Video Archives

Overall Survival with Sipuleucel-T in Patients Treated for Advanced Prostate Cancer

Posted by Rana R. McKay, MD | Dec 2020

Rana R. McKay, MD, Associate Professor of Medicine at the University of California, San Diego, and Co-Leader of the Genitourinary Oncology Disease Team at the Moores Cancer Center, discusses the results of a study that compared the efficacy of first-line and any-line sipuleucel-T to that of novel hormonal agents in Medicare beneficiaries with metastatic castration-resistant prostate cancer (mCRPC). The intent of the study was to see how the use of sipuleucel-T, which has been available for just over a decade and was the first autologous vaccine approved for a solid tumor, might be impacted by the introduction of so many new therapies for mCRPC in the last 10 years. Dr. McKay explains that the results show that, for the population studied, use of sipuleucel-T, both as first-line and any-line therapy, results in a statistically significant improvement in overall survival compared to patients who never received sipuleucel-T and were instead treated with other novel hormonal agents. Following her presentation, E. David Crawford, MD, Editor-in-Chief of Grand Rounds in Urology, conducts a Q&A session with Dr. McKay in which they discuss the increasing acceptance of sipuleucel-T among medical oncologists, combination therapies with sipuleucel-T, and the future of sipuleucel-T, among other subjects.

The HERO Study and the Approval of Relugolix

Posted by Neal D. Shore, MD | Dec 2020

E. David Crawford, MD, Professor of Urology at UC San Diego and Editor-in-Chief of Grand Rounds in Urology, interviews Neal D. Shore, MD, FACS, Medical Director for the Carolina Urologic Research Center, and Daniel J. George, MD, Director of Genitourinary Oncology at Duke Cancer Center, about relugolix, which became the first oral testosterone-suppressive drug approved by the FDA on Friday, December 18, 2020. Drs. Shore and George discuss the results of the international, randomized HERO study, which looked at patients with advanced prostate cancer and found that relugolix, a daily oral GNRH antagonist, had a 97% sustained T-suppression rate as compared to leuprolide’s 88% sustained T-suppression rate. In addition to this high degree of efficacy, they emphasize that patients taken off relugolix saw their testosterone return to higher levels within 90 days than patients taken off leuprolide, which is important for patient quality-of-life. Drs. Shore and George also underline that patients in the relugolix arm of the HERO study saw a more than 50% reduction in risk of major adverse cardiovascular events compared with patients in the leuprolide arm, which suggests that relugolix might be a safer option for prostate cancer patients at high cardiovascular risk. Other topics covered include the benefits of antagonists versus agonists and the possible risks of patient non-compliance.

Painless Urology Using Nitrous Oxide for Office-Based Procedures

Posted by Neil H. Baum, MD | Dec 2020

In this eight-minute commentary, Grand Rounds in Urology Contributing Editor Neil H. Baum, MD, Professor of Urology at Tulane Medical School, discusses the use of nitrous oxide for office-based urologic procedures. First, he covers the difference between nitrous and nitric oxide, as well as the safety protocols one needs to be aware of when using nitrous oxide. Next, he goes over the important contraindications for using nitrous oxide before discussing the required training. Dr. Baum talks about how to get started using it in a practice and emphasizes the importance of having consent for use. He then discusses all the costs involved and highlights that despite the fact that most insurance companies do not not actually cover nitrous oxide’s use, it is still a very useful tool for minimally-invasive procedures like vasectomies. Overall, he highly recommends that urologists add nitrous oxide to their armamentarium as more and more urologic procedures are being done as out-patient procedures and it significantly adds to patient comfort.

Hormonal Intervention for the Treatment of Veterans with COVID-19 Requiring Hospitalization (HITCH)

Posted by Matthew Rettig, MD | Dec 2020

Matthew Rettig, MD, Chief of Hematology-Oncology at the VA Medical Center in Greater Los Angeles and Professor of Medicine and Urology at the David Geffen School of Medicine at the University of California, Los Angeles, discusses the rationale and goals of a current study looking at whether androgen deprivation therapy (ADT) may benefit men with COVID-19. Dr. Rettig notes that men appear to be both slightly more susceptible than women to COVID-19 and to have significantly worse outcomes, possibly as a result of differences in behavior and comorbidities, but also potentially because androgens may exacerbate the effects of COVID-19, while estrogen may be protective against it. Small early studies were inconclusive as to whether patients with prostate cancer already being treated with ADT had a reduced incidence of COVID-19, but data from the VA system suggests that ADT has a modest protective effect against a diagnosis of COVID-19. Dr. Rettig explains that the currently-recruiting Hormonal Intervention for the Treatment of Veterans with COVID-19 Requiring Hospitalization (HITCH) study is designed to determine whether, in addition to its protective effects, ADT also reduces the severity of COVID-19 illness. To that end, the study investigators plan to see if treating men between the ages of 18 and 85 who have been hospitalized due to COVID-19 with degarelix improves clinical outcomes by reducing mortality, ongoing need for hospitalization, or requirement for mechanical ventilation.

Current Clinical Utility of MRI and Multi-Modality Imaging

Posted by Masoom Haider, MD | Dec 2020

Masoom Haider, MD, Professor of Medical Imaging at the University of Toronto, discusses the clinical utility of multiparametric MRI (mpMRI) in prostate cancer diagnosis, noting current knowledge and practice gaps and highlighting key areas for future research. He explains that while the benefits of mpMRI in biopsy-naïve men at high risk of prostate cancer have been confirmed several times over and it is increasingly recommended prior to biopsy, mpMRI can still miss between 3 and 11% of clinically significant cancers, so some kind of follow-up strategy or safety net is needed. Dr. Haider then discusses the need for a quality assurance system, like PI-QUAL, to ensure that mpMRIs are correctly performed and interpreted, as well as the need for a directed pathway to create a better flow of patients from initial assessment through to follow-up. He also briefly summarizes research on the comparative risks of lesions visible on mpMRI to lesions invisible on mpMRI, reducing mpMRI through better risk stratification, and comparing cancer detection with mpMRI to cancer detection with 68Ga-PSMA PET/CT. He concludes that a great deal remains to be learned both about the long term implications of using mpMRI and about the best ways to use it.