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Late Breaking news today! Now we have guidelines! Thanks to Dr. Rachel Rubin for coming on IG to do this live with me! AUA GSM Guidelines Learn more about your ad choices. Visit podcastchoices.com/adchoices
Featuring an interview with Dr William K Oh, including the following topics: Use of secondary hormonal agents for patients with metastatic hormone-sensitive prostate cancer (0:00) Data supporting the clinical activity of PARP inhibitors for metastatic castration-resistant prostate cancer (mCRPC) (11:10) Radiopharmaceuticals for the treatment of mCRPC (16:53) Available data on cabozantinib for mCRPC (24:38) Cabozantinib combinations for advanced renal cell carcinoma (RCC) (26:17) Subcutaneous nivolumab versus intravenous nivolumab for advanced RCC (30:00) Addition of nivolumab to tivozanib compared to tivozanib alone in advanced relapsed/refractory RCC previously treated with an immune checkpoint inhibitor (31:28) Long-term follow-up with belzutifan for relapsed/refractory advanced RCC (33:39) Major findings from the NIAGARA study of perioperative durvalumab for muscle-invasive bladder cancer (MIBC) (35:44) Data surrounding adjuvant immunotherapy for MIBC (38:07) Clinical development of TAR-200 for high-risk non-muscle-invasive bladder cancer (39:44) Updated analysis of EV-302 study of enfortumab vedotin in combination with pembrolizumab for previously untreated advanced urothelial cancer (UC) (41:06) Implementation of emerging data in the treatment landscape of UC (41:56) CME information and select publications
Dr William Oh from the Yale Cancer Center in New Haven, Connecticut, discusses recent updates on available and novel treatment strategies for genitourinary cancers. CME information and select publications here.
In this episode, Zev A. Wainberg, MD; Funda Meric-Bernstam, MD; Alexandra Leary, MD, PhD; and Catherine Fahey, MD, PhD, explore testing for HER2 alterations and the incidence of HER2-positive disease in the treatment of genitourinary, gastrointestinal, and gynecologic malignancies. HER2 Testing in Advanced Cancers: Recommendations for when and how to test for HER2 in advanced cancers and how these tests guide therapy selectionVariability in HER2 Expression Across Tumor Types: Insights into the heterogeneity of HER2 expression and amplification in different cancersChallenges in Standardizing HER2 Testing: The complexities of scoring and testing HER2 in different cancers and institutions, and the need for better harmonization of guidelines and approachesPresenters:Zev A. Wainberg, MDProfessor of Medicine and SurgeryCo-Director of GI OncologyDirector, Early Phase Clinical Research ProgramJonsson Comprehensive Cancer CenterUCLA School of MedicineLos Angeles, CaliforniaFunda Meric-Bernstam, MDChair, Department of Investigational Cancer TherapeuticsMedical Director, Institute for Personalized Cancer TherapyNellie B. Connally Chair in Breast CancerThe University of Texas MD Anderson Cancer CenterHouston, TexasAlexandra Leary, MD, PhDPresident, GINECO GroupCo-Director, Department of Medical OncologyMedical Oncologist GynecologyTeam Leader, Gynecologic Translational Research Lab, INSERM u981Institut Gustave RoussyVillejuif, FranceCatherine Fahey, MD, PhDAssistant ProfessorDivision of OncologyUniversity of North Carolina at Chapel HillChapel Hill, North CarolinaLink to full program:https://bit.ly/42iEDjVTo claim credit for listening to this episode, please visit the podcast online at the link above.
In this episode, I discuss with medical student, Sara Perelmuter: What is genitourinary syndrome of lactation (GSL)?Reasons why the postpartum vulvovaginal tissues resemble those of a menopausal womanSigns and symptoms of GSLPostpartum hormone changes How to talk to your provider about this What we need to know as providersDoes using topical estrogen harm the baby?Dose, frequency and length of time one may expect to use estrogenSara Perelmuter is a medical student at Weill Cornell in New York city and is already innovating the field of sexual medicine. She has over 7 scientifically peer reviewed publications and is currently the president of the Sexual Medicine Research Team. She is a passionate advocate for women's reproductive and sexual health and is on track to become an OB/GYN. Her prior research experience exposed her to the profound gap in research on women's sexual health and her clinical work exposed her to the prevalence of medical gaslighting and the dismissal of women's pain. Paired with her feminist values, this has motivated her to pursue a career dedicated to improving women's sexual health. Sara believes education, accessibility, and awareness are vital to break the barriers and help empower women to take control over their own bodies. Links mentioned in this episode: Genitourinary syndrome of lactation: a new perspective on postpartum and lactation-related genitourinary symptomsWebsite link of my Sexual Medicine Research Team with GSL infoSurvey Information SheetSurvey linkTHANK YOU TO THE EPISODE SPONSORSSRC Health: discount code and website: https://srchealth.com/?ref=Sto_l3PawmnH4. Discount Code: THEPELVICFLOORPROJECTThanks for joining me! Here is where you can find out how to work with me: www.pelvicfloorprojectspace.com/Support the show
Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern Medicine have established the Collaborative Advanced Reconstructive Evaluation (CARE) Clinic, which provides multidisciplinary care for children, adolescents and women with congenital anomalies and acquired diseases of the genitourinary tract. In this episode, two of the clinic's leaders, Drs. Julia Geynisman-Tan and Dr. Julia Grabowski, talk about the transformative surgical innovations they've developed and life-changing procedures and supportive care they offer to help women achieve functional vaginal anatomy, relief from pain, the ability to menstruate and more.
In this episode of The Life Transformer Show, Tara is chatting with Dr Sandar Hlaing about Genitourinary Syndrome. The reasons why it's not spoken about very often, and symptoms to look out for. Treatment and prevention for this syndrome and more. What You Will Learn In This Episode: What is Genitourinary Syndrome? Symptoms to watch out for. Why it's not spoken about. Treatment and prevention options. How To Contact Tara Hammett: tarahammett.com Facebook
I sit down with Dr William Oh, newly appointed Precision Medicine Director at Yale Cancer Center. Dr Oh is a Medical Oncologist who has focused mainly on Genitourinary cancers, so we of course talk about prostates. We discuss high risk populations and of course finding cancer early, knowing family histories and decision making about having surgery.
CME credits: 1.25 Valid until: 20-12-2025 Claim your CME credit at https://reachmd.com/programs/cme/emerging-immunotherapy-combination-strategies-in-genitourinary-malignancies/29201/ This online CME activity, presented in collaboration with the National Comprehensive Cancer Network (NCCN®), focuses on translating oncology clinical practice guidelines into practical strategies for treating genitourinary malignancies. Participants will learn how to integrate clinical trial data into guideline-concordant first- and subsequent-line treatment plans for patients with metastatic urothelial cancer (UC), metastatic castration-resistant prostate cancer (mCRPC), and metastatic renal cell carcinoma (RCC). The program highlights the importance of evidence-based approaches and the use of immunotherapy and targeted therapies for advanced genitourinary malignancies. Attendees will also explore emerging data that could influence future treatment guidelines, patient case examples, and insights from international faculty to develop region-specific therapeutic strategies aligned with NCCN recommendations.
CME credits: 1.25 Valid until: 20-12-2025 Claim your CME credit at https://reachmd.com/programs/cme/emerging-targeted-therapy-combination-strategies-in-genitourinary-malignancies/29200/ This online CME activity, presented in collaboration with the National Comprehensive Cancer Network (NCCN®), focuses on translating oncology clinical practice guidelines into practical strategies for treating genitourinary malignancies. Participants will learn how to integrate clinical trial data into guideline-concordant first- and subsequent-line treatment plans for patients with metastatic urothelial cancer (UC), metastatic castration-resistant prostate cancer (mCRPC), and metastatic renal cell carcinoma (RCC). The program highlights the importance of evidence-based approaches and the use of immunotherapy and targeted therapies for advanced genitourinary malignancies. Attendees will also explore emerging data that could influence future treatment guidelines, patient case examples, and insights from international faculty to develop region-specific therapeutic strategies aligned with NCCN recommendations.
CME credits: 1.25 Valid until: 20-12-2025 Claim your CME credit at https://reachmd.com/programs/cme/insights-from-global-key-opinion-leaders-on-optimizing-patient-care-in-genitourinary-malignancies/29202/ This online CME activity, presented in collaboration with the National Comprehensive Cancer Network (NCCN®), focuses on translating oncology clinical practice guidelines into practical strategies for treating genitourinary malignancies. Participants will learn how to integrate clinical trial data into guideline-concordant first- and subsequent-line treatment plans for patients with metastatic urothelial cancer (UC), metastatic castration-resistant prostate cancer (mCRPC), and metastatic renal cell carcinoma (RCC). The program highlights the importance of evidence-based approaches and the use of immunotherapy and targeted therapies for advanced genitourinary malignancies. Attendees will also explore emerging data that could influence future treatment guidelines, patient case examples, and insights from international faculty to develop region-specific therapeutic strategies aligned with NCCN recommendations.
