Video Archives

Universal Germline Screening in Prostate Cancer: The Argument Against

Posted by Alan H. Bryce, MD | Jan 2021

Alan H. Bryce, MD, Medical Director of the Genomic Oncology Clinic at Mayo Clinic in Scottsdale, Arizona, argues against universal germline screening in prostate cancer in a point-counterpoint debate. While he agrees that identifying germline mutations is important and can have important implications for therapy and for patients’ families, Dr. Bryce observes that very few carriers are identified through germline testing. Approximately ⅔ of carriers are identified through family history-based screening, and while germline mutations are more common in men with metastatic cancer, they are uncommon in the total prostate cancer population. This means that among low- and intermediate-risk patients, 200-300 people must be screened to find one additional carrier, and among high-risk patients, approximately 50 people must be screened to find an additional carrier. Genetic testing costs money and takes up valuable counseling time, so Dr. Bryce argues that testing all patients is not a sensible allocation of resources.

All Men with Prostate Cancer and All Patients with Advanced Disease Should Undergo Germline Testing

Posted by Brian T. Helfand, MD, PhD | Jan 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 in Evanston, Illinois, takes the pro side in a point-counterpoint debate on the merits of germline testing for all patients with prostate cancer, from the screening stage to the advanced treatment stage. Dr. Helfand argues that germline testing is beneficial during screening since the identification of rare pathogenic mutations can indicate which patients are at high risk for more aggressive prostate cancer. Germline testing for patients with localized disease is also useful since if a patient has a genetic variant it is more advisable to proceed to definitive treatment with surgery or radiation as opposed to putting them on active surveillance. Dr. Helfand concludes by observing that it can be particularly useful for patients with advanced disease to undergo germline testing since some genetic variants are associated with increased response to certain treatments, such as PARP inhibitors and platinum-based therapies for men with DNA damage repair mutations and immunotherapies for DNA mismatch repair mutations.

The Myth of Multitasking

Posted by Neil H. Baum, MD | Jan 2021

Grand Rounds in Urology Contributing Editor Neil H. Baum, MD, Professor of Urology at Tulane Medical School, discusses the pitfalls of multitasking. He outlines the illusory thinking behind multitasking and its impact on productivity, and then offers solutions. Dr. Baum notes that multitasking often causes people to feel as though they are accomplishing more in a shorter period of time, but the opposite is actually true. Not only does multitasking decrease the quality of work performed, it also creates a vicious cycle: stress levels increase, which increases cortisol levels leading to impeded cognitive functioning, thereby further increasing stress. Dr. Baum notes that it takes approximately 25 minutes to refocus after an interruption, meaning doctors can lose up to two hours a day by multitasking. This ultimately creates unnecessary financial cost and contributes to feelings of burnout. Dr. Baum advises that physicians practice “unitasking,” or working on a single task at a time, take short breaks between tasks, and reduce distractions, especially during patient visits. He concludes by sharing several technology solutions, such as wearable sensors and free apps, that can help block out disruptions.

Retzius-Sparing Radical Prostatectomy: Tips and Tricks

Posted by Koon Ho Rha, MD, PhD | Jan 2021

Peter K.F. Chiu, MD, PhD, FRCSEd, Associate Consultant and Honorary Clinical Assistant Professor at the Prince of Wales Hospital at the Chinese University of Hong Kong, interviews Koon Ho Rha, MD, PhD, Professor of Urology and Robotic and Minimally Invasive Surgery at Yonsei University Medical School, on Retzius-sparing robot-assisted radical prostatectomy (RS-RALP), a technique intended to preserve continence in patients who must undergo radical prostatectomy. Dr. Rha explains that incontinence is one of the biggest concerns about radical prostatectomy the patients he treats have, and RS-RALP appears to have better outcomes in this area than standard RALP since it preserves more key structures. He goes over the history of the technique and then discusses its pros and cons, highlighting the potentially excellent early preservation of continence and potency but also the difficulty of the procedure, especially in patients with large prostates. Dr. Rha then shows and discusses a video of an RS-RALP procedure. He concludes that RS-RALP is a valuable additional technique in the contemporary robotic surgical armamentarium that may especially benefit patients over 70.

In My Opinion: The Future of Independent Practice

Posted by Edward S. Cohen, MD | Jan 2021

Edward S. Cohen, MD, CEO of Genesis Healthcare Partners in San Diego, California, discusses the future of independent private physician practices. He defines the three main types of private practices: solo, small group, and large group. Private practices face mounting pressures, including increasing expenses, decreased reimbursement, and an aging MD population. For these reasons, Dr. Cohen believes solo practices and small group practices are dying out. He suggests that independent private practice physicians provide a necessary counter-balance to foundation-based doctors, making large group practices the best way to move forward.