With multiple clinical trials evaluating PARP inhibitor combinations, how do clinicians determine the best approach for advanced prostate cancer? In this episode of BackTable Urology, Dr. Alan Tan is joined by Dr. Rana McKay and Dr. Emmanuel Antonarakis to discuss how evolving evidence, patient selection, timing, toxicity, and genetic testing are shaping the use of PARP inhibitor combinations in clinical practice.

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Timestamps

00:00 - Introduction
02:51 - PARPi Basics
14:12 - Major Study Differences
19:00 - Timing and Selection of PARPi Combinations
26:39 - Case: Somatic BRCA2 loss and mHSPC
35:51 - Case Continued: BRCA2 Reversion
39:57 - BRCAAway Study
42:59 - Takeaways from the 2026 APCCC

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More about this episode

The conversation reviews lessons learned from major clinical trials, including PROpel, MAGNITUDE, TALAPRO-2, and AMPLITUDE, and addresses how these studies inform real-world treatment choices. The doctors dig into case examples, such as BRCA2 loss and reversion, and highlight practical strategies for using germline and somatic testing to personalize care. Key insights from the 2026 Advanced Prostate Cancer Consensus Conference are also shared, emphasizing the importance of precision medicine in this rapidly evolving field.

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Resources

Study on Olaparib Plus Abiraterone as First-line Therapy in Men With Metastatic Castration-resistant Prostate Cancer (PROpel) https://clinicaltrials.gov/study/NCT03732820

A Study of Niraparib in Combination With Abiraterone Acetate and Prednisone Versus Abiraterone Acetate and Prednisone for Treatment of Participants With Metastatic Prostate Cancer (MAGNITUDE) https://clinicaltrials.gov/study/NCT03748641?tab=study

Talazoparib + Enzalutamide vs. Enzalutamide Monotherapy in mCRPC (TALAPRO-2) https://clinicaltrials.gov/study/NCT03395197

A Study of Niraparib in Combination With Abiraterone Acetate and Prednisone Versus Abiraterone Acetate and Prednisone for the Treatment of Participants With Deleterious Germline or Somatic Homologous Recombination Repair (HRR) Gene-Mutated Metastatic Castration-Sensitive Prostate Cancer (mCSPC) (AMPLITUDE) https://clinicaltrials.gov/study/NCT04497844

BRCAAway: A randomized phase 2 trial of abiraterone, olaparib, or abiraterone + olaparib in patients with metastatic castration-resistant prostate cancer (mCRPC) bearing homologous recombination-repair mutations (HRRm) https://pubmed.ncbi.nlm.nih.gov/39115414/

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Is pelvic lymph node dissection still necessary in the era of PSMA PET imaging? In this episode of BackTable Urology, Dr. Ruchi Talwar interviews Dr. Kirsten Greene about how advanced imaging is influencing decisions for radical prostatectomy. They examine the strengths and limits of PSMA PET, the risks and benefits of PLND, and why careful, evidence-based decision-making remains essential.

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Timestamps

00:00 - Introduction
03:12 - Risk Calculators and Consent
04:39 - Nomograms vs. Complications
09:57 - Endpoints That Matter
11:38 - PSMA PET Strengths and Limits
13:51 - Negative PET Decision-Making
15:08 - Positive PET and Multimodal Care
18:02 - Fluorescence Guided Surgery
19:10 - Counseling on Complications
22:27 - Preventing Lymphocele
24:56 - How Lahey Wrap Works
26:45 - Future Mapping and Therapy
28:47 - Research Gaps and Dogma
31:07 - Key Pearls and Wrap Up

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More about this episode

Dr. Greene explains her approach using MSK and Briganti nomograms alongside PSMA PET, noting that PET scans may miss small nodal disease and quality varies between centers. She emphasizes PLND as a staging tool rather than a curative procedure, outlining potential complications like lymphocele, lymphedema, vascular and ureteral injury, and neuropraxia. The episode highlights her shared decision-making process, surgical techniques for limiting risk, and the importance of multimodal planning, especially for PET-positive nodal disease. Dr. Greene also shares practical tips for lymphocele prevention, including the use of metal clips and the Lahey wrap.