Moderated by Sue Saville. With speakers: Susan Davis, James Simon, Tommaso Simoncini, Jean-Yves Reginster, Angelica Hirschberg. These podcasts were sponsored by Besins Healthcare.
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Prof Enrique Grande, a medical oncologist from Madrid, Spain, is our guest on Oncology for the Inquisitive Mind this week. Enrique is not your average oncologist nor your average podcast guest with a fascinating back story, a varied career and the charisma and wisdom to match!Enrique has worked in all facets of oncology, including industry and is helping transform how patients access oncology care in Spain. He is the director of the Medical Oncology Program and Clinical Research Lead at the MD Anderson Centre Madrid. Prof Grande strongly focused on genitourinary and endocrine cancer research and was awarded his PhD in pharmacokinetic and pharmacodynamics study of tyrosine kinase inhibitors in liver metabolism.Listen on, and you will learn all there is to know about bladder cancer and the world of medical oncology.We explore the #NIAGARA trial, #EV302 and many other trials that are changing the face of bladder cancer!For more episodes, resources and blog posts, visit www.inquisitiveonc.comPlease find us on Twitter @InquisitiveOnc!If you want us to look at a specific trial or subject, email us at inquisitiveonc@gmail.comOncology for the Inquisitive Mind is recorded with the support of education grants from our foundation partners Pfizer, Gilead Pharmaceuticals and Merck Pharmaceuticals. Our partners have no editorial rights or early previews, and they have access to the episode at the same time you do.Art courtesy of Taryn SilverMusic courtesy of AlisiaBeats: https://pixabay.com/users/alisiabeats-39461785/Disclaimer: This podcast is for educational purposes only. If you are unwell, seek medical advice. Hosted on Acast. See acast.com/privacy for more information.
In Oncology Unplugged, a podcast series from MedNews Week, host Chandler Park, MD, a medical oncologist at the Norton Cancer Institute in Louisville, Kentucky, talks through key updates in genitourinary cancer research from the 2024 ESMO Congress. In this episode, Dr Park highlights potentially practice-changing data in prostate, kidney, and bladder cancer; spotlights the potential clinical implications of findings with the intravesical therapy TAR-200 in patients with muscle-invasive bladder cancer (MIBC); and zooms in on data from the phase 3 NIAGARA trial (NCT03732677) of durvalumab (Imfinzi) plus gemcitabine and cisplatin in patients with MIBC.
ESMO 2024 was the year genitourinary cancer took front and centre stage with many exciting updates, trials, and tribulations. This week, OFTIM brings their greatest champion back to dive deep into the changes that will impact our patients and their families, the NCCN guidelines, and how we practice medicine. Unfortunately, the heavyweight champion boxer was unavailable, but we got the next best thing - Prof Anthony Joshua from St Vincent's Health and The Garvan Institute of Medical Research. This week, he discusses all things genitourinary cancer and gives a knockout performance.Enough boxing analogies - on with the show!Links to studies discussed in this episode (subscription may be required):PATCH+STAMPEDEARANOTESTAMPEDE (metformin Arm)PEACE-3SPLASHNIAGARAAMBASSADORTiNivo-2For more episodes, resources and blog posts, visit www.inquisitiveonc.comPlease find us on Twitter @InquisitiveOnc!If you want us to look at a specific trial or subject, email us at inquisitiveonc@gmail.comOncology for the Inquisitive Mind is recorded with the support of education grants from our foundation partners Pfizer, Gilead Pharmaceuticals and Merck Pharmaceuticals. Our partners have no editorial rights or early previews, and they have access to the episode at the same time you do.Art courtesy of Taryn SilverMusic courtesy of AlisiaBeats: https://pixabay.com/users/alisiabeats-39461785/Disclaimer: This podcast is for educational purposes only. If you are unwell, seek medical advice. Hosted on Acast. See acast.com/privacy for more information.
Send us a textIn today's episode, I sit down with Sara Perelmuter, a medical student and future OBGYN, who is already leading innovations in the field of sexual medicine. As president of the Sexual Medicine Research Team and with over seven peer-reviewed publications, Sara's latest work, "Genitourinary Syndrome of Lactation: A New Perspective on Postpartum and Lactation-Related Genitourinary Symptoms," introduces a new term encompassing genitourinary symptoms related to low estrogen during the postpartum and lactation periods.Sara's passion for women's health is deeply personal—her own struggle with pelvic pain during intercourse led to her diagnosis of hypertonic overactive pelvic floor muscle dysfunction. The medical gaslighting and dismissal she experienced, along with her feminist values and love for physiology, motivated her to pursue a career dedicated to improving women's sexual health. In this episode, Sara discusses the importance of education, accessibility, and awareness in empowering women to take control of their own bodies.We cover topics including:
OBGYN Briefs - Managing Genitourinary Syndrome of Menopause Frequent UTIs and vaginal atrophy/dryness are common signs of genitourinary syndrome of menopause (GSM). In this Brief, Dr. Rachel Rubin discusses the management of GSM and why estrogen is so vital to these tissues. They address the lack of information and awareness about GSM among urologists and gynecologists while emphasizing its impact on the urinary and genital symptoms experienced by menopausal women. Dr. Rubin details how GSM is not just a matter of vaginal atrophy but involves broader symptoms like urinary tract infections and bladder issues. The doctors also discuss a range of treatment options available, including local vaginal supplementation products like estradiol creams and DHEA suppositories, and their benefits for urinary health. TIMESTAMPS 00:00 - Introduction 00:20 - Understanding Genitourinary Syndrome of Menopause (GSM) 01:42 - Symptoms and Implications of GSM 03:00 - Vaginal Supplementation Products 05:09 - DHEA and SERM Therapy 08:44 - Estrogen and Vaginal Health CHECK OUT THE FULL EPISODE OBGYN Ep. 33 - Genitourinary Syndrome of Menopause (GSM): Improving a DRY Topic https://www.backtable.com/shows/obgyn/podcasts/33/genitourinary-syndrome-of-menopause-gsm-improving-a-dry-topic
Dr. Rachel S. Rubin is a board certified urologist with fellowship training in sexual medicine. She is an assistant clinical professor in urology at Georgetown University and owns her own practice in Washington DC. Dr. Rubin provides comprehensive care to all genders. She treats issues such as pelvic pain, menopause, erectile dysfunction, and low libido. Dr. Rubin is the director at large and former education chair for the International Society for the Study of Women's Sexual Health (ISSWSH) and an associate editor for the journal Sexual Medicine Reviews. Her work has been featured in the NYT, NPR and PBS. She was named a Washingtonian Top Doctor in 2019-2023.She has co-authored several publications on Genitourinary Syndrome ofMenopause (GSM) including:Houston CG, Azar WS, Huang SS, Rubin R, Dorris CS, Sussman RD. A Cost Savings Analysis of Topical Estrogen Therapy in Urinary Tract Infection Prevention Among Postmenopausal Women. Urology Practice. 2024 Mar 1; 11(2):257-266.https://doi.org/10.1097/UPJ.0000000000000513Wasserman MC and Rubin RS. Urologic view in the management of genitourinary syndrome of menopause. Climacteric. 2023 Apr 27;1-7. doi: 10.1080/13697137.2023.2202811. Epub aheadof print. PMID: 37104711.To learn more about Dr. Rachel Rubin MD, check out: https://www.rachelrubinmd.com/Or follow her on Instagram @drrachelrubinTo Follow US check out: Heather- www.theshowcenter.comJackie- https://www.mymonarchhealthco.comThe podcast- @justaskhiveHeather- @showcenterdrqJackie- @jackiep_gynnpThe course is live and available at:the-hive8.teachable.com
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Dr. Ardelle Piper is a Royal College Certified OB/GYN, and focuses her gynecology practice on midlife women's health. She is known as a leader and pioneer in telemedicine, and provides menopause assessments over videoconference to women across Ontario since 2020. As a subject matter expert, Dr. Piper is frequently called upon as keynote speaker to provide menopause education to medical colleagues and the community, and collaborates with other social media educators. She advocates for improved appreciation of menopause in organizations and the general public, and health education in workplace wellness programs.Dr. Piper completed a BSc(H) in Cell and Developmental Biology, then achieved her medical degree (MD) at the University of British Columbia in Vancouver in 2006. Appreciating her passion for women's health and education, she pursued an Obstetrics & Gynecology residency and a MEd in Saskatchewan, with a thesis on School Based Sexual Health Education. Through this she enjoyed leadership opportunities as a provincial representative with the Canadian Association of Interns and Residents (CAIR) and was Chair of the Junior Member Committee of the Society of Obstetricians and Gynecologists of Canada (SOGC). During her obstetrical training and career, Dr. Piper welcomed into the world over 1500 babies, and co-chaired the Management of Postpartum Hemorrhage Simulation Workshops at the Federation of International Gynecologist and Obstetricians (FIGO) World Congress in Vancouver (2015) and Brazil (2018).She realized her interest in education, advocacy, and women's health aligned perfectly with the field of Menopause, and she achieved a final year of sub-specialty training in Midlife Women's Health at The Shirley E. Greenberg Women's Health Centre in Ottawa in 2014, and has maintained NAMS Certified Menopause Practitioner status since (NCMP has now been renamed MSCP). Her gynecology practice provides subspeciality consultation focused on menopause education, hormone therapy, sexual function, post-cancer thrivership, and preventive health promotion. With the pandemic, she has pioneered providing menopause assessments through telemedicine across Ontario. As a subject matter expert, she frequently provides menopause education to not only her physician colleagues, but also in public forums and workplaces, advocating for improved midlife women's health care.https://bywardfht.ca/our-services/menopause-clinic/https://www.instagram.com/dr.a.piper/?hl=enThank you so much for listening! I use fitness and movement to help women prevent and overcome pelvic floor challenges like incontinence and organ prolapse. There is help for women in all life stages! Every Woman Needs A Vagina Coach! Please make sure to LEAVE A REVIEW and SUBSCRIBE to the show for the best fitness and wellness advice south of your belly button. *******************I recommend checking out my comprehensive pelvic health education and fitness programs on my Buff Muff AppYou can also join my next 28 Day Buff Muff Challenge https://www.vaginacoach.com/buffmuffIf you are feeling social you can connect with me… On Facebook https://www.facebook.com/VagCoachOn Instagram https://www.instagram.com/vaginacoach/On Twitter https://twitter.com/VaginaCoachOn The Web www.vaginacoach.comGet your Feel Amazing Vaginal Moisturizer Here
