Latest Videos

Updates on PSMA Imaging and PSMA CAR T Therapy

Posted by | Oct 2021

Daniel P. Petrylak, MD, Director of Genitourinary Oncology, Professor of Medicine and Urology, Co-Leader of Cancer Signaling Networks, and Co-Director of the Signal Transduction Program at Yale University Cancer Center in New Haven, Connecticut, discusses CAR T therapy for prostate cancer and the ways in which its efficacy is impacted by tumor type and stem memory T cells (TSCM). He begins by reviewing the VISION Trial of LuPSMA which found a 40% reduction in the risk of death and 4-month improvement in median overall survival (OS) versus standard of care (SOC) alone. He also looks at the FDA approval of PYLARIFY in May 2021, the first commercially available PSMA PET imaging agent for prostate cancer. Dr. Petrylak then poses the question of how to combine immunotherapy with PSMA. He suggests that the answer may exist in CAR T therapy despite its historically poor results in solid tumors, and discusses the different types of CAR T cells along a spectrum of less differentiated, self-renewing, and long-lived cells to more differentiated, less stem-like cells. Dr. Petrylak states that TSCM, which exist on the less differentiated side of the spectrum, are key to CAR T therapy’s success in solid tumors based on evidence from a study using a TSCM-based approach that found 100% tumor elimination in animals at standard and low doses after 2 weeks. He reviews early information on a Phase I trial of TSCM based CAR T therapy on mCRPC patients which appears to have positive early results. Dr. Petrylak concludes that PSMA is proving to be an excellent target for imaging and therapy in mCRPC and CAR T therapy may be able to enhance treatment as well.

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Renal Mass and Localized Renal Cancer Evaluation and Management

Posted by | Oct 2021

In part 1 of a 2-part series, Steven C. Campbell, MD, PhD, Professor of Surgery, Associate Director of Graduate Medical Education, Program Director and Vice Chair of Urology, and Eric A. Klein Chair for Urologic Oncology and Education at the Cleveland Clinic’s Glickman Urological and Kidney Institute, presents significant 2021 updates to the American Urological Association (AUA) guidelines on localized renal cancer, focusing on evaluation and management. 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. Campbell, who served as Chair of the AUA Guidelines Panel for Management of Localized Kidney Cancer, explains that the primary focus of the panel was clinically localized renal masses suspicious for cancer in adults, including solid enhancing renal tumors and Bosniak 3 and 4 complex cystic renal masses. He then summarizes what has changed since the last guideline update. For evaluation and diagnosis, he highlights that MRI with contrast can now be used even in patients with severe chronic kidney disease or with end-stage renal disease since the risk of nephrogenic fibrosis with 2nd generation gadolinium agents is extremely low. Dr. Campbell also notes that language has been changed around renal mass biopsy to emphasize a utility-based approach, and that there are expanded indications for genetic counseling since 4 to 6% of cases of renal cell carcinoma are now thought to be familial. He then moves on to look at the revised management guidelines, pointing out a new statement advising that patients with high-risk or locally advanced, fully resected renal cancers should be counseled about the risks/benefits of adjuvant therapy and encouraged to participate in adjuvant clinical trials, facilitated by medical oncology consultation when needed. Dr. Campbell concludes by looking at new guidance on thermal ablation indicating that renal mass biopsy should be performed prior to thermal ablation rather than at the time of thermal ablation.

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Using Templates to Enhance Efficiency and Productivity in Your Urology Practice

Posted by | Oct 2021

Grand Rounds in Urology Contributing Editor Neil H. Baum, MD, Professor of Urology at Tulane Medical School, presenting on behalf of his colleagues James E. Gottesman, MD, and Evan R. Goldfischer, MD, MBA, reviews tools for improving efficiency in a urology practice. He explains that efficiency is important for practices because revenues are decreasing, overhead is increasing, and incomes are being squeezed. Dr. Baum’s first recommendation for improving efficiency is to use scribes, since they improve patient flow, increase productivity, and improve both patient and physician satisfaction. He then highlights the benefits of voice recognition software, which significantly reduces time needed for documentation, as well as the utility of telemedicine, which has been adopted by the majority of urologists since the start of the COVID-19 pandemic. Dr. Baum notes that new software for prior authorization approval also increases efficiency. He then goes in depth about the effectiveness of using urology electronic medical record (EMR) templates, explaining that most urologic conditions can be managed with 10 to 15 templates, and that EMR templates enhance efficiency, enhance documentation, improve the learning curve of scribes and medical assistants, and may assist in coding and billing. Dr. Baum concludes by inviting interested viewers to contact either himself, Dr. Goldberg, or Dr. Gottesman for more information on the templates.

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