Centers of Excellence: From the Editor

Centers of Excellence: From the Editor

Details: 18 March 2026

As in most areas of medicine—and of course, most areas of modern life—artificial intelligence (AI) is blazing its way into urology practice with extraordinary speed. Its impact is coming perhaps hardest and fastest in the arena of prostate cancer diagnostics, where tools aimed at improving radiology and pathology are already in clinical use and appearing in guidelines with unprecedented speed, particularly in comparison to the prior generation of genomic tests.

As of December 2025, the FDA has approved 1451 AI-enabled devices, 1104 in radiology.¹ Only 3 of these, all in the area of diabetic retinopathy, are intended to work autonomously; all others are meant to augment rather than replace human clinician workflows. As in most domains, prostate cancer lags well behind breast cancer and behind colorectal and lung cancer as well.² Clearly, however, we stand at an inflection point in prostate cancer, with a bevy of tools in varying stages of development and promulgation, mostly in the areas of pathology and radiology.

Details: 14 January 2026

It is with great pleasure that I welcome all of you to the Urotoday Center of Excellence on Functional Urology. My goal is to highlight current topics of interest by citing selected and specific presentations, published articles, and commentaries on important topics in the areas encompassed by the term “functional urology.”

We will include video interviews, text summaries of presentations at key meetings (prepared by those with expertise in the area and in attendance at the meeting), summaries of published articles by the authors themselves and by me, and, occasionally, referenced commentaries on currently discussed topics. Expect some of the “expert opinions” to contradict one another on certain points- this means that whatever topic is being discussed is still a matter of some controversy.

Details: 30 June 2025

Welcome to UroToday’s Center of Excellence on upper tract urothelial carcinoma (UTUC). We share peer-to-peer video conversations, expert reviews, commentaries, and conference updates to help you stay apace with best practices for managing this challenging disease. Here, I provide a brief overview of UTUC and some key updates on recent therapeutic developments.

Details: 22 May 2025

A bladder cancer diagnosis creates many possible stressors for patients and caregivers: complex treatment decisions, time and financial burdens, the physical and emotional toll of treatment and recovery, sexual health concerns, and anxiety about disease recurrence.^1-4

Details: 15 November 2024

I am delighted to serve as the new editor for UroToday’s Center of Excellence on mCRPC Treatment. We provide a multimedia, data-driven hub for information on regulatory approvals, clinical trials, diagnostics, guidelines, investigational treatments, and other aspects of this rapidly evolving field. In this editorial, I cover recent therapeutic approvals in mCRPC, clinical trials, and investigational therapies.

Prostate cancer is the second leading cancer and the most common cause of cancer-related mortality in men, resulting in approximately 397,000 deaths globally in 2022.¹ Metastatic castration-resistant prostate cancer (mCRPC) is the final and most aggressive stage of disease, and its prevalence is rising.^2,3 Currently, median survival after diagnosis of mCRPC is just over 2 years.^4,5 Progressive, symptomatic mCRPC greatly diminishes patients’ functioning and quality of life, and its management consumes significant healthcare resources, making thoughtful clinical decision-making imperative.

Details: 21 October 2024

Importance: Understanding the diagnostic accuracy of postoperative trial of void (TOV) parameters is important for decision making related to postoperative catheterization.

Objective: The aim of the study was to compare the diagnostic accuracies of common postoperative TOV parameters.

Design: The study population comprised a prospective cohort undergoing outpatient urogynecologic procedures at a tertiary referral center from September 2018 to June 2021. Participants recorded their postvoid residual volume (PVR), voided volume, and subjective force of stream (sFOS) for all postoperative voids until meeting criteria to stop. The primary outcome was the sensitivity of TOV parameters in predicting postoperative urinary retention, defined as PVR ≥1/2 voided volume on the first 2 postoperative voids. Sample size was set at 183 to detect a 20% difference (α = 0.05, β = 0.2, up to 20% with missing data) in sensitivity between TOV parameters. Diagnostic accuracies were compared with McNemar’s test for paired proportions, with Youden’s index calculated to determine optimal thresholds.

Results: The 160 participants had a mean age of 52.1 ± 11.4 years and a mean body mass index of 28.9 ± 5.8 kg/m2 (calculated as weight in kilograms divided by height in meters squared).Mean preoperative PVR was 25.8 ± 29.9 mL. Most participants had surgery that included a midurethral sling (137/160, 85.6%). Thirty-four (34/160, 21.3%) participants met criteria for postoperative urinary retention. The optimal recovery room TOV thresholds to predict postoperative urinary retention were PVR ≥87 mL (sensitivity 96.8%, specificity 60.0%), voided volume ≤ 150 mL (sensitivity 83.9%, specificity 72.3%), and sFOS ≤60% (sensitivity 100%, specificity 50.8%). Voided volume ≤ 150 mL had greater diagnostic accuracy than PVR ≥100 mL (156.2 vs 151.8).

