Duke University Medical Center Archives

Transperineal Prostate Biopsy Under Local Anesthesia: Systematic and MRI-Ultrasound Fusion Biopsy

Posted by Peter K.F. Chiu, MD, PhD, FRCSEd | Mar 2020

Peter K.F. Chiu, MD, PhD, FRCSEd, Honorary Clinical Assistant Professor and Associate Consultant in the Division of Urology in the Department of Surgery at the Prince of Wales Hospital, Chinese University of Hong Kong, discusses the rationale and procedure for conducting transperineal prostate biopsies. He highlights how the decreased occurrence of sepsis makes transperineal biopsy a better choice than transrectal, in addition to a higher chance of obtaining cores and a reduced chance of deformation from the TRUS probe. Dr. Chiu also details the administration of local anesthesia, and illustrates successful procedures for both systematic and MRI-ultrasound fusion approaches to obtaining prostate biopsy cores.

Prostate Cryoablation: Tips and Tricks

Posted by Thomas J. Polascik, MD, FACS | Mar 2020

Thomas J. Polascik, MD, FACS, a professor of urology at the Duke Cancer Institute, gives an overview of tips and tricks for successful cryoablation of the prostate while avoiding preventable complications from the procedure. He discusses common areas of complication and injury during cryoablation, including sphincteric incontinence, rectal fistula, and urethral slough, as well as the possibility of incomplete ablation resulting in PSA recurrence. Dr. Polascik then outlines common reasons for injury or incomplete cover to the prostate, urethra, rectum, and sphincter, as well as techniques to ensure a successful cryoablation surgery.

Exosomal Liquid Biopsy in Prostate Cancer: Role in Prostate Biopsy Decision-Making

Posted by Judd W. Moul, MD | Feb 2020

Judd Moul, MD, Professor of Surgery and Anesthesiology as well as the James H. Semans, MD, Distinguished Professor of Urologic Surgery at Duke University School of Medicine, discusses the ExoDx Prostate Intelliscore (EPI), a urine-based liquid biopsy test with high negative predictive value (NPV) that may be a useful prostate cancer (PCa) diagnostic tool for primary care providers (PCPs). He emphasizes EPI’s relative ease of use, noting that it is necessary to have simple screening procedures in order to take the burden off of over-stretched urologists.

The HERO Study and the Approval of Relugolix

Posted by Daniel J. George, MD | Dec 2019

E. David Crawford, MD, Professor of Urology at UC San Diego and Editor-in-Chief of Grand Rounds in Urology, interviews Neal D. Shore, MD, FACS, Medical Director for the Carolina Urologic Research Center, and Daniel J. George, MD, Director of Genitourinary Oncology at Duke Cancer Center, about relugolix, which became the first oral testosterone-suppressive drug approved by the FDA on Friday, December 18, 2020. Drs. Shore and George discuss the results of the international, randomized HERO study, which looked at patients with advanced prostate cancer and found that relugolix, a daily oral GNRH antagonist, had a 97% sustained T-suppression rate as compared to leuprolide’s 88% sustained T-suppression rate. In addition to this high degree of efficacy, they emphasize that patients taken off relugolix saw their testosterone return to higher levels within 90 days than patients taken off leuprolide, which is important for patient quality-of-life. Drs. Shore and George also underline that patients in the relugolix arm of the HERO study saw a more than 50% reduction in risk of major adverse cardiovascular events compared with patients in the leuprolide arm, which suggests that relugolix might be a safer option for prostate cancer patients at high cardiovascular risk. Other topics covered include the benefits of antagonists versus agonists and the possible risks of patient non-compliance.

Ask the Expert: What Are the Barriers to Focal Therapy Becoming More Widely Accepted?

Posted by Thomas J. Polascik, MD, FACS | Oct 2017

Thomas J. Polascik, MD, Duke University, Durham, North Carolina, discusses the barriers to focal...