International Prostate Cancer Update

Panel Discussion on Integration of Stakeholders in Healthcare: Academic Urology

Christopher J. Kane, MD, FACS, Dean of Clinical Affairs at the University of California San Diego School of Medicine, discusses the role of academic institutions in supporting the wider urology community, using USCD as an example. He notes that the UC medical system is the 4th largest provider of healthcare in California and UCSD is the 8th producer of scientific output in life sciences of any institution globally, therefore contributing greatly to the medical field as a whole. USCD Urology provides numerous specific benefits to the greater urology community, including practitioners in LUGPAs and integrated practice systems. These benefits include subspecialty coordinated care, CME opportunities, principled defense and professional support, and a clinically integrated network, among others.

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The Present and Future of LUGPA

Richard G. Harris, MD, discusses the Large Urology Group Practice Association’s (LUGPA) 2020 Strategic Plan. He observes that as the United States’ population ages and grows, and as new technology causes the cost of treatment to rise, demands on urology practices will increase. LUGPA will help urologists meet these challenges by continuing its advocacy work protecting independent urology practice, especially in Washington, D.C., and by developing the leadership skills of young urologists through programs like LUGPA Forward and the Rising Chief Resident Summit. Other initiatives will focus on easing operational challenges, increasing member engagement, and ensuring organizational excellence.

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Prostate Imaging and Biopsy Controversies

Neal D. Shore, MD, FACS, Medical Director for the Carolina Urologic Research Center, discusses the evolution of transrectal (TR) versus transperineal (TP) prostate biopsy, and compares the efficacy of multi-parametric MRI (mpMRI) versus next generation micro-ultrasound. He goes on to discuss several studies that review the complication rates of TR and TP biopsy, differences in their diagnostic sensitivity, and various procedural techniques associated with TP prostate biopsy. Dr. Shore then examines several landmark studies that summarize the clinical utility of mpMRI and micro-ultrasound and describes the strengths and weaknesses associated with each technique. He concludes by discussing preliminary data comparing the diagnostic performance of micro-ultrasound to mpMRI.

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New Concepts in Cavernous Nerve Localization and Functional Recovery after Radical Prostatectomy

Arthur L. Burnett II, MD, MBA, FACS, Professor of Urology at Johns Hopkins University School of Medicine, discusses therapeutic and investigational strategies for improving erectile function after prostatectomy. He goes on to discuss how cavernous nerve-sparing techniques have reduced erectile dysfunction after prostatectomy by 10-40%, how mapping cavernous nerves with novel imaging techniques can help minimize nerve and vascular injury at the time of surgery, as well as the impact of investigational, local electrostimulation of damaged cavernous nerves in an animal model cohort.

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Update on Brachytherapy for the Treatment of Prostate Cancer in 2020

Peter J. Rossi, MD, a radiation oncologist with Kaiser Permanente and Valley View Hospital in Glenwood Springs, Colorado, and Steven J. Frank, MD, a professor of radiation oncology at the University of Texas MD Anderson Cancer Center, present important updates on brachytherapy for the treatment of prostate cancer. Dr. Rossi notes that radiation-resistant tumors can be treated with well-executed brachytherapy, and highlights the level-one evidence for prostate brachytherapy over other treatments. He also discusses some drawbacks to brachytherapy, particularly toxicity, and how they can be addressed. Dr. Frank follows, discussing MRI-assisted radiosurgery (MARS) and highlighting the strengths of MRI over CT scans and ultrasounds in brachytherapy. He also outlines the findings of a study he led regarding the use of MRI-assisted brachytherapy, emphasizing that the quality of MRI imaging allows for higher quality of care and largely avoids the problem of toxicity. Dr. Frank also discusses the difference between MRI-guided and MRI-assisted therapy, and highlights important steps to avoid certain negative outcomes.

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