Latest Videos Archives

International Prostate Cancer Update 2021 Session Review: Next Generation Imaging – Focus on PSMA

Posted by Phillip J. Koo, MD | Nov 2021

Phillip J. Koo, MD, summarizes talks from a session he moderated on next generation imaging, with a focus on PSMA, during IPCU 31.

The OPTIMUM Trial: 29 MHz Micro-Ultrasound vs. MRI in Diagnosis of Prostate Cancer

Posted by Gerald L. Andriole, Jr., MD | Nov 2021

Gerald L. Andriole, Jr., MD, Robert K. Royce Distinguished Professor and Chief of Urologic Surgery at Barnes-Jewish Hospital, the Siteman Cancer Center, and Washington University School of Medicine in St. Louis, Missouri, introduces the OPTIMUM trial comparing high-resolution 29 MHz micro-ultrasound to MRI in the diagnosis of prostate cancer. After an introduction by E. David Crawford, MD, Professor of Urology at the University of California, San Diego, and Editor-in-Chief of Grand Rounds in Urology, Dr. Andriole explains that micro-ultrasound is a novel ultrasound-based system operating at 29 MHz that results in a 300 percent improvement in resolution compared to conventional ultrasound. He explains that micro-ultrasound can be used for transrectal or transperineal biopsy, with or without MRI. Dr. Andriole also notes that, like MRI with PI-RADS, micro-ultrasound has its own prostate risk identification using micro-ultrasound (PRI-MUS) classification system and works with all the skills urologists already have. He observes that several small studies have found superior or comparable sensitivity and/or clinically-significant prostate cancer detection with micro-ultrasound as compared to MRI, but that level 1 evidence is lacking. Dr. Andriole explains that the OPTIMUM trial, a 3-arm randomized controlled trial, is intended to fill in that gap and provide better evidence regarding micro-ultrasound’s efficacy. He describes the design of the trial, noting that 1200 biopsy-naïve subjects will be randomized to micro-ultrasound-only biopsy, MRI/micro-ultrasound “FusionVu” biopsy, and MRI/ultrasound biopsy with conventional fusion system, and that the trial is set to begin in winter 2021 and finish by spring 2023. The discussion concludes with a question and answer session in which Drs. Crawford and Andriole discuss which fusion platforms will be used, the price of micro-ultrasound, other potential applications for micro-ultrasound, and more.

Next Generation Imaging for Localization of Recurrent Prostate Cancer

Posted by Brian T. Helfand, MD, PhD | Nov 2021

Brian T. Helfand, MD, PhD, Chief of the Division of Urology and the Ronald L. Chez Family and Richard Melman Family Endowed Chair at NorthShore University HealthSystem in Evanston, Illinois, discusses the efficacy of next generation imaging options for localization of recurrent prostate cancer. He states that conventional imaging is consistently lacking in the sensitivity necessary to localize recurrence in patients with PSA levels below 10 ng/ml and that waiting for PSA levels to become this high produces worse oncologic outcomes in patients. Dr. Helfand suggests that next generation imaging is superior to conventional imaging due to the ability of MRI and PET CT scans to produce more accurate results at lower PSA levels. He then looks at the different available next generation imaging agents, focusing on choline C-11, fluciclovine, gallium, and DCFPyl, and expresses a need to understand how these agents compare to one another. Dr. Helfand reviews data on choline C-11 PET imaging which shows positive scans in 36% of patients at PSA levels below 1 ng/ml. He then discusses data from the LOCATE trial showing a 30% detection rate at 0 to 0.5 ng/ml, and evidence of PSMA having a 57.89% detection rate at 0.2 to 0.5 ng/ml. Dr. Helfand shows comparative data of the agents wherein PSMA has a better detection rate than choline C-11 of 86% vs. 70%, respectively, and a better detection rate than fluciclovine of 80% vs. 62%, respectively. He concludes that all next generation imaging options are superior to conventional imaging but more data is needed on how they improve oncological outcomes and on situational use of imaging agents.

The PRONOUNCE Trial: The Cardiovascular Safety of Degarelix vs. Leuprolide

Posted by Thomas E. Keane, MD | Nov 2021

Thomas E. Keane, MD, Professor and Chairman of the Department of Urology at the Medical University of South Carolina in Charleston, summarizes the design and results of the PRONOUNCE trial on the cardiovascular safety of degarelix versus leuprolide in patients with advanced prostate cancer. The PRONOUNCE trial looked at whether there was a difference in adverse cardiovascular effects between patients treated with a gonadotropin-releasing hormone (GnRH) antagonist (degarelix) and a GnRH agonist (leuprolide). Dr. Keane says that he believes that the different mechanisms of action of the two kinds of drugs logically seem to favor the GnRH antagonist as less likely to cause cardiovascular complications, although he notes that this remains a contentious topic. He observes that while the PRONOUNCE did find some advantage to degarelix over leuprolide, it was significantly less in this trial compared to others that have compared agonists and antagonists, including the HERO trial. Dr. Keane suggests this may be due to the fact that all patients in the PRONOUNCE trial were under the supervision of a cardiologist for the duration of the trial. He concludes that, although PRONOUNCE was a prospective trial that was cut short and only included 545 out of 900 planned patients, its results are suggestive and will hopefully help lead to further research.

Retroperitoneoscopic Kidney Surgery Tips and Tricks

Posted by Qian Zhang, MD, PhD | Nov 2021

As part of Grand Rounds in Urology’s ongoing series highlighting urologists working in Asia, Qian Zhang, MD, PhD, Professor and Vice Director in the Department of Urology at Peking University First Hospital in Peking, China, presents surgical tips and tricks for performing retroperitoneoscopic kidney surgery. After an introduction by Peter K.F. Chiu, MD, PhD, FRCSEd, Associate Professor of Urology at the S.H. Ho Urology Centre of the Chinese University of Hong Kong, Prof. Qian goes over the advantages of the retroperitoneal versus the transperitoneal approach, highlighting the shorter operation time, the ability to directly control the renal artery, and the lack of gastrointestinal interference. He also discusses some improvements to patient positioning, including placing the patient’s head as far forward as possible while placing their hip as far back as possible. Dr. Qian then looks at trocar placement and considers the importance of practicing 6 basic surgical skills, including cut, twist, rip, open up, pull, and push. He summarizes the 3-step and 2-step methods of needle adjustment, and then follows this by showing videos demonstrating his 6-step partial nephrectomy technique. The 6 steps include: (1) open fascia; (2) find tumor; (3) artery dissection; (4) tumor resection; (5) surface suture; and (6) unblock artery. Dr. Qian also shares some tips and tricks, focusing on his blocking method. The presentation concludes with a question and answer session led by Dr. Chiu.