Latest Videos Archives

The Changing Landscape of Focal Therapy for Prostate Cancer

Posted by Herbert Lepor, MD | Dec 2024

In this 20-minute presentation, Herbert Lepor, MD, reflects on a 40-year journey in prostate cancer management and emphasizes the evolving role of focal therapy. Having performed over 5,000 radical prostatectomies, outcomes like continence, potency, and complications are critically evaluated. Challenges such as climacturia, penile shortening, and recurrence prompt the exploration of focal therapy as a patient-centered alternative. The shift towards minimally invasive options like cryoablation reflects efforts to balance cancer control with improved quality of life.

Early studies demonstrate that focal therapy effectively ablates targeted lesions with minimal in-field recurrence. MRI is a cornerstone in lesion identification and treatment planning, ensuring precision in disease localization and minimizing overtreatment. Functional outcomes from focal therapy show marked improvements, particularly in preserving sexual function and reducing urinary symptoms. Focal therapy’s growing adoption, bolstered by robust evidence and improved techniques, positions it as a transformative approach in prostate cancer care. This evolution marks a paradigm shift, with patients increasingly opting for therapies prioritizing oncologic control and quality of life.

Patient Selection: How to Pick a Focal Therapy Candidate

Posted by Derek Lomas, MD | Dec 2024

Derek Lomas, MD, outlines a comprehensive approach to patient selection for focal therapy in prostate cancer in this 12-minute presentation. The overarching criteria emphasize that focal therapy is suitable for patients with localized, clinically significant disease, distinct from candidates for active surveillance or those unsuitable for surgery or radiation. Two key dimensions, patient and disease characteristics, guide decision-making, balancing individualized patient factors with disease-specific metrics like tumor location and grade.

Patient health status is central, with functional baseline metrics, particularly urinary and sexual function, critical for setting realistic expectations. Patients must be well-informed about focal therapy’s pros, cons, and guideline limitations.

Disease characteristics identify the ideal focal candidate as patients with low- and intermediate-risk cancer. Multiparametric MRI and systematic and targeted biopsies, sometimes repeated, ensure comprehensive mapping.

Dr. Lomas emphasizes the importance of tailoring treatment to available modalities, such as HIFU for posterior lesions or cryoablation for anterior challenges. Critical to the most successful strategy is patient understanding and a willingness to decline unsuitable candidates, reinforcing a commitment to patient-centered care and optimal outcomes.

Urologist Led Advanced Prostate Cancer Practice Tips, Tricks and Pitfalls

Posted by Aaron Berger, MD | Dec 2024

Aaron Berger, MD, delivers an in-depth discussion on the evolution and importance of urology-led advanced prostate cancer practices. In this 21-minute presentation, Dr. Berger traces the transformation of urological management from limited ADT to a multidisciplinary and pathway-driven approach today. Berger highlights the pivotal moments, such as the introduction of immunotherapy, effective oral options, and advancements in imaging guidelines, which allowed urologists to retain and expand their roles in treating advanced prostate cancer. He emphasizes the establishment of specialized clinics as critical, enabling comprehensive care through navigation systems, in-office dispensaries, and dedicated teams. Collaboration with radiation and medical oncologists is vital for managing complex cases and adopting innovations like PSMA-based therapies and triple therapy.

TRAVERSE: Meaning of the Testosterone Safety Trials

Posted by Martin M. Miner, MD | Dec 2024

Martin M. Miner, MD, reviews testosterone safety trials and recent data on the cardiometabolic effects of testosterone, addressing concerns from the FDA about off-label testosterone use among aging men. The TRAVERSE trial, conducted in response to these concerns, examines whether testosterone therapy increases the risk of myocardial infarction or stroke.

In this 12-minute presentation, Dr. Miner provides a comprehensive review of studies from 1940 to 2014, which found minimal evidence suggesting cardiovascular risks associated with testosterone. However, key studies released in 2013-2014 raised concerns about testosterone therapy, indicating a potential increased risk of non-fatal myocardial infarctions. In response, the FDA issued a directive in 2015, leading to the large-scale TRAVERSE trial, a double-blind, placebo-controlled trial that assessed testosterone gel effects over five years.

The TRAVERSE study is notable as the longest randomized, controlled trial on testosterone safety among hypogonadal men to date. Findings indicate that testosterone therapy poses low cardiovascular risk, improves sexual health, and has no significant impact on prostate cancer risk or progression. This suggests that normalized testosterone levels may reduce risks of mortality and adverse cardiovascular events, without elevating prostate cancer concerns.

The BARCODE 1 Study: Enrichment of Prostate Cancer Detection in Those with Higher Polygenic Risk

Posted by Ros Eeles, PhD, FRCP, FRCR | Dec 2024

Ros Eeles, PhD, FRCP, FRCR, introduces the BARCODE 1 study, which explores the enrichment of prostate cancer detection using polygenic risk scores (PRS) and addresses challenges with traditional screening methods.

In this six-minute presentation, Eeles interprets the study’s results, concluding that PRS offers a robust, one-time genetic test to guide targeted screening, detecting more significant cancers without contributing to overdiagnosis.