Reviews in UrologyLetter From the President of LUGPAScott B SellingerI am incredibly honored to be the new president of LUGPA, an organization that is pivotal to the future of independent urology practice. Ensuring a sustainable model for independent physicians is paramount to providing high-quality, affordable urologic care to our patients.
LUGPA NewsLUGPA NewsCeleste KirschnerEvan R GoldfischerThank you to everyone who joined us November 14 to 16, 2024, for the LUGPA 2024 Annual Meeting! We met in Chicago, Illinois, where we learned more about our clinical practice, exchanged ideas, and celebrated LUGPA’s accomplishments in support of independent urology practices. If you missed the annual meeting, you can visit lugpa.org/annual to see photos from the event and read a recap of the entire meeting. You can also follow #LUGPA2024 on social media to access more news and photos from the event and see what attendees had to say about the meeting.
Prostate CancerDeep Learning for Magnetic Resonance Imaging–Based Radiation Therapy for Prostate Cancer: Current StatusJessica E. ScholeyAbhejit RajagopalJulian HongPeder LarsonKe ShengMagnetic resonance imaging (MRI) is increasingly being used for external beam radiation therapy in the treatment of prostate cancer because of its excellent soft tissue contrast and ability to provide functional and physiologic information about tumor behavior. At the same time, deep learning has seen widespread applications in medical imaging, including for MRI-based classification and synthesis. Deep learning–based approaches are being incorporated into the MRI-guided clinical external beam radiation therapy workflow for patient simulation, contouring of targets and critical structures, treatment planning, and treatment delivery. In this review, we examine the current status of deep learning for MRI-guided prostate external beam radiation therapy.Artificial intelligenceProstatic neoplasmsRadiotherapyMagnetic resonance imaging (MRI)Deep Learning
Bladder CancerUnmet Needs in High-Risk Non–Muscle-Invasive Bladder Cancer From the Patient’s Perspective: Challenges and Potential SolutionsAshish KamatJason HafronNon–muscle-invasive bladder cancer (NMIBC) represents about 75% of bladder cancer cases, often leading to recurrence, considerable emotional distress, and a decline in health-related quality of life for affected patients. There are substantial unmet treatment needs for patients with NMIBC.Quality of lifenon-muscle invasive bladder neoplasmstransurethral resection of bladderBCG vaccinepatient satisfaction
Kidney CancerImaging Techniques in the Diagnosis of Renal Cell Carcinoma: Contemporary Trends and Future DirectionsGautam JayramIncreasing radiographic detection of incidental small renal masses has led to a growing concern regarding overtreatment of these lesions. Given the limitations of computed tomography and magnetic resonance imaging, there is an unmet need for improved kidney imaging techniques that can provide more accurate assessments of renal lesions. This review provides a summary of established kidney imaging modalities and also those likely to be meaningful in the near future. Kidney imaging has evolved, with several modalities contributing to the overall diagnostic landscape. There is great optimism that a new era of molecular imaging in renal cell carcinoma can vastly improve diagnostic capabilities and limit unnecessary invasive procedures.Carcinoma, renal cellCarcinomaKidney neoplasmsmolecular imagingpositron-emission tomography
Business of UrologyOutpatient Urological Surgery: Outcomes and Cost by Site of Service in Community PracticeRobert A. DowlingJinghan ZhangSong ZhangEvan R GoldfischerDavid M. AlbalaUrologic surgery is most commonly performed in 1 of 3 ambulatory settings—a physician office, a hospital outpatient setting, or an ambulatory surgery center—but differences in value among these settings are poorly understood. This study examines real-world practice patterns of community urologists and documents outcomes and costs for a set of common urologic procedures performed in outpatient settings.Physician practice patternsAmbulatory surgical proceduresurologic diseasesambulatory care
Coding CornerReimbursement Considerations for Instillation of Medications to Treat Low-Grade Upper Tract Urothelial CarcinomaJonathan RubensteinMark PainterCeleste KirschnerUnlike non–muscle invasive bladder cancer, which can be treated with surgical and intravesical medication administration, upper tract urothelial (renal pelvis and ureter) cancer was historically treated only surgically. If a tumor could not be treated with ureteroscopic or percutaneous surgical control, removal of the kidney and ureter was often the only treatment option. When mitomycin for pyelocalyceal instillation 0.4% gel for low-grade upper urothelial cancer became commercially available, nonsurgical treatment became possible.MitomycinAdministration intravesicalureteral neoplasms
Case ReviewExceptional Response to Radiation Therapy to the Primary Tumor in a Patient With de Novo Metastatic Prostate Cancer With High Tumor Mutation BurdenBenjamin MercierAndrew TamDaniela V. CastroSalvador Jaime-CasasAbhishek TripathiYun Rose LiRegina Barragan-CarrilloWe present the case of a patient diagnosed with de novo, low-volume metastatic prostate cancer who received first-line treatment with androgen-deprivation therapy in combination with darolutamide. The patient presented with symptoms derived from local growth from the primary tumor and received pelvic radiation therapy to the primary tumor and pelvic nodes. He experienced complete tumor regression, with high serum prostate-specific antigen declining to nondetectable levels. Next-generation genomic analysis indicated high tumor mutation burden and high microsatellite status instability. Here, we contextualize this patient’s case regarding the importance of precision genomics in radiation oncology and its potential importance for optimizing treatment.Prostatic neoplasmsRadiation therapyNeoplasm metastasisAndrogen antagonistsprostate neoplasmcastration resistant
Editorial2024 LUGPA Advocacy Year in Review: Confronting Challenges, Advancing ProgressMatthew GlansIn 2024, independent practices nationwide faced new and mounting challenges, including increasing and expanding regulatory obligations and growing patient demands against a background of rising input costs and financial pressures. Amid a shifting health care landscape, urologists were tasked with the pressing challenge of doing more with less.Telemedicinehealth care costsinsurance, healthhealth services accessibility
Reviews in UrologyMeet the Expert: Stephanie Chisolm, PhDTom JayramThank you for joining us today for our final “Meet the Expert” of the year, with our special guest, Stephanie Chisolm, PhD. Dr Chisolm is director of education and advocacy at the Bladder Cancer Advocacy Network, affectionately known to all of us as BCAN (pronounced “Beacon”). I’m your moderator for today, Tom Jayram. I’m a urologic oncologist in Nashville, Tennessee, where I lead a large urologic oncology program at a 30-person private practice group. I am also fortunate to be the editor of the bladder cancer section for Reviews in Urology.UrologyUrinary bladderpatient advocacy