2024 Archives

Antibiotic Stewardship for Procedures and Patients with Recurring Infections

Brian J. Flynn, MD | 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.

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

Thomas J. Walsh, MD, MBA, MS | 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.

Optimizing Perioperative Nutrition and Assessing Frailty

Jennifer M. Taylor, MD, MPH | 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.

Integrated Diagnostics (Radiogenomics) and Patient Selection and Monitoring for Active Surveillance, Surgical, and Radiation Treatment

Sanoj Punnen, MD, MAS, MBA | Mar 2024

Sanoj Punnen, MD, MAS, discusses the use and benefits of integrated diagnostics for monitoring prostate cancer during Active Surveillance (AS). He begins by noting that AS is becoming a popular treatment for a wide range of low-risk prostate cancers, thanks to more granular risk-stratification methods and an increasing clinical emphasis on lowering patient burden during treatment.

Dr. Punnen then discusses lowering the frequency of serial biopsies as a means of lowering patient burden during treatment. He explores studies which indicate that MRI and Gleason scoring alone are insufficient for monitoring prostate cancer progression.

Dr. Punnen concludes with an exploration of the ongoing Miami MRI-Guided Active Selection for Treatment of Prostate Cancer (MAST) trial examining the use of MRI, 4Kscore, and Decipher scores during AS. The data thus far indicates that MRI alone is not predictive of progression, and that clinicians should consider integrating other prognostic data into their AS treatment protocols.

Construction and Multi-Center Validation of the Radiomics Model for Non-Invasive Identification of Active Surveillance Candidates

Liang Wang, MD, PhD | Mar 2024

Liang Wang, MD, PhD, presents current data on the use of noninvasive approaches with radiomics models to identify prostate cancer in active surveillance (AS) patients. Dr. Wang begins by sharing data on the risk reduction that early detection provides, but notes risks of overdiagnosis and overtreatment. He then addresses the role of magnetic resonance imaging (MRI) in prostate cancer management, noting improved techniques and better image interpretation by the Prostate Imaging Reporting & Data System (PI-RADS). However, Dr. Wang highlights that other biomarkers along with MRI must guide further diagnosis and treatment.

Dr. Wang discusses the rapidly evolving field of radiomics, explaining it enables the digital decoding of images into quantitative features that may uncover disease characteristics unseen by the naked eye. Further, it assesses a broad set of predefined features to define patterns relevant to pathology using statistical methods.

Dr. Wang concludes by cautioning that current data on the use of radiomics were from single-institution retrospectives with small cohort sizes and an absence of independent, external validation. Dr. Wang mentions broader, ongoing research which may lead to a non-invasive, radiomics-based tool that may be used to identify AS candidates with prostate cancer in the future.