In this 10-minute video, Thomas Hope, MD, Assistant Professor in Abdominal Imaging and Nuclear Medicine in the Department of Radiology at the University of California, San Francisco, discusses the appropriate use criteria (AUC) of PSMA PET in clinical practice. He summarizes the guidelines for the appropriate use of PSMA PET and delves into the studies that inform them.
Read More
Abdulmaged M. Traish, MBA, PhD, Research Director at The Institute for Sexual Medicine and Emeritus Professor of Urology, both at Boston University School of Medicine in Boston, MA, discusses what he calls a fundamental question—whether age-related testosterone deficiency (TD) should be treated. He cites data demonstrating that T therapy in older men with TD produces significant health benefits. Dr. Traish questions why the U.S. Food and Drug Administration (FDA) opposes testosterone (T) therapy in older men but not in men with classical hypogonadism, concluding his talk by asserting that age-related TD does, indeed, merit treatment and by respectfully disagreeing with the FDA stance.
Read More
Philip J. Koo, MD, Division Chief of Diagnostic Imaging and Northwest Region Oncology Physician Executive at the Banner MD Anderson Cancer Center in Phoenix, Arizona, discusses PSMA PET and how it is poised to supplant conventional imaging techniques in the diagnosis of prostate cancer. He begins by observing the shortcomings of conventional imaging techniques such as bone scintigraphy and computed tomography. While these remain the current standard of care, they result in false negative diagnoses in most patients with biochemical recurrence, especially when the lesion is less than 1 cm with a PSA of <20 ng/ML. Dr. Koo then focuses on prostate-specific membrane antigen (PSMA) positron emission tomography (PET) imaging. He cites a study that found PMSA has double the detection rates over fluciclovine, with an exception of lesions in the prostate bed, indicating that different tools may be appropriate depending on lesion location. However, Dr. Koo clarifies that there currently is no data that proves the superiority of a specific PET radiopharmaceutical. Additionally, he cautions that overdiagnosis using next-generation imaging, such as PSMA PET, is likely as physicians continue to learn the benefits and drawbacks. To that end, he notes that there is a spectrum of visible lesions when using PET and a threshold below which it cannot detect disease. Dr. Koo concludes that while conventional imaging is more readily available than next-generation imaging, its limited sensitivity indicates a necessary shift to more advanced tools like PMSA PET. Similarly, since prostate cancer will advance after initial treatment in 30-50% of patients, he sees an opportunity to use PSMA PET to identify patients who require further treatment or who have metastases undetected by conventional imaging.
Read More
Jianfeng Xu, MD, DrPH, Vice President of Translational Research at NorthShore University HealthSystem (NorthShore), the Ellrodt-Schweighauser Family Chair of Cancer Genomic Research, Director of the Program for Personalized Cancer Care (PPCC) at NorthShore, and a Research Professor at the University of Chicago Pritzker School of Medicine, discusses the role of genetic testing in prostate cancer risk identification. Dr. Xu discusses who is at elevated risk for prostate cancer, the relationship among three inherited risk factors (family history [FH], monogenic rare pathogenic mutations [RPMs], and polygenic genetic risk score [GRS]), the idea that monogenic and polygenic may be tested at the same time, key challenges for germline testing, and the improvement of current guidelines for prostate cancer early detection.
Read More
Mira Keyes, MD, FRCPC, a Clinical Professor at the University of British Columbia (UBC) and a radiation oncologist at the Vancouver Centre of the British Columbia Cancer Agency (BCCA), discusses the benefits of prostate brachytherapy (PB) for men with high- and very high-risk prostate cancer. Dr. Keyes explains PB has excellent long-term outcomes (with the best cure rates of all radiation therapy [RT] treatments), requires less androgen deprivation therapy (ADT), has less downstream toxicity and lower cost than alternatives, calling it a “royal flush” treatment when used as a boost with external beam radiation therapy (EPRT).