Conclusions: In this cohort, PVR ≥87 mL, voided volume ≤ 150 mL, and sFOS ≤60% had optimal diagnostic accuracy for postoperative urinary retention.

Julia K. Shinnick, MD,* Christina A. Raker, ScD,† Elizabeth J. Geller, MD,‡ Charles R. Rardin, MD,* and Anne C. Cooper, MD, MA§

*Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Women & Infants Hospital of Rhode Island, Teaching Affiliate of the Warren Alpert Medical School of Brown University, Providence, RI; †Division of Research, Department of Obstetrics and Gynecology, Women & Infants Hospital of Rhode Island, Teaching Affiliate of the Warren Alpert Medical School of Brown University, Providence, RI; ‡Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC; and §Division of Urogynecology, Department of Obstetrics & Gynecology, Dartmouth Geisel School of Medicine, Dartmouth, NH.

Source: Shinnick, et al. Comparison of Diagnostic Accuracies of Commonly Used Trial of Void Parameters. Urogynecology 2024;00:00–00 DOI: 10.1097/SPV.0000000000001539.

Details: 28 August 2024

Welcome to UroToday’s Center of Excellence on metastatic hormone-sensitive prostate cancer (mHSPC). I am honored to serve as its new editor. This multimedia Center helps audiences in the United States and worldwide stay abreast of clinical trials, real-world studies, biomarker data, regulatory approvals, and expert perspectives on this challenging, dynamic disease and treatment landscape. As therapies for patients with mHSPC evolve, real-world practice has lagged behind. Indeed, five years after the regulatory approvals of novel androgen receptor pathway inhibitors (ARPIs) for treating mHSPC, data suggest that less than half of patients are receiving them in the metastatic hormone-sensitive setting. In this editorial, I cover key data and approvals in mHSPC, what we know about real-world treatment patterns, and how we can narrow gaps between data and practice.

In the United States, the National Cancer Institute estimates that at least 8% of all prostate cancer cases are metastatic when first diagnosed (ie, de novo or synchronous mHSPC),¹ and this proportion is higher in regions where prostate-specific antigen (PSA) screening is not routine and thus patients are more likely to be diagnosed only after they become symptomatic.^2-4

Details: 22 August 2024

For more than 20 years, UroToday has been THE premier online educational resource for genitourinary oncology – clinicians educating clinicians. During this time, advanced prostate cancer has been completely transformed, pa≥ particularly in the last 10+ years. Since then, we have seen (briefly) the following in advanced prostate cancer:

Docetaxel for mCRPC progression
Cabazitaxel following docetaxel for mCRPC progression
Radium-223 for mCRPC
Docetaxel + ADT for mHSPC
Abiraterone + prednisone for mHSPC
ARPIs + ADT for mHSPC
ARPIs + ADT for M0 CRPC
Enzalutamide +/- ADT for non-metastatic HSPC
PARP inhibitors for mCRPC
Radioligand therapy for mCRPC

Details: 16 May 2024

For years, the standard treatment for muscle-invasive bladder cancer (MIBC) was radical cystectomy (RC), preceded by neoadjuvant cisplatin-based chemotherapy (NAC), if tolerable. Currently, the National Comprehensive Cancer Center (NCCN) has two category 1 recommendations for patients with cT2-T4aN0 MIBC: NAC followed by cystectomy, and trimodal therapy (TMT).¹

Details: 27 March 2024

More than three years after the first FDA approval of a PSMA radiotracer for detecting prostate cancer (PCa), we are seeing an evolution and maturation of use in the clinic. The availability of PSMA PET with different tracers enables us to detect lesions that conventional imaging misses, identify disease recurrence at very low (<0.5 ng/mL) PSA levels, and distinguish between benign and malignant tissue.^1-3 In some countries and regions, PSMA PET is now standard practice for initial PCa staging, treatment planning, and monitoring treatment response. However, questions persist about how to manage patients in the PSMA PET era, particularly because registrational trials of current therapies predated the widespread availability of PSMA PET and therefore used only conventional imaging (i.e., CT, bone scan). Here, I discuss current knowledge gaps pertaining to the use of PSMA PET in various scenarios and how we can best steward this resource.

Details: 07 March 2024

Gender disparities –the underrepresentation of women and other gender minorities—have historically and continually plagued many fields of medicine and scientific research. The fields of urology, genitourinary (GU) oncology, and prostate cancer research have especially been male-dominated.^1,2

Details: 21 February 2024

Advanced renal cell carcinoma (RCC) accounts for about 2% of cancer deaths globally, and its incidence is increasing in the United States and worldwide.¹ Clear cell RCC (ccRCC) comprises about 75% of RCCs and is the most aggressive subtype, although survival rates are substantially improving with the advent of targeted systemic therapies and immune checkpoint inhibitors. In this editorial, I update readers on current therapeutic approaches for patients with advanced RCC, including clear cell and other histotypes. I also review the role of (neo)adjuvant treatment and biomarkers in advanced RCC management.

