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    Burnout, biopsy, BPH, and more: Post-AUA review




    New drug treatments and guidelines

    One of the exciting new treatments I learned about at the AUA was the new PD-1 checkpoint inhibitor, durvalumab (Imfinzi). This medication showed an overall response rate of 26.3% among patients with high PD-L1 scores who had already received first-line therapy for locally advanced or metastatic bladder cancer. For those curious about how this and other new immunotherapy agents work, I recommend a wonderful course, Chemotherapy and Immunotherapy Options for Genitourinary Malignancies, the video of which can be see here.

    The only downside to this drug is that the wholesale price is $13,000 per month for a drug that needs to be given monthly for life. That translates to $156,000 per year. Given the prevalence of metastatic bladder cancer, I’m not sure how we, as a society, can continue to pay for drugs such as this even given its response rate.

    While I did not attend any of the new guideline presentations at the AUA, I acknowledge the wonderful presenters and those who worked incredibly hard to draft these always useful statements. On the other hand, since leaving Boston, I have watched every presentation online and have read the guidelines in whole. For us small-town plumbers who strive to practice normal, boring, standard-of-care medicine, guidelines are gold. Here is a link to all five of the guidelines presented at the AUA: muscle-invasive bladder cancer, renal cell cancer, and localized prostate cancer (divided into low, intermediate, and high risk).

    I was especially impressed with the guidelines on localized intermediate-risk prostate cancer, as that is the situation I find myself in most commonly. I thought the way the guidelines split this into favorable and unfavorable categories was very clever.

    Henry Rosevear, MD
    Dr. Rosevear, a member of the Urology Times Clinical Practice Board, is in private practice at Pikes Peak Urology, Colorado Springs, CO.


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