Memorial Sloan-Kettering Cancer Center Archives

Who Needs a Prostate Biopsy? Risk-stratification Strategies Before Prostate Biopsy

Posted by Sigrid V. Carlsson, MD, PhD, MPH | Sep 2024

Sigrid V. Carlsson, MD, PhD, MPH, discusses the evolving paradigm in prostate cancer diagnostics, moving away from the traditional model where an elevated prostate-specific antigen (PSA) level directly leads to a biopsy. In this 8-minute talk, she emphasizes the importance of incorporating risk stratification methods before proceeding to biopsy, which helps reduce unnecessary interventions.

Dr. Carlsson discusses current guidelines that recommend using MRI as part of the initial biopsy strategy, with a more mandatory role in repeat biopsy settings if it has not previously been performed. Risk calculators provide a cost-effective and accessible means to estimate the likelihood of high-grade disease, further refining the decision-making process.

The presentation also highlights the rapid advancement in biomarkers and the integration of artificial intelligence (AI) in improving MRI interpretation and enhancing prostate cancer diagnostics’ accuracy and efficiency.

Robotic GU Fistula Repair

Posted by Divya Ajay, MD, MPH | Sep 2024

Divya Ajay, MD, MPH, covers diagnosing and managing genitourinary (GU) fistulas, emphasizing the complexity and challenges involved. Fistulas can occur throughout the urinary system, affecting the lower and upper tracts. Common causes include gynecological surgeries, cancer treatments, radiation, and infections.

In this 24-minute presentation, Dr. Ajay discusses vesicovaginal, urethral, and colovesical fistulas, with treatment strategies varying based on fistula type and patient condition. Ajay shares several surgical approaches, including robotic, vaginal, and open surgeries, tailored to the fistula’s location and severity. Ultimately, successful outcomes depend on precise diagnosis, appropriate surgical technique, and postoperative management.

Lower Ureteroplasty – Reimplants, Hitch, Boari Flap

Posted by Divya Ajay, MD, MPH | Sep 2024

Divya Ajay, MD, MPH, focuses on strategies and considerations for lower ureteroplasty, emphasizing meticulous surgical technique and patient management.

In this 13-minute presentation, Dr. Ajay addresses various causes of ureteral pathology, including trauma, stones, infections, and malignancy. She stresses that successful outcomes depend on detailed preoperative planning, including a thorough understanding of stricture length after removing stents to avoid incomplete assessment.
Ajay outlines common surgical strategies with videos of procedures, including psoas hitch and Boari flap for distal ureteral reconstruction, and advocates for individualized approaches based on anatomy and patient history. The use of stents is debated, with newer evidence suggesting fewer complications in select cases when stents are avoided, though caution is recommended in complex or radiated patients.

High Intensity Focused Ultrasound Ablation Outcomes – TR, In Bore

Posted by Behfar Ehdaie, MD, MPH | Aug 2024

Behfar Ehdaie, MD, MPH, discusses High-Intensity Focused Ultrasound (HIFU) ablation, particularly focusing on its application in treating prostate cancer. The presentation highlights the recent advancements and clinical outcomes associated with both transrectal (TR) and in-bore HIFU procedures.

Dr. Ehdaie emphasizes the precision and minimal invasiveness of HIFU and outlines the selection criteria for patients. He also discusses the integration of real-time imaging with magnetic resonance imaging (MRI) in in-bore HIFU.

Dr. Ehdaie highlights the promising results demonstrated in clinical outcomes of HIFU ablation, making HIFU an attractive option for eligible patients. He also addresses the ongoing challenges and future directions in HIFU research. The potential for combining HIFU with other therapeutic modalities, such as immunotherapy and targeted therapies, is a promising avenue for enhancing treatment efficacy.

Convergent Therapeutics: Next-Generation Targeted Radiotherapies

Posted by Philip Kantoff, MD | Jun 2024

Philip Kantoff, MD, explores the advancements in targeted radiotherapies, emphasizing their potential to revolutionize prostate cancer treatment. He introduces next-generation targeted radiotherapies, such as radioligand therapy, which utilize molecules designed to bind specifically to cancer cell markers, delivering lethal doses of radiation directly to the tumor cells. This approach minimizes damage to surrounding healthy tissues, a limitation of traditional radiotherapy.

Dr. Kantoff highlights convergent therapeutics, which combines targeted radiotherapy with other treatment modalities, including immunotherapy and conventional chemotherapy. Kantoff also addresses the challenges of implementing these advanced therapies in clinical practice.