Video Archives

Can One Biopsy Event Determine Type and Amount of Focal Therapy Treatment?

Posted by Nelson N. Stone, MD | May 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 argues for the use of Transperineal Mapping Biopsy (TPMB), and against the use of strict criteria and cursory cancer identification methods for finding Focal Therapy eligible patients. He expresses a clinical need for a process that identifies Focal Therapy candidates and lists which portions of the prostate require treatment. He suggests that TPMB can fulfill these goals. Dr. Stone summarizes a review of the evidence for using focal therapy for the treatment of prostate cancer and found that despite at least 50% of patients being Focal Therapy eligible only a minority of patients actually receive the therapy. He critiques a study on Focal Therapy eligibility determined by MRI/US fusion biopsy on the basis of using too strict of criteria for selecting patients and in consideration of the possibility of missing many patients due to not using a biopsy. Dr. Stone discusses several other studies that depict MRI as unreliable in accurately identifying Focal Therapy patients compared to TPMP due to the lower accuracy of MRI across the prostate.

One-Page Marketing Plan for a Urology Practice (Part 3 of 3)

Posted by Neil H. Baum, MD | May 2021

In the third part of his series on urology practice marketing strategies, Grand Rounds in Urology Contributing Editor Neil H. Baum, MD, Professor of Urology at Tulane University, discusses the result of successful prospecting and conversion as well as how to cultivate “raving fans” of a practice. After converting leads to patients, it is critical to create an exceptional customer experience. To do so, Dr. Baum emphasizes reducing “pain points” in a practice, such as patients completing duplicate demographic forms and excessive waiting prior to an appointment. He suggests calculating the total time a patient spends in the office versus the time spent with the doctor. Dr. Baum advises leaving one to two time slots open every day to account for inevitable delays. Another helpful tool is to provide each patient with a card for writing down three questions they want to be answered and responding to a brief feedback survey. This simple system allows the doctor to finish consultations on time and ensures patients receive the information they need, with the added benefit of conveying their customer experience. Dr. Baum then describes how increasing customer value translates into a stellar patient experience and ultimately into ambassadors for the practice.

Focal Therapy Compared to Radical Prostatectomy

Posted by David Utz | May 2021

Steven N. Gange, MD, FACS, Director of Research and Education at Granger Medical Clinic/Summit Urology Group, reviews a propensity score-matched study comparing focal therapy (FT) for localized prostate cancer to radical prostatectomy (RP). Dr. Gange explains that, until now, this information has never been reported, as randomized controlled trials (RCTs) comparing RP to FT methods such as high-intensity focused ultrasound (HIFU), brachytherapy, or cryotherapy have historically failed to enroll and could be considered unethical given the disparity of risk. By using propensity score matching, the researchers for this study roughly simulated an RCT by selecting patients with matching entry criteria from a diverse dataset, ultimately testing 246 patients on each respective side. The primary outcome was failure-free survival, and Dr. Gange notes that at 3, 5, and 8 years the results were similar for both cohorts. Each cohort also had similar biochemical and histopathological outcomes. Dr. Gange concludes that this appears to be a reasonable comparison between RP and FT, but observes that there are some limitations to the study, including an inability to account for confounding variables and to adjust for baseline urinary and sexual function, as well as a lack of long-term outcomes.

Non-Invasive Molecular Imaging and its Impact on Management of the Localized Disease and Suspected Recurrence

Posted by Andrei H. Iagaru, MD, FACNM | May 2021

Andrei H. Iagaru, MD, FACNM, Professor of Radiology and Chief of the Division of Nuclear Medicine and Molecular Imaging at Stanford University, enumerates the applications of a dual radiopharmaceutical-targeted imaging approach using prostate-specific membrane antigen (PSMA) and gastrin-releasing peptide receptor (GRPR) in prostate cancer care. He explains that while PSMA-targeted PET imaging is more widely accepted, GRPR-targeted imaging may identify tumors that PSMA-targeted PET misses and vice versa. Therefore, combining the two can give clinicians a clearer understanding of the patient’s cancer. Dr. Iagaru suggests that the dual target approach can be particularly helpful in guiding biopsy decisions in patients with suspected prostate cancer, as well as in helping identify all lesions prior to local therapy with high-intensity focused ultrasound (HIFU) or brachytherapy. Using two targets can also sometimes allow clinicians to find more lesions prior to prostatectomy and pelvic lymph node dissection. He notes that targeting GRPR with 68Ga-RM2 can be particularly useful in patients with biochemical recurrence, since PSA velocity is higher in 68Ga-RM2 positive scans than in 68Ga-RM2 negative scans. Dr. Iagaru concludes by considering the potential of these two targets in theranostics, noting that phase 3 trials of theranostics with PSMA are awaiting results and that phase 1 and 2 trials of theranostics with GRPR are promising.

TheraP Trial and Effectiveness of Lu-PSMA-617

Posted by Daniel J. George, MD | May 2021

Daniel J. George, MD, Professor of Medicine and Surgery, Divisions of Medical Oncology and Urology at Duke University, comments on the TheraP trial that was presented at the 2021 GU ASCO conference. He reviews the results of the study, compares prior research, and discusses side effects of the treatment. The TheraP trial compared Lu-PSMA-617 against cabazitaxel in mCRPC patients with prior docetaxel chemotherapy. Dr. George contrasts this trial with the VISION study that analyzed patient response to abiraterone and enzalutamide during the chemorefractory setting, but which lacked a comparison to cabazitaxel. He emphasizes that the TheraP trial used two PET scans to identify PSMA-dominant tumors and excluded patients with FDG-positive tumors. This subset of patients was then assigned to either cabazitaxel or Lu-PSMA-617. Results showed increased progression-free survival as well as a decline in PSMA. Dr. George describes some of the side effects of Lu-PSMA-617 and concludes that it may be an optimal option, especially for patients with FDG-negative tumors.