Philadelphia Archives

Next Generation DNA Sequencing for Genitourinary Implants

Posted by Paul H. Chung, MD | Jan 2021

Paul H. Chung, MD, Assistant Professor and Director of the Division of Reconstructive Urology at the Sidney Kimmel Medical College of Thomas Jefferson University, discusses infection of genitourinary implants and how next-generation sequencing can be used to manage device infection. Presenting his results from a recently published article with the Canadian Journal of Urology, he outlines the methods, outcomes, and recommendations for clinicians, specifically those removing malfunctioning or infected penile prostheses and artificial sphincters. Dr. Chung highlights the benefits of polymerase chain reaction (PCR) and next-generation sequencing (NGS) including faster processing time, greater sensitivity, and the ability to run both fungal and bacterial analysis in the same setting. Additionally, NGS is useful in the selection of perioperative antibiotics and irrigation solutions, as well as determining how to coat devices during implant surgery. Following the presentation, Grand Rounds in Urology editor J. Curtis Nickel, MD, FRCSC interviews Dr. Chung to further discuss the clinical implications of his research. In the conversation, they compare biofilm collection techniques, noting that PCR and NGS are most helpful in a clinical setting, whereas extended culture is useful in a research setting.

Panel Discussion: Next Generation Genomics and Prostate Cancer Biomarkers

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

Leonard G. Gomella, MD, FACS, leads a panel discussion with Gerald L. Andriole, Jr., MD; Alan H. Bryce, MD; Brian F Chapin, MD; E. David Crawford, MD; Steven E. Finkelstein, MD, FACRO; A. Karim Kader, MD, PhD; and Neal D. Shore, MD, FACS on how biomarkers are being used to treat prostate cancer. Biomarkers are used to diagnose PCa and to decide whether or not to biopsy or repeat biopsy. They also discuss how biomarkers are used to treat localized disease and advanced disease. Both tissue and liquid biopsies are used for somatic DNA mutations, with liquid biopsies becoming increasingly important since it gives real-time results. Guidelines for germline testing and counseling are being updated, and germline testing for family members is becoming increasingly important. PARP inhibitors are now approved for detecting BRCA mutations. There is broader approval for the medication olaparib for both germline and somatic testing. They also review the updated biomarker map. They discuss how these changes will shape precision medicine and personalized care. It is essential for the urology community to be familiar with all these aspects of testing and clinical applications. They discuss why the PCA 3 test has been declining. They also discuss the need to send a clear message to primary care physicians.

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.