BackTable Urology

In this episode of BackTable Urology, Dr. James Eastham, chief of urology at Memorial Sloan Kettering Cancer Center, discusses evolving approaches and treatments in prostate cancer. First, he discusses topics such as patient preparation, pre-treatment discussions, and individualized treatment options based on the patient's risk levels. Dr. Eastham also summarizes crucial advancements in testing and imaging prostate cancers, including the use of genetic and biochemical markers, like PSA levels. Additionally, he emphasizes how advances in radiation therapy have improved treatment outcomes and patient experiences. Finally, Dr. Eastham emphasizes the need for consistent monitoring and communication with patients during and post-treatment. --- CHECK OUT OUR SPONSOR Veracyte https://www.veracyte.com/decipher --- SHOW NOTES 00:00 - Introduction 06:24 - Treatment Strategies and Patient Preferences 11:30 - Exploring the Role of Imaging in Prostate Cancer Treatment 18:29 - Dealing with Persistently Detectable PSA and Pre-op Staging 27:48 - Understanding Prostate Cancer Recurrence 36:08 - The Role of PSA Doubling Time in Treatment Decisions 43:34 - The Future of Personalized Medicine and Genomic Classifiers in Prostate Cancer 52:42 - The Importance of Patient Education and Preparation --- RESOURCES Decipher Prostate by Veracyte: https://www.veracyte.com/decipher-prostate/

In this episode of BackTable Urology, Dr. Aditya Begrodia interviews Dr. Mara Holton, a urologist and healthcare policy expert, on the recent healthcare policy changes that have affected the field of urology. First, Dr. Holton shares her educational journey, which included healthcare policy lobbying even before she started medical school. She eventually became involved in leadership positions within the Maryland Patient Care and Access Coalition and the Large Urology Group Practice Association (LUGPA). The discussion then turns to challenges surrounding health policies, such as the persistent use of fee-for-service reimbursement guidelines despite the benefits of value-based care. Dr. Holton also highlights the critical issue of workforce shortages, particularly the need for urologists within rural areas and the impact of healthcare policy on patient access. She ends the episode by emphasizing the necessity for urologists to participate in policy advocacy efforts. --- SHOW NOTES 00:00 - Introduction 04:58 - The Impact and Complexities of Healthcare Policies 07:27 - Success Stories in Healthcare Policy Advocacy 12:37 - The Impact of Prior Authorization Rules 14:27 - The Role of Pharmacy Benefit Managers in Healthcare 21:18 - The Challenges of Value-Based Care 32:48 - The Importance of Patient Access in Healthcare 41:24 - The Importance of Advocacy in Health Policy --- RESOURCES LUGPA website https://www.lugpa.org/ Episode 82: Advocacy Basics for the Urologist: From Your Clinic to Capitol Hill with Dr. Ruchika Talwar https://open.spotify.com/episode/0hcLrKuf5QU7TZCHSErs4Z?si=f4d06ffe6cff4cc4

In this episode, Dr. Edward Schaeffer, chair of urology at Feinberg School of Medicine, discusses precision medicine in prostate cancer with Dr. Aditya Bagrodia. First, Dr. Schaeffer introduces the importance of using a defined screening strategy for prostate cancer that includes analyzing a patient’s genomic and germline risk. Then, he summarizes existing and new diagnostic tools for prostate cancer. Additionally, Dr. Schaeffer discusses genomic testing and PSMA testing and explains how he applies them to individual patient cases depending on their cancer stage and grade. Finally, the doctors highlight the ability of future tools, like PET PSMA scans, to advance precision medicine. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/3XO8iL --- SHOW NOTES 00:00 - Introduction 10:32 - Precision Medicine and Prostate Cancer 16:17 - Screening and Diagnosis of Prostate Cancer 29:41 - Personalizing Surveillance and Disease Management 33:11 - The Role of Genomic Testing in Prostate Cancer 45:00 - The Use of PET PSMA Scans in Prostate Cancer Staging 48:08 - The Future of Precision Medicine in Prostate Cancer

