2024

Gleason Scoring Has Served Us Well for More than 50 Years, But It Is Time to Start Afresh

Gleason Scoring Has Served Us Well for More than 50 Years, But It Is Time to Start Afresh

Posted by | Feb 2024

Andrew J. Vickers, PhD, discusses the weaknesses of Gleason scoring in diagnosing localized prostate cancer. Dr. Vickers begins by differentiating between Gleason “scoring” and Gleason “grading,” explaining that Gleason grading is robust, while scoring is not as robust. He emphasizes that Gleason Grade Groups 2 through 4 depend on the ratios of tissue with various Gleason scores, which he asserts make little sense.

Dr. Vickers offers clinical examples to support his assertion and explains that, with patients with Gleason Grade Group 2 disease, the total length of biopsied tissue with a Gleason score of 4 is strongly predictive of adverse surgical pathology risk. Dr. Vickers explains that in patients with Gleason Grade Group 2 disease, the amount of tissue with a Gleason score of 3 is not predictive. Dr. Vickers shares data out of France that indicate that the amount of Gleason score 4 or 5 tissue is more predictive of biochemical recurrence (BCR) and metastasis than total Gleason score.

Dr. Vickers asserts that there is a need for urologic oncologists to find a replacement for the Gleason score as the dominant influence on decision-making in localized prostate cancer. Dr. Vickers emphasizes the value of focusing on tumor size and tissue quality in disease assessment, as is done with other cancers.

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Year in Review: Emerging Data and Advances in Prostate Cancer Screening

Year in Review: Emerging Data and Advances in Prostate Cancer Screening

Posted by | Feb 2024

Sigrid V. Carlsson, MD, PhD, MPH, presents an overview of advances and emerging trends in prostate cancer screening in 2023. Dr. Carlson begins by presenting data supporting the continued use of routine PSA tests for prostate cancer screening, while highlighting the need for more granular risk stratification based on individual PSA baselines to bridge existing mortality gaps based on individual PSA baselines.

Dr. Carlsson then examines current trends in using genetics for biopsy risk stratification. She presents evidence that the polygenic risk scores which predict prostate cancer incidence are not useful in predicting mortality. She then discusses the role of biomarkers, risk calculators, and MRI-based screening techniques that are available pre-biopsy.

Turning to emerging data, Dr. Carlsson concludes by presenting a selection of national and international ongoing efforts to develop risk-stratified algorithms for early prostate cancer detection. She touches on the European Union’s “Praise U” initiative, Germany’s “PROBASE” trial, the Stockholm 3 trial, and the ProScreen study.

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Loops, Lasers, Robots, Staples, and Steam: What to Offer for BPH Today and Tomorrow?

Loops, Lasers, Robots, Staples, and Steam: What to Offer for BPH Today and Tomorrow?

Posted by | Jan 2024

Ricardo R. Gonzalez, MD, presents current and emerging novel treatment options for benign prostatic hyperplasia (BPH). He begins by establishing appropriate categorization of Minimally Invasive Surgical Therapies (MIST) versus Surgical (OR) treatment options for BPH, and the patient criteria for each.

Dr. Gonzalez then presents current FDA-approved MIST options for BPH, including steam-based treatments, devices, and implant options, and FDA-approved OR options, including water-based ablation treatments. He then presents patient examples of the presented treatment options, discussing the pros and cons of each option for the patient.

Dr. Gonzalez then discusses emerging treatment options for BPH which have not yet been approved by the FDA. He discusses nitinol prostate stents as an emerging MIST option, and laparoscopic shunting to decrease testosterone around the prostate as an emerging OR option.

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Focal and Salvage Therapies for Prostate Cancer: What’s Worth It and What’s Not?

Focal and Salvage Therapies for Prostate Cancer: What’s Worth It and What’s Not?

Posted by | Jan 2024

Peter A. Pinto, MD, examines the current state of focal and salvage therapies for the treatment of prostate cancer, and offers his insights into which therapies are worth pursuing. He begins by addressing various kinds of salvage therapy, acknowledging that salvage therapy is a response to failed focal, radiation, or surgical therapy, and specifying that this presentation will focus on salvage therapy after failed radiation therapy.

Dr. Pinto explains that focal ablation therapy, whole gland ablation therapy, and surgical therapy are the most common salvage therapies after a radiation therapy failure. He recommends using an MRI-based biopsy method over more traditional methods to maximize accuracy in identifying lesions.

Dr. Pinto then recommends focal ablation over whole gland ablation as a salvage therapy after failed radiation therapy due to the high morbidity associated with whole gland ablation. Dr. Pinto concludes by listing the many ablation options for salvage therapy, and presents studies which examined the pros and cons of each option, offering his insights on each study.

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Programmatic and Institutional Paradigms for Building and Sustaining a Successful Wellness Program

Programmatic and Institutional Paradigms for Building and Sustaining a Successful Wellness Program

Posted by | Jan 2024

Wesley A. Mayer, MD, presents actionable programmatic and institutional paradigms for building and sustaining a successful wellness program within one’s practice or institution while avoiding burnout. He begins by defining the elements of burnout, their impact on institution-wide productivity, and the high rate of burnout in the field of Urology.

Dr. Mayer then turns to the ACGME’s well-being requirements for Urology programs. While these requirements were intended to preserve the wellness of faculty and residents in theory, Dr. Mayer highlights that the lack of specific goals in institutional wellness programs can lead to “hedonistic” initiatives and inconsistent results.

Dr. Mayer then turns to how his own institution, the Scott Department of Urology at Baylor Medical School, sought to consistently address burnout. He outlines the paradigm created by his department, the tools they used to evaluate the success of their efforts, and the results.

He concludes by enumerating the steps other institutions can take to implement similar anti-burnout programs. He provides suggestions for national-level interventions, and reinforces the need for intentionality behind wellness programs.

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