Los Angeles Archives

Urine Biomarkers for the Detection of Urothelial Carcinoma

Posted by Siamak Daneshmand, MD | Jul 2021

Siamak Daneshmand, MD, Associate Professor of Urology and Director of Clinical Research at the University of Southern California discusses the ability of urinary markers to rule out bladder cancer and decrease the frequency of and need for cystoscopy and cytology. He goes over the limitations and adverse effects of cystoscopy and cytology before summarizing the findings of several studies looking at different urinary biomarkers for bladder cancer, including Cxbladder, Bladder EpiCheck, Bladder CARE™, and Decipher Bladder.

Application of MRI Fusion Biopsy Results to Focal Therapy

Posted by Leonard S. Marks, MD | Jun 2021

Leonard S. Marks, MD, Professor and inaugural holder of the deKernion Chair in Urology at the David Geffen School of Medicine at the University of California, Los Angeles, discusses focal therapy using MRI fusion biopsy and a novel process to determine tumor margins. He outlines the rationale for focal therapy, addresses previous concerns about the treatment, and discusses focal therapy failure and how to address it.

Transrectal mpMRI Fusion Biopsy

Posted by Leonard S. Marks, MD | May 2021

Leonard S. Marks, MD, Professor and inaugural holder of the deKernion Chair in Urology at the David Geffen School of Medicine at the University of California, Los Angeles, shares lessons from the first decade of transrectal multiparametric (mp) MRI fusion prostate biopsy at UCLA. Dr. Marks explains that while fusion biopsy of the prostate has been available since 2009, the AUA only endorsed it in 2020, and very few institutions have as much experience with it as UCLA, which assembled a multidisciplinary team for its first Artemis fusion biopsy unit in 2010. Dr. Marks follows this history with a brief summary of the fusion biopsy process, emphasizing the importance of having quality MRI and involving a radiologist and a pathologist, and noting that UCLA’s system is so efficient that they are able to perform approximately 15 of these procedures per week. He then goes over key lessons the UCLA team has learned from its first 4,000 fusion biopsies, which include: (1) targeted sampling of MRI lesions using PI-RADS is necessary; (2) systematic sampling is important for finding invisible lesions; (3) tracking of prior biopsy sites is extremely helpful in detecting upgrades; (4) MRI lesions do not necessarily indicate what the pathology is; and (5) fusion biopsy provides better security than ultrasound biopsy in predicting final pathology . Dr. Marks concludes by remarking on the advantages of the transrectal versus the transperineal approach, arguing that sepsis is easily preventable, patients find the transrectal approach more comfortable, and transrectal fusion systems are more mature.

Mycoplasma and Ureaplasma Molecular Testing Does Not Correlate with Irritative or Painful Lower Urinary Tract Symptoms

Posted by A. Lenore Ackerman, MD, PhD | May 2021

A. Lenore Ackerman, MD, PhD, Director of Research for FPMRS in the Department of Urology at the University of California, Los Angeles, shares data from her research group evaluating diagnostic testing patterns for ureaplasma and mycoplasma and characterizing the associations of these bacteria with irritative lower urinary tract symptoms (LUTS) using molecular detection techniques. Dr. Ackerman explains the context and rationale for the study and reviews how it illustrates Robert Koch’s postulates. She also addresses topics such as how physicians should approach LUTS in culture-negative patients, the significance of the bacteria detected through new sensitive methods, and whether symptoms are proof of infection or if they could be related to something else. Ultimately, she concludes with two main points: that the physician’s focus should be on treating the patient, not on treating a test; and that not all bacteria are bad, as some healthy genitourinary commensal bacteria play an important role in preventing urinary tract infections.

Industry Perspective: Panel Discussion on Cxbladder Genomic Urine Test for Bladder Cancer

Posted by Siamak Daneshmand, MD | May 2021

Siamak Daneshmand, MD, Associate Professor of Urology and Director of Clinical Research at the University of Southern California (USC), along with Anne Schuckman, MD, Assistant Professor of Clinical Urology at the USC, and Sima P. Porten MD, MPH, Associate Professor at the USC participated in a panel discussion on the Cxbladder Genomic Urine Test for Bladder Cancer at the 5th Annual International Bladder Cancer Update. Dr. Daneshmand reviews a research study that audited the clinical utility of the Cxbladder monitor assay and found that it accurately ruled out patients who did not have recurrent UC, enabling low risk patients to undergo cystoscopy at a longer-than-recommended interval, thereby reducing the cystoscopy burden by 39%. He then asks Drs. Porten and Schuckman questions about their experience with Cxbladder, leading the two to discuss ideal patient populations for Cxbladder, in-home sampling procedures, and situations wherein Cxbladder is most effective.