David M. Albala, MD, presented “Live-Primary Cell Phenotypic Biomarkers and Prostate Cancer Prognosis” during the 29th Annual International Prostate Cancer Update on January 24, 2019 in Beaver Creek, Colorado.

How to cite: Albala, David M. “Live-Primary Cell Phenotypic Biomarkers and Prostate Cancer Prognosis” January 24, 2019. Accessed Oct 2026. https://grandroundsinurology.com/live-primary-cell-phenotypic-biomarkers-and-prostate-cancer-prognosis/

Live-Primary Cell Phenotypic Biomarkers and Prostate Cancer Prognosis

David M. Albala, MD, emphasizes the need for improved prostate cancer diagnostics to allow for better risk-stratification and guidance of personalized treatment. He then reviews findings from an analytical validation study of live-primary cell phenotypic biomarker-based diagnostic assay with the potential to address this need. 

Abstract:

Due to inconsistencies in existing molecular, genomic, and pathophysiologic markers for patient risk-stratification, effective prostate cancer diagnostics and treatment remains a challenge in clinical practice. Therefore, the development of a diagnostic platform that differentiates cancer patients who have clinically significant disease from those who have a low-risk of progression is an important area of interest. 

To address this issue, a diagnostic platform was tested that combines a scalable microfluidic device, enabling an automated live cell assay. This assay measures phenotypic biomarkers (as defined here as functional biophysical and molecular biomarkers) via objective machine vision algorithms to evaluate both local invasive and metastatic potential of prostate cancer.

An analytical validation study was performed on fresh prostate cancer samples (n=238) obtained at the time of radical prostatectomy (RP). The diagnostic platform enables: 1) growth of patient cells ex vivo on extracellular matrix formulations supporting adhesion/survival for 72 hours post biopsy; 2) high-throughput imaging of multiple phenotypic biomarkers such as morphology, cytoskeleton dynamics, and protein subcellular localization & modification states; and 3) objective quantification of biomarkers via machine vision analysis. The study imaged patient samples over a three-hour period, capturing live-cell biophysical biomarkers. After three hours, cells were fixed and stained for molecular biomarkers. Machine vision technology was then utilized to analyze phenotypic biomarkers to yield specific metrics that correlated with RP specimen pathologic findings.

Predictive scores for the risk stratification of 238 prostate cancer patients, with values for area under the curve in receiver-operating-characteristic curves surpassing 80%, support the validation of the assay and its potential clinical applicability for the prognosis and risk-stratification of prostate cancer patients.

About the International Prostate Cancer Update

The International Prostate Cancer Update (IPCU) is an annual, multi-day CME conference focused on prostate cancer treatment updates. The conference’s faculty consists of international experts, and the event caters to urologists, medical oncologists, radiation oncologists, and other healthcare professionals. Topics encompass prostate cancer management, from diagnosis to treating advanced and metastatic disease. Dr. Albala presented this lecture during the 29th IPCU in 2019. Please visit this page in order to learn more about future IPCU meetings. 

Paul D. Maroni, MD, presented “Salvage Lymph Node Dissection for Prostate Cancer” during the 29th Annual International Prostate Cancer Update on January 24, 2019 in Beaver Creek, Colorado.

How to cite: Maroni, Paul D. “Salvage Lymph Node Dissection for Prostate Cancer” January 24, 2019. Accessed Oct 2026. https://grandroundsinurology.com/salvage-lymph-node-dissection-for-prostate-cancer/

Salvage Lymph Node Dissection for Prostate Cancer

Paul D. Maroni, MD, argues that salvage pelvic lymph node dissection is feasible, safe, and may be efficacious in the treatment of oligometastatic prostate cancer. He reviews data suggesting that this method can optimize locoregional control, limit the risk of distant progression, avoid the necessity for immediate androgen deprivation therapy (ADT), and improve cancer-specific survival.

Abstract:

As imaging technologies have improved, salvage lymph node dissection (SLND) has emerged as a treatment alternative for oligometastatic prostate cancer. Next generation positron emission tomography (PET) scans can identify patients with limited pelvic or retroperitoneal disease who may be candidates for salvage surgery. Open and robotic approaches have efficacy and tolerable morbidity in these situations.

Imaging generally does not determine the full extent of lymph node disease. Given this, the surgical approach should include an extended template of the area involved. Prior pelvic surgery and/or radiotherapy can create unique challenges in these procedures. 

Multiple retrospective reviews assessing SLND in nodal recurrent prostate cancer show a PSA response rate of about 40% at 2-years and 20% at 5-years. This may help some patients avoid or delay the need for systemic therapies. There are no randomized trials proving superiority of this approach compared to non-surgical management. Risk factors for early PSA failure (less than 1 year) include higher Gleason score at radical prostatectomy (RP), early PSA rise after RP, retroperitoneal involvement, 3 or more positive spots, or higher PSA at the time of salvage. 

Radioguided surgery has very interesting potential in the area of recurrent prostate cancer lesions. Additionally, stereotactic body radiation therapy (SBRT) has been used successfully for treatment of oligometastatic disease. 

Salvage pelvic lymph node dissection is feasible, safe, and may be efficacious in prostate cancer management. Further study is needed to determine appropriate clinical situations for the application of this therapy.

About the International Prostate Cancer Update

The International Prostate Cancer Update (IPCU) is an annual, multi-day CME conference focused on prostate cancer treatment updates. The conference’s faculty consists of international experts, and the event caters to urologists, medical oncologists, radiation oncologists, and other healthcare professionals. Topics encompass prostate cancer management, from diagnosis to treating advanced and metastatic disease. Dr. Maroni presented this lecture during the 29th IPCU in 2019. Please visit this page in order to learn more about future IPCU meetings. 

James Sylora, MD, presented “Telehealth in Urology” during the 29th Annual International Prostate Cancer Update on January 25, 2019 in Beaver Creek, Colorado.

How to cite: Sylora, James “Telehealth in Urology” January 25, 2019. Accessed Oct 2026. https://grandroundsinurology.com/tele-health-in-urology/

Telehealth in Urology

James A. Sylora, MD, discusses the increasing demand for telemedicine services and the advantages it provides to patients and clinical practices. He outlines steps, as well as practical and legal considerations, for establishing a telemedicine protocol in a practice. 

Abstract:

Telemedicine is the application of technology to create communication channels between healthcare providers and patients in remote locations. Given advances in software technology, telemedicine has now entered the mainstream. The Veterans Administration has more than 1.2 million telemedicine visits per year, serving over 690,000 patients across 44 specialties in 2014.

Patients are becoming increasingly sophisticated and are demanding telemedicine services. Already, virtual hospitals and virtual emergency rooms are emerging around the country. Patients can obtain second opinions on their diagnosis and treatment plans by searching the internet to find a telemedicine provider. Generally, patients seeking these services tend to be younger, college-educated, and have expressed satisfaction with telemedicine visits.

The federal government continues to expand the types of providers that can administer telemedicine visits and the number of procedure codes eligible for reimbursement. Medicaid and private insurance companies will examine this trend and are likely to follow suit. Trade associations such as the American Telemedicine Association (ATA) are advocating for the expansion of telemedicine. Therefore, it is incumbent upon practices to examine this new service line and implement it into their practice.

