BackTable Urology

What does a urologist actually need to know to confidently manage advanced prostate cancer in the clinic? On this episode of BackTable Urology, host Dr. Ruchika Talwar interviews Dr. Kristen Scarpato, director of the advanced prostate cancer clinic at Vanderbilt University Medical Center, and Dr. Jason Hafron, chief medical officer of the Michigan Institute of Urology. They break down how the landscape has shifted, why more patients stay in urology for treatment, and how to select and monitor therapy based on disease state, comorbidities, and patient goals.

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https://www.backtable.com/app

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This podcast is supported by

Bayer

https://www.bayer.com

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Timestamps

00:00 - Introduction
02:41 - Shift to Urology-Led Advanced Prostate Management
07:07 - Sorting Therapies by Disease State
10:33 - Treatment Intensification and Doublet Therapy
17:54 - ARPI Selection and the Four Ps Framework
25:46 - Managing Financial Toxicity
29:30 - Monitoring, Labs, and Imaging
34:11 - Red Flags and Comanagement
36:49 - When to Refer to Medical Oncology
41:11 - Future Directions and Practice Economics
46:33 - Closing Remarks

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More about this episode

The discussion covers sorting therapies by disease state rather than drug class, doublet and triplet intensification, the nuances of choosing between abiraterone, enzalutamide, apalutamide, and darolutamide, and Dr. Hafron’s “four Ps” framework for drug selection. Dr. Scarpato addresses financial toxicity, surveillance protocols, and red flag symptoms. Both guests share their referral triggers for medical oncology, approaches for oligometastatic disease and metastasis-directed therapy, and practical tips for running an advanced prostate cancer clinic.

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Resources

Advanced Prostate Cancer: AUA/SUO Guideline
https://www.auanet.org/guidelines-and-quality/guidelines/advanced-prostate-cancer

Trial Design and Objectives for Patients With Prostate Cancer: Recommendations From the Prostate Cancer Working Group 4 (JCO)
https://ascopubs.org/doi/10.1200/JCO-25-02834

ARACOG (AFT-47): Darolutamide vs Enzalutamide and Cognitive Function, ClinicalTrials.gov NCT04335682
https://clinicaltrials.gov/study/NCT04335682

ARASENS: Darolutamide and Survival in Metastatic, Hormone-Sensitive Prostate Cancer (NEJM)
https://www.nejm.org/doi/full/10.1056/NEJMoa2119115

PSMAddition: 177Lu-PSMA-617 Plus Standard of Care in mHSPC, ClinicalTrials.gov NCT04720157
https://clinicaltrials.gov/study/NCT04720157

Medicare Plan Finder, referenced on air for comparing Part D out-of-pocket drug costs
https://www.medicare.gov/plan-compare/

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BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

How can private practice and academic residency programs work together to shape the next generation of urologists? On this episode of BackTable Urology, Dr. Jose Silva interviews Dr. Javier Castillo about launching an academic residency within a busy private urology group in Puerto Rico. They highlight the business, training, and research challenges involved, as well as the innovations that make real collaboration possible. Dr. Castillo also reflects on why building character in trainees is just as important as teaching surgical skill.

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https://www.backtable.com/app

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Timestamps

00:00 - Introduction
04:04 - Launching a Residency and Building the Practice
08:13 - Teaching in the OR and Progressive Responsibility
13:58 - Clinic, Administration, and Resident Training
16:38 - Expanding BPH Treatment Options
25:21 - Creating a Research Culture and AI Projects
32:42 - AI Uroflow Project and Follow Up
40:21 - BPH Case Workup and Shared Decision-Making
47:11 - Patient Goals and Procedure Selection
55:43 - Sacral Neuromodulation and New Technologies
01:00:19 - Teaching Character and Mentorship
01:03:07 - Closing Remarks

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More about this episode

The conversation explores how to teach residents in the OR while maintaining efficiency, build a research culture, and leverage advanced technologies like AI-driven home uroflowmetry. Dr. Castillo and Dr. Silva discuss individualized BPH treatment, expanding procedural options, and aligning care with patient goals. The episode closes with practical lessons on mentorship, character, and the strategies that make a residency program thrive for both trainees and patients.

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BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

How can reconstructive urologists improve quality of life for cancer survivors beyond the initial cure? On this episode of BackTable Urology, Dr. George Koch interviews Dr. Hiren Patel about building a comprehensive survivorship practice that addresses the long-term needs of patients following genitourinary cancer treatment. They discuss moving beyond post-prostatectomy ED and incontinence to include management of radiation sequelae, immunotherapy effects, and urethral strictures, as well as the role of patient-centered communication, care coordination, and technology.

