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BACKGROUND: Upgrading following prostate biopsy is very common in clinical practice. This study investigated whether the use of 5-alpha reductase inhibitors (ARI) and alpha blockers affect known clinical predictors of Gleason score upgrading or not. MATERIALS AND METHODS: A retrospective study on 998 patients treated with robotic assisted laparoscopic prostatectomy for clinically localized biopsy Gleason score 6 prostate cancer were studied. The logarithm of prostate specific antigen concentration, prostate size and tumor volume were compared on the basis of the medication history of 5-ARIs and alpha blockers in the cohort of biopsy Gleason 6 patients with benign prostatic hyperplasia history, and patients whose prostate sizes fall in the top quartile. We compared known clinical and pathologic characteristics associated with upgrading in regression models with and without the addition of medications. RESULTS: Alpha blockers, but not 5-ARI were associated with a bigger prostate. Upgrading was associated with older age (OR 1.03, 95% CI 1.01-1.06), higher BMI (OR 1.00 CI 1.01-1.08), higher log prostate specific antigen (OR 7.32, CI 3.546-15.52), smaller prostate size (OR 0.97, CI 0.96-0.98), fewer biopsy cores (OR 0.96 CI 0.92-0.99), more positive cores (OR 1.20, CI 1.08-1.34), and higher percentage of tumor at biopsy (OR 1.02, CI 1.01-1.03). Neither of the two medication classes were a significant predictor of upgrading. Medications made minimal changes in the multivariate predictive models. CONCLUSION: Although, alpha blockers were associate with bigger prostate size, the modulating effects of alpha blockers and 5-ARIs on common predictors of Gleason score upgrading was not significant.
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OBJECTIVE: To examine and characterize the demographics and scholarly characteristics of academic urology chairmen at the time of appointment. MATERIALS AND METHODS: The chairman of each United States urology residency program as of September 2016 was included in the study. Interim chairmen, as well as programs for which no clearly defined chair could be identified, were excluded. Demographic and academic data were collected via publically available curriculum vitae, departmental websites, Google search engine, and PubMed and Scopus websites. RESULTS: One hundred thirteen chairmen were included in the study. The majority were male (96%) and mean age at appointment was 46 years (standard deviation = 6.3 years). Mean number of publications and H-index at the time of appointment was 105 and 31.1, respectively. Fellowship training was completed by 75% of chairmen, of which urologic oncology (N = 43), endourology (N = 12), and infertility/andrology (N = 10) were the most common. The most common additional graduate degrees prior to appointment were MBA (N = 7) and PhD (N = 6). The most frequently attended institutions for residency were Johns Hopkins University (13) and Northwestern University (5), whereas Memorial Sloan Kettering Cancer Center (13) and Baylor University (7) were the most frequent for fellowship. Twenty percent of chairmen attained the chairman position at their former residency program and 7% at their former fellowship program. CONCLUSION: Our study describes the demographic and academic characteristics of urology academic chairmen at the time of appointment. The majority of chairmen are male and specialize in urologic oncology. Chairmen often receive the chair appointment at their former residency program.