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2024

APP-Directed Management of Female Sexual Health and GU Syndrome of Menopause

APP-Directed Management of Female Sexual Health and GU Syndrome of Menopause

Posted by | May 2024

Aleece R. Fosnight, MSPAS, PA-C, CSCS, CSE, IF, NCMP, HAES, discusses APP-lead treatment of female sexual health and genitourinary syndrome of menopause (GSM). Ms. Fosnight begins by describing symptoms of GSM, including hormonal, sexual, and GI symptoms. She notes that, while up to 84% of menopausal women face GSM symptoms, half have never been treated.

Ms. Fosnight then turns to GSM diagnosis and treatment options, including hormonal treatments, non-hormonal treatments, and physical therapy. For each treatment, she addresses safety, side effects, and contraindications.

Ms. Fosnight concludes by emphasizing the importance of clear communication and preventative action. As many menopausal patients are likely to experience GSM, she emphasizes the importance of a frank, supportive dialogue between practitioner and patient, noting that there are many safe treatment options available.

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Bladder Cancer: Optimizing Detection and Minimally-Invasive Management

Bladder Cancer: Optimizing Detection and Minimally-Invasive Management

Posted by | May 2024

Alejandro R. Rodriguez, MD, discusses detection and minimally invasive management of bladder cancer. Dr. Rodriguez begins by noting that bladder cancer is the 10th most-commonly diagnosed cancer worldwide, and presents the American Urological Association (AUA) risk stratification that provides the basis for non-muscle-invasive bladder cancer (NMIBC) management.

Dr. Rodriguez notes that the most frequent treatment for NMIBC is Transurethral Resection of Bladder Tumor (TURBT.) While he contends that conventional TURBT is the best tool for clinical staging of NMIBC, he enumerates the risks and drawbacks of the procedure.

Dr. Rodriguez then describes narrow-band imaging (NBI) as an additional modality, and presents data showing that TURBT performed in NBI modality reduces NMIBC recurrence risk. Further, NBI with white light cystoscopy TURBT may lower recurrence risk with little-to-no effect on risks of adverse events.

Finally, Dr. Rodriguez turns to the role of TUR in muscle-invasive bladder cancer (MIBC), with a focus on clinical staging, histology and grade, and bladder preservation options. He notes that trimodality therapy is the primary option for patients with MIBC that seek bladder preservation as an alternative to radical cystectomy.

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Molecular Targeted Imaging

Molecular Targeted Imaging

Posted by | May 2024

Phillip J. Koo, MD, gives a high-level overview of the current state of molecular targeted imaging in identifying prostate cancer. Dr. Koo begins by establishing the sensitivity and accuracy of PSMA PET molecular targeted imaging at various PSA levels. He compares the efficacy of the four most commonly used commercially available agents in PSMA PET, noting that there is no data available that indicates one agent is superior to another.

Dr. Koo then delves into the sensitivity of different PSMA PET agents, including Gallium-68-PSMA-11 and Fluorine-18-DCFPyl. He highlights that imaging is not yet a reliable replacement for prostatectomy, using a few case studies as supporting evidence.

Dr. Koo concludes by reviewing the issue of biochemical recurrence and how it impacts disease management. He notes that molecular targeted imaging can detect recurrences in different sites in the body, and how current data may support a more aggressive treatment approach in the future.

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Care Considerations for the Man on ADT

Care Considerations for the Man on ADT

Posted by | May 2024

Alejandro R. Rodriguez, MD, discusses the management of metabolic, cardiovascular, and other side effects of Androgen Deprivation Therapy (ADT). In this lecture, Dr. Rodriguez highlights common side effects of ADT as a treatment, including:

Bone-Density Loss
Cardiovascular Disease
Diabetes and Other Metabolism Changes
Sexual Dysfunction

For each of these conditions, Dr. Rodriguez presents management strategies that can be used by physicians, patients, and members of the patients’ care team.

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Micro-ultrasound and MRI for Visualization of Prostate Cancer

Micro-ultrasound and MRI for Visualization of Prostate Cancer

Posted by | May 2024

Wayne Brisbane, MD, explores micro-ultrasound (micro-US) and MRI in visualizing prostate cancer, highlighting their respective strengths and applications in clinical practice.
Micro-ultrasound has emerged as a promising imaging modality for prostate cancer detection due to its high resolution and real-time capabilities. This technology enhances the identification and characterization of suspicious lesions, offering superior spatial resolution. In contrast, MRI, particularly multiparametric MRI (mpMRI), excels in detecting larger and more complex tumors.
Dr. Brisbane emphasizes that while mpMRI remains pivotal in pre-biopsy evaluations and treatment planning, micro-ultrasound complements these efforts by enhancing real-time visualization during targeted biopsies and focal therapies. Combining the strengths of both modalities allows clinicians to leverage the high sensitivity of mpMRI for initial lesion detection and the high resolution and real-time capabilities of micro-ultrasound for precise biopsy guidance and treatment monitoring.

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