About the International Prostate Cancer Update

The International Prostate Cancer Update (IPCU) is an annual, multi-day CME conference focused on prostate cancer treatment updates. The conference’s faculty consists of international experts, and the event caters to urologists, medical oncologists, radiation oncologists, and other healthcare professionals. Topics encompass prostate cancer management, from diagnosis to treating advanced and metastatic disease. Dr. Sylora presented this lecture during the 29th IPCU in 2019. Please visit this page in order to learn more about future IPCU meetings. 

Mohit Khera, MD, MBA, MPH, presented “Recovering Sexual Function After Prostate Cancer” during the 29th Annual International Prostate Cancer Update on January 25, 2019 in Beaver Creek, Colorado.

How to cite: Khera, Mohit “Recovering Sexual Function After Prostate Cancer” January 25, 2019. Accessed Oct 2026. https://grandroundsinurology.com/recovering-sexual-function-after-prostate-cancer/

Recovering Sexual Function After Prostate Cancer

Mohit Khera, MD, MBA, MPH, reviews current practices for treatment of erectile dysfunction, including timing of therapy after radical prostatectomy, risk factors for penile rehabilitation, and the current American Urological Association (AUA) guidelines.

Abstract:

Treatment of erectile dysfunction (ED) used to begin with a PD5 inhibitor, such as Viagra. However, current practice uses shared decision making, which gives the patient options in their treatment plan. In shared decision making, physicians explain available treatment options, and the patient is given a choice of which treatment plan to use. In some cases, this means skipping the PD5 inhibitor and going straight to an injection, or even a penile implant.

Regardless of the choice, there can be certain complications with the timing of treatment. Dr. Khera discusses the risks of waiting to treat ED, which can lead to negative results such as venous leak and even a lack of success in treatment. A study of biopsies before and after radical prostatectomy (RP) showed the importance of quick treatments. Patients who do not get immediate treatment may experience venous leak at 14% at four months, 30% at 8 months, and 50% at 12 months. Risk factors for failure of natural erections returning after RP include age, trimis dose of >0.50cc, presence of one or more vascular comorbidity, and commencement of penile rehabilitation over six months post RP.

Additionally, there is conflicting evidence on the effectiveness of PD5 inhibitors. The 2018 AUA ED guidelines for penile rehabilitation state that early use of PD5 inhibitors after radical prostatectomy may not improve unassisted erectile function. Testosterone may aid the ED process, but currently it is not used as a monotherapy. However, the combination of PD5 inhibitors and testosterone may show better results, according to the AUA guidelines. 

About the International Prostate Cancer Update

The International Prostate Cancer Update (IPCU) is an annual, multi-day CME conference focused on prostate cancer treatment updates. The conference’s faculty consists of international experts, and the event caters to urologists, medical oncologists, radiation oncologists, and other healthcare professionals. Topics encompass prostate cancer management, from diagnosis to treating advanced and metastatic disease. Dr. Khera presented this lecture during the 29th IPCU in 2019. Please visit this page in order to learn more about future IPCU meetings. 

Jason N. Hafron, MD, presented “What Makes Millennials Tick? Understanding the Young Urologist” during the 29th Annual International Prostate Cancer Update on January 26, 2019 in Beaver Creek, Colorado.

How to cite: Hafron, Jason N. “What Makes Millennials Tick? Understanding the Young Urologist” January 26, 2019. Accessed Oct 2026. https://grandroundsinurology.com/what-makes-millennials-tick-understanding-the-young-urologist/

What Makes Millennials Tick? Understanding the Young Urologist – Summary:

Jason M. Hafron, MD, discusses the growing presence of millennials in the workplace, particularly in urologic practices. He emphasizes that millennial physicians’ have the ability to advance the urologic field by applying their talents and perspectives regarding technology, efficiency, and physician/patient relationships. 

Abstract:

Millennials will direct the future of urology, and they may have a different approach and set of priorities regarding medicine than current physicians do. 

Millennials will comprise more than 1 in 3 adult Americans by 2020, and will then make up as much as 75% of the United States workforce by 2025. In 2016, Millennials will surpass Baby Boomers as the largest population group.

 A generation’s attitudes, values, and beliefs develop during significant life events in their formative years. Attributes generally ascribed to the millennial generation include dependence on technology, valuing a work/life balance, and having less reverence for authority. Millennials are also the most culturally diverse generation to date. The older generation of physicians may sometimes perceive millennials as entitled, disloyal, needing praise and feedback, needing answers to questions, as well as having authority issues. Millennials are in a position to conflict with older generations due to their differing outlook and priorities on life.

If urologists alienate and resist this generation, patients will consequently stand to suffer. Urologists must instead recognize the advantages of the unique aspects millennials have to offer. Millennials can apply their unique talents and perspectives, such as the aptitude with technologies, innate desire for efficiency, and tendencies to break down barriers between physicians and patients, to their work in urology and catapult the field forward. Acknowledging, respecting, and understanding millennials’ values will create an overall loyal and driven workforce.

About the International Prostate Cancer Update

The International Prostate Cancer Update (IPCU) is an annual, multi-day CME conference focused on prostate cancer treatment updates. The conference’s faculty consists of international experts, and the event caters to urologists, medical oncologists, radiation oncologists, and other healthcare professionals. Topics encompass prostate cancer management, from diagnosis to treating advanced and metastatic disease. Dr. Hafron presented this lecture during the 29th IPCU in 2019. Please visit this page in order to learn more about future IPCU meetings. 

Robert E. Reiter, MD, presented “Can MRI Be Used to Select Patients for Focal Therapy or To Guide Therapy?” during the 29th Annual International Prostate Cancer Update on January 24, 2019 in Beaver Creek, Colorado.

How to cite: Reiter, Robert E. “Can MRI Be Used to Select Patients for Focal Therapy or To Guide Therapy?” January 24, 2019. Accessed Oct 2026. https://grandroundsinurology.com/can-mri-be-used-to-select-patients-for-focal-therapy-or-to-guide-therapy/

Can MRI Be Used to Select Patients for Focal Therapy or To Guide Therapy? – Summary:

Robert E. Reiter, MD, reviews data comparing tumor analysis as seen on MRI and fusion biopsy to whole-mount histology following radical prostatectomy. He discusses whether evidence supports the use of MRI for determining patient eligibility and planning for focal therapy. 

Abstract:

MRI is a well-established technology for prostate cancer detection, biopsy guidance, and informing management. However, there is not yet a consensus as to whether or not MRI or MRI-targeted biopsies are sufficient for guiding focal therapy, patient selection, and treatment planning. 

The generally-established focal therapy eligibility criteria include the presence of clinical stage T2c or less, serum PSA of 20 ng/mL or less, and a PI-RADS region of interest (ROI) Grade 3 or higher visible on MRI.

In an assessment of focal therapy eligibility, out of patients who were eligible according to multiparametric MRI and targeted biopsy findings, a significant number were found to be ineligible based on whole-mount histology after radical prostatectomy. This calls into question the sensitivity and specificity of fusion biopsy for predicting focal therapy eligibility.

The discordance of fusion biopsy and whole-mount tumor analysis could be due to the limited sensitivity and detection rates of MRI. The mean difference in size between ROIs seen on MRI and whole-mount tumors is about 15mm. This shows that MRI significantly under-detects the dimensions of tumors, and is an insufficient tool for planning ablation.

