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2024

Erectile Dysfunction Treatment – State of the Art Care in 2024

Erectile Dysfunction Treatment – State of the Art Care in 2024

Posted by | Jun 2024

Thomas J. Walsh, MD, MBA, MS, reviews erectile dysfunction (ED) prevalence, risk factors, lifestyle, and treatments available for patients. He addresses the stigma and the biology of ED, emphasizing the importance of explaining both to patients as part of the treatment discussion.

Dr. Walsh explains that for approximately half of men, oral medications are insufficient to treat ED and shares the updated American Urological Association (AUA) guidelines for ED treatment including oral agents, intra-penile therapies, surgery, and lifestyle changes. He outlines advantages and disadvantages of therapies such as type-5 selective phosphodiesterase inhibitors, intraurethral and topical alprostadil, intracavernosal injection, penile implants, vacuum erection devices, and low-intensity shock wave (LISW) therapy.

Dr. Walsh concludes by outlining his approach to patients, emphasizing the importance of general health and using the opportunity to help patients understand the link between lifestyle and ED. He also emphasizes the importance of referring patients to a specialist when a practitioner is outside their comfort zone or if the patient requires treatments outside of their toolbox.

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Multi-modality (MRI+PET) Imaging for Improved Detection of csPC

Multi-modality (MRI+PET) Imaging for Improved Detection of csPC

Posted by | Jun 2024

David Margel, MD, PhD, explores the integration of multi-modality imaging, specifically combining MRI with PET (positron emission tomography), to enhance the detection of clinically significant prostate cancer (csPC).

Dr, Margel explains that MRI provides detailed anatomical information and is widely used for localizing suspicious lesions within the prostate gland; however, MRI alone may have limitations in accurately distinguishing aggressive cancers from indolent ones. PET imaging, on the other hand, offers functional insights by detecting metabolic activity within tissues. Radiotracers like 18F-fluorodeoxyglucose (FDG) or prostate-specific tracers such as 68Ga-PSMA are utilized to target specific molecular markers associated with prostate cancer cells.

The combination of MRI and PET leverages the strengths of both modalities: MRI for precise anatomical localization and PET for functional characterization based on metabolic activity. This synergistic approach improves the accuracy of prostate cancer detection, particularly in identifying csPC that may be missed by either modality alone.

Dr. Margel emphasizes the clinical implications of multi-modality imaging in guiding treatment decisions. By accurately identifying and characterizing csPC, clinicians can tailor personalized treatment plans, including targeted biopsies, focal therapies, or systemic treatments. This approach minimizes overtreatment of indolent disease while ensuring aggressive cancers are appropriately managed.

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Combination of Prostate Ablation with Systemic Therapy for Management of Prostate

Combination of Prostate Ablation with Systemic Therapy for Management of Prostate

Posted by | Jun 2024

Abhinav Sidana, MD, MPH, addresses the integration of prostate ablation with systemic therapy for the management of prostate cancer. This strategy aims at improving treatment outcomes through synergistic effects and personalized care.
Prostate ablation techniques, including cryoablation or high-intensity focused ultrasound (HIFU), target localized prostate tumors while preserving surrounding healthy tissue. Dr. Sidana emphasizes that these minimally invasive procedures offer potential advantages over traditional treatments by reducing treatment-related side effects such as urinary incontinence and erectile dysfunction. The integration of systemic therapy, such as hormonal therapy or chemotherapy, complements prostate ablation by addressing systemic disease and enhancing treatment efficacy.
By leveraging both local and systemic treatment modalities, clinicians can tailor treatment strategies to individual patient profiles, ultimately improving long-term survival and quality of life for prostate cancer patients.

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Patient Selection for Prostate Cancer Focal Therapy: Urologic Perspective

Patient Selection for Prostate Cancer Focal Therapy: Urologic Perspective

Posted by | Jun 2024

Geoffrey Sonn, MD, discusses patient selection criteria for prostate cancer focal therapy from a urologic perspective.
Focal therapy aims to treat only the cancerous lesion while preserving surrounding healthy tissue. Candidates for focal therapy typically have localized prostate cancer confined to a specific area of the gland. Imaging techniques such as multiparametric MRI (mpMRI) play a pivotal role in accurately identifying and characterizing these lesions, guiding treatment planning, and ensuring precise targeting during therapy.
Patient selection also hinges on tumor biology and clinical factors. Dr. Sonn explains that biomarkers and genomic testing help assess the aggressiveness and molecular characteristics of the cancer, aiding in risk stratification and predicting the likelihood of disease progression.
Dr. Sonn underscores the importance of patient-centered care in the era of precision medicine. When considering focal therapy as an option, each patient’s preferences, overall health status, and potential impact of treatment on quality of life must be carefully weighed.

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