JCO PO author Dr. Jonathan D. Tward, M.D., Ph.D., FASTRO, at the HCI Genitourinary Cancers Center and the Huntsman Cancer Institute at the University of Utah, shares insights into his JCO PO article, “Using the Cell-Cycle Risk Score to Predict the Benefit of Androgen-Deprivation Therapy Added to Radiation Therapy in Patients With Newly Diagnosed Prostate Cancer.” Host Dr. Rafeh Naqash and Dr. Tward discuss how the cell-cycle risk score predicts the benefit of androgen-deprivation therapy in prostate cancer treatment. TRANSCRIPT Dr. Abdul Rafeh Naqash: Hello and welcome to JCO Precision Oncology Conversations, where we bring you engaging conversations with authors of clinically relevant and highly significant JCO PO articles. I'm your host, Dr. Rafeh Naqash, Assistant Professor at the OU Health Stephenson Cancer center. Today, we are excited to be joined by Dr. Jonathan Tward, Leader at the HCI Genitourinary Cancer Center, and Vincent P. and Janet Mancini Presidential Endowed Chair in Genitourinary malignancies at the Huntsman Cancer Institute at the University of Utah. Dr. Tward is also the lead author of the JCO Precision Oncology article titled “Using the Cell-Cycle Risk Score to Predict the Benefit of Androgen-Deprivation Therapy Added to Radiation Therapy in Patients With Newly Diagnosed Prostate Cancer.” At the time of this recording, our guest's disclosures will be linked in the transcript. Doctor Tward, welcome to the podcast and thank you for joining us today. Dr. Jonathan Tward: Thank you so much, Dr. Naqash. I'm excited to share this important research with your audience. Dr. Abdul Rafeh Naqash: Awesome. For the sake of simplicity, we'll refer to each other using our first names, if that's okay with you. Dr. Jonathan Tward: That's great. Dr. Abdul Rafeh Naqash: Okay. So, Jonathan, this complex but very interesting topic revolves around a lot of different subtopics as I understand it. There is genomics, there are implications for treatment, there is machine learning and computational data science research. So, to start off why you started this project or why you did this research, could you, for the sake of our audience, try to help us understand what androgen deprivation therapy is? When is it used in prostate cancer? When is it used in combination with radiation therapy? And that would probably give us a decent background of why you were trying to do what you actually did in this research. Dr. Jonathan Tward: Yes, thank you very much. So, men who are diagnosed with localized prostate cancer, which is the majority of prostate cancer diagnosis, are faced with a lot of treatment decisions. And those decisions range all the way from, “Should I just go on active surveillance with the idea that it might be safe to treat later?” to “Should I consider surgery or radiation?” And then there's various forms of radiation. Now, as a radiation oncologist, one of the things that I have to consider when I meet a patient with localized prostate cancer who is pondering receiving radiation therapy, is whether or not we want to intensify treatment by doing more than just radiation alone. And androgen deprivation therapy, very specifically also thought of as chemical castration, what that really is is some kind of therapy where you are trying to reduce a man's testosterone levels to nearly zero. And the rationale for using androgen deprivation therapy in prostate cancer and in this case, specifically localized prostate cancer, is that one can think of testosterone almost as the food and growth signal for prostate cancer. There have been numerous prospective randomized trials that have been performed in the past that have clearly demonstrated that adding androgen deprivation therapy to certain contexts of patients with localized prostate cancer receiving radiation improves the outcome, including risk of metastasis and overall survival. The problem is, we don't want to just intensify therapy for everybody who walks through our doors with localized prostate cancer. Some men have lower risk disease, and some men have higher risk disease. And conventionally, the way we make this decision is by looking at things like NCCN risk groups, which kind of lump patients into a few different boxes, generally speaking, called low risk, intermediate risk, and high risk. And if you think of those risk groups, the patients with the contemporary standard of who to add ADT to are men who are considered high risk localized, or men who are considered unfavorable intermediate risk localized. That being said, I think there's a recognition that we're overtreating some unfavorable intermediate risk men and undertreating them, and the same could be said of high-risk disease. So, I think we're always looking for better tools that make it a little bit more personalized, rather than lumping men into just one of several boxes. Dr. Abdul Rafeh Naqash: Sure. And this sort of reminds me of the oncotype DX, in a way, trying to connect people with ER/PR, breast cancer, and where chemotherapy, plus anti-estrogen and progesterone therapy may be applicable. So, I think you were trying to do something similar in this research, and as far as I remember, please correct me if I'm wrong, this is knowledge that I remember from my board exams, we classify this high risk, intermediate risk, and low risk based on the Gleason score. Is that correct? Is that still true, or has this changed? Dr. Jonathan Tward: It's still true. Conventional risk stratification, which is still used, literally only looks at a few parameters. You mentioned one, which is the Gleason score, which is really a human subjective judgment by a pathologist about how deranged cells look under a microscope. That's one parameter. The second parameter is the PSA value at the time of diagnosis. And the third parameter is the cT stage, which is really based on the digital rectal exam. Now, when you ponder that the entirety of our risk classification system is based on two subjective and one objective pieces of information, meaning what a Gleason score looks like, what the T stage is based on human interpretation, and then the only objective piece of data, PSA, it's rather rudimentary way of classifying men. I mean, it's done us well since the late ‘90s, when that particular classification system was derived. But it strikes me as odd that we should take all newly diagnosed localized prostate cancer patients and say you fit into one of three boxes, when we know there's so much more complexity to people and so many different treatment options and choices out there, which we're trying to match to the patient to ensure that we right size the treatment for them. Dr. Abdul Rafeh Naqash: Understood. Now, as we go into the precision medicine component of this research, there's genomics research in metastatic cancers. But is there any genomics research in early-stage prostate cancer where there have been differences that have been identified between the intermediate low risk, high risk? Is that something that has been explored to date? Dr. Jonathan Tward: Well, there are certainly somatic mutations that track with certain aggressive features. But I think when I think about the spirit of your question, within the localized prostate cancer space, there's been several molecular signatures that have been developed and, in fact, been commercialized that have been shown quite clearly that if you have a certain array of gene expressions, let's say, that that can correlate with metastasis or risk of recurrence or death. And the work that we're talking about today is one that actually uses one of the commercially available biomarkers, commercially it's known as Prolaris. But very specifically, in the work that I think we're discussing today, what we're looking at is cell cycle progression genes. And these are genes that maybe, to simplify it, are sort of hallmarks of how quickly cells are turning over. And what's interesting about looking at cell cycle progression is it's not certainly particular to prostate cancer. I mean, you could make an argument that cell cycle progression genes are probably relevant measures in any cancers, but there's been much work done over the past 15 to 20 years that have clearly validated that this particular cell cycle progression gene signature, which is now commercially available, clearly correlates with risk of progression, risk of metastasis in localized prostate cancer patients, whether they're receiving surgery or radiation. But what we've done is we've built upon this molecular work and added clinical risk features and added results of prospective randomized trials to use this test to personalize the precise risk reduction of what would happen to a man who is pondering adding ADT to radiation therapy. So, it's a very powerful precision tool. Dr. Abdul Rafeh Naqash: Sounds very interesting. When you go deeper into this platform, is this genomic testing platform, does it incorporate RNA transcriptome or is it DNA, or is it a composite of both? Dr. Jonathan Tward: There