Baylor College of Medicine Archives

Counseling Men with Favorable Intermediate Risk Disease- How to Advise, What Evidence Do You Share?

Posted by Dov Kadmon, MD | Oct 2024

Dov Kadmon, MD, provides a comprehensive overview of managing favorable intermediate-risk prostate cancer, focusing on patient counseling, treatment decisions, and long-term outcomes.

In this 21-minute presentation, Dr. Kadmon begins by defining favorable intermediate-risk prostate cancer as grade group 2 (Gleason 3+4), with PSA levels under 10 and limited tumor burden based on biopsy. Patients are reassured that this type of cancer is common, typically indolent, and confined to the prostate, with a slow doubling time of three to five years, allowing a broad window for therapeutic intervention.

The discussion then shifts to treatment options, emphasizing the choice between active surveillance and curative interventions like radical prostatectomy or radiation therapy. Surgery’s side effects, including urinary incontinence and erectile dysfunction, are acknowledged. Radiation therapy, while sparing immediate surgery, carries risks of chronic toxicity.

Dr. Kadmon shares insights from the UK-based ProtecT trial, comparing active monitoring, surgery, and radiation therapy. The trial shows similar overall survival rates across treatment arms, but highlights increased rates of metastasis and disease progression in the active monitoring group. He underscores that while surveillance may be appropriate for select patients, curative treatment offers a more definitive approach, especially in younger individuals or those with a longer life expectancy.

Management of Posterior Urethral Strictures

Posted by Shyam S. Sukumar, MD | Oct 2024

Shyam S. Sukumar, MD, provides an in-depth exploration of managing posterior urethral strictures, focusing on the anatomical and procedural complexities unique to posterior cases. Throughout this 16-minute presentation, Dr. Sukumar shares drawings and images to illustrate the nuanced approaches necessary for managing posterior stenosis.

Stress incontinence becomes a crucial consideration, especially in patients with radical prostatectomy histories. Sukumar emphasizes the need for a comprehensive preoperative assessment to accurately gauge stricture extent and plan the repair approach. For surgical reconstructions, Dr. Sukumar highlights differing procedures from anastomotic urethroplasty and flap procedures, depending on patient need.

Sukumar believes posterior urethral stricture repair demands flexibility in approach and a readiness to adapt intraoperatively based on the challenges presented. Mastery of various reconstructive techniques and a patient-specific approach ensure optimal outcomes, especially in these anatomically and procedurally demanding cases.

Advances and Controversies in Theranostic Approaches to Prostate Cancer

Posted by Eric M. Rohren, MD, PhD | Sep 2024

Eric M. Rohren, MD, PhD, analyzes how theranostics—combining therapeutic and diagnostic processes—are reshaping prostate cancer management. For example, prostate-specific membrane antigen (PSMA), used as a biomarker for both imaging and targeted therapy in PSMA-targeted PET scans, offers precise tumor localization, significantly enhancing diagnostic accuracy. PSMA-targeted radiopharmaceuticals such as 68Ga-PSMA-11 for PET imaging and 177Lu-PSMA-617 for therapy have been shown to improve detection rates and treatment outcomes, particularly in metastatic and castration-resistant prostate cancer.

Despite these advancements, Dr. Rohren acknowledges the challenges in theranostic approaches. The variability in PSMA expression among patients can impact the effectiveness of both imaging and therapy. Additionally, he discusses the potential side effects and toxicity associated with radioligand therapy, emphasizing the need for careful patient selection and monitoring.

Dr. Rohren also explores the ethical and regulatory considerations in the adoption of theranostics. He highlights the need for standardized protocols and guidelines to ensure consistent application and patient safety.

Changing Paradigm in the Diagnosis Band Management of Erectile Dysfunction

Posted by Mohit Khera, MD, MBA, MPH | Aug 2024

Mohit Khera, MD, MBA, MPH, Professor of Urology and Director of the Laboratory for Andrology Research at the McNair Medical Institute at Baylor College of Medicine, identifies the paradigm shifts presented in 2018 guidelines for erectile dysfunction (ED), and the current landscape of treating these patients with regenerative therapies.

Competing Risks for Small Renal Masses

Posted by Jeremy Slawin, MD, MBA | Aug 2024

Jeremy Slawin, MD, MBA, addresses competing risks in managing small renal masses (SRM), balancing treatment versus active surveillance of low risk disease. He begins by illustrating the characteristics of SRMs.

Dr. Slawin recognizes the low metastatic potential of SRMs. In combination with their average slow growth rate, SRMs under 3cm often do not need intervention beyond surveillance.

Dr. Slawin concludes by comparing the 5-year survival rates of patients with SRM versus all other causes. He offers online tools, like the RCC Competing Risk Model, and framing techniques to help clinicians effectively communicate the risks of SRM treatments to individual patients.