About the International Prostate Cancer Update

The International Prostate Cancer Update (IPCU) is an annual, multi-day CME conference focused on prostate cancer treatment updates. The conference’s faculty consists of international experts, and the event caters to urologists, medical oncologists, radiation oncologists, and other healthcare professionals. Topics encompass prostate cancer management, from diagnosis to treating advanced and metastatic disease. Dr. Reiter presented this lecture during the 29th IPCU in 2019. Please visit this page in order to learn more about future IPCU meetings.

Raoul S. Concepcion, MD, FACS, presented “AR Resistance Mechanisms: Focusing on Variants and Testing” during the 29th Annual International Prostate Cancer Update on January 26, 2019 in Beaver Creek, Colorado.

How to cite: Concepcion, Raoul S. “AR Resistance Mechanisms: Focusing on Variants and Testing” January 26, 2019. Accessed Oct 2026. https://grandroundsinurology.com/ar-resistance-mechanisms-focusing-on-variants-and-testing/

New Considerations for Oligometastatic Prostate Cancer – Summary: 

Raoul S. Concepcion, MD, FACS, reviews the role of androgen receptor (AR) resistance mechanisms in recently-approved drugs for metastatic castration-resistant prostate cancer (mCRPC) and disease progression. He then emphasizes the need for better predictive and prognostic biomarkers and the optimization of therapeutic choices.

Abstract: 

Over the last decade, there have been many advancements in treatment for patients diagnosed with metastatic castration-resistant prostate cancer (mCRPC). Several drugs that prolong overall survival in these patients, such as docetaxel, cabazitaxel, abiraterone, enzalutamide, and radium-223, are now approved. However, exposure to these newer targeted agents, especially as physicians prescribe them earlier in the disease state, will present significant subsequent consequences. 

Drug resistance, which consequently allows for the progression of disease, is a result of mutations by cell lines and treatment pressure selection. Pharmacogenetics, or the understanding of how one’s genetic makeup can predict the response to certain drugs, plays an integral part of precision medicine. This concept forms the basis in the development of predictive biomarkers, which are sorely needed for the management of advanced prostate cancers.

This presentation will review mechanisms of resistance and how the application of this knowledge can inform biomarker testing to optimize therapy for patients with progressive disease.

About the International Prostate Cancer Update

The International Prostate Cancer Update (IPCU) is an annual, multi-day CME conference focused on prostate cancer treatment updates. The conference’s faculty consists of international experts, and the event caters to urologists, medical oncologists, radiation oncologists, and other healthcare professionals. Topics encompass prostate cancer management, from diagnosis to treating advanced and metastatic disease. Dr. Concepcion presented this lecture during the 29th IPCU in 2019. Please visit this page in order to learn more about future IPCU meetings.

J. Kellogg Parsons, MD, MHS, FACS, presented “Diet and Prostate Cancer – Now What?” during the 29th Annual International Prostate Cancer Update on January 25, 2019 in Beaver Creek, Colorado.

How to cite: Parsons, J. Kellogg. “Diet and Prostate Cancer – Now What?” January 25, 2019. Accessed Oct 2026. https://grandroundsinurology.com/diet-and-prostate-cancer-now-what/

Diet and Prostate Cancer – Now What? – Summary:

J. Kellogg Parsons, MD, MHS, FACS, reviews the Men’s Eating and Living (MEAL) study, a randomized, phase III clinical trial testing diet intervention in prostate cancer patients under active surveillance. He describes the trial methodology and design, as well as clinical progression and quality of life outcomes.

Abstract:

In the past, only low-level evidence was available regarding diet and prostate cancer. To address the lack of robust data in this area, the MEAL study, a randomized, phase III clinical trial, investigated the efficacy of diet intervention in prostate cancer patients under active surveillance.

The study utilized a scientifically designed, validated behavior change with the theory of self-efficacy in the intervention arm with the goal of increasing patients’ intake of vegetables, specifically raw carotenoids from tomatoes and carrots, to seven or more servings a day. Importantly, this intervention removes economic and practical burdens from patients. It is also is scalable to large populations.

The primary endpoint was a composite of clinical progression, defined as either PSA levels increasing to 10 ng/mL or above, a PSA doubling time (PSADT) of less than 3 years, or pathological progression on follow-up biopsy.

At 12 and 24 months, the intervention group experienced significant increases to vegetable intake as opposed to the control condition group. Corroborating this, blood carotenoid levels significantly increased in the intervention arm at 12 months. Conversely, fat intake decreased at 12 and 24 months.

Despite the changes in diet, primary outcomes showed no significant effect on shorter-term clinical progression. Nor was there a significant observed difference in quality of life. Long-term effects are unclear.

However, this study shows that lifestyle changes in men with prostate cancer is feasible. Possibly, investigation of this intervention in a population of metastatic patients could yield different results. Further lifestyle intervention studies could include the introduction of  intense exercise in patients. Ultimately, because there is no hard evidence to support it, physicians should not tell their patients that changing their diet will treat prostate cancer.

About the International Prostate Cancer Update

The International Prostate Cancer Update (IPCU) is an annual, multi-day CME conference focused on prostate cancer treatment updates. The conference’s faculty consists of international experts, and the event caters to urologists, medical oncologists, radiation oncologists, and other healthcare professionals. Topics encompass prostate cancer management, from diagnosis to treating advanced and metastatic disease. Dr. Parsons presented this lecture during the 29th IPCU in 2019. Please visit this page in order to learn more about future IPCU meetings.

Nelson N. Stone, MD, presented “3DBiopsy™: Transperineal Mapping Biopsy in 2019” during the 29th Annual International Prostate Cancer Update on January 26, 2019 in Beaver Creek, Colorado.

How to cite: Stone, Nelson N. “3DBiopsy™: Transperineal Mapping Biopsy in 2019” January 26, 2019. Accessed Oct 2026. https://grandroundsinurology.com/3dbiopsy-transperineal-mapping-biopsy-in-2019/

3DBiopsy™: Transperineal Mapping Biopsy in 2019 – Summary:

Nelson N. Stone, MD, discusses the need for adequate and accurate prostate cancer identification techniques, especially when selecting patients for active surveillance. He then reviews an emerging transperineal prostate mapping biopsy system that could be an improved tool for fusion biopsy, replace current transrectal biopsy devices, and better detect and localize lesions.  

Abstract:

According to data on the upgrading of prostate tumors at the time of radical prostatectomy, the rate of upgrading in patients with negative confirmatory tests is 54%. Physicians must recognize this when using tests such as transrectal ultrasound biopsy, MRI, and molecular classifiers to select patients for active surveillance. Furthermore, active surveillance survival outcomes data shows that patients categorized as  Gleason score 7 had a 3.1 times higher prostate cancer death rate than Gleason score 6 patients. In other words, determining treatment decisions based on inaccurate detection of Gleason scores could compromise a patient’s survival. Therefore, it is essential to have extremely accurate methods for identifying prostate cancer.

Transperineal prostate mapping biopsy (TPMB) could be the solution to this unmet need. However, there is no standardization to this technique. There is no consensus regarding the amount of cores taken, core spacing, whether or not to take in-line cores, nor whether or not to increase the number of cores in cases of larger prostate volume.

