Testosterone and Cardiovascular Risk: TRAVERSE Trial and New FDA Label Change
Mohit Khera, MD, MBA, MPH, discusses testosterone therapy and cardiovascular risk, focusing on the TRAVERSE trial and FDA label changes.
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Baylor College of Medicine
Through the Perineum or Through the Rectum: How to Best Biopsy the Prostate
Guilherme Godoy, MD, MS, addresses prostate biopsy techniques, contrasting transrectal and transperineal approaches.
In this 20-minute presentation, Dr. Godoy highlights the current debate between transrectal and transperineal approaches. Transrectal biopsy remains a familiar, office-based procedure requiring only local anesthesia, offering easy access and minimal patient discomfort. However, it poses infection risks. Conversely, the transperineal approach minimizes infection risk. This approach, however, is often more painful, typically requires sedation, and may incur higher equipment and procedural costs, as well as a longer learning curve for practitioners. Godoy also discusses recent studies comparing the effectiveness of these techniques. Research indicates no significant difference in cancer detection rates between transrectal and transperineal biopsies.
The integration of MRI-ultrasound fusion and cognitive fusion biopsy techniques continues to enhance the precision of both approaches, especially in targeting smaller, more localized prostate lesions. Godoy feels biopsy methods may evolve further as MRI technology improves, potentially eliminating the need for whole-prostate sampling. Instead, biopsies could focus more on specific, MRI-identified lesions, reducing patient discomfort and procedural risks while improving diagnostic accuracy.
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Management of Kidney Injuries: An Evidence-Based Approach
Michael Coburn, MD, FACS, delves into the complexities of kidney trauma management
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PCNL Challenges: How to Keep the Train on the Rails
Wesley A. Mayer, MD, offers a comprehensive discussion on optimizing percutaneous nephrolithotomy (PCNL), focusing on minimizing complications, strategic planning, and adaptive surgical techniques.
In this 20-minute presentation, Dr. Mayer reviews indications for PCNL with updates on guidelines. He stresses the importance of individualized treatment decisions. Mini PCNL is emphasized for challenging lower pole stones, and for smaller stones, balancing efficiency and patient outcomes.
Dr. Mayer stresses preoperative preparation, underscoring the value of detailed imaging. The choice of access (prone vs. supine) is tailored based on patient anatomy, stone location, and procedural requirements. The importance of a flexible and adaptive approach is stressed, with practical examples illustrating the decision-making process when encountering complications.
Lastly, Dr. Mayer underscores the importance of knowing when to continue versus when to safely abort a procedure, reflecting on the need for prudent judgment to optimize patient safety and surgical outcomes.
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Key Principles from the 2024 AUA Guidelines Updates on Salvage Prostate Cancer Therapy
Justin J. Badal, MD, reviews the updated 2024 guidelines for advanced prostate cancer, reflecting substantial advancements since the last revision in 2013. The revision synthesizes evidence from numerous trials to reshape recommendations, focusing particularly on treatment strategies for biochemical recurrence (BCR) following radical prostatectomy.
In this 18-minute presentation, Badal shares guidelines emphasizing utilizing prognostic factors, such as PSA doubling time and Gleason grade, to stratify patient risk and guide treatment timing. He notes that ultra-sensitive PSA testing for high-risk individuals and PET imaging, particularly PSMA PET scans, is recognized as valuable tools for detecting biochemical recurrence.
The integration of androgen deprivation therapy (ADT) with SRT is advised for patients showing high-risk features, while, for those without high-risk markers, radiation monotherapy remains an option. For recurrent or node-positive cases post-primary therapy, combined modality approaches, including the use of expanded radiation fields and intensified androgen receptor suppression, are encouraged within a clinical trial setting.
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