Video Archives

Future Directions in Molecular and Multi-Modality Imaging and Theranostics of Prostate Cancer

Posted by Phillip J. Koo, MD | Feb 2021

Phillip J. Koo, MD, Division Chief of Diagnostic Imaging and Northwest Region Oncology Physician Executive at the Banner MD Anderson Cancer Center in Phoenix, Arizona, discusses the clinical, research, and educational targets that will advance nuclear medicine’s future role in prostate cancer treatment. He proposes that physicians should consider nuclear medicine the fourth pillar of a cancer specialty, not only for its role in diagnostics but also due to the increased use of radiopharmaceuticals. Dr. Koo reviews results from the TheraP and VISION trials that illustrate the efficacy of PSMA PET/CT, the current diagnostic standard in clinical care. Dr. Koo then describes how nuclear medicine clinicians and radiologists can partner with medical oncologists in clinical settings to create patient-friendly, multidisciplinary care models. This model further integrates nuclear medicine clinicians and radiologists into diagnostic and therapeutic discussions, with the aim of determining the appropriate type of therapy faster. Relatedly, he sees an opportunity for nuclear medicine physicians to lead clinical trials as principal investigators. Dr. Koo concludes with a discussion about the role of education, contending that exposing medical students and residents to nuclear medicine is key to developing a future workforce.

Advances in Treating Upper Tract Urothelial Cancer

Posted by Seth P. Lerner, MD, FACS | Feb 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 College of Medicine, discusses developments in upper tract urothelial carcinoma (UTUC) treatment. He delivers a rationale for adjuvant therapy based on a lack of clinical staging accuracy, a lack of high-level evidence to support perioperative systemic therapy, the perceived benefit in cases of high-risk bladder cancer, and the ability of pathologic staging to identify patients most likely to benefit. He then reviews the POUT trial of adjuvant chemotherapy, noting that it found a statistically significant benefit in disease-free survival and metastasis-free survival. Dr. Lerner continues by summarizing guideline statements. The EAU statement recommends perioperative chemo to patients with muscle invasive UTUC. ICUD states that it is unknown if adjuvant chemotherapy or waiting for the development of clinically evident disease is better. The French ccAFU recommends adjuvant chemotherapy after radical nephroureterectomy in pT2-T4 N0-3 M0 disease. Dr. Lerner then discusses neoadjuvant therapy, which studies suggest is beneficial to patients with optimized renal function. A Hopkins study specifically displayed a pathologic complete response of 9.4%, while the EA8141 trial found a total pathologic complete response of 13.8%. Dr. Lerner continues with a review of management options for low-grade UTUC, a rare disease with limited treatment options. He posits that a kidney-sparing treatment option is needed for patients, as there is a high chance of recurrence and kidney damage with the treatments currently available. Dr. Lerner theorizes that if durability of complete response following ablation with UGN-101 is demonstrated, this could provide a potential new kidney-sparing treatment for patients with low-grade UTUC. Dr. Lerner concludes with a discussion of the OLYMPUS study on UGN-101, which found a complete response in 59% of patients.

The miR Scientific Sentinel Assay

Posted by Laurence Klotz, MD, FRCSC | Feb 2021

Laurence Klotz, MD, Professor of Surgery and holder of the Sunnybrook Chair of Prostate Cancer Research at the University of Toronto, explains how the miR Scientific Sentinel Assay works and its potential benefits for patients with prostate cancer. Dr. Klotz uses results from a September 2020 study to display how the Sentinel PCa, CS, and HG Tests demonstrate high levels of sensitivity and specificity in these patients. The Sentinel™ PCa Test classifies patients based on absence or presence of disease, the miR Sentinel CS Test stratifies patients based on low-risk disease (Grade Group 1) or intermediate- and high-risk disease (Grade Groups 2-5), and the miR Sentinel HG Test stratifies patients based on low- and favorable intermediate-risk disease (Grade Groups 1 or 2) or high-risk disease (Grade Groups 3-5). This is the first report of the development and performance of a platform that interrogates small noncoding RNAs (sncRNA) isolated from urinary exosomes, and highlights the utility of these non-invasive, highly precise techniques for diagnosing and classifying prostate cancer.

Improving Your Urology Practice: Addressing Financial Toxicity

Posted by Neil H. Baum, MD | Feb 2021

Grand Rounds in Urology Contributing Editor Neil H. Baum, MD, Professor of Urology at Tulane Medical School in New Orleans, Louisiana, discusses financial toxicity and how urologists can help their patients navigate the stress associated with medical expenses. An estimated 40% of newly-diagnosed cancer patients will deplete their assets within two years after diagnosis. The compounding stress over direct and indirect costs of cancer treatment can ultimately lead to financial toxicity. Patients at higher risk of financial toxicity include those with advanced stage cancer, minorities, low-income patients, and patients receiving chemotherapy and radiation therapy, among others. Similarly, other factors in a patient’s life, such as whether cancer will impact their ability to continue working, whether they are the primary breadwinner, and their level of health insurance coverage, can increase financial stress. Dr. Baum advises urologists to ask their patients if the costs will be a burden and direct them to a financial navigator, such as a hospital social worker. Urologists can also help patients by offering pricing transparency, connecting them to cancer support groups, and even asking pharmaceutical companies for reduced cost medications.

Imaging Strategies for GU Cancers: PSMA PET

Posted by Phillip J. Koo, MD | Feb 2021

In conversation with E. David Crawford, MD, Editor-in-Chief of Grand Rounds in Urology and Professor of Urology at the University of California, San Diego, Phillip J. Koo, MD, Division Chief of Diagnostic Imaging and Northwest Region Oncology Physician Executive at the Banner MD Anderson Cancer Center in Phoenix, Arizona, discusses the recent FDA approval of Gallium (Ga) 68 PSMA-11 PET/CT and its implications for prostate cancer care. Dr. Koo discusses the indications for use approved by the FDA, noting the emphasis on PSMA PET/CT’s role in treating oligometastatic disease. He observes that it is still unclear what impact the availability of PSMA PET will have on patient care and outcomes, but suggests that studies like the ORIOLE trial indicate that better imaging will lead to better outcomes. Dr. Koo then goes over the availability and potential of different PSMA imaging agents, noting that while Ga 68 PSMA-11 is the only approved agent and has the benefit of being a generic product, it is prohibitively difficult to manufacture and its supply may always be limited. Not-yet-approved alternatives like the Ga 68 PSMA kit, F-18 PyL, and F-18 rhPSMA could all potentially be easier to distribute but may be very expensive. Dr. Koo also mentions that coverage might be a concern for PSMA generally, and he argues that physicians must fight to ensure that insurance pays for PSMA imaging. The talk concludes with a Q&A session during which Drs. Crawford and Koo discuss whether PSMA will replace bone scans and how PSMA compares to MRI.