This presentation previews the 3DBiopsy(TM) TPMB system with a targeted launch date in 2020. This technology could significantly assist in creating a more standardized process. It also could reduce the number of biopsies taken from patients and possibly provide enough information to guide focal ablation.

About the International Prostate Cancer Update

The International Prostate Cancer Update (IPCU) is an annual, multi-day CME conference focused on prostate cancer treatment updates. The conference’s faculty consists of international experts, and the event caters to urologists, medical oncologists, radiation oncologists, and other healthcare professionals. Topics encompass prostate cancer management, from diagnosis to treating advanced and metastatic disease. Dr. Stone presented this lecture during the 29th IPCU in 2019. Please visit this page in order to learn more about future IPCU meetings.

Raoul S. Concepcion, MD, FACS, presented “New Considerations for Oligometastatic Prostate Cancer” during the 29th Annual International Prostate Cancer Update on January 26, 2019 in Beaver Creek, Colorado.

How to cite: Concepcion, Raoul S. “New Considerations for Oligometastatic Prostate Cancer” January 26, 2019. Accessed Oct 2026. https://grandroundsinurology.com/new-considerations-for-oligometastatic-prostate-cancer-2/

New Considerations for Oligometastatic Prostate Cancer – Summary:

Raoul S. Concepcion, MD, FACS, discusses the management of patients with oligometastatic prostate cancer. Currently, there is no standard definition of what defines oligometastatic.  Additionally, questions remain about the handling of the primary tumor in this setting, as well as whether therapy directed at the primary has a long term benefit in overall survival. Also, physicians must take into consideration patients presenting with synchronous or metachronous lesions, the location of their disease (bone, nodal or visceral), and whether or not they are hormone-naïve versus castration-resistant. Increasing utilization of biomolecular/next generation imaging will surely compound the issue, due to the increased sensitivity of these scans relative to traditional staging modalities. In this presentation, Dr. Concepcion highlights these issues and reviews the current status of this challenging, evolving patient population.

About the International Prostate Cancer Update

The International Prostate Cancer Update (IPCU) is an annual, multi-day CME conference focused on prostate cancer treatment updates. The conference’s faculty consists of international experts, and the event caters to urologists, medical oncologists, radiation oncologists, and other healthcare professionals. Topics encompass prostate cancer management, from diagnosis to treating advanced and metastatic disease. Dr. Concepcion presented this lecture during the 29th IPCU in 2019. Please visit this page in order to learn more about future IPCU meetings. 

Steven E. Finkelstein, MD, FACRO, presented “Brachytherapy/Caesium” during the 29th Annual International Prostate Cancer Update on January 24, 2019 in Beaver Creek, Colorado.

How to cite: Finkelstein, Steven E. “Brachytherapy/Caesium” January 24, 2019. Accessed Oct 2026. https://grandroundsinurology.com/brachytherapy-caesium/

Brachytherapy/Caesium – Summary:

Steven E. Finkelstein, MD, FACRO, discusses the increasing prevalence of brachytherapy as an option for prostate cancer patients in need of radiation therapy, specifically in the recurrent space. Additionally, he addresses the limitations of the technique and the lack of studies directly comparing brachytherapy to other options.

About the International Prostate Cancer Update

The International Prostate Cancer Update (IPCU) is an annual, multi-day CME conference focused on prostate cancer treatment updates. The conference’s faculty consists of international experts, and the event caters to urologists, medical oncologists, radiation oncologists, and other healthcare professionals. Topics encompass prostate cancer management, from diagnosis to treating advanced and metastatic disease. Dr. Finkelstein presented this lecture during the 29th IPCU in 2019. Please visit this page in order to learn more about future IPCU meetings.

Gerald L. Andriole, Jr., MD, presented “Fluciclovine (18F) PET/CT Impact on Clinical Management of Recurrent Prostate Cancer” during the 29th Annual International Prostate Cancer Update on January 25, 2019 in Beaver Creek, Colorado.

How to cite: Andriole, Jr., Gerald L. “Fluciclovine (18F) PET/CT Impact on Clinical Management of Recurrent Prostate Cancer” January 25, 2019. Accessed Oct 2026. https://fluciclovine-18f-pet-ct-impact-on-clinical-management-of-recurrent-prostate-cancer/

Fluciclovine (18F) PET/CT Impact on Clinical Management of Recurrent Prostate Cancer

Gerald L. Andriole, MD, FACS, asserts that the fluciclovine PET-CT scan has a significant impact on the management of patients with biochemically recurrent prostate cancer.

Summary:

Gerald L. Andriole, MD, FACS, asserts that the fluciclovine PET-CT scan has a significant impact on the management of patients with biochemically recurrent prostate cancer. Prostate cancer recurs in up to 40% of patients treated with surgery or radiation therapy for presumed localized disease. Unfortunately, conventional imaging is unlikely to identify the site of recurrence until the Prostate Specific Antigen (PSA) level exceeds 20 mg/mL. Choline PET scans are an improvement over conventional imaging but are not recommended until the PSA level exceeds 20 mg/mL.  

Fluciclovine PET scans identify recurrence disease in about 40% of patients with PSA levels less than 0.8 mg/mL, but identifies higher portions of patients as PSA levels rise. In a treatment impact trial of more than 200 men with biochemically recurrent prostate cancer (the LOCATE study), treatment was changed in 59% of patients once the results of the fluciclovine PET scan were known. In 78% of these  cases, the treatment changes were considered to be major.

Neal D. Shore, MD, presented “The Gold Standard for Bladder Cancer Detection” during the 3rd Annual International Bladder Cancer Update on January 23, 2019 in Beaver Creek, Colorado.

How to cite: Shore, Neal D. “The Gold Standard for Bladder Cancer Detection” January 23, 2019. Accessed Oct 2026. https://grandroundsinurology.com/the-gold-standard-for-bladder-cancer-detection/

The Gold Standard for Bladder Cancer Detection- Summary:

Neal D. Shore, MD, discusses the benefits of using blue light cystoscopy (BLC) in adjunct with white light cystoscopy (WLC) in the diagnosis and treatment of bladder cancers. He then reviews the body of evidence evaluating the accuracy of BLC in detecting significant tumors and briefly compares BLC and narrow band imaging.

Abstract:

While white light cystoscopy (WLC) is the gold standard for bladder cancer detection, there is room for improvement with this technique. Due to the chronic nature of the disease, bladder cancer is very expensive to manage. Surveillance and recurrence costs account for the majority of this economic burden. Improving imaging techniques can help alleviate this issue, as well as improve patient care.

Blue light cystoscopy (BLC) can augment the use of WLC to improve both the detection and resection of bladder cancers. BLC is an optical imaging agent and supplement to WLC that involves the insertion of a photosensitizer into the bladder. Under blue light illumination, abnormal cells fluoresce red, enabling the detection of cancer cells not visible in white light settings. 

Notably, BLC can specifically produce defined visualizations of carcinoma in situ (CIS), papillary tumors, small lesions, and, conceivably, large tumors around the margins of the bladder.

