Philadelphia Archives

Implementation of Germline Testing for Prostate Cancer: Philadelphia Prostate Cancer Consensus Conference 2019

Posted by Veda N. Giri, MD | Jul 2020

Veda N. Giri, MD, Director of Cancer Risk Assessment and Clinical Cancer Genetics at the Sidney Kimmel Cancer Center of Thomas Jefferson University, discusses the decisions reached about the implementation of germline testing at the 2019 Philadelphia Prostate Cancer Consensus Conference. She summarizes the conclusions the voting participants came to, including recommendations on who should receive germline testing, what should be discussed with men in terms of informed consent, which genes should be prioritized for testing, and who should be enrolled in precision medicine trials, among other topics. In a follow-up interview, E. David Crawford, MD, Professor of Urology at the University of California, San Diego, asks Dr. Giri about which laboratories and panels to use, the limitations of commercial genetic testing like 23andMe, and the role of online genetic counseling.

Guidelines for Surgery in Urologic Cancer Patients Amid COVID-19 Outbreak

Posted by Robert G. Uzzo, MD, MBA, FACS | Mar 2020

Robert G. Uzzo, MD, MBA, FACS, Chairman of the Department of Surgery and G. Willing “Wing” Pepper Endowed Professor of Surgery at Fox Chase Cancer Center–Temple University Health System, and Fernando J. Kim, MD, MBA, FACS, Chief Emeritus of Urology at Denver Health Medical Center, Professor of Surgery/Urology at the University of Colorado at Denver, and Associate Editor of the Patient Safety in Surgery Journal, discuss the rationale behind guidelines Dr. Uzzo helped develop for the American College of Surgeons and published in the Annals of Internal Medicine on when and whether to delay surgical treatment for urologic cancer during the COVID-19 outbreak. They discuss the inconsistent initial approach to delaying surgeries, as well as the system of disease classification Dr. Uzzo has been using to identify which patients can wait, which should wait, and which can’t wait for their surgeries. With a focus on kidney cancer, Dr. Uzzo discusses how these classifications are made by identifying clinical capacity, physiological age of the patient, competing risks and comorbidities, and how difficult cases are determined with a consensus among colleagues. He gives examples of patients with low volume metastatic disease with excellent performance status or locally advanced disease as candidates for systemic therapy and a delay in surgery, while patients with aggressive disease that may progress rapidly as requiring immediate treatment despite the risk of COVID-19 infection.

How Academic Urology Institutions are Coping with the COVID-19 Pandemic

Posted by Leonard G. Gomella, MD, FACS | Mar 2020

Leonard G. Gomella, MD, FACS, the Bernard W. Godwin, Jr., Professor of Prostate Cancer and Chairman of the Department of Urology at the Sidney Kimmel Medical College at Thomas Jefferson University, discusses how academic urologic institutions are coping with the COVID-19 crisis. He highlights how the pandemic has created an asymmetric practice model as cases go before an OR committee to determine which can be postponed and which need to go forward. This asymmetric model may affect relative value units (RVUs) as the year goes on, but Dr. Gomella emphasizes the need to care for patients in this time of crisis over worrying about the details of reimbursement. He further discusses the need to transition to telehealth but also recognizes that this is not a practical solution for some older patients who are not confident in their use of technology. Phone visits have proven to be an effective solution in these cases, as cross-state licensing rules have been temporarily abolished. Dr. Gomella also speculates on the potential need to suspend all truly non-life threatening surgeries and its impact on patients.

Contrast-Enhanced Ultrasound of the Prostate

Posted by Ethan J. Halpern, MD | Feb 2020

Ethan J. Halpern, MD, Professor and Vice-Chair for Research in the Department of Radiology at Jefferson University Hospital, reviews the history and limitations of using standard grayscale and doppler TRUS imaging to identify cancers within the prostate. He further discusses contrast-enhanced ultrasound of the prostate, and how, when combined with subharmonic flash replenishment imaging, it represents a major step forward in identifying malignant vascular patterns within the prostate.

Guidelines Based Management of Localized and Locally Advanced RCC

Posted by Robert G. Uzzo, MD, MBA, FACS | Feb 2020

Robert G. Uzzo, MD, MBA, FACS discusses the updated American Urological Association (AUA) guidelines on renal cell carcinoma (RCC) and notes the remarkable advances made in the past 20 years. He emphasizes the importance of careful patient selection and the key role of systemic therapy.