This episode focuses on the complex management of recurrent low-grade bladder tumors and highlights the limitations and challenges of current treatments, including intravesical chemotherapy and BCG, and underscores the need for better therapies and clinical trials in this area.
“The primary outcome will be feasibility of in-home treatments,” says Timothy D. Lyon, MD, FACS.
“Overall, I'd say these shorter-term outcomes at 6 months look to be very similar to those outcomes measured with the smaller glands. In a sense, at least within this range, volume may not be a deal breaker,” says Kevin T. McVary, MD.
“In addition to the psychological and emotional burden associated with infertility, it's also been growing in incidence,” says Catherine S. Nam, MD.
“[We can use] the study to help further those arguments that we should be able to make our clinical decisions based on the patient's presentation, a risk-benefit discussion between patient and physician, and not based on what insurance companies will pay for,” says Michelle E. Van Kuiken, MD.
“So, always going where the point of max curve is gives a much better outcome compared to if you're using any other technique,” says Landon Trost, MD.
“We were pleased and excited to see that 72% of patients reported openness to receiving in-home intravesical therapy,” says Timothy D. Lyon, MD, FACS.
Jeffrey T. Schiff, MD, MPH, describes PEG hydrogel spacers and discusses their role in treating patients with prostate cancer undergoing radiation therapy.
The expert panel concludes its discussion by providing key takeaways on the evolving bladder cancer treatment landscape following ESMO 2023.
A urologist discusses treatments in the pipeline that can further improve the therapeutic landscape in BCG-unresponsive NMIBC.
Rizwan Nurani, MD, an expert on prostate cancer, describes the role of balloon spacers in the treatment space.
"For me, as a physician who treats patients with kidney cancer and does surgeries, where this study is going to help me and change my practice is making me more thoughtful and intentional in the way I approach my patients with their pain management," says Craig G. Rogers, MD.
The panel discusses the Large Urology Group Practice Association and provides insights on collaborative care approaches in bladder cancer.
Comprehensive insights on the unmet needs addressed by TAR-200 in BCG-unresponsive non-muscle-invasive bladder cancer.
“There's a bit of an unmet need about the impact of Rezum in these bigger prostates,” says Kevin T. McVary, MD.
“Gone are the days when scalpel was king or queen in this space. The armamentarium of medications and systemic treatments, combination treatments has exploded, and our understanding of the biology of disease is expanding,” says Harras B. Zaid, MD.
“Probably one of the most meaningful findings was that insurance type did influence the choice of medication first prescribed by urologists for overactive bladder,” says Michelle E. Van Kuiken, MD.
The various treatment approaches for NMIBC in the context of a BCG shortage, with a focus on initial cases, are shared. Urologists discuss their strategies for treating a hypothetical patient with a 3 cm bladder tumor, weighing options like perioperative chemotherapy, the importance of thorough resection, and adapting treatment protocols based on tumor characteristics and the ongoing BCG shortage.
The impact of the BCG shortage on the treatment of bladder cancer, exploring various strategies adopted by urologists to optimize patient care. The conversation highlights the importance of risk stratification in deciding treatment protocols, considering factors like tumor size, location, multifocality, and histology, as well as patient age and overall health.
“I believe that at this point in time, we should be able to offer our patients some options, to at least give them a sense of feeling that they're participating in this procedure, that they have some control over this procedure. I think nitrous oxide can provide that,” says Heidi J. Rayala, MD, PhD.
“So, we see that in [the] men who have sex with men population, they have a greater mental health burden from this disease as they report having a more negative experience with a urologist,” says Thairo Pereira, MD.
“The main rationale for this research was we felt like there was an unaddressed population of patients living with urinary incontinence,” says Nathan M. Shaw, MD.
“The bladder muscle can get weak as you get older, so developing urinary incontinence or ur-gency is very common as you get older,” says Vikas Desai, MD.
"I think that what most people will find is, if you're in an academic center, it can be a little bit difficult to set up a nitrous oxide program because there is a lot of red tape for bringing a gas into the ambulatory setting," says Heidi J. Rayala, MD, PhD.
“So, my take home message for the urology community is even if you're not doing clinical trials, we already have FDA-approved, CMS-covered, most commercial insurances-covered genetic alterations now for our CRPC populations, and there will be more to come,” says Neal D. Shore, MD, FACS.
“I think we should all be pretty selective in whom we're operating on in the metastasectomy setting,” says Harras B. Zaid, MD.
Neal Shore, MD, FACS, reviews agents and treatment options being researched in the BCG-unresponsive NMIBC treatment space.
Following a review of rectal spacer options, Varun Sundaram, MD, offers clinical perspectives on hyaluronic acid spacers for patients with prostate cancer undergoing radiation.
Following a review of the limitations of current treatment options, Neal Shore, MD, MFACS, discusses the SunRISe-1 trial investigating TAR-200 plus cetrelimab in patients with high-risk NMIBC.
Clinical insights on challenges and complications of rectal spacing encountered in the treatment of patients with prostate cancer.
