In this episode of Pearls & Perspectives, host Amy Pearlman, MD, welcomes Katherine Chan, MD, MPH, a pediatric urologist and former vice chair of research at University of North Carolina School of Medicine in Chapel Hill, to discuss her unexpected yet purposeful transition into the world of bladder cancer drug development.

Chan shares how her passion for research and desire to impact patients on a broader scale led her from academia to industry. She highlights the surprising rigor behind industry-sponsored clinical trials and the extensive collaboration required to run large global studies—dispelling common misconceptions about bias and scientific quality.

Now part of enGene, Chan describes her role in developing detalimogene voraplasmid, a nonviral gene therapy for non–muscle invasive bladder cancer (NMIBC). Unlike viral-based agents, this therapy offers easier handling, storage, and redosing, making it more practical for community urologists. Currently being studied in the global LEGEND trial (NCT04752722), the agent targets BCG-unresponsive NMIBC using a dual mechanism that activates both innate and adaptive immunity.

The conversation explores the broader challenges in NMIBC research, including trial recruitment, tumor heterogeneity, and the growing need for collaboration between academia, community practice, and industry. Chan also emphasizes the importance of visibility and networking—particularly through platforms like LinkedIn—for urologists interested in becoming key opinion leaders or transitioning to industry roles.

Looking ahead, Chan sees artificial intelligence and sub-specialized “centers of excellence” as shaping the future of bladder cancer care. Her key message: This is an unprecedentedly exciting time in bladder cancer, with new, patient-friendly therapies on the horizon. For patients, she underscores one takeaway—there are more options than ever before, and hope is stronger than ever.

Chapters

1:30 How a pediatric urologist gets into the bladder cancer space

12:04 How to become a key opinion leader

19:01 The NMIBC treatment landscape

25:55 Naming detalimogene voraplasmid

31:09 Where enGene stands in the clinical trial process

37:21 Implications of treatment for community urologists

In this episode of First Assist: GU Oncology Unpacked, host Taylor Goodstein, MD, speaks with Tullika Garg, MD, MPH, FACS, a urologic oncologist at Geisinger Medical Center in Danville, Pennsylvania, about the nuances of caring for older adults with genitourinary malignancies. Garg—who has authored the American Urological Association Core Curriculum chapter on geriatric oncology—shares her passion for improving outcomes in a population that represents the majority of new cancer diagnoses yet remains underrepresented in clinical trials.

Garg emphasizes the need to move beyond chronological age, using tools such as the Cancer and Aging Resilience Evaluation and the Cancer and Aging Research Group chemotherapy toxicity calculator to assess physiologic fitness. She encourages urologists to employ frameworks like the 3-talk model of shared decision-making—team talk, option talk, and decision talk—to align treatment plans with patient goals and values. Even simple questions such as, “What’s a typical day like for you?” or “What are you looking forward to?” can uncover key insights about function and priorities.

The discussion spans practical approaches to frailty screening, prehabilitation, and nutritional optimization, as well as strategies for discussing palliative options when surgery or chemotherapy may not be feasible. Garg also reviews perioperative considerations—minimizing delirium, avoiding anticholinergics and opioids, and the importance of early mobility and home health support.

She and Goodstein explore cancer-specific issues, from immunotherapy use in older patients to balancing risks of androgen deprivation therapy in prostate cancer. Garg closes with a call for trainees to recognize and challenge ageism in clinical practice, urging clinicians to treat each older adult as an individual—not by number, but by capacity and life goals.

Chapters

0:52 How Dr Garg became interested in geriatric oncology

10:02 Assessing geriatric patients

14:36 Patient resources for improving fitness

21:54 Exercise vs nutrition

29:55 Immune checkpoint inhibitors

35:50 Drugs to avoid in older patients

40:58 Robotic vs open surgery

49:00 Being mindful of ageism

In this episode of Speaking of Urology, Gregory E. Tasian, MD, MSc, MSCE, (Children’s Hospital of Philadelphia), Jonathan S. Ellison, MD, (Medical College of Wisconsin), and patient partner Annabelle Pleskoff reflect on the origins, design, and key findings of the PKIDS trial—a nearly decade-long, patient-centered study aimed at improving surgical outcomes for children and adolescents with kidney and ureteral stones.

