Ann Arbor Archives

Transperineal Biopsy: Rationale, Outcomes, and Techniques

Posted by Arvin George, MD | Apr 2024

Arvin K. George, MD, discusses the rationale behind performing transperineal biopsies over transrectal biopsies, supporting outcome data, and actionable techniques to combat the perceived shortcomings of the procedure. Dr. George begins by providing data on the fluoroquinolone-resistant infection risks of transrectal biopsies, and that, by avoiding the issue of antibiotic-resistant rectal flora, transperineal biopsies circumvent the rising rate of infections and strengthen antibiotic stewardship during procedures.

Dr. George then addresses the issue of patient pain in transperineal biopsies. He offers techniques on ideal administration of local anesthetic for decreasing patient pain.

Dr. George concludes by providing information on patient set-up, procedure equipment, and transperineal guides, presenting multiple options and encouraging urologists to choose according to their needs. He offers several resources for urologists and their patients from the Michigan Urologic Surgery Improvement Collaborative.

Focal HIFU

Posted by Arvin George, MD | Mar 2024

Arvin K. George, MD, discusses the use of Focal High Intensity Focused Ultrasound (HIFU) ablation for prostate cancer treatment. He begins by listing the indicators and guidelines for Focal HIFU, particularly after failed radiation therapy.

Dr. George then walks through the selection process for Focal HIFU. He presents the ideal patient and disease characteristics for HIFU ablation therapy, and contraindications for the treatment, including tumor size.

Turning to complications associated with HIFU ablation therapy, Dr. George discusses the common early-, medium-, and late-stage complications associated with Focal HIFU. The most common complications for Focal HIFU ablation therapy being urinary retention and erectile dysfunction. He discusses strategies for avoiding common complications from HIFU.

Dr. George concludes by reviewing patient outcomes of Focal HIFU ablation compared to other treatments for prostate cancer. He presents studies comparing failure-free survival outcomes between patients treated with Focal HIFU over three, five, and eight years compared to other established prostate cancer treatments.

Optimizing Biopsy Approach Before Precision Prostatectomy

Posted by Arvin George, MD | Sep 2023

Arvin K. George, MD, reviews the strengths and limitations of prostate magnetic resonance imaging (MRI), identifies strategies to optimize the detection of clinically significant prostate cancer, and reviews outcomes of precision prostatectomy. Dr. George begins by addressing the weak predictive value of multiparametric MRI (mpMRI,) calling it imperfect. However, data from the PROMIS study supports mpMRI over transrectal ultrasound (TRUS.)

Dr. George cites data on MRI-targeted, systematic, and combined biopsy for prostate cancer diagnosis, and defines precision prostatectomy as a subtotal prostatectomy that preserves tissue and nerves. Dr. George illustrates two scenarios to support the use of precision prostatectomy in conjunction with a 3D ultrasound to guide treatment—one for biopsy-naive patients and the other for patients with prior biopsy. He then shares data on precision prostatectomy outcomes, in which all patients maintained social continence and 85% of patients maintained potency after one year.

In regards to remission rates, only 6.6% of post-mpMRI biopsy patients presented with clinically significant prostate cancer at 36 months, with over 90% of patients requiring no secondary treatment. Dr. George reiterates that mpMRI is not perfect, but its preservative effects on patients makes it worth further exploration.

About the 26th Annual Southwest Prostate Cancer Symposium:
This conference educated attendees about advances in the management of localized and advanced prostate cancer, with a focus on imaging, technology, and training in the related devices. It included a scientific session, as well as live demonstrations of surgical techniques. You can learn more about the conference here.

Vitamin D and Men’s Health

Posted by Mark A. Moyad, MD, MPH | May 2023

Mark A. Moyad, MD, MPH, the Jenkins/Pokempner Director of Preventive/Complementary and Alternative Medicine (CAM) in the Department of Urology at the University of Michigan Medical Center in Ann Arbor, Michigan, presents on the current status of vitamin D in men’s health. While randomized trials have shown limited benefits in major endpoints, such as preventing cardiovascular disease and cancer, there is a significant signal indicating the potential of vitamin D in autoimmune disease prevention. He discusses exciting findings from the VITAL trial suggesting that a moderate dose of vitamin D may reduce the risk of autoimmune disease. Additionally, individuals with a healthy BMI and those at high risk for bone loss could potentially benefit more from vitamin D supplementation. Dr. Moyad emphasizes the importance of understanding the limitations of vitamin D blood tests and suggests that targeted screening is recommended for specific groups. Overall, he says, fortification and supplementation of vitamin D remain safe and cost-effective strategies for improving men’s health.

In-Office Water Vapor Ablation

Posted by Arvin George, MD | Jan 2023

Arvin K. George, MD, discusses the advantages and limitations of the Rezum procedure for symptomatic benign prostatic hyperplasia (BPH).