Video Archives

HIFU Focal Therapy: Prostate Cancer – Emerging Data and Clinical Utility vs. Standard Care

Posted by Andre Abreu, MD | Jan 2021

Andre Abreu, MD, Urologist at the Keck Hospital of University of Southern California, describes how high-intensity focused ultrasound (HIFU) works, and the data that earned it FDA-approval for prostatic tissue ablation in November 2015. Following this, Dr. Abreu reviews the three main goals of focal therapy: selectively ablating known disease, preserving functions, and minimizing morbidity, all without compromising life expectancy. He then uses two systematic reviews, one from 2017 and one from 2019, to explain how focal therapy benefits continence and potency rates. Further presented data includes a 2020 review of evidence and reported outcomes from an October 2020 study of hemigland HIFU ablation as primary treatment for localized prostate cancer, both of which exhibit HIFU’s safety, excellent potency, and continence preservation, as well as adequate short-term prostate cancer control. Dr. Abreu also addresses comparisons to radiation and acknowledges that HIFU works well for intermediate-disease but is still controversial for low- or high-risk disease, showing a need for further study.

Advocating for Your Patient

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 how to and why one should advocate for patients following a denial of coverage by an insurance company. He explains why insurers deny coverage for mediations, services, durable medical goods, and treatments, noting that even if a rejection is successfully appealed, the process adds weeks or months to the reimbursement. Dr. Baum shares a success story of going the extra mile for a patient and the lessons he learned from that experience. He highlights the value of pursuing these cases, particularly the most egregious rejections. While appealing a rejection will not always be successful, he contends that nothing provides as much satisfaction as advocating for one’s patient.

New Prescribing Information on Survival Benefit for Nubeqa® (Darolutamide) Approved

Posted by Neal D. Shore, MD | Jan 2021

E. David Crawford, MD, Editor-in-Chief of Grand Rounds in Urology and Professor of Urology at the University of California, San Diego, interviews Neal D. Shore, MD, Medical Director for the Carolina Urologic Research Center in Myrtle Beach, about the recent FDA amendment to the package insert for NUBEQA®, or darolutamide. The amendment includes new information for patients with non-metastatic castration-resistant prostate cancer (nmCRPC) from the ARAMIS trial on overall survival and other endpoint data, including time to pain progression and time to the requirement for cytotoxic chemotherapy. Drs. Crawford and Shore discuss how the recent data demonstrating darolutamide’s overall survival benefit validates the previous use of metastasis-free survival as a surrogate for value. They also talk about the value of darolutamide for patients with nmCRPC who may not see much benefit to taking another medication. Drs. Crawford and Shore conclude by considering darolutamide’s future, mentioning the ARASENS trial looking at darolutamide’s benefits for patients with metastatic hormone-sensitive prostate cancer and discussing potential new research into darolutamide in the mCRPC space.

Use of Social Media in Men’s Health Urologic Practice

Posted by Brian S. Christine, MD | Jan 2021

Brian S. Christine, MD, a urologist and Fellowship Director and Director of Prosthetic Urology and Men’s Sexual Health at the Urology Centers of Alabama in Birmingham, discusses the use of social media in men’s health urologic practices. He begins by discussing older mediums and why they are no longer effective at getting the word out, as well as the limitations of word of mouth. He goes on to talk about why leveraging social media platforms is important for reaching the widest possible audience and attracting new patients. Dr. Christine then explains what has worked for him and his practice and what has not. He emphasizes the importance of creating a personal website that is separate from the practice that can be linked to all of one’s social media accounts. He also highlights the social media platform that has been the most effective for him: Youtube. Youtube is particularly helpful because it allows users to upload high-quality educational videos; the majority of Dr. Christine’s new patients that seek him out on their own do so after watching one of his surgical videos. Dr. Christine then gives advice about how to be successful on Youtube and pitfalls to avoid when making videos. He offers specific tips about how to make the same kind of high-quality videos that appear on his Youtube channel. Finally, he observes that the biggest roadblock is not making the commitment to begin.

COVID-19 Vaccine Roundtable Discussion

Posted by E. David Crawford, MD | Jan 2021

E. David Crawford, MD, Professor of Urology at UC San Diego and Editor-in-Chief of Grand Rounds in Urology, interviews Alan H. Bryce, MD, Medical Director of the Genomic Oncology Clinic at Mayo Clinic Arizona in Scottsdale, and Neil H. Baum, MD, Professor of Urology at Tulane Medical School, about the COVID-19 vaccine—how it works, its safety, and possible side effects. Currently, Pfizer and Moderna have each created a vaccine for the novel coronavirus, both of which are mRNA vaccines containing code for the protein found within the virus. Dr. Bryce describes how this portion of RNA causes cells to synthesize what is known as a “spike protein,” which then stimulates an immune response. He observes that side effects are typically mild and similar to what one could expect with a standard flu vaccine, notwithstanding rare, severe reactions. Dr. Baum then addresses the psychological manifestations associated with COVID-19, such as anxiety, fear of contracting or spreading the disease, PTSD, depression, and even suicide. It is important to note that these symptoms are also associated with burnout which, within the medical community, impacts urologists to a greater degree. Dr. Baum warns that the stress of being a frontline worker, decreases in income, and the shift from in-person to telehealth appointments and related “Zoom fatigue” may further increase burnout among urologists.