2022 Archives

The Role of Legislation in Innovation and Inequality in Medicine

Posted by Gregory F. Murphy, MD | Jul 2022

Congressman Gregory F. Murphy, MD, a practicing urologist and the Representative from North Carolina’s 3rd District, speaks with E. David Crawford, MD, concerning the federal approval process for new medical treatments and racial inequality in medicine. The two note that prior to the Covid-19 vaccine it could take a long time to get a treatment approved, and that the Covid-19 vaccine set a new precedent for timelines where medical treatments can reach the general population. Next, Rep. Murphy discusses racial inequity in medicine, specifically how he believes medicine has become an instrument for politics. He states that the focus should be on patients getting the treatment they need, as well as allowing an open opportunity for qualified candidates to get into medical school and enter the profession. Rep. Murphy also discusses his belief that public faith in medicine has plummeted since the Covid-19 pandemic. Rep. Murphy continues by stating that due to the tragedy of the Tuskegee vaccine issues, the black community has a lot of reluctance getting vaccines. Both agree that it is important to remove politics from medicine and for politicians to work on issues in medicine in a bipartisan manner.

Active Surveillance 2022: Who Qualifies, Who Does Not and How Should it be Monitored

Posted by Laurence Klotz, MD, FRCSC | Jul 2022

In this 12-minute presentation, Laurence Klotz, MD, Professor of Surgery at the University of Toronto and the Sunnybrook Chair of Prostate Cancer Research, outlines recent progress in active surveillance (AS), highlighting molecular genetics of GG1 vs. higher grade cancers, patient selection, germline testing, imaging, biomarkers, predictive nomograms, modeling, long-term outcomes, follow-up strategies, the tumor microenvironment, and dietary modifications. Dr. Klotz summarizes current AS follow-up strategy and explains that an emerging strategy is dynamic risk profiling with accurate biomarkers that will replace most serial biopsies.

AUA Urethral Stricture Guideline Review

Posted by John Thomas Stoffel, MD | Jul 2022

John Thomas Stoffel, MD, Associate Professor of Urology and Chief of the Division of Neurourology and Pelvic Reconstruction within the University of Michigan Department of Urology in Ann Arbor, Michigan, reviews the 2016 American Urological Association (AUA) Urethral Stricture Guideline, focusing on diagnosis & initial management, dilation & internal urethrotomy, as well as managing longer strictures with urethroplasty.

Bone Health and ADT

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.

Racial Justice and Prostate Cancer

Posted by Christopher J. Kane, MD, FACS | Jul 2022

Christopher J. Kane, MD, FACS, the Dean of Clinical Affairs at the University of California San Diego School of Medicine, and the CEO of the UC San Diego Health Physician Group, discusses the role of race in prostate cancer mortality among Black men. Dr. Kane presents data showing that both the incidence and rate of death from prostate cancer are significantly higher in Black men, and that this ratio has remained consistent over time. Referencing the SEER database, Dr. Kane notes that Black men were twice as likely to die of prostate cancer. While there are claims that biologic differences between Black and White men are to blame for the rate of death, Dr. Kane points out that the genetic differences between Black men are similar to the genetic difference between White men. He further adds that inheritance patterns of Black Americans are highly variable and cannot be considered a homogenous biological construct. Beyond genetic factors, Dr. Kane mentions other possible causes for the disparity including environmental factors, care dynamics, care quality, and availability. He then reviews a study that analyzed three cohorts to determine whether Black race was associated with inferior prostate cancer outcomes if patients had similar access to care and standardized treatment. The results indicate that Black men were not at higher risk of prostate cancer mortality when they had access to better healthcare. He concludes that physicians can save nearly 4,000 Black men who would otherwise die of prostate cancer each year. Regardless of potential factors impacting disease risk and progression in Black men, Dr. Kane maintains that providing superb screening, detection, and treatment can reduce the observed racial difference in prostate cancer outcomes.