About

Judd Wendell Moul is the James H. Semans, M.D. Distinguished Professor of Urologic Surgery in the School of Medicine at Duke University. He holds positions as a Professor of Urology and a Professor in Anesthesiology, and is a member of the Duke Cancer Institute. His professional roles are centered around urologic surgery, with a focus on urologic oncology, and he is actively involved in the Duke Urologic Oncology Fellowship and the Urology Residency Program. His work encompasses research, education, and clinical practice within the field of urology, contributing to advancements in urologic surgery and cancer treatment.

Research topics

• Medicine
• Internal medicine
• Oncology
• Surgery
• Psychiatry
• Anesthesia
• Cardiology
• Gynecology
• Radiology
• Gastroenterology

Selected publications

• Real-world analyses of major adverse cardiovascular events and mortality risk after androgen deprivation therapy initiation in black vs. white prostate cancer patients

  Prostate Cancer and Prostatic Diseases · 2025-04-18

  articleOpen access1st authorCorresponding

  BACKGROUND: Prostate cancer(PCa) patients treated with androgen deprivation therapy(ADT) may experience major adverse cardiovascular events(MACE) [1]. Racial disparities in PCa incidence and outcomes have been noted. In contrast to older studies, three recent studies found significantly longer overall survival in Black vs. White patients: 2019 meta-analysis of nine phase III trials in men with metastatic castration-resistant PCa(CRPC) (n = 8820) [2]; 2020 registry study in men with metastatic CRPC (n = 1902) [3]; and 2023 study in men with non-metastatic CRPC (n = 12,992) [4]. Our "real-world" data study compared MACE and all-cause mortality risk for Black vs. White PCa patients. Compared to prior studies [1-4], our study encompassed a broader scope and was not exclusive to CRPC patients. METHODS: ), oncology vs. urology setting, antagonist vs. agonist, personal MACE history, tobacco history, baseline prostate-specific antigen (>4 vs. ≤4 ng/mL), race (White vs. Black), statin use, increasing age per year, ethnicity (non-Hispanic vs. Hispanic), increasing ADT exposure per year, diabetes, hypertension, and family MACE history. RESULTS: MACE risk was higher for White patients than Black (4.0% vs. 2.4% at one year after ADT initiation; 21.0% vs. 13.3% at four years). Mortality risk after ADT initiation was 1.6% and 2.6% at 1 year and 11.7% and 18.1% at 4 years for Black and White patients, respectively. CONCLUSIONS: Our analysis reveals a unique finding that MACE and all-cause mortality incidence were higher in White vs. Black patients. Black race is associated with lower MACE rates and improved survival for men undergoing ADT treatment. Whether selection bias, underlying biology or other factors are responsible for these differences remains unknown.

  PublisherOA PDFDOI

• MP04-18 ECONOMIC EVALUATION OF OPEN AND ROBOTIC RADICAL PROSTATECTOMY, RADIATION THERAPY, AND ABLATIVE SURGICAL TECHNIQUES IN THE MANAGEMENT OF LOW-TO-INTERMEDIATE RISK PROSTATE CANCER

  The Journal of Urology · 2025-04-08

  article
  PublisherDOI

• MP32-19 CHARACTERIZING THE ACTIVITY OF INFLAMMASOME GENES AND THEIR ASSOCIATION WITH ONCOLOGICAL OUTCOMES IN PROSTATE CANCER

  The Journal of Urology · 2025-04-08

  article
  PublisherDOI

• Predilection for Perplexion: Preoperative microstructural damage is linked to postoperative delirium

