Philadelphia Archives

The Bespoke Future of Cancer Care

Posted by Leonard G. Gomella, MD, FACS | Nov 2024

Leonard G. Gomella, MD, explores the concept of “bespoke” cancer care, emphasizing its personalized, patient-centered approach. Originally a British term referring to custom-made items, “bespoke” now highlights the customization of cancer treatments through precision medicine, pharmacogenomics, AI technologies, and individualized care plans.

In this 10-minute presentation, Dr. Gomella stresses that innovations in cancer care reflect the growing trend of leveraging AI to enhance screening efficiency and reduce reliance on traditional biopsy methods. He discusses how precision medicine increasingly enables oncologists to tailor treatment plans by analyzing genetic mutations and matching patients to the most promising therapies or clinical trials. The need to balance technological advancements with affordability and patient access is a central concern.

Bespoke care offers better outcomes and underscores the importance of informed decision-making, empowering patients to actively participate in their treatment journey.

Utilizing ctDNA in Bladder Cancer

Posted by Leonard G. Gomella, MD, FACS | Nov 2024

Leonard G. Gomella, MD, FACS, explores the potential of circulating tumor DNA (ctDNA) and cell-free DNA (cfDNA) as biomarkers in cancer detection, treatment monitoring, and prognosis.

In this 12-minute presentation, Dr. Gomella reviews recent studies, such as those conducted at the European Association of Urology (EAU), demonstrating ctDNA’s potential for early detection, risk assessment, treatment response evaluation, and post-treatment surveillance in bladder cancer. Trials such as InVigor010 highlight ctDNA’s prognostic utility, where analysis revealed that ctDNA positivity predicted a higher risk of relapse.

Gomella reports that innovations extend to ctDNA detection in urine, offering a non-invasive method to monitor disease burden. These developments and the integration of advanced sequencing technologies mark a new era in cancer management, facilitating earlier interventions and more effective treatment planning.

Role of Precision Medicine in the Diagnosis and Management of Prostate Cancer

Posted by Leonard G. Gomella, MD, FACS | Sep 2024

Leonard G. Gomella, MD, FACS explores the rapid evolution of precision medicine, particularly in the context of prostate cancer, highlighting the shift from a one-size-fits-all approach to more personalized, genomics-based strategies. Precision medicine aims to tailor treatment and prevention strategies to the individual, moving beyond traditional methods to incorporate genetic, genomic, and molecular data.

In this 12-minute presentation, Dr. Gomella discusses key components of precision medicine in prostate cancer, including biomarkers, risk prediction, stratification, and drug repurposing. Advances in imaging technologies, such as improved MRI and ultrasound, as well as liquid biopsies, allow for deeper insights beyond histology, utilizing biomarkers, RNA tumor markers, and detailed genomic analysis. These innovations facilitate a more precise understanding of individual patients’ cancer profiles, helping to refine screening and treatment decisions.

Further, he asserts that precision medicine has substantially impacted the management of advanced prostate cancer, with targeted therapies tailored to genetic mutations and molecular characteristics. This approach exemplifies the precision targeting of treatments based on individual tumor profiles, optimizing outcomes and minimizing unnecessary interventions.

Urethral Strictures and Bladder Neck Contractures Made Simple

Posted by R. Caleb Kovell, MD | Jul 2024

R. Caleb Kovell, MD, provides an overview of the diagnosis, treatment, and management of urethral strictures and bladder neck contractures. In this presentation, he provides anatomical and surgical examples of urethral stricture:

Presentation
Work-Up
Endoscopic and Surgical Management
Post-Treatment Follow-Up

Effective Strategies for Priapism

Posted by R. Caleb Kovell, MD | May 2024

R. Caleb Kovell, MD, discusses management strategies for acute refractory ischemic priapism, including shunting, tunneling, and prosthesis. Dr. Kovell begins his lecture by reviewing the erectile recovery windows and imaging techniques for establishing acute ischemic priapism.

Dr. Kovell then turns to effective treatment options after intracavernosal phenylephrine and corporal aspiration fail. He outlines various types of distal shunting, corporal tunneling, penoscrotal decompression, and early prosthesis placement.

Dr. Kovell concludes by discussing outpatient management of acute ischemic priapism. He highlights the importance of establishing the patient’s Sickle Cell Disease status, and cautioning against immediately prescribing PDE5is to outpatients.