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2024

Metastatic Prostate Cancer: Can Urologists Work Alongside Medical Oncologists in Advanced Disease?

Metastatic Prostate Cancer: Can Urologists Work Alongside Medical Oncologists in Advanced Disease?

Posted by | Mar 2024

A. Edward Yen, MD, discusses the importance of collaborating with medical oncologists when using hormone-directed therapy to treat metastatic prostate cancer. He begins by illustrating changes in treatment approach, using a case study to contrast past treatment algorithms with modern treatment approaches.

Dr. Yen presents a treatment algorithm from the early 2000s, calling attention to the isolation of “urologist” versus “oncologist” options in patient treatment and the impact of those isolated treatment approaches on overall survival. Dr. Yen contrasts this approach with modern agents and therapies which require collaboration between urologists, medical oncologists, and other medical disciplines.

Dr. Yen then addresses practical challenges associated with increased multidisciplinary collaboration, including keeping up with rapid advancements, managing treatment toxicities, and sequencing and selecting treatment.

Dr. Yen concludes by presenting a model of collaboration used by his practice which integrates urology, medical oncology, radiation oncology, nuclear medicine, pathology, interventional radiology, palliative/supportive care, genetics, nutrition and dietetics, psychology, and social work in treatment. He notes that the involvement of these specialties in the treatment of advanced prostate cancer leads to comprehensive evaluations, tailored treatment plans, and better outcomes for patients.

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In-Office Management of Female SUI: Optimizing Productivity

In-Office Management of Female SUI: Optimizing Productivity

Posted by | Mar 2024

Robert J. Evans, MD, FACS, presents guidance on how practice leaders can optimize in-office management of female stress urinary incontinence. He begins with a review of pre-visit intakes, and best-practices for gathering pertinent information in the office intake form.

Dr. Evans then turns to appropriate delegation of tasks within the practice, noting that APPs can evaluate patients in-office and initiate some treatments for female stress urinary incontinence. Additionally, the patient’s gynecologist can provide additional insight into treating female stress urinary incontinence.

Dr. Evans concludes by reviewing best practices for in-office procedures, and reiterates the importance of delegating tasks appropriately. APPs are a practice’s greatest resource for optimizing patient treatment in-office.

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Tips and Tricks for Managing Stones in the Complex Patient

Tips and Tricks for Managing Stones in the Complex Patient

Posted by | Feb 2024

Colin E. Kleinguetl, MD, presents guidance and strategies for kidney stone management in chronically infected and pregnant patients. He begins by discussing challenges to managing kidney stones in the pregnant patient, including:

The weaknesses of kidney stone imaging options
The pros and cons of radiation during diagnosis
The importance of working with the patient’s OBGYN during treatment
The treatment options available to pregnant kidney stone patients

Dr. Kleinguetl concludes by turning to patients with chronic UTIs, acknowledging the circular relationship between recurrent/persistent UTI and kidney stone disease. He then addresses common causes of stones in chronically infected patients and effective treatment options depending on the cause of the infection.

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Gleason 6 (GG1) – Should It Be Called Prostate Cancer?

Gleason 6 (GG1) – Should It Be Called Prostate Cancer?

Posted by | Feb 2024

Jeremy Slawin, MD, MBA, presents arguments for and against the reclassification of Gleason 6 (GG1) as something other than prostate cancer. He begins with a brief overview of the definition and perception of prostate cancer, and the psychological burdens and implications which come with cancer diagnoses.

Dr. Slawin then addresses the growing momentum in favor of a change in nomenclature for Gleason 6 (GG1) that does not include the word “cancer,” as has been done for diseases like noninvasive follicular thyroid neoplasm with papillary-like features (NIFTP), formerly called papillary thyroid cancer. Dr. Slawin presents data supporting the idea that GG1 is closer to pre-cancer in clinical behavior, detection, and management, and that calling it a cancer may drive overtreatment of GG1.

Dr. Slawin then turns to arguments against the reclassification of GG1. He addresses the issue of undersampling in biopsies which lead to GG1 diagnoses, the risk of under-grading, and how failing to call GG1 “cancer” could give a false perception of risk and lower the already-low patient compliance rates in active surveillance treatment.

Dr. Slawin concludes by giving his perspective on the issue of changing the nomenclature for GG1. He, along with most pathologists, is not in favor of reclassifying GG1, and leads a Q&A with the audience to gather their perspectives.

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Selection and Outcomes of Image-Guided, Minimally-Invasive Treatment

Selection and Outcomes of Image-Guided, Minimally-Invasive Treatment

Posted by | Feb 2024

Abhinav Sidana, MD, MPH, aims to identify key selection criteria for image guided minimally invasive treatments, also known as focal therapy, for prostate cancer. Dr. Sidana begins by noting that the use of focal therapy for prostate cancer treatment has become widespread in the past decade.

Dr. Sidana then addresses current EAU and NCCN guidelines for focal therapy. He highlights the lack of guidelines specific to focal therapy, and notes that the medical community has been trying to address this deficiency in recent years.

Dr. Sidana concludes by summarizing current best-practices regarding appropriate imaging modalities for screening, appropriate biopsy strategies, and optimal characteristics for determining focal therapy candidacy. He highlights the importance of the correct selection of energy modality in treating prostate cancer, noting that not every surgeon will have access to all the available energy modalities.

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