The body of clinical evidence evaluating BLC shows a pronounced difference between visualizations made solely with WLC, and those made with WLC paired with BLC. In a phase III, comparative, multicenter study, BLC significantly improved detection of reccurent bladder cancer in 20.6% of patients, and of CIS in 34.6% of patients. In another prospective, randomized study, BLC detected Ta/T1 tumors in 16.4% of patients and CIS in 46% of patients that WLC did not.

BLC is the standard of care throughout most of Europe. Comparatively, the mainstream urologic community in the United States does not use BLC as widely. This is because of reimbursement issues and costs associated with the purchase of needed equipment. In the future, additional related studies are necessary to investigate BLC in the context of disease progression and patient survival.

About the International Bladder Cancer Update

The International Bladder Cancer Update (IBCU) is an annual one-day CME conference focused on bladder cancer treatment updates. IBCU takes place during its sister conference, the International Prostate Cancer Update (IPCU). The conference’s faculty consists of international experts, and the event caters to urologists, urologic oncologists, and other healthcare professionals. In addition to didactic lectures, IBCU features interactive discussions, a panel roundtable, debates, and case presentations. Dr. Shore presented this lecture during the 3rd IBCU in 2019. Please visit this page in order to learn more about future IBCU meetings.

Priya N. Werahera, PhD, presented “TRUS Biopsy, MRI, and PROMIS Trial” during the 29th Annual International Prostate Cancer Update on January 26, 2019 in Beaver Creek, Colorado.

How to cite: Werahera, Priya N. “TRUS Biopsy, MRI, and PROMIS Trial”. January 26, 2019. Accessed Oct 2026. https://grandroundsinurology.com/trus-biopsy-mri-and-promis-trial/

TRUS Biopsy, MRI, and PROMIS Trial

Priya N. Werahera, PhD, discusses the PROstate MR Imaging Study (PROMIS) trial and its implications for use in prostate cancer screening.

Summary:

Priya N. Werahera, PhD, discusses the PROstate MR Imaging Study (PROMIS) trial, which investigated whether multi-parametric (MP)-MRI can discriminate between men with and without clinically-significant prostate cancer who are at risk prior to first biopsy. Results showed mpMRI performed better than expected in a multicenter setting when used across 11 centers and by over a dozen radiologists. Dr. Werahera also discusses several limitations of the PROMIS trial as well as assessing the utility of biomarkers to identify men with clinically significant prostate cancer.

About the International Prostate Cancer Update

The International Prostate Cancer Update (IPCU) is an annual, multi-day CME conference focused on prostate cancer treatment updates. The conference’s faculty consists of international experts, and the event caters to urologists, medical oncologists, radiation oncologists, and other healthcare professionals. Topics encompass prostate cancer management, from diagnosis to treating advanced and metastatic disease. Dr. Werahera presented this lecture during the 29th IPCU in 2019. Please visit this page in order to learn more about future IPCU meetings.

Phillip J. Koo, MD, presented “Update on Radiopharmaceuticals: Choosing a Companion Drug to Radium-223” during the 29th Annual International Prostate Cancer Update on January 26, 2019 in Beaver Creek, Colorado.

How to cite: Koo, Phillip J. “Update on Radiopharmaceuticals: Choosing a Companion Drug to Radium-223” January 26, 2019. Accessed Oct 2026. https://grandroundsinurology.com/update-on-radiopharmaceuticals-choosing-a-companion-drug-to-radium-223/

Update on Radiopharmaceuticals: Choosing a Companion Drug to Radium-223 – Summary:

Phillip J. Koo, MD, reviews the data evaluating the use of radium-223 in combination with AR inhibitors for treating patients with CRPC. He discusses findings from the ERA 223 trial and the issues with this combination it highlighted, especially regarding bone health.

Abstract:

When the ALSYMPCA trial evaluated the efficacy and safety of radium-223 in patients with castration-resistant prostate cancer (CRPC) and symptomatic bone metastases, it demonstrated the first instance of a radium-based pharmaceutical improving overall survival. These results, as well as the mechanism of action of radium-223, positioned it as a potential option in combination therapy, especially in combination with androgen receptor (AR) inhibitors. An early access trial done after the ALSYMPCA study showed that the use of abiraterone and enzalutamide concomitantly with radium-223 was safe, and may also provide a survival benefit. The eRADicAte study also evaluated the layering of radium-223 and abiraterone in CRPC patients and showed clinically meaningful improvements in quality of life and bone pain.

With the precedent of these trials in mind, the overall urologic community foresaw the ERA 223 trial as being positive. This trial, beginning in March 2014, investigated abiraterone plus radium-223 as compared to abiraterone alone in metastatic CRPC patients.

However, in November 2017, an important drug warning letter called for the un-blinding of this study. The warning was due to an Independent Data Monitoring Committee (IDMC) recommendation. Their preliminary data had found an increased incidence of deaths and fractures in the combination arm.

In its final recommendations, ERA 223 advised against using abiraterone and radium-223 in combination. Despite this, there is still much physicians can take away from this study. Most importantly, it highlights the need to factor in bone health when treating these patients.

About the International Prostate Cancer Update

The International Prostate Cancer Update (IPCU) is an annual, multi-day CME conference focused on prostate cancer treatment updates. The conference’s faculty consists of international experts, and the event caters to urologists, medical oncologists, radiation oncologists, and other healthcare professionals. Topics encompass prostate cancer management, from diagnosis to treating advanced and metastatic disease. Dr. Koo presented this lecture during the 29th IPCU in 2019. Please visit this page in order to learn more about future IPCU meetings.

Arturo Mendoza-Valdés, MD, presented “Prostate Cancer Screening: The Latin American Perspective” during the 29th Annual International Prostate Cancer Update on January 26, 2019 in Beaver Creek, Colorado.

How to cite: Mendoza-Valdés, Arturo “Prostate Cancer Screening: The Latin American Perspective” January 26, 2019. Accessed Oct 2026. https://grandroundsinurology.com/update-on-clinical-trials-of-radium-223/

Prostate Cancer Screening: The Latin American Perspective

Arturo Mendoza-Valdés, MD, provides an update and perspective of treating prostate cancer in Latin America.

Summary:

Arturo Mendoza-Valdés, MD, provides an update and perspective of treating prostate cancer in Latin America. Latin American countries are very heterogeneous regarding their size, population, races, diet, economy, life expectancies, and healthcare problems and systems. The Latin American population is mostly young (60% under 40 in many countries) and includes slightly more women than men. Some of these factors could explain the lower incidence of prostate cancer in these countries compared to that of Europe, USA, or Canada. Due to the variability of these factors, prostate cancer incidence, mortality, and screening in Latin America is also very heterogeneous. Using an internet research platform from the CAU (Confederación Americana de Urología), which unites the urological associations of most of Latin American countries, a survey of screening trends in those countries was performed. Conclusions of this study were as follows:

• Prostate cancer in Latin America is as heterogeneous as its population. 
• Prostate cancer incidence in LAM is lower than Europe, USA, and Canada, but is increasing. 
• Prostate cancer is the number 1 cancer in some countries. 
• Real epidemiology is unknown. 
• 75% of PC detected is in advanced stages. 
• There are no screening policies except in Venezuela. 
• There are some isolated efforts in individual hospitals, not even in cities or regions. 
• Screening is unorganized, isolated, and unpublished. 
• There is no justification for massive screening. 
• Screening may be done in countries with high or increasing incidence. 
• What is done most frequently is preventative (education and promotion).  

