Sidney Kimmel Medical College at Thomas Jefferson University Archives

The Bespoke Future of Cancer Care

Posted by Leonard G. Gomella, MD, FACS | Nov 2024

Leonard G. Gomella, MD, explores the concept of “bespoke” cancer care, emphasizing its personalized, patient-centered approach. Originally a British term referring to custom-made items, “bespoke” now highlights the customization of cancer treatments through precision medicine, pharmacogenomics, AI technologies, and individualized care plans.

In this 10-minute presentation, Dr. Gomella stresses that innovations in cancer care reflect the growing trend of leveraging AI to enhance screening efficiency and reduce reliance on traditional biopsy methods. He discusses how precision medicine increasingly enables oncologists to tailor treatment plans by analyzing genetic mutations and matching patients to the most promising therapies or clinical trials. The need to balance technological advancements with affordability and patient access is a central concern.

Bespoke care offers better outcomes and underscores the importance of informed decision-making, empowering patients to actively participate in their treatment journey.

Role of Precision Medicine in the Diagnosis and Management of Prostate Cancer

Posted by Leonard G. Gomella, MD, FACS | Sep 2024

Leonard G. Gomella, MD, FACS explores the rapid evolution of precision medicine, particularly in the context of prostate cancer, highlighting the shift from a one-size-fits-all approach to more personalized, genomics-based strategies. Precision medicine aims to tailor treatment and prevention strategies to the individual, moving beyond traditional methods to incorporate genetic, genomic, and molecular data.

In this 12-minute presentation, Dr. Gomella discusses key components of precision medicine in prostate cancer, including biomarkers, risk prediction, stratification, and drug repurposing. Advances in imaging technologies, such as improved MRI and ultrasound, as well as liquid biopsies, allow for deeper insights beyond histology, utilizing biomarkers, RNA tumor markers, and detailed genomic analysis. These innovations facilitate a more precise understanding of individual patients’ cancer profiles, helping to refine screening and treatment decisions.

Further, he asserts that precision medicine has substantially impacted the management of advanced prostate cancer, with targeted therapies tailored to genetic mutations and molecular characteristics. This approach exemplifies the precision targeting of treatments based on individual tumor profiles, optimizing outcomes and minimizing unnecessary interventions.

Case Discussion 1 – Patient and Treatment Selection

Posted by Abhinav Sidana, MD, MPH | Aug 2024

Abhinav Sidana, MD, MPH, Peter K.F. Chiu, MD, PhD, FRCSEd, Behfar Edhaie, MD, Arvin K. George, MD, Preston C. Sprenkle, MD, and Samir S. Taneja, MD

Physics of HDR Brachytherapy for Urologists

Posted by Firas Mourtada, MSE, PhD, DABR | Sep 2023

Firas Mourtada, MSE, PhD, DABR, discusses the physics of high-dose rate (HDR) brachytherapy in this talk sponsored by the American Brachytherapy Society (ABS). Dr. Mourtada enumerates prostate cancer treatment options before identifying HDR brachytherapy as the ultimate approach for dose escalation, asserting that with image guidance, HDR for prostate can be implemented safely and result in an increase in biochemical disease-free survival.

Dr. Mourtada describes the advantages of HDR brachytherapy technology and illustrates how brachytherapy delivers high dose within the prostate, with less dose to surrounding normal tissue. He enumerates advantages such as bringing the source close to the target, using inverse-planning, and the potential for high-efficacy combined with lower-risk of toxicity or secondary malignancy.

Dr. Mourtada reviews common radionuclides in brachytherapy before defining HDR and addressing methodology, workflow, and equipment involved in using transrectal ultrasound (TRUS) for prostate brachytherapy. He explains the feedback loop and illustrates the iterative contouring and reconstruction of the gland that takes place during this workflow and the optimization settings involved.

Dr. Mourtada turns to radiation safety, emphasizing the importance of time, distance, and shielding and citing regulatory radiation safety programs, ALARA (as low as reasonably achievable,) and QMP (Quality Management Program.) He reviews radiation terminology and emphasizes the importance of radiation dosimeters and required radiation area signs.

Dr. Mourtada then concludes that prostate HDR with real-time image guidance provides high-quality implants with an efficient process using inverse planning, HDR radiation exposure is minimal due to the afterloading technology and ALARA controls, and quality management steps are essential to providing high-quality HDR implants.

Next Generation DNA Sequencing for Genitourinary Implants

Posted by Paul H. Chung, MD | Jan 2021

Paul H. Chung, MD, Assistant Professor and Director of the Division of Reconstructive Urology at the Sidney Kimmel Medical College of Thomas Jefferson University, discusses infection of genitourinary implants and how next-generation sequencing can be used to manage device infection. Presenting his results from a recently published article with the Canadian Journal of Urology, he outlines the methods, outcomes, and recommendations for clinicians, specifically those removing malfunctioning or infected penile prostheses and artificial sphincters. Dr. Chung highlights the benefits of polymerase chain reaction (PCR) and next-generation sequencing (NGS) including faster processing time, greater sensitivity, and the ability to run both fungal and bacterial analysis in the same setting. Additionally, NGS is useful in the selection of perioperative antibiotics and irrigation solutions, as well as determining how to coat devices during implant surgery. Following the presentation, Grand Rounds in Urology editor J. Curtis Nickel, MD, FRCSC interviews Dr. Chung to further discuss the clinical implications of his research. In the conversation, they compare biofilm collection techniques, noting that PCR and NGS are most helpful in a clinical setting, whereas extended culture is useful in a research setting.