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Resources

Different lymph node dissection ranges during radical prostatectomy for patients with prostate cancer: a systematic review and network meta-analysis
https://pubmed.ncbi.nlm.nih.gov/36872312/

Limited versus Extended Pelvic Lymph Node Dissection for Prostate Cancer: A Randomized Clinical Trial https://pubmed.ncbi.nlm.nih.gov/33865797/

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How can clinics minimize toxicity and maximize outcomes in intravesical bladder cancer treatment? In this episode of BackTable Urology, host Dr. Vignesh Packiam talks with nurse practitioners Mary Dunn (UNC) and Meredith Donahue (Vanderbilt) about how advanced practice providers (APP) workflows and hands-on management are transforming care for non-muscle-invasive bladder cancer. The discussion highlights innovative strategies for symptom management, patient education, catheter techniques, and streamlined operational protocols across both established and emerging intravesical therapies.

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This podcast is supported by an educational grant from Johnson & Johnson.

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Timestamps

00:00 - Introduction
04:25 - Non Drug Symptom Tips
09:39 - Day Of Treatment Clearance
14:50 - Post Treatment Triage
20:36 - Treatment Fatigue Strategies
24:48 - Pelvic Floor And IC Tools
27:33 - Teamwork Final Pearls

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More about this episode

They share individualized pharmacologic and non-pharmacologic approaches for managing lower urinary tract symptoms, such as NSAIDs, anticholinergics, beta-3 agonists, Pyridium, timed voiding, avoidance of irritants, and constipation management. The episode covers patient education resources from the Bladder Cancer Advocacy Network (BCAN), catheterization techniques tailored to patient needs, and a gravity installation method to reduce spasms. The conversation also reviews day-of-treatment clearance and triage protocols, operational considerations for new agents like Enlexo, Adstiladrin, and gemcitabine/docetaxel, as well as financial workflows that prevent drug wastage. Additional topics include managing cumulative bladder toxicity, pelvic floor PT, addressing treatment fatigue, and integrating multifactorial evaluation and exercise into patient care.

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Resources

Bladder Cancer Advocacy Network (BCAN) Basic Handbook & Patient Resources

https://bcan.org/bladder-cancer-basics-handbook/

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What happens when urologists look beyond the clinic and take on leadership in the life sciences industry? In this episode of BackTable Urology, host Dr. Raj Pruthi talks with Dr. Kelly Parsons and Dr. Pat Keegan about their journeys from academic urology to executive roles in biotech and pharma. They discuss what motivated their transitions, how physician expertise adds value in industry, and the realities of life outside of traditional clinical practice.

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Timestamps

00:00 - Introduction
05:36 - Choosing a Non-Clinical Path
11:07 - Reactions from Mentors and Peers
14:31 - What Feels Most Fulfilling
18:31 - A Typical Week in Biotech
26:04 - Working with Investors
31:21 - Additional Degrees and MBA Debate
35:31 - Is it Risky to Leave Clinical Practice?
44:13 - Networking and Next Steps
47:59 - Wrap Up

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More about this episode

The conversation explores the day-to-day work of industry leaders, the impact of advanced degrees like MBAs, and the importance of networking for physicians considering a nonclinical path. Drs. Parsons and Keegan reflect on the challenges and rewards of leaving clinical medicine, the support and reactions from mentors and peers, and what they miss most about patient care. They also share practical advice for urologists and other specialists who are curious about new career opportunities beyond the exam room.