are various molecular tests that are out there. In this particular case, these are mRNA expression levels of cell cycle progression genes, and they are kind of calibrated against some normal housekeeping genes, which is how the test is run. Dr. Abdul Rafeh Naqash: Understood. So, from what I understand in the discussion, you very appropriately said, in fact in your first paragraph, the goal here is to match patient level precision medicine approaches and reconcile them with population level therapeutic options. It's a very catchy statement. Can you help explain for our audience how you tried to do that? And this goes back to the question that you were trying to understand, where to use combination therapy in a localized prostate cancer based on risk stratification and deriving that risk stratification from the cell cycle score and then arriving to certain thresholds. So could you go through that in simple terms to help us understand how you tried to do it and what was the outcome and what are the implications of that? Dr. Jonathan Tward: Sure, there's a lot to unpack there, but I'll do my best to simplify it. So, we'll start with the basic question that faces a patient and their radiation oncologist, which is, if they're going to receive radiation, should you add hormone therapy? And if hormone therapy was completely nontoxic, you'd say, “Sure, just add it to everybody if there's a benefit.” But the problem is, of course, hormone therapy is associated with all kinds of unpleasant side effects and additional risks, so we don't want to utilize it unless we're sure that the benefit is clear. When you think about the way most of oncology decides whether or not adding an intervention should be done in a particular patient context, it's actually been derived originally from prospectively randomized trials, which usually assigned a hazard ratio or some kind of known relative reduction to doing ‘thing B' versus ‘thing A' or ‘thing B' in addition to ‘thing A'. But what's curious about always looking at hazard ratios and saying that those are the reasons why you should do additional things, discounts a really important fact, which is the baseline risk of something bad happening has to be accounted for first before you decide whether or not it a relative risk reduction matters. So to state more clearly, if I knew a prostate cancer patient sitting in front of me only had a 2% risk of developing metastasis within 10 years, if I just did radiation alone, if I then say adding hormone therapy might cut that in half from 2% to 1%, a patient might say, “You know what? I'm not sure I want to accept the toxicity of many months of hormone therapy to cut my risk of metastasis from 2% to 1%.” But if you had a patient where that risk was 20% risk of metastasis with radiation alone, and you told them I can cut that risk down to 10% or 12%, then that's something they would seriously consider. And so what this work really does is precisely that. It gives us a tool where, using the molecular signature of the cell cycle progression genes, which afford a patient a certain risk of metastasis, and also taking into account clinical risk factors that we know are prognostic, Gleason score, PSA, their age, how many cores of the biopsy were possible. We use all this information, and I'll use a strange term, multiplex it into a robust risk model that will prognosticate extremely clearly what that patient's precise risk of metastasis will be within the next 10 years, and this is the key point, if they receive radiation alone. So, think of this work in two phases. Phase one is calibrate the risk in a patient if they get radiation alone, by using both molecular and clinical prognosticators. But then take the power of numerous randomized trials, which have clearly set the hazard ratio reduction for adding the hormone therapy, and then using mathematical principles, applying that hazard ratio risk reduction to the absolute risk. And then what you ultimately do is, at a very individual level, have a patient sitting in front of you where you can say, “Mr. Jones, I've run this test on you, and I can tell you definitively that if you receive radiation therapy for your localized prostate cancer, the risk of metastasis will be 12%. But if you add, let's say, six months of hormone therapy, that could be reduced to 7%, and the absolute risk reduction might only be 5%.” And if you think about that number in a number needed to treat mentality, then you could say, “Listen, I have to give 20 men identical to you, hormone therapy for one to benefit. Is that worth it to you?” And what it really does is it empowers the patient. Rather than following a guideline that says, “Effectively, thou shalt do this for this risk group,” you really want to engage the patient in the conversation about the risk benefit of what you're going to do. And I think it's uncommon in oncology for physicians to be able to very precisely tell a patient sitting in front of them, if you do ‘thing A', this is the risk, something bad happen. If you do ‘thing B', this is how the risk reduces. And I think now we really get into shared decision making, rather than a, “Trust me, I'm a doctor,” paternalistic situation. Dr. Abdul Rafeh Naqash: That's a very interesting approach. Again, you're basically personalizing the personalized medicine approach, refining it further, and involving the patient in discussions, which helps them understand why something would make sense. And some of this, as you might already know, people have tried to do in some other tumor types, hasn't necessarily led to significant clinical decision-making changes. But I think the way the field is evolving, especially this research that you published on and others are working towards, will hopefully result in more personalized approaches for individual decision making for these patients. Now, I do understand that simplicity sometimes results in more uptake of some information versus when sometimes things get more complex. So, in your assessment, when you came up with these results, you looked at the genomic score, you took the randomized clinical trial data, you did the absolute risk reduction. From what I understood in the manuscript, it does look like you did come up with a threshold of what would appropriately risk stratify individuals, meaning individuals that are at a higher risk if they cross that threshold, versus individuals that are at a lower risk if they cross that threshold. Is that a fair statement or is this a continuum? So there is no binary, but this is over a scale that this assessment can be made. Dr. Jonathan Tward: So, there are elements of your summary that are fair, but this is a continuum which allows any individual to accept whatever risk reduction they want. That being said, there is no standard in oncology for what percent risk should you intensify a treatment for? And when you poll physicians and doctors as to how much reduction in death or how much reduction in metastasis, doctors and patients are all over the map at what they consider to be a threshold. But we designed these thresholds actually from prior work, based on surveying both patients themselves, as well as experts who were on cooperative trial group steering committees, and ask them, essentially, “At what level of risk reduction would you want to intensify treatment?” And what's interesting is most people who are asked that question are willing to do more treatment intensity for an important outcome like metastasis if the absolute risk reduction of that event happening is 5%. So as a general principle, that's how it was set. These thresholds in the current paper we're discussing actually weren't defined in this current work. They were defined in prior works, where we had clearly shown in retrospective data sets that they could discriminate very well who does or doesn't benefit from hormone therapy. What's, I think, novel about this paper, even though we had previously validated those thresholds, is that now that we're using the randomized trial data, it's extremely robust in our risk estimates, and we can say that it's truly a predictive biomarker. Because it's one thing to prognosticate an outcome, but predict a difference in treatment A versus treatment B usually requires randomized trial data so that you get the highest level of evidence and the confidence that it works. Dr. Abdul Rafeh Naqash: So the next steps for this very, very provocative research, is it something prospective validation or are you going to try to utilize maybe proper group trial data or other pharma trial data, individual patient data to risk stratify these individuals and validate? Dr. Jonathan Tward: So these thresholds, for example, that you refer to are very well validated. There's multiple prior studies, well over at this point, 1500 patients where there's validation. And yes, we have reached out to cooperative groups to do some additional validation. That being said, this work is already ready for prime time and being used. In fact, this test is the commercially available Prolaris test. The results gleaned from this work are published on the score report that a patient and a physician receives. So the reality is that this is already existing as a clinical tool in the community. And the NCCN guidelines also support the use of this and other tests to move from a stratification to personalized medicine. So it's not like this is so much in the experimental realm as it is effectively a complete tool that is being used today. And effectively, it's available for any patient or physician diagnosed with localized prostate cancer to immediately order on biopsy tissue. Dr. Abdul Rafeh Naqash: One naive question, Jonathan, I wanted to ask is most prostate cancers tend to be prostatic adenocarcinoma. So if it's a neuroendocrine localized prostate cancer, does the same risk assessment apply? Because neuroendocrine tumors in general seem to be higher replication stress or higher tendency to metastasis. Does it change from your perspective, from the genomic assessment standpoint, the CCR score standpoint? Dr. Jonathan Tward: That's a very interesting question, because what I will tell you is that there are probably a lot