2021 Archives

Androgen Society 3rd Annual Meeting Review (Day 3)

Posted by Abraham Morgentaler, MD, FACS | Jun 2021

Abraham Morgentaler, MD, FACS, Associate Clinical Professor of Urologic Surgery at Harvard University, reviews day three of the 3rd annual meeting of the Androgen Society, an international organization consisting of healthcare professionals interested in testosterone deficiency and its treatment. The day began when Martin Miner, MD, and Jean-Paul Deslypere, MD, PhD, debated the correct threshold for diagnosing testosterone deficiency, ultimately concluding that the lower the T level, the better. Dr. Desylpere then discussed the role of active metabolites of testosterone in manhood, specifically the importance of testosterone in developing structural and functional characteristics of the sex. Hugh Jones, MD, followed with an analysis of androgen receptor sensitivity and its implications for clinical disorders and mortality. Abdulmaged Traish, PhD, then presented on whether or not age-related testosterone deficiency should be treated, respectfully disagreeing with the FDA’s position on not treating men with age-related hypogonadism. Martin Miner, MD, then looked at the relationship between testosterone and mood, depression, and dementia. Next, David Sullivan, MS, PhD, shared information about the preventative effect of androgens on dry eyes. Ernani Rhoden, MD, spoke on testosterone and gynecomastia before engaging in a debate on whether testosterone therapy may be used as monotherapy treatment of erectile dysfunction. The day concluded with a discussion by Dr. Morgentaler on testosterone, science, and human dignity that stemmed from his experiences with patients wanting testosterone therapy despite the impact on their life expectancies out of a desire to improve their quality of life.

Screening and Prevention of Prostate Cancer 2021 (Part 1): Evidence for PSA Screening

Posted by Sigrid V. Carlsson, MD, PhD, MPH | Jun 2021

In part 1 of a 3-part series, Sigrid V. Carlsson, MD, PhD, MPH, Assistant Attending Epidemiologist at Memorial Sloan Kettering Cancer Center, looks at the evidence supporting widespread prostate specific antigen (PSA) screening. She looks at a range of large studies with long follow-up that demonstrate a reduction in prostate cancer mortality of approximately 30% as a result of widespread PSA screening. Dr. Carlsson also looks at how PSA screening decisions can be made by taking other risk factors into account in order to minimize unnecessary testing. She also notes that the loss in quality-adjusted life years somewhat offsets the benefits of widespread screening. She concludes by introducing her 5 Golden Rules of testing to keep the benefits and reduce the harms.

Does Anatomic Rectal Displacement Improve Dosimetry and Reduce Injury?

Posted by Richard G. Stock, MD | May 2021

Richard G. Stock, MD, Professor of Radiation Oncology and Director of Genitourinary Radiation Oncology at the Icahn School of Medicine at Mount Sinai in New York City, reviews the literature on rectal displacement to prevent damage to the rectum from prostate brachytherapy and external beam radiation therapy (EBRT). First, he summarizes the findings of numerous papers from the past 20 years that have identified a relationship between the dose and volume of radiation and damage to the rectum such as bleeding and mucosal changes. The more radiation reaches the rectum, and the greater the surface area of the rectum affected, the more likely patients will experience adverse effects, including greater levels of morbidity. Dr. Stock then considers how the rectum can be spared, focusing on the evidence around rectal spacers such as endorectal balloons and hydrogel spacers such as SpaceOAR. He explains that numerous studies demonstrate that by inserting a physical barrier between the rectum and the prostate, the rectum is kept separate from the radiation and therefore receives a lower rate of toxicity. Dr. Stock notes that patients experience more rectal discomfort with spacers like SpaceOAR than without, but suggests that the reduction of significant issues such as bleeding outweigh the downsides. He concludes by discussing a recent study of his which found that SpaceOAR can be inserted before brachytherapy and EBRT.

Androgen Society 3rd Annual Meeting Review (Day 2)

Posted by Abraham Morgentaler, MD, FACS | May 2021

Abraham Morgentaler, MD, FACS, Associate Clinical Professor of Urologic Surgery at Harvard University, reviews the second day of the 3rd annual meeting of the Androgen Society, an international organization consisting of healthcare professionals interested in testosterone deficiency and its treatment. The day began with presentations on testosterone therapy and type 2 diabetes by Gary Wittert, MD, Hugh Jones, MD, and Farid Saad, MD. These presenters suggested that testosterone could lead to remission of diabetes mellitus, potentially prevent diabetes, and improve glycemic control. They were followed by a presentation on testosterone, anemia, and hematocrit by Sudarshan Ramachandran, PhD, one on COVID-19 and testosterone by Mary Samplaski, MD, and a panel discussion on testosterone’s impact on prostate cancer. Mohit Khera, MD, presented on the possibility of testosterone therapy performing a protective and/or therapeutic role against prostate cancer. Sharon Parish, MD, and Leah Millheiser, MD, presented on testosterone therapy for women and how it benefits sexual function. The day concluded with a presentation by Daniel Kelly, MD, on the complex, context-dependent relationship between testosterone and atherosclerosis.

Transrectal mpMRI Fusion Biopsy

Posted by Leonard S. Marks, MD | May 2021

Leonard S. Marks, MD, Professor and inaugural holder of the deKernion Chair in Urology at the David Geffen School of Medicine at the University of California, Los Angeles, shares lessons from the first decade of transrectal multiparametric (mp) MRI fusion prostate biopsy at UCLA. Dr. Marks explains that while fusion biopsy of the prostate has been available since 2009, the AUA only endorsed it in 2020, and very few institutions have as much experience with it as UCLA, which assembled a multidisciplinary team for its first Artemis fusion biopsy unit in 2010. Dr. Marks follows this history with a brief summary of the fusion biopsy process, emphasizing the importance of having quality MRI and involving a radiologist and a pathologist, and noting that UCLA’s system is so efficient that they are able to perform approximately 15 of these procedures per week. He then goes over key lessons the UCLA team has learned from its first 4,000 fusion biopsies, which include: (1) targeted sampling of MRI lesions using PI-RADS is necessary; (2) systematic sampling is important for finding invisible lesions; (3) tracking of prior biopsy sites is extremely helpful in detecting upgrades; (4) MRI lesions do not necessarily indicate what the pathology is; and (5) fusion biopsy provides better security than ultrasound biopsy in predicting final pathology . Dr. Marks concludes by remarking on the advantages of the transrectal versus the transperineal approach, arguing that sepsis is easily preventable, patients find the transrectal approach more comfortable, and transrectal fusion systems are more mature.