Latest Videos Archives

Bladder Cancer Journal Vol. 7, Issue 3

Posted by Bladder Cancer Journal | Sep 2021

Muscle-Invasive Bladder Cancer in Patients with Liver Cirrhosis: A Review of Pertinent...

High Intensity Focused Ultrasound for Prostate Cancer: Guidelines, Complications, and Outcomes

Posted by Arvin George, MD | Sep 2021

Arvin George, MD, Assistant Professor of Urology at the University of Michigan in Midland, Michigan, reviews high intensity ultrasound (HIFU) for prostate cancer and outlines guidelines, patient selection, complications, and outcomes for the treatment. The NCCN guidelines state that HIFU is included as a salvage option after prior treatment failure, specifically radiation failure, but is not recommended as routine primary therapy due to lack of long-term comparative data. The EAU guidelines say to only offer HIFU within clinical trials or well-designed prospective cohorts. Dr. George describes the ideal HIFU patient as having unifocal, clinically-significant, and MRI-visible disease that has an absence of high-risk features. He then goes over a list of common complications and their rates of occurrence: retention (7-27%), hematoma (0-1.6%), sloughing (3-8%), urinary tract infection (5-18%), orchitis (2-8%), abscess (1-2%), fistula (.3-3%), pain (.5-3%), erectile dysfunction (12-30%), incontinence (0-5%), and stricture (2-4%). Dr. George says that to prevent complications one should not retreat the posterior zone, and should plan above the capsule while avoiding near field heat. He then reviews a study on focal therapy compared to radical prostatectomy for non-metastatic prostate cancer that found mostly HIFU focal therapy to have a failure free survival (FFS) rate comparable to that of radical prostatectomy, never exceeding a difference of 13%. Dr. George also discusses another study of medium-term oncological outcomes in a large cohort of men treated with either focal or hemi-ablation using high-intensity focused ultrasonography for primary localized prostate cancer which showed FFS rates of 86% at 24 months, 64% at 60 months, and 54% at 96 months. He concludes with a final study which consolidated and compared HIFU’s outcomes to those of active monitoring, radiotherapy, and radical prostatectomy, showing that HIFU produces consistently better quality of life outcomes.

Role of PARP Inhibitors in Prostate Cancer

Posted by Daniel P. Petrylak, MD | Sep 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 PARP inhibitors for castrate-resistant prostate cancer (CRPC). He begins by considering the relevant pathogenic germline mutations, outlining how PARP inhibitors function and presenting studies demonstrating their effectiveness. He notes that the 2015 TOPARP study was the first to suggest that PARP inhibitors could be used to treat metastatic CRPC (mCRPC). Dr. Petrylak then discusses phase III of the PROfound study which found that BRCA 1 and 2 mutations responded best to PARP. In describing the clinical implications, Dr. Petrylak reviews recently FDA-approved PARP inhibitors including olaparib and rucaparib. Olaparib was approved for treatment of homologous recombination repair (HRR) gene-mutated or deleterious germline mCRPC in patients who have progressed following prior treatment with enzalutamide or abiraterone. Rucaparib received accelerated approval for BRCA-mutated mCRPC in patients who have been treated with androgen receptor directed therapy and a taxane-based chemotherapy. Lastly, Dr. Petrylak comments on PARP inhibitor toxicities which include anemia, thrombocytopenia, and neutropenia and may necessitate infusions to help the patient’s blood count. He concludes that PARP inhibition is effective in patients with some DNA repair mutations but may be less effective on ATM mutations.

Contemporary Brachytherapy: A View from the ABS

Posted by In Memory of Brian J. Moran, MD | Sep 2021

Brian J. Moran, MD, the Medical Director for the Chicago Prostate Cancer Center and the Director of Radiation Oncology at DuPage Medical Group, outlines how improved diagnostics have led to better-targeted brachytherapy treatment for localized prostate cancer. He begins by asserting that the debate is over—low-dose rate (LDR)/high-dose rate (HDR) brachytherapy is an effective treatment for localized prostate cancer, and he argues that the focus should shift to innovative brachytherapy techniques. Dr. Moran explains that improved diagnostics such as MRI and fusion biopsy, transperineal mapping biopsy, and genomic analysis allow urologists to better differentiate cancer types and better understand risk groups. He then presents the American Brachytherapy Society guidelines for various treatment groups. Despite this, Dr. Moran cites a decline in the use of brachytherapy due to competing treatments such as robotic surgery, intensity-modulated radiation therapy (IMRT), and proton therapy and due to low active brachytherapy volumes in most training programs in the United States. Dr. Moran says there is robust patient demand for brachytherapy because it offers patients a single-treatment option vs. nine weeks of external-beam radiation therapy (EBRT) or surgery, producing excellent patient outcomes while maintaining quality of life. Dr. Moran differentiates LDR and HDR brachytherapy and then reiterates the importance of urologists being able to understand the precise location of a malignancy and to target therapy to that location, highlighting a book, Focal Therapy in Prostate Cancer. Dr. Moran expounds on this notion by contrasting transperineal prostate mapping biopsy (TRPB) with stereotactic transperineal prostate biopsy (STPB), asserting that, unlike TRPB, STPB allows doctors to map the precise location of the samples taken. Dr. Moran then outlines methods of focal brachytherapy and identifies which patients are candidates for it, including those with low-risk, low-volume disease; intermediate-risk, low-volume disease; and high-risk, low-volume disease, provided it was accurately identified. Dr. Moran asserts it would be irresponsible for urologists not to explore brachytherapy, citing patient demand, low cost, and efficacy. He concludes by addressing recurrence and treatment options for previously-treated focal brachytherapy patients who may develop a new cancer.

Next Generation Imaging in Prostate Cancer – PYLARIFY

Posted by E. David Crawford, MD | Sep 2021

E. David Crawford, MD, Editor-in-Chief of Grand Rounds in Urology and Professor of Urology at the University of California, San Diego, explains how next generation imaging (NGI) can benefit prostate cancer patients and improve care, focusing on PYLARIFY PET/CT. He begins by providing some background, defining biochemical failure, noting that conventional imaging has poor sensitivity, and briefly reviewing RADAR I and III guidelines. Dr. Crawford then gives an in-depth summary of the design, patient entry criteria, and results of the CONDOR study on the clinical utility of PYLARIFY PET/CT in patients with biochemical recurrence of prostate cancer and non-informative standard of care baseline imaging. He explains that CONDOR’s primary endpoint was correct localization rate (CLR) of PYLARIFY PET/CT imaging, meaning the percentage of patients with a 1-to-1 correspondence between lesion level localization of ≥1 lesion on PYLARIFY PET/CT imaging and the composite truth standard, and notes that the results far exceeded the 20% baseline for success, with PYLARIFY imaging detecting ≥1 lesion in 59-66% of patients. Dr. Crawford also looks at the secondary endpoint of percentage of patients with a change in intended treatment management due to PYLARIFY PET/CT, observing that 64% of evaluable patients saw a change in management.