In this episode of Pearls & Perspectives, host Amy Pearlman, MD, sits down with Susan MacDonald, MD, associate professor of surgery in the division of urology at the Penn State Health Milton S. Hershey Medical Center, to discuss the first-ever American Urological Association (AUA) guidelines on male pelvic pain ("Diagnosis and Management of Male Chronic Pelvic Pain [Chronic Prostatitis/Chronic Pelvic Pain Syndrome and Chronic Scrotal Content Pain))"—a milestone in understanding and managing chronic scrotal content pain and chronic pelvic pain syndrome.

MacDonald shares how her interest in pelvic pain evolved from her background in reconstructive urology. While training in genital reconstruction, she began to notice recurring patterns in men with overlapping symptoms—voiding issues, testicular pain, and erectile dysfunction—often linked by 1 root cause: pelvic floor dysfunction. Her clinical curiosity and patient-driven need for better care led her to join the AUA guideline panel, where she contributed to shaping practical, evidence-based recommendations.

The conversation explores key takeaways from the new guidelines, including a more judicious approach to antibiotic use—emphasizing a single, limited course only for antibiotic-naïve patients—and the expanding role of pelvic floor physical therapy as a first-line intervention. MacDonald also highlights emerging therapies such as acupuncture, shock wave treatment, and phytotherapeutics, as well as the importance of recognizing psychosomatic and stress-related components of pelvic pain.

She underscores the need for clinicians to perform rectal exams to identify pelvic floor dysfunction, to validate patients’ pain, and to approach management through a multidisciplinary, empathetic lens.

Finally, MacDonald shares her next venture—her new YouTube series, aimed at helping trainees master fundamental surgical skills through concise, accessible video education, reflecting her passion for teaching and the future of digital medical learning.

Chapters

0:56 How MacDonald developed her clinical interest in chronic orchialgia/male pelvic pain

10:35 MacDonald describes her involvement in the AUA guidelines

16:46 The role of antibiotics

22:16 Vasovasostomy for postvasectomy pain syndrome

24:56 Vas reversal vs spermatic cord denervation

30:25 Defining chronic scrotal content pain

38:04 The role of acupuncture

42:28 Practical tips for incorporating guidelines into daily practice

In this episode of The Expert Approach: Conversations in Uro-Oncology, host Joy Maulik, CRNP, speaks with J. Brandon Arruda, APRN, AGNP-C, CUNP, a urologic oncology nurse practitioner at WVU Medicine, about the evolving role of advanced practice providers (APPs) in urology. Arruda, who also directs the WVU Urology APP fellowship and serves in multiple leadership and educational capacities, shares insights into clinical practice, fello

Arruda recalls how he came to urology “by accident” but has remained in the field for over a decade due to the specialty’s culture of collaboration and strong support for APPs. He highlights the success of WVU’s pilot urology fellowship program, which launched in 2024 to address provider shortages in West Virginia. The program’s goal is to “train to retain” APPs in the region by combining structured didactics with hands-on rotations in general urology, pediatrics, and urologic oncology.

Clinically, Arruda performs a wide range of procedures, including cystoscopies, BCG instillations, intravesical chemotherapy, stent removals, and diagnostic evaluations for hematuria. He emphasizes the importance of APPs being procedurally proficient, particularly as innovations in bladder cancer therapies—such as the gemcitabine intravesical system Inlexzo (formerly TAR-200) and novel intravesical agents—expand treatment options. For hematuria workups, Arruda stresses guideline-based risk stratification, careful history-taking, and patient reassurance through cystoscopy when appropriate.

Beyond the bedside, Arruda underscores the strategic value of APPs in leadership roles. As health systems shift toward value-based care, he sees APPs as uniquely positioned to lead disease-specific care pathways, enhance procedural efficiency, and strengthen team-based models. He encourages organizations to “sprinkle the salt where it’s needed most,” recognizing APPs as integral to work force sustainability and patient-centered care.

Chapters

5:52 What makes you stay in urology?

11:48 WVU APP fellowship program

22:17 Arruda on procedures he performs

27:01 Evaluation of hematuria

33:38 Alternatives to BCG in bladder cancer

41:10 APPs as part of the leadership team

In this debut episode of The Expert APProach: Conversations in Uro-Oncology, host Joy Maulik, CRNP, a urology nurse practitioner who leads an advanced prostate cancer clinic with Chesapeake Urology, introduces the vision and mission behind this new Urology Times podcast series.

Maulik sets the stage by acknowledging the evolving role of advanced practice providers (APPs) in urology and oncology. No longer just members of the care team, APPs are increasingly at the forefront—running specialized prostate cancer clinics, advancing genetic testing programs, and leading survivorship care initiatives. This podcast aims to highlight their contributions while also creating a space where practical strategies meet evidence-based innovation.

