Video Archives

Does the Radiation Dose Required to Eradicate Local Disease Differ by Gleason Grade Group?

Posted by Nelson N. Stone, MD | Jun 2021

Nelson N. Stone, MD, Professor of Urology, Radiation Oncology, and Oncological Sciences at the Icahn School of Medicine at Mount Sinai and at the Derald H. Ruttenberg Cancer Center at Mount Sinai, discusses the radiation dose requirements for local disease eradication and the implications for focal therapy. He presents studies of external vema radiation and brachytherapy, which both showed that as the radiation dose increased the likelihood of a positive biopsy decreased two years post treatment. Dr. Stone concludes that it does not matter what type of disease the patient has, it matters how much radiation is used to get rid of the disease. Longer term follow up is needed to see the impact of radiation doses. Post-irradiation biopsies imply that a BED of over 240 Gy can eradicate all prostate cancer. If a tumor is small then there is a potential for a high dose of radiation just to the affected regions. Larger tumors or cases with extensive multifocality will require a full dose treatment with a full or partial implant.

Updates in Upper Tract Urothelial Cancer

Posted by Seth P. Lerner, MD, FACS | Jun 2021

Seth P. Lerner, MD, Professor of Urology and holder of the Beth and Dave Swalm Chair in Urologic Oncology in the Scott Department of Urology at Baylor University, provides an update on recent trials and treatment options for Upper Tract Urothelial Cancer (UTUC). He begins with the OLYMPUS study, outlines the rationale for neoadjuvant therapy, reviews ECOG’s EA8141 trial, and concludes with a discussion of adjuvant therapy.

Leveraging the EMR to Improve Quality in Risk Stratification for Prostate Cancer

Posted by Franklin Gaylis, MD, FACS | Jun 2021

In part 1 of a 3-part series, Franklin Gaylis, MD, FACS, Chief Scientific Officer of Genesis Healthcare Partners and Voluntary Professor of Urology at the University of California, San Diego, looks at how improved quality reporting can improve risk stratification for prostate cancer. He explains that quality reporting is expensive and time-consuming, but also necessary, and looks at how it can be improved. As an example, he considers a study by Genesis Healthcare intended to improve documentation and staging templates for digital rectal examinations (DREs) for prostate cancer staging and risk stratification. They found that by leveraging the electronic medical record (EMR) with explicit templates, they were able to increase physician confidence in DRE findings. Dr. Gaylis concludes that by encouraging urology practices to record more accurate and precise DRE information, better templates for reporting can improve patient care.

Screening and Prevention of Prostate Cancer 2021 (Part 3): Incorporating MRI for Early Detection

Posted by Sigrid V. Carlsson, MD, PhD, MPH | Jun 2021

In the final part of a 3-part series, Sigrid V. Carlsson, MD, PhD, MPH, Assistant Attending Epidemiologist at Memorial Sloan Kettering Cancer Center, considers the current role of MRI in early detection of prostate cancer. She explains that while MRI is a useful screening tool, it is not foolproof, and its accuracy varies widely depending on user expertise. For this reason, using a negative MRI to justify not getting a biopsy is not always strongly advised. However, many studies are underway that may identify combinations of MRI and biomarker tests that will ultimately help patients avoid more unnecessary biopsies.

Application of MRI Fusion Biopsy Results to Focal Therapy

Posted by Leonard S. Marks, MD | Jun 2021

Leonard S. Marks, MD, Professor and inaugural holder of the deKernion Chair in Urology at the David Geffen School of Medicine at the University of California, Los Angeles, discusses focal therapy using MRI fusion biopsy and a novel process to determine tumor margins. He outlines the rationale for focal therapy, addresses previous concerns about the treatment, and discusses focal therapy failure and how to address it.