of, well, I wouldn't say a lot, but there are some neuroendocrine cancers mixed in with the adenocarcinomas that no one identified as neuroendocrine, which in a way were baked into the cake of the risk signature. Even though that is so, I dont think we've independently looked very specifically at known neuroendocrine cancers and compared them to the adenocarcinomas. What I would actually argue though, is that if you have a neuroendocrine cancer sitting in front of you, the point about whether or not you're adding ADT is relatively moot because neuroendocrine cancers may or may not respond to ADT, and you have to start considering chemotherapeutic-like decisions. So the question, which is very interesting and academic, is that I would presume the cell cycle progression score should be elevated, although I don't know that in a neuroendocrine cancer, this tool doesn't appear to be useful at this moment for neuroendocrine cancers because we're not making decisions about chemo. That's an interesting and provocative question, and now you make me want to study that. So potentially, the next paper would be neuroendocrine cancers, whether or not it might prognosticate using a topicide or something else like this. But we would have to rely on prospective trial data as well to see whether or not we could use it the same way. Dr. Abdul Rafeh Naqash: Hopefully, if you do work on it, then you can submit the manuscript again to JCO PO for us to talk again. Dr. Jonathan Tward: Yeah, and you'll be on the author bar. Dr. Abdul Rafeh Naqash: Appreciate the inclusion. So thank you so much, Jonathan, for talking to us about the science. And a few quick minutes about yourself. Can you tell us a little bit about your career trajectory, how you ended up doing what you're doing, and maybe some lessons learned and some advice for early career junior investigators that would be helpful for them? Dr. Jonathan Tward: Yes, that's a happy memory. When I was a young undergrad, I was fortunate to do some volunteer work in a radiation oncology department and had mentors there who guided me into considering a career in medicine and specifically a career as a physician scientist. So I'll start with the best advice is to get mentors early on and throughout your career who are really interested in your career development and who are accomplished that can kind of help you along. But I went to medical school with an open mind and continued to love oncology. I think it has some of the most complex questions that are unanswered. It is very high stakes oncology. There's still a lot of death and disability and consequences of our therapies. And I just love the idea of working in an environment, both clinically and as a researcher, to try to solve some of those questions like, how do I improve outcomes? How do I make therapy less toxic? And radiation oncology for me, was a nice fit in genitourinary cancer, I guess, specifically because mid GU cancer realm patients are presented with a menu of treatment options. It's kind of interesting. It's a little bit unlike other cancers. But I had fantastic mentors throughout both my medical school as well as residency program who really helped guide me and encourage me along the way. And so without spending too much time, I would say go out of your way to find people who are successful at what they do, are interested in making you better, and really sit at their knee and listen to them when they are trying to guide you because they really have your best interests in mind. And I think as a mentor and a mentee, what makes me most proud is watching people I've trained go out and succeed. I mean, the reward of being a mentor is watching your mentees succeed. Dr. Abdul Rafeh Naqash: Thank you. Appreciate all those words of wisdom, Jonathan, and excited to see all the subsequent steps and results from the research that you're doing. Thank you again for joining us today and providing a very simple summary of a very complex topic which I think our audience and perhaps some of the trainees listening to this podcast will appreciate. We really appreciate your time. Dr. Jonathan Tward: Thank you so much, Rafeh. Dr. Abdul Rafeh Naqash: And thank you for listening to JCO Precision Oncology Conversations. Don't forget to give us a rating or review and be sure to subscribe so you never miss an episode. You can find all ASCO shows at asco.org/podcast. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity or therapy should not be construed as an ASCO endorsement. Dr. Tward Diclosures: HonorariaCompany name: Bayer Consulting or Advisory RoleCompany name: Myriad Genetics, Blue Earth Diagnostics, Janssen Scientific Affairs, Merck, Bayer, Boston Scientific, Myovant Sciences, Myriad Genetics, Lantheus Medical Imaging Research FundingCompany name: Bayer, Myriad Genetics Travel, Accommodations, ExpensesCompany name: Myriad Genetics, Bayer
“It was nothing to worry about,” Andrew was repeatedly told, when he visitedurgent care twice for pain in his pelvis area. But the discomfort wouldn't go away, so he met with his primary care physician who referred him to a urologist for an ultrasound. The scans led to a testicular cancer diagnosis in early 2023. It was caught early enough, and he was told there was a good prognosis. The cancer had only spread very lightly to his lymph nodes. Adam works as the director of data analytics for a pharmaceutical company. Heloves vacationing with his family, watching his children play their sports (soccer for his son Jacob and gymnastics for his daughter Julia) and caring for his 2004 BMW. He hopes to help normalize conversations around testicular cancer for other men so they can overcome stigmas and shame around it. Today, he and his wife Kara arecelebrating their wedding anniversary. Dr. Atish Choudhury is a medical oncologist and clinical/translational investigatorwithin the Lank Center for Genitourinary Oncology at Dana-Farber Cancer Institute, and currently serves as Chair of the Gelb Center for Translational Research. He also serves as an Assistant Professor of Medicine at Harvard Medical School. His research interests include investigation of genetic and epigenetic biomarkers from circulating free DNA from patients with metastatic cancer, biomarker studies from other banked human specimens from patients participating in clinical trials, and clinical investigation in novel therapeutics for genitourinary malignancies. According to the American Cancer Society, testicular cancer is not common. About 1 of every 250 males will develop testicular cancer at some point during their lifetime. The American Cancer Society's estimate for testicular cancer in the United States for 2024 is about 9,760 new cases of testicular cancer diagnosed. The average age of males when first diagnosed with testicular cancer is about 33. This is largely a disease of young and middle-aged men, but about 6% of cases occur in children and teens, and about 8% occur in men older than 55.
Wondering if your hormone deficiency symptoms could be the genitourinary syndrome of menopause (GSM)?In this episode, I dive deep into the often-overlooked but crucial topic of GSM, a condition affecting a significant percentage of postmenopausal and perimenopausal women. GSM extends beyond vaginal dryness, causing discomfort, pain during intercourse, and urinary issues.I discuss the importance of shifting away from the term "atrophic" and embracing the more comprehensive "genitourinary syndrome of menopause." This change in terminology reflects the wide-ranging impact of hormone deficiencies on genital and urinary health.Highlighting the chronic and progressive nature of GSM, I emphasize the need for ongoing treatment and open communication between patients and healthcare providers. Unfortunately, many cases go unrecognized and under treated due to stigma and hesitancy surrounding menopause and perimenopause.I also explore various treatment options for GSM, including topical estrogen, vaginal DHEA, and CO2 laser therapy. Importantly, I clarify that GSM can affect individuals at various stages of hormone deficiency, not just during perimenopause or postmenopause.Throughout the episode, I advocate for the use of sensitive language when discussing these issues and encourage clinicians to prioritize patient comfort and understanding. By promoting education and open dialogue, we can break down barriers and ensure that individuals receive the care they need.Remember, you don't have to suffer in silence. If you're experiencing symptoms of GSM, reach out to your healthcare provider and advocate for your well-being. Together, we can work towards better recognition, treatment, and support for this critical aspect of women's health.Highlights:- Understanding GSM: Learn about the comprehensive impact of hormone deficiencies on genitourinary health, extending beyond vaginal dryness to include discomfort, pain, and urinary symptoms.- Shifting Terminology: Discover the significance of embracing the term "genitourinary syndrome of menopause" and moving away from the potentially hurtful "atrophic" label.- Treatment Options: Explore various approaches to managing GSM, including topical estrogen, vaginal DHEA, and CO2 laser therapy, and understand their potential benefits.- Breaking Stigmas: Recognize the importance of open communication and sensitive language in addressing the hesitancy and shame surrounding menopause and perimenopause.- Advocating for Your Health: Gain the knowledge and confidence to discuss GSM with your healthcare provider and prioritize your well-being throughout the menopausal transition and beyond.Who would you like me to interview next? Remember, this podcast is here to empower you with the information you need to advocate for your health. If you found this episode valuable, please give us a 5-star review on Apple Podcasts, subscribe, and share with your friends!Get in Touch with Dr. Rahman:WebsiteInstagramYoutube
Description: Dr. Katie Epstein summaries the article “Troubleshooting Tips for Diagnosing Complex Fetal Genitourinary Malformations” published in RadioGraphics Troubleshooting Tips for Diagnosing Complex Fetal Genitourinary Malformations. Griffith et al. RadioGraphics 2024; 44(1):e230084.
