup of a randomized clinical trial of radiotherapy to reduce risk of subsequent metastatic disease and death. Materials and Methods 431 men with pT3N0M0 prostate cancer were randomized to 60–64 Gy adjuvant radiotherapy or observation. The primary study endpoint was metastasis-free survival. Results Of 425 eligible men, 211 were randomized to observation and 214 to adjuvant radiation. Of those receiving observation, 70 ultimately received radiotherapy. Metastatic-free survival was significantly less with radiotherapy (93 events out of 214 on the RT arm, 114 events out of 211 on observation, Hazard Ratio [HR] 0.71, 95% confidence interval [CI] 0.54, 0.94; p=0.016). Survival was improved significantly with adjuvant radiation (88 deaths out of 214 on the RT arm, 110 deaths out of 211 on observation HR 0.72, 95% CI 0.55,0.96; p=0.023). Conclusions Adjuvant radiotherapy after radical prostatectomy for a man with pT3N0M0 prostate cancer significantly reduces the risk of metastasis and increases survival.

In men who had undergone radical prostatectomy for pathologically advanced prostate cancer, adjuvant radiotherapy resulted in significantly reduced risk of PSA relapse and disease recurrence, although the improvements in metastasis-free survival and overall survival were not statistically significant. Trial Registration clinicaltrials.gov Identifier: NCT00394511.

Immediate antiandrogen therapy after radical prostatectomy and pelvic lymphadenectomy improves survival and reduces the risk of recurrence in patients with node-positive prostate cancer.

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AMH is only diagnosed by microscopy; a dipstick reading suggestive of hematuria should not lead to imaging or further investigation without confirmation of three or greater red blood cells per high power field. The evaluation and follow-up algorithm and guidelines provide a systematic approach to the patient with AMH. All patients 35 years or older should undergo cystoscopy, and upper urinary tract imaging is indicated in all adults with AMH in the absence of known benign causation. The imaging modalities and physical evaluation techniques are evolving, and these guidelines will need to be updated as the effectiveness of these become available. Please visit the AUA website at http://www.auanet.org/content/media/asymptomatic_microhematuria_guideline.pdf to view this guideline in its entirety.

ARTICLEMen have a substantially higher risk of bladder cancer than women ( 1 ). Excessive exposure of men to cigarette smoke and industrial chemicals, both of which include amines, has been suggested to result in the development of bladder cancer ( 2 ). However, sexrelated differences in the risk of bladder cancer have been shown to persist in the absence of exposure to known carcinogenic factors ( 2 ). In animal experimental models, males are more likely than females to develop bladder cancer induced by certain chemical carcinogens (e.g., aromatic amines, such as N -butyl-N -(4-hydroxybutyl) nitrosamine [BBN]) ( 3 ). In contrast, a recent study ( 4 ) showed that certain other carcinogens, such as the arsenical metabolite dimethylarsinic acid, are more toxic to the female bladder than the male bladder in rats. This finding is consistent with epidemiologic evidence suggesting that women are more susceptible to arsenic-induced bladder cancer than men ( 5 ). Thus, the basis for the sex-specific difference in bladder cancer incidence is not understood.A potential mediator of sex-specifi c differences is the androgen receptor (AR). The AR, a member of the nuclear receptor superfamily, is a ligand-dependent transcriptional factor that mediates the biologic effects of androgens ( 6 , 7 ). Expression of the AR has been detected in normal bladder epithelium ( 8 ) and in bladder carcinomas from both male and female patients ( 9 ). However, little is known about AR function in the bladder or about androgen metabolism in the bladder urothelium. Early studies ( 10 ) showed that levels of cytochrome P450 CYP4B1, which is present at higher levels in male bladder than female bladder and activates Affiliations of authors:

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