  medRxiv · 2025-01-09 · 2 citations

  preprintOpen access

  Postoperative delirium is the most common postsurgical complication in older adults and is associated with an increased risk of long-term cognitive decline and Alzheimer's disease (AD) and related dementias (ADRD). However, the neurological basis of this increased risk-whether postoperative delirium unmasks latent preoperative pathology or leads to AD-relevant pathology after perioperative brain injury-remains unclear. Recent advancements in neuroimaging techniques now enable the detection of subtle brain features or damage that may underlie clinical symptoms. Among these, Neurite Orientation Dispersion and Density Imaging (NODDI) can help identify microstructural brain damage, even in the absence of visible macro-anatomical abnormalities. To investigate potential brain microstructural abnormalities associated with postoperative delirium and cognitive function, we analyzed pre- and post-operative diffusion MRI data from 111 patients aged ≥60 years who underwent non-cardiac/non-intracranial surgery. Specifically, we investigated preoperative variation in diffusion metrics within the posterior cingulate cortex (PCC), a region in which prior work has identified glucose metabolism alterations in the delirious brain, and a key region in the early accumulation of amyloid beta (Aβ) in preclinical AD. We also examined the relationship of preoperative PCC NODDI abnormalities with preoperative cognitive function. Compared to patients who did not develop postoperative delirium (n=99), we found increased free water (FISO) and neurite density index (NDI) and decreased orientation dispersion index (ODI) in the dorsal PCC before surgery among those who later developed postoperative delirium (n=12). These FISO differences before surgery remained present at six weeks postoperatively, while these NDI and ODI differences did not. Preoperative dorsal PCC NDI and ODI values were also positively associated with preoperative attention/concentration performance, independent of age, education level, and global brain atrophy. Yet, these diffusion metrics were not correlated with cerebrospinal fluid Aβ positivity or levels. These results suggest that preoperative latent brain abnormalities within the dorsal PCC may underlie susceptibility to postoperative delirium, independent of AD-related (i.e., Aβ) neuropathology. Furthermore, these preoperative microstructural differences in the dorsal PCC were linked to preoperative deficits in attention/concentration, a core feature of postoperative delirium. Our findings highlight microstructural vulnerability within the PCC, a key region of the default mode network, as a neuroanatomic locus that can help explain the link between preoperative attention/concentration deficits and increased postoperative delirium risk among vulnerable older surgical patients.

  PublisherOA PDFDOI

• Comparative Economic Evaluation of Radical Prostatectomy, Radiation, and Ablative Techniques in the Management of Localized Prostate Cancer

  Preprints.org · 2025-08-18

  preprintOpen access

  Background: To compare the costs of open retropubic radical prostatectomy (RRP), robotic-assisted radical prostatectomy (RALP), intensity-modulated radiation therapy (IMRT), low-dose brachytherapy (LDBT), stereotactic body radiotherapy (SBRT), cryotherapy (Cryo), and high-intensity focused ultrasound (HIFU) for low/intermediate-risk prostate cancer (PCa), from the healthcare system perspective. Methods: This retrospective, IRB-approved study compared the costs and charges of primary treatment options for localized PCa at Duke University Hospital between January 2018 and December 2019. Case identification was carried out by querying the relevant disease, procedural, and charge codes from Duke Finance. Consecutive cases with NCCN high-risk disease, prior treatment, or missing institutional financial information were excluded. Costs were calculated from the point at which the treatment option was selected until the last treatment session (SBRT and IMRT) or hospital discharge (other modalities). All modalities except RRP were considered technology-intensive. Results: A total of 552 patients with a mean age of 65.0 years met the inclusion criteria. NCCN risk categories included 85 (13%) low, 218 (41%) favorable-intermediate, and 249 (46%) unfavorable-intermediate risk cases. RALP, RRP, Cryo, and HIFU were single-session treatments, whereas IMRT, SBRT, and LDBT were delivered over multiple sessions. IMRT and SBRT were the most expensive modalities, followed by RALP, HIFU, LDBT, Cryo, and RRP. The number of sessions (ρ=0.55, p<0.001) and being technology-intensive (ρ=0.58, p<0.001) were significantly correlated with treatment costs. Conclusions: In this cohort of PCa patients, treatment costs were highest for IMRT and SBRT, followed by RALP, HIFU, LDBT, Cryo, and RRP. The number of treatment sessions significantly correlated with increased costs.

  PublisherOA PDFDOI

• MP19-10 EVALUATING EXODX PROSTATE TEST IN MEN WITH LOW-GRADE PROSTATE CANCER ON ACTIVE SURVEILLANCE–A MULTI-CENTER PROSPECTIVE TRIAL

  The Journal of Urology · 2025-04-08

  article1st authorCorresponding
  PublisherDOI

• Comparative Economic Evaluation of Radical Prostatectomy, Radiation, and Ablative Techniques in the Management of Localized Prostate Cancer