Listeners can expect a blend of expert insights, clinical pearls, and real-world stories from across the GU oncology community. Topics will span from the latest breakthroughs and guideline updates to the everyday challenges and victories of patient care. Just as importantly, The Expert APProach will shine a light on the people behind the work—APPs, physicians, navigators, and researchers—whose efforts often go unseen but make a profound difference.

Collaborating with Urology Times, Maulik promises a credible, engaging, and accessible forum designed to make GU oncology care more personal, practical, and impactful—especially for communities that need it most.

n this episode of Pearls and Perspectives, Amy Pearlman, MD, speaks with Vahan Kassabian, MD, director of the Atlanta Prostate Cancer Center and Advanced Therapeutics at Advanced Urology in Atlanta, Georgia. Kassabian is a nationally recognized surgeon and pioneer in high-intensity focused ultrasound (HIFU), with a strong focus on advanced prostate cancer and on sustaining private practice models.

Kassabian describes the evolving practice landscape for urologists, contrasting academic medicine, hospital employment, private practice, and private equity-backed models. He emphasizes that modern private practices can mirror academic centers in subspecialization, research, and advanced therapeutics, while still offering physicians greater autonomy. As a board member of LUGPA, he highlights efforts to keep independent practice viable and competitive.

A major focus of the discussion is the integration of advanced prostate cancer therapeutics into urology offices. Kassabian outlines how practices can implement in-office dispensing pharmacies, infusions, and theranostics, such as prostate-specific membrane antigen (PSMA) imaging and lutetium (177Lu) vipivotide tetraxetan (177Lu-PSMA-617; Pluvicto) therapy, noting that even small groups can successfully run oral therapeutic programs. He stresses that urologists—who see patients with prostate cancer daily—are well-positioned to manage the disease across its continuum, often more consistently than medical oncologists whose scope is broader.

The conversation also touches on practical infrastructure needs, from nurse navigators to imaging investments, and on survivorship concerns such as bone health and frailty prevention. Kassabian underscores the importance of exercise, vitamin D, and multidisciplinary collaboration in optimizing patient outcomes.

Looking ahead, he sees PSMA theranostics, focal therapy, and precision medicine via tumor sequencing as transformative. For younger urologists, his message is to remain adaptable—pivoting every decade if needed to stay current—and to embrace innovation while keeping patient-centered care at the core.

Learn more about Kassabian here

In this episode of First Assist: GU Oncology Unpacked, host Taylor Goodstein, MD, speaks with Kamal Pohar, MD, associate professor in the College of Medicine at The Ohio State University in Columbus, about the evolution of management and surveillance for non–muscle invasive bladder cancer (NMIBC).

Pohar begins by tracing the origins of intravesical therapy. Before BCG became standard, chemotherapy agents delivered directly into the bladder showed modest benefits in reducing recurrence. The pivotal moment came in the 1970s, when autopsy observations linking tuberculosis with lower cancer incidence, coupled with animal studies, laid the groundwork for Morales’s landmark trial introducing BCG for bladder cancer. Early randomized studies quickly confirmed its benefit, transforming the field.

The discussion moves to BCG dosing and maintenance regimens. Interestingly, the 6-week induction course arose from the number of vials available in a package rather than strong biologic rationale, yet it has persisted across therapies. Maintenance protocols were later shaped by cytokine response studies and solidified through SWOG-led trials.

Surveillance strategies, repeat transurethral resection of the bladder tumor for T1 tumors, and the introduction of enhanced cystoscopy techniques such as blue light and narrow band imaging are also reviewed. Pohar notes their proven impact on tumor detection and recurrence, with blue light holding stronger evidence and FDA approval for both OR and office settings.

The episode also covers biomarkers, from traditional cytology—refined by the Paris Consensus—to newer adjuncts like UroVysion FISH, used selectively to adjudicate difficult cases. Risk stratification models (EORTC, CUETO) are examined for their contributions and limitations, particularly in the modern BCG era.

Finally, Pohar addresses perioperative intravesical chemotherapy, the impact of BCG shortages, and exciting frontiers such as recombinant BCG and en bloc resection techniques. He emphasizes that although NMIBC management has come far, clinical trials and technological innovation continue to shape a rapidly evolving field.

