2022 Archives

Physics of HDR Brachytherapy for Urologists

Posted by Firas Mourtada, MSE, PhD, DABR | Sep 2023

Firas Mourtada, MSE, PhD, DABR, discusses the physics of high-dose rate (HDR) brachytherapy in this talk sponsored by the American Brachytherapy Society (ABS). Dr. Mourtada enumerates prostate cancer treatment options before identifying HDR brachytherapy as the ultimate approach for dose escalation, asserting that with image guidance, HDR for prostate can be implemented safely and result in an increase in biochemical disease-free survival.

Dr. Mourtada describes the advantages of HDR brachytherapy technology and illustrates how brachytherapy delivers high dose within the prostate, with less dose to surrounding normal tissue. He enumerates advantages such as bringing the source close to the target, using inverse-planning, and the potential for high-efficacy combined with lower-risk of toxicity or secondary malignancy.

Dr. Mourtada reviews common radionuclides in brachytherapy before defining HDR and addressing methodology, workflow, and equipment involved in using transrectal ultrasound (TRUS) for prostate brachytherapy. He explains the feedback loop and illustrates the iterative contouring and reconstruction of the gland that takes place during this workflow and the optimization settings involved.

Dr. Mourtada turns to radiation safety, emphasizing the importance of time, distance, and shielding and citing regulatory radiation safety programs, ALARA (as low as reasonably achievable,) and QMP (Quality Management Program.) He reviews radiation terminology and emphasizes the importance of radiation dosimeters and required radiation area signs.

Dr. Mourtada then concludes that prostate HDR with real-time image guidance provides high-quality implants with an efficient process using inverse planning, HDR radiation exposure is minimal due to the afterloading technology and ALARA controls, and quality management steps are essential to providing high-quality HDR implants.

Results from the TRAVERSE Trial

Posted by Mohit Khera, MD, MBA, MPH | Aug 2023

Mohit Khera, MD, MBA, MPH, provides an update on the results of the landmark TRAVERSE Trial, which examined the potential cardiovascular effects of testosterone therapy in men. After reviewing the complex recent history and controversies surrounding testosterone therapy, Dr. Khera walks through the TRAVERSE Trial, a randomized, double-blind, placebo-controlled study of over 5,000 hypogonadal men who either had cardiovascular disease (CVD), or were at increased risk for CVD over 5 years.

Dr. Khera highlights the thoroughness of the trial’s design, giving special focus to the primary, secondary, and tertiary endpoints relating to any MACE events for the trial participants. He concludes by presenting the results of the trial; testosterone therapy, for a mean duration of 22 months, did not increase the risk of major cardiovascular events in hypogonadal men over 40 years old with previous CVD or elevated risk for CVD.

Nonverbal Communication

Posted by Neil H. Baum, MD | Jul 2023

Grand Rounds in Urology Contributing Editor Neil H. Baum, MD, Professor of Urology at Tulane Medical School, discusses 14 practical tips to enhance body language skills for stronger connections and improved patient care. Drawing from his vast experience, Dr. Baum highlights the remarkable correlation between effective communication skills and enhanced patient satisfaction scores, improved compliance, and potentially superior outcomes. He underscores the fact that a significant portion of human interaction is conveyed through nonverbal means, emphasizing the crucial role of body language in conveying genuine emotions and establishing a profound connection with patients.

Throughout the presentation, Dr. Baum provides practical advice to healthcare professionals, cautioning against common distractions such as diverting attention to computers or cell phones during patient encounters. Dr. Baum highlights the impact of simple yet powerful gestures like smiling and employing a firm handshake. By emphasizing the importance of respecting personal space, healthcare providers can also create a comfortable and secure environment for patients. By implementing the suggested tips, practitioners can enhance their ability to connect with patients, foster trust, and ultimately improve the doctor-patient relationship, resulting in more positive healthcare experiences for all parties involved.

Implications of the FDA Approval of Combination Talazoparib & Enzalutamide Therapy

Posted by Neeraj Agarwal, MD | Jul 2023

Dr. E. David Crawford and Dr. Neeraj Argawal, MD, FASCO, discuss the recent FDA approval of Enzalutamide combined with Talazoparib. In this discussion, they examine a Phase 3 trial comparing Enzalutamide and Talazoparib versus Enzalutamide alone on mCRPC patients.

The results of the trial yielded significant differences in the outcomes between the Enzalutamide and Talazoparib combination arm and the Enzalutamide-Only arm. 37% decrease in the risk of progression or death was observed in the combination arm of the trial. In patient populations with tumors containing HRR mutations, the risk of progression or death was decreased by 55%.

Following its recent FDA approval, Dr. Crawford and Dr. Argawal discuss the clinically appropriate populations for Enzalutamide and Talazoparib combination therapy, the process of diagnosis, and the limitations of the therapy. Dr. Argawal emphasizes the necessity of germline testing in identifying predispositions to mCRPC patients and their families.

Dr. Crawford and Dr. Argawal conclude by examining the time to PSA progression in the two trial arms. In the Enzalutamide-Only arm of the trial, average time to progression was 11 months, whereas time to progression in the Combination arm was 28 months. They recognize that the overall survival data is immature at this time, but recognize that short-term benefits of combination therapy for this patient population are significant across the board.

NMIBC Trials for BCG Naive Patients: What is Exciting

Posted by Joshua J. Meeks, MD, PhD | May 2023

Joshua J. Meeks, MD, PhD, Associate Professor of Urology, Biochemistry and Molecular Genetics at the Northwestern University Feinberg School of Medicine in Chicago, IL, provides insights into the latest advancements in bladder cancer research. He highlights the potential of large-scale clinical trials and the role of immunotherapy in shaping future treatment strategies. The North American trial, with a thousand patients, offers numerous opportunities to explore new treatment modalities. Additionally, the Bridge study led by Max Kate examines the efficacy of gemcitabine docetaxel compared to the standard BCG treatment. Despite initial skepticism, the trial presents promising results that may offer an alternative for patients who cannot access BCG. Dr. Meeks emphasizes the importance of identifying the patient population that would benefit most from checkpoint immunotherapy and coordinating care effectively.

He discusses ongoing trials that investigate the synergy between immunotherapy and BCG, the possibility of using less BCG, and the introduction of a Sub-Q delivery system. The Sunrise trials, TAR 200, and the Danish study DaBlaCa all hold potential in improving treatment outcomes for bladder cancer patients. Dr. Meeks concludes by highlighting the transformative impact of the Terra system, a device that delivers gemcitabine consistently and may revolutionize bladder cancer treatment. Overall, this comprehensive summary underscores the significant advancements and future prospects in bladder cancer research.