Dr. Mendoza-Valdés, MD, asserts that urological associations MUST take the lead and get more involved in Latin America.

About the International Prostate Cancer Update

The International Prostate Cancer Update (IPCU) is an annual, multi-day CME conference focused on prostate cancer treatment updates. The conference’s faculty consists of international experts, and the event caters to urologists, medical oncologists, radiation oncologists, and other healthcare professionals. Topics encompass prostate cancer management, from diagnosis to treating advanced and metastatic disease. Dr. Mendoza-Valdés presented this lecture during the 29th IPCU in 2019. Please visit this page in order to learn more about future IPCU meetings.

Lawrence I. Karsh, MD, FACS, presented “Emerging Indications for a Novel Absorbable Hydrogel Spacer” during the 29th Annual International Prostate Cancer Update on January 24, 2019 in Beaver Creek, Colorado.

How to cite: Karsh, Lawrence I. “Emerging Indications for a Novel Absorbable Hydrogel Spacer” January 24, 2019. Accessed Oct 2026. https://grandroundsinurology.com/ar-resistance-mechanisms-focusing-on-variants-and-testing/

New Considerations for Oligometastatic Prostate Cancer – Summary:

Lawrence I. Karsh, MD, addresses the problem of long-term complications following prostate radiation therapy and describes how a novel absorbable hydrogel spacer can alleviate these issues. Additionally, he describes how the spacer can improve conventional radiology, enable dose escalation as well as salvage therapy and hypofractionation, and improve the safety of these patients. 

About the International Prostate Cancer Update

The International Prostate Cancer Update (IPCU) is an annual, multi-day CME conference focused on prostate cancer treatment updates. The conference’s faculty consists of international experts, and the event caters to urologists, medical oncologists, radiation oncologists, and other healthcare professionals. Topics encompass prostate cancer management, from diagnosis to treating advanced and metastatic disease. Dr. Karsh presented this lecture during the 29th IPCU in 2019. Please visit this page in order to learn more about future IPCU meetings. 

Ronald P. Kaufman, MD, presented “The AUA, CPT, and RUC: Interactions and Impact” during the 29th Annual International Prostate Cancer Update on January 24, 2019 in Beaver Creek, Colorado.

How to cite: Kaufman, Ronald P. “The AUA, CPT, and RUC: Interactions and Impact” January 24, 2019. Accessed Oct 2026. https://grandroundsinurology.com/the-aua-cpt-and-ruc-interactions-and-impact/

The AUA, CPT, and RUC: Interactions and Impact – Summary:

Ronald P. Kaufman, Jr. MD, reviews Current Procedural Terminology (CPT) coding and reimbursement within the urologic field. Additionally, he discusses the need for today’s practicing urologists to understand the importance of American Urological Association (AUA) department of Public Policy and Advocacy and the Public Policy Council in the preservation of economic viability.

About the International Prostate Cancer Update

The International Prostate Cancer Update (IPCU) is an annual, multi-day CME conference focused on prostate cancer treatment updates. The conference’s faculty consists of international experts, and the event caters to urologists, medical oncologists, radiation oncologists, and other healthcare professionals. Topics encompass prostate cancer management, from diagnosis to treating advanced and metastatic disease. Dr. Kaufman presented this lecture during the 29th IPCU in 2019. Please visit this page in order to learn more about future IPCU meetings.

Mark A. Moyad, MD, MPH presented “B____, Statins, Aspirin, and Metformin (B. S.A.M.): The Best Natural Pill for Patients Concerned About Prostate Cancer” during the 29th Annual International Prostate Cancer Update on January 25, 2019 in Beaver Creek, Colorado.

How to cite: Moyad, Mark A. “B____, Statins, Aspirin, and Metformin (B. S.A.M.): The Best Natural Pill for Patients Concerned About Prostate Cancer” January 25, 2019. Accessed Oct 2026. https://grandroundsinurology.com/b____-statins-aspirin-and-metformin-b-s-a-m-the-best-natural-pill-for-patients-concerned-about-prostate-cancer/

B____, Statins, Aspirin, and Metformin (B. S.A.M.): The Best Natural Pill for Patients Concerned About Prostate Cancer: – Summary:

Mark A. Moyad, MD, MPH, the Jenkins/Pokempner Director of Preventive & Complementary Medicine at the University of Michigan Medical Center, discusses new findings concerning supplements in prostate cancer treatment and the best natural alternatives.

About the International Prostate Cancer Update

The International Prostate Cancer Update (IPCU) is an annual, multi-day CME conference focused on prostate cancer treatment updates. The conference’s faculty consists of international experts, and the event caters to urologists, medical oncologists, radiation oncologists, and other healthcare professionals. Topics encompass prostate cancer management, from diagnosis to treating advanced and metastatic disease. Dr. Moyad presented this lecture during the 29th IPCU in 2019. Please visit this page in order to learn more about future IPCU meetings.

Thomas E. Keane, MD, presented “Timing of ADT with Chemotherapy in 2019” during the 29th Annual International Prostate Cancer Update on January 26, 2019 in Beaver Creek, Colorado.

How to cite: Keane, Thomas E. “Timing of ADT with Chemotherapy in 2019” January 26, 2019. Accessed Oct 2026. https://grandroundsinurology.com/timing-of-adt-with-chemotherapy-in-2019/

Timing of ADT with Chemotherapy in 2019 – Summary:

Thomas E. Keane, MD, reviews the data supporting and opposing the advancement of chemotherapy into the metastatic castration-sensitive prostate cancer (mCSPC) disease state. He then discusses a current trial introducing chemotherapy in patients prior to androgen deprivation therapy (ADT).

Abstract:

The use of chemotherapy in prostate cancer has typically been reserved for patients with very advanced disease. Recently, as a result of a number of phase III randomized, controlled trials, this modality has been advanced to the castrate-sensitive metastatic disease state with very encouraging results.

The results of the E3805 (CHAARTED) trial were surprising to the urologic community. It showed a significant overall survival benefit with chemohormonal therapy in mCSPC patients. However, only patients with high-volume prostate cancer saw benefits in extent of metastatic disease. The STAMPEDE trial then confirmed the observations from CHAARTED.

On the contrary, the GETUG-AFU 15 study showed a highly significant biochemical progression-free survival, but no overall survival benefit to docetaxel plus androgen-deprivation therapy (ADT) in mCSPC. Notably, patients who failed in GETUG-AFU 15 did not have the availability of enzalutamide and abiraterone, while those in CHAARTED did.

When comparing toxicity data from GETUG-AFU 15, CHAARTED, and TAX327, the study that led to docetaxel’s approval in castration-resistant prostate cancer (CRPC), patients in GETUG-AFU 15 showed the relatively highest rates of febrile neutropenia. This suggests that docetaxel may be surprisingly more toxic in mCSPC. Additionally, docetaxel pharmacokinetics have proven to play a role in these variations of toxicity rates.

This presentation reviews the data examining the possibility that if docetaxel leads to greater toxicity in patients in a pre-castration state, then it may also lead to greater efficacy. An in vitro study, animal model, breast cancer study, and human trials in prostate cancer have explored this idea. It will also briefly discuss a current phase II trial introducing chemotherapy prior to ADT. Finally, It will review the current issues physicians should consider when initiating ADT.    

