Latest Videos Archives

LUGPA Government Policy Panel: Overview

Posted by R. Jonathan Henderson, MD | Nov 2021

R. Jonathan Henderson, MD, a urologist with Regional Urology, LLC, in Shreveport, Louisiana, discusses the Large Urology Group Practice Association, or LUGPA, the only nonprofit urology trade association in the United States. Dr. Henderson, who is the current President of LUGPA, explains LUGPA’s mission to preserve and advance the independent practice of urology; its core values of quality, collaboration, innovation, and integrity; and its strategic priorities, including advocacy and health policy, value-based care, practice management and benchmarking, and leadership development. Dr. Henderson expounds upon LUGPA’s dyad leadership model, wherein a practice is run by both a physician leader and an administrator, and he asserts this results in stronger practices, both medically and businesswise. Dr. Henderson then promotes Practice Management for Urology Groups, LUGPA’s Guidebook as a “recipe book for what we do in urology” before summarizing LUGPA’s benchmarking and executive leadership programs. Turning to the future, Dr. Henderson says LUGPA is following innovation and breakthroughs in urologic care, cost containment pressures, evolving payment methods, and practice and hospital integration and consolidation. He highlights health care personnel (HCP) shortages, citing data to support his assertion that it is a “perfect storm,” with 277 urologists completing residency annually, 2,000-3,000 current US job openings, and an average urologist age of 58. Dr. Henderson concludes by discussing the LUGPA 2021 Annual Meeting as well as new virtual offerings spurred by the COVID-19 pandemic, emphasizing LUGPA’s value in facilitating powerful networks and its relevance to all urology practitioners, whether they be academic, hospital-based, independent, or employed.

Use of Polygenic Risk Scores for Prostate Cancer Screening

Posted by Peter R. Carroll, MD, MPH | Nov 2021

Peter R. Carroll, MD, MPH, Professor of Prostate Cancer and Urology at the University of California, San Francisco, introduces his talk on polygenic risk scores by asserting that serum prostate-specific antigen (PSA) testing has limitations as a stand-alone screening tool. He explains that hereditary factors have a strong influence on prostate cancer risk and outcomes and that prostate cancer has high heritability. Dr. Carroll argues that while high-penetrance genes are important, they only explain a fraction of prostate cancer risk. Further, numerous genome-wide association studies (GWAS) have identified over 250 single nucleotide polymorphisms (SNPs) associated with risk. Dr. Carroll lays out the potential relevance of polygenic risk scores, showing where the scores have the potential to impact clinical care by supporting risk prediction, diagnosis, treatment decision-making, and prognosis of disease course and outcome. He then reviews a trans-ancestry genome-wide association meta-analysis of prostate cancer that demonstrates that genomic risk score (GRS) was predictive across populations. The study concluded that 269 risk variants were estimated to capture 33.6 percent of familial relative risk (FRR) in men of East Asian ancestry, 38.5 percent in Hispanic men, 42.6 percent in men of European ancestry, and 43.2 percent in men of African ancestry, with higher GRS associated with younger age at diagnosis and family history, but not disease aggressiveness. Dr. Carroll concludes with a summary of the use of GRS in prostate cancer early detection: prostate cancer is related to many risk variants across populations; GRS improves on the use of age and family history in assessing risk, though early detection guidelines have not incorporated GRS use yet; and larger populations (particularly those of African ancestry) require further examination.

Real World Utilization of Guideline Based Therapy in mCSPC: Update From the 2021 ASCO Annual Meeting

