2024 Archives

Optimizing In-Office Management for BPH, by the Numbers

Ricardo R. Gonzalez, MD | Feb 2024

Ricardo R. Gonzalez, MD, outlines an algorithm to determine optimal in-office BPH treatment options for both patient and practice. Dr. Gonzalez begins by categorizing BPH treatment options by risk and benefit, ranging from non-invasive to open surgical options.

While categorizing BPH treatment options, Dr. Gonzales gives examples of optimal treatment options based on patient presentation and priorities. He walks through the algorithm based on different patient priorities, emphasizing that a systemic approach to BPH treatment is necessary to pair the correct treatment with individual patients.

Surgical Training for Radical Prostatectomy – Should the Open Approach Still Be Taught? Which Patients? Retropubic, Perineal, Mini-Incision, etc.?

Guilherme Godoy, MD, MS | Feb 2024

Guilherme Godoy, MD, MS, explores the question of whether or not to teach residents open radical prostatectomy, weighing multifunctional surgical skills with robotic advancements. He then explains that the open approach to radical prostatectomy is the gold standard in the medical community; however, the robotic approach is more commonly performed.

Dr. Godoy proceeds by questioning whether a sufficient number of open-approach radical prostatectomies are being conducted to warrant training residents in this method. Referring to a 2020 study, he finds that perhaps too few open-approach procedures are occurring to allow for resident proficiency.

Dr. Godoy then asks whether the open approach offers any benefits, exploring four situations in which the open approach is preferred over the robotic method. Dr. Godoy then cites a 2007 study to evaluate the learning curves of open-approach radical prostatectomy subtypes compared to the robotic approach, finding drastic differences in the climb to proficiency.

He completes his presentation by stressing that resident skill and comfort level should be considered in the debate between the open and robotic approaches. Following the presentation, audience members offer points of consideration regarding rural populations, new robots, and current robot malfunctions during radical prostatectomies.

Year in Review: Emerging Data and Advances in Prostate Cancer Screening

Sigrid V. Carlsson, MD, PhD, MPH | Feb 2024

Sigrid V. Carlsson, MD, PhD, MPH, presents an overview of advances and emerging trends in prostate cancer screening in 2023. Dr. Carlson begins by presenting data supporting the continued use of routine PSA tests for prostate cancer screening, while highlighting the need for more granular risk stratification based on individual PSA baselines to bridge existing mortality gaps based on individual PSA baselines.

Dr. Carlsson then examines current trends in using genetics for biopsy risk stratification. She presents evidence that the polygenic risk scores which predict prostate cancer incidence are not useful in predicting mortality. She then discusses the role of biomarkers, risk calculators, and MRI-based screening techniques that are available pre-biopsy.

Turning to emerging data, Dr. Carlsson concludes by presenting a selection of national and international ongoing efforts to develop risk-stratified algorithms for early prostate cancer detection. She touches on the European Union’s “Praise U” initiative, Germany’s “PROBASE” trial, the Stockholm 3 trial, and the ProScreen study.

Loops, Lasers, Robots, Staples, and Steam: What to Offer for BPH Today and Tomorrow?

Ricardo R. Gonzalez, MD | Jan 2024

Ricardo R. Gonzalez, MD, presents current and emerging novel treatment options for benign prostatic hyperplasia (BPH). He begins by establishing appropriate categorization of Minimally Invasive Surgical Therapies (MIST) versus Surgical (OR) treatment options for BPH, and the patient criteria for each.

Dr. Gonzalez then presents current FDA-approved MIST options for BPH, including steam-based treatments, devices, and implant options, and FDA-approved OR options, including water-based ablation treatments. He then presents patient examples of the presented treatment options, discussing the pros and cons of each option for the patient.

Dr. Gonzalez then discusses emerging treatment options for BPH which have not yet been approved by the FDA. He discusses nitinol prostate stents as an emerging MIST option, and laparoscopic shunting to decrease testosterone around the prostate as an emerging OR option.

Focal and Salvage Therapies for Prostate Cancer: What’s Worth It and What’s Not?

Peter A. Pinto, MD | Jan 2024

Peter A. Pinto, MD, examines the current state of focal and salvage therapies for the treatment of prostate cancer, and offers his insights into which therapies are worth pursuing. He begins by addressing various kinds of salvage therapy, acknowledging that salvage therapy is a response to failed focal, radiation, or surgical therapy, and specifying that this presentation will focus on salvage therapy after failed radiation therapy.

Dr. Pinto explains that focal ablation therapy, whole gland ablation therapy, and surgical therapy are the most common salvage therapies after a radiation therapy failure. He recommends using an MRI-based biopsy method over more traditional methods to maximize accuracy in identifying lesions.

Dr. Pinto then recommends focal ablation over whole gland ablation as a salvage therapy after failed radiation therapy due to the high morbidity associated with whole gland ablation. Dr. Pinto concludes by listing the many ablation options for salvage therapy, and presents studies which examined the pros and cons of each option, offering his insights on each study.