Perspectives in Urology: Point-Counterpoint Archives

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

Posted by Tyler F. Stewart, MD | Aug 2023

Dr. Tyler F. Stewart, MD, delivers an insightful discussion on the significant role of conventional imaging techniques in the diagnosis and treatment of this complex disease. The transformative impact of PSMA scans on precision and early detection is undeniable, offering promising prospects for improved patient prognosis.

While PSMA scans have emerged as a game-changer in various clinical scenarios, Dr. Stewart acknowledges that conventional imaging still holds value in specific contexts such as active surveillance and metastatic disease. However, he underscores the ongoing research in assessing the full potential of PSMA scans for monitoring metastatic disease, an area that continues to be explored by the scientific community.

To ensure a comprehensive evaluation and the formulation of tailored treatment strategies, Dr. Stewart emphasizes the integration of both PSMA and non-PSMA imaging techniques. By leveraging the strengths of each modality, healthcare providers can optimize diagnostic accuracy, monitor disease progression, and make informed decisions regarding the most appropriate course of action for prostate cancer patients.

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

Neoadjuvant Therapy for Localized Upper Tract Urothelial Carcinoma

Posted by Tyler F. Stewart, MD | Aug 2023

Tyler F. Stewart, MD, analyzes how neoadjuvant chemotherapy options involving cisplatin or carboplatin affect upper tract urothelial carcinoma (UTUC) patients. Dr. Stewart first reviews UTUC patient outcomes, transitioning to a discussion of the POUT trial. He highlights the POUT trial’s study of cisplatin- and carboplatin-based adjuvant chemotherapies in UTUC patients following radical nephroureterectomy (RNU), noting the trial’s discovery of significant improvement in disease-free survival.

However, Dr. Stewart expresses concern with the trial’s gemcitabine-carboplatin results while emphasizing the slightly more preferable outcomes of gemcitabine-cisplatin. He sheds light on additional concerns, explaining that RNU affects cisplatin eligibility.

Dr. Stewart then discusses upstaging UTUC after RNU. He continues by evaluating the favorable results of a 2023 study involving gemcitabine and split-dose cisplatin. Dr. Stewart also analyzes other neoadjuvant chemotherapy options, including atezolizumab as studied by the ImVigor010 trial and nivolumab as studied by the CheckMate 274 trial. He pinpoints the negative results of the ImVigor010 trial, contrasting this with nivolumab’s potential as a UTUC neoadjuvant chemotherapy and FDA approval under certain conditions.

However, Dr. Stewart notes concerns with nivolumab and emphasizes the need for further study. Ultimately, Dr. Stewart highlights the benefits of perioperative cisplatin chemotherapy in comparison to carboplatin while promoting caution during the treatment of T1 patients.

The Value of Advanced Practice Providers: Increasing Revenue, Improving Operations, and Decreasing Physician Burnout

Posted by Edward S. Cohen, MD | Aug 2023

Edward S. Cohen, MD, discusses the immense value of Advanced Practice Providers (APPs) in Urology as a field. In this presentation, Dr. Cohen discusses the demographic and demand gaps covered by APPs for physicians and patients, the value of APPs in urologic surgery, clinics, and hospital environments, and the importance of providing training to APPs and treating them as equals within the practice. Throughout his presentation, Dr. Cohen presents multiple use-cases to support the value of providing APPs with careful training and direction in order to maximize clinical efficiency.

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: Cystectomy vs. Trimodal Therapy for Muscle Invasive Bladder Cancer – Trimodal Therapy

Posted by Tyler F. Stewart, MD | Jul 2023

Dr. Tyler F. Stewart, MD, presents a comprehensive discussion on the topic of cystectomy versus trimodal therapy for muscle invasive bladder cancer. Highlighting the importance of a multidisciplinary approach, he emphasizes that the decision-making process involves urologists, medical oncologists, and radiation oncologists working as a team.

Dr. Stewart explores the current treatment strategies, comparing the outcomes of cystectomy and chemoradiation based on existing studies. He acknowledges the life-saving potential of cystectomies and recognizes specific scenarios where it remains the preferred option. However, he also highlights the complications associated with cystectomy, such as quality of life issues and post-surgical challenges.

Additionally, Dr. Stewart discusses trimodal therapy, which involves a combination of maximal debulking, chemoradiation, and ongoing surveillance. He addresses the lack of definitive randomized trials in this area and presents retrospective studies demonstrating comparable oncologic outcomes between trimodal therapy and cystectomy with neoadjuvant chemotherapy.

Dr. Stewart delves into the complications and late toxicities associated with trimodal therapy while discussing its potential benefits in terms of quality of life outcomes. He concludes by mentioning the exciting advancements in systemic therapies and ongoing research to improve local disease control in bladder sparing options.

This lecture is part of a Point-Counterpoint debate. Its opposing lecture is “Point-Counterpoint: Cystectomy vs. Trimodal Therapy for Muscle Invasive Bladder Cancer–Cystectomy.”

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: Cystectomy vs. Trimodal Therapy for Muscle Invasive Bladder Cancer – Cystectomy

Posted by Aditya Bagrodia, MD | Jul 2023

Aditya Bagrodia, MD, FACS, discusses the standard treatment for muscle-invasive bladder cancer, cystectomy, focusing on the effectiveness of cystectomy in comparison to trimodal therapy. He highlights the weaknesses of trimodal therapy, focusing on the importance of selecting highly suitable candidates for trimodal therapy, emphasizing factors such as tumor size, absence of extra bladder disease, proper bladder function, and lymph node evaluation.

Dr. Bagrodia presents data from German and Mass General Hospital experiences, demonstrating the negative outcomes of trimodal therapy. The results show that while trimodal therapy can achieve disease-free status in about two-thirds of patients initially, a significant proportion may require subsequent treatment, including cystectomy. Cancer-specific and overall survival rates at 10 years vary depending on the extent of the disease, with more advanced stages showing a decline in outcomes. The study also compares these outcomes to those of cystectomy, highlighting the higher recurrence-free survival rates associated with organ-confined disease and the potential benefits of neoadjuvant chemotherapy.

Overall, the data suggests that highly selected patients receiving cystectomy may have better outcomes compared to those receiving trimodal therapy. However, individual patient characteristics and preferences should be considered when deciding the most appropriate treatment approach.

This lecture is part of a Point-Counterpoint debate. Its opposing lecture is “Point-Counterpoint: Cystectomy vs. Trimodal Therapy for Muscle Invasive Bladder Cancer–Trimodal Therapy.”

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.