BackTable Urology

Every prostate cancer biomarker returns a number, but the real question is whether that number changes what you do next for the patient. On this episode of BackTable Urology, Dr. Ruchika Talwar welcomes Dr. Amir Lebastchi, urologic oncologist at Keck Medicine of USC, to discuss how biomarkers are moving prostate cancer care from numbers to meaningful clinical decisions. They define what makes a biomarker clinically useful, organize the growing list of blood, urine, and tissue tests into pre-biopsy, post-negative-biopsy, and post-diagnosis settings, and talk through where these tests fit alongside MRI after an elevated PSA.

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

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This podcast is supported by

Cleveland Diagnosticshttps://www.isopsa.com/

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Timestamps

00:00 - Introduction02:59 - Clinical Utility and a Framework for Biomarkers08:43 - Workup of an Elevated PSA11:42 - Pre-Biopsy Blood and Urine Tests13:29 - Equivocal MRI, Outside Imaging, and Community Practice20:26 - Patient Factors and Practical Considerations24:44 - Case: Elevated PSA and a Negative MRI30:11 - Case: Biopsy Approach and Discordant Results34:41 - Counseling on PSA Limitations and Overdiagnosis37:05 - Biomarkers in Active Surveillance and Renaming Grade Group 140:56 - AI and the Future of Biomarkers44:38 - Take-Home Points and Closing Remarks

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More about this episode

The discussion covers equivocal MRI findings, patient counseling, and the practical impact of age, family history, and race when interpreting PSA levels. Through real cases, Dr. Lebastchi explains when he repeats a PSA, how he performs a templated transperineal biopsy, and why a negative MRI plus a negative biomarker can give him the confidence to forgo a biopsy. They also touch on active surveillance, the debate over renaming grade group 1 prostate cancer, and how AI may help future tests guide treatment intensity rather than just risk category. Dr. Lebastchi closes with the clinician’s obligation to know all available tests and use those that truly inform management.

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Resources

Early Detection of Prostate Cancer: AUA/SUO Guideline (2023)https://www.auanet.org/guidelines-and-quality/guidelines/early-detection-of-prostate-cancer-guidelines Clinical validation of IsoPSA, a single parameter, structure-focused assay for improved detection of prostate cancer: A prospective, multicenter study. Urol Oncol. 2022https://pubmed.ncbi.nlm.nih.gov/35840465/ Using IsoPSA With Prostate Imaging Reporting and Data System Score May Help Refine Biopsy Decision Making in Patients With Elevated PSA. Urology. 2023https://pubmed.ncbi.nlm.nih.gov/36965817/ Low-Grade Prostate Cancer: Time to Stop Calling It Cancer. J Clin Oncol. 2022https://pubmed.ncbi.nlm.nih.gov/35436144/ The influence of the "cancer" label on perceptions and management decisions for low-grade prostate cancer. J Natl Cancer Inst. 2023https://pubmed.ncbi.nlm.nih.gov/37285311/ Dr. Amir Lebastchi, Keck Medicine of USC physician profilehttps://keckmedicine.org/provider/amir-h-lebastchi Dr. Ruchika Talwar, BackTable Urology contributor pagehttps://www.backtable.com/shows/urology/contributors/dr-ruchika-talwar

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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 is suction technology changing what it means to be “stone-free” after ureteroscopy? On this episode of BackTable Urology, Dr. Ruchika Talwar welcomes Dr. Karen Stern, endourologist at Mayo Clinic Arizona, for a practical discussion of how ureteroscopy is evolving in the era of suction. They discuss how thin-slice CT has revealed just how much stone typically remains after surgery, why dusting versus fragmenting is now a patient-dependent choice, and what to consider when selecting between suction sheaths, aspiration scopes, and traditional access.

