2022 Archives

The Elevator Speech: Getting Your Point Across in Thirty Seconds

Posted by Neil H. Baum, MD | Jan 2022

Grand Rounds in Urology Contributing Editor Neil H. Baum, MD, Professor of Urology at Tulane Medical School, discusses elevator speeches and explains how physicians can use them to effectively advertise their practice to potential patients and business partners. He defines an elevator speech as a way to tell your professional story in 30 seconds. Dr. Baum states that, due to the fact that first impressions are established in less than seven seconds, elevator speeches are effective thanks to their short length. He recommends beginning an elevator speech with a 7-10 word headline to grab a listener’s attention, and following up with an explanation of how you will achieve the promise in your headline. Dr. Baum suggests ending an elevator speech with a 1-3 sentence success story that is customized to your listener’s needs and makes them want to invest more time with you. He concludes that elevator speeches provide a great opportunity to connect with potential patients and that a good elevator speech will capture the listener’s attention.

Point-Counterpoint: Management of mCRPC (Con)

Posted by Alan H. Bryce, MD | Jan 2022

Taking the con position in a point-counterpoint debate, Alan H. Bryce, MD, Medical Director of the Genomic Oncology Clinic at Mayo Clinic Arizona in Scottsdale, makes an argument against treating metastatic castration-resistant prostate cancer (mCRPC) based on the differences between trial and real-world populations, and the challenges of extreme treatments. Dr. Bryce cites quality of life post-treatment, financial toxicity, and patient-centric treatment as cons of mCRPC treatment. He shows a graph of mCRPC treatment management in clinical practice and states that the rapid drop off after first-line therapy could be caused by patient drop outs instead of undertreatment. Dr. Bryce discusses the mCRPC treatment process in detail, focusing on how after the first line of therapy, treatment options become much more extreme and mostly consist of chemo, and most patients only have about a year left to live if they are beyond second-line treatment. He uses a case study of a 73-year-old patient to show how real-world patients can differ from selected trial patients due to how patient selection leads to optimized outcomes. Dr. Bryce reviews data showing that 20% of patients report financial toxicity, something which is associated with anxiety and depression. He concludes that clinicians should exercise prudent judgment in deciding whether or not to treat patients with advanced cancer due to trials testing beyond third-line therapy not reflecting real-world patients and financial toxicity being a significant issue.

MRI Guided Focal Laser Ablation

Posted by Aytekin Oto, MD, MBA | Jan 2022

Aytekin Oto, MD, MBA, Professor of Radiology and Surgery and Chair of the Department of Radiology at the University of Chicago, discusses MRI guided focal laser ablation for prostate cancer including challenges and future considerations. He first describes the benefits, technique, and trial data showing 1-year, 3-year, and 5-year follow up. Focal laser ablation is minimally invasive and targets lesions while sparing surrounding tissue and preserving options for future treatment. Dr. Oto notes that the goal of this therapy is to replace surgery and radiation, but not active surveillance. Currently, MRI guided focal laser ablation is offered at five centers in North America, is conducted mostly transrectally, and is sometimes reimbursed by insurance. Dr. Oto identifies several key challenges to this therapy: lesion mapping, monitoring and planning while in procedure, and high local recurrence. He states the importance of considering other ultrasound guided procedures and notes that one of the limitations of MRI guided focal laser ablation is underestimating prostate volume. For this reason, he introduces hybrid multi-dimensional MRI that may help address this issue. Dr. Oto concludes that MRI guided focal laser ablation is both a safe and feasible treatment and underscores the importance of imaging in determining patient eligibility and accurate planning. Lastly, he adds that local recurrence must be addressed in long-term follow-up.

Standard Treatments and Global Perspective

Posted by Marc B. Garnick, MD | Jan 2022

Marc B. Garnick, MD, the Gorman Brothers Professor of Medicine at Harvard Medical School and the Beth Israel Deaconess Medical Center, summarizes recent developments in nomenclature, disease states, and standard treatments for advanced prostate cancer. Using material from a chapter he wrote for ASCO-SEP with David J. Einstein, MD, Assistant Professor of Medicine at Harvard Medical School, Dr. Garnick begins by considering the new language used to describe different states of advanced prostate cancer, including non-metastatic castrate-sensitive prostate cancer (nmCSPC), non-metastatic castrate-resistant prostate cancer (nmCRPC), metastatic castrate-sensitive prostate cancer (mCSPC), and oligometastatic prostate cancer. He then discusses new standards of care for these different states, highlighting recent research indicating the benefits of using darolutamide, enzalutamide, and apalutamide in the nmCRPC setting, and explaining how to appropriately layer and sequence therapies across disease states. He briefly looks at the role of next-generation sequencing in informing the potential benefit of PARP or PD-L1 inhibitors and touches on bone considerations in mCRPC. Dr. Garnick concludes with some comments on the global inequities of prostate cancer treatment, citing data on the significant disparity in mortality-to-incidence rate of prostate cancer in high-income countries compared to low- to middle-income countries.

Conducting Effective Staff Meetings

Posted by Neil H. Baum, MD | Jan 2022

Grand Rounds in Urology Contributing Editor Neil H. Baum, MD, Professor of Urology at Tulane Medical School, gives advice on how urologists can improve staff morale in their practices with effective staff meetings. He explains that a highly motivated staff is one of the pillars of a successful practice and argues that the purpose of staff meetings is to get staff feedback, identify problems, introduce new ideas, and enhance morale. Dr. Baum notes that key elements of running effective staff meetings include circulating an agenda, taking notes, preparing a to-do list, and sending out notes within a day or two of the meeting. He particularly focuses on the importance of bringing “sparkle” to staff meetings by, for example, having staff share the best things that have happened to them in the practice since the previous meeting, or by acting out relevant scenarios. Dr. Baum emphasizes providing an environment that is fun, rather than an environment where everyone is moving from one crisis to the next. He also gives suggestions on how to improve performance reviews, recommending that urologists try to do one with each staff person every three to four months and have them complete a worksheet with questions about their goals before each review. Dr. Baum also suggests periodically surprising staff with fun activities to show appreciation. His bottom line is that by taking good care of staff, a urologist ensures that staff will take outstanding care of patients.