Video Archives

Cancer Control in 1379 Men Undergoing HIFU: A Multi-institute 15-year Experience

Posted by Mark Emberton, MD, FRCS | Apr 2022

Mark Emberton, MD, FRCS, Professor of Interventional Oncology at University College London, summarizes the design and findings of a 15-year multi-institute study of high-intensity focused ultrasound (HIFU) in patients with nonmetastatic prostate cancer. After an introduction from E. David Crawford, MD, Professor of Urology at the University of California, San Diego, and Editor-in-Chief of Grand Rounds in Urology, Dr. Emberton notes that the results of this 15-year study resulted in a wave of positive press about HIFU in popular outlets, observing that this widespread enthusiasm is due not just to HIFU’s efficacy, but its safety and adverse event profile as well. He then details the design of the study, beginning with the patient profile. Noting that outcomes in prostate cancer treatment are largely dependent on the risk profile of the patient, Dr. Emberton explains that in this study the average patient age was 66, ⅕ of patients had a PSA greater than 10, the average prostate volume was relatively low, the majority of patients were Gleason 3+4, and the majority of patients were T2. He mentions that intervention varied, and that while the majority of patients had quadrant ablation, about ⅓ had hemiablation. Dr. Emberton then considers the outcomes, observing that the “headline” of the study was the 83% 5-year failure-free survival for intermediate-risk disease. He also highlights that only 0.5% of patients experienced greater than 2 adverse events. Dr. Emberton discusses some supplementary data, emphasizing that if a clinician commits to HIFU, they also commit to retreating a subset of patients. He concludes that HIFU is very safe and that the data suggests that the majority of eligible patients with intermediate-risk disease can defer or avoid radical therapy with HIFU.

The Future of Medical Marketing

Posted by Neil H. Baum, MD | Apr 2022

Grand Rounds in Urology Contributing Editor Neil H. Baum, MD, Professor of Urology at Tulane Medical School, gives 8 suggestions for marketing and promoting a medical practice in 2022. He begins by saying that old methods of promotion are no longer effective since the internet has “leveled the playing field” and patients now have as much information as physicians. Dr. Baum then lists his suggestions, starting with embracing telemedicine, which he says provides safe and effective care while allowing practices to reach new and untapped markets. Next, he recommends using video marketing, since people are 4 times more likely to watch a video than read an article, and search engine optimization (SEO) algorithms prioritize video content. Dr. Baum also suggests using psychographic marketing which, unlike demographic marketing, identifies the attitudes and mindsets of patients. He follows this by recommending a focus shift from illness to wellness, explaining that the current healthcare system focuses on symptoms and illness and is inherently reactive, while a wellness-focused practice is proactive and able to identify early transitions from wellness to disease. Dr. Baum then considers the benefits of personalized marketing and personalized medicine, highlighting the utility of the right patients receiving the right messages. He brings up the use of virtual assistants, noting that tools like Amazon’s Alexa can conduct various healthcare tasks, from tracking glucose levels to helping patients with parking at the office. Dr. Baum’s final marketing and promotion tips include carefully managing a practice’s online reputation, and embracing artificial intelligence in healthcare marketing. He notes that a practice’s marketing budget should be about 3-5% of gross revenues, and he suggests getting marketing assistance from firms with medical experience. Dr. Baum concludes that if practices want to be around in 3 to 5 years, they should consider implementing a few of these ideas.

Private Equity and Value-Based Care: Is There a Future?

Posted by Edward S. Cohen, MD | Apr 2022

Edward S. Cohen, MD, CEO of Genesis Healthcare Partners in San Diego, California, looks at how private equity can help independent urology practices provide value-based care and remain financially viable. He begins by emphasizing the importance of value-based care, noting that the United States currently spends more on healthcare than any other country, and does not get the best value for the money spent. Dr. Cohen also observes that Medicare’s value-based payment model trajectory is supposed to get to capitation, meaning that practices will not be paid for how many procedures they perform but for how many patients they manage. He then considers the various difficulties facing independent practice, such as increasing difficulty in remaining viable, increasing cost of doing business, the need to have other income streams to maintain viability, and the need to be competitive with the employed physician market. Dr. Cohen argues that independent practitioners need a “seat at the table,” and he suggests that private equity is a good, viable way to do so. He claims that private equity can provide capital, improve management, help with expansion of ancillary revenue streams, allow for consolidation, and provide leverage in the community, all while allowing independent private practice to maintain its identity. Dr. Cohen stipulates that practices need to find the right partner with an aligned vision, but argues that when practices and private equity form good partnerships, they can help independent practice thrive and form a counterbalance to large hospitals.

Combining Therapy with SBRT and Brachytherapy

Posted by Richard G. Stock, MD | Apr 2022

Richard G. Stock, MD, Professor of Radiation Oncology and Director of Genitourinary Radiation Oncology at the Icahn School of Medicine at Mount Sinai in New York City, discusses the efficacy of SBRT and brachytherapy for treating patients with prostate cancer. He explains that combined SBRT and brachytherapy seems to be particularly helpful for intermediate-risk cancer, with studies showing about a 90% biochemical control rate. Dr. Stock then goes over the rationale for combined SBRT and brachytherapy, noting that brachytherapy combined with external beam radiation therapy (EBRT) at standard fractionation demonstrates excellent and safe outcomes for both intermediate- and high-risk prostate cancer, and SBRT appears to be comparable or better than standard fractionation without increased toxicity. He summarizes the findings of several different studies, explaining that with low-dose-rate brachytherapy and SBRT, researchers are seeing very similar results to using standard fractionation with brachytherapy. Dr. Stock also looks at a recent trial with high-dose-rate brachytherapy with SBRT which found a favorable early toxicity profile and encouraging cancer control outcomes. He concludes that the combination of SBRT and brachytherapy is promising, and the initial clinical impression is that patients tolerate the treatment well.

ExactVu™ Micro-Ultrasound for Diagnosis of Prostate Cancer

Posted by Priya N. Werahera, PhD | Apr 2022

Priya N. Werahera, PhD, Research Associate Professor in the Departments of Pathology and Bioengineering at the University of Colorado Anschutz Medical Campus, discusses the advantages of using the ExactVu micro-ultrasound platform to diagnose prostate cancer. First, he considers whether MRI imaging can be considered standard of care, arguing that it cannot be seen as such since many cancers are MRI-invisible, it is not cost effective, the technology remains in evolution, and there is high interobserver variability among radiologists. Dr. Werahera then turns to micro-ultrasound, explaining that the new ExactVu system is a 29 MHz machine which provides real-time imaging of prostate cancer lesions, has a high resolution of 70 microns, and can provide both lateral and axial resolution. He cites a meta-analysis which shows that micro-ultrasound is a relatively convenient and cost-effective method of real-time imaging which is highly sensitive in detecting clinically significant prostate cancer. Dr. Werahera then discusses a study at the University of Colorado comparing micro-ultrasound lesions vs. histopathology data of mapping biopsy which found that PRIMUS scores 4-5 have 100% sensitivity at the patient-level and 80% sensitivity at lesion-level for diagnosis of ≥ Gleason Grade 2 prostate cancer lesions. There were 2 undiagnosed Gleason Grade 2 lesions, both of which were small and located anteriorly. Dr. Werahera concludes that ExactVu micro-ultrasound has the potential to improve current imaging standards since it has comparable screening performance to MRI and comparable biopsy performance to MRI fusion, while also allowing for easier, more effective micro-ultrasound/MRI fusion. He also notes that ExactVu micro-ultrasound may enable widespread focal therapy due to its high accuracy in finding satellite lesions and lesion boundaries.