From the Editorial Board

E. David Crawford, MD

In this new year of Grand Rounds in Urology (GRU), we continue our tradition of providing the practicing urologist with the latest in information on genitourinary diseases. I am also pleased that we will exand our coverage from four issues to six in 2008. Our first issue, Vol- ume 7, Issue 1, focuses on Hypogonadism, and includes a thorough review by Dr. Al- varo Morales, Director of the Centre of Applied Urological Research at Kingston General Hospital and Queen’s University in Kingston, Ontario, Canada.

A primary goal of GRU is to provide cutting edge information that fills knowledge gaps in medical education and care. There are, in my opinion, a number of reasons for these gaps. Foremost is the lack of accrual to randomized clinical trials designed to answer important clinical questions. Witness the fact that we do not have head to head comparisons of surgery versus radiation for local prostate cancer treatment. Nearly 30% to 40% of men will fail a local therapy for prostate cancer and experience biochemcial failure. We have no randmized clinical traials to help determine the value of early hormonal therapy. We do know that certain characteristics lead to a risk of prostate cancer specifc death, and these include early failture, rapid doubling time of PSA, and higher Gleason Score. A randomized clinical trial comparing no treatment to standard hormal therapy is lacking. Pharmaceutical companies are reluctant to study this population because of concerns for accrual and also the long length of time required for a relevant clinical endpoint.

Another reason for a gap in knowledge relates to incomplete dissemination of cutting edge materials. Dr. Morales discusses one of these areas and provides a very succinct overview of the area of testosterone replacement therapy (TRT). The whole concept of Androgen Deficiency in the Aging Male is controversial because of the lack of randomized trials to establish the risk/benefit. A major concern of TRT is the risk of promoting prostate disease, especially cancer. To date, evidence would suggest that this is not the case; however, as he discussed, men on TRT must be carefully monitored. It appears from the results of a number of recent reports cited by Dr. Morales, that TRT may actually be beneficial to overall health.

I encourage you to join in on this ongoing discussion of bridging the treatment gaps in the management of hypogonadism. After reading the article, please be sure to take the CME post-test and apply for CME credit. I hope you enjoy this issue of GRU. There is much more to come throughout the year.

Sincerely,

E. David Crawford,

 

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