Video Archives

PSMA PET Imaging in Advanced Prostate Cancer

Posted by Jérémie Calais, MD, PhD | Dec 2020

Jeremie Calais, MD, MSc, Assistant Professor and Director of the Clinical Research Program of the Ahmanson Translational Theranostics Division at UCLA, discusses the use of prostate-specific membrane antigen PET imaging, or PSMA PET, in diagnosing advanced prostate cancer. Noting that PSMA PET is currently the most sensitive imaging technique, he reviews well-known studies, STOMP and ORIOLE, and shares patient success stories of PSMA PET guided therapy. PSMA PET is able to detect tumor deposits of 4.5 mm with 90% accuracy and 2.3 mm with 50% accuracy making it more effective in locating disease migration. However, there will still be some micrometastases that are too small to yet be detected by PSMA PET. Because active distant lesions are not successfully identified under all imaging types, Dr. Calais proposes including the modality employed when stating a patient’s disease progression; for example, “mCRPC by PSMA-PET,” thereby expressing the means by which the disease stage was determined. PSMA PET can be used to follow disease mutation and more quickly identify non-metastatic castration-resistant prostate cancer.

Telephone Techniques to Generate New Patients

Posted by Neil H. Baum, MD | Dec 2020

Grand Rounds in Urology Contributing Editor Neil H. Baum, MD, Professor of Urology at Tulane Medical School, offers advice on improving clinic telephone protocols, which in turn can help generate new patients for a practice. He discusses the importance of telephone etiquette, as well as specific techniques that are important to do correctly. Dr. Baum urges consistency when answering the phone, and stresses the importance of giving top priority to new patients. He covers different ways to improve the new patient telephone experience, and emphasizes the importance of avoiding gaps in phone coverage during office hours. Overall, he urges practices to get rid of phone trees and highlights the importance of talking to a human. Dr Baum also offers some advice on how to handle after hours telephone calls that will help maintain a good patient experience.

Clinical Case Discussion: Metastatic Prostate Cancer and Evidence for More Precision Therapy

Posted by A. Edward Yen, MD | Dec 2020

A. Edward Yen, MD, Assistant Professor of Medicine in the Hematology and Oncology Section at Baylor College of Medicine, introduces a metastatic prostate cancer case, and through it explores and reviews treatment options. He discusses homologous recombination and the role that it plays in DNA repair pathways, noting that 25% of patients with advanced prostate cancer have deleterious mutations in DNA damage repair genes which lead to an increased risk of prostate cancer and chance of having nodal and/or distant metastases. Dr. Yen then reviews the TRITON2 study on rucaparib in mCRPC patients with homologous recombination deficiency and the PROfound study on olaparib in mCRPC patients with homologous recombination repair alterations, both of which found a far greater response to treatment in the cohorts with the target mutations. Next, Dr. Yen discusses PARP inhibitors and their side effects, such as fatigue, nausea, pulmonary embolism, anemia, and others. Through his exploration of treatment options, Dr. Yen concludes that next-line chemotherapy is the best option for the patient given the visceral progression of their disease.

PSMA PET Gallium Scan Approved by FDA

Posted by Robert E. Reiter, MD, MBA | Dec 2020

E. David Crawford, MD, Editor-in-Chief of Grand Rounds in Urology, interviews Robert E. Reiter, MD, Bing Professor of Urology and Molecular Biology, Director of the Prostate Cancer Program, and Director of Urologic Research at the David Geffen School of Medicine at UCLA, on yesterday’s FDA approval of PSMA PET gallium scans for use in prostate cancer patients at the University of California, Los Angeles, and the University of California, San Francisco. Dr. Reiter, one of the investigators on the study that led to this, discusses how the approval, which was a joint effort between teams at UCLA and UCSF, is the first approval of a PSMA targeting agent in the United States, and will give new, potentially more effective options for urologists to stage prostate cancer for both newly-diagnosed and recurrent disease, leading to earlier detection of both metastatic disease and sites of recurrence, as well as improved overall management of the disease. They also discuss costs and potential insurance coverage at the currently-approved UCLA/UCSF sites and beyond, next steps for broader approval, and the implications of using PSMA PET in a theranostics approach to diagnosis and treatment of mCRPC and oligometastatic prostate cancer, as well as other disease states.

Updates in Upper Tract Urothelial Cancer: Challenges in Diagnosis and Treatment

Posted by Surena F. Matin, MD | Dec 2020

Surena F. Matin, MD, the Monteleone Family Foundation Distinguished Professor in the Department of Urology at MD Anderson Cancer Center, gives an overview of upper tract urothelial carcinoma (UTUC), comparing it to bladder UC and outlining risk factors, imaging options, and possible treatment paths. He posits that the lack of research on UTUC is a major reason for the challenges in diagnosing and treating the illness. When compared to bladder UC, UTUC has more imprecise staging options, more anatomical barriers for therapy, and unclear lymphadenectomy templates. Dr. Matin identifies UTUC risk factors such as tobacco, exposure to aromatic amines and arsenic, and also discusses classification issues related to patients with hereditary UTUCs. He then discusses how imaging is the backbone of staging and grading, but has limitations, recommending a CT chest scan or chest X-ray to rule out metastases, a cystoscopy to assess bladder capacity, and a ureteroscopy to assess tumor size. Dr. Matin concludes with a discussion of radical nephroureterectomy as a treatment option, stating that it is highly curative but at the cost of kidney function. He believes that adjuvant topical therapy could help solve the problem of treatment options but notes that there is not enough data to be certain of this yet.