Video Archives

NCCN Guidelines for Early Detection of Prostate Cancer 2023

Posted by Preston C. Sprenkle, MD | Jun 2024

Preston C. Sprenkle, MD outlines the 2023 NCCN Guidelines for Early Detection of Prostate Cancer, emphasizing the importance of these guidelines in standardizing prostate cancer screening and improving patient outcomes. These guidelines aim to balance the benefits of early cancer detection with the risks of overdiagnosis and overtreatment.
The guidelines advocate for shared decision-making between physicians and patients, emphasizing the importance of informed discussions about the benefits and harms of prostate-specific antigen (PSA) testing. Dr. Sprenkle also underscores the role of multiparametric MRI (mpMRI), particularly for men with elevated PSA levels or abnormal digital rectal exams. He discusses the incorporation of novel biomarkers, such as the Prostate Health Index (PHI) and the 4Kscore, which provide additional information to guide biopsy decisions.
Dr. Sprenkle explains that identifying high-risk individuals allows for more personalized screening strategies and early intervention. The guidelines provide criteria for selecting patients for active surveillance and outline protocols for monitoring, including periodic PSA testing, mpMRI, and repeat biopsies.

Advanced Prostate Cancer: Sequencing of Treatment

Posted by Arnulf Stenzl, MD | Jun 2024

Arnulf Stenzl, MD, discusses the challenges of appropriately sequencing advanced prostate cancer treatment and presents possible solutions. In his presentation, he addresses:

Recent and Anticipated Changes in Advanced Prostate Cancer Treatment
The Issue of Physician Information Overload
The Lack of Easily Accessible Comparative Data Between Agents
Possible Applications of Artificial Intelligence in Literature Searches

The Microbiome and Prostate Cancer

Posted by Michael A. Liss, MD, PhD, MAS, FACS | Jun 2024

Michael A. Liss, MD, PhD, MAS, FACS explores the relationship between various microbiomes and prostate cancer diagnosis and treatment. He begins with a brief summary of the history of microbes in medicine and the role of various microbiomes in the human body.

Dr. Liss then explores the relationships between the genitourinary microbiome, the gut microbiome, the prostate microbiome, and prostate cancer. He notes the direct relationship between the genitourinary and prostate microbiomes and prostate cancer, focusing on the interactions of specific microbes with prostate tissue and their potential predictive value in determining prostate cancer prognosis.

Dr. Liss concludes with an overview of the indirect relationship between the microbiome of the gut and prostate cancer. He focuses on the deleterious interactions of specific gut microbes on prostate cancer treatments like ADT and the potential use of certain gut microbes in combating urologic cancers.

Erectile Dysfunction Treatment – State of the Art Care in 2024

Posted by Thomas J. Walsh, MD, MBA, MS | Jun 2024

Thomas J. Walsh, MD, MBA, MS, reviews erectile dysfunction (ED) prevalence, risk factors, lifestyle, and treatments available for patients. He addresses the stigma and the biology of ED, emphasizing the importance of explaining both to patients as part of the treatment discussion.

Dr. Walsh explains that for approximately half of men, oral medications are insufficient to treat ED and shares the updated American Urological Association (AUA) guidelines for ED treatment including oral agents, intra-penile therapies, surgery, and lifestyle changes. He outlines advantages and disadvantages of therapies such as type-5 selective phosphodiesterase inhibitors, intraurethral and topical alprostadil, intracavernosal injection, penile implants, vacuum erection devices, and low-intensity shock wave (LISW) therapy.

Dr. Walsh concludes by outlining his approach to patients, emphasizing the importance of general health and using the opportunity to help patients understand the link between lifestyle and ED. He also emphasizes the importance of referring patients to a specialist when a practitioner is outside their comfort zone or if the patient requires treatments outside of their toolbox.

Multi-modality (MRI+PET) Imaging for Improved Detection of csPC

Posted by David Margel, MD, PhD | Jun 2024

David Margel, MD, PhD, explores the integration of multi-modality imaging, specifically combining MRI with PET (positron emission tomography), to enhance the detection of clinically significant prostate cancer (csPC).

Dr, Margel explains that MRI provides detailed anatomical information and is widely used for localizing suspicious lesions within the prostate gland; however, MRI alone may have limitations in accurately distinguishing aggressive cancers from indolent ones. PET imaging, on the other hand, offers functional insights by detecting metabolic activity within tissues. Radiotracers like 18F-fluorodeoxyglucose (FDG) or prostate-specific tracers such as 68Ga-PSMA are utilized to target specific molecular markers associated with prostate cancer cells.

The combination of MRI and PET leverages the strengths of both modalities: MRI for precise anatomical localization and PET for functional characterization based on metabolic activity. This synergistic approach improves the accuracy of prostate cancer detection, particularly in identifying csPC that may be missed by either modality alone.

Dr. Margel emphasizes the clinical implications of multi-modality imaging in guiding treatment decisions. By accurately identifying and characterizing csPC, clinicians can tailor personalized treatment plans, including targeted biopsies, focal therapies, or systemic treatments. This approach minimizes overtreatment of indolent disease while ensuring aggressive cancers are appropriately managed.