Vanderbilt University School of Medicine

Surgical BPH: 2024 Updates and Where Are We Going

Surgical BPH: 2024 Updates and Where Are We Going

Posted by | Jan 2025

Nicole L. Miller, MD, FACS, delivers an incisive update on the surgical management of benign prostatic hyperplasia (BPH). In this 11-minute presentation, Dr. Miller outlines the current AUA guidelines, highlighting a broad spectrum of treatments tailored to prostate size. Trends in national data reveal that transurethral resection of the prostate (TURP) remains the dominant procedure, while minimally invasive options like UroLift have gained substantial traction.

Dr. Miller discusses emerging technologies, including the OptilumeⓇ BPH System. She also reviews promising data on MRI-guided transurethral ultrasound ablation (TULSA). Advanced laser techniques, particularly holmium pulse modulation, and thulium fiber laser, are explored for their efficacy in enucleation procedures, showing advantages in operative time, hemostasis, and same-day discharge rates. Miller highlights evolving techniques like en bloc enucleation with early apical release. A brief discussion on robotic-assisted simple prostatectomy includes recent shifts toward single-port approaches.

Dr. Miller stresses the importance of aligning treatment with patient preferences and quality-of-life goals, emphasizing shared decision-making as central to optimizing outcomes in this rapidly advancing field.

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Metastatic Castrate Resistant Prostate Cancer – Immunotherapy and PARP Inhibitors

Metastatic Castrate Resistant Prostate Cancer – Immunotherapy and PARP Inhibitors

Posted by | Dec 2024

Alan Tan, MD, discusses multiple advanced treatment options for prostate cancer, focusing on genomic testing, PARP inhibitors, and emerging immunotherapy strategies. His 26-minute presentation begins with data indicating that 12% of prostate cancer patients carry germline mutations, predominantly in the BRCA family, emphasizing the prognostic significance of BRCA alterations. Genomic testing advancements, particularly in homologous recombination repair (HRR) alterations, reveal actionable pathways in approximately 25-27% of cases. PARP inhibitors are highlighted for their efficacy in BRCA-mutated cancers, with the latest trials—PROpel, TALAPRO-2, and MAGNITUDE—demonstrating survival benefits in combination therapies.

Dr. Tan also addresses immunotherapy, with a compelling clinical example underscoring the transformative impact of pembrolizumab in an ultra-high tumor mutation burden case. He also examines T-cell engagers, which show promise in overcoming downregulated MHC expression, and early-phase trials for bispecific antibodies. Toxicity management in PARP inhibitors is discussed in detail.

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