  Cancers · 2025-08-28

  articleOpen access

  Background: To compare the costs of open retropubic radical prostatectomy (RRP), robotic-assisted radical prostatectomy (RALP), intensity-modulated radiation therapy (IMRT), low-dose brachytherapy (LDBT), stereotactic body radiotherapy (SBRT), cryotherapy (Cryo), and high-intensity focused ultrasound (HIFU) for low/intermediate-risk prostate cancer (PCa), from the healthcare system perspective. Methods: This retrospective, IRB-approved study compared the costs and charges of primary treatment options for localized PCa at Duke University Hospital between January 2018 and December 2019. We identified cases by querying the relevant disease, procedural, and charge codes from Duke Finance. Consecutive cases with NCCN high-risk disease, prior treatment, or missing institutional financial information were excluded. Costs were calculated from the point at which the treatment option was selected until the last treatment session (SBRT and IMRT) or hospital discharge (other modalities). All modalities except RRP were considered technology-intensive. Results: A total of 552 patients with a mean age of 65.0 years met the inclusion criteria. NCCN risk categories included 85 (13%) low, 218 (41%) favorable-intermediate, and 249 (46%) unfavorable-intermediate risk cases. RALP, RRP, Cryo, and HIFU were single-session treatments, whereas IMRT, SBRT, and LDBT were delivered over multiple sessions. IMRT and SBRT were the most expensive modalities, followed by RALP, HIFU, LDBT, Cryo, and RRP. The number of sessions (ρ = 0.55, p < 0.001) and being technology-intensive (ρ = 0.58, p < 0.001) were significantly correlated with treatment costs. Conclusions: In this cohort of PCa patients, treatment costs were highest for IMRT and SBRT, followed by RALP, HIFU, LDBT, Cryo, and RRP. The number of treatment sessions was a significant predictor of higher costs.

  PublisherOA PDFDOI

• 2461P Baseline (BL) features and metastasis-free survival (MFS) by prior definitive treatment (tx) in patients (pts) with high-risk biochemically recurrent prostate cancer (hrBCR): EMBARK post hoc analysis

  Annals of Oncology · 2025-09-01

  article
  PublisherDOI

• Characterizing the activity of inflammasome genes and their association with oncological outcomes in prostate cancer.

  Journal of Clinical Oncology · 2025-02-10

  article

  410 Background: Inflammasomes are multiprotein complexes that regulate inflammation-associated signaling pathways. Although inflammation plays a crucial role in cancer cell proliferation, the specific role of inflammasomes in prostate cancer (PCa) remains underexplored. This study aims to elucidate the expression of inflammasome-related genes in PCa and assess their association with clinical outcomes. Methods: De-identified transcriptome data from a cohort of 52,266 radical prostatectomy (RP) samples tested (2016-2024) with the Decipher prostate genomic classifier (Veracyte, San Diego, CA) were retrieved from the GRID registry (NCT02609269). Expression analysis focused on 33 genes involved in inflammatory pathways. Outcomes analysis was conducted on a retrospective cohort of 855 patients treated with RP (META855), using Cox regression analysis, adjusting for baseline pathological characteristics. Results: Analysis of baseline gene expression in the GRID RP cohort revealed that most genes exhibit low baseline expression, whereas HSP90AB1, APP, TXN, and TXNIP demonstrate strong expression signals. Higher expression of most genes was associated with higher rate of Gleason grade group 4 or 5 in the GRID RP cohort. On survival analysis of the META855 cohort, higher expression (top 25%) of AIM2 and HSP90AB1 were associated with worse metastasis-free survival (p<0.05 for both). Conversely, both high and low expression levels of NLRP3 were associated with better metastasis-free survival outcomes following RP compared to average expression (p<0.05). On multivariable Cox regression analysis, adjusting for grade group, seminal vesicle involvement, lymph node involvement, and margin status, higher expression of AIM1 (HR 1.75) and HSP90AB1 (HR 1.60) were significantly associated with shorter time to metastasis following RP (p<0.05 for both). Conclusions: There is a molecular heterogeneity within pro-inflammatory genes among patients with PCa.Our findings showed thathigher expression of HSP90AB1 is linked to poorer oncological outcomes, whereas both high and low expression levels of NLRP3 are associated with better outcomes following RP.Further refinement is required to build a robust signature, along with external validation of these findings in other cohorts.

  PublisherDOI

• PD19-05 FOCAL CRYOTHERAPY VS RADICAL PROSTATECTOMY: A PROPENSITY SCORE MATCHED ANALYSIS FROM THE INTERNATIONAL FOCAL THERAPY SOCIETY (FTS) REGISTRY

  The Journal of Urology · 2025-04-08

  article
  PublisherDOI

Frequent coauthors

• David G. McLeod

  Walter Reed National Military Medical Center

  327 shared

• Leon Sun

  Jiangnan University

  272 shared

• Isabell A. Sesterhenn

  246 shared

• Shiv Srivastava

  209 shared

• Gastrointestinal Cancer

  Society of Surgical Oncology

  175 shared

• James B. Yu

  Yale Cancer Center

  170 shared

• James L. Mulshine

  Rush University Medical Center

  169 shared

• Sara Hurvitz

  Clarke University

  169 shared

Education

• Urologic Oncology Fellowship, Surgery

  Duke Medicine

  1989