Chapters

0:41: The emergence of BCG

9:20: The origin of the 6-week induction cycle

13:06: Understanding the maintenance schedule of cystoscopy

21:41: The advent of hexaminolevulinate

38:18: Risk groups

45:14: Perioperative chemotherapy

In this special Prostate Cancer Awareness Month episode of Pearls and Perspectives, host Amy Pearlman, MD, welcomes Mark Gonzalgo, MD, PhD, chair of the Desai Sethi Urology Institute and a nationally recognized expert in prostate cancer surgery. Their discussion highlights innovations in surgical technique, the importance of patient-centered decision-making, and how multidisciplinary care can optimize outcomes.

Gonzalgo explains the Retzius-sparing robotic radical prostatectomy, a technique that avoids disturbing critical tissues controlling urination and can accelerate recovery of continence and sexual function in appropriately selected patients. He shares insights on ideal candidates, surgical learning curves, and the balance between cancer control and functional preservation. Real-world examples, including a shared patient who recovered sexual function remarkably quickly, underscore the impact of surgical nuance combined with prehabilitation strategies such as pelvic floor training.

The conversation also tackles testosterone therapy in men with prostate cancer, a complex and sometimes controversial issue. Gonzalgo emphasizes individualized decisions, noting that for men with lower- to intermediate-risk disease, continuing therapy may be reasonable. Both physicians stress the value of keeping patients anabolic and active before surgery to support postoperative recovery.

Looking ahead, Gonzalgo outlines how artificial intelligence, advanced imaging, and genomic classifiers are shaping the future of prostate cancer care by enabling more precise personalization of treatment. He offers guidance for colleagues on optimizing patient communication, reminding early-career urologists to “never lose sight of the person behind the cancer.” His closing message to patients: Take time, gather information, and know you are not alone in your decision-making.

This episode provides practicing urologists with practical insights into evolving surgical techniques, multidisciplinary collaboration, and strategies to enhance both oncologic and quality-of-life outcomes in prostate cancer care.

Chapters

2:14 Discussing a shared patient

6:23 The ideal candidate for Retzius-sparing prostatectomy

8:33 Testosterone and prostatectomy

13:27 Can prostatectomy be improved?

14:58 The role of AI

15:40 What excites Dr Gonzalgo in the prostate cancer space

In this episode of Pearls & Perspectives, Amy Pearlman, MD, speaks with Dan Sperling, MD, DABR, a board-certified radiologist and medical director of the Sperling Prostate Center (Florida, New York) and the Sperling Diagnostic Group (Florida). The discussion focuses on advances in prostate MRI, targeted biopsy, and focal therapies for prostate cancer.

Sperling shares how his career evolved from traditional diagnostic imaging into prostate MRI after collaborating with large urology groups frustrated by the limitations of standard transrectal ultrasound-guided prostate biopsy. Early exposure to European innovators in multi-parametric MRI (mpMRI) and in-bore biopsy fueled his adoption of advanced imaging and eventually focal therapies. Although initially met with skepticism, mpMRI is now a central component of prostate cancer care, with MRI-ultrasound fusion biopsies widely adopted as a cost-effective and accurate option.

The conversation highlights the infrastructure required for in-bore MRI biopsies, the evolution of targeted fusion approaches, and how patients often seek Sperling from across the globe for cutting-edge imaging and treatment. His patients, many of whom prioritize quality of life and minimal adverse events, are increasingly exploring focal therapies as alternatives to surgery or radiation.

Sperling explains his use of 3 main focal therapy modalities—focal laser ablation, MRI-guided focused ultrasound, and TULSA (transurethral ultrasound ablation). He outlines factors influencing treatment selection, including tumor location, prostate size, presence of calcifications, and genomic risk. Adverse events are generally mild, with catheter use for a short period post-procedure.

The episode also underscores the role of artificial intelligence (AI) in prostate imaging. Sperling uses multiple AI platforms to refine detection, reduce false positives, aid in targeting, and even help differentiate scar tissue from recurrence after treatment. He sees AI as a rapidly evolving tool that will reshape diagnosis, treatment planning, and surveillance in prostate cancer.

For urologists, Sperling emphasizes the importance of close collaboration with radiologists, adopting MRI-guided diagnostic strategies, and staying informed about focal therapy research. He encourages open-mindedness toward these evolving technologies, which he believes represent an exciting new era in prostate cancer management.

Chapters

1:17 Dr Sperling outlines his background

6:46 Barriers to adoption of MRI-guided biopsy

12:14 Decision making for focal therapy treatments

21:28 Who is the ideal candidate for focal therapy?

24:45 AI's role in Dr Sperling's practice

29:26 Urologist-radiologist collaboration