Posted by Neeraj Agarwal, MD | Nov 2021

Neeraj Agarwal, MD, Professor of Medicine and Presidential Endowed Chair of Cancer Research at the Huntsman Cancer Institute at the University of Utah in Salt Lake City, examines the underutilization of effective intensified androgen deprivation therapy (ADT) for patients with metastatic castration-sensitive prostate cancer (mCSPC). He begins by emphasizing the unprecedented efficacy of intensified ADT in improving survival for patients with mCSPC. Dr. Agarwal then asserts that, despite those findings, less than a third of patients are being offered intensified ADT therapies as first-line (1L) treatment for mCSPC, even four to five years after data has become available. Dr. Agarwal supports this argument by citing three studies from the 2021 ASCO Annual Meeting: real-world utilization of advanced therapies and racial disparity among patients with mCSPC, a Medicare database analysis of over 35,000 patients (2009-2018); real-world 1L treatment patterns in patients with mCSPC in a U.S. health insurance database (2014-2019); and real-world treatment patterns among patients diagnosed with mCSPC in community oncology settings (2014-2019). Dr. Agarwal summarized the most salient finding: less than one-third of men received intensified treatment (ADT combined with docetaxel or with a novel hormonal therapy) as their first-line treatment for mCSPC. Additionally, most men received ADT alone or ADT combined with a nonsteroidal antiandrogen as their 1L treatment, even as recently as 2019, with Black and Hispanic men even less likely than White men to receive an intensified treatment. Further, most men whose cancer had spread to soft organs (e.g., liver, lungs) had received ADT alone. Dr. Agarwal concludes by reemphasizing that the vast majority of patients are not receiving intensification therapy which is backed by level-one evidence. Dr. Agarwal points to the importance of education, awareness, and access as critical to developing better science around implementation and leading to more patients being able to receive these transformative treatments.

The Medicinal Value of Humor

Posted by Neil H. Baum, MD | Nov 2021

Grand Rounds in Urology Contributing Editor Neil H. Baum, MD, Professor of Urology at Tulane Medical School, discusses the health benefits of humor and gives suggestions on how urologists can incorporate it into their practices. He begins with a brief history of humor and medicine, noting that sources from as far back as the Old Testament link humor to good health. Dr. Baum then considers the scientific relationship between laughter and illness, noting that laughter increases heart rate, releases endorphins, stimulates the immune system, and decreases cortisol. He explains that research indicates these physiological effects can decrease stress, increase pain tolerance, and perhaps even help with depression. Dr. Baum highlights the particular importance of humor in the high-stress COVID era, especially since laughter may increase immunity for upper respiratory illnesses. He then provides some examples of how to bring humor into a urologic practice, such as hanging humorous images on the walls, keeping comedy magazines in the lobby, and putting jokes on fax sheets. Dr. Baum concludes that humor is great medicine, and that urologists should not only use it with their patients, but should also prescribe it to themselves.

TITAN Phase 3 Trial with Apalutamide in Metastatic Castration Sensitive Prostate Cancer

Posted by Neeraj Agarwal, MD | Nov 2021

Neeraj Agarwal, MD, Professor of Medicine and Presidential Endowed Chair of Cancer Research at the Huntsman Cancer Institute at the University of Utah in Salt Lake City, summarizes results from the phase 3 TITAN trial of apalutamide in metastatic castration-sensitive prostate cancer (mCSPC), focusing on patient-reported quality of life outcomes. He briefly discusses the design of the study, explaining that it featured a 1:1 randomization of over 1000 patients to apalutamide plus ADT or placebo plus ADT and had dual endpoints of overall survival (OS) and radiographic progression-free survival (rPFS). Dr. Agarwal notes that both primary and final analysis found significant improvements in both OS and rPFS. Surprisingly, adjusting for the approximately 40% crossover from the placebo arm to the apalutamide arm actually led to an even greater reduction in risk of death (48% compared to 35%). Dr. Agarwal notes that this is an unprecedented improvement in survival with mCSPC, and also that rapid and deep PSA decline with apalutamide and ADT was associated with improved OS. He also considers quality of life (QoL) measurements, describing the assessment tools for evaluating pain, fatigue, and health-related QoL, and then highlighting that neither primary nor final analysis saw declines in any of these with apalutamide as compared to placebo. In fact, patients on apalutamide reported experiencing less pain. Dr. Agarwal concludes that in men with mCSPC treatment with apalutamide significantly improved survival outcomes without adversely affecting quality of life and fatigue.