The second of our two GU ASCO 2024 episodes focusses on prostate and penile cancer, two diseases at different ends of the therapeutic spectrum. Prostate cancer is one of the most common cancers in men, with well established, nuanced treatment paradigms and a glut of high-quality evidence. Penile SCC is a very rare cancer that tragically is much more common in low socioeconomic countries. Treatment options are as limited as available evidence, so any new studies of this cancer are very welcome. Are there any more practice changing twists and turns from ASCO 2024? You'll have to listen to find out!Links to studies discussed in this episode (subscription may be required)Cabazitaxel with abiraterone versus abiraterone alone randomized trial for extensive disease following docetaxel: The CHAARTED2 trial of the ECOG-ACRIN Cancer Research Group (EA8153): LinkCYCLONE 2: A phase 3 study of abemaciclib with abiraterone in patients with metastatic castration-resistant prostate cancer: LinkA randomized, double-blind, placebo-controlled trial of metformin in reducing progression among men on expectant management for low-risk prostate cancer: The MAST (Metformin Active Surveillance Trial) study: Link A phase II trial of pembrolizumab plus platinum-based chemotherapy as first-line systemic therapy in advanced penile cancer: HERCULES (LACOG 0218) trial. LinkFor more episodes, resources and blog posts, visit www.inquisitiveonc.comPlease find us on Twitter @InquisitiveOnc!If you want us to look at a specific trial or subject, email us at inquisitiveonc@gmail.comOncology for the Inquisitive Mind is recorded with the support of education grants from Pfizer, Gilead Pharmaceuticals and Merck Pharmaceuticals. Our partners have no editorial rights or early previews, and they have access to the episode at the same time you do.Art courtesy of Taryn SilverMusic courtesy of AlisiaBeats: https://pixabay.com/users/alisiabeats-39461785/The Star Spangled Banner courtesy of Music_Unlimited: https://pixabay.com/users/music_unlimited-27600023/Disclaimer: This podcast is for educational purposes only. If you are unwell, seek medical advice. Hosted on Acast. See acast.com/privacy for more information.
Genitourinary Cancers dominated ASCO24 this year, and Josh and Michael's ASCO Odyssey needed two episodes to fit it all in. Join them as they board the Nautilus with Captain Nemo in search of the best trials to propel bladder and renal cancer to the forefront of your mind. This episode covers both the use of perioperative sacituzumab govitecan, avelumab as neoadjuvant therapy for bladder cancer and camrelizumab for previously treated advanced adrenocortical carcinoma. Not to be forgotten, they explore a biomarker analysis of the CLEAR trial to see whether any treasure is to be found...Links to studies discussed in this episode (subscription may be required)SURE 01/02: LinkAURA: LinkCLEAR biomarker analysis: LinkCamrelizumab plus apatinib for previously treated advanced adrenocortical carcinoma: A single-arm, open-label, phase 2 trial: LinkFor more episodes, resources and blog posts, visit www.inquisitiveonc.comPlease find us on Twitter @InquisitiveOnc!If you want us to look at a specific trial or subject, email us at inquisitiveonc@gmail.comOncology for the Inquisitive Mind is recorded with the support of education grants from Pfizer, Gilead Pharmaceuticals and Merck Pharmaceuticals. Our partners have no editorial rights or early previews, and they have access to the episode at the same time you do.Art courtesy of Taryn SilverMusic courtesy of AlisiaBeats: https://pixabay.com/users/alisiabeats-39461785/The Star Spangled Banner courtesy of Music_Unlimited: https://pixabay.com/users/music_unlimited-27600023/Disclaimer: This podcast is for educational purposes only. If you are unwell, seek medical advice. Hosted on Acast. See acast.com/privacy for more information.
A patient with multiple sclerosis experiences bladder dyssynergia during micturition. Which of the following descriptions BEST matches this condition? Find it all out in the podcast! Be prepared for the NPTE so that you can pass with flying colors! Check out www.ptfinalexam.com/podcast for more information and to stay up-to-date with our latest courses and projects.
Drs. Jonathan Rosenberg and Alicia Morgans share their insights into some late-breaker abstracts presented at the 2024 ASCO GU symposium in San Francisco. The first is a subgroup analysis from EV‑302 with enfortumab vedotin and pembrolizumab, and the other is AMBASSADOR, which looks at adjuvant pembrolizumab in locally advanced and muscle invasive urothelial cancer.
Germline and somatic testing for in prostate cancer can improve outcomes and promote early detection and prevention, yet many patients are not aware of testing and the impact it can have on treatment options. In this episode, CANCER BUZZ speaks with David Gill, MD, medical oncologist at Intermountain Healthcare's Intermountain Cancer Center and Lindsey Byrne, MS, LCGC, licensed certified genetic counselor at The Ohio State University Comprehensive Cancer Center, who discuss how genetic counselors and increased patient education can help cancer programs close the practice gap and promote guideline-concordant testing among patients diagnosed with prostate cancer. “I'd really advocate—even in your patients with a negative NGS panel—please still consider getting germline testing in those patients.” –David Gill, MD “We know that individuals, yes, they're dealing with a diagnosis of cancer, but the first thing people say to me when I sit down with them is, ‘All right, I have this figured out, but what does this mean for my family?' They're really worried about their family, and that's where our focus is, to help take care of that.”—Lindsey Byrne, MS, LCGC David Gill, MD Medical Oncologist Intermountain Healthcare - Intermountain Cancer Center Salt Lake City, Utah Lindsey Byrne, MS, LCGC Licensed Certified Genetic Counselor The Ohio State University Comprehensive Cancer Center – The James Columbus, Ohio This episode was developed in connection with the ACCC education program Germline and Somatic Testing for Mutations to Optimize Outcomes in Metastatic Prostate Cancer and is supported by AstraZeneca, Johnson & Johnson, and Pfizer. Resources: Germline and Somatic Testing for Mutations to Optimize Outcomes in Metastatic Prostate Cancer - ACCC Abstract: Homologous recombination repair gene mutation (HRRm) testing patterns and treatment selection from a real-world cohort of patients with metastatic castration-resistant prostate cancer (mCRPC) Abstract: Utilization of genetic counseling and testing for patients with prostate cancer following integration of a genetic counselor into a genitourinary cancer clinic
Dr. Guru Sonpavde, Medical Director of Genitourinary Oncology (GU), AdventHealth Cancer Institute joins the podcast to dive deep into some of the clinical research that AdventHealth is pioneering and the work around a new bladder cancer therapy vaccine that represents the forefront of precision oncology.
This week on BackTable Urology, Dr. Ramon Virasoro, a reconstructive urologist in Eastern Colorado, interviews his mentor, Dr. Gerald Jordan, Professor Emeritus of Urology at Eastern Virginia Medical School. First, they explore Dr. Jordan's multifaceted career, starting from his upbringing in El Paso and his military career, which eventually led him to medicine and urology. Dr. Jordan shares anecdotes from his time as a Navy fighter pilot and how his service influenced his medical path. He eventually chose to focus on reconstructive urology and played a pivotal role in the formation of the Society of Genitourinary Reconstructive Surgeons (GURS). Significant emphasis is placed on global surgical education and Dr. Jordan's involvement in establishing and contributing to key nonprofits aimed at improving urological care worldwide. The podcast also delves into Dr. Jordan's tenure at the American Board of Urology, and the urologists also discuss the evolving landscape of urology education and certification. Finally, Dr. Jordan reflects on the importance of mentorship, the joy of lifelong learning, and the future of urology as a fulfilling specialty. --- SHOW NOTES 00:00 - From Fighter Pilot to Urologist 07:32 - Transitioning from the Military to a Medical Career 14:21 - The Evolution of Reconstructive Urology and Global Surgical Education 22:01 - Dr. Jordan's Role in the American Board of Urology 26:31 - Reflecting on a Distinguished Career and Looking Ahead --- RESOURCES Society of Genitourinary Reconstructive Surgeons https://societygurs.org/ BackTable Urology Episode 52- Legends in Urology: Dr. Jack McAninch https://open.spotify.com/episode/46wrxyhB2XCwERp4Z2ySc0?si=fe62e35cff934e74
Drs. Rosenberg and Morgans share their insights into some late-breaker abstracts presented at the 2024 ASCO GU symposium in San Francisco. The first is a subgroup analysis from EV‑302 with enfortumab vedotin and pembrolizumab, and the other is AMBASSADOR, which looks at adjuvant pembrolizumab in locally advanced and muscle invasive urothelial cancer.
