Video Archives

Renal Ablation Technologies – Impact on the Treatment of Small Renal Masses

Posted by Thomas W. Jarrett, MD | Oct 2024

Thomas W. Jarrett, MD, explores the evolving role of renal ablation technologies in managing small renal masses (SRMs), highlighting their increasing importance as an alternative to traditional surgical approaches. In this 20-minute talk, he provides a detailed overview of the various ablation techniques, including radiofrequency ablation (RFA), cryoablation, and microwave ablation, emphasizing their distinct mechanisms of action and clinical applications.

The presentation delves into the outcomes associated with renal ablation, discussing the advantages and disadvantages of the different ablation options. Dr. Jarrett also addresses the limitations and challenges of renal ablation, including the potential for incomplete tumor destruction and the difficulties in monitoring long-term outcomes.

Updates on the RADAR Series

Posted by E. David Crawford, MD | Oct 2024

E. David Crawford, MD, reviews the RADAR series and addresses concerns about excessive CT and bone scans for prostate cancer. He reflects on the progression of prostate cancer imaging practices, originating from discussions at meetings over the last 12 years. This led to the formation of the RADAR series, which categorizes diagnostic and monitoring strategies into stages: newly diagnosed disease, biochemical recurrence, and castrate-resistant cases.

In this 11-minute presentation, Dr. Crawford discusses RADAR 1 through 7. Each version builds on earlier guidelines and focuses on goals to enhance diagnosis and treatment. RADAR 1, one of the most widely cited guidelines in prostate cancer, established criteria to limit imaging based on factors like PSA levels and Gleason scores. RADAR 2 introduced “therapeutic layering,” recommending combination therapies for metastatic cases. RADAR 3 then integrated advanced PSMA imaging for cases where traditional scans yield ambiguous results. The most recent update, RADAR 8, discusses targeted focal therapy, advocating for accurate targeting to maximize treatment outcomes.

Throughout, the RADAR series has prioritized adaptive, patient-centered imaging and treatment strategies, backed by extensive collaboration within the medical community. This progression reflects the continual refinement of prostate cancer care, with imaging now positioned as a vital, evolving tool for improving patient management and reducing overtreatment.

mpMRI of the Prostate and Correlation with CT +/- PSMA PET findings: Prostate Imaging Lessons for the Urologist

Posted by Desencia E. Thomas, MD | Oct 2024

Desencia E. Thomas, MD, covers the advancements in imaging techniques for prostate cancer, focusing on integrating multiparametric MRI (mpMRI) and PSMA PET imaging, and their evolving roles in diagnosis, prognosis, and management.

In this 24-minute presentation, Thomas discusses the standardized PI-RADS scoring system, which aids in assessing the likelihood of significant cancer and has undergone revisions (PI-RADS 2.1) to address limitations in lesion evaluation. She also discusses the PI-QUAL score, which assesses MRI quality, and the PRECISE scoring system, which evaluates radiologic stability for patients undergoing active surveillance. She shares several images illustrating the advantages of the scoring systems, ultimately showing the benefits of advanced imaging techniques.

The presentation highlights the role of PSMA PET. FDA-approved PSMA PET agents have shown superior sensitivity in detecting biochemical recurrence and metastasis compared to conventional imaging. The integration of PSMA PET with MP-MRI, exemplified by the new P-score system, aims to refine diagnostic accuracy and reduce the need for invasive biopsies.

Counseling Men with Favorable Intermediate Risk Disease- How to Advise, What Evidence Do You Share?

Posted by Dov Kadmon, MD | Oct 2024

Dov Kadmon, MD, provides a comprehensive overview of managing favorable intermediate-risk prostate cancer, focusing on patient counseling, treatment decisions, and long-term outcomes.

In this 21-minute presentation, Dr. Kadmon begins by defining favorable intermediate-risk prostate cancer as grade group 2 (Gleason 3+4), with PSA levels under 10 and limited tumor burden based on biopsy. Patients are reassured that this type of cancer is common, typically indolent, and confined to the prostate, with a slow doubling time of three to five years, allowing a broad window for therapeutic intervention.

The discussion then shifts to treatment options, emphasizing the choice between active surveillance and curative interventions like radical prostatectomy or radiation therapy. Surgery’s side effects, including urinary incontinence and erectile dysfunction, are acknowledged. Radiation therapy, while sparing immediate surgery, carries risks of chronic toxicity.

Dr. Kadmon shares insights from the UK-based ProtecT trial, comparing active monitoring, surgery, and radiation therapy. The trial shows similar overall survival rates across treatment arms, but highlights increased rates of metastasis and disease progression in the active monitoring group. He underscores that while surveillance may be appropriate for select patients, curative treatment offers a more definitive approach, especially in younger individuals or those with a longer life expectancy.

Management of Posterior Urethral Strictures

Posted by Shyam S. Sukumar, MD | Oct 2024

Shyam S. Sukumar, MD, provides an in-depth exploration of managing posterior urethral strictures, focusing on the anatomical and procedural complexities unique to posterior cases. Throughout this 16-minute presentation, Dr. Sukumar shares drawings and images to illustrate the nuanced approaches necessary for managing posterior stenosis.

Stress incontinence becomes a crucial consideration, especially in patients with radical prostatectomy histories. Sukumar emphasizes the need for a comprehensive preoperative assessment to accurately gauge stricture extent and plan the repair approach. For surgical reconstructions, Dr. Sukumar highlights differing procedures from anastomotic urethroplasty and flap procedures, depending on patient need.

Sukumar believes posterior urethral stricture repair demands flexibility in approach and a readiness to adapt intraoperatively based on the challenges presented. Mastery of various reconstructive techniques and a patient-specific approach ensure optimal outcomes, especially in these anatomically and procedurally demanding cases.