Highlights of NCCN/AUA Guidelines 2024
Siamak Daneshmand, MD, covers recent updates in bladder cancer guidelines, focusing on the 2024 NCCN and AUA recommendations.
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Topic: AUA Guidelines
SUI – AUA/SUFU Guidelines 2017 — Amendment 2023
Suzette E. Sutherland, MD, MS, URPS, discusses the AUA and SUFU guidelines for evaluating and treating stress urinary incontinence (SUI). In this five-minute talk, Dr. Sutherland reviews the five key components for evaluating a patient with SUI and discusses indications for advanced diagnostic tools such as cystoscopy and urodynamics.
Dr. Sutherland’s discussion continues with the Guideline’s treatment options, both non-surgical (pessaries, vaginal inserts, and pelvic floor muscle exercises), and surgical (bulking agents, midurethral slings). The recent amendment to the guidelines now allows clinicians to offer single-incision slings alongside retropubic and transobturator slings for patients, reflecting their comparable safety and effectiveness.
Prostate Microultrasound
Gerald L. Andriole, Jr., MD, Director of Urology in the National Capital Region at the Brady Urologic Institute at Johns Hopkins University, discusses the uses of microultrasound in prostate assessment using the PRIMUS (Prostate Risk Identification using Micro-UltraSound) protocol, which allows most prostate ducts to be visualized and tissue patterns appreciated. He compares the accuracy of PRIMUS to its conventional analog, PRIMAD. Dr. Andriole cites research that suggests novice mircroultrasound practitioners can become adept at interpreting images and identifying lesions after as few as 30-40 scans.
He compares images and biopsy results from conventional ultrasound, microultrasound, and multiparametric magnetic resonance imaging (mpMRI) to illustrate the accuracy of microultrasound. Dr. Andriole also shares data that supports the use of systematic biopsy, micro-ultrasound targeted biopsy, and MRI together to identify the greatest proportion of clinically significant prostate cancer. However, Dr. Andriole concludes that while microultrasound is a promising tool for future identification of prostate risk, current studies like the OPTIMUM trial have yet to determine whether it can fully replace conventional diagnostic MRIs.
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Changing Paradigm in the Diagnosis and Management of Erectile Dysfunction
Mohit Khera, MD, MBA, MPH, discusses the shared decision-making model of ED treatment and the current shift toward regenerative therapies.
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Guidelines and Practical Applications: Erectile Dysfunction
William O. Brant, MD, FACS, FECSM explores the latest clinical guidelines and their application in managing erectile dysfunction (ED).
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Behind the ICS, AUS and AUA Incontinence After Prostate Treatment Guidelines
Dr. O. Lenaine Westney, MD addresses the intricacies of the ICS, AUS, and AUA guidelines for incontinence after prostate treatment.
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Controversies in NMIBC: Guidelines and Beyond
Sam S. Chang, MD, MBA, discusses NMIBC guidelines, best practices, and controversies related to risk-stratification, surveillance, and treatment strategies.
Read MoreThe Surge of Male Mortality
Martin M. Miner, MD, Co-Director of the Men’s Health Center and Chief of Family and Community Medicine for Miriam Hospital, and Clinical Professor of Family Medicine and Urology at the Warren Alpert Medical School of Brown University in Providence, Rhode Island, discusses differences in mortality and life expectancy based on sex. He states that in most countries, males have shorter life spans than females. He then reviews the hypotheses for why males tend to have shorter life spans, including higher rates of cigarette smoking and drinking, which can lead to increased risk of heart disease. Dr. Miner reviews a research article stating that heart disease is the major condition associated with excess male mortality in the twentieth century. He determines that obesity is the most modifiable factor in cardiovascular disease and can be treated with a weight-centric approach, and weight loss treatment plans. He explains that the findings from the STEP trials with semaglutide show similar levels of weight loss to those presently attained with bariatric surgery. Lastly, he considers PDE5i therapy, which he explains may provide cardioprotective effects to improve survival with cardiovascular disease in males.
Read MoreSemaglutide as a Game Changer for Weight Loss
Mark A. Moyad, MD, MPH, the Jenkins/Pokempner Director of Preventive/Complementary and Alternative Medicine (CAM) at the University of Michigan Medical Center in the Department of Urology in Ann Arbor, Michigan, and Martin M. Miner, MD, Co-Director of the Men’s Health Center and Chief of Family and Community Medicine for Miriam Hospital, and Clinical Professor of Family Medicine and Urology at the Warren Alpert Medical School of Brown University in Providence, Rhode Island, discuss the potential benefits of semaglutide, a newly approved weight-loss drug. Dr. Moyad begins by summarizing the damage done by past weight-loss drugs, noting that they inevitably came with a huge catch and were never heart-healthy. He then introduces semaglutide, a recently-approved drug which has been shown to result in 15% weight loss over 2 years. Dr. Miner elaborates, explaining that there have been 4 studies of semaglutide featuring over 4500 individuals and that it is extremely safe. He highlights that the smaller dose in diabetics has also been shown to improve renal and cardiovascular outcomes, and that these outcomes are now being studied in non-diabetics. Dr. Miner argues that these results suggest semaglutide is a game changer. Dr. Moyad then discusses potential catches, noting that while the side effect profile seems good, the cost is very high at nearly $900 per month, and it is not covered by most insurance. Dr. Miner suggests that the price will go down once some time has passed from the initial approval. He does highlight as a negative the fact that semaglutide is given once per week as a subcutaneous injection, and suggests that it will be beneficial if the oral version currently under investigation is found to be effective. Drs. Miner and Moyad also ponder the long term impacts of semaglutide and sustained weight loss on testosterone levels, blood pressure, and depression. Dr. Moyad concludes by discussing his curiosity about the potential impact of semaglutide in a urologic setting.