Details: 01 February 2024

“Nothing in life is to be feared; it is only to be understood.” – Marie Curie

As we embark on 2024, we continue to see an explosion of research and clinical trials in bladder cancer. Every FDA approval is the fruit of thousands of hours of dedicated work by investigators, patients, research, and clinical teams. However, regulatory approval is only the first step in linking patients with new therapies. Without effective dissemination of knowledge and guidance, many patients will not receive evidence-based treatments and indeed may not even know their treatment options.

Details: 14 July 2023

Bladder cancer can be seen as a chronic condition—patients with nonmetastatic disease can live years, even decades, after diagnosis, and they often die of unrelated causes.¹ This chronicity intensifies the impacts of initial management: Clinical decisions made in the first weeks or months of the patient’s journey exert a domino effect that spans the entire disease trajectory. Early detection and appropriate initial management significantly improve patient outcomes and quality of life, while delayed detection and excessive or inappropriate treatment lead to needless suffering and financial toxicity.

Details: 22 June 2023

Muscle-invasive bladder cancer (MIBC) represents 1/3 of the approximately 81,000 newly diagnosed bladder cancer cases in the US each year.¹ Cisplatin-based neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC) has been the traditional and most widely used management approach to MIBC.

Details: 05 June 2023

Diane Newman welcomes viewers to the Pelvic health Center of Excellence on UroToday.com The leading location for state of the art lectures, original articles, research, current treatments and emerging clinical care in pelvic health and pelvic floor dysfunction. Diane encourages viewers to utilize this center as a resource for current research, clinical expertise and to stay up to date with current treatments and interventions.

Details: 24 May 2023

Welcome to UroToday’s new Center of Excellence on Disparities: Social Determinants of Health. I am honored to serve as its Editor and excited to share new research and expert conversations with you. The World Health Organization and the United States Centers for Disease Control and Prevention define social determinants of health (SDOH) not as individual variables, but as the environments in which people are born, grow, learn, work, play, and age.^1,2 Specific characteristics of these environments can either increase or reduce disparities in health, healthcare access, and quality of life among individuals, regions, and nations. This Center focuses on SDOH and healthcare disparities within urology, particularly genitourinary (GU) oncology. However, it is important to emphasize that SDOH affects all persons and all healthcare fields in a multitude of ways, and therefore, many topics covered by this Center will appeal to a broad audience. In this editorial, I outline the current status of GU research on SDOH and disparities, how experts are redefining SDOH and downstream effects in order to improve research and policy, and why it is crucial to engage medically underserved communities in these efforts.

Details: 07 March 2023

Over the past several decades, significant strides have been made in the development of new treatments for prostate cancer. Twenty years ago, the only option for patients with metastatic castration-resistant prostate cancer (mCRPC) was to continue androgen deprivation therapy (ADT), despite diminishing efficacy; today, there are over a dozen treatment options and combinations for patients with advanced prostate cancer. These new treatments and the advent of PSA screening have reduced prostate cancer mortality rates by over 50% since 1993; however, an estimated 34,700 patients in the U.S. and 375,000 globally are still dying from prostate cancer each year. ^{1, 2} Our work is not yet done.

Details: 31 January 2023

It’s a great pleasure to welcome you to the UroToday Center of Excellence focusing on sex- and gender-based disparities among urologists and their patients. Some may wonder why a site like UroToday is taking on this focus – hopefully, as you digest the data that this center will provide, it will become clear that the bias and disparities existing in our society critically affect our professional interactions and career satisfaction, the delivery of urologic care, and outcomes for our patients.

Details: 30 November 2022

The term “cancer” dates to the time of Hippocrates, when the crab (karkinos)-like cutaneous manifestations of advanced tumors heralded incurable disease, pain, decline, and death. Today the term denotes an incredibly diverse spectrum of conditions, all characterized by abnormal cell division and growth—and nearly all by the capacity for metastasis—but varying very widely in aggressiveness and kinetics of progression. In the era of microscopy and histopathology, each cancer now has its formal criteria for diagnosis, and clinicians recognize the variable meaning of each. To the public, however, the connotation of the diagnosis “You have cancer” has changed only to an extent in the modern age.

In the case of prostate cancer, prostate specific antigen (PSA)-based early detection and the years-to-decades lead time associated with screening has radically changed the clinical meaning of the diagnosis. Countless research articles and reviews on prostate cancer begin by citing the fact that it is the most common non-cutaneous cancer diagnosed among men in the US and in many other countries.