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.
Kevin C. Zorn, MD, FRCSC, FACS, discusses the factors that clinicians should consider when selecting among different MIST options for BPH.
New bladder cancer trials test perioperative immunotherapy combos, weighing added enfortumab vedotin vs adjuvant de-escalation to boost durable cures.
EV/pembrolizumab in EV-304 delivers strong pathologic response, event-free and overall survival gains versus standard chemo, reshaping neoadjuvant bladder cancer choices.
In this video, R. Jeffrey Karnes, MD, translates MMAI scoring into practical clinical guidance, discussing how MMAI High and MMAI Low results can inform surveillance intensity, early salvage radiation consideration, and adjuvant therapy planning, and outlining the shared decision-making framework he uses when ordering the test.
In this video, Nicole L. Miller, MD, FACS, discusses her approach to assessing patients after prior treatment failure for benign prostatic hyperplasia.
Abigail Keller shares findings showing that nadofaragene firadenovec is associated with increased urine production during instillation compared with gemcitabine/docetaxel.
Praful Ravi, MB, BChir, MRCP, discusses results from PSMAtrack, which assessed changes in PSMA-PET during initial systemic therapy for metastatic hormone-sensitive prostate cancer.
Rana R. McKay, MD, FASCO, and Neal D. Shore, MD, FACS, explain ARASEC's use of a synthetic historical control arm derived from the CHAARTED trial, a design approach they describe as both ethically necessary and methodologically efficient.
This episode, titled “Comparing Perioperative Strategies in Cisplatin-Eligible MIBC,” features panelists discussing how the KEYNOTE-B15/EV-304 trial is reshaping perioperative treatment considerations for patients with muscle-invasive bladder cancer (MIBC). The expert faculty review the study design evaluating perioperative enfortumab vedotin plus pembrolizumab (EVP) compared with standard neoadjuvant gemcitabine-cisplatin (Gem-CIS), and discuss how these findings may influence treatment selection in cisplatin-eligible patients.
In “Perioperative Therapy Expansion in Cisplatin-Ineligible MIBC,” our panel explores how the treatment paradigm for muscle-invasive bladder cancer (MIBC) is rapidly evolving with the emergence of effective perioperative therapies for cisplatin-ineligible patients. The expert faculty discuss how traditional approaches that relied heavily on determining cisplatin eligibility are changing in light of recent clinical trial data supporting enfortumab vedotin plus pembrolizumab (EVP) in patients who historically would have proceeded directly to surgery.
R. Jeffrey Karnes, MD, presents the performance results of the MMAI model in the Mayo Clinic long-term survivor cohort, including its ability to outperform CAPRA-S in multivariable analysis, its sustained discrimination at 15 years of follow-up, and its prognostic value in patients with biochemical recurrence, salvage radiotherapy receipt, and persistent postoperative PSA.
Pedro C. Barata, MD, MSc, FACP, discusses preliminary findings from the phase 3 ProstACT Global study evaluating 177Lu-rosopatamab plus standard of care for patients with mCRPC.
Tanya B. Dorff, MD, FASCO, shares phase 1 data on ABBV-969, an investigational antibody-drug conjugate being explored for metastatic castration-resistant prostate cancer.
Kim Chi, MD, highlights findings from a pre-planned analysis of the PLUDO trial examining the impact of crossover on survival outcomes between 177Lu-PSMA-617 vs docetaxel in mCRPC.
This episode reviews treatment intensification in metastatic castration-sensitive prostate cancer, focusing on why ADT plus an ARPI is the current backbone of care, what barriers still limit its use, and how clinicians think about triplet therapy, de-intensification, frail patients, and emerging biomarker-driven options such as PARP inhibitors.
This episode examines how indirect trial comparisons can help guide ARPI selection in metastatic castration-sensitive prostate cancer when head-to-head studies are unavailable, while emphasizing the importance of patient-specific factors, tolerability, and clinical judgment.