This week on BackTable Urology, Dr. Ben Chew, professor and clinical researcher with the University of British Columbia, provides valuable insights on laser treatments for kidney stones. First, Dr. Chew provides a comprehensive overview of the current landscape of laser treatment for kidney stones. Dr. Silva and Dr. Chew then discuss the unique characteristics of different laser types, such as the Holmium and the Thulium lasers. Dr. Chew also covers critical safety considerations, like maintaining low intravenous pressure, using cold irrigation, and taking breaks during sustained laser treatment. Additionally, they delve into emerging technology, such as the use of electromagnetic guidance, for more accurate laser application. --- SHOW NOTES 00:00 - Introduction 06:49 - Choosing the Right Laser 12:11 - Energy Settings for Lasers 18:49 - Upper Tract Tumors and Lasers 23:54 - Preventing Thermal Injuries During Laser Treatment 27:03 - Dusting vs Fragmentation with Lasers 34:27 - The Impact of New Technologies on Kidney Stone Treatment 41:30 - Final Thoughts and Safety Recommendations

This week on BackTable Urology, Dr. Aditya Bagrodia invites Dr. Stacy Loeb, Professor of Urology at NYU Grossman School of Medicine, to discuss the role of lifestyle medicine in prostate cancer prevention. First, the doctors discuss the negative impacts of red and processed meat consumption as cancer-causing agents and encourage a shift towards whole, plant-based foods. They also emphasize the importance of engaging in regular physical activity and maintaining a healthy sleep schedule. Additionally, Dr. Loeb highlights substance abuse, particularly smoking and opioid consumption, as a health threat that needs to be managed. Lastly, the doctors discuss the importance of maintaining social connections and managing stress effectively in order to optimize preventative health. --- CHECK OUT OUR SPONSOR Veracyte https://www.veracyte.com/decipher --- SHOW NOTES 00:00 - Introduction 03:32 - The Importance of Lifestyle Medicine in Urology 07:57 - The Role of Nutrition in Cancer Prevention 14:07 - The Importance of Physical Activity 15:50 - The Impact of Sleep on Health 19:57 - Avoidance of Toxic Substances 34:02 - The Importance of Social Connections and Stress Management --- RESOURCES BackTable Urology Ep. 54 Smoking Cessation for the Urologist with Dr. Christian Fankhauser and Dr. Richard Matulewicz https://open.spotify.com/episode/1LUfPqJY4eEiaMJFW2VCwt?si=03ce7b67cdce4cf5 BackTable Urology Ep. 28 Holistic and Integrative Approaches to Prostate Cancer with Dr. Geo Espinosa https://open.spotify.com/episode/0XhnjdUGXXfZoU51miHhlS?si=7e743f1937044640

In this episode, host Dr. Aditya Bagrodia speaks with guests Dr. C.J. Stimson and Dr. Ruchika Talwar from Vanderbilt University about the relationship between physicians and big business in modern healthcare. First, the doctors discuss significant transformation in the healthcare sector, with multiple corporations like Amazon, Walmart, and Best Buy entering the healthcare realm. Although earlier practices were physician-centric, the evolving trends show an inclination towards a more consumer-centric approach focusing on efficiency and value. The guests share their views on the necessity of doctors asserting their role in the changing landscape, emphasizing the importance of the doctor-patient relationship. The conversation also addresses innovations in the field such as value-based arrangements that prioritize patient experience while reducing costs. --- SHOW NOTES 00:00 - Understanding Market Dynamics in Urology 02:18 - The Role of Big Corporations in Healthcare 07:14 - The Shift from Doctor-Centric to Patient-Centric Care 13:07 - The Commodification of Healthcare Services 19:36 - The Future of Healthcare: Vertical Integration 21:22 - The Impact of Value-Based Care on Healthcare 29:28 - The Role of Employers in Healthcare 41:50 - The Future of Healthcare: An Optimistic Outlook

