2021 Archives

Recalculating Route: Options Besides Clinical Urology

Posted by Neil H. Baum, MD | May 2021

Grand Rounds in Urology Contributing Editor Neil H. Baum, MD, Professor of Urology at Tulane Medical School, discusses alternative careers for clinical urologists seeking to switch paths. He lists factors that can lead to a departure from clinical practice and provides five examples of career options that effectively utilize a urologist’s skillset. Dr. Baum highlights decreased reimbursements, increased overhead costs, loss of autonomy, and other pain points like burnout as some of the key reasons why clinical practice may lose its appeal. He then describes alternative careers such as medical educator, pharma and medical manufacturing, legal advisor, healthcare appraiser, or medical writer. For example, a physician may have an opportunity to teach internationally or provide legal advice to defense attorneys in malpractice claims or by serving as an expert witness. Dr. Baum concludes that physicians who leave clinical practice can apply their experience in a variety of ways.

Management of Recurrent Prostate Cancer After Focal Therapy

Posted by Kelly L. Stratton, MD | May 2021

Kelly L. Stratton, MD, Assistant Professor of Urologic Oncology in the University of Oklahoma (OU) Department of Urology in Oklahoma City rationalizes the implementation of Focal Therapy despite chances of recurrence and discusses salvage therapy. He characterizes Focal Therapy as an option between radical treatment and active surveillance, which preserves quality of life. The perfect candidate is hard to achieve, according to Dr. Stratton, due to the rarity of a patient with intermediate-risk cancer, lesion localization, intact erections, and minimal urinary tract symptoms; however, he states that the ideal candidate doesn’t have to be perfect. Dr. Stratton overviews the two main types of recurrence: in-field recurrence and contralateral recurrence, through patient examples, which display how recurrence may occur post Focal Therapy and the abilities of high intensity focused ultrasound, prostatectomy, and cryoablation as salvage therapies. A multicentre study of five year outcomes post Focal Therapy found a failure free survival rate of 88% with 25% of patients having had undergone retreatment, data that Dr. Stratton states to suggest a need for providers to openly discuss the chances of repeat focal therapy against having a more aggressive treatment. He reviews data that supports implementation of Focal Therapy and displays the impact of different salvage therapies. Dr. Stratton concludes by stating that Focal Therapy’s success requires adherence to the principles of active surveillance, follow-up biopsies, and a willingness to provide definitive local therapy when focal treatment fails.

The TRANSFORMER Study: Bipolar Androgen Therapy vs. Enzalutamide in Asymptomatic Men With mCRPC

Posted by Samuel R. Denmeade, MD | May 2021

E. David Crawford, MD, Editor-in-Chief of Grand Rounds in Urology and Professor of Urology at University of California, San Diego discusses the TRANSFORMER study and bipolar androgen therapy with Samuel R. Denmeade, MD, Professor of Oncology and Urology at Johns Hopkins University and co-leader of the Prostate Cancer Program for the Johns Hopkins Kimmel Cancer Center. Dr. Denmeade presents the study results, outlines the conceptual background, and notes the benefits of bipolar androgen therapy. TRANSFORMER compared enzalutamide with bipolar androgen therapy, a treatment in which testosterone levels are oscillated between low and high levels in order to prevent the adaptation of prostate cancer cells to a low-androgen environment. Results indicate that while bipolar androgen therapy may not have superior progression free survival rates when compared with enzalutamide, it can improve patient response to enzalutamide, suggesting that further research on sequential treatment is warranted. Notably, some men undergoing bipolar androgen therapy experienced a return in sexual function and also better physical functioning which contributed to improved quality of life.

Can One Biopsy Event Determine Type and Amount of Focal Therapy Treatment?

Posted by Nelson N. Stone, MD | May 2021

Nelson N. Stone, MD, Professor of Urology, Radiation Oncology, and Oncological Sciences at the Icahn School of Medicine at Mount Sinai and at the Derald H. Ruttenberg Cancer Center at Mount Sinai argues for the use of Transperineal Mapping Biopsy (TPMB), and against the use of strict criteria and cursory cancer identification methods for finding Focal Therapy eligible patients. He expresses a clinical need for a process that identifies Focal Therapy candidates and lists which portions of the prostate require treatment. He suggests that TPMB can fulfill these goals. Dr. Stone summarizes a review of the evidence for using focal therapy for the treatment of prostate cancer and found that despite at least 50% of patients being Focal Therapy eligible only a minority of patients actually receive the therapy. He critiques a study on Focal Therapy eligibility determined by MRI/US fusion biopsy on the basis of using too strict of criteria for selecting patients and in consideration of the possibility of missing many patients due to not using a biopsy. Dr. Stone discusses several other studies that depict MRI as unreliable in accurately identifying Focal Therapy patients compared to TPMP due to the lower accuracy of MRI across the prostate.

One-Page Marketing Plan for a Urology Practice (Part 3 of 3)

Posted by Neil H. Baum, MD | May 2021

In the third part of his series on urology practice marketing strategies, Grand Rounds in Urology Contributing Editor Neil H. Baum, MD, Professor of Urology at Tulane University, discusses the result of successful prospecting and conversion as well as how to cultivate “raving fans” of a practice. After converting leads to patients, it is critical to create an exceptional customer experience. To do so, Dr. Baum emphasizes reducing “pain points” in a practice, such as patients completing duplicate demographic forms and excessive waiting prior to an appointment. He suggests calculating the total time a patient spends in the office versus the time spent with the doctor. Dr. Baum advises leaving one to two time slots open every day to account for inevitable delays. Another helpful tool is to provide each patient with a card for writing down three questions they want to be answered and responding to a brief feedback survey. This simple system allows the doctor to finish consultations on time and ensures patients receive the information they need, with the added benefit of conveying their customer experience. Dr. Baum then describes how increasing customer value translates into a stellar patient experience and ultimately into ambassadors for the practice.