Latest Videos Archives

Adaptive Radiotherapy

Posted by Richard G. Stock, MD | Feb 2025

In this 23-minute presentation, Richard D. Stock, MD, explores integrating artificial intelligence in radiation oncology, focusing on adaptive radiation therapy (ART). Three categories of ART—offline, online, and real-time—are detailed, explaining their respective timelines, imaging technologies, and resource requirements. The discussion critically evaluates ART in prostate cancer, where anatomical shifts due to bladder or rectal changes can influence treatment accuracy.

Examples of imaging technologies like MRI and PET scans are discussed for their contributions to ART’s precision and potential to adapt treatment based on tumor shrinkage or biological response. Comparative studies from the Netherlands and other institutions demonstrate ART’s ability to refine target margins, decrease normal tissue exposure, and predict patient outcomes more accurately.

As ART shows promise in improving treatment precision, Dr. Stock emphasizes its potential for advancing radiation oncology, driven by technological innovation and ongoing research.

Starting a Transperineal Prostate Biopsy Program Cost Effective Strategy for Implementation

Posted by Richard C. Wu, MD | Feb 2025

Richard C. Wu, MD, discusses his innovative approach to enhancing the feasibility and cost-effectiveness of transperineal prostate biopsies, a method recognized for its reduced infection risk and safety advantages over traditional transrectal biopsies.

In this 9-minute presentation, Dr. Wu draws from his research in Michigan and subsequent experiences in Taiwan to address the financial and equipment-related barriers to adopting transperineal biopsy in resource-limited settings. His strategy employs basic equipment to perform free-hand biopsies effectively. He provides a step-by-step overview of his method, including local anesthesia administration, single puncture techniques, and biopsy site targeting, ensuring optimal access to various prostate zones. His approach eliminates the need for expensive alignment systems while maintaining diagnostic accuracy.

Dr. George concludes that his cost-conscious approach makes transperineal biopsies viable in low-resource settings, improving patient outcomes and satisfaction while reducing complications. His work underscores the value of innovative adaptations in global healthcare.

Point Counterpoint: Is Focal Therapy Ready for Prime Time (No)

Posted by Michael Rothberg, MD | Feb 2025

Michael Rothberg, MD, critically examines whether focal therapy for prostate cancer is ready for widespread clinical adoption, emphasizing the need for rigorous evaluation. The 10-minute discussion highlights prostate cancer’s biological complexity, including its multifocal and heterogeneous nature, which challenges the premise of focal therapy targeting the “index lesion.”

Dr. Rothberg underscores significant limitations in current diagnostic tools, particularly MRI and biopsy techniques. Imaging inconsistencies and operator variability reduce the reliability of identifying clinically significant lesions.

Current guidelines from leading organizations like NCCN and AUA do not endorse focal therapy as a standard treatment due to insufficient high-level evidence. Dr. Rothberg cites the lack of randomized controlled trials comparing focal therapy to whole-gland treatments, which leaves gaps in understanding survival and recurrence rates beyond medium-term follow-ups.

Point Counterpoint: Is Focal Therapy Ready for Prime Time (Yes)

Posted by Ruben Olivares, MD | Feb 2025

Ruben Olivares, MD, emphasizes the growing momentum of focal therapy in prostate cancer management, urging clinicians to embrace its evolving philosophy. The 9-minute discussion highlights a shift from whole-gland treatment to strategies aimed at cancer control, progression delay, and preserving quality of life.

Dr. Olivares underscores the importance of tailored approaches, utilizing advanced imaging like MRI to localize aggressive lesions. Enhanced biopsy techniques and energy-based modalities offer new avenues for precise and effective treatments. Emphasizing the balance between oncological control and functional preservation, his talk highlights the need for proficiency and sufficient patient volumes to optimize outcomes. Focal therapy is presented as a safe, feasible, and effective strategy with excellent functional and medium-term oncological outcomes, marking it as a critical component of the evolving prostate cancer treatment paradigm.

Urodynamics Review

Posted by Stephen R. Kraus, MD, MBA, FACS | Feb 2025

Stephen R. Kraus, MD, MBA, FACS, provides a comprehensive review of urodynamics, discussing key concepts and practical applications in evaluating lower urinary tract function. This 14-minute presentation emphasizes the importance of understanding both the storage and emptying phases of bladder function.

Dr. Kraus details how dysfunction can arise from a bladder issue, an outlet problem, or both. Specific examples are given and complex cases are also included. Kraus notes results from various tests, such as those for stress incontinence, overactive bladder, and neurogenic bladder, help guide the use of urodynamics in clinical practice. He highlights the need for careful interpretation of test results to ensure accurate diagnosis and treatment planning.