Video Archives

Margin Call: Focal vs. Regional Ablation

Posted by Preston C. Sprenkle, MD | Aug 2024

Preston C. Sprenkle, MD, analyzes focal versus regional ablation in prostate cancer treatment, examining the nuances and outcomes associated with each approach. His discussion centers on the effectiveness, risks, and clinical decision-making processes involved in choosing between these two strategies.

Dr. Sprenkle highlights the advantages of focal ablation, including reduced side effects, such as urinary incontinence and erectile dysfunction. Dr. Sprenkle also discusses the potential benefits of regional ablation, particularly in patients with multifocal or higher-risk disease.

Multiparametric MRI (mpMRI) and targeted biopsies play crucial roles in mapping the extent of the disease and guiding the ablation strategy. Dr. Sprenkle underscores the need for a personalized approach, considering factors such as tumor size, location, Gleason score, and patient comorbidities. The discussion also covers the technical aspects and outcomes of both ablation techniques, with data on success rates, complications, and long-term efficacy.

Dr. Sprenkle highlights future directions in prostate cancer ablation, including advancements in imaging, robotic assistance, and the integration of novel therapeutic agents to enhance precision and effectiveness.

APC Pathways – The Large Urology Group Practice Model

Posted by Jeffrey M. Spier, MD | Aug 2024

Jeffrey M. Spier, MD, and Travis Mendel, MD, discuss the use of Advanced Prostate Cancer (APC) Pathways within large urology group practices. Dr. Spier begins by reviewing the impact of oral options and other advances in treatment collaboration between APC patients and their physicians which led to the formation of large urology group practices.

Dr. Spier then discusses the factors which contribute to the success of large urology groups in treating patients with APC, with an emphasis on improved quality of care. He highlights the importance of combining real-world clinical intelligence with a multidisciplinary approach for continuous improvement in the quality of care received by patients.

Dr. Mendel takes over from Dr. Spier by explaining the differences between clinical guidelines and clinical pathways. He presents examples of treatment pathways for various stages of APC, with a focus on the impact of PSMA-PET.

Dr. Mendel concludes by discussing the potential use of these pathways in creating better AI treatment aids for physicians. Dr. Spier ends the presentation with an emphasis on the positive impact of a multidisciplinary team.

Avoiding the Problem Patient in Penile Prosthetic Surgery

Posted by Ryan P. Terlecki, MD, FACS | Aug 2024

Ryan P. Terlecki, MD, FACS, provides physicians with tips for effective communication in prosthetic candidates, recognizing behaviors that might suggest patients have unrealistic expectations, and the best practices for assessing and counseling patients prior to prosthetic surgery.

While urologists familiar with this procedure commonly cite infection and erosion as the most troublesome issues in these patients, Dr. Terlecki argues that patient expectations are the hardest to manage. Oftentimes, patients will exhibit characteristics in the mnemonic CURSED Patient (Compulsive/obsessive, Unrealistic, Revision, Surgeon Shopping, Entitled, Denial, and Psychiatric). Preoperative counseling can help immensely in managing these patients’ expectations. Stressing that the goal of this procedure is not penile lengthening, but rather creating rigidity on demand; the device length is custom-fit to the patient’s anatomy; future lengthening is possible, but not guaranteed; and the truth behind common misconceptions can attribute to patient contentedness.

Planning in all stages of approaching these cases will set up physicians for success, mitigating backlash and pressure to make rash decisions from the patient. Starting with patient selection, it is imperative to judge surgery suitability, health status, relevant history, and body habitus carefully. In addition to these medical considerations, the role of the patient’s partner is a key factor in this decision. Scheduling confirmations on insurance preoperatively; ensuring all products, devices/instruments, and graft materials are available at the time of the surgery; and educating the operating room support staff on specifics in advance can alleviate stressors and complications during the procedure. Confidence in choice of device, surgical approach (penoscrotal vs infrapubic vs subcoronal), and reservoir positioning is also crucial to ensuring optimal outcomes.

PSMA Imaging as a Biomarker for Early Stage Prostate Cancer

Posted by Robert E. Reiter, MD, MBA | Aug 2024

Robert E. Reiter, MD, discusses PSMA imaging’s potential as a biomarker for early-stage prostate cancer. In this 11-minute presentation, Dr. Reiter compares PSMA PET and MRI. PSMA PET imaging, more sensitive than MRI, can detect cancer presence, tumor size, and potential spread beyond MRI’s capability, offering a possible advantage in early and focal disease management.

PSMA’s prognostic value is explored. Data indicate a correlation between high PSMA uptake (SUV) and higher Gleason scores. Low PSMA expression is linked with more aggressive cancer markers.

Additionally, Dr. Reiter asserts that PSMA’s potential as a guide in surgical procedures, such as radio-guided lymph node removal, could enhance surgical precision and reduce the chance of residual disease.

Update on Robotic Prostatectomy PSMA Scanning – Setting up a Program in Your Practice

Posted by David M. Albala, MD | Aug 2024

David M. Albala, MD, outlines the steps and considerations for establishing a PSMA screening program within a urology practice, emphasizing its potential as a transformative tool for prostate cancer management.

In this 12-minute presentation, Dr. Albala discusses the key considerations for implementing PSMA screening, including regulatory, logistical, and financial planning. Significant capital investment is necessary, and operational logistics—such as proximity to cyclotrons for timely tracer delivery—are vital for efficiency. The practice size and volume of patient referrals also influence the feasibility.

Dr. Albala addresses practicalities like accreditation, insurance reimbursements, and partnerships. Ultimately, PSMA imaging is feasible and advantageous in private practice, offering patients convenient access to advanced diagnostics while underscoring the importance of careful pre-planning to ensure program success.