Perspectives in Urology: Point-Counterpoint Archives

Penile Cancer Fundamentals

Posted by Aditya Bagrodia, MD | Sep 2023

Aditya Bagrodia, MD, FACS, discusses the fundamentals of penile cancer. He begins by acknowledging that penile cancer is rare, with approximately 2,000 cases diagnosed and 470 deaths reported each year.

In this presentation, Dr. Bagrodia covers, Types of Penile Cancer, Risk and Mitigating Factors for Penile Cancer, and Diagnosis, Treatment, and Outcomes for Penile Cancer.

Dr. Bagrodia concludes that penile cancer is treatable when diagnosed at an early stage. He stresses the importance of early biopsies, and overcoming patient hesitance and embarrassment by reinforcing the gravity of the situation.

Update on Testosterone and Treatment for Diabetes Mellitus: T2DM Australian Study

Posted by T. Mike Hsiech, MD, MBA | Aug 2023

T. Mike Hsieh, MD, MBA, provides an update on a study examining the use of testosterone therapy (TT) to treat type 2 diabetes mellitus (T2DM) in men. He describes the Testosterone Trials and summarizes findings in men treated with TT, including a significant increase in testosterone (T) levels and subsequent improvement of symptoms.

Dr. Hsieh discusses T and diabetes, and explains that obesity with or without diabetes is associated with lower T and an increased risk of T2DM. He explains that lifestyle intervention and metformin were shown to prevent progression of prediabetes to T2DM without TT. He discusses TT and cardiovascular disease (CVD), explaining T deficiency is associated with CVD. Though there is conflicting data on the benefit of TT on CVD, the 2018 American Urological Association (AUA) Testosterone Deficiency guideline cites no definitive evidence linking TT to a higher incidence of venous thromboembolism (VTE).

Dr. Hsieh discusses an Australian double-blind, randomized, controlled trial that aimed to determine whether TT combined with lifestyle intervention vs. lifestyle intervention alone reduced T2DM incidence and improved glucose tolerance at two years, while closely monitoring for signs of CVD. The study supported that, while TT plus lifestyle modification can prevent or revert T2DM in men without hypogonadism, hematocrit (HCT) levels must be closely monitored in men undergoing TT, and long-term safety and cardiovascular outcomes of TT remains to be determined. Finally, Dr. Hsieh cites the ongoing TRAVERSE study, examining the complications of TT in older men.

Biomarkers for Bladder Cancer

Posted by Amirali Salmasi, MD | Aug 2023

Amirali Salmasi, MD, delivers a comprehensive presentation on the significance of biomarkers in detecting and monitoring bladder cancer. He reviews the various types and classifications of biomarkers, and their role in identifying the presence or confirmation of diseases and medical conditions, including bladder cancer.

Dr. Salmasi focuses on the concept of response biomarkers, shedding light on how changes in biomarker levels can indicate the efficacy of exposure or treatment. He delves into the specific mechanisms and capabilities of URO17 and ADXBLADDER tests, both of which exhibit promising sensitivity and specificity in detecting bladder cancer.

Concluding the presentation, Dr. Salmasi emphasizes the need for large-scale validation studies to confirm the role of these biomarkers. He mentions the potential role of circulating free DNA, the emerging significance of microRNA, extracellular vesicles, exosomes, and artificial intelligence in revolutionizing the field of biomarker research.

Requests for Same-Gender Providers

Posted by Edward S. Cohen, MD | Aug 2023

Edward S. Cohen, MD, discusses the gender disparities in the field of urology, where the representation of women practitioners stands at 10%. Drawing from a comprehensive German study, Dr. Cohen sheds light on how patient preferences for same-sex providers tend to emerge concerning intimate and potentially embarrassing medical concerns.

For consultations alone, the influence of gender preference was relatively diminished, being close to 35%, indicating a shift in patient perspectives further in the treatment process, where same-sex provider preference rises sharply. Unraveling the complexities of patient decision-making, Dr. Cohen emphasizes that professional skill and clinical experience hold paramount significance in shaping patient choices when seeking medical care. He suggests exploring the tremendous potential of nurse practitioners and physician assistants to effectively cater to patients’ unique requirements and enhance access to quality care.

About the 30th Annual Perspectives in Urology: Point Counterpoint conference: Presented by Program Chair and Grand Rounds in Urology Editor-in-Chief E. David Crawford, MD, this conference brought together leading experts in urology, medical oncology, and radiation oncology to discuss and debate the latest topics in genitourinary cancers, primarily prostate cancer and bladder cancer. This interactive conference offered topical lectures, pro/con debates, interesting-case presentations, interactive panel discussions, and interactive audience and faculty networking.

Point-Counterpoint: Will Conventional Imaging Become Obsolete? – Pro

Posted by Phillip J. Koo, MD | Aug 2023

Philip J. Koo, MD, delves into the ProPSMA Study, shedding light on the remarkable superiority of PSMA PET over conventional imaging in detecting prostate cancer. The study’s findings showcased an impressive treatment impact of 92% for PSMA PET, surpassing the 65% achieved by conventional imaging, while also demonstrating fewer uncertain results.

Dr. Koo emphasizes that PSMA PET is recommended for patients classified as unfavorable, intermediate, high, and very high-risk, while low or intermediate-risk patients do not require conventional imaging. Moreover, the recognition of PSMA PET’s performance in response assessment is steadily growing, signaling its potential as a reliable and accurate tool in evaluating treatment effectiveness.

The increasing utilization of PSMA PET in other countries hints at an imminent shift in the global landscape of prostate cancer imaging. With ongoing advancements and cost reductions, the wider accessibility and affordability of PSMA PET hold the promise of revolutionizing the field and improving patient outcomes on a global scale.

This lecture is part of a Point-Counterpoint debate. Its opposing lecture is “Point-Counterpoint: Will Conventional Imaging Become Obsolete? – Con.”