Video Archives

Role of Molecular Targeted Imaging in Oligometastatic Disease

Posted by Phillip J. Koo, MD | May 2024

Phillip J. Koo, MD, explores the current state and evolution of the role of molecular targeted imaging in oligometastatic prostate cancer. He begins by examining oligometastatic disease as a diagnosis, and highlights the importance of shared decision-making in approaching treatment and management.

Dr. Koo then reviews recent trials examining the impact of various treatments on oligometastatic disease, including the EMBARK, STOMP, and ORIOLE trials. He discusses weaknesses in these trials, with particular emphasis on the lack of risk stratification in each trial, and the lack of PSMA-PET in the EMBARK and STOMP trials.

On the topic of progression, Dr. Koo highlights current weaknesses in detecting microscopic disease, which allows micrometastatic disease to progress until it is oligometastatic disease. He discusses the weaknesses of BCR, and the low sensitivity of initial diagnostic imaging.

Dr. Koo concludes by outlining future directions for research. He emphasizes the importance of keeping patient goals top-of-mind when exploring treatments.

Perspectives in mCRPC in 2024

Posted by Alan H. Bryce, MD | May 2024

Alan H. Bryce, MD, reviews current research, perspectives and practices in the treatment of metastatic castration-resistant prostate cancer (mCRPC). Dr. Bryce begins with an overview of current treatment options and patterns of care and addresses the National Comprehensive Cancer Network (NCCN) Guidelines Version 4.2023 for prostate cancer.

Dr. Bryce asserts that in light of few patients receiving treatments beyond first-line, a key operational principle should be to use the best drugs as early as possible. He explains that the management of mCRPC has become increasingly complex as new treatment paradigms have developed and new drugs have been approved. He recommends thinking about classes of drugs and considering how switching or combining classes can have advantages from the perspective of disease evolution.

Dr. Bryce concludes with a brief overview of recent phase-three trial results including PSMAfore, SPLASH, and CONTACT-2. He acknowledges that after several years of continuous success, the development of new classes of drugs for prostate cancer has hit a lull but he asserts the pipeline is still full and since there is not yet a cure for prostate cancer, trials must continue.

Role of Neoadjuvant/ Adjuvant Immunotherapy in Patients with Localized Renal Cell Carcinoma: The PROSPER Trial and Beyond

Posted by Mohamad E. Allaf, MD | May 2024

Mohamad E. Allaf, MD, reviews current literature on the role of neoadjuvant and adjuvant immunotherapy in treating localized renal cell carcinoma (RCC). He begins by establishing that surgical monotherapy fails to cure a significant proportion of patients with “localized” RCC thanks to micrometastatic disease.

Dr. Allaf then discusses how the inclusion of neoadjuvant therapies reduces the size of the tumor, controls potential metastases at the earliest point, and provides a litmus test for how appropriate it would be to treat the patient with surgical monotherapy. He also addresses adjuvant therapies, which can lower the likelihood of recurrence, and prolong patient survival. He acknowledges that older studies of adjuvant Tyrosine Kinase Inhibitor (TKI) therapy for RCC were negative, resulting in high toxicity and low effectiveness in treatment.

Dr. Allaf compares the performance of recent neoadjuvant checkpoint inhibitors in the metastatic setting to the current standard of care, demonstrating that the durability of disease response continued even after the discontinuation of the therapy. He then explores the rationale and early results supporting the administration of neoadjuvant therapy in localized RCC, and how they laid the groundwork for the PROSPER trial.

The PROSPER trial was a Phase III international, randomized trial which examined the effect of a single dose of neoadjuvant checkpoint inhibitors 7-28 days before partial or radical nephrectomy. He presents the study design, the cohort composition, and the results, which did not support the use of neoadjuvant therapy for RCC patients.

Dr. Allaf concludes by presenting multiple recent studies supporting the use of adjuvant therapy for intermediate-high-risk and high-risk RCC patients. While adjuvant therapy has been approved for use by the FDA, additional trials and investigations are still needed to advance the field.

Management of Neurogenic Lower Urinary Tract Dysfunction: Surgical Options with Reference to the Guidelines

Posted by Fiona C. Burkhard, MD | May 2024

Fiona C. Burkhard, MD, discusses the surgical management of neurogenic lower urinary tract dysfunction (NLUTD). Dr. Burkhard begins with an overview of the prevalence of NLUTD, its patterns related to spinal cord injury (SCI), and treatment goals. She summarizes guidelines from the European Association of Urology (EAU), the American Urological Association (AUA) and the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) regarding the surgical management of NLUTD.

Dr. Burkhard then describes clam ileocystoplasty, and shares data on the procedures’ success in stabilizing renal function and preventing anatomical deterioration. She cautions that lifelong follow-up is essential. Dr. Burkhard shares quality-of-life (QoL) data showing improvement after augmentation.

She addresses additional EAU, AUA, and SUFU guidelines on urinary diversion, before highlighting data on sex differences in bladder management, symptoms, and satisfaction after SCI. Dr. Burkhard addresses reflux prevention, bladder outlet, and catheterization issues.

Dr. Burkhard summarizes her lecture by emphasizing that, while variations exist in the grading of recommendations, overall recommendations for treatment are similar across guidelines. She reiterates the importance of the patient’s perspective and lifelong follow-up in highlighting the advantages of surgical management.

Diagnostic and Prognostic Biomarkers for Prostate Cancer

Posted by Ericka Bagi, BSN, RN | May 2024

Ericka Bagi, BSN, RN, discusses diagnostic and prognostic biomarkers in prostate cancer, emphasizing their pivotal role in guiding personalized treatment decisions and improving patient outcomes.
Bagi analyzes biomarker tests, such as prostate-specific antigen (PSA) and its derivatives, PSA density, and PSA velocity. Further, she discusses biomarkers such as the Gleason score, genomic classifiers (e.g., Oncotype DX, Prolaris), and molecular markers (e.g., TMPRSS2-ERG fusion). Information from these tests is instrumental in tailoring treatment plans to individual patient profiles, optimizing therapeutic strategies, and minimizing unnecessary interventions for low-risk patients.
Novel biomarkers, including circulating tumor cells (CTCs), exosome-based markers, and genetic mutations (e.g., BRCA mutations), hold promise for further refining risk assessment and treatment selection. These biomarkers provide complementary information to traditional clinical and imaging evaluations, enabling a comprehensive understanding of disease biology and response to therapy.
Ericka Bagi underscores the importance of integrating biomarker testing into routine clinical practice to enhance diagnostic accuracy, prognostic certainty, and therapeutic efficacy in prostate cancer management. Standardized protocols for biomarker assessment and interpretation ensure consistency across healthcare settings, facilitating evidence-based decision-making and improving patient care outcomes.