Video Archives

Expectations for Mentorship Among APPs: What Urologists Should Know

Posted by Mikel L. Gray, PhD, FNP, PNP, CUNP, CCN-AP, FAANP, FAAN | May 2024

Mikel L. Gray, PhD, PNP, FNP, CUNP, CCCN, FAANP, FAAN, provides guidance on how Urologists and APPs can get the most out of mentorships. Dr. Gray begins by reviewing the critical importance of APPs in Urology, and highlighting the AUA’s history of explicit support of APPs in urologic practice.

Dr. Gray then outlines the general experiences of APPs regarding training and fellowship in urology practices, and the lack of available structure for advancement. He outlines the various paths for APPs to enter into practice, and the challenges they represent.

Dr. Gray then turns to the role of the Urologist in mentoring urologic APPs. He explicitly highlights the “4 Cs” that the Mentor Urologist must actively facilitate for a successful mentorship: Connection, Conversation, Community, and Culture.

Dr. Gray concludes by providing guidance on what an APP should actively seek out in a mentor. He underscores the importance of finding the right mix of subspecialty and general urology in a practice, and seeking both Urologist and APP mentors.

Novel Targeted Treatment and Its Integration with Precision Diagnostics

Posted by Daniel P. Petrylak, MD | May 2024

Daniel P. Petrylak, MD, highlights advanced therapeutic approaches and cutting-edge diagnostic techniques in prostate cancer treatment.

Update on PROBASE Trial: Baseline PSA in Young Men (Aged 45 and 50)

Posted by Peter Albers, MD | May 2024

Peter Albers, MD, provides an update on the ongoing PROBASE trial, which examines the relationship between PSA tests and PCa overdiagnosis. He begins with an overview of the state of PCa screening, noting that there is no current standard practice for using PSA as a screening tool in younger patients.

Dr. Albers shares the background and design of the PROBASE trial, in which more than 46,000 participants were randomized into 2 risk-adapted arms, Immediate Screening and Deferred Screening. The Immediate Screening arm is composed of men who had their PSA levels tested at age 45. The Deferred Screening arm delayed PSA testing until age 50.

After testing, participants in each arm of the trial were classified according to their PSA level. Participants with a PSA level of under 1.5 ng/ml were classified as Low-Risk and only required to repeat testing every 5 years, those with PSA levels between 1.5 and 2.99 ng/ml were considered “Intermediate-Risk” and were required to test every 2 years, and those with PSA levels of 3.0 ng/ml and above were considered “High-Risk” and sent for immediate MRI and biopsy.

Dr. Albers notes that 90% of participants were classified as “Low-Risk,” and have yet to be diagnosed with prostate cancer. In the High-Risk group, 40% were diagnosed with prostate cancer to date.

Dr. Albers concludes by noting that future directions for the study may include investigating the value of MRI, genetic risk factors, the occurrence of other blood/urine-based biomarkers, and other “Smart Screening” mechanisms for early prostate cancer detection. Overall, he notes that the current data supports the hypothesis that PSA testing alone for early detection of prostate cancer creates overdiagnosis with minimal benefit and that risk-adapted screening is effective.

Lasers in Stone Surgery: Principles and Tips/Tricks for Lasers in URS and PCNL

Posted by Seth K. Bechis, MD | May 2024

Seth K. Bechis, MD, discusses applications, principles, and tips for using lasers in ureteroscopy and percutaneous nephrolithotomy. He begins by providing an overview of currently available laser technology, including short vs. long pulse and pulse modulation lasers, and their underlying mechanics.

Dr. Bechis then delves into how to match the appropriate laser with the desired treatment result based on the pros and cons of each device. Dr. Bechis provides real-world examples and use cases for laser devices, including:

Low Power Holmium Lasers
High Power Holmium Lasers
Pulse Modulation Lasers
Thulium Fiber Lasers
Thulium:YAG Lasers

Dr. Bechis concludes by summarizing laser-based approaches to stone treatment, explaining that important considerations include the desired treatment result and the laser’s pulse energy, frequency, and pulse width/modulation. He notes the importance of accounting for unique patient factors, such as anatomy and comorbidities, in addition to the technology’s capabilities when selecting laser treatment.

Restriction Spectrum Imaging Guided Biopsy

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

Michael A. Liss, MD, PhD, MAS, FACS, discusses how Restriction Spectrum Imaging (RSI) Guided Biopsy can aid in processing and interpreting MRIs by reducing false positives and improving MRI distortion. Dr. Liss begins by describing the top current issues with MRI sequencing: varied positive predictive values and Apparent Diffusion Coefficient (ADC) distorting MRI results.

Dr. Liss then discusses the role of RSI-guided biopsy in mitigating the weaknesses of conventional MRI. He illustrates what an MRI sequence with RSI using compartmental, nuclear volume, and geometric filtering looks like.

Dr. Liss concludes with examples of RSI-MRI results in patients with different Gleason scores and inflammation. He compares the efficacy of RSI-MRI in differentiating between inflammatory and regular lesions and presents data that supports the use of RSI-MRI in lowering the frequency of false positive biopsies due to the misclassification of inflammatory lesions.