Your Premier Urology Education Resource

E. David Crawford, MD, Editor-in-Chief

LEARNING CENTERS

Next Generation Microbiome and Urologic Infections

Editor: J. Curtis Nickel, MD, FRCSC

Next Generation Androgen Deprivation Therapy

Editor: Celestia S. Higano, MD

Next Generation Genomics and Biomarkers

Editor: Leonard G. Gomella, MD

Next Generation Upper Tract Urothelial Carcinoma

Editor: Seth P. Lerner, MD

Creating Balance in Your Personal and Professional Life (Part 1 of 2)

Neil H. Baum, MD, Clinical Professor of Urology at Tulane Medical School in New Orleans, Louisiana, discusses how important it is for physicians to create balance in their personal and professional lives. Dr. Baum offers five suggestions for how urologists can do this in order to avoid burnout. He highlights why doctors have such problems balancing life and career and discusses what happens when they are out of balance. The solutions that Dr. Baum offers are: continue learning, be ethical, set priorities, just say no, and make a difference.

Genetic Testing in Prostate Cancer

Mohammad O. Ramadan, MD, discusses the importance of genetic testing for prostate cancer screening, diagnosis, and treatment. He notes that there is currently a professional practice gap in this area, even as genetic testing becomes more widely available. Studies suggest that approximately 17% of prostate cancer patients are biomarker positive, and therefore may benefit more than other patients from treatments like PARP inhibitors. Research like this has led the NCCN to recommend germline genetic testing for all men with high-risk, very-high-risk, regional, or metastatic prostate cancer. With this guideline in place, urologists will have to quickly figure out how to provide widespread testing, and may have to partner with geneticists.

Practical Considerations for the Use of Molecular Diagnostics for Diagnosis and Management of Recurrent UTI

Ngoc-Bich “Nikki” Phan Le, MD, a urologist specializing in female pelvic medicine and reconstructive surgery at the Austin Diagnostic Clinic, and A. Lenore Ackerman, MD, PhD, Assistant Professor of Surgery, Urology, and Pelvic Medicine and Reconstructive Surgery at Cedars-Sinai Medical Center and Section Editor of the Next Generation Microbiome and Urologic Infection Learning Center on Grand Rounds in Urology, discuss how to effectively use molecular diagnostics to help in the process of diagnosing and managing recurrent UTIs. They outline the differences between patients with multiple types of infections over time and those with truly recurrent infections by the same bacterium, and how this difference creates the need for alternatives in initial evaluation. They also specifically detail how the strength of molecular diagnostics is in their ability to detect bacteria missed in cultures, which can help prescribers make better decisions when choosing antibiotics for treatment. Drs. Le and Ackerman conclude by discussing how to proceed with treatment, and how the data presented by molecular diagnostics allow for more precise treatment methods.

Phase 1 Trial of ARV-110 in Patients with mCRPC

Daniel P. Petrylak, MD, Director of Genitourinary Oncology, Professor of Medicine and Urology, Co-Leader of Cancer Signaling Networks, and Co-Director of the Signal Transduction Program at Yale University Cancer Center, discusses promising new developments coming out of a trial that interferes with the androgen receptor and degrades it. Phase 1 of this trial looks at ARV-110 in patients with mCRPC and Dr. Petrylak highlights why the study’s recent findings are so exciting. He goes into detail the study methodology and how ARV-110 works in comparison to traditional treatments. Dr. Petrylak also explains why the findings are so promising and what the next steps are for the study.

Anti-Androgen Trials

Daniel P. Petrylak, MD, Director of Genitourinary Oncology, Professor of Medicine and Urology, Co-Leader of Cancer Signaling Networks, and Co-Director of the Signal Transduction Program at Yale University Cancer Center, gives an overview of the most important, recent anti-androgen trials, as well as those that are currently still underway. He highlights how the trials were conducted, what the researchers found, and what he feels is still missing from the research. Dr. Petrylak compares and contrasts the different studies and draws conclusions about each. He also goes over a couple of trials with novel anti-androgens with unique mechanisms of action, which are currently in phase 1, that are showing promise.