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Timestamps

00:00 - Introduction
04:26 - Redefining Survivorship
11:29 - Why Survivorship Practices Matter
17:53 - Workup and Aligning Care
21:05 - Managing Active Cancer Scenarios
27:20 - Building a Survivorship Program
30:12 - Growing Referrals and Optimizing Workflow
39:24 - System Support and Research Gaps
44:04 - Tech Advances in Reconstruction
48:50 - Single-Port Retroperitoneal Case
59:55 - Tips, Tricks, and Wrap-Up

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More about this episode

The conversation covers patient expectation setting, logistics of establishing a survivorship clinic, aligning care with patient goals, and multidisciplinary collaboration with oncology and primary care. Dr. Patel highlights strategies to reduce ER visits and system burden, the importance of continuity, and advances such as single-port robotic retroperitoneal ureteral reconstruction. The episode concludes with practical tips on trust-building, workflow optimization, and advocating for survivorship programs within larger health systems.

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BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

With so many treatment options for bladder outlet obstruction, how do you select the best approach for each patient? On this episode of BackTable Urology, host Dr. Jose Silva is joined by Dr. John DiBianco for a practical discussion on evaluating lower urinary tract symptoms and matching patients with the right intervention. They emphasize confirming that symptoms are truly due to benign prostatic hyperplasia (BPH) before proceeding, and walk through triggers for intervention, including quality-of-life impact, UTIs, renal impairment, high post-void residual, bladder stones, and retention.

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https://www.backtable.com/app

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Timestamps

00:00 - Introduction
03:24 - Complex BPH Referrals and Symptom Assessment
06:07 - Deciding When to Operate
11:12 - Imaging and Prostate Sizing
14:27 - When to Use Cystoscopy and Urodynamics
16:43 - Incorporating Patient Preferences
21:53 - Medical Therapy and Pills
23:45 - Decision Aids and Personal Experience
27:13 - Managing HoLEP Complications and Leakage
32:57 - Advances in HoLEP Technique
36:07 - TURP Indications and Outcomes
38:36 - Special Considerations: Radiation and UroLift
39:58 - ThULEP vs. HoLEP
41:17 - Redo Surgery Strategies
43:52 - Counseling Through Case Scenarios
56:16 - Future Directions in BPH Treatment
59:05 - Wrap Up and Credits

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More about this episode

The conversation covers everything from surveillance and imaging-based prostate sizing to when to use cystoscopy and urodynamics for complex or high-risk patients. Drs. Silva and DiBianco compare procedure options like HoLEP, TURP, GreenLight, UroLift, PAE, iTind, and aquablation, highlighting how factors like prostate size, morphology, history, and patient goals drive decision-making. They discuss durability, redo surgery issues, management of radiation patients, and postoperative care including leakage management and pelvic floor therapy. The episode wraps up with future directions in BPH procedures and practical counseling tips for patient satisfaction.

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Resources

Love this episode? Check out BackTable.com and search “BPH” to get more information on a variety of the surgical options discussed in this episode, including HoLEP, Aquablation, PAE, and more! Further resources include the BackTable App, which has a course on treating Benign Prostatic Hyperplasia.

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BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

Can shared decision-making and patient support change the treatment journey for overactive bladder? On this episode of BackTable Urology, host Dr. Suzette Sutherland and OAB expert Dr. Jannah Thompson discuss how patient education, clear counseling, and ongoing follow-up improve care for patients with overactive bladder and urge incontinence. They cover practical strategies for building an effective OAB care pathway, staff training for better patient navigation, and proactive approaches that increase adherence and access to advanced therapies.

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Get the BackTable app
https://www.backtable.com/app

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This podcast is supported by

Medtronic Pelvic Health
https://urgencyisreal.com/

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Timestamps

00:00 - Introduction
04:00 - Shared Decision-Making
06:51 - Clinic Efficiency
10:38 - Expanding OAB Therapy Options
12:27 - Long-Term OAB Care
17:41 - Building an OAB Program
18:18 - Staff Training and Follow-Up
25:32 - OAB Navigator Implementation
27:14 - Navigation Outcomes
28:39 - Scaling with Staff and Epic
30:35 - Algorithm Resources
34:08 - Neuromodulation Advances
38:37 - New Tibial and Battery-Free Devices
40:56 - Quality of Life in OAB Care
46:11 - Access and Adoption
51:22 - Streamlining Therapy Discussions
52:47 - Closing Remarks

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More about this episode

The conversation explores the diverse landscape of OAB treatment options, the evolving role of neuromodulation, and how new technologies are enabling more personalized care. Dr. Thompson shares insights on empowering staff as part of the clinical team, leveraging patient navigators to boost follow-up and advanced therapy uptake, and the importance of integrating patient preferences and lifestyle factors into every decision. They emphasize that quality of life, not just symptom control, should be central to OAB management, and discuss how to engage patients as partners throughout their treatment journey.