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

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This podcast is supported by

Dornierhttps://www.dornier.com/backtable

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Timestamps

00:00 - Introduction02:16 - Residual Stone and Defining Success04:59 - Dusting, Fragmentation and Suction Devices07:15 - Patient Selection, OR Setup and Laser Settings11:39 - Evidence, Stone Clearance and Infection Risk15:39 - Community Adoption and Technique Pearls20:05 - Integrated Systems and Artificial Intelligence22:29 - Take-Home Points and Closing Remarks

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More about this episode

The doctors discuss patient selection, OR setup, stenting, and why stones over a centimeter benefit most from a suction approach. Dr. Stern shares her tips for suction device setup, irrigation and suction settings, and how even a short learning curve can make these techniques routine. They review infection risks, evidence on residual stone volume, pearls for community adoption, and look ahead to integrated laser-suction platforms and AI tools that may one day help define when a case is truly finished. Dr. Karen Stern closes with advice for urologists on the fence: every technology works, but the best choice is the one that fits your practice.

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Resources

Are We Overreporting Post-Op Sepsis? The Difference Between Reported and Verified Rates of Post-Ureteroscopy Sepsis Using the Sepsis 3 Criteria at a Single Institution. J Endourol. 2026https://doi.org/10.1177/08927790251394736 Flexible Ureteroscopy with a Flexible and Navigable Suction Ureteral Access Sheath Versus Mini-Percutaneous Nephrolithotomy for Treatment of 2-3 cm Renal Stones: An International, Multicenter, Randomized, Noninferiority Trial. Eur Urol. 2026https://doi.org/10.1016/j.eururo.2025.06.001 Dr. Karen Stern, Mayo Clinic physician profilehttps://www.mayoclinic.org/biographies/stern-karen-l-m-d/bio-20464490 Dr. Ruchika Talwar, BackTable Urology contributor pagehttps://www.backtable.com/shows/urology/contributors/dr-ruchika-talwar

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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

Same risk group, very different benefit. Can biomarkers help identify who needs treatment intensification in prostate cancer? On this episode of BackTable Urology, Dr. Ruchika Talwar and Dr. Angela Jia, a radiation oncologist at University Hospitals Cleveland Medical Center, break down the difference between prognostic and predictive biomarkers and how genomic testing is informing the way clinicians counsel patients. They review trial data suggesting that men with a low genomic score may gain little from adding hormone therapy, along with early prospective evidence that the luminal B subtype may help identify who benefits most from intensification.

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

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This podcast is supported by

Verasytehttps://www.veracyte.com/

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Timestamps

00:00 - Introduction02:08 - Prognostic vs. Predictive Biomarkers06:34 - The NRG/RTOG 0815 Biomarker Cohort10:15 - Applying a Low Genomic Score in Clinic15:16 - Genomic Classifiers After Prostatectomy18:52 - RTOG 9601, SPPORT and the Salvage Evidence24:39 - Stage Migration and the Case for an ARPI28:13 - Ordering and Reading the Genomic Report34:31 - Common Mistakes in Interpretation37:31 - Where Genomics Could Go Next41:03 - Reflex Testing, EMR Integration and AI44:44 - Closing Remarks

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More about this episode

The conversation covers practical application of test results, counseling with absolute risk numbers, and the pitfalls of stretching predictive claims beyond their evidence. Dr. Jia explains the limits of biopsy sampling, how stage migration with advanced imaging may shift baseline risk, and why a large portion of the genomic score remains unexplained by standard variables. The episode closes with a look at reflex testing, the potential role of AI, and the longer-term goal of giving patients clear, individualized benefit estimates for each treatment option.