This week on BackTable Urology, urologic oncologist Dr. Bogdana Schmidt (University of Utah) hosts a discussion with medical oncology experts Dr. Rana McKay (UC San Diego) and Dr. Neeraj Agarwal (University of Utah) on recent clinical trials from bladder, kidney, and prostate cancer research presented at the 2023 European Society for Medical Oncology (ESMO) Meeting. First, they discuss impactful data regarding bladder cancers, specifically the CheckMate 901 and the EV-302 trials which show improvement in overall survival and promise for urothelial carcinoma patients’ quality of life. The conversation moves onto kidney-specific trials such as the LITESPARK-005, which offers improved progression-free survival for patients through the use of belzutifan. The panel rounds off by discussing the progress made in prostate-specific trials with emphasis on the EMBARK and SPLASH trials involving Lutetium therapy. Finally, the doctors discuss the trend towards personalized treatment plans based on the unique goals and health requirements of the patients. --- SHOW NOTES 00:00 - Discussion on Urothelial Carcinoma: CheckMate 901 and EV-302 11:22 - Discussion on Kidney Cancer: LITESPARK-005 23:53 - Discussion on Prostate Cancer: EMBARK 31:41 - Discussion on Prostate Cancer: SPLASH vs PSMA 36:39 - Future Directions for Lutetium Therapy for Prostate Cancer 37:50 - Closing Remarks and Future Expectations --- RESOURCES CheckMate 901 Trial Investigators. Nivolumab plus Gemcitabine-Cisplatin in Advanced Urothelial Carcinoma. https://www.nejm.org/doi/full/10.1056/NEJMoa2309863 LBA6 EV-302/KEYNOTE-A39: Open-label, randomized phase III study of enfortumab vedotin in combination with pembrolizumab (EV+P) vs chemotherapy (Chemo) in previously untreated locally advanced metastatic urothelial carcinoma (la/mUC). https://www.sciencedirect.com/science/article/pii/S0923753423042709 LBA88 Belzutifan versus everolimus in participants (pts) with previously treated advanced clear cell renal cell carcinoma (ccRCC): Randomized open-label phase III LITESPARK-005 study. https://www.sciencedirect.com/science/article/pii/S0923753423042345 LBA02-09 EMBARK: A Phase 3 Randomized Study of Enzalutamide or Placebo Plus Leuprolide Acetate and Enzalutamide Monotherapy in High-risk Biochemically Recurrent Prostate Cancer. https://pubmed.ncbi.nlm.nih.gov/37119051/ 177Lu-Labeled Prostate-Specific Membrane Antigen Radioligand Therapy of Metastatic Castration-Resistant Prostate Cancer: Safety and Efficacy. https://pubmed.ncbi.nlm.nih.gov/26795286/

In this episode, Dr. Wayne Kuang (MD for Men LLC in Albuquerque, NM) discusses his initiative to redefine the benign prostatic hyperplasia (BPH) care pathway for patients, doctors, and the healthcare industry. One of his main focuses is to prioritize bladder health and end the polypharmacy approach to BPH. Dr. Kuang also introduces the 5 Stages of Bladder Health, emphasizing the risks if BPH is not treated effectively and earlier. He underlines the importance of strategic treatment planning based on detailed data collection of the patient’s prostate and bladder health. Dr. Kuang also examines different surgical and medical treatments for BPH. He ends the episode by explaining the Man vs. Prostate initiative and the significant global impact of his advocacy. --- SHOW NOTES 00:00 - Introduction 02:01 - The Impact of BPH on Patients 05:57 - The Importance of Bladder Health 10:38 - The Five Stages of Bladder Health 23:00 - The Role of Primary Care Physicians in BPH Treatment 26:03 - The Role of Medications in Treating BPH 34:06 - The Role of Urologists in BPH Treatment 39:07 - The Importance of Personalized Therapy in BPH Treatment 44:17 - The Man vs. Prostate Initiative --- RESOURCES Dr. Wayne Kuang on LinkedIn https://www.linkedin.com/in/wayne-kuang-md/ Man vs. Prostate https://www.manvsprostate.com/