Which of the following groups of signs and symptoms are MOST commonly present in a patient with dyssynergic bladder? Find it all out in the podcast! Be prepared for the NPTE so that you can pass with flying colors! Check out www.ptfinalexam.com/podcast for more information and to stay up-to-date with our latest courses and projects.
It's been a busy few weeks here at CURE® and in the oncology space as a whole, as the last two weekends had back-to-back meetings: the American Society of Clinical Oncology's Gastrointestinal Cancers Symposium, and then their Genitourinary Cancers Symposium. Here are some highlights from the conference, but as always, you can find all of our coverage at curetoday.com. Gastrointestinal Cancers Symposium Imfinzi, Avastin, TACE May ‘Set a New Standard of Care' in Liver Cancer For patients with liver cancer whose disease is not eligible to be removed via surgery, adding Imfinzi and Avastin to transarterial chemoembolization — also known as TACE — tended to lengthen the time patients lived before their disease got worse, according to findings from the EMRALD-1 trial. These improvements in progression-free survival over TACE alone could lead to a new standard of care for this patient population, according to the lead study author, Dr. Riccardo Lencioni. More specifically, patients who received Imfinzi and Avastin plus TACE lived for a median of 15 months before death or disease worsening, compared to 8.2 months for patients who received TACE alone. This correlates to a 23% reduction in the risk of disease progression or death, and benefits were seen across different patient subgroups. Notably, the researchers on EMRALD-1 are still monitoring how the addition of the two drugs impacts overall survival. Once those data become more clear, it is possible that the drug manufacturers could submit this regimen to the FDA for approval, thereby officially shaking up the standard of care of TACE, which has remained the main treatment in this setting for about two decades. Cancer in Bloodstream May Predict CRC Outcomes Circulating tumor DNA — also known as ctDNA — was another hot topic at the Gastrointestinal Cancers Symposium. So ctDNA measures little fragments of cancer that are found in the bloodstream after cancer treatment. Now, findings from the BESPOKE trial highlight the fact that ctDNA may offer insight into the recurrence risk in patients with stage 2/3 colorectal cancer who underwent surgery and then chemotherapy. The researchers used ctDNA to help determine minimal residual disease, or MRD, status. Essentially, patients with disease still detected in the blood stream were MRD positive, while those without detectable cancer were MRD negative. Findings showed that those with MRD negativity tended to live longer without experiencing relapse or death compared to patients with MRD positivity. Genitourinary Cancers Symposium Survival Benefits with Keytruda and Padcev in Advanced Urothelial Cancer Back in December, the Food and Drug Administration approved Padcev plus Keytruda for patients with previously treated locally advanced or metastatic bladder cancer. The approval was based on primary findings from the EV-302 trial. Now, updated findings from that trial are showing that the drug duo continues to outperform chemotherapy when it comes to progression-free survival — that's the time patients live before their disease gets worse — as well as overall survival, which is the time patients live before death of any cause. Notably, these survival benefits were seen across patient subgroups, such as those with visceral metastases and lymph node-only disease. According to the lead study author, Dr. Michiel S. Van Der Heijden, this could result in a new standard of care in patients with locally advanced or metastatic urothelial carcinoma. Many Patients Miss Out on Testing to Guide Prostate Cancer Treatment On the prostate cancer front, a study found that many people with metastatic castration-resistant prostate cancer are not undergoing germline or somatic testing. Now this is really important because back in 2020, two PARP inhibitors were approved in this setting. These are targeted drugs approved for patients whose cancers have certain characteristics, which can be determined by these types of tests. Rates of germline and somatic testing have increased since the FDA approvals, but according to the study — which looked at real-world evidence of patients being treated in community cancer and urology centers — about 40% of patients did not undergo standard-of-care testing. Study author, Dr. Neal Shore, said that this indicates the need for improved education on the importance of germline and somatic testing. For more news on cancer updates, research and education, don't forget to subscribe to CURE®'s newsletters here.
Which of the following aerobic exercise intensities is MOST appropriate for a pregnant patient? Find it all out in the podcast! Be prepared for the NPTE so that you can pass with flying colors! Check out www.ptfinalexam.com/podcast for more information and to stay up-to-date with our latest courses and projects. Free NPTE Premium Course in Chicago, Feb 29-Mar 1 (Free housing and meals)
PRE-ORDER MY NEW BOOK SWEET INDULGENCE!!! https://www.amazon.com/Chef-AJs-Sweet-Indulgence-Guilt-Free/dp/1570674248 or https://www.barnesandnoble.com/w/book/1144514092?ean=9781570674242 Save Your Receipt! We will be offering bonuses for pre-orders ASAP. GET MY FREE INSTANT POT COOKBOOK: https://www.chefaj.com/instant-pot-download ------------------------------------------------------------------------------------ MY LATEST BESTSELLING BOOK: https://www.amazon.com/dp/1570674086?tag=onamzchefajsh-20&linkCode=ssc&creativeASIN=1570674086&asc_item-id=amzn1.ideas.1GNPDCAG4A86S ----------------------------------------------------------------------------------- Disclaimer: This podcast does not provide medical advice. The content of this podcast is provided for informational or educational purposes only. It is not intended to be a substitute for informed medical advice or care. You should not use this information to diagnose or treat any health issue without consulting your doctor. Always seek medical advice before making any lifestyle changes. Ashley Winter, MD is a board certified urologist based in Los Angeles. As a practicing urologist she witnessed first hand how the intersectionality of male and female urinary, genital, and hormonal health was underserved by traditional medical specialties. It is her professional mission to build technologies and healthcare platforms that increase access to sexual health. Dr. Winter completed her BS in biomedical engineering and her medical degree from Rutgers University. She completed her urology residency at New York Presbyterian- Weill Cornell Medical center, and a fellowship in male and female sexual dysfunction with Dr. Irwin Goldstein at San Diego Sexual medicine. She is working on a smart wearable device for the clitoris with FirmTech (www.myfirmtech.com). She can be found influencing patients and physicians all over the world through her social media @ashleygwinter (most active on Twitter/X). On Twitter: https://twitter.com/AshleyGWinter On Instagram: https://www.instagram.com/ashleygwinter/
The AUA Expert Exchange Podcast: Discussions in Managing GU Cancer: Novel Imaging for Genitourinary Cancers - Diagnostics and Theranostics CME Available: https://auau.auanet.org/node/39411 Release Date: December, 2023 Expiration Date: December, 2024 LEARNING OBJECTIVES At the conclusion of this activity, participants will be able to: 1. Review the latest clinical trials investigating the use of PET imaging agents in prostate, kidney, and urothelial cancer, including their diagnostic accuracy and impact on patient management. 2. Discuss the available PET imaging agents for prostate cancer, with a specific focus on PSMA (Prostate-Specific Membrane Antigen) PET imaging, including its mechanism of action and its potential for detection of primary tumors, lymph node metastases, and distant metastases. 3. Discuss the benefits of incorporating PET imaging, including PSMA PET, in guiding treatment decisions for GU cancers, such as its impact on treatment selection, treatment response assessment, and the potential for theranostic approaches. ACKNOWLEDGEMENTS: Support provided by independent educational grants from: Astellas and Pfizer, Inc AstraZeneca Janssen Biotech, Inc., administered by Janssen Scientific Affairs, LLC Lantheus Medical Imaging Merck & Co., Inc.