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Why does up to 10% of bladder cancer pathology change on expert review, and what does that mean for your intermediate and high-risk patients? In this episode of BackTable, Dr. Bogdana Schmidt interviews urologists Dr. Kristen Scarpato and Dr. Sunil Patel to explore the complexities of diagnosis and risk assessment in non–muscle invasive bladder cancer (NMIBC). They discuss the real-world challenges of pathology interpretation, risk-group assignment, evolving diagnostic tools, and the impact these factors have on treatment decisions and patient outcomes.

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This podcast is supported by an educational grant from Johnson & Johnson.

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Timestamps
00:00 - Introduction
01:02 - Risk Stratification
07:22 - Upstaging to High Risk
10:06 - Calculators and Patient Education
15:22 - Specific Tests Use Cases
18:50 - Conflicting Biomarker Results
21:36 - Adjunct Tests and Counseling
24:03 - Recurrence After Chemo Next Steps
27:01 - Escalation Deescalation Balance
32:48 - Future Research Priorities
35:43 - Biology Based Risk Stratification
38:03 - Clinical Pearls and Wrap Up

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More about this episode
The conversation highlights the heterogeneity of intermediate-risk disease, the role and importance of expert pathology over-reads, and the need to accurately document the risk category for ongoing care. They discuss selective use of urinary and genomic assays and how these tests fit alongside cystoscopy and blue light endoscopy. Practical treatment approaches are reviewed, including when to use intravesical gemcitabine or BCG, managing care during BCG shortages, and balancing escalation versus de-escalation of therapy. Additional topics include strategies for long-term surveillance, upper tract imaging, rising rates of bladder cancer in younger patients, and why thorough TURBT and strong patient-provider communication remain central to optimal management.

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Resources

The Memorial Study
https://www.mskcc.org/cancer-care/clinical-trials/19-288

The BRIDGE Study
https://www.nejm.org/doi/full/10.1056/NEJMoa1501035

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Robotic technology is expanding what’s possible in reconstructive urology, prompting surgeons to rethink traditional approaches and consider new minimally invasive procedures. In this episode of BackTable Urology, Dr. Ziho Lee joins host Dr. George Koch to explore the rapid evolution of robotic reconstructive surgery and its expanding role in complex pelvic and retroperitoneal procedures.They discuss the the role of single-port platforms, new strategies for managing ureteral strictures and urinary diversion, and how research, training, and patient-reported outcomes are shaping the future of minimally invasive urologic care.

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Timestamps
00:00 - Introduction
03:10 - Bridging Reconstruction and Robotics
07:41 - Where Robots Help Most
14:33 - Ureteral Rest
16:41 - 20% Nephrectomy Rule
19:04 - Single Port Indications
20:55 - Ileal Ureter Tips and Tricks
22:34 - Robotic Reconstruction Course
28:55 - Case: VUAS Repair
39:35 - Final Advice

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Resources
Ureteral Rest is Associated With Improved Outcomes in Patients Undergoing Robotic Ureteral Reconstruction of Proximal and Middle Ureteral Strictures
https://pubmed.ncbi.nlm.nih.gov/33639184/

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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.
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What matters most to patients with non-muscle invasive bladder cancer (NMIBC)? In this episode of BackTable Urology, Dr. Kelly Bree, Dr. Saum Ghodoussipour, and Meredith Donahue, N.P., join host Dr. Vignesh Packiam to discuss the power of shared decision-making across the NMIBC spectrum. They explore risk-adapted treatment selection, when to escalate or de-escalate therapy, and how to navigate conversations about recurrence risk, treatment burden, quality of life, and the possibility of cystectomy.

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This podcast is supported by an educational grant from Johnson & Johnson.

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Timestamps

00:00 - Introduction
01:55 - Second Opinions and Patient Counseling
06:08 - Intermediate Risk Stratification
12:13 - Treatment Options for Intermediate Risk NMIBC
16:20 - BCG and Alternative Treatments for High Risk NMIBC
26:49 - Options for BCG-Unresponsive NMIBC
31:42 - Sequencing and Cystectomy
37:03 - Financial and Time Toxicity
41:08 - Biomarkers and ctDNA
44:04 - Future Trials and NMIBC Innovations

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More about this episode

They also review emerging therapies such as ZUSDURI, the evolving role of intravesical treatments, and the promise of biomarkers and ctDNA for personalized care. The discussion covers practical strategies for patient counseling, key updates to clinical guidelines, and a preview of innovations shaping the future of NMIBC management.