Read More
Matthew R. Cooperberg, MD, MPH, Professor of Urology and Epidemiology & Biostatistics and Helen Diller Family Chair in Urology at the University of California, San Francisco, addresses prostate-specific antigen (PSA) testing and explains that a PSA below the median has a very strong negative predictive value (NPV) in terms of meaningful cancer. He asserts that, when combined with secondary biomarker testing before biopsy, early baseline PSA can be very effective in terms of risk assessment. He also explains that as research on biomarkers evolves, the field will get closer to being able to use genomic information derived from the primary tumor to make initial and follow-on treatment decisions.
Read More
Jérémie Calais, MD, MSc, Associate Professor of Nuclear Medicine and Theranostics in the Department of Molecular and Medical Pharmacology at the University of California, Los Angeles (UCLA), Director of the UCLA Theranostics Program, and Director of the Clinical Research Program of the Ahmanson Translational Theranostics Division discusses how to integrate prostate-specific membrane antigen (PSMA) positron emission tomography (PET) findings into treatment algorithms. Dr. Calais explains that PSMA PET results in new staging categories, has predictive value, and has value in response assessment. He emphasizes that inclusion criteria of randomized phase-3 trials must include PSMA PET staging/screening/selection for PSMA PET to be integrated into treatment algorithms.
Read More
Peter J. Rossi, MD, a board-certified radiation oncologist affiliated with Calaway Young Cancer Center at Valley View Hospital in Glenwood Springs, Colorado discusses innovations and advances in low-dose-rate (LDR) and high-dose-rate (HDR) prostate brachytherapy as well as American Brachytherapy Society (ABS) initiatives and training opportunities. Dr. Rossi explains that innovations have resulted in brachytherapy treatment that is evidence-based, innovative, efficient, cost effective, flexible, yields highly personalized treatment, and is of high value to multidisciplinary teams and to patients.
Read More
Geoffrey B. Johnson, MD, PhD, Chair of the Division of Nuclear Medicine at the Mayo Clinic in Rochester, MN, discusses 177Lu-PSMA-617 treatment for castration-resistant metastatic prostate cancer (mCRPC) along with other advances in theranostics. He reviews how drug treatments target prostate-specific membrane antigen (PSMA) receptors, then highlights the VISION trial which tested 177Lu-PSMA-617 on patients who had previously undergone chemotherapy and hormone therapy. This trial found that patients with advanced prostate cancer had well-tolerated side effects, leading to studies like PSMAfore with patients who had not started chemotherapy. Dr. Johnson points out several drawbacks of 177LuPSMA-617, namely that it does not cure prostate cancer, there are dosing limitations, it is very expensive, and not all prostate cancer patients can be treated with it. He also notes that not all prostate cancer tumors express PSMA thereby reducing the benefit of 177LuPSMA-617. Dr. Johnson then describes combination therapies using hormonal therapy, chemotherapy, immunotherapy, external radiation, cocktail radionuclide therapy, and external radiation. Finally, he presents new technologies like PSMA post-therapy imaging, strategies to improve efficacy of cell binding, and targeting agents such as fibroblast activation protein (FAP) inhibitors.
Read More
Panelists Dr. Evan Goldfischer, MD, MBA; Alan Walker, MHSA, FACMPE; and Allison Griffin discuss urology employment issues. Specifically, the panel covers physician recruitment, physician burnout and resilience, and staff recruitment and engagement, emphasizing employment paradigm shifts and creative, proactive solutions to today’s staffing challenges.
Read More
Mark A. Moyad, MD, MPH, the Jenkins/Pokempner Director of Preventive/Complementary and Alternative Medicine (CAM) in the Department of Urology at the University of Michigan Medical Center in Ann Arbor, Michigan, reports on the latest trends in men’s health and related research. Covering topics from blood pressure to vitamin D, Dr. Moyad brings levity to the array with a “hot or not” rating.
Read More
In this 11-minute video, David M. Albala, MD, Chief of Urology at Crouse Hospital in Syracuse, New York, discusses the increasing use of robotic prostatectomy and its effectiveness today. He compares robotic prostatectomy surgery to open surgery regarding perioperative outcomes, positive surgical margins, oncological outcomes, and functional outcomes.
Read More