About the International Prostate Cancer Update

The International Prostate Cancer Update (IPCU) is an annual, multi-day CME conference focused on prostate cancer treatment updates. The conference’s faculty consists of international experts, and the event caters to urologists, medical oncologists, radiation oncologists, and other healthcare professionals. Topics encompass prostate cancer management, from diagnosis to treating advanced and metastatic disease. Dr. Keane presented this lecture during the 29th IPCU in 2019. Please visit this page in order to learn more about future IPCU meetings.

John W. Davis, MD, presented “The Optimal Nadir T Level on ADT Is <20mg/mL” during the 29th Annual International Prostate Cancer Update on January 26, 2019 in Beaver Creek, Colorado.

How to cite: Davis, John W. “The Optimal Nadir T Level on ADT Is <20mg/mL” January 26, 2019. Accessed Oct 2026. https://grandroundsinurology.com/the-optimal-nadir-t-level-on-adt-is/

The Optimal Nadir T Level on ADT Is <20mg/mL

John W. Davis, MD, debates the pros of using <20mg/mL as a threshold for the optimal nadir level of serum testosterone in prostate cancer patients treated with ADT.

Summary:

John W. Davis, MD, debates the pros of using <20mg/mL as a threshold for the optimal nadir level of serum testosterone in prostate cancer patients treated with androgen deprivation therapy (ADT). Dr. Davis reviews commonly-held perspectives on maintaining testosterone over 20 mg/mL on ADT and how these perspectives relate to ADT predictions. He then reviews studies focusing on the connection between the M1 space and T levels.

About the International Prostate Cancer Update

The International Prostate Cancer Update (IPCU) is an annual, multi-day CME conference focused on prostate cancer treatment updates. The conference’s faculty consists of international experts, and the event caters to urologists, medical oncologists, radiation oncologists, and other healthcare professionals. Topics encompass prostate cancer management, from diagnosis to treating advanced and metastatic disease. Dr. Davis presented this lecture during the 29th IPCU in 2019. Please visit this page in order to learn more about future IPCU meetings.

Francisco G. La Rosa, MD, presented “Second Opinion Diagnosis in Prostate Pathology” during the 29th Annual International Prostate Cancer Update on January 26, 2019 in Beaver Creek, Colorado.

How to cite: La Rosa, Francisco G. “Second Opinion Diagnosis in Prostate Pathology” January 26, 2019. Accessed Oct 2026. https://grandroundsinurology.com/second-opinion-diagnosis-in-prostate-pathology/

Second Opinion Diagnosis in Prostate Pathology

Francisco G. La Rosa, MD, discusses how poor preparation of biopsy and prostatectomy specimens, as well as pathologists’ misreadings, can lead to significant discrepancies in the diagnosis of prostate cancer. He emphasizes the importance of reevaluation by in-house urologic pathologists of all outside specimens before evaluating treatment options for patients.

Abstract:

Prostate cancer (PCa) is one of the most common male diseases in the USA. The gold standard for PCa diagnosis is based on a careful and comprehensive histopathologic examination of prostatic tissue to deliver allied specialty colleagues with the correct information. This allows them to tailor the most appropriate therapeutic procedures to individual patients.

An accurate diagnosis is not only based on the expertise of the pathologists recognizing PCa under the microscope, but also on the support of a proficient histology laboratory with enough experience in the preparation of biopsies and prostatectomy specimens.

Pathologists need to keep updated in the constant changes in PCa classification and in the evaluation of other specific tumor features. They also need to maintain a permanent and close professional collaboration with their clinical, oncology, and surgical colleagues to construct sound clinical-pathological correlations that can secure the right care for their patients.

An accurate pathology diagnosis relies on a precise evaluation of tumor grading, together with important features such as perineural invasion, extraprostatic extension, lymphovascular invasion, surgical margins, invasion of seminal vesicles, therapy effect, etc., as well as the assessment of metastatic disease in lymph nodes and other organs. This is in conjunction with the implementation of special histological stainings for the proper identification of PCa. In many cases, due to poor histopathological preparations and the pathologist’s lack of proficiency, we find significant discrepancies in the diagnosis of PCa that may lead to inadequate therapeutic procedures.

We have found significant discrepancies between general pathologists outside our institution and our in-house pathologists [1], with the most important discrepancies involving tumor undergrading predominating above overgrading, and in the differentiation between primary and secondary PCa grades. Outside pathologists also failed to report important features relevant to the patient’s prognosis, such as perineural invasion, extraprostatic extension, and surgical margins.

Since histopathological evaluation is a critical factor for appropriate treatment selection, we recommend that a reevaluation by in-house urologic pathologists should be performed in all outside specimens before patients are evaluated for treatment in any given institution.

About the International Prostate Cancer Update

The International Prostate Cancer Update (IPCU) is an annual, multi-day CME conference focused on prostate cancer treatment updates. The conference’s faculty consists of international experts, and the event caters to urologists, medical oncologists, radiation oncologists, and other healthcare professionals. Topics encompass prostate cancer management, from diagnosis to treating advanced and metastatic disease. Dr. La Rosa presented this lecture during the 29th IPCU in 2019. Please visit this page in order to learn more about future IPCU meetings.

Scott Eggener, MD, and E. David Crawford, MD discuss an abstract presented during the American Urological Association’s 2019 Annual Meeting on May 5, 2019, in Chicago, Illinois, in this presentation titled “Pivotal Trial of MRI-Guided Transurethral Ultrasound Ablation in Men with Localized Prostate Cancer.”

How to cite: Eggener, Scott and Crawford, E. David. “Pivotal Trial of MRI-Guided Transurethral Ultrasound Ablation in Men with Localized Prostate Cancer” May 8, 2019. Accessed Oct 2026. https://grandroundsinurology.com/pivotal-trial-of-mri-guided-transurethral-ultrasound-ablation-in-men-with-localized-prostate-cancer/

Pivotal Trial of MRI-Guided Transurethral Ultrasound Ablation in Men with Localized Prostate Cancer
– Summary:

Scott Eggener, MD, reviews the findings from a phase II international, multi-institutional trial evaluating a new minimally-invasive technology for prostate tissue ablation. He covers the primary safety and efficacy endpoints of the trial, as well as future directions for this technology.

Dr. Eggener’s Late-breaking Abstract at the AUA’s 2019 Annual Meeting

Several important findings and presentations came out of the American Urological Association’s (AUA’s) 2019 Annual Meeting. One notable presentation is this late-breaking abstract involving a new technology called the MRI-guided Transurethral Ultrasound Ablation (TULSA) system. Scott Eggener, MD, Professor of Surgery and Radiology at the University of Chicago Medicine, presented this abstract. He is the principal investigator of the phase II international, multi-institutional trial evaluating this technology. During this video, he shares his findings with the Grand Rounds in Urology audience.

MRI-Guided Transurethral Ultrasound Ablation

The TULSA system employs a transurethral device that continuously rotates and emits directional ultrasound and uses active MRI thermometry feedback control in order to ablate the prostate.

