Chicago Archives

NMIBC Trials for BCG Naive Patients: What is Exciting

Posted by Joshua J. Meeks, MD, PhD | May 2023

Joshua J. Meeks, MD, PhD, Associate Professor of Urology, Biochemistry and Molecular Genetics at the Northwestern University Feinberg School of Medicine in Chicago, IL, provides insights into the latest advancements in bladder cancer research. He highlights the potential of large-scale clinical trials and the role of immunotherapy in shaping future treatment strategies. The North American trial, with a thousand patients, offers numerous opportunities to explore new treatment modalities. Additionally, the Bridge study led by Max Kate examines the efficacy of gemcitabine docetaxel compared to the standard BCG treatment. Despite initial skepticism, the trial presents promising results that may offer an alternative for patients who cannot access BCG. Dr. Meeks emphasizes the importance of identifying the patient population that would benefit most from checkpoint immunotherapy and coordinating care effectively.

He discusses ongoing trials that investigate the synergy between immunotherapy and BCG, the possibility of using less BCG, and the introduction of a Sub-Q delivery system. The Sunrise trials, TAR 200, and the Danish study DaBlaCa all hold potential in improving treatment outcomes for bladder cancer patients. Dr. Meeks concludes by highlighting the transformative impact of the Terra system, a device that delivers gemcitabine consistently and may revolutionize bladder cancer treatment. Overall, this comprehensive summary underscores the significant advancements and future prospects in bladder cancer research.

Bladder Cancer Risk Stratification: Moving from the Old to the New

Posted by Joshua J. Meeks, MD, PhD | Mar 2023

Joshua J. Meeks, MD, PhD, discusses risk stratification and treatment options for patients with non-muscle-invasive bladder cancer (NMIBC).

MRI Guided Focal Laser Ablation

Posted by Aytekin Oto, MD, MBA | Jan 2022

Aytekin Oto, MD, MBA, Professor of Radiology and Surgery and Chair of the Department of Radiology at the University of Chicago, discusses MRI guided focal laser ablation for prostate cancer including challenges and future considerations. He first describes the benefits, technique, and trial data showing 1-year, 3-year, and 5-year follow up. Focal laser ablation is minimally invasive and targets lesions while sparing surrounding tissue and preserving options for future treatment. Dr. Oto notes that the goal of this therapy is to replace surgery and radiation, but not active surveillance. Currently, MRI guided focal laser ablation is offered at five centers in North America, is conducted mostly transrectally, and is sometimes reimbursed by insurance. Dr. Oto identifies several key challenges to this therapy: lesion mapping, monitoring and planning while in procedure, and high local recurrence. He states the importance of considering other ultrasound guided procedures and notes that one of the limitations of MRI guided focal laser ablation is underestimating prostate volume. For this reason, he introduces hybrid multi-dimensional MRI that may help address this issue. Dr. Oto concludes that MRI guided focal laser ablation is both a safe and feasible treatment and underscores the importance of imaging in determining patient eligibility and accurate planning. Lastly, he adds that local recurrence must be addressed in long-term follow-up.

Image-Guided Focal Treatment of Prostate Cancer

Posted by Scott Eggener, MD | Nov 2021

Scott Eggener, MD, Professor of Surgery and Radiology and Vice-Chair of Urology at University of Chicago Medicine, discusses image-guided focal therapy and why, despite the challenges of research and adoption of the treatment, it should be researched and taken seriously as a potential standard of care. He explains that focal therapy can be used to minimize unnecessary biopsies and preserve organs. Dr. Eggener then compares the state of breast cancer focal treatment to that of prostate cancer focal treatment by presenting a randomized trial in breast cancer which suggests that prostate cancer care is 50 years behind breast cancer care in this regard. He then states the pros of focal imaging, noting that there have been multiple high-quality trials, that it lowers patients’ likelihood of needing a biopsy, and that it optimizes detection rates. Dr. Eggener then considers the cons of image-guided focal therapy, stating that not all prostate cancer is MR-visible, that MRI tends to underestimate tumor volume, and that MRI is poor at predicting extraprostatic extension. He then summarizes available data on focal therapy showing that vascular targeted photodynamic therapy has much higher outcomes than standard of care, HIFU hemi-ablation has very low rates of salvage therapy or metastases, and gold nanoparticle thermotherapy can result in metastasis-free survival at 1 year after treatment. Dr. Eggener concludes by stating that image-guided focal therapy is worthy of study and physicians should be attentive to results of ongoing and future studies.

The Present and Future of LUGPA

Posted by Richard G. Harris, MD | May 2020

Richard G. Harris, MD, discusses the Large Urology Group Practice Association’s (LUGPA) 2020 Strategic Plan. He observes that as the United States’ population ages and grows, and as new technology causes the cost of treatment to rise, demands on urology practices will increase. LUGPA will help urologists meet these challenges by continuing its advocacy work protecting independent urology practice, especially in Washington, D.C., and by developing the leadership skills of young urologists through programs like LUGPA Forward and the Rising Chief Resident Summit. Other initiatives will focus on easing operational challenges, increasing member engagement, and ensuring organizational excellence.