Latest Videos Archives

Testosterone as a Fasting Blood Test?

Posted by Mark A. Moyad, MD, MPH | Jan 2022

Mark A. Moyad, MD, MPH, the Jenkins/Pokempner Director of Preventive/Complementary and Alternative Medicine (CAM) at the University of Michigan Medical Center in the Department of Urology in Ann Arbor, Michigan, and Martin M. Miner, MD, Co-Director of the Men’s Health Center and Chief of Family and Community Medicine for Miriam Hospital, and Clinical Professor of Family Medicine and Urology at the Warren Alpert Medical School of Brown University in Providence, Rhode Island, discuss recent guidance suggesting that a fasting blood test is needed for testosterone. Dr. Moyad begins by explaining that in 2018, the Endocrine Society Clinical Practice Guidelines included a recommendation of measuring fasting morning testosterone. He suggests that this is a logical recommendation since, in a subset of men, testosterone levels may be temporarily lowered by food intake, but notes that this guidance does not appear to be widely known or followed. Dr. Miner says that he actually does usually include testosterone with other morning fasting tests to meet the demands of insurance, although he argues that this may also result in inaccurate levels since testosterone is supposedly at its peak in the afternoon. He also mentions that the American Urological Association does not recommend getting testosterone tested in a fasting specimen, although he is unsure why this is. Dr. Moyad concludes that this is a topic that is just beginning to be explored and should be watched.

Decisional Tools to Determine Need for Biopsy and Re-Biopsy in Men with Elevated PSAs

Posted by Guilherme Godoy, MD, MS | Jan 2022

Guilherme Godoy, MD, MPH, Assistant Professor of Urology and Urology Oncology at Baylor College of Medicine, in Houston, Texas, discusses how and when to use elevated PSA and other markers to determine whether a biopsy is needed. Dr. Godoy cautions that relying solely on an abnormal level for a sensitive biomarker like PSA can lead to false positives and overtreatment, noting that an elevated PSA is an indicator of the prostate but not necessarily of cancer. He reminds physicians to consider the PSA level related to the size of the prostate before jumping ahead to other steps. Dr. Godoy describes how oft-overlooked PSA derivatives in conjunction with family history and other risk factors can be used to individualize risk and personalize assessments for a patient. He then presents an array of current and emerging molecular, genetic, and imaging-based testing options. The 4Kscore assesses the probability of high-risk cancer (Gleason 7 or higher) in the biopsy and informs risk of metastatic disease in 20 years. This test can also indicate risk stratification for mortality. Urine-based tests such as SelectMDx and EPI ExoDx Prostate Intelliscore similarly provide risk stratification for biopsy-naïve men, while tissue-based tests such as ConfirmMDx are useful when a patient has had a previous negative prostate biopsy. He summarizes with a diagram of the clinical integration of MRI and molecular markers illustrating how these testing options should be used.

The Elevator Speech: Getting Your Point Across in Thirty Seconds

Posted by Neil H. Baum, MD | Jan 2022

Grand Rounds in Urology Contributing Editor Neil H. Baum, MD, Professor of Urology at Tulane Medical School, discusses elevator speeches and explains how physicians can use them to effectively advertise their practice to potential patients and business partners. He defines an elevator speech as a way to tell your professional story in 30 seconds. Dr. Baum states that, due to the fact that first impressions are established in less than seven seconds, elevator speeches are effective thanks to their short length. He recommends beginning an elevator speech with a 7-10 word headline to grab a listener’s attention, and following up with an explanation of how you will achieve the promise in your headline. Dr. Baum suggests ending an elevator speech with a 1-3 sentence success story that is customized to your listener’s needs and makes them want to invest more time with you. He concludes that elevator speeches provide a great opportunity to connect with potential patients and that a good elevator speech will capture the listener’s attention.

MRI Guided Focal Laser Ablation

Posted by Aytekin Oto, MD, MBA | Jan 2022

Aytekin Oto, MD, MBA, Professor of Radiology and Surgery and Chair of the Department of Radiology at the University of Chicago, discusses MRI guided focal laser ablation for prostate cancer including challenges and future considerations. He first describes the benefits, technique, and trial data showing 1-year, 3-year, and 5-year follow up. Focal laser ablation is minimally invasive and targets lesions while sparing surrounding tissue and preserving options for future treatment. Dr. Oto notes that the goal of this therapy is to replace surgery and radiation, but not active surveillance. Currently, MRI guided focal laser ablation is offered at five centers in North America, is conducted mostly transrectally, and is sometimes reimbursed by insurance. Dr. Oto identifies several key challenges to this therapy: lesion mapping, monitoring and planning while in procedure, and high local recurrence. He states the importance of considering other ultrasound guided procedures and notes that one of the limitations of MRI guided focal laser ablation is underestimating prostate volume. For this reason, he introduces hybrid multi-dimensional MRI that may help address this issue. Dr. Oto concludes that MRI guided focal laser ablation is both a safe and feasible treatment and underscores the importance of imaging in determining patient eligibility and accurate planning. Lastly, he adds that local recurrence must be addressed in long-term follow-up.

Standard Treatments and Global Perspective

Posted by Marc B. Garnick, MD | Jan 2022

Marc B. Garnick, MD, the Gorman Brothers Professor of Medicine at Harvard Medical School and the Beth Israel Deaconess Medical Center, summarizes recent developments in nomenclature, disease states, and standard treatments for advanced prostate cancer. Using material from a chapter he wrote for ASCO-SEP with David J. Einstein, MD, Assistant Professor of Medicine at Harvard Medical School, Dr. Garnick begins by considering the new language used to describe different states of advanced prostate cancer, including non-metastatic castrate-sensitive prostate cancer (nmCSPC), non-metastatic castrate-resistant prostate cancer (nmCRPC), metastatic castrate-sensitive prostate cancer (mCSPC), and oligometastatic prostate cancer. He then discusses new standards of care for these different states, highlighting recent research indicating the benefits of using darolutamide, enzalutamide, and apalutamide in the nmCRPC setting, and explaining how to appropriately layer and sequence therapies across disease states. He briefly looks at the role of next-generation sequencing in informing the potential benefit of PARP or PD-L1 inhibitors and touches on bone considerations in mCRPC. Dr. Garnick concludes with some comments on the global inequities of prostate cancer treatment, citing data on the significant disparity in mortality-to-incidence rate of prostate cancer in high-income countries compared to low- to middle-income countries.