Video Archives

Clinical Impact of PSMA PET Prior to Prostatectomy

Posted by Robert E. Reiter, MD, MBA | May 2024

Robert E. Reiter, MD, MBA, illustrates the diagnostic and predictive value of PSMA PET imaging and the role of PSMA as a biomarker. He begins by examining the sensitivity of PSMA PET against that of MRI and the benefits of using combined PSMA PET/MRI for intermediate-risk tumors.

Dr. Reiter then turns to the functionality of PSMA PET/CT as a predictor of clinical outcome. He presents data comparing pre- and post-prostatectomy PSMA and CAPRA-(S) scores in association with biochemical recurrence, noting that PSMA outperformed CAPRA-(S) scores in some situations.

Dr. Reiter concludes by examining the utility of PSMA as a biomarker for tumor biology and how that can inform treatment. He presents data comparing tumors with high PSMA expression against those with low PSMA expression. He notes that PSMA-high tumors are responsive to primary treatment, while low-PSMA tumors are likely to require secondary treatment.

APP-Directed Management of Female Sexual Health and GU Syndrome of Menopause

Posted by Aleece R. Fosnight, MSPAS, PA-C, CSCS, CSE, IF, NCMP, HAES | May 2024

Aleece R. Fosnight, MSPAS, PA-C, CSCS, CSE, IF, NCMP, HAES, discusses APP-lead treatment of female sexual health and genitourinary syndrome of menopause (GSM). Ms. Fosnight begins by describing symptoms of GSM, including hormonal, sexual, and GI symptoms. She notes that, while up to 84% of menopausal women face GSM symptoms, half have never been treated.

Ms. Fosnight then turns to GSM diagnosis and treatment options, including hormonal treatments, non-hormonal treatments, and physical therapy. For each treatment, she addresses safety, side effects, and contraindications.

Ms. Fosnight concludes by emphasizing the importance of clear communication and preventative action. As many menopausal patients are likely to experience GSM, she emphasizes the importance of a frank, supportive dialogue between practitioner and patient, noting that there are many safe treatment options available.

Bladder Cancer: Optimizing Detection and Minimally-Invasive Management

Posted by Alejandro R. Rodriguez, MD | May 2024

Alejandro R. Rodriguez, MD, discusses detection and minimally invasive management of bladder cancer. Dr. Rodriguez begins by noting that bladder cancer is the 10th most-commonly diagnosed cancer worldwide, and presents the American Urological Association (AUA) risk stratification that provides the basis for non-muscle-invasive bladder cancer (NMIBC) management.

Dr. Rodriguez notes that the most frequent treatment for NMIBC is Transurethral Resection of Bladder Tumor (TURBT.) While he contends that conventional TURBT is the best tool for clinical staging of NMIBC, he enumerates the risks and drawbacks of the procedure.

Dr. Rodriguez then describes narrow-band imaging (NBI) as an additional modality, and presents data showing that TURBT performed in NBI modality reduces NMIBC recurrence risk. Further, NBI with white light cystoscopy TURBT may lower recurrence risk with little-to-no effect on risks of adverse events.

Finally, Dr. Rodriguez turns to the role of TUR in muscle-invasive bladder cancer (MIBC), with a focus on clinical staging, histology and grade, and bladder preservation options. He notes that trimodality therapy is the primary option for patients with MIBC that seek bladder preservation as an alternative to radical cystectomy.

Molecular Targeted Imaging

Posted by Phillip J. Koo, MD | May 2024

Phillip J. Koo, MD, gives a high-level overview of the current state of molecular targeted imaging in identifying prostate cancer. Dr. Koo begins by establishing the sensitivity and accuracy of PSMA PET molecular targeted imaging at various PSA levels. He compares the efficacy of the four most commonly used commercially available agents in PSMA PET, noting that there is no data available that indicates one agent is superior to another.

Dr. Koo then delves into the sensitivity of different PSMA PET agents, including Gallium-68-PSMA-11 and Fluorine-18-DCFPyl. He highlights that imaging is not yet a reliable replacement for prostatectomy, using a few case studies as supporting evidence.

Dr. Koo concludes by reviewing the issue of biochemical recurrence and how it impacts disease management. He notes that molecular targeted imaging can detect recurrences in different sites in the body, and how current data may support a more aggressive treatment approach in the future.

Care Considerations for the Man on ADT

Posted by Alejandro R. Rodriguez, MD | May 2024

Alejandro R. Rodriguez, MD, discusses the management of metabolic, cardiovascular, and other side effects of Androgen Deprivation Therapy (ADT). In this lecture, Dr. Rodriguez highlights common side effects of ADT as a treatment, including:

Bone-Density Loss
Cardiovascular Disease
Diabetes and Other Metabolism Changes
Sexual Dysfunction

For each of these conditions, Dr. Rodriguez presents management strategies that can be used by physicians, patients, and members of the patients’ care team.