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Resources

NRG/RTOG 0815: A Phase III Prospective Randomized Trial of Dose-Escalated Radiotherapy With or Without Short-Term Androgen Deprivation Therapy for Patients With Intermediate-Risk Prostate Cancer (trial record)https://clinicaltrials.gov/study/NCT00936390 NRG-GU006 (BALANCE): A Phase II Randomized Trial of Salvage Radiotherapy With or Without Apalutamide in Recurrent Prostate Cancer (trial record)https://clinicaltrials.gov/study/NCT03371719 Feng FY, et al. Validation of a 22-Gene Genomic Classifier in Patients With Recurrent Prostate Cancer: An Ancillary Study of the NRG/RTOG 9601 Randomized Clinical Trial. JAMA Oncol. 2021https://pubmed.ncbi.nlm.nih.gov/33570548/ Pollack A, et al. The addition of androgen deprivation therapy and pelvic lymph node treatment to prostate bed salvage radiotherapy (NRG Oncology/RTOG 0534 SPPORT). Lancet. 2022https://pubmed.ncbi.nlm.nih.gov/35569466/ Zhao SG, et al. Associations of Luminal and Basal Subtyping of Prostate Cancer With Prognosis and Response to Androgen Deprivation Therapy. JAMA Oncol. 2017https://pubmed.ncbi.nlm.nih.gov/28494073/ Patel KR, Nguyen PL, et al. Biopsy-based Basal-luminal Subtyping Classifier in High-risk Prostate Cancer: A Combined Analysis of the NRG Oncology/RTOG 9202, 9413 and 9902 Phase 3 Trials. Eur Urol Oncol. 2026https://pubmed.ncbi.nlm.nih.gov/39542826/ Grist E, et al. Tumor transcriptome-wide expression classifiers predict treatment sensitivity in advanced prostate cancers (STAMPEDE). Cell. 2025https://pubmed.ncbi.nlm.nih.gov/40865526/ Jia AY, et al. Cross-Comparison Individual Patient-Level Analysis of Three Gene Expression Signatures in Localized Prostate Cancer in Over 50,000 Men. JCO Precis Oncol. 2025https://pubmed.ncbi.nlm.nih.gov/40479622/ Dr. Angela Jia, University Hospitals physician profilehttps://www.uhhospitals.org/doctors/Jia-Angela-1902338718 Dr. Ruchika Talwar, BackTable Urology contributor pagehttps://www.backtable.com/shows/urology/contributors/dr-ruchika-talwar

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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 do you decide if a neurogenic bladder is a safety problem or a quality of life problem for each patient, and how do you move from guideline risk categories to a real surveillance plan? On this episode of BackTable Urology, Dr. Anjali Kapur interviews Dr. Benjamin Brucker, professor of urology and director of neuro-urology at NYU Langone Health, about navigating neurogenic lower urinary tract dysfunction. They start with the AUA and SUFU guideline framework, covering history, physical exam, mobility, cognition, voiding diaries, and risk stratification to sort patients into low, unknown, or high risk. Dr. Brucker outlines the findings that move a patient between categories and the workup needed, from renal ultrasound and urodynamics to identifying unsafe storage pressures and elevated post-void residual.

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

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This podcast is supported byMedtronic

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Timestamps

00:00 - Introduction03:20 - Initial Evaluation Under the AUA and SUFU Guidelines05:39 - Risk Stratification and Surveillance13:08 - Role of Fluoroscopy in Urodynamics14:55 - Spinal Cord Injury and Detrusor Sphincter Dyssynergia17:35 - Multiple Sclerosis, Parkinson Disease, and Stroke23:13 - Cognitive and Functional Status in Therapy Selection25:16 - Neuromodulation in the Neurogenic Population29:07 - Catheter Management and Sphincterotomy35:49 - Medical Therapy, Chemodenervation, and Surgical Escalation42:50 - Asymptomatic Bacteriuria and Antibiotic Stewardship46:04 - Gaps in Practice and Research on the Horizon50:48 - Closing Remarks

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More about this episode

The conversation dives into the nuances of managing neurogenic bladder by underlying disease, from detrusor sphincter dyssynergia after spinal cord injury to the variable patterns in multiple sclerosis, Parkinson disease, and stroke. Dr. Brucker explains the role of videourodynamics, the importance of matching therapy to cognition and mobility, and how to counsel patients on medical therapy, neuromodulation, catheterization, and surgery. They discuss antibiotic stewardship for asymptomatic bacteriuria, gaps between guidelines and real-world care, and what new devices and bladder transplant might mean for the future. The episode closes with a reminder that management is about treating the whole person, not just the diagnosis.