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Resources

Patient navigation for overactive bladder improves access to care
https://link.springer.com/article/10.1007/s00192-019-04085-7

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BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

What are the key considerations for choosing between surveillance, surgery, and chemotherapy in testicular cancer? On this episode of BackTable Urology, host Dr. Rich Matulewicz is joined by Dr. Sean Kern and Dr. Sam Funt for an in-depth discussion on clinical approaches to testicular cancer. They start with a real-world case, reviewing initial evaluation, imaging, tumor markers, and counseling on fertility, body image, and hypogonadism. The conversation highlights how nuanced patient selection influences decisions between surveillance, surgical intervention, and adjuvant chemotherapy.

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Get the BackTable app
https://www.backtable.com/app

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Timestamps

00:00 - Introduction
01:40 - Initial Case Workup and Counseling
06:28 - Why Testicular Cancer Happens
09:17 - Management Considerations with Post-Orchiectomy Pathology
19:21 - RPLND Benefits and Drawbacks
23:39 - Surveillance Schedule and Long Term Follow Up
28:17 - Second Tumor Risk
30:36 - Evolving Seminoma Treatment
37:57 - RPLND Selection Factors
40:10 - Adjuvant Chemo Debate and Pathology
46:06 - Closing Takeaways

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More about this episode

The episode explores postoperative management, including long-term surveillance, risk of a second tumor, and strategies for lifelong follow-up. The doctors discuss evolving practice in the management of low-volume stage II seminoma, the increasing use of RPLND to reduce chemo and radiation exposure, and the importance of extended patient counseling over multiple visits. The discussion emphasizes individualized care, the role of new diagnostics, and the need for reassurance and support throughout the treatment journey.

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Resources

Society of Urologic Oncology https://suonet.org/home.aspx

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BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

How can high-stakes surgical cases be optimized for teaching while ensuring patient safety and trainee growth? On this episode of BackTable Urology, Dr. Ruchika Talwar interviews Dr. Kelvin Moses about intentional strategies for surgical education, especially during complex urologic oncology operations. They discuss workflows that prioritize preoperative planning, structured debriefs, and progressive autonomy for trainees, as well as the importance of psychological safety and open communication with patients and families.

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Get the BackTable app
https://www.backtable.com/app

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Timestamps

00:00 - Introduction
02:19 - Teaching In High Stakes Cases
07:57 - Rethinking See One, Do One, Teach One
10:24 - Assessing Trainee Readiness
14:29 - Preop Preparation
16:06 - Teaching Cues in the OR
17:42 - Tips for Trainees
21:40 - Intentional Teaching
24:02 - Teaching Rare and Complex Cases
26:40 - Anticipating Complications and Debrief After Disaster
33:09 - Psychological Safety In the OR
37:41 - Reflections on Past, Current, and Future Training Models
43:56 - Patients And Trainees
46:51 - Takeways

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More about this episode

The conversation explores practical intraoperative teaching cues, tips for trainees such as visualization, recording cases, and repetition, and methods for relating rare cases to more common procedures. Dr. Moses reflects on the strengths and challenges of past, present, and future training models, including the debate over whether surgical education has gone “too soft.” The episode emphasizes the value of mentorship, transparency with patients, and the need to continually adapt surgical training for the next generation.

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BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

Is an elevated prostate-specific antigen (PSA) the beginning or the end of the prostate cancer workup? On this episode of BackTable Urology, Dr. Ruchika Talwar interviews Dr. Tarik Benidir to explore the “PSA problem,” explaining why PSA is biologically useful but clinically imprecise, often leading to false positives, unnecessary biopsies, and detection of indolent disease. They discuss a rational, patient-centered approach to elevated PSA, including when to repeat the test, how to interpret results in the context of age, race, family history, and prostate size, and the use of PSA density and age-adjusted norms instead of rigid cutoffs.