In this episode, host Dr. Suzette Sutherland is joined by Dr. Kelly Casperson, a urologist who specializes in women’s sexual health, to discuss the importance of education, therapy, and hormone replacement in female sexual health. They explore topics such as the role of estrogen and testosterone in women’s sexual desire, FDA-approved medications for hypoactive sexual desire disorder, and the importance of sex education and communication within relationships. They also highlight the topic of gender inequality in sexual health care delivery and the lack of clinical resources specifically tailored to women’s needs. In sum, they aim to provide a deeper understanding of female sexual health and offer strategies for practitioners to provide more effective care. --- SHOW NOTES 00:00 - Introduction 05:53 - The Role of Urologists in Women’s Sexual Health 07:18 - The Importance of Communication in Addressing Sexual Dysfunction 10:23 - The Role of the Clitoris in Female Orgasm 19:52 - Understanding the Hormones Behind Female Sexual Desire 25:32 - The Misconceptions and Gender Bias Surrounding Hormones 26:04 - The Role of Testosterone in Menopause and Sexual Desire 30:02 - The Challenges of Commercially Available Testosterone Products 32:52 - Non-Hormonal Treatments for Low Libido 42:41 - The Importance of Referring to Sex Therapists and Other Resources --- RESOURCES Dr. Kelly Casperson’s Website https://kellycaspersonmd.com/ You Are Not Broken Podcast https://kellycaspersonmd.com/you-are-not-broken-podcast/ “You Are Not Broken” by Kelly Casperson https://kellycaspersonmd.com/you-are-not-broken-book/ “Magnificent Sex” by Peggy Kleinplatz https://www.amazon.com/Magnificent-Sex-Lessons-Extraordinary-Lovers/dp/0367181371 American Association of Sexuality Educators, Counselors, and Therapists https://www.aasect.org/

In this episode, Dr. Suzette Sutherland and Dr. Alana Desai from the University of Washington discuss the management of urinary tract stones in pregnant patients, considerations for ureteroscopy, and consequences of radiation exposure in the fetus. First, the doctors underscore the importance of ultrasound as the first line imaging modality to minimize fetal exposure to radiation. Dr. Sutherland and Dr. Desai also delve into nausea and pain management options, recommended diets for prevention of stone formation during pregnancy, and the necessity of involving a multidisciplinary team in such cases. The episode concludes with a remarkable case study from Dr. Desai’s experience. --- SHOW NOTES 00:00 - Introduction 02:06 - Incidence and Risk Factors of Kidney Stones in Pregnancy 03:29 - Physiological Changes and Stone Formation in Pregnancy 07:04 - Diagnosing Kidney Stones in Pregnancy 13:08 - Expectant Management vs. Intervention 14:41 - Managing Pain and Nausea in Pregnant Patients with Kidney Stones 17:13 - Decompression Methods for Kidney Stones in Pregnancy 23:13 - Ureteroscopy as a Preferred Intervention 26:05 - Case Description from Dr. Desai 30:04 - Considerations for Ureteroscopy in Pregnant Patients 31:14 - Preventing Kidney Stones in Pregnancy --- RESOURCES Lyon, M., Sun, A., Shah, A., Llarena, N., Dempster, C., Sivalingam, S., Calle, J., Gadani, S., Zampini, A., & De, S. (2023). Comparison of Radiation Exposure for Pregnant Patients Requiring Intervention for Suspected Obstructing Nephrolithiasis. Urology, 182, 61–66. https://doi.org/10.1016/j.urology.2023.09.023 Thongprayoon, C., Vaughan, L. E., Chewcharat, A., Kattah, A. G., Enders, F. T., Kumar, R., Lieske, J. C., Pais, V. M., Garovic, V. D., & Rule, A. D. (2021). Risk of Symptomatic Kidney Stones During and After Pregnancy. American journal of kidney diseases : the official journal of the National Kidney Foundation, 78(3), 409–417. https://doi.org/10.1053/j.ajkd.2021.01.008