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Resources

Neurogenic Lower Urinary Tract Dysfunction: AUA/SUFU Guidelinehttps://www.auanet.org/guidelines-and-quality/guidelines/adult-neurogenic-lower-urinary-tract-dysfunction Ginsberg DA, Boone TB, Cameron AP, et al. The AUA/SUFU Guideline on Adult Neurogenic Lower Urinary Tract Dysfunction: Diagnosis and Evaluation. J Urol. 2021https://doi.org/10.1097/JU.0000000000002235 Ginsberg DA, Boone TB, Cameron AP, et al. The AUA/SUFU Guideline on Adult Neurogenic Lower Urinary Tract Dysfunction: Treatment and Follow-up. J Urol. 2021https://doi.org/10.1097/JU.0000000000002239 Vurture G, Peyronnet B, Palma JA, et al. Urodynamic Mechanisms Underlying Overactive Bladder Symptoms in Patients With Parkinson Disease. Int Neurourol J. 2019.https://doi.org/10.5213/inj.1938086.043 Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU). https://sufuorg.com/ American Urological Association (AUA)https://www.auanet.org/ First human bladder transplant, UCLA Health, 2025.https://www.uclahealth.org/news/release/first-human-bladder-transplant-performed-ucla Dr. Benjamin Brucker, NYU Langone Health physician profilehttps://nyulangone.org/doctors/1235295619/benjamin-m-brucker Dr. Benjamin Brucker, BackTable Urology contributor pagehttps://www.backtable.com/shows/urology/contributors/dr-benjamin-brucker Dr. Anjali Kapur, BackTable Urology contributor pagehttps://www.backtable.com/shows/urology/contributors/dr-anjali-kapur

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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 is the difference between mentorship, sponsorship, and coaching in a physician’s career, and how can coaching influence your professional development? On this episode of BackTable Urology, Dr. Helen Bernie interviews Dr. Emilie Johnson and Dr. Angie Smith about the transformative impact of career coaching for urologists. They break down how coaching differs from mentorship and sponsorship, who stands to benefit most, and the real value of having a conversation focused entirely on your goals and growth.

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

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This podcast was developed in collaboration withSociety of Women in Urologyhttps://swiu.org/home.aspx

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Timestamps

00:00 - Introduction03:21 - Mentorship, Sponsorship, and Coaching06:23 - Paths Into Physician Coaching11:39 - Who Should Seek a Coach15:56 - What a Coach Does Differently22:57 - Anatomy of a Coaching Session28:21 - Coaching Frameworks and Tools35:14 - Uncovering Unrecognized Goals42:12 - Coaching Beyond the Workplace47:16 - Advice for the Undecided Urologist52:08 - Closing Remarks

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More about this episode

The discussion explores what a coaching session looks like, from low-stakes one-offs to multi-month programs, and the frameworks and tools that stick, like strengths-based assessments, DiSC, and the career portfolio exercise. Dr. Smith shares insights from her credentialed coaching program, while Dr. Johnson explains how coaching changes everything from listening at home to decision-making in the OR. The episode closes with advice on finding the right coach, recognizing when you are ready, and why coaching is about unlocking what you already know.

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Resources

Society of Women in Urology (SWIU)https://www.swiu.org/ Effect of a Professional Coaching Intervention on the Well-being and Distress of Physicians: A Pilot Randomized Clinical Trial (Dyrbye et al., JAMA Internal Medicine, 2019)https://doi.org/10.1001/jamainternmed.2019.2425 International Coaching Federation, credentialing and coach education requirements (ACC, PCC, MCC)https://coachingfederation.org/credentialing/prepare-for-icf-credential-application/education-training-requirements/ UNC School of Medicine coaching programs, Office of Faculty Affairs and Leadership Developmenthttps://www.med.unc.edu/facultyaffairs/coaching-culture/ VIA Character Strengths Survey, the free strengths assessment Dr. Smith recommendshttps://www.viacharacter.org/ CliftonStrengths (Gallup)https://www.gallup.com/cliftonstrengths/en/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