Catherine A. Matthews, MD, FACS, FACOG, FPMRS, shares key steps for safe and effective endoscopic and robotic correction of POP/fSUI. In this presentation, Dr. Matthews provides guidance on:
Sacral Anatomy and Landmarks
Surgical Planes for Vaginal Dissection
Optimizing Mesh Attachment
Steps to Prevent Common Complications
Seth K. Bechis, MD, explores the question of whether or not minimally invasive surgical therapies (MIST) should be first line treatment for BPH. He begins by highlighting the prevalence of BPH in men over 60. He acknowledges that combination therapy is extremely effective in combating BPH in the short-term, but it has several long-term risks which impact patient QoL.
Dr. Bechis highlights the negative side-effects of the 5-ARIs, alpha blockers, and surgery post-medication-failure. Side-effects included increased risk of cardiac failure, dementia, depression, and sexual dysfunction.
Dr. Bechis then examines current MIST procedures for BPH treatment, including prostatic urethral lifts, water vapor thermal therapy, temporarily implanted nitinol devices, and balloons. He examines the durability, effectiveness, and side-effects for each procedure, and compares them to patients on medication
Dr. Bechis concludes by comparing the cost-effectiveness of MIST procedures to the cost of medication, taking into account IPSS improvement and Quality-Adjusted Life Years over time. Overall, he suggests that MIST procedures should be explored as a first-line treatment for BPH.
Read More
Phillip J. Koo, MD, explores the current state and evolution of the role of molecular targeted imaging in oligometastatic prostate cancer. He begins by examining oligometastatic disease as a diagnosis, and highlights the importance of shared decision-making in approaching treatment and management.
Dr. Koo then reviews recent trials examining the impact of various treatments on oligometastatic disease, including the EMBARK, STOMP, and ORIOLE trials. He discusses weaknesses in these trials, with particular emphasis on the lack of risk stratification in each trial, and the lack of PSMA-PET in the EMBARK and STOMP trials.
On the topic of progression, Dr. Koo highlights current weaknesses in detecting microscopic disease, which allows micrometastatic disease to progress until it is oligometastatic disease. He discusses the weaknesses of BCR, and the low sensitivity of initial diagnostic imaging.
Dr. Koo concludes by outlining future directions for research. He emphasizes the importance of keeping patient goals top-of-mind when exploring treatments.
Read More
Alan H. Bryce, MD, reviews current research, perspectives and practices in the treatment of metastatic castration-resistant prostate cancer (mCRPC). Dr. Bryce begins with an overview of current treatment options and patterns of care and addresses the National Comprehensive Cancer Network (NCCN) Guidelines Version 4.2023 for prostate cancer.
Dr. Bryce asserts that in light of few patients receiving treatments beyond first-line, a key operational principle should be to use the best drugs as early as possible. He explains that the management of mCRPC has become increasingly complex as new treatment paradigms have developed and new drugs have been approved. He recommends thinking about classes of drugs and considering how switching or combining classes can have advantages from the perspective of disease evolution.
Dr. Bryce concludes with a brief overview of recent phase-three trial results including PSMAfore, SPLASH, and CONTACT-2. He acknowledges that after several years of continuous success, the development of new classes of drugs for prostate cancer has hit a lull but he asserts the pipeline is still full and since there is not yet a cure for prostate cancer, trials must continue.
Read More
Mohamad E. Allaf, MD, reviews current literature on the role of neoadjuvant and adjuvant immunotherapy in treating localized renal cell carcinoma (RCC). He begins by establishing that surgical monotherapy fails to cure a significant proportion of patients with “localized” RCC thanks to micrometastatic disease.
Dr. Allaf then discusses how the inclusion of neoadjuvant therapies reduces the size of the tumor, controls potential metastases at the earliest point, and provides a litmus test for how appropriate it would be to treat the patient with surgical monotherapy. He also addresses adjuvant therapies, which can lower the likelihood of recurrence, and prolong patient survival. He acknowledges that older studies of adjuvant Tyrosine Kinase Inhibitor (TKI) therapy for RCC were negative, resulting in high toxicity and low effectiveness in treatment.
Dr. Allaf compares the performance of recent neoadjuvant checkpoint inhibitors in the metastatic setting to the current standard of care, demonstrating that the durability of disease response continued even after the discontinuation of the therapy. He then explores the rationale and early results supporting the administration of neoadjuvant therapy in localized RCC, and how they laid the groundwork for the PROSPER trial.
The PROSPER trial was a Phase III international, randomized trial which examined the effect of a single dose of neoadjuvant checkpoint inhibitors 7-28 days before partial or radical nephrectomy. He presents the study design, the cohort composition, and the results, which did not support the use of neoadjuvant therapy for RCC patients.
Dr. Allaf concludes by presenting multiple recent studies supporting the use of adjuvant therapy for intermediate-high-risk and high-risk RCC patients. While adjuvant therapy has been approved for use by the FDA, additional trials and investigations are still needed to advance the field.
Read More