Latest Videos Archives

Comparative Outcomes: Prostate Brachytherapy vs. EBRT vs. SBRT for Low/Intermediate Risk Disease

Posted by Michael J. Zelefsky, MD | Apr 2022

As part of a special course on brachytherapy for prostate cancer from the American Brachytherapy Society (ABS) and Grand Rounds in Urology, Michael J. Zelefsky, MD, Vice Chair of Clinical Research in the Department of Radiation Oncology and Chief of the Brachytherapy Service at Memorial Sloan Kettering in New York City, compares outcomes for prostate brachytherapy vs. external-beam radiation therapy (EBRT) vs. stereotactic body radiotherapy (SBRT) for patients with low- and intermediate-risk disease. Dr. Zelefsky explains that when comparing outcomes, the focus is on toxicity after therapy and the efficacy of therapy. He also notes several limitations in comparing different radiotherapeutic modalities as well as dramatic technological innovation over the last 10 years that have greatly improved radiotherapy delivery. While this has been revolutionary in the treatment of disease, it creates what he calls “a moving target” when comparing outcomes because of the difficulty in comparing studies completed at various points in this technological revolution. Dr. Zelefsky cites a comparative study of patient-reported quality-of-life (QOL) outcomes after SBRT, low-dose-rate (LDR) brachytherapy, and high-dose-rate (HDR) brachytherapy for prostate cancer. Another study compared patient-reported QOL following SBRT and conventionally fractionated EBRT compared with active surveillance in those with localized prostate cancer. He reviews highlights from five-year outcomes of the HYPO-RT-PC randomized, non-inferiority, phase 3 trial that examined ultra-hypofractionated versus conventionally fractionated radiotherapy for prostate cancer, including that the estimated failure-free survival at five years was 84 percent in both treatment groups. Dr. Zelefsky notes that genitourinary and gastrointestinal toxicity were similar in both groups as well. He presents a chart illustrating urinary symptoms post-therapy which shows that while LDR has a higher rate of acute grade two urinary symptoms, late urinary toxicity and late urinary incontinence are similar across LDR, EBRT, and SBRT. Dr. Zelefsky outlines the benefits of prostate brachytherapy for favorable and intermediate-risk disease, pointing out that it has the most ablative potential, prostate-specific antigen nadirs are generally significantly lower than with EBRT, and post-treatment biopsy outcomes are positive in just seven percent of patients. He compares this with data showing that EBRT results in post-treatment positive biopsy outcomes of approximately 25-30 percent and data showing that SBRT with a dose of 40 Gy results in post-treatment positive biopsy outcomes of 11 percent. Dr. Zelefsky suggests then that SBRT has more ablative potential than EBRT but that brachytherapy has even more ablative potential than either of these. Finally, Dr. Zelefsky summarizes by explaining how these findings help inform patient decisions and treatment selection, pointing out that prostate brachytherapy may be preferable for the younger patient with few urinary symptoms, while patients with significant urinary symptoms may prefer SBRT. Patients with a larger prostate who may otherwise require downsizing with ADT may opt for SBRT over brachytherapy.

PCa Commentary | Volume 164 – April 2022

Posted by Edward Weber, MD | Apr 2022

This Commentary looks at an emerging management trifecta for recurrent prostate cancer: PSMA PET, oligometastatic cancer & focal therapy.

Off-Label Use of Xiaflex for Peyronie’s Disease

Posted by Jesse N. Mills, MD | Apr 2022

Jesse N. Mills, MD, Associate Clinical Professor and Director of the Men’s Clinic at UCLA, discusses techniques for Xiaflex on and off label, and when and how it can be used to treat Peyronie’s disease. These include alternative injection techniques, plaques involving the penile urethra, use for men on anticoagulation treatments, and non-goniometric deformity.

Cancer Control in 1379 Men Undergoing HIFU: A Multi-institute 15-year Experience

Posted by Mark Emberton, MD, FRCS | Apr 2022

Mark Emberton, MD, FRCS, Professor of Interventional Oncology at University College London, summarizes the design and findings of a 15-year multi-institute study of high-intensity focused ultrasound (HIFU) in patients with nonmetastatic prostate cancer. After an introduction from E. David Crawford, MD, Professor of Urology at the University of California, San Diego, and Editor-in-Chief of Grand Rounds in Urology, Dr. Emberton notes that the results of this 15-year study resulted in a wave of positive press about HIFU in popular outlets, observing that this widespread enthusiasm is due not just to HIFU’s efficacy, but its safety and adverse event profile as well. He then details the design of the study, beginning with the patient profile. Noting that outcomes in prostate cancer treatment are largely dependent on the risk profile of the patient, Dr. Emberton explains that in this study the average patient age was 66, ⅕ of patients had a PSA greater than 10, the average prostate volume was relatively low, the majority of patients were Gleason 3+4, and the majority of patients were T2. He mentions that intervention varied, and that while the majority of patients had quadrant ablation, about ⅓ had hemiablation. Dr. Emberton then considers the outcomes, observing that the “headline” of the study was the 83% 5-year failure-free survival for intermediate-risk disease. He also highlights that only 0.5% of patients experienced greater than 2 adverse events. Dr. Emberton discusses some supplementary data, emphasizing that if a clinician commits to HIFU, they also commit to retreating a subset of patients. He concludes that HIFU is very safe and that the data suggests that the majority of eligible patients with intermediate-risk disease can defer or avoid radical therapy with HIFU.

The Future of Medical Marketing

Posted by Neil H. Baum, MD | Apr 2022

Grand Rounds in Urology Contributing Editor Neil H. Baum, MD, Professor of Urology at Tulane Medical School, gives 8 suggestions for marketing and promoting a medical practice in 2022. He begins by saying that old methods of promotion are no longer effective since the internet has “leveled the playing field” and patients now have as much information as physicians. Dr. Baum then lists his suggestions, starting with embracing telemedicine, which he says provides safe and effective care while allowing practices to reach new and untapped markets. Next, he recommends using video marketing, since people are 4 times more likely to watch a video than read an article, and search engine optimization (SEO) algorithms prioritize video content. Dr. Baum also suggests using psychographic marketing which, unlike demographic marketing, identifies the attitudes and mindsets of patients. He follows this by recommending a focus shift from illness to wellness, explaining that the current healthcare system focuses on symptoms and illness and is inherently reactive, while a wellness-focused practice is proactive and able to identify early transitions from wellness to disease. Dr. Baum then considers the benefits of personalized marketing and personalized medicine, highlighting the utility of the right patients receiving the right messages. He brings up the use of virtual assistants, noting that tools like Amazon’s Alexa can conduct various healthcare tasks, from tracking glucose levels to helping patients with parking at the office. Dr. Baum’s final marketing and promotion tips include carefully managing a practice’s online reputation, and embracing artificial intelligence in healthcare marketing. He notes that a practice’s marketing budget should be about 3-5% of gross revenues, and he suggests getting marketing assistance from firms with medical experience. Dr. Baum concludes that if practices want to be around in 3 to 5 years, they should consider implementing a few of these ideas.