Read MoreTestosterone, Weight Loss / Weight Gain, and Testosterone Replacement Therapy (TRT)
Mark A. Moyad, MD, MPH, the Jenkins/Pokempner Director of Preventive/Complementary and Alternative Medicine (CAM) at the University of Michigan Medical Center in the Department of Urology in Ann Arbor, Michigan, and Martin M. Miner, MD, Co-Director of the Men’s Health Center and Chief of Family and Community Medicine for Miriam Hospital, and Clinical Professor of Family Medicine and Urology at the Warren Alpert Medical School of Brown University in Providence, Rhode Island, investigate the ways in which body mass index (BMI) correlates with testosterone levels and how this knowledge can be used in a medical setting. Dr. Moyad begins the discussion with Dr. Miner’s presentation on the possibility of testosterone needs increasing as BMI increases, wherein Dr. Miner found that obese men required higher doses of testosterone to reach eugonadal levels than men who were not obese. Dr. Miner states that he expects the results of a long-term safety study of testosterone will soon show that testosterone therapy is safe over the long term, allowing physicians and researchers to focus on the symptomatic benefit of testosterone in areas such as mood and cardiovascular risk. Dr. Moyad asks if weight loss and increased fitness could possibly reduce the need for testosterone therapy, to which Dr. Miner responds that it may be possible if both weight loss and a reduction in comorbidities occur but it is unlikely in patients over 60. They conclude that weight loss can help make testosterone therapy more effective but it is unclear if it would be enough to reduce testosterone therapy altogether because of a multitude of genetic variables.
Read MoreSemaglutide as a Game Changer for Weight Loss
Mark A. Moyad, MD, MPH, the Jenkins/Pokempner Director of Preventive/Complementary and Alternative Medicine (CAM) at the University of Michigan Medical Center in the Department of Urology in Ann Arbor, Michigan, and Martin M. Miner, MD, Co-Director of the Men’s Health Center and Chief of Family and Community Medicine for Miriam Hospital, and Clinical Professor of Family Medicine and Urology at the Warren Alpert Medical School of Brown University in Providence, Rhode Island, discuss the potential benefits of semaglutide, a newly approved weight-loss drug. Dr. Moyad begins by summarizing the damage done by past weight-loss drugs, noting that they inevitably came with a huge catch and were never heart-healthy. He then introduces semaglutide, a recently-approved drug which has been shown to result in 15% weight loss over 2 years. Dr. Miner elaborates, explaining that there have been 4 studies of semaglutide featuring over 4500 individuals and that it is extremely safe. He highlights that the smaller dose in diabetics has also been shown to improve renal and cardiovascular outcomes, and that these outcomes are now being studied in non-diabetics. Dr. Miner argues that these results suggest semaglutide is a game changer. Dr. Moyad then discusses potential catches, noting that while the side effect profile seems good, the cost is very high at nearly $900 per month, and it is not covered by most insurance. Dr. Miner suggests that the price will go down once some time has passed from the initial approval. He does highlight as a negative the fact that semaglutide is given once per week as a subcutaneous injection, and suggests that it will be beneficial if the oral version currently under investigation is found to be effective. Drs. Miner and Moyad also ponder the long term impacts of semaglutide and sustained weight loss on testosterone levels, blood pressure, and depression. Dr. Moyad concludes by discussing his curiosity about the potential impact of semaglutide in a urologic setting.
Read MoreTestosterone as a Fasting Blood Test?
Mark A. Moyad, MD, MPH, the Jenkins/Pokempner Director of Preventive/Complementary and Alternative Medicine (CAM) at the University of Michigan Medical Center in the Department of Urology in Ann Arbor, Michigan, and Martin M. Miner, MD, Co-Director of the Men’s Health Center and Chief of Family and Community Medicine for Miriam Hospital, and Clinical Professor of Family Medicine and Urology at the Warren Alpert Medical School of Brown University in Providence, Rhode Island, discuss recent guidance suggesting that a fasting blood test is needed for testosterone. Dr. Moyad begins by explaining that in 2018, the Endocrine Society Clinical Practice Guidelines included a recommendation of measuring fasting morning testosterone. He suggests that this is a logical recommendation since, in a subset of men, testosterone levels may be temporarily lowered by food intake, but notes that this guidance does not appear to be widely known or followed. Dr. Miner says that he actually does usually include testosterone with other morning fasting tests to meet the demands of insurance, although he argues that this may also result in inaccurate levels since testosterone is supposedly at its peak in the afternoon. He also mentions that the American Urological Association does not recommend getting testosterone tested in a fasting specimen, although he is unsure why this is. Dr. Moyad concludes that this is a topic that is just beginning to be explored and should be watched.
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