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Get the BackTable app
https://www.backtable.com/app

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This podcast is supported by
Cleveland Diagnostics
https://www.isopsa.com/

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Timestamps

00:00 - Introduction
04:03 - Why PSA Can Be Misleading
06:43 - Approach to Elevated PSA and Initial Workup
09:51 - MRI, PSA Density, and Biomarker Testing
14:31 - Guidelines, Diagnostics, and When to Biopsy
20:16 - Comparing 4K, IsoPSA, and Other Biomarkers
25:23 - Choosing Between Transperineal and Transrectal Biopsy
28:42 - Management Considerations for Elderly and Comorbid Patients
33:09 - Active Surveillance, Recurrence, and Long-Term Monitoring
40:47 - Key Takeaways and Closing Remarks

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More about this episode

The conversation highlights the role of reflex biomarkers, MRI scans, and selective biopsy strategies to reduce unnecessary procedures and focus on identifying clinically significant cancers. Dr. Benidir explains how to weigh MRI results, when to use biomarkers, and how to approach decisions in elderly or comorbid patients. They also discuss new biopsy modalities, active surveillance, and future directions for optimizing PSA-based screening and management.

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BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

What should you do differently when a UTI becomes a recurring problem? In this episode of the Backtable Podcast, host Dr. Anjali Kapur is joined by physician-scientist Dr. Glenn Werneburg to discuss the latest approaches to recurrent urinary tract infections, including key updates from the 2025 AUA, CUA, and SUFU guidelines. They use real clinical cases to explore diagnosis, prevention, antibiotic selection, and the management of complex patients.

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Get the BackTable app
https://www.backtable.com/app

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This podcast is supported by

Medtronic
https://www.medtronic.com/en-us/e/patients-caregivers/urinary/overactive-bladder.html

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Timestamps

00:00 - Introduction
04:05 - Case One: Recurrent UTIs
05:19 - Workup Basics
08:50 - Non-Antibiotic Prevention
11:42 - Antibiotic Prophylaxis Options
15:16 - Case Two: Asymptomatic Bacteriuria
19:14 - Case Three: Complex Patients
19:58 - Male vs. Female UTIs
21:22 - Neurogenic Bladder Workup
22:52 - Elderly Patients and ID Consults
25:01 - Case Four: Transplant ESBL
25:23 - Machine Learning for Antibiotics
29:49 - Catheter Biofilms
31:55 - Embedded Bladder Reservoirs
35:23 - Recurrent UTI Vaccine
36:23 - Future of Recurrent UTIs
39:04 - Wrap Up

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More about this episode

The doctors define recurrent UTI and outline the standard workup, including history, physical and pelvic exam, urinalysis, urine culture, and antibiotic sensitivities. They also review occasions where additional testing may be warranted. The discussion covers interpretation of urinalysis, non-antibiotic prevention options, and antibiotic prophylaxis strategies, with consideration of antibiotic resistance and microbiome disruption. They address asymptomatic bacteriuria and when treatment is indicated, along with management considerations for men, patients with neurogenic bladder or CIC, and elderly patients. Dr. Werneburg also discusses his work with machine learning tools to predict antibiotic susceptibility earlier, catheter biofilms, the concept of embedded bladder bacteria reservoirs, and his multidisciplinary complex UTI clinic.

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Resources

Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline (2025)
https://www.auanet.org/guidelines-and-quality/guidelines/recurrent-uti

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BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

Recurrent low-grade, intermediate-risk bladder cancer presents a unique treatment challenge: recurrence is common, progression is uncommon, and the burden of repeated procedures can add up quickly. On this episode of the BackTable Urology Podcast, Dr. Ruchika Talwar interviews Dr. Charles “Chas” Peyton about how to manage intermediate-risk bladder cancer patients while balancing disease control and quality of life. They discuss the cumulative impact of repeated TURBTs and explore the evolving role of office-based treatments and chemoablative therapies as alternatives to the traditional treatment cycle.

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Get the BackTable app

https://www.backtable.com/app

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Timestamps

00:00 - Introduction
05:58 - Comparing Office Ablation and OR TURBT
08:26 - TURBT Impact on Quality of Life
11:37 - Uncovering Hidden Patient Burdens and Costs
14:44 - Integrating Chemoablation into Practice
18:20 - ENVISION QoL Study Setup
22:04 - Comparing TURBT Preferences
27:40 - Counseling Risk-Averse Patients
29:10 - Community Adoption Advice
31:59 - Upcoming Clinical Trials
35:28 - Biomarkers and Expanding Access
36:23 - Final Thoughts and Closing Remarks

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More about this episode

The conversation covers practical strategies like office-based surveillance and fulguration for small recurrences, identifying triggers for returning to the OR, and recognizing the hidden burdens of TURBT complications such as hematuria, incontinence, and unplanned ER visits. Dr. Peyton reviews the role of chemoablative options for selected patients, discusses trial data on patient-reported outcomes, and addresses the mixed evidence, high costs, and need for individualized decision-making. The episode also explores new intravesical and FGFR-targeted therapies, underscores the importance of cost-conscious adoption and biomarkers, and considers how management approaches must evolve, especially in community practice settings.

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BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app