2021 Archives

Focal Therapy Compared to Radical Prostatectomy

Posted by David Utz | May 2021

Steven N. Gange, MD, FACS, Director of Research and Education at Granger Medical Clinic/Summit Urology Group, reviews a propensity score-matched study comparing focal therapy (FT) for localized prostate cancer to radical prostatectomy (RP). Dr. Gange explains that, until now, this information has never been reported, as randomized controlled trials (RCTs) comparing RP to FT methods such as high-intensity focused ultrasound (HIFU), brachytherapy, or cryotherapy have historically failed to enroll and could be considered unethical given the disparity of risk. By using propensity score matching, the researchers for this study roughly simulated an RCT by selecting patients with matching entry criteria from a diverse dataset, ultimately testing 246 patients on each respective side. The primary outcome was failure-free survival, and Dr. Gange notes that at 3, 5, and 8 years the results were similar for both cohorts. Each cohort also had similar biochemical and histopathological outcomes. Dr. Gange concludes that this appears to be a reasonable comparison between RP and FT, but observes that there are some limitations to the study, including an inability to account for confounding variables and to adjust for baseline urinary and sexual function, as well as a lack of long-term outcomes.

Non-Invasive Molecular Imaging and its Impact on Management of the Localized Disease and Suspected Recurrence

Posted by Andrei H. Iagaru, MD, FACNM | May 2021

Andrei H. Iagaru, MD, FACNM, Professor of Radiology and Chief of the Division of Nuclear Medicine and Molecular Imaging at Stanford University, enumerates the applications of a dual radiopharmaceutical-targeted imaging approach using prostate-specific membrane antigen (PSMA) and gastrin-releasing peptide receptor (GRPR) in prostate cancer care. He explains that while PSMA-targeted PET imaging is more widely accepted, GRPR-targeted imaging may identify tumors that PSMA-targeted PET misses and vice versa. Therefore, combining the two can give clinicians a clearer understanding of the patient’s cancer. Dr. Iagaru suggests that the dual target approach can be particularly helpful in guiding biopsy decisions in patients with suspected prostate cancer, as well as in helping identify all lesions prior to local therapy with high-intensity focused ultrasound (HIFU) or brachytherapy. Using two targets can also sometimes allow clinicians to find more lesions prior to prostatectomy and pelvic lymph node dissection. He notes that targeting GRPR with 68Ga-RM2 can be particularly useful in patients with biochemical recurrence, since PSA velocity is higher in 68Ga-RM2 positive scans than in 68Ga-RM2 negative scans. Dr. Iagaru concludes by considering the potential of these two targets in theranostics, noting that phase 3 trials of theranostics with PSMA are awaiting results and that phase 1 and 2 trials of theranostics with GRPR are promising.

TheraP Trial and Effectiveness of Lu-PSMA-617

Posted by Daniel J. George, MD | May 2021

Daniel J. George, MD, Professor of Medicine and Surgery, Divisions of Medical Oncology and Urology at Duke University, comments on the TheraP trial that was presented at the 2021 GU ASCO conference. He reviews the results of the study, compares prior research, and discusses side effects of the treatment. The TheraP trial compared Lu-PSMA-617 against cabazitaxel in mCRPC patients with prior docetaxel chemotherapy. Dr. George contrasts this trial with the VISION study that analyzed patient response to abiraterone and enzalutamide during the chemorefractory setting, but which lacked a comparison to cabazitaxel. He emphasizes that the TheraP trial used two PET scans to identify PSMA-dominant tumors and excluded patients with FDG-positive tumors. This subset of patients was then assigned to either cabazitaxel or Lu-PSMA-617. Results showed increased progression-free survival as well as a decline in PSMA. Dr. George describes some of the side effects of Lu-PSMA-617 and concludes that it may be an optimal option, especially for patients with FDG-negative tumors.

One-Page Marketing Plan for a Urology Practice (Part 2 of 3)

Posted by Neil H. Baum, MD | Apr 2021

In the second part of his series on urology practice marketing strategies, Grand Rounds in Urology Contributing Editor Neil H. Baum, MD, Professor of Urology at Tulane Medical School, presents three elements of lead capture and conversion. For example, after giving a talk to a lay audience, Dr. Baum suggests collecting the names and contact details of these potential patients. Once these marketing leads have been captured, it is critical to nurture them through consistent follow-up. The most effective way to manage this with potential patients is by using a customer relationship management (CRM) database. While offering tokens like pens or notepads is commonplace, Dr. Baum instead recommends sending materials that distinguish the urologist or practice from competitors, such as articles that have appeared in local or national media or were published in professional journals. Finally, urologists need a conversion strategy that demonstrates their expertise to potential patients. If a doctor is a leading robotic surgeon, treats erectile dysfunction without medication or surgery, or provides other specialized services, these should be emphasized in their follow-up communication.

Pathologist’s Perspective on Focal Therapy

Posted by M. Scott Lucia, MD | Apr 2021

M. Scott Lucia, MD, Professor and Vice Chair of the Department of Pathology and Director of Anatomic Pathology of the Prostate Diagnostic Laboratory at the University of Colorado Anschutz Medical Campus (CAMC) School of Medicine reviews study data to help physicians decide which biopsy route is best when selecting patients for focal therapy. Using results from the SEER, PROMIS, and PRECISION studies, among others, he argues that TRUS biopsies are insufficient and miss too many high-grade tumors, while TTMP plus mpMRI guided biopsy appears to provide the most accurate results.