Guilherme Godoy, MD, MS

Guilherme Godoy, MD, MS

Baylor College of Medicine

Houston, Texas

Dr. Godoy is an Assistant Professor of Urology at Baylor College of Medicine, Houston, Texas. He received his MD from Fundacao Universitaria do ABC in Sao Paulo, Brazil, and has received numerous fellowships at several institutions, including Memorial Sloan Kettering Cancer Center in New York City, Irmandade da Santa Casa de Misericordia de Sao Paulo Medical School in Sao Paulo, Brazil, Vancouver General Hospital in Vancouver, British Columbia, New York University School of Medicine in New York City, and Baylor College of Medicine. Dr. Godoy is skilled at managing patients with bladder cancer, kidney cancer, prostate cancer, and testis cancer. He also specializes in bladder issues, erectile dysfunction, kidney stones, and prostatitis. Dr. Godoy is a respected writer, researcher, and presenter as well, and has published numerous articles and papers. He has won a Best Published Clinical Research Paper Award from European Urology and has been recognized on several occasions as a Best Poster of the Section at American Urological Association Annual Meetings and European Association of Urology Annual Congresses. Dr. Godoy is also heavily involved in the medical community, both nationally and internationally. He is a member or candidate member of nine medical societies, including the Pan American Society of Anatomy, the Brazilian Society of Anatomy, the American Association of Cancer Research, and the Southwest Oncology Group.

Disclosures:

Talks by Guilherme Godoy, MD, MS

Surgical Training for Radical Prostatectomy – Should the Open Approach Still Be Taught? Which Patients? Retropubic, Perineal, Mini-Incision, etc.?

Guilherme Godoy, MD, MS, explores the question of whether or not to teach residents open radical prostatectomy, weighing multifunctional surgical skills with robotic advancements. He then explains that the open approach to radical prostatectomy is the gold standard in the medical community; however, the robotic approach is more commonly performed.

Dr. Godoy proceeds by questioning whether a sufficient number of open-approach radical prostatectomies are being conducted to warrant training residents in this method. Referring to a 2020 study, he finds that perhaps too few open-approach procedures are occurring to allow for resident proficiency.

Dr. Godoy then asks whether the open approach offers any benefits, exploring four situations in which the open approach is preferred over the robotic method. Dr. Godoy then cites a 2007 study to evaluate the learning curves of open-approach radical prostatectomy subtypes compared to the robotic approach, finding drastic differences in the climb to proficiency.

He completes his presentation by stressing that resident skill and comfort level should be considered in the debate between the open and robotic approaches. Following the presentation, audience members offer points of consideration regarding rural populations, new robots, and current robot malfunctions during radical prostatectomies.

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NMIBC Post-FDA Approval of New Drugs

Guilherme Godoy, MD, MS, explores recently FDA-approved treatments for NMIBC high-risk patients, with a focus on alternatives for BCG-unresponsive patients. He examines studies comparing the effectiveness of drug-based and gene-based therapies for the treatment of NMIBC against BCG, including:

Pembrolizumab
GemDOCE
Adstiladrin (Nadofaragene Firadenovec-vngc)

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When is Radical Cystectomy Indicated for NMIBC?

Guilherme Godoy, MD, MPH, Assistant Professor of Urology at Baylor College of Medicine, in Houston, Texas, discusses the role of cystectomy in non-muscle invasive bladder cancer (NMIBC). He begins by describing the management options for NMIBC, including transurethral resection of the bladder tumor (TURBT), intravesical treatment, systemic therapy, and radical cystectomy. Dr. Godoy then explains the importance of re-TURBT, stating that it is one of the most critical steps in management for reducing understaging and improving intravesical therapy response in patients. He summarizes the indicators for cystectomy, including failure to resect, adverse pathology, and treatment failures. Dr. Godoy reviews data from a large single-institution retrospective study showing a significant difference in recurrence-free survival, cancer-specific survival, and overall survival in favor of the primary muscle invasion at presentation group vs. the progressive MIBC group. He then discusses data from a systematic review and meta-analysis of 14 studies on oncological outcomes of primary and secondary MIBC, finding worse outcomes overall for secondary muscle invasive cystectomy. Dr. Godoy looks at the European and AUA risk stratification tables, focusing on how both support aggressive management of high risk disease. He shows data from a study of the impact of variant histology on outcomes with intravesical immunotherapy, finding 40% progression-free survival compared to 17.5% in conventional bladder cancer. He states that all of this data supports cystectomy as an important and integral tool in the management of NMIBC due to its excellent oncological outcomes and potential benefit of abbreviated management and follow-up for aggressive NMIBC despite its morbidity, though the treatment may not be appropriate for everyone.

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Decisional Tools to Determine Need for Biopsy and Re-Biopsy in Men with Elevated PSAs

Guilherme Godoy, MD, MPH, Assistant Professor of Urology and Urology Oncology at Baylor College of Medicine, in Houston, Texas, discusses how and when to use elevated PSA and other markers to determine whether a biopsy is needed. Dr. Godoy cautions that relying solely on an abnormal level for a sensitive biomarker like PSA can lead to false positives and overtreatment, noting that an elevated PSA is an indicator of the prostate but not necessarily of cancer. He reminds physicians to consider the PSA level related to the size of the prostate before jumping ahead to other steps. Dr. Godoy describes how oft-overlooked PSA derivatives in conjunction with family history and other risk factors can be used to individualize risk and personalize assessments for a patient. He then presents an array of current and emerging molecular, genetic, and imaging-based testing options. The 4Kscore assesses the probability of high-risk cancer (Gleason 7 or higher) in the biopsy and informs risk of metastatic disease in 20 years. This test can also indicate risk stratification for mortality. Urine-based tests such as SelectMDx and EPI ExoDx Prostate Intelliscore similarly provide risk stratification for biopsy-naïve men, while tissue-based tests such as ConfirmMDx are useful when a patient has had a previous negative prostate biopsy. He summarizes with a diagram of the clinical integration of MRI and molecular markers illustrating how these testing options should be used.

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