HERO Phase 3 Trial: Relugolix vs. Leuprolide Acetate for Advanced Prostate Cancer

Neal D. Shore, MD, FACS, Medical Director for the Carolina Urologic Research Center, presents the key aspects of the HERO phase 3 trial. The Hero trial looked at Relugolix, an oral GnRH receptor antagonist, versus Leuprolide Acetate for the treatment of advanced prostate cancer. Following this in an interview with Celestia S. Higano, MD, section editor of the ADT Next Generation Learning Center on Grand Rounds in Urology, about the study’s findings, and the implications that this exciting new development in prostate cancer treatment could have in the field of urology.

Panel on Androgen Deprivation Therapy: A Closer Review of the Cardiovascular Risk

Thomas E. Keane, MD, Professor and Chairman of the Department of Urology at the Medical University of South Carolina, Charleston, leads a panel discussion including Lawrence I. Karsh, MD, Peter J. Rossi, MD, and Neal D. Shore, MD, FACS, to discuss the process of treating prostate cancer in a patient who is at risk for cardiovascular disease and how extra care is needed in such cases. They also stress the importance of being in contact with a patient’s PCP even if one chooses to do their own assessment of patient risk, as well as when ADT should not be considered an option, such as in the case of a patient with significant CAD and elevated liver enzymes. The group, over the course of the panel, discuss the many ADT options available, including their strengths and weaknesses.

Multiparametric MRI for the Detection of Clinically Significant Prostate Cancer

Jelle Barentsz, MD, PhD, Professor of Radiology at the Nijmegen Medical Center of Radboud University in Nijmegen, The Netherlands, discusses the ins and outs of diagnosing clinically significant prostate cancer (csPC) using mpMRI. He goes on to discuss how to improve the diagnostic accuracy of mpMRI, including optimizing image acquisition, use of training sessions to refine the radiologist’s expertise and interpretation of results, as well as how to reduce systematic and random error associated with MRI-directed biopsy.

The Capacity of MRI to Predict Extracapsular Disease

Jelle Barentsz, MD, PhD, Professor of Radiology at the Nijmegen Medical Center of Radboud University in Nijmegen, The Netherlands, discusses the capacity of MRIs to predict extracapsular disease. He notes that this is not a perfect technology and it is not possible to predict with one hundred percent accuracy, but he emphasizes how it can be useful for staging. He also discusses when it is necessary to wait and how long to wait after a biopsy for a staging MRI. Lastly, he covers situations where it is not necessary to wait for an MRI.

Vetting Your Telemedicine Vendor

Neil H. Baum, MD, clinical professor of urology at Tulane Medical School in New Orleans, Louisiana, discusses how to choose the best telemedicine vendor for your practice. He goes over important questions to ask vendors before getting into business with them as well as the first steps for setting up. According to Dr. Baum, it is also imperative that a vendor has experience working in the urology field so that they are familiar with federal and state regulations. He also goes over technology concerns that can affect how well a certain platform will work for different doctors and for patients. He emphasizes the importance of privacy and security, as well as several concerns about how the system actually works and the support they offer.

Innovation in the Treatment of Male Urinary Incontinence

Culley C. Carson III, MD, Emeritus Rhodes Distinguished Professor in the Department of Urology at the University of North Carolina School of Medicine, discusses innovations in the treatment of male urinary incontinence. He outlines different treatments and their various pros and cons, including some cutting-edge technology that is not yet available in the US. He also goes over innovations, which still need to be made in order to further improve certain technologies like the artificial urinary sphincter. He highlights how important it is to come up with a more cost-effective model because, currently, artificial urinary sphincters are extremely expensive. There are also several significant causes of revision surgery for artificial urinary sphincters, demonstrating the need for further innovation. Dr. Carson also emphasizes the importance of customizing the pumps to individual patients, and goes over current research intended to improve patient outcomes.