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

In this episode of Pearls & Perspectives, Amy Pearlman, MD, speaks with Adam Gvili, PT, DPT, a pelvic floor physical therapist and founder of Pelvis NYC, about his personal and professional journey in treating male pelvic floor dysfunction.

Gvili shares that from ages 19 to 25, he experienced pelvic floor dysfunction. After seeing multiple urologists, undergoing invasive tests, and trying various medications without relief, he eventually found effective care through pelvic floor physical therapy—though it took several providers before finding the right fit. This personal experience inspired him to enter the field and focus on treating men, a population often underserved in pelvic health.

Gvili explains that many patients with pelvic floor dysfunction are young men (20–45 years old), though he also treats patients who have undergone radical prostatectomy. Symptoms range from urinary issues and erectile dysfunction to groin pain, constipation, and tip-of-penis pain. He stresses that pelvic floor therapy for men cannot simply replicate female treatment approaches; instead, therapy should be individualized, patient-centered, and focused on retraining underused or overactive muscles.

A major theme of the discussion is the disconnect between urologists and pelvic floor therapists. Both agree that collaboration is essential: urologists should rule out infection, strictures, or anatomic abnormalities, whereas physical therapists help address musculoskeletal and functional issues. Gvili emphasizes that many patients feel dismissed or “gaslit” when their symptoms don’t show up on standard tests, which underscores the need for compassionate listening and validation.

On erectile dysfunction (ED), Gvili notes a growing number of young men presenting with ED, often linked to pelvic floor tension, psychological factors, or unrealistic expectations shaped by cultural narratives. He advocates for pelvic PT as a complementary treatment and stresses open communication between providers and patients.

He closes by urging young men not to feel shame—pelvic floor therapy can significantly improve quality of life—and encouraging health care providers to stay open-minded about pelvic floor dysfunction, even if the science is still evolving.

Learn more about Gvili here

Chapters

1:07 Dr Gvili's experience with pelvic floor dysfunction

10:51 Gaslighting and pelvic floor dysfunction

15:00 Dr Gvili on the types of men he treats

19:17 The urologist's role vs the pelvic floor physical therapist's role

28:10 Tip-of-penis pain

34:31 Dr Gvili's "megaphone message"

In this episode of First Assist: GU Oncology Unpacked, host Taylor Goodstein, MD, speaks with Eric A. Singer, MD, MA, MS, FACS, FASCO, The Dave Longaberger Endowed Chair in Urology, professor of urology and bioethics, chief of the urologic oncology, and director of the Urologic Oncology Fellowship Program at The Ohio State University in Columbus about how historical milestones in genitourinary oncology; specifically, kidney cancer, have shaped current practice.

Singer traces the evolution of kidney cancer management from the era of radical surgery to today’s precision approaches, highlighting how improved imaging, minimally invasive techniques, and molecular insights have transformed treatment. He underscores the shift from one-size-fits-all surgery toward tailored strategies that balance oncologic control with preservation of renal function and quality of life.

The discussion also explores the arc of immunotherapy in urologic cancers—from early cytokine-based regimens to the immune checkpoint inhibitors now embedded in standard care. Singer reflects on how clinical trial design, patient selection, and biomarker research are driving more individualized therapy choices.

Throughout the conversation, Goodstein emphasizes the value of understanding the past to better interpret the present and anticipate the future. The two also address how a deeper appreciation for the history of GU oncology can help trainees navigate today’s rapidly expanding knowledge base without losing sight of core principles.

Looking ahead, Singer points to ongoing challenges, including optimizing multidisciplinary collaboration, improving trial access for diverse patient populations, and integrating novel therapies in ways that are both evidence-based and patient-centered. His take-home message: progress in GU oncology is built on decades of incremental advances, and the next wave of breakthroughs will require the same blend of innovation, rigorous science, and thoughtful application.

Chapters

1:30 Where does the story of kidney cancer treatment begin?

6:54 The strengths and limitations of IL-2

17:40 Comparing mTOR inhibitors and TKIs

25:38 Cytoreductive nephrectomy

36:00 First-line regimens

45:09 Upcoming trials to watch

In this inaugural episode of First Assist: GU Oncology Unpacked, host Taylor Goodstein, MD, sets the stage for a podcast designed to demystify the complex and fast-moving world of genitourinary oncology. Currently entering her second year of a Society of Urologic Oncology fellowship at Emory University after completing residency at The Ohio State University, Goodstein brings a unique “in-between” perspective—no longer a resident, not yet a long-established attending—offering listeners a relatable guide through one of urology’s most knowledge-dense subspecialties.