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Resources

Active Surveillance Versus Intravesical Bacillus Calmette-Guérin for High-grade T1 Bladder Cancer with Negative Second Transurethral Resection: The Randomized Noninferiority Phase 3 JCOG1019 Trial:
https://pubmed.ncbi.nlm.nih.gov/41571573/

Twelve-Month Results From the CISTO Study Comparing Radical Cystectomy Versus Bladder-Sparing Therapy for Recurrent High-Grade Non–Muscle-Invasive Bladder Cancer
https://ascopubs.org/doi/10.1200/JCO-25-01324

CIRCULATING TUMOR DNA AS A BIOMARKER FOR UPSTAGING AND ADVERSE PATHOLOGY IN HIGH-RISK NON–MUSCLE-INVASIVE BLADDER CANCER:
https://www.auajournals.org/doi/abs/10.1097/01.JU.0001191388.74345.c9.09

Preoperative Circulating Tumor DNA Predicts Upstaging and Recurrence in High-Risk Nonmuscle-Invasive Bladder Cancer Undergoing Radical Cystectomy
https://pubmed.ncbi.nlm.nih.gov/41843048/

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

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Can you really treat prostate cancer effectively without knowing the genetics? In this episode of BackTable Urology, Dr. Evan Yu and Dr. Tanya Dorff join host Dr. Alan Tan to discuss why genetic testing is essential in personalized prostate cancer care. They discuss when and how to perform germline and somatic testing, address common barriers, and share best practices for counseling patients.

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This podcast is supported by an educational grant from Pfizer.

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Timestamps

00:00 - Introduction
02:18 - Who Gets Somatic Testing?
06:43 - Patient Barriers to Testing
09:00 - Genetic Testing Workflow
12:28 - Treating BRCA2 Alterations
24:18 - Monitoring Progression: ctDNA vs. PSA vs. Imaging
29:32 - Treating mCRPC with ATM Mutations
34:39 - CDK12 Classification
37:43 - Closing Takeaways

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More about this episode

The doctors explore how BRCA2 and other DNA repair alterations can directly shape treatment decisions, focusing on the roles of PARP inhibitors and platinum therapy in advanced cases. The discussion highlights why both germline and somatic testing are critical for identifying actionable mutations and discuss the nuances of interpreting test results, including current limitations and emerging biomarkers. They also examine challenges such as insurance coverage, patient misconceptions, and workflow integration, as well as the movement toward truly personalized, biology-driven approaches in prostate cancer care.

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Resources

Niraparib and abiraterone acetate plus prednisone for HRR-deficient metastatic castration-sensitive prostate cancer: a randomized phase 3 trial:
https://pmc.ncbi.nlm.nih.gov/articles/PMC12705445/

Capivasertib plus abiraterone in PTEN-deficient metastatic hormone-sensitive prostate cancer: CAPItello-281 phase III study:
https://www.annalsofoncology.org/article/S0923-7534(25)04936-1/fulltext

Apalutamide for Metastatic, Castration-Sensitive Prostate Cancer:
https://www.nejm.org/doi/full/10.1056/NEJMoa1903307

ARCHES 5-year Survival with Enzalutamide Plus Androgen-deprivation Therapy in Metastatic Hormone-sensitive Prostate Cancer Patients
https://www.sciencedirect.com/science/article/pii/S0302283825048766

First-Line Camizestrant for Emerging ESR1-Mutated Advanced Breast Cancer:
https://www.nejm.org/doi/abs/10.1056/NEJMoa2502929

