Video Archives

Industry Perspective: Panel Discussion on Cxbladder Genomic Urine Test for Bladder Cancer

Posted by Siamak Daneshmand, MD | May 2021

Siamak Daneshmand, MD, Associate Professor of Urology and Director of Clinical Research at the University of Southern California (USC), along with Anne Schuckman, MD, Assistant Professor of Clinical Urology at the USC, and Sima P. Porten MD, MPH, Associate Professor at the USC participated in a panel discussion on the Cxbladder Genomic Urine Test for Bladder Cancer at the 5th Annual International Bladder Cancer Update. Dr. Daneshmand reviews a research study that audited the clinical utility of the Cxbladder monitor assay and found that it accurately ruled out patients who did not have recurrent UC, enabling low risk patients to undergo cystoscopy at a longer-than-recommended interval, thereby reducing the cystoscopy burden by 39%. He then asks Drs. Porten and Schuckman questions about their experience with Cxbladder, leading the two to discuss ideal patient populations for Cxbladder, in-home sampling procedures, and situations wherein Cxbladder is most effective.

Freehand Transperineal Prostate Biopsy Under Local Anesthesia

Posted by Michael A. Gorin, MD | May 2021

Michael A. Gorin, MD, a urologist with Urology Associates of Cumberland, Maryland, explains the benefits of transperineal prostate biopsy compared to the transrectal approach for prostate cancer patients. First, he discusses the complications of transrectal biopsy, specifically infection risk, and demonstrates how the transperineal approach can decrease this risk without contributing to antibiotic resistance. He then explains how transperineal biopsy aids in improved detection and cancer upgrading. Dr. Gorin goes on to review transperineal biopsy methods, including the use of the Precisionpoint Transperineal access system. Finally, he summarizes block techniques and biopsy templates for freehand transperineal prostate biopsy under local anesthesia in the outpatient setting.

Recalculating Route: Options Besides Clinical Urology

Posted by Neil H. Baum, MD | May 2021

Grand Rounds in Urology Contributing Editor Neil H. Baum, MD, Professor of Urology at Tulane Medical School, discusses alternative careers for clinical urologists seeking to switch paths. He lists factors that can lead to a departure from clinical practice and provides five examples of career options that effectively utilize a urologist’s skillset. Dr. Baum highlights decreased reimbursements, increased overhead costs, loss of autonomy, and other pain points like burnout as some of the key reasons why clinical practice may lose its appeal. He then describes alternative careers such as medical educator, pharma and medical manufacturing, legal advisor, healthcare appraiser, or medical writer. For example, a physician may have an opportunity to teach internationally or provide legal advice to defense attorneys in malpractice claims or by serving as an expert witness. Dr. Baum concludes that physicians who leave clinical practice can apply their experience in a variety of ways.

Management of Recurrent Prostate Cancer After Focal Therapy

Posted by Kelly L. Stratton, MD | May 2021

Kelly L. Stratton, MD, Assistant Professor of Urologic Oncology in the University of Oklahoma (OU) Department of Urology in Oklahoma City rationalizes the implementation of Focal Therapy despite chances of recurrence and discusses salvage therapy. He characterizes Focal Therapy as an option between radical treatment and active surveillance, which preserves quality of life. The perfect candidate is hard to achieve, according to Dr. Stratton, due to the rarity of a patient with intermediate-risk cancer, lesion localization, intact erections, and minimal urinary tract symptoms; however, he states that the ideal candidate doesn’t have to be perfect. Dr. Stratton overviews the two main types of recurrence: in-field recurrence and contralateral recurrence, through patient examples, which display how recurrence may occur post Focal Therapy and the abilities of high intensity focused ultrasound, prostatectomy, and cryoablation as salvage therapies. A multicentre study of five year outcomes post Focal Therapy found a failure free survival rate of 88% with 25% of patients having had undergone retreatment, data that Dr. Stratton states to suggest a need for providers to openly discuss the chances of repeat focal therapy against having a more aggressive treatment. He reviews data that supports implementation of Focal Therapy and displays the impact of different salvage therapies. Dr. Stratton concludes by stating that Focal Therapy’s success requires adherence to the principles of active surveillance, follow-up biopsies, and a willingness to provide definitive local therapy when focal treatment fails.

The TRANSFORMER Study: Bipolar Androgen Therapy vs. Enzalutamide in Asymptomatic Men With mCRPC

Posted by Samuel R. Denmeade, MD | May 2021

E. David Crawford, MD, Editor-in-Chief of Grand Rounds in Urology and Professor of Urology at University of California, San Diego discusses the TRANSFORMER study and bipolar androgen therapy with Samuel R. Denmeade, MD, Professor of Oncology and Urology at Johns Hopkins University and co-leader of the Prostate Cancer Program for the Johns Hopkins Kimmel Cancer Center. Dr. Denmeade presents the study results, outlines the conceptual background, and notes the benefits of bipolar androgen therapy. TRANSFORMER compared enzalutamide with bipolar androgen therapy, a treatment in which testosterone levels are oscillated between low and high levels in order to prevent the adaptation of prostate cancer cells to a low-androgen environment. Results indicate that while bipolar androgen therapy may not have superior progression free survival rates when compared with enzalutamide, it can improve patient response to enzalutamide, suggesting that further research on sequential treatment is warranted. Notably, some men undergoing bipolar androgen therapy experienced a return in sexual function and also better physical functioning which contributed to improved quality of life.