University of Michigan Medical Center Archives

Transperineal Biopsy: Rationale, Outcomes, and Techniques

Posted by Arvin George, MD | Apr 2024

Arvin K. George, MD, discusses the rationale behind performing transperineal biopsies over transrectal biopsies, supporting outcome data, and actionable techniques to combat the perceived shortcomings of the procedure. Dr. George begins by providing data on the fluoroquinolone-resistant infection risks of transrectal biopsies, and that, by avoiding the issue of antibiotic-resistant rectal flora, transperineal biopsies circumvent the rising rate of infections and strengthen antibiotic stewardship during procedures.

Dr. George then addresses the issue of patient pain in transperineal biopsies. He offers techniques on ideal administration of local anesthetic for decreasing patient pain.

Dr. George concludes by providing information on patient set-up, procedure equipment, and transperineal guides, presenting multiple options and encouraging urologists to choose according to their needs. He offers several resources for urologists and their patients from the Michigan Urologic Surgery Improvement Collaborative.

Focal HIFU

Posted by Arvin George, MD | Mar 2024

Arvin K. George, MD, discusses the use of Focal High Intensity Focused Ultrasound (HIFU) ablation for prostate cancer treatment. He begins by listing the indicators and guidelines for Focal HIFU, particularly after failed radiation therapy.

Dr. George then walks through the selection process for Focal HIFU. He presents the ideal patient and disease characteristics for HIFU ablation therapy, and contraindications for the treatment, including tumor size.

Turning to complications associated with HIFU ablation therapy, Dr. George discusses the common early-, medium-, and late-stage complications associated with Focal HIFU. The most common complications for Focal HIFU ablation therapy being urinary retention and erectile dysfunction. He discusses strategies for avoiding common complications from HIFU.

Dr. George concludes by reviewing patient outcomes of Focal HIFU ablation compared to other treatments for prostate cancer. He presents studies comparing failure-free survival outcomes between patients treated with Focal HIFU over three, five, and eight years compared to other established prostate cancer treatments.

Vitamin D and Men’s Health

Posted by Mark A. Moyad, MD, MPH | May 2023

Mark A. Moyad, MD, MPH, the Jenkins/Pokempner Director of Preventive/Complementary and Alternative Medicine (CAM) in the Department of Urology at the University of Michigan Medical Center in Ann Arbor, Michigan, presents on the current status of vitamin D in men’s health. While randomized trials have shown limited benefits in major endpoints, such as preventing cardiovascular disease and cancer, there is a significant signal indicating the potential of vitamin D in autoimmune disease prevention. He discusses exciting findings from the VITAL trial suggesting that a moderate dose of vitamin D may reduce the risk of autoimmune disease. Additionally, individuals with a healthy BMI and those at high risk for bone loss could potentially benefit more from vitamin D supplementation. Dr. Moyad emphasizes the importance of understanding the limitations of vitamin D blood tests and suggests that targeted screening is recommended for specific groups. Overall, he says, fortification and supplementation of vitamin D remain safe and cost-effective strategies for improving men’s health.

ADT and Cognitive Health

Posted by Mark A. Moyad, MD, MPH | Jul 2022

Mark A. Moyad, MD, MPH, the Jenkins/Pokempner Director of Preventive/Complementary and Alternative Medicine (CAM) at the University of Michigan Medical Center in the Department of Urology in Ann Arbor, Michigan, interviews Celestia S. Higano, MD, FACP, Adjunct Professor in the Department of Urologic Sciences at the University of British Columbia and Medical Director of the Prostate Cancer Supportive Care Program at the Vancouver Prostate Centre, about the importance of dual-energy X-ray absorptiometry (DEXA) screening to preserve bone health in men initiating androgen deprivation therapy (ADT). Dr. Moyad begins by highlighting the findings of an article recently published in JAMA which showed that while DEXA screening was associated with a decreased risk of osteoporotic fracture, only 7.9% of older men starting ADT received this screening. Dr. Moyad argues that this demonstrates that while many focus on calcium and vitamin D deficiency as the causes of bone issues in men on ADT, the real deficiency is in DEXA screening. Dr. Higano concurs, explaining that the only good way to monitor bone density in men on ADT is to get a baseline, and noting that every patient in her practice undergos DEXA screening before initiating ADT unless they are on a bone health agent already. She also mentions that she performs a repeat DEXA after a year. Dr. Moyad then considers whether quantitative computed tomography (QCT) is a reasonable alternative to DEXA, arguing that it is not since it is more expensive, uses a lot of radiation, and overestimates bone health issues. Dr. Higano agrees, observing that QCT was designed as a research tool rather than a diagnostic one, while DEXA is the “gold standard” in this area. They then hypothesize that some clinicians are switching from DEXA to QCT because of higher reimbursement rates. Drs. Moyad and Higano conclude by underscoring that wider DEXA screening is the most significant change needed to preserve bone health in men on ADT.

Bone Health and ADT

Posted by Mark A. Moyad, MD, MPH | Jul 2022

Mark A. Moyad, MD, MPH, the Jenkins/Pokempner Director of Preventive/Complementary and Alternative Medicine (CAM) at the University of Michigan Medical Center in the Department of Urology in Ann Arbor, Michigan, interviews Celestia S. Higano, MD, FACP, Adjunct Professor in the Department of Urologic Sciences at the University of British Columbia and Medical Director of the Prostate Cancer Supportive Care Program at the Vancouver Prostate Centre, about the importance of dual-energy X-ray absorptiometry (DEXA) screening to preserve bone health in men initiating androgen deprivation therapy (ADT). Dr. Moyad begins by highlighting the findings of an article recently published in JAMA which showed that while DEXA screening was associated with a decreased risk of osteoporotic fracture, only 7.9% of older men starting ADT received this screening. Dr. Moyad argues that this demonstrates that while many focus on calcium and vitamin D deficiency as the causes of bone issues in men on ADT, the real deficiency is in DEXA screening. Dr. Higano concurs, explaining that the only good way to monitor bone density in men on ADT is to get a baseline, and noting that every patient in her practice undergos DEXA screening before initiating ADT unless they are on a bone health agent already. She also mentions that she performs a repeat DEXA after a year. Dr. Moyad then considers whether quantitative computed tomography (QCT) is a reasonable alternative to DEXA, arguing that it is not since it is more expensive, uses a lot of radiation, and overestimates bone health issues. Dr. Higano agrees, observing that QCT was designed as a research tool rather than a diagnostic one, while DEXA is the “gold standard” in this area. They then hypothesize that some clinicians are switching from DEXA to QCT because of higher reimbursement rates. Drs. Moyad and Higano conclude by underscoring that wider DEXA screening is the most significant change needed to preserve bone health in men on ADT.

University of Michigan Medical Center

Transperineal Biopsy: Rationale, Outcomes, and Techniques

Focal HIFU

Vitamin D and Men’s Health

ADT and Cognitive Health

Bone Health and ADT

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