2022 Archives

The Wild, Wild West of Radiation Oncology: An Update on Radiation Tools, Toys and Trials

Posted by Peter F. Orio III, DO, MS | Jul 2022

In this 12-minute presentation, Peter F. Orio III, DO, MS, Vice Chair of Network Operations for Dana-Farber/Brigham and Women’s Cancer Center Department of Radiation Oncology and Associate Professor of Radiation Oncology at Harvard Medical School in Boston, Massachusetts, explains prostate brachytherapy is effective, efficient, and convenient, and he says it is “the right thing to do for patients.” He sees a threat to patients posed by radiation oncology without brachytherapy and concludes by encouraging urologists to explore a broad range of treatments to maximize the benefit to patients.

The Urinary Microbiome and Prostate Disease

Posted by J. Curtis Nickel, MD, FRCSC | Jul 2022

In this 17-minute presentation, J. Curtis Nickel, MD, FRCSC, the Canada Research Chair in Urologic Pain and Inflammation and Professor of Urology at Queen’s University in Kingston, Ontario, discusses recent research on the relationship between prostate cancer and the male urinary tract microbiome.

Forward Progress in Molecular Markers in Prostate Cancer

Posted by Matthew R. Cooperberg, MD, MPH | Jul 2022

Matthew R. Cooperberg, MD, MPH, Professor of Urology and Epidemiology & Biostatistics and Helen Diller Family Chair in Urology at the University of California, San Francisco, explores a range of biomarkers used for diagnosis, risk stratification, and guiding treatment for prostate he cancer. He first details pre-biopsy diagnosis or prostate cancer, including PSA, 4K, phi, MyProstateScore, ExoDX, SelectMDx, and mpMRI. Dr. Cooperberg discusses how post-diagnosis biomarkers must be shown to improve on an existing, validated, multivariable model reflecting all available clinical information rather than on a single variable or nonlinear risk grouping, and reviews post-diagnosis options for risk stratification and treatment.

The Surge of Male Mortality

Posted by Martin M. Miner, MD | Jul 2022

Martin M. Miner, MD, Co-Director of the Men’s Health Center and Chief of Family and Community Medicine for Miriam Hospital, and Clinical Professor of Family Medicine and Urology at the Warren Alpert Medical School of Brown University in Providence, Rhode Island, discusses differences in mortality and life expectancy based on sex. He states that in most countries, males have shorter life spans than females. He then reviews the hypotheses for why males tend to have shorter life spans, including higher rates of cigarette smoking and drinking, which can lead to increased risk of heart disease. Dr. Miner reviews a research article stating that heart disease is the major condition associated with excess male mortality in the twentieth century. He determines that obesity is the most modifiable factor in cardiovascular disease and can be treated with a weight-centric approach, and weight loss treatment plans. He explains that the findings from the STEP trials with semaglutide show similar levels of weight loss to those presently attained with bariatric surgery. Lastly, he considers PDE5i therapy, which he explains may provide cardioprotective effects to improve survival with cardiovascular disease in males.

ADT and Cognitive Health

Posted by Mark A. Moyad, MD, MPH | Jul 2022

Mark A. Moyad, MD, MPH, the Jenkins/Pokempner Director of Preventive/Complementary and Alternative Medicine (CAM) at the University of Michigan Medical Center in the Department of Urology in Ann Arbor, Michigan, interviews Celestia S. Higano, MD, FACP, Adjunct Professor in the Department of Urologic Sciences at the University of British Columbia and Medical Director of the Prostate Cancer Supportive Care Program at the Vancouver Prostate Centre, about the importance of dual-energy X-ray absorptiometry (DEXA) screening to preserve bone health in men initiating androgen deprivation therapy (ADT). Dr. Moyad begins by highlighting the findings of an article recently published in JAMA which showed that while DEXA screening was associated with a decreased risk of osteoporotic fracture, only 7.9% of older men starting ADT received this screening. Dr. Moyad argues that this demonstrates that while many focus on calcium and vitamin D deficiency as the causes of bone issues in men on ADT, the real deficiency is in DEXA screening. Dr. Higano concurs, explaining that the only good way to monitor bone density in men on ADT is to get a baseline, and noting that every patient in her practice undergos DEXA screening before initiating ADT unless they are on a bone health agent already. She also mentions that she performs a repeat DEXA after a year. Dr. Moyad then considers whether quantitative computed tomography (QCT) is a reasonable alternative to DEXA, arguing that it is not since it is more expensive, uses a lot of radiation, and overestimates bone health issues. Dr. Higano agrees, observing that QCT was designed as a research tool rather than a diagnostic one, while DEXA is the “gold standard” in this area. They then hypothesize that some clinicians are switching from DEXA to QCT because of higher reimbursement rates. Drs. Moyad and Higano conclude by underscoring that wider DEXA screening is the most significant change needed to preserve bone health in men on ADT.