# Urologic Oncology Essentials — GCMD Library living collection

Updated: n/a · 6 episodes · 33 cited statements

## Episodes
### Prostate Cancer
- [iQuestions: Cyberknife Procedure for Prostate Cancer](https://qa.library.globalcastmd.com/watch/iquestions-cyberknife-procedure-for-prostate-cancer-13661) — video · 3:34 · [machine version](https://qa.library.globalcastmd.com/watch/iquestions-cyberknife-procedure-for-prostate-cancer-13661.md)
- [Cuts Like a Cyberknife: New Surgical Technique for Prostate Cancer](https://qa.library.globalcastmd.com/watch/cuts-like-a-cyberknife-new-surgical-technique-for-prostate-cancer-13662) — video · 3:27 · [machine version](https://qa.library.globalcastmd.com/watch/cuts-like-a-cyberknife-new-surgical-technique-for-prostate-cancer-13662.md)
- [Prostate Cancer](https://qa.library.globalcastmd.com/watch/prostate-cancer-13663) — video · 1:58 · [machine version](https://qa.library.globalcastmd.com/watch/prostate-cancer-13663.md)

### Kidney Cancer
- [ponsky urologybook laparoscopic radical nephrectomy](https://qa.library.globalcastmd.com/watch/ponsky-urologybook-laparoscopic-radical-nephrectomy-13660) — video · [machine version](https://qa.library.globalcastmd.com/watch/ponsky-urologybook-laparoscopic-radical-nephrectomy-13660.md)

### More resources
- [Update Course Rewind: 2024 Top Ten Key Takeaways](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591) — podcast · [machine version](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591.md)
- [Update Course Rewind: Pectus Excavatum 2021](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668) — podcast · 11:55 · [machine version](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668.md)

## Chapters
- [0:00](https://qa.library.globalcastmd.com/watch/iquestions-cyberknife-procedure-for-prostate-cancer-13661?t=0) Introduction and Definition of CyberKnife (Ep 1)
- [1:08](https://qa.library.globalcastmd.com/watch/iquestions-cyberknife-procedure-for-prostate-cancer-13661?t=68) Patient Selection Criteria (Ep 1)
- [1:48](https://qa.library.globalcastmd.com/watch/iquestions-cyberknife-procedure-for-prostate-cancer-13661?t=108) Treatment Duration and Schedule (Ep 1)
- [2:24](https://qa.library.globalcastmd.com/watch/iquestions-cyberknife-procedure-for-prostate-cancer-13661?t=144) Side Effects and Outcomes (Ep 1)
- [0:06](https://qa.library.globalcastmd.com/watch/cuts-like-a-cyberknife-new-surgical-technique-for-prostate-cancer-13662?t=6) CyberKnife treatment planning and delivery mechanism (Ep 2)
- [1:21](https://qa.library.globalcastmd.com/watch/cuts-like-a-cyberknife-new-surgical-technique-for-prostate-cancer-13662?t=81) Fractionation schedules and early clinical outcomes (Ep 2)
- [2:21](https://qa.library.globalcastmd.com/watch/cuts-like-a-cyberknife-new-surgical-technique-for-prostate-cancer-13662?t=141) Cost-effectiveness and insurance coverage (Ep 2)
- [2:54](https://qa.library.globalcastmd.com/watch/cuts-like-a-cyberknife-new-surgical-technique-for-prostate-cancer-13662?t=174) Questions patients should ask their physician (Ep 2)
- [0:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=0) Introduction and Case Presentation: Pain Control Options (Ep 6)
- [1:53](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=113) Cryoanalgesia: Technique, Results, and Concerns (Ep 6)
- [3:50](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=230) Alternative Pain Control: Erector Spinae Catheters and Multimodal Regimens (Ep 6)
- [6:15](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=375) Bar Stability and Measurement Considerations (Ep 6)
- [8:01](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=481) Surgical Technique: Safe Introducer Passage and Bar Direction (Ep 6)
- [10:25](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=625) Summary and Closing (Ep 6)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- CyberKnife is a newer technology that allows noninvasive treatment of prostate cancer — Lee Ponsky (clinical) [Ep 1 · 0:30](https://qa.library.globalcastmd.com/watch/iquestions-cyberknife-procedure-for-prostate-cancer-13661?t=30)
- University Hospitals Case Medical Center is one of the initial institutions offering CyberKnife technology — Lee Ponsky (clinical) [Ep 1 · 0:36](https://qa.library.globalcastmd.com/watch/iquestions-cyberknife-procedure-for-prostate-cancer-13661?t=36)
- CyberKnife delivers highly focused radiation directly at the prostate and tracks the movement as the prostate moves — Lee Ponsky (clinical) [Ep 1 · 0:46](https://qa.library.globalcastmd.com/watch/iquestions-cyberknife-procedure-for-prostate-cancer-13661?t=46)
- CyberKnife allows very precise treatment of the prostate while minimizing injury or side effects from surrounding organs — Lee Ponsky (clinical) [Ep 1 · 0:53](https://qa.library.globalcastmd.com/watch/iquestions-cyberknife-procedure-for-prostate-cancer-13661?t=53)
- CyberKnife treatment does not involve chemotherapy or other treatments and is standalone — Lee Ponsky (clinical) [Ep 1 · 1:01](https://qa.library.globalcastmd.com/watch/iquestions-cyberknife-procedure-for-prostate-cancer-13661?t=61)
- Current CyberKnife treatment is for patients with low risk or intermediate risk prostate cancer — Lee Ponsky (guideline) [Ep 1 · 1:12](https://qa.library.globalcastmd.com/watch/iquestions-cyberknife-procedure-for-prostate-cancer-13661?t=72)
- CyberKnife candidates have PSA less than 10 — Lee Ponsky (guideline) [Ep 1 · 1:22](https://qa.library.globalcastmd.com/watch/iquestions-cyberknife-procedure-for-prostate-cancer-13661?t=82)
- CyberKnife candidates have Gleason score of 3+4 or less — Lee Ponsky (guideline) [Ep 1 · 1:22](https://qa.library.globalcastmd.com/watch/iquestions-cyberknife-procedure-for-prostate-cancer-13661?t=82)
- Standard external beam radiation can be