Topic: Localized Disease

Management of Post Prostatectomy Vesicourethral Stenosis

Chris Gonzalez, MD, MBA, FACS, discusses incision and dilation options for vesicourethral anastomotic stenosis (VUAS) following radical retropubic prostatectomy (RRP). Specifically, he reviews the efficacy and safety of using cold knife, electrocautery, laser ablation, and mitomycin C in this setting. He cites the 2016 American Urological Association (AUA) urethral strictures guidelines during his analysis.

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Is Focal Ablation of Prostate Cancer Ready for Prime Time?

Herbert Lepor, MD, defines focal ablation and its quality of life, oncological, and cost benefits to patients. He then discusses best practices for the procedure, including optimal patient selection, energy source options, and extent of the ablation zone. Furthermore, he explains the research and improvement needed to make focal ablation of prostate cancer ready for prime time.

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The LUGPA Alternative Payment Model (APM) on Newly Diagnosed PCa and the Role of Active Surveillance

R. Jonathan Henderson, MD, summarizes the Large Urology Group Practice Association’s (LUGPA’s) efforts to develop an alternative payment model (APM) for urologists treating newly diagnosed prostate cancer patients. He explains the roadblocks to reaching this goal, including conflicts with the Physician-Focused Payment Model Technical Advisory Committee (PTAC).

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Timing of ADT and Chemotherapy

Thomas E. Keane, MD, explains how the current prostate cancer treatment paradigm is evolving. He discusses the optimal timing of androgen deprivation therapy (ADT), and how moving it upfront, even in a castrate sensitive setting, could benefit patients, but potentially hinder responsiveness to second-line therapies.

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Point Counterpoint in ADT—Agonists versus Antagonists

Lawrence Karsh, MD, FACS, argues that agonists are effective, sustainable androgen deprivation therapies (ADT) for treating prostate cancer, and claims that agonists present a high cardiovascular (CV) risk could be due to selection bias in trials. Conversely, Thomas Keane, MD, argues that patients treated with antagonists have lower CV risk and are more responsive to ADT than those treated with agonists.

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3D Biopsy – The Complete Interrogation of the Gland

Nelson N. Stone, MD, argues that performing prostate biopsies is beneficial for detecting malignancies and lesions and cannot be replaced by MRI, despite controversies. He describes the transperineal mapping biopsy (TPMB) procedure, the inadequacies of current technology, targeted focal therapy, and future directions in these techniques.

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An Overview of MRI Guided Biopsies for Prostate Cancer

Robert Abouassaly, MD, argues that the DECIPHER marker is not an ideal test for predicting patient’s response to chemotherapy. He cites the inconclusiveness of trials and research and the cost inefficiency of this biomarker. Also, he explains that the DECIPHER test’s classification system is based on RNA expression profiles, and not meant for therapeutic guidance. This is a counter argument to Alan H. Bryce’s lecture, “The DECIPHER Marker Can Predict Chemotherapy.” 

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