PROMISE Registry:
https://www.prostatecancerpromise.org/

Talazoparib plus enzalutamide in men with HRR-deficient metastatic castration-resistant prostate cancer: final overall survival results from the randomised, placebo-controlled, phase 3 TALAPRO-2 trial:
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00683-X/abstract

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

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Are traditional bladder cancer care models falling behind as new therapies flood the field and reshape the landscape? In this episode of BackTable Urology, Dr. Bogdana Schmidt talks with Dr. Amy Luckenbaugh and DNP/APP Meredith Donahue about building a co-managed intravesical therapy clinic that rethinks care for patients with non–muscle invasive bladder cancer (NMIBC). With innovative agents increasing patient volume and complexity, the team discusses adapting care models to new realities.

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This podcast is supported by an educational grant from Johnson & Johnson.

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Timestamps

00:00 - Why Clinic Models Need to Change Now
04:03 - Overcoming Financial and J-Code Hurdles
11:04 - High Volume Workflow
14:10 - Pharmacy Coordination And Timing
19:02 - Proactive Lower Urinary Tract SYmptom Management
22:25 - Handling Difficult Catheters
32:08 - Defining Clinic Success

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More about this episode

The conversation covers prioritizing clinical trials, managing operational challenges such as prior authorizations and billing hurdles, and the importance of pharmacy coordination and predictable clinic workflows. Donahue describes a high-efficiency installation day model managing up to 50 patients a week with specialized staff, real-time decisions, and tailored logistics for therapies like Adstiladrin. They also discuss symptom prevention, patient triage, and clinic success measures including therapy availability, patient satisfaction, and opportunities to preserve bladder function.

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Resources

Gemcitabine IDRS Drug Delivery Trial
https://ascopubs.org/doi/10.1200/JCO.2026.44.7_suppl.635

BCG-IO Combination Trial
https://www.astrazeneca.com/media-centre/press-releases/2026/imfinzi-approved-in-us-for-early-bladder-cancer.html

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

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Ready to move beyond “one-size-fits-all” for BCG-unresponsive NMIBC? In this episode of BackTable Urology, Dr. Ruchika Talwar hosts Dr. Sam Chang to discuss the evolving treatment landscape for BCG-unresponsive non-muscle invasive bladder cancer (NMIBC). They explore why BCG may fail, the science and clinical rationale behind new immunotherapies and gene therapies, practical approaches to patient selection, treatment sequencing, and surveillance, and the value of emerging biomarkers, empowering urologists to make more informed, personalized decisions in complex cases of NMIBC.

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This podcast is supported by

ImmunityBio
https://anktiva.com/

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Timestamps

00:00 - Introduction
03:48 - BCG: How it Works and Why it Fails
11:13 - Pembrolizumab Role and Limits
14:38 - Nadofaragene firadenovec
16:34 - Cretostimogene grenadenorepvec
18:39 - BCG + Anktiva Rationale
29:50 - Explaining Options to Patients
33:05 - Post Treatment Surveillance
37:32 - Future of Biomarkers and AI
42:05 - Key Takeaways

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Resources

N-803 Plus BCG Treatment for BCG-Naïve or -Unresponsive Non-Muscle Invasive Bladder Cancer: A Plain Language Review
https://pmc.ncbi.nlm.nih.gov/articles/PMC11524197/

Safety, Tolerability, and Long-Term Clinical Outcomes of an IL-15 analogue (N-803) Admixed with Bacillus Calmette-Guérin (BCG) for the Treatment of Bladder Cancer
https://doi.org/10.1080/2162402X.2021.1912885

IL-15 Superagonist NAI in BCG-Unresponsive Non–Muscle-Invasive Bladder Cancer
https://evidence.nejm.org/doi/full/10.1056/EVIDoa2200167

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More about this episode

This podcast is for informational purposes only. The views and opinions expressed in this podcast are solely those of the moderator and individual guest.

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

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