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2024

PSMA PET for Prostate Cancer: Primary Staging, Recurrent Disease Localization

PSMA PET for Prostate Cancer: Primary Staging, Recurrent Disease Localization

Posted by | Mar 2024

Steven P. Rowe, MD, PhD, discusses the strengths of Prostate-Specific Membrane Antigen (PSMA) PET in PCa staging and localization. Dr. Rowe begins with a brief overview of PSMA PET and its correlation with metastases and tumor aggressiveness.

Dr. Rowe focuses on the sensitivity and specificity of PSMA PET for identifying metastases. He establishes that PSMA PET has high specificity, regardless of metastatic tumor size, but that the sensitivity to tumors below 5 millimeters in diameter is low. For treatment of the primary disease in the prostate, Dr. Rowe discusses the role of PSMA PET in tumor segmentation.

Dr. Rowe concludes by addressing the use of PSMA PET in identifying recurrent disease and salvage therapy candidates. He discusses the design and results of the CONDOR trial, and the lesion-level positive predictive value of PSMA PET in recurrent disease.

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Learning HoLEP Once Already in Practice: Value, Learning Curve, and Tips/Tricks

Learning HoLEP Once Already in Practice: Value, Learning Curve, and Tips/Tricks

Posted by | Mar 2024

Rebecca C. Gerber, MD, presents practical guidance on the use of Holmium Laser Enucleation of the Prostate (HoLEP) in clinical practice. Dr. Gerber begins by enumerating the benefits of HoLEP as a treatment, and pre-operative requirements for patients.

Dr. Gerber then provides an overview of perioperative considerations and the steps for the procedure. She presents a video demonstration of the procedure in practice, providing her clinical perspective for each step.

Dr. Gerber concludes by presenting examples of past HoLEP procedures, and providing her perspectives on which cases are better for practitioners with less HoLEP experience. She highlights the benefits of using HoLEP to treat catheter-dependent patients.

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Antibiotic Stewardship for Procedures and Patients with Recurring Infections

Antibiotic Stewardship for Procedures and Patients with Recurring Infections

Posted by | Mar 2024

Brian J. Flynn, MD, presents guidance on effective UTI management while minimizing antibiotic resistance. Dr. Flynn begins with an overview of recurring UTI pathogenesis and diagnosis.

Dr. Flynn then addresses common treatment options for recurrent UTI management, like Fosfomycin. He reviews the common first-line antibiotics, highlighting the importance of short-duration antibiotics after non-antibiotic treatments have failed.

Dr. Flynn then delves into other prophylactic strategies for treating recurrent UTIs. He discusses prophylactics relating to cleanliness, specific cranberry products, water intake, and methanamine hippurate.

Dr. Flynn concludes by addressing the social and psychological impact of recurrent UTIs, particularly in post-menopausal women. He stresses the importance of discussing contributing factors frankly, but empathetically, with patients to achieve the desired treatment outcome.

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The Association Between Testosterone Treatment and Incident of Cardiovascular Events among Testosterone Deficient U.S. Veterans

The Association Between Testosterone Treatment and Incident of Cardiovascular Events among Testosterone Deficient U.S. Veterans

Posted by | Mar 2024

In this 19-minute presentation, Thomas J. Walsh, MD, MBA, MS, University of Washington, Seattle, Washington, highlights the need for further research to clarify the long-term effects of testosterone therapy on cardiovascular health, advocating for a balanced approach that weighs the potential benefits against the risks. Dr. Walsh’s presentation underscores the importance of personalized medicine in managing testosterone deficiency.

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Optimizing Perioperative Nutrition and Assessing Frailty

Optimizing Perioperative Nutrition and Assessing Frailty

Posted by | Mar 2024

Jennifer M. Taylor, MD, MPH, discusses interventions for optimizing perioperative outcomes surrounding patient frailty and nutrition. Dr. Taylor begins by defining the causes of frailty and acknowledging that most cancer patients will have a certain level of frailty.

Dr. Taylor presents tools for the assessment of frailty that medical practitioners can use to evaluate frailty-based risks of invasive treatments. She notes that frail patients have a higher risk of mortality after surgery, and demonstrates a prototype of a Risk Analysis Index that is currently being trialed at multiple VA hospitals.

Dr. Taylor concludes by discussing the importance of having a multidisciplinary team that includes a dietician to support the frail patient pre- and post-operatively. She highlights that preoperative nutritional interventions, particularly in malnourished patients, are effective in reducing frailty in a short amount of time.

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