Aleece Fosnight, MSPAS, PA-C, explains how she translates the guideline's Grade A evidence for sacral neuromodulation, posterior tibial nerve stimulation, and intradetrusor onabotulinumtoxinA into individualized treatment recommendations, and describes the shared decision-making process she uses when a patient is a candidate for all 3 options.
In this video, Aleece Fosnight, MSPAS, PA-C, reviews the evidence and practical application of behavioral interventions and pharmacologic therapy for OAB, including the clinical and safety rationale for leading with beta-3 agonists over anticholinergics, and outlines how she frames the transition to minimally invasive therapy for patients who have not responded to prior treatments.
EV+pembrolizumab drives deep nodal responses in bladder cancer, shifting decisions on cystectomy and retroperitoneal node dissection.
See how cystectomy after immunotherapy looks surprisingly routine, with insights on pelvic node dissection and post-op treatment decisions.
Aleece Fosnight, MSPAS, PA-C, introduces her practice philosophy and credentials, characterizes the full scope of OAB's impact on patients who go undiagnosed or undertreated, and explains what the 2024 AUA/SUFU guideline's shift away from mandatory step therapy means for patient-centered care.
Mina M. Fam, MD, discusses the significance of the FDA's recent approval of tebipenem pivoxil for patients with complicated urinary tract infections.
Rahul Winayak, MD, discusses the prognostic and predictive value of microbial dysbiosis in patients receiving CBM588 plus first-line immune checkpoint inhibitor-based regimens for metastatic renal cell carcinoma.
Eugene Pietzak, MD, highlights results from a phase 2 study of pembrolizumab plus BCG for patients with very high-risk, BCG-naive high-grade T1 NMIBC who declined upfront radical cystectomy.
Unwanaobong Nseyo, MD, MHS, discusses a retrospective analysis comparing treatment continuation outcomes with minimally invasive therapies for idiopathic overactive bladder.
Sandip Prasad, MD, discusses 3-year data from the phase 3 ENVISION trial evaluating mitomycin for intravesical solution for recurrent low-grade intermediate-risk non–muscle-invasive bladder cancer.
Andrew J. Armstrong, MD, MSc, discusses efficacy results from a phase 2 study evaluating a chemoimmunotherapy regimen for patients with neuroendocrine or aggressive-variant metastatic prostate cancer.
Amar U. Kishan, MD, describes how the ArteraAI Prostate Test was built and validated, with particular attention to the RTOG 9408 data showing that more than 60% of intermediate-risk patients are biomarker-negative.
In this episode, “Preserving Quality of Life in Metastatic Castration-Sensitive Prostate Cancer,” the expert faculty explores how cognitive function, independence, and patient priorities influence treatment selection for metastatic castration-sensitive prostate cancer (mCSPC). Through the case of a 74-year-old man with low-volume metastatic disease, mild cognitive impairment, and a strong desire to maintain an active lifestyle, the panel examines the importance of treating the whole patient, rather than focusing solely on disease characteristics.
Neal D. Shore, MD, FACS, and Rana R. McKay, MD, FASCO, present the primary rPFS and key secondary OS results from ARASEC and contextualize the findings within the broader darolutamide (Nubeqa) evidence base.
Watch surgeons review cystectomy after immunotherapy—tissue planes stay familiar, lymph node dissection matters, and adjuvant choices remain unclear.
Proactive scheduling of the next onabotulinumtoxinA (Botox) treatment before the patient leaves the office—combined with a streamlined, reduced-site injection protocol—is a central strategy in Steven Bernstein, MD's practice for sustaining long-term persistence on therapy in patients with OAB.
In more than 1000 onabotulinumtoxinA (Botox) treatments using a reduced-site protocol, Steven Bernstein, MD, observed a UTI rate of approximately 4.9% per treatment, a single clinically significant post-procedural bleed (early in experience with 20-site injection), and only 1 patient advised to undergo post-procedural catheterization—findings that support a streamlined, symptom-guided approach to complication management.
R. Jeffrey Karnes, MD, addresses the limitations of the retrospective validation study design, outlines the future research he considers necessary for broad clinical adoption of MMAI, and offers his perspective on the trajectory of digital pathology and multimodal AI across urologic oncology over the next 5 years.
EV-pembro and immunotherapy may shorten time to cystectomy, with fewer chemo-era blood issues but new immune toxicities to manage.
Jenny Guo, MD, discusses data suggesting that hemi-HoLEP may be a viable treatment option for patients with prior pelvic radiation.
Louise Emmett, MD, PhD, MBChB, FRACP, discusses findings from the phase 1 AcTION trial, which evaluated the safety and preliminary activity of 225Ac-PSMA-617 in patients with metastatic castration-resistant prostate cancer.
Toni K. Choueiri, MD, discusses the FDA approval of adjuvant belzutifan plus pembrolizumab for clear cell renal cell carcinoma, describing the regimen as a major advancement in kidney cancer treatment.
Data from the BREEZE trial support the efficacy, safety, and tolerability of the Zenflow Prostatic Spring for BPH-related LUTS.
In this video, Benjamin H. Lowentritt, MD, FACS, discusses findings from the real-world OPTYX study, assessing testosterone suppression and recovery among patients receiving relugolix for advanced prostate cancer.
Jonathan D. Harper, MD, discusses findings from a secondary analysis of the PUSH trial showing that modest increases in urine volume and lower urine osmolality were associated with reduced kidney stone recurrence, even when patients did not reach the guideline-recommended urine output target.
Amar U. Kishan, MD, establishes why individualized ADT decision-making remains an unsolved problem in intermediate-risk prostate cancer.
Welcome back to another Urology Times Virtual Tumor Board series. In this episode titled “Navigating Comorbidities and Treatment Decisions in Metastatic Castration-Sensitive Prostate Cancer,” expert faculty discuss a patient with advanced prostate cancer whose management highlights the importance of individualized treatment decisions that extend beyond tumor characteristics alone.
In this segment, Rana R. McKay, MD, FASCO, and Neal D. Shore, MD, FACS, detail the 6 prognostic variables used for propensity score matching, the mechanics of 1:1 patient pairing, and the practical advantages of the ARASEC design over a large randomized phase 3 trial.
Through a methodical, patient-driven evolution from 20 injection sites to a single posterior bladder wall injection, Steven Bernstein, MD, maintained onabotulinumtoxinA (Botox) efficacy—with a greater than 93% response rate and a mean retreatment interval of 7.5 months—while substantially improving patient comfort and persistence on therapy.
OAB is a chronic, potentially debilitating condition affecting a substantial proportion of patients in urologic practice, and effective long-term management depends on systematic escalation from behavioral modification through pharmacotherapy to third-line procedural options—including onabotulinumtoxinA (Botox)—when treatment objectives are not met.