Speaking directly to trainees while ensuring relevance for seasoned clinicians, Goodstein acknowledges the steep learning curve in GU oncology and her mission to make it more approachable. She promises to ask the questions that others may hesitate to voice—like “What is CIS, anyway?” or “What does this chemotherapy cycle actually entail?”—and to explore these topics through interviews with leading urologists, radiation oncologists, medical oncologists, and basic scientists from across the country.

The podcast will span a wide range of subjects, from breaking trial data in non–muscle invasive bladder cancer to advances in focal therapy for prostate cancer to practical guidance for approaching an IVC thrombectomy. Episodes will blend guideline updates, expert commentary, and practical insights into both the “why” and the “how” of modern oncologic care.

The first series of episodes will take a historical look at how treatments for common urologic malignancies have evolved—because, as Goodstein notes, understanding where the field has been is essential to knowing where it’s going. Future episodes will intersperse this with timely, topic-driven conversations shaped in part by listener suggestions. (Please email us at [email protected] with any suggestions.)

With a focus on accessibility, curiosity, and high-yield learning, First Assist invites trainees and experts alike to engage in candid, informed discussions about the realities and innovations shaping GU oncology today.

In this episode of Pearls & Perspectives, host Amy Pearlman, MD, speaks with David Canes, MD, a urologist with Lahey Hospital and Medical Center in Massachusetts and founder of Wellprept, a digital platform designed to streamline patient education and communication. Their conversation explores how Wellprept arose from Canes’s desire to make office visits more efficient, patient-centered, and consistent—while preserving the human connection that drives high-quality care.

Canes describes the challenges of modern urology practice, from the deluge of portal messages to the variability in how clinicians deliver pre- and post-visit instructions. He explains how Wellprept organizes procedure explanations, prep instructions, and educational materials into a clean, branded interface that patients can access anytime, reducing confusion and freeing clinic time for more meaningful interaction.

Key themes include:

• How standardized, accessible education can reduce patient anxiety and improve compliance

• The limits of verbal-only counseling and the benefits of on-demand, multimedia resources

• Ways Wellprept supports both large health systems and small practices by integrating seamlessly into existing workflows

• The impact of consistent messaging on trust-building and patient satisfaction

• Why digital tools must enhance—not replace—the empathy and personal touch that patients value most

Canes emphasizes that technology like Wellprept is not about replacing physicians, but about elevating their ability to communicate effectively, reduce inefficiencies, and deliver a better patient experience. His vision: a health care environment where patients feel informed, empowered, and connected, both inside and outside the clinic.

You can learn more about Wellprept at https://www.wellprept.com/

0:00 Introducing Dr Canes

8:22 Helping with burnout in others

16:45 Starting Wellprept

25:40 What is Wellprept?

34:20 What can be included on a Wellprept page?

40:14 What’s next?

53:48 Dr Canes’ message to health care professionals

Panelists discuss the impact of long-term care in patients with non–muscle-invasive bladder cancer (NMIBC), considering the unique needs of specific patient groups and highlighting advancements in NMIBC treatment that may support better care experiences for patients.

In this episode of Pearls & Perspectives, host Amy Pearlman, MD, sits down with Utsav Bansal, MD, a Miami, Florida-based urologist who brings both surgical expertise and thoughtful pragmatism to the evolving field of benign prostatic hyperplasia (BPH) management. Drawing from his broad clinical experience, Bansal unpacks how to personalize treatment plans in a therapeutic landscape now filled with minimally invasive and surgical options.

The conversation explores how to develop procedural versatility while maintaining focus on patient-centered decision-making. Bansal emphasizes shared decision-making as the foundation of BPH care—ensuring that lifestyle factors, prostate size, and patient priorities guide treatment choices, whether it’s medical therapy, UroLift, Rezūm, or more definitive procedures like Aquablation or enucleation.

Key topics include:

• How to match the right patient to the right BPH procedure without overpromising

• The importance of investing in a select number of procedures—and doing them well

• Lessons learned from high-volume centers, and how to translate them into community-based care

• The future of BPH innovation and how newer technologies can improve quality of life without increasing provider burnout

• Why managing patient expectations and setting clear follow-up protocols are critical for long-term success

Whether you’re an early-career urologist or looking to expand your BPH offerings, Bansal delivers practical insights on how to build a sustainable, high-value BPH practice that adapts to both new tools and timeless patient needs.

You can learn more about Bansal at www.bansalurology.com

0:00 Introducing Utsav Bansal, MD

1:04 What Bansal Offers Patients

4:34 Explaining Procedures To Patients

7:54 New Technologies

13:03 Developing a BPH Portfolio Early in Your Career

18:00 Demos for Patients

19:10 Having Your Own Website