Los Angeles Archives

Contemporary Management and Prevention of Artificial Urinary Sphincter Erosion

Posted by Jeffrey Loh-Doyle, MD | Sep 2024

Jeffrey Loh-Doyle, MD, provides a detailed analysis of artificial urinary sphincter (AUS) erosion, focusing on its causes, risk factors, management, and prevention. In this 18-minute presentation, Dr. Loh-Doyle examines this complication of the gold standard treatment for moderate to severe male stress urinary incontinence.
Dr. Loh-Doyle stresses the importance of identifying and managing AUS erosion. Patients may present with symptoms such as worsening incontinence, perineal or scrotal swelling, or, in more subtle cases, no symptoms at all. Cystoscopy is necessary to confirm erosion, especially in cases of severe discomfort or urinary retention. He discusses treatment, which involves removing the AUS device, draining the bladder with a catheter, and, depending on the severity of the erosion, repairing the urethra.
Prevention is key, especially in high-risk patients. Loh-Doyle advocates for conservative management, including using lower-pressure balloons, delayed activation, and educating patients on deactivating the device to reduce compressive forces. He also shares that, while AUS is effective, repeated erosions increase the likelihood of poor outcomes.

The Prostate Cancer Proteome

Posted by Paul Boutros, PhD, MBA | Aug 2024

Paul Boutros, PhD, MBA, gives a talk on the under-explored prostate cancer proteome. Dr. Boutros discusses proteomics by delving into five reasons why they are a useful tool. His talk focuses on these reasons and he goes into detail about each one. They include the fact that proteins are the actual function units of the central dogma, they are far more diverse than RNA, they have not been looked at in much detail yet, they are abundant in urine and they have immense dynamic range. His talk then goes on to cover what tissue proteomics look like, how the proteome relates to other things we care about such as MRI visibility and urinary proteomics. He ends the talk by going over some of the caveats and reasons that proteomics might not work. Overall proteomics are incredibly complex and few have the skills to properly analyze, but it remains a major opportunity to move forward in the field.

Assessing and Managing Metabolic Risk in Patients with Prostate Cancer

Posted by Robert H. Eckel, MD, FAHA, FACC, FNLA | Aug 2024

Robert H. Eckel, MD, FAHA, FACC, FNLA, presents a high-level overview of the assessment of metabolic risk in patients with prostate cancer. He begins with a summary of the known metabolic risks associated with Androgen Deprivation Therapy (ADT) in prostate cancer management.

Dr. Eckel then presents data on the changes in patient body composition which result from 12 weeks of ADT. He notes that while weight does not significantly change in patients being treated with ADT, he reviews the impact of changes in insulin resistance, waist circumference, and other factors which contribute to metabolic syndrome.

He concludes by examining racial disparities in those who develop metabolic syndrome after being treated with ADT for prostate cancer. He presents a short questionnaire that urologists can use to assess ongoing risk during ADT.

Integration of Histology, Genomics and Proteomics with MRI

Posted by Steven S. Raman, MD | Aug 2024

Steven S. Raman, MD, explores how histology, genomics, and proteomics with MRI revolutionize the diagnosis and treatment of prostate cancer. Histology provides critical insights into the pathological features of prostate cancer; genomics offers a deeper understanding of the genetic mutations and alterations that drive cancer progression; and proteomics sheds light on the protein expressions and interactions that occur within the tumor microenvironment. Raman asserts that each modality, while powerful on its own, gains significance when integrated with MRI prostate imaging.

He elaborates on the technological advancements and methodological innovations that facilitate this integration. Raman highlights how multi-parametric MRI (mpMRI) can be augmented with molecular data from histology, genomics, and proteomics to create a more comprehensive and nuanced diagnostic picture. Recent studies show significant improvements in the detection, characterization, and monitoring of prostate cancer, leading to more personalized and effective treatment strategies.

PSMA Imaging as a Biomarker for Early Stage Prostate Cancer

Posted by Robert E. Reiter, MD, MBA | Aug 2024

Robert E. Reiter, MD, discusses PSMA imaging’s potential as a biomarker for early-stage prostate cancer. In this 11-minute presentation, Dr. Reiter compares PSMA PET and MRI. PSMA PET imaging, more sensitive than MRI, can detect cancer presence, tumor size, and potential spread beyond MRI’s capability, offering a possible advantage in early and focal disease management.

PSMA’s prognostic value is explored. Data indicate a correlation between high PSMA uptake (SUV) and higher Gleason scores. Low PSMA expression is linked with more aggressive cancer markers.

Additionally, Dr. Reiter asserts that PSMA’s potential as a guide in surgical procedures, such as radio-guided lymph node removal, could enhance surgical precision and reduce the chance of residual disease.