The TULSA-PRO Ablation Clinical Trials (TACT) pivotal study included 115 patients from 13 institutions and 5 countries. Of these patients, 67% had intermediate-risk and 33% had low-risk prostate cancer. Patients received TULSA with the intent of whole-gland ablation. The trial met its primary efficacy endpoints with 96% of patients achieving a PSA decrease of 75% or more, 65% of patients with no evidence of disease on biopsy, and 79% of men with baseline Grade Group 2 disease had no evidence of Grade Group 2 disease on biopsy at 1-year follow-up.

The safety profile from this trial appears favorable towards this technology. Upon 1-year follow-up, 96% of patients maintained or returned to baseline continence level, and 75% of patients maintained or returned to erections sufficient for penetration.

In the future, there will be a protocol-mandated 5-year follow up with these patients. Also, there are ongoing discussions with regulatory authorities in the United States and abroad regarding potential approval of this technology for prostate ablation.

Following Dr. Eggener’s review of this data, he and E. David Crawford, MD, confer about the plans for long-term follow-up from this trial, clarifying the differences between TULSA and high-intensity focused ultrasound (HIFU), and the possibility of using TULSA for targeted focal therapy.

Deepak A. Kapoor, MD, FACS, presented “2019 Economic Outlook for Urology in the United States” during the 29th Annual International Prostate Cancer Update on January 26, 2019 in Beaver Creek, Colorado.

How to cite: Kapoor, Deepak A. “2019 Economic Outlook for Urology in the United States” January 26, 2019. Accessed Oct 2026. https://grandroundsinurology.com/3dbiopsy-transperineal-mapping-biopsy-in-2019/

2019 Economic Outlook for Urology in the United States – Summary:

Deepak A. Kapoor, MD, FACS, discusses the history of efforts in the United States to transition healthcare toward a structure of value-based care. He then outlines major 2019 regulatory initiatives and how they will impact healthcare payments and the administrative burden for urologists.

Abstract:

It has been challenging for urologists in the United States, as well as physicians in general, to navigate rapidly changing healthcare policies. The passing of the Affordable Care Act in 2010 initiated a directive to move the structure of healthcare toward value-based care. Unfortunately, there have been no substantial actions implemented to integrate that idea into real-life practices.

The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 set forth a timeline that would realize this shift into value-based care. However, physicians have yet to see these changes take place. Perhaps this is due to a lack of stability related to changes in leadership. Since 2015, there have been 6 separate Secretaries of Health and Human Services (HHS). The incumbent HHS Secretary, Alex Azar, has been clear in his intentions to transition 75% of Medicare payments away from fee-for-service to value-based-care models within the next two years.

It is important to realize that while lawmakers in Congress must introduce and pass legislation, federal agencies, under the control of the executive branch, promulgate regulations. Once these federal agencies publish a regulation that does not have a contravening statute, it carries the binding force of the law.

This presentation explains the impact of major regulation initiatives from healthcare leadership in 2019. These initiatives include Stark Law reform, a Medicare Part B demonstration project, updates to the Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) covered procedure list and payments, as well as the the CY 2019 Physician Fee Schedule Final Rule and how it specifically changes documentation, Current Procedural Terminology coding, and payment changes for urologists.

Due to these changes, independent physician practices are in a unique position to thrive and form novel collaborative relationships with institutional and academic practitioners.

About the International Prostate Cancer Update

The International Prostate Cancer Update (IPCU) is an annual, multi-day CME conference focused on prostate cancer treatment updates. The conference’s faculty consists of international experts, and the event caters to urologists, medical oncologists, radiation oncologists, and other healthcare professionals. Topics encompass prostate cancer management, from diagnosis to treating advanced and metastatic disease. Dr. Kapoor presented this lecture during the 29th IPCU in 2019. Please visit this page in order to learn more about future IPCU meetings.

Sigrid V. Carlsson, MD, PhD, MPH, and Gerald L. Andriole, Jr., MD, recount the arguments and conclusions from the “The Guidelines Controversies Session, Part Two,” held during the 34th Annual European Association of Urology Congress in Barcelona, Spain from March 15-19, 2019, in this video titled “Prostate Cancer – No Biopsy in Case of a Normal MRI.”

How to cite: Carlsson, Sigrid V. and Andriole, Gerald L. “Prostate Cancer – No Biopsy in Case of a Normal MRI” January 25, 2019. Accessed Oct 2026. https://grandroundsinurology.com/Prostate-Cancer-No-Biopsy-in-Case-of-a-Normal-MRI/

Prostate Cancer – No Biopsy in Case of a Normal MRI – Summary:

Sigrid V. Carlsson, MD, PhD, MPH, and Gerald L. Andriole, Jr., MD, discuss the pros and cons of omitting biopsy in patients with abnormal PSA levels and a negative MRI. While avoiding standard biopsy can mitigate serious complications, the data may not support full confidence in MRI’s detection quality.

Panel on Guidelines Controversies at the 34th Annual EAU Congress

Since 2017, there have been several large trials, namely PROMIS, Porpiglia, PRECISION, MRI-FIRST, and the 4M Trial, investigating the possibility of omitting biopsy in patients with abnormal PSA levels and a negative MRI. This evidence has informed changes seen in the 2019 European Association of Urology (EAU) Guidelines.

During a Guidelines Controversies session at the EAU’s 2019 annual meeting in Barcelona, Spain, independent experts explored the evidence base for these new recommendations. Nicolas Mottet, MD, PhD (Saint-Etienne, France) led the panel, while Professor Caroline M. Moore (London, Great Britain), Sigrid V. Carlsson, MD, PhD, MPH (New York, United States), and Olivier Rouvière, MD, PhD (Lyon, France) participated in a debate on the pros and cons of forgoing biopsy after MRI. Following the debate, the audience engaged in the discussion and voted on the matter. The vote was nearly 50% in favor of forgoing biopsy in these patients and 50% against it. This speaks to the fact that there is still much exploration and discussion needed to clarify the best course of action for patients in this situation.

The Role of MRI in Patients with Abnormal PSA Levels

Regardless of whether or not MRI can replace the need for a biopsy, there are many advantages to MRI itself when it shows a lesion. MRI-targeting enhances the ability to detect significant prostate cancer, reduce the overdiagnosis of insignificant disease, and more accurately characterize the size and Gleason score of the tumor than would be possible with random biopsy.

However, controversy still remains regarding what to do when an MRI does not show a significant lesion. According to the MRI-FIRST study, obtaining a multiparametric MRI before biopsy in biopsy-naive patients does not seem to supersede the need for systematic biopsy. Particularly for physicians working in the United States, failing to perform a biopsy when a patient is concerned about elevated PSA and delaying the ultimate diagnosis of cancer could result in serious liability consequences. Inter-observer variability also poses a limitation to MRI’s ability to accurately assess the presence of significant cancers, even among expert radiologists. Most importantly, the negative predictive value of MRI is not optimal, supporting the conclusion that a negative MRI cannot replace a biopsy.

A major argument for avoiding biopsy is that systematic transrectal ultrasound (TRUS) biopsy carries a burden of overdiagnosis, infectious complications, and hospitalizations.

In the future, risk-stratification with biomarkers and clinical information, such as PSA density, could determine low-risk patients who may be able to undergo mpMRI and avoid biopsy.