242. Modern Sex Challenges with Dr. Marianne Brandon Thanks to our sponsor Uber Lube 10% off, Code NOTBROKEN uberlube.com Check out my retreat March 2024! https://ascendretreats.com/ Dr. Marianne Brandon is a clinical psychologist and Diplomate in sex therapy. Dr. Brandon is the author of “Monogamy: The Untold Story” and the ebook “Unlocking the Sexy in Surrender: Using the Neuroscience of Power to Recharge Your Sex Life”. She is co-author of the book “Reclaiming Desire: 4 Keys to Finding Your Lost Libido.” Dr. Brandon makes cutting edge research on relationships and intimacy accessible for the general public — advice that the people are clearly starving for. Consider the stats: Over 50% of marriages end in divorce Over 40% of women and 30% of men report a sexual concern 20% of marriages are “sexless” Over 20% of women report “marked distress” about their sexual relationships Approximately 30% of spouses have had an affair Dr. Marion Brandon highlights the challenges of sex in society, the lack of comprehensive sex education, and the nuances of pornography. Dr. Brandon also explores the complexities of monogamy, the impact of AI and sex tech, and the role of power dynamics in relationships. She emphasizes the importance of treating couples, not just individuals, and the benefits of having a biopsychosocial perspective. The conversation explores the importance of hormone changes in midlife and the impact it has on sexual health. It highlights the lack of awareness and treatment of genital urinary syndrome, which can significantly affect relationship dynamics. The discussion also addresses the lack of knowledge among physicians regarding available treatments. The impact of intimate connection on overall well-being is emphasized, and Marianne Brandon's Psychology Today blog is recommended as a valuable resource. Comprehensive sex education is lacking, particularly in the digital age. Pornography can be a complex topic, with both positive and negative aspects. Monogamy can be challenging and requires effort, communication, and mindfulness. The rise of AI and sex tech presents both opportunities and concerns. Power dynamics can play a role in sexual relationships and can be explored in a healthy way. Understanding hormone changes and desire discrepancy is important in addressing sexual issues. Treating couples as a unit is crucial for addressing sexual concerns. Taking a biopsychosocial perspective can provide a more comprehensive understanding of sex and relationships. Midlife hormone changes can have a significant impact on sexual health and overall well-being. What to do when the man has a low libido. Genitourinary syndrome is often under-treated and can lead to changes in relationship dynamics. Physicians may lack knowledge about available treatments for sexual health issues. A satisfying intimate connection has a profound impact on relationships and overall life satisfaction. Marianne Brandon's Psychology Today blog is a valuable resource for information on sexual health. The testosterone conference for clinicians is an important event for learning about biopsychosocial and hormonal aspects of sexual health. She asks her clients about their best sex ever because I can learn a lot about them from this memory. https://www.drbrandon.net/ https://www.psychologytoday.com/us/blog/the-future-intimacy twitter @drbrandon https://www.instagram.com/drmbrandon/ Harvard Testosterone Course https://hmstestosteronecourse.com/ Check out details for my retreat: https://ascendretreats.com/ Did you get my “You Are Not Broken” Book Yet? https://amzn.to/3p18DfK Listen to my Tedx Talk: Why we need adult sex ed Join my NEW Adult Sex Ed Master Class: https://www.kellycaspersonmd.com/adult-sex-ed Join my membership to get these episodes ASAP when they are created and without advertisement and even listen live to the interviews and episodes. www.kellycaspersonmd.com/membership --- Send in a voice message: https://podcasters.spotify.com/pod/show/kj-casperson/message
A patient with a lower lumbar spinal cord injury is MOST likely to experience which of the following groups of bladder symptoms? Find it all out in the podcast! Be prepared for the NPTE so that you can pass with flying colors! Check out www.ptfinalexam.com/podcast for more information and to stay up-to-date with our latest courses and projects.
This week on the podcast Dr Louise speaks to Dr Ashley Winter, a urologist and sexual medicine specialist, based in Los Angeles. Dr Ashley has seen the transformative effects of vaginal hormones on women – not only those who are menopausal, but also women who experience cyclical symptoms of bladder pain, UTIs and painful sex. She shares her frustration on the situation in the US, where inaccurate and harmful warnings are included in every oestrogen product available, and her hopes of dispelling the fearmongering by talking, looking at the evidence and sharing her clinical experience. Finally, Dr Ashley gives three reasons why women should use vaginal hormones: It's extraordinarily safe. No risk of any cancer or blood clots, 100% safe. It can prevent you from needing so many other unnecessary treatments that don't address root causes, and so you will probably save money. It is not just a vaginal treatment. It is a bladder treatment, a urethral treatment, a vulva treatment. The medication acts locally, but acts locally throughout the pelvis. Follow Ashley on X and Instagram @ashleygwinter
In this episode, we delve into the important topic of vaginal health and genitourinary symptoms, especially as we age and experience changes in our hormone levels. If you're experiencing symptoms like burning, pain, irritation, itching, bladder urgency or leaking, recurrent UTIs, painful sex, vaginal dryness, loss of libido, increased yeast infections, or other vaginal discomfort, this episode is a must-listen! Join us for the discussion on: 1️⃣ Vaginal Microbiome: The vaginal microbiome is dominated by Lactobacillus species, which keeps the pH optimal at about 4 to 4.5. Estrogen plays a crucial role in maintaining this bacterial balance and acidic pH, so as estrogen levels decrease with age, the vaginal ecosystem can change, leading to various symptoms. 2️⃣ Assessing Vaginal Health: Monitoring vaginal pH is an essential way to assess vaginal health. 3️⃣ Hormone Therapy: If hormonal imbalances are contributing to vaginal health issues, hormone therapy may be necessary. If you or someone you know is experiencing vaginal health symptoms, don't miss this informative episode. Remember to share it with anyone who can benefit from understanding their hormonal health and finding solutions for vaginal well-being. Mentioned in this episode: MegaSporeBiotic – Click HERE to grab this probiotic and use my practitioner code, which also gets you 10% off: TaraMegaSpore ** BLACK FRIDAY SALE ** Check out my Black Friday Hormone Balance Solution Quick Start packages here.
A pregnant patient is being evaluated for low back pain and pelvic girdle pain. The patient was placed briefly in supine positioning and has now risen to a standing position. Immediately after rising, the patient describes the presence of significant dizziness, fatigue, and faintness that was not present at rest. Which of the following interventions would be MOST appropriate to perform first? Find it all out in the podcast! Be prepared for the NPTE so that you can pass with flying colors! Check out www.ptfinalexam.com/podcast for more information and to stay up-to-date with our latest courses and projects.
Menopause and Hormones in the Modern Era AKA: Why the Boomers Should be Pissed This is a lecture I gave for the Society of Women in Urology about hormones. If you like this episode also check out number 197. Genitourinary syndrome of menopause Men at age 60 have more estrogen in their bodies then women Why I don't do a loading dose of vaginal estrogen. The problem with the vaginal estrogen labeling by the FDA. How the nation used estrogen prior to the Women's Health Initiative Scare. I explain why the WHI study was created and what question it was trying to answer. Myth: you have to be a year without a period to be on hormones. I break down the three concerns about progestin and breast cancer from the WHI 1) Was the placebo arm flawed 2) Was it the synthetic progestin and now we use bioidentical 3) Maybe progestin increases risk but it is small and perhaps benefits still outweigh risk as breast cancer is so curable and all the other benefits are worth the small increased risk I discuss the “critical window” hypothesis and “healthy cell” hypothesis and why hormones are recommended to be started “early” in menopause which means less than ten years. Why I think the Boomers should be pissed. Vaginal estrogen for all and get an okay from your Best practices - If you have a uterus, with systemic estrogen you need a progestin - You can continue hormones for life as long as your benefit > risks - Vaginal bleeding after menopause is never normal - If there is an FDA approved product use it instead of compounded - Checking hormones is often not necessary - One size does not fit all What about hormones for prevention? On a national level the answer is no. But everyone needs their own analysis. National guidelines on how to give testosterone to women for low desire. Hormones: are we being equitable to all genders in regards to hormones. NAMS 2022 guidelines: According to NAMS, “the benefits of hormone therapy outweigh the risks for most healthy symptomatic women who are aged younger than 60 years and within 10 years of menopause onset.” For women with primary ovarian insufficiency and premature or early menopause who are at higher risk of bone loss, heart disease, and cognitive or affective disorders, “hormone therapy can be used until at least the mean age of menopause unless there is a contraindication to its use.” Where is the black box warning on alcohol? What about lasers for GSM? Where are we on removing the FDA black box warning on vaginal estrogen? My thoughts on online hormone companies. Estrogen plays a role in the gut microbiome and may affect the risk of osteoporosis. Our podcast sponsor today is AG1. Use AG1 to build a foundation for better health. FREE ONE YEAR SUPPLY OF VITAMIN D3+K2, 5 TRAVEL PACKS drinkag1.com/youarenotbroken Did you get the You Are Not Broken Book Yet? https://amzn.to/3p18DfK Did you watch the Tedx Talk yet? Why We Need Adult Sex Ed Join my NEW Adult Sex Ed Master Class: https://www.kellycaspersonmd.com/adult-sex-ed Join mymembership to get these episodes ASAP when they are created and without advertisement and even listen live to the interviews and episodes. www.kellycaspersonmd.com/membership --- Send in a voice message: https://podcasters.spotify.com/pod/show/kj-casperson/message
When instructing a female patient in pelvic floor muscle training, which of the following interventions is MOST appropriate if inward movement of the perineal area is detected during pelvic floor muscle contraction? Find it all out in the podcast! Be prepared for the NPTE so that you can pass with flying colors! Check out www.ptfinalexam.com/podcast for more information and to stay up-to-date with our latest courses and projects.
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