2022 Archives

PCa Commentary | Volume 164 – April 2022

Posted by Edward Weber, MD | Apr 2022

This Commentary looks at an emerging management trifecta for recurrent prostate cancer: PSMA PET, oligometastatic cancer & focal therapy.

Off-Label Use of Xiaflex for Peyronie’s Disease

Posted by Jesse N. Mills, MD | Apr 2022

Jesse N. Mills, MD, Associate Clinical Professor and Director of the Men’s Clinic at UCLA, discusses techniques for Xiaflex on and off label, and when and how it can be used to treat Peyronie’s disease. These include alternative injection techniques, plaques involving the penile urethra, use for men on anticoagulation treatments, and non-goniometric deformity.

Cancer Control in 1379 Men Undergoing HIFU: A Multi-institute 15-year Experience

Posted by Mark Emberton, MD, FRCS | Apr 2022

Mark Emberton, MD, FRCS, Professor of Interventional Oncology at University College London, summarizes the design and findings of a 15-year multi-institute study of high-intensity focused ultrasound (HIFU) in patients with nonmetastatic prostate cancer. After an introduction from E. David Crawford, MD, Professor of Urology at the University of California, San Diego, and Editor-in-Chief of Grand Rounds in Urology, Dr. Emberton notes that the results of this 15-year study resulted in a wave of positive press about HIFU in popular outlets, observing that this widespread enthusiasm is due not just to HIFU’s efficacy, but its safety and adverse event profile as well. He then details the design of the study, beginning with the patient profile. Noting that outcomes in prostate cancer treatment are largely dependent on the risk profile of the patient, Dr. Emberton explains that in this study the average patient age was 66, ⅕ of patients had a PSA greater than 10, the average prostate volume was relatively low, the majority of patients were Gleason 3+4, and the majority of patients were T2. He mentions that intervention varied, and that while the majority of patients had quadrant ablation, about ⅓ had hemiablation. Dr. Emberton then considers the outcomes, observing that the “headline” of the study was the 83% 5-year failure-free survival for intermediate-risk disease. He also highlights that only 0.5% of patients experienced greater than 2 adverse events. Dr. Emberton discusses some supplementary data, emphasizing that if a clinician commits to HIFU, they also commit to retreating a subset of patients. He concludes that HIFU is very safe and that the data suggests that the majority of eligible patients with intermediate-risk disease can defer or avoid radical therapy with HIFU.

The Future of Medical Marketing

Posted by Neil H. Baum, MD | Apr 2022

Grand Rounds in Urology Contributing Editor Neil H. Baum, MD, Professor of Urology at Tulane Medical School, gives 8 suggestions for marketing and promoting a medical practice in 2022. He begins by saying that old methods of promotion are no longer effective since the internet has “leveled the playing field” and patients now have as much information as physicians. Dr. Baum then lists his suggestions, starting with embracing telemedicine, which he says provides safe and effective care while allowing practices to reach new and untapped markets. Next, he recommends using video marketing, since people are 4 times more likely to watch a video than read an article, and search engine optimization (SEO) algorithms prioritize video content. Dr. Baum also suggests using psychographic marketing which, unlike demographic marketing, identifies the attitudes and mindsets of patients. He follows this by recommending a focus shift from illness to wellness, explaining that the current healthcare system focuses on symptoms and illness and is inherently reactive, while a wellness-focused practice is proactive and able to identify early transitions from wellness to disease. Dr. Baum then considers the benefits of personalized marketing and personalized medicine, highlighting the utility of the right patients receiving the right messages. He brings up the use of virtual assistants, noting that tools like Amazon’s Alexa can conduct various healthcare tasks, from tracking glucose levels to helping patients with parking at the office. Dr. Baum’s final marketing and promotion tips include carefully managing a practice’s online reputation, and embracing artificial intelligence in healthcare marketing. He notes that a practice’s marketing budget should be about 3-5% of gross revenues, and he suggests getting marketing assistance from firms with medical experience. Dr. Baum concludes that if practices want to be around in 3 to 5 years, they should consider implementing a few of these ideas.

Private Equity and Value-Based Care: Is There a Future?

Posted by Edward S. Cohen, MD | Apr 2022

Edward S. Cohen, MD, CEO of Genesis Healthcare Partners in San Diego, California, looks at how private equity can help independent urology practices provide value-based care and remain financially viable. He begins by emphasizing the importance of value-based care, noting that the United States currently spends more on healthcare than any other country, and does not get the best value for the money spent. Dr. Cohen also observes that Medicare’s value-based payment model trajectory is supposed to get to capitation, meaning that practices will not be paid for how many procedures they perform but for how many patients they manage. He then considers the various difficulties facing independent practice, such as increasing difficulty in remaining viable, increasing cost of doing business, the need to have other income streams to maintain viability, and the need to be competitive with the employed physician market. Dr. Cohen argues that independent practitioners need a “seat at the table,” and he suggests that private equity is a good, viable way to do so. He claims that private equity can provide capital, improve management, help with expansion of ancillary revenue streams, allow for consolidation, and provide leverage in the community, all while allowing independent private practice to maintain its identity. Dr. Cohen stipulates that practices need to find the right partner with an aligned vision, but argues that when practices and private equity form good partnerships, they can help independent practice thrive and form a counterbalance to large hospitals.