Modern advances in genomic and molecular technologies have sparked substantial research on the human intestinal microbiome over the past decade. A deeper understanding of the microbiome has illuminated that dysbiosis, or a disruption in the microbiome, is associated with inflammatory disease states and carcinogenesis. Novel therapies that target the microbiome and restore healthy flora may have value in dampening the immunopathologic state induced by dysbiosis. A narrative review of the literature on the use of microbiota-centered interventions (MCIs) was conducted. Several randomized clinical trials show that MCIs can augment response to immune checkpoint inhibitor (ICI) therapy in patients with metastatic cancer. Clinical trials have also demonstrated that modulation of the intestinal microbiome can enhance recovery and reduce infectious complications in the surgical management of colorectal adenocarcinoma. Overall, these major discoveries suggest future clinical applications of MCIs for a wide range of immune-mediated conditions. These results may also translate to improved patient outcomes in systemic immunotherapy for urothelial carcinoma as well as in patients recovering from radical cystectomy (RC), which is complicated by high infection rates. Further research is needed to evaluate the optimal bacterial composition of microbiota-centered therapies and the specific cellular changes that lead to improved tumor antigen recognition after microbiota-centered therapies.
MEDICAL students receive limited and intermittent exposure to urology, a pattern standing in stark contrast to other surgical subspecialties. Take orthopedics, for example, where public perception is colored by mass media, popular culture, or even personal experience. On the other hand, the sensitive nature of urological conditions limits public discourse and leads to further misinformation. In reality, medical students chance upon urology during cursory clinical encounters, rather than structured didactic or clinical courses. 1 Although efforts exist to enhance urological training in undergraduate medical education, these efforts are not standardized across institutions. Moreover, almost one-quarter of medical schools (24.2%) lack a home urology program, where students are even further disadvantaged. This creates a 2-fold dilemma to the pursuit of urological training: (1) medical students are uninformed of the diversity of urological conditions and their innovative management options, and (2) mentorship and opportunities in urology are not universally publicized to all medical trainees.A minority of medical schools offer preclinical urology coursework, only 5% of schools have a mandatory urology clerkship, and program directors report that student exposure to urology has declined over the last decade. 2,3 There are various barriers to timely exposure, including limited time in the medical school curriculum, perceived importance of common urology conditions, availability of a home program, mentorship, and research opportunities. While applications for the urology match far exceed spots, there is still room for increasing student interest, as we must address issues including the lack of diversity and the looming urology workforce shortage.The single best way to increase awareness and interest is by creating and advertising new opportunities for student involvement. Studies have repeatedly shown that a few medical schools with robust urology programming match a disproportionately large number of students, a trend that has downstream consequences for diversity. 4,5 Additionally, given the aging population and modern appreciation for genitourinary issues, demand for urological services is only increasing. Yet the
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.
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