Video Archives

The Veteran’s Prostate Cancer Treatment and Research Act

Posted by Gregory F. Murphy, MD | Aug 2021

Congressman Gregory F. Murphy, MD, a urologist and the Representative from North Carolina’s 3rd District, introduces the bipartisan Veteran’s Prostate Cancer Treatment and Research Act, also known as H.R. 4880. After an introduction from E. David Crawford, MD, Editor-in-Chief of Grand Rounds in Urology and Professor of Urology at the University of California, San Diego, Rep. Murphy explains that H.R. 4880 seeks to create a streamlined approach to care for prostate cancer, the most-diagnosed cancer in the VA system. Rep. Murphy then lists the elements of the bill, including the development of: a national prostate cancer clinical pathway that reflects prostate cancer guidelines that are up-to-date and change as needed; a comprehensive prostate cancer program at the VA that will implement this pathway and present a coordinated effort from VAs all across the system; a prostate cancer education plan; and a prostate cancer registry. Rep. Murphy particularly highlights the importance of prostate cancer education and early management, noting that certain veteran groups may be at particularly high risk of developing prostate cancer due to exposure to chemicals like Agent Orange or contaminants such as those formerly found in the drinking water at Camp Lejeune. The presentation concludes with a conversation between Rep. Murphy and Dr. Crawford on how the urology community can help H.R. 4880 pass. Rep. Murphy emphasizes the importance of communication between healthcare providers and legislators, and encourages audience members to develop relationships with their state and federal representatives, as well as to call their congressperson regarding this bill.

Patient Advocacy for Prostate Conditions: Advocate Perspective

Posted by Wendy L. Poage, MHA | Aug 2021

Wendy L. Poage, MHA, President of the Prostate Conditions Education Council (PCEC), discusses a survey done with primary care physicians (PCPs), explains what PCEC, a non-profit advocacy group, has been doing during the COVID-19 pandemic, and provides action items to urologists to help with advocacy work. Giving the caveat that the survey was just a pilot study with fewer than 100 PCPs, Ms. Poage explains that the data show that even though 90 percent of PSA screenings for prostate cancer are performed by PCPs, only 68 percent of PCPs say it is a valuable test, suggesting that there may be some gaps in who receives screening. Ms. Poage emphasizes PCEC’s commitment to PSA screening, explaining that PCEC teamed up with LabCorp to provide online screening forms and in-person discussions and screenings throughout the COVID-19 pandemic. They also worked with MDxHealth on managing prostate cancer patients during the pandemic. Ms. Poage explains that they worked on a telehealth collaboration tool so prostate cancer patients could still receive treatment. She notes as well that PCEC also focuses on education for veterans, genetic risk groups, people exposed to environmental hazards, people of lower socioeconomic status, marginalized racial groups, and rural populations. Ms. Poage concludes with a call to action, asking urologists to host educational events and reach out to their primary care partners.

Germline Genetics in Prostate Cancer

Posted by Brian T. Helfand, MD, PhD | Aug 2021

Brian T. Helfand, MD, PhD, Chief of the Division of Urology and the Ronald L. Chez Family and Richard Melman Family Endowed Chair at NorthShore University HealthSystem, Director of the Personalized Prostate Program, and Director of Clinical Research in the Program for Personalized Cancer Care, discusses germline genetic testing and its ability to support prostate cancer (PCa) diagnosis and prognosis when used effectively. He begins with the NCCN guidelines for PCa germline testing, detailing its recommended use for patients with: intermediate-risk, high-risk, regional or metastatic disease; intraductal histology; Ashkenazi Jewish ancestry; family history (FH) of high-risk germline mutations; and positive family history of cancer. Dr. Helfand then considers genetic assessments, stressing the importance of FH, rare pathogenic mutations (RPMs), and SNPs in reaching conclusions. He continues with an explanation of genetic risk score (GRS), a number calculated based on the cumulative variation across multiple SNPs which is then used to provide an estimate of disease risk, and shows data supporting the idea that GRS is more informative than FH. He looks at how to complete genetic testing with intention, suggesting screening with the goal of identifying men at risk of PCa and aggressive cancer, as well as identifying men who are likely to respond to specific chemotherapies. Dr. Helfand also reviews data from the UK biobank showing the associations FH, RPMs, and GRS have with PCa incidence and mortality. He also presents data on active surveillance showing that it should be used with caution if patients have any DNA damage repair genes. Dr. Helfand reviews data on DNA damage response and cancer therapy, showing that men with DNA double repair gene mutations are more responsive to PARP inhibitors and platinum-based chemo, while men with mismatch mutations are more responsive to immune checkpoint inhibitors. Dr. Helfand concludes by saying that genetic testing should be included in PCa decision-making more often and used to understand the future of PCa patients.

Can We Trust TRUS Biopsies?

Posted by Francisco G. La Rosa, MD | Aug 2021

Francisco G. La Rosa, MD, Associate Professor in the Department of Pathology at the University of Colorado Anschutz Medical Campus in Denver, evaluates the efficacy of transrectal ultrasonography (TRUS) biopsy and contrasts the technique with transperineal prostate mapping biopsy (TPMB). He describes the development of biopsy techniques, explains how to select a biopsy sample size, and demonstrates why the 360-degree view of the prostate offered by TPMB is advantageous. Dr. La Rosa underscores that sampling should be volume-dependent as the percentage of prostate cancer and high-grade prostatic intraepithelial neoplasia detected using a conventional 8-12 core biopsy declines as the volume of the prostate gland increases. He recommends a scaled approach, beginning with eight biopsy cores for glands up to 15cc and increasing up to 14-20 cores for glands over 50cc. Dr. La Rosa then contrasts TRUS with TPMB, remarking that the latter diagnoses prostate cancer in twice the number of patients and can detect or rule out more aggressive disease. Additionally, two-thirds of men with a previous negative TRUS biopsy were later diagnosed with prostate cancer after undergoing TPMB. Dr. La Rosa concludes that TPMB, which also has lower complication rates, is more reliable than TRUS biopsy.

Prostate Cancer Risk Assessment: Focus on Early PSA and Hereditary Risk

Posted by Gerald L. Andriole, Jr., MD | Aug 2021

Gerald L. Andriole, Jr., MD, Robert K. Royce Distinguished Professor and Chief of Urologic Surgery at Barnes-Jewish Hospital, the Siteman Cancer Center, and Washington University School of Medicine in St. Louis, Missouri, discusses two areas of prostate cancer risk assessment: age-adapted PSA and hereditary risk. Dr. Andriole begins with an early trial which showed that for men who have a PSA of <1 in their first screening, their 15-year chance of developing metastatic prostate cancer or dying is less than 1%. Their risk level drops down to <0.2% if their PSA value remains at <1 in a second screening. If screenings continue to show low PSA levels as the patient ages, one could conclude that a low-risk score should result in no further screening, but Dr. Andriole cautions against this approach. He then discusses the PROBASE study, a prospective study randomizing PSA testing in men starting at age 45 vs. the standard age of 50. The early arm of the study has 23,301 men and the goal is to look at the detection of Gleason grade group 2 or above cancer by the time a man reaches age 50. Dr. Andriole addresses the role of family history, noting that a positive family history increases the probability of developing prostate cancer, but not necessarily mortality. In contrast, a higher genetic risk score (GRS) is associated with a higher mortality rate. He then discusses using a Prompt score, which is more efficient when compared with a PSA screening alone. Dr. Andriole concludes that physicians should assess PSA early in life and may consider adding in 4K score. Ultimately, a combination of a number of factors, including family history, race and ethnicity, genetic risk score, and PSA, will be needed.