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

Panel Discussion on Challenges of Managing Androgen Deprivation Therapy Patients During COVID-19

Richard Harris, MD, President of LUGPA and UroPartners, moderates a discussion between Daniel R. Saltzstein, MD, from Urology San Antonio, and Timothy D. Langford, MD, from Arkansas Urology. They discuss the challenges of managing prostate cancer patients during COVID-19, including the ways the pandemic has changed the manner and frequency of how they bring in patients in for treatment, particularly for therapies like androgen deprivation. Both Dr. Saltzstein and Dr. Langford emphasize the precautions they are taking at their practices to address the risks of COVID-19, and acknowledge how challenging this patient population can be given their need for frequent visits. They highlight the limitations of telehealth, as well as the risks of not bringing patients in often enough to receive the therapies that they need, even though lengthening the time between visits has been the answer a lot of doctors have found to reduce the risk of COVID-19 exposure.

Hiring Nonclinical Staff

Neil H. Baum, MD, Clinical Professor of Urology at Tulane Medical School, discusses the business of medicine and some important numbers that urologists need to know. Highlighting the need for doctors to improve their business skills in order to survive in today’s market, Dr. Baum goes over five important metrics that will help doctors truly understand the value of the service they are providing. These numbers include charges and receipts, accounts receivable, charge lag, denials, and new patient percentages. He talks about what these numbers look like in a perfect world versus reality and what doctors can do about them. Dr. Baum emphasizes that doctors need only spend five minutes every month monitoring these metrics in order to become more involved in the business of their practice.

Implementation of Germline Testing for Prostate Cancer: Philadelphia Prostate Cancer Consensus Conference 2019

Veda N. Giri, MD, Director of Cancer Risk Assessment and Clinical Cancer Genetics at the Sidney Kimmel Cancer Center of Thomas Jefferson University, discusses the decisions reached about the implementation of germline testing at the 2019 Philadelphia Prostate Cancer Consensus Conference. She summarizes the conclusions the voting participants came to, including recommendations on who should receive germline testing, what should be discussed with men in terms of informed consent, which genes should be prioritized for testing, and who should be enrolled in precision medicine trials, among other topics. In a follow-up interview, E. David Crawford, MD, Professor of Urology at the University of California, San Diego, asks Dr. Giri about which laboratories and panels to use, the limitations of commercial genetic testing like 23andMe, and the role of online genetic counseling.

Kidney Cancer Journal | Volume 4, Issue 2

Biomarkers Towards New Era of Therapeutics for Metastatic Renal Cell Carcinoma Abstract With the improved knowledge of molecular oncology and the introduction of targeted therapies as well as immunotherapies, there has been significant progress in the treatment of...

Theranostics & Radiopharmaceutical 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, reviews several studies in which radium-223 is used both alone and in combination with other treatments for prostate cancer. Since radium-223 is an alpha particle, it requires fewer hits to damage DNA, offering an advantage over beta particles. Dr. Petrylak further explains the benefits of theranostics which deliver isotopes directly to the tumor site. He concludes that radium-223 is effective in treating metastatic castration-resistant prostate cancer (mCRPC), but cautions that until potential toxicity levels are better understood, combining radium-223 with either abiraterone or prednisone is not advised.

Transurethral Surgery Re-Imagined: Exploration of a Novel Robotics Platform

Nicole L. Miller, MD, FACS, Associate Professor of Urology at Vanderbilt University Medical Center, discusses advances in robotics that could transform rigid endoscopic surgery by giving surgeons more degrees of freedom while operating. She argues that the evolution from open surgery to minimally-invasive surgery is perhaps as significant as the discovery of anesthesia and suggests that improved robotics are continuing this surgical revolution. Dr. Miller focuses on the work of Virtuoso Surgical, Inc., which has developed a prototype for transurethral endoscopy that features two needle-sized robotic arms that allow for complex two-handed maneuvers in the smallest surgical sites in the body. She suggests that this tool and others like it could make HoLEP faster and easier, improve en-bloc resection quality in bladder tumor patients, and improve resection of uterine polyps, among other applications.

Cannabis in the Urologic Practice

Richard J. Boxer, MD, FACS, Clinical Professor of Urology in the David Geffen School of Medicine at the University of California, Los Angeles, discusses the use of cannabis in the urology practice. Dr. Boxer describes how cannabis works and dispels many of the myths associated with its use. He delineates the safe use of cannabis and its specific urologic applications, emphasizing the role it can play in pain management and nausea from chemotherapy for urology patients, among other debilitating ailments. He also highlights the important role cannabis can play as an alternative to opioid use, which he points out are misused by 11 million Americans. Dr. Boxer concludes that cannabis is safe, is not a gateway drug, and that it may serve an important role in some urologic applications.

Evaluation and Management of Recurrent Prostate Cancer Following Radiation Therapy

Aaron Katz, MD, FACS, Chairman of Urology at Winthrop University Hospital and Professor of Urology at NYU Long Island School of Medicine, discusses the ins and outs of various salvage therapies for the treatment of patients that have failed primary radiation treatment. He begins by discussing different methods of patient selection for salvage therapy, including differentiation of isolated local recurrence versus systemic spread, patient age, and comorbidities, as well as the proper steps in conducting thorough patient history and workup. Next, Dr. Katz reviews several non-curative and potentially curative salvage therapy options and discusses the impact these therapies have on relative quality of life, in addition to their relative 5 and 10-year biochemical free survival rates. He concludes with a patient case study along with data from numerous single and multi-institution studies that demonstrate the relative quality of life impacts as well as relative 5 and 10-year disease-specific survival rates for these salvage procedures.

GRU Challenging Case: Androgen Deprivation Therapy

Neal D. Shore, MD, FACS, Medical Director for the Carolina Urologic Research Center, discusses the physiological and economic factors impacting the ADT selection process. He particularly emphasizes the impact of the current volume-based and economically incentivized model of treatment and how this can restrict urologists. He also discusses the physiological impacts of drug-drug interactions, alternate modes of administration, and the complex prospect of an oral alternative.

Numbers to Know

Neil H. Baum, MD, Clinical Professor of Urology at Tulane Medical School, discusses the business of medicine and some important numbers that urologists need to know. Highlighting the need for doctors to improve their business skills in order to survive in today’s market, Dr. Baum goes over five important metrics that will help doctors truly understand the value of the service they are providing. These numbers include charges and receipts, accounts receivable, charge lag, denials, and new patient percentages. He talks about what these numbers look like in a perfect world versus reality and what doctors can do about them. Dr. Baum emphasizes that doctors need only spend five minutes every month monitoring these metrics in order to become more involved in the business of their practice.

Endourological Stone Management: Complicated Cases

Jens Rassweiler, MD, Professor and Head of the Department of Urology at Klinikum Heilbronn, the academic hospital of Heidelberg University in Germany, discusses the management of complicated cases of endourological stones. First, he defines what exactly makes a case complicated, and then goes on to detail the procedures involved. He compares various management methods, noting the pros and cons of each and emphasizing the importance of staying away from open surgery when possible. He does discuss the best techniques for open surgery when it is unavoidable, but emphasizes that a combination of robotic and laparoscopic surgery is best.