2024 Archives

Point Counterpoint: Is Focal Therapy Ready for Prime Time (Yes)

Posted by Ruben Olivares, MD | Feb 2025

Ruben Olivares, MD, emphasizes the growing momentum of focal therapy in prostate cancer management, urging clinicians to embrace its evolving philosophy. The 9-minute discussion highlights a shift from whole-gland treatment to strategies aimed at cancer control, progression delay, and preserving quality of life.

Dr. Olivares underscores the importance of tailored approaches, utilizing advanced imaging like MRI to localize aggressive lesions. Enhanced biopsy techniques and energy-based modalities offer new avenues for precise and effective treatments. Emphasizing the balance between oncological control and functional preservation, his talk highlights the need for proficiency and sufficient patient volumes to optimize outcomes. Focal therapy is presented as a safe, feasible, and effective strategy with excellent functional and medium-term oncological outcomes, marking it as a critical component of the evolving prostate cancer treatment paradigm.

Urodynamics Review

Posted by Stephen R. Kraus, MD, MBA, FACS | Feb 2025

Stephen R. Kraus, MD, MBA, FACS, provides a comprehensive review of urodynamics, discussing key concepts and practical applications in evaluating lower urinary tract function. This 14-minute presentation emphasizes the importance of understanding both the storage and emptying phases of bladder function.

Dr. Kraus details how dysfunction can arise from a bladder issue, an outlet problem, or both. Specific examples are given and complex cases are also included. Kraus notes results from various tests, such as those for stress incontinence, overactive bladder, and neurogenic bladder, help guide the use of urodynamics in clinical practice. He highlights the need for careful interpretation of test results to ensure accurate diagnosis and treatment planning.

Immunotherapy in Prostate Cancer

Posted by Sandy Srinivas, MD | Feb 2025

Sandy Srinivas, MD, delves into the potential and challenges of using immunotherapy as a treatment modality for prostate cancer.

Post-Vasectomy Pain Syndrome

Posted by Jeffrey C. Morrison, MD | Feb 2025

Jeffrey C. Morrison, MD, addresses post-vasectomy pain syndrome (PVPS) following vasectomy. In this 11-minute presentation, he highlights the significant challenge PVPS presents to patients and clinicians, emphasizing that a broad differential and comprehensive workup, including physical exams and diagnostic tests, is essential.

Although the cause of PVPS remains uncertain, Dr. Morrison discusses possible contributing factors, such as neuropathic, obstructive, or immune-driven etiologies. He presents treatments, both conservative approaches like scrotal support and anti-inflammatory medications, and options like neuromodulator therapy, pelvic floor physical therapy, and acupuncture.

Dr. Morrison also discusses treatment for those who require additional management, such as spermatic cord block, and surgical options, including microdenervation and vasectomy reversal.

Expanding Treatment Options at Ambulatory Surgical Centers: LDR Brachytherapy for Prostate Cancer

Posted by E. David Crawford, MD | Feb 2025

H1: LDR Brachytherapy for the Treatment of Prostate Cancer

E. David Crawford, MD, Professor of Urology, University of California, San Diego, California, Mira Keyes, MD, FRCPC, Clinical Professor Radiation Oncology, University of British Columbia, BC Cancer, Vancouver Cancer Centre, Vancouver BC, Canada, and Steven M. Kurtzman, MD, Director of Prostate Brachytherapy, Western Radiation Oncology, Mountain View, California, discuss low-dose rate (LDR) brachytherapy as a treatment for prostate cancer.

H2: Benefits of Brachytherapy for Prostate Cancer

Dr. Crawford explains that brachytherapy gets excellent results in prostate cancer patients across different risk and demographic groups, Gleason scores, and PSA levels. Dr. Keyes then shares the clinical rationale for performing LDR brachytherapy in ambulatory surgical centers (ASC).

H3: Prostate Cancer Treatment Strategies: Benefits of Brachytherapy on Different Risk Groups

Dr. Keyes explains that patients eligible for the low-dose rate brachytherapy, also referred to as seed implants, include all prostate cancer patients. She highlights that hormone treatment duration is significantly shorter when brachytherapy is included in the treatment plan. For example, in high risk prostate cancer patients, randomized controlled trials show that six months of androgen deprivation therapy (ADT) is enough when combined with brachytherapy. Avoiding 12 or 24 months of ADT, which is necessary when external beam radiation is utilized, helps decrease unwanted side effects for patients.

Finally, Dr. Keyes discusses toxicity in brachytherapy treatments and asserts that data cited on this topic often utilize older studies. Dr. Keyes emphasizes considering results from more recent publications.

H4: Expanding Treatment Options at Ambulatory Surgical Centers: LDR Brachytherapy for Prostate Cancer

Next, Dr. Kurtzman discusses how to set up high quality programs in ambulatory surgical centers and his opinion that LDR brachytherapy is an underutilized treatment for prostate cancer. He examines LDR brachytherapy’s high cure rates, low-long term complication rates, convenience for patients, financial benefits, and reasons LDR brachytherapy is not as prevalent.

Additionally, Dr. Kurtzman presents his strategy for bringing prostate brachytherapy programs to communities and reasons to perform it at ASCs, including fostering a genuine collaboration between urologists and radiation oncologists. Overall, he highlights how incorporating LDR brachytherapy into urology practices and ASCs fosters collaboration between urologists and radiation oncologists.

Conclusion

This 20-minute discussion concludes with Dr. Crawford’s comments on the importance of multidisciplinary care for better patient outcomes and strong interdisciplinary collaboration between urologists and radiation oncologists.

Appendix

Dr. Keyes also provided analysis of some recent studies that review:
Results showing 77% of patients in low and intermediate risk groups have PSA equal to or less than 0.2 five years after treatment with 1-2% recurrence, suggesting brachytherapy is very consistent with very low risk of prostate cancer recurrence
The ASCENDE RT trial that compared external beam radiation and LDR brachytherapy boat or dose-escalated external beam boost, and LDR boost in intermediate and high risk patients. Trial results showed a huge difference in PSA outcomes
If hormone treatment is needed for high risk prostate cancer patients who are also treated with external beam radiation with brachytherapy boost
Outcomes of intermediate and high risk patient groups treated with brachytherapy versus radical prostatectomy that showed positive outcomes for patients treated with brachytherapy, particularly in high risk groups
A study evaluating outcomes of patients with very high risk groups with Gleason 9 and 10 treated with prostate brachytherapy boost, external beam radiation, or prostatectomy. The study showed very favorable outcomes for patients treated with brachytherapy