Video Archives

Early Detection of Prostate Cancer: Navigating the Challenges in 2023

Posted by E. David Crawford, MD | Jun 2023

E. David Crawford, MD, Editor-in-Chief of Grand Rounds in Urology and Professor of Urology at the University of California, San Diego, discusses the challenges of early detection of prostate cancer (PCa) and recommends a prostate-specific antigen (PSA) cut-off of 1.5 ng/ml. Because most diagnostic testing is completed by primary care physicians who may not understand the nuances of PSA testing, Dr. Crawford recognizes that they need a simple message from urologists. Dr. Crawford contends that PSA testing should be considered as routine as measuring a patient’s cholesterol, especially since more than 70% of men will have a PSA of less than 1.5 and will not require further screening for another 5 to 10 years.

He states that a PSA of 1.5 ng/ml to 4.0 ng/ml may be in a “danger zone” and require additional testing for benign prostatic hyperplasia (BPH), PCa, and PCa risk. Dr. Crawford concludes by reiterating the importance of simple messaging to move forward with effective screening and early detection of PCa.

Role of Circulating Tumor DNA and Adjuvant Therapy in Urothelial Carcinoma

Posted by Tyler F. Stewart, MD | Jun 2023

Tyler F. Stewart, MD, discusses the groundbreaking role of circulating tumor DNA (ctDNA) in adjuvant therapy for urothelial carcinoma, highlighting its potential to revolutionize cancer treatment. ctDNA, a fragmented DNA shed by cells into the bloodstream, holds immense promise in identifying minimal residual disease and predicting patient outcomes.

Dr. Stewart emphasizes the significance of ctDNA as a biomarker and its successful application in various cancer types, including colorectal and bladder cancer. He presents studies showcasing the prognostic value of ctDNA monitoring throughout the treatment course, revealing its ability to accurately predict disease recurrence. The assay DNA methodologies, such as digital PCR and targeted capture NGS, offer remarkable sensitivity and customization to individual patients.

Dr. Stewart explores the potential of ctDNA as a predictive marker for perioperative systemic therapy, which could aid in identifying patients who would benefit most from adjuvant therapy. He highlights the positive outcomes observed in ctDNA-positive patients receiving adjuvant atezolizumab, leading to improved disease-free survival and overall survival rates.

Ongoing clinical trials, such as TOMBOLA and ImVigor011, further explore the integration of ctDNA as an essential biomarker in the management of muscle invasive bladder cancer. The extensive research on ultrasensitive ctDNA assays, novel ctDNA assays, and the use of urinary biomarkers for disease monitoring adds to the growing body of evidence supporting the clinical utility of ctDNA in cancer care.

Hormone Replacement Therapy in Menopause

Posted by Maria Uloko, MD | Jun 2023

Maria Uloko, MD delves into the complexities and clinical considerations of hormone replacement therapy (HRT) in menopause.

Primer on Testosterone Therapy for Women: Treatment of HSDD

Posted by Maria Uloko, MD | Jun 2023

Maria Uloko, MD, discusses testosterone therapy for women with hypoactive sexual desire disorder (HSDD). She explains that people with HSDD have higher rates of impaired body image, low self-confidence and self-worth, relationship stress, depression and anxiety, and increased healthcare costs.

Dr. Uloko shares the Basson Model of Sexual Motivation and emphasizes there is no “quick fix” for low libido. Dr. Uloko advocates a biopsychosocial approach that incorporates the biological, psychological, and social aspects that can affect HSDD. She explains the importance of patient education and therapy as well as medication treatments like flibanserin and testosterone.

Dr. Uloko emphasizes that testosterone is not FDA-approved for women, and it remains challenging to dose women appropriately. She cites studies that conclude testosterone, either alone or in concert with estrogen therapy, can be effective and safe for the treatment of HSDD. Dr. Uloko states that symptomatic improvement takes approximately 12 weeks, and treatment should be discontinued if no improvement occurs within six months.

Dr. Uloko then concludes that HSDD is a common but multifactorial condition for women with significant detriment to quality of life. She re-emphasizes the importance of a biopsychosocial approach to diagnosis and treatment that may include treatment with testosterone therapy.

Radioligand Therapy in Prostate Cancer

Posted by Geoffrey B. Johnson, MD, PhD | Jun 2023

Geoffrey B. Johnson, MD, PhD, Chair of the Division of Nuclear Medicine at the Mayo Clinic in Rochester, MN, discusses radioligand therapy in prostate cancer. Dr. Johnson briefly reviews the specific activity of this therapy, with a focus on Lutetium-177-PSMA-617.
Dr. Johnson highlights the benefits and tolerable side-effects of Lutetium-177-PSMA-617, and mentions the therapy is approved for patients with metastatic castrate-resistant prostate cancer who have been previously treated with androgen receptor pathway inhibition and taxane-based therapy.

The presentation further explores the process of patient selection for PSMA imaging, with the requirement of at least one lesion that shows higher PSMA expression than the liver. Dr. Johnson showcases post-therapy imaging examples, and discusses the potential of advanced scanning techniques, such as CZT-based scanners, which offer higher sensitivity and faster scans for accurate tracking of therapy response.

Dr. Johnson emphasizes the promising future of radionuclide therapy. He mentions the potential combinations of PSMA therapy with hormonal therapy, chemotherapy, immunotherapy, and external radiation. Additionally, he mentions ongoing trials exploring the use of alpha and beta emitters and the incorporation of different targets.