Insights

In this Urology Times^® Insights program, Roger Li, MD, of the Genitourinary Oncology Program at Moffitt Cancer Center in Tampa, Florida, reviews how the phase 3 NIAGARA (NCT03732677), KEYNOTE-905 (NCT03924895), KEYNOTE-B15 (NCT04700124), and VOLGA (NCT04960709) trials are moving perioperative care for muscle-invasive bladder cancer (MIBC) beyond cisplatin-based chemotherapy, citing their pathologic complete response, event-free survival, and overall survival results. Li explains where patients are lost between TURBT and a medical oncology visit, and how strong urologist–medical oncologist relationships and newer non-cisplatin regimens should change referral patterns and surgical timing.

Rahul Mehan, MD, founder of East Valley Urology Center, shares real-world experience with drug-coated balloon dilation (Optilume) for BPH, covering patient selection, PINNACLE trial outcomes, the procedural learning curve, recovery compared with TURP and waterjet therapy, adverse-event counseling, and where traditional resective procedures still hold the advantage.

This educational series features C. Shawn West, MD, discussing the evolution of benign prostatic hyperplasia management from traditional invasive surgery to a rapidly expanding array of minimally invasive surgical therapies. Across multiple segments, West reviews the clinical evidence supporting current treatment options, highlighting key considerations such as safety, durability, patient experience, and preservation of sexual function while comparing mechanical, ablative, and emerging technologies. He also outlines practical strategies for patient selection, the role of symptom assessment tools such as IPSS, and best practices for implementing procedures like the prostatic urethral lift (UroLift) in routine care.

Christopher E. Kelly, MD, discusses how emerging pharmaceutical interventions, minimally invasive surgical techniques, and personalized treatment strategies revolutionize management approaches for benign prostatic hyperplasia. He focuses on improving patient outcomes, reducing adverse effects, and addressing the complex symptomatology of this common age-related urological condition.

Karim Chamie, MD, MSHS, discusses how innovative non–muscle invasive bladder cancer (NMIBC) delivery systems such as TAR-200 offer targeted, less toxic treatment options, showing promise for high-risk patients with improved efficacy and patient tolerance through localized drug administration.

Mark D. Tyson, II, M.D., M.P.H., explores the current NMIBC landscape, covering risk stratification approaches, established treatments like BCG immunotherapy and TURBT, emerging investigational agents spanning multiple mechanisms of action, and remaining challenges including BCG supply shortages and biomarker development, while highlighting future directions in personalized medicine and novel delivery systems.

Katie S. Murray, DO, discusses how advancements in targeted gene therapies and immunotherapeutic options are transforming the management of BCG-unresponsive non–muscle-invasive bladder cancer (NMIBC), offering urologists more effective, accessible treatment alternatives and reducing patient burden.

Dean Elterman, MD, explores the latest advancements in minimally invasive treatment options for benign prostatic hyperplasia (BPH), detailing emerging techniques and their impact on patient care

Expert insight from David M. Albala, MD, on the evolving landscape of imaging modalities in prostate cancer and how it has impacted treatment pathways.

Amir H. Lebastchi, MD, investigates advancements in precision-based approaches to prostate cancer diagnosis and therapy, with a focus on the role of MRI and ultrasound fusion technologies.

Boris Gershman, MD discusses recent advancements in prostate cancer imaging, touching on the clinical application of multiparametric MRI (mpMRI), effective strategies for communication between urologists and radiologists, and how machine learning may shape the future of prostate cancer imaging.

Gerald Andriole, MD discusses pre-biopsy biomarker testing as a risk assessment tool in patients suspected of having prostate cancer, highlighting key advantages and reviewing available options and clinical data, and shares his clinical experience regarding implementation.

Mark Emberton, BSc, MBBS, FRSC (Urol), MD, FMedSci, provides a historical perspective on treatment options for clinically localized prostate cancer, reviews emerging focal therapy options including HIFU, and discusses how focal therapy has impacted the field.

John J. Kowalczyk, DO, FACOS, shares his experience and perspectives on urology practice management and implementing software tools to improve practice workflows.

Stephen J. Freedland, MD, provides an overview of the diagnosis and staging of high-risk, clinically localized prostate cancer and explains how genomic testing helps inform risk stratification and treatment-decision making in his clinical practice.

Expert perspectives on the use of saw palmetto extracts to manage patients with benign prostatic hyperplasia and lower urinary tract symptoms.

Robert Dreicer, MD, provides an overview of advances in the treatment of metastatic castration-resistant prostate cancer (mCRPC) and available and emerging second-line treatment options for mCRPC.

Kyle Wood, MD, reviews currently available treatment options for enteric hyperoxaluria and the importance of disease education.

Brad Schwartz, DO, FACS, comments on newer urologic imaging techniques that can reduce exposure to radiation.

Dr. Neal Shore reviews treatment options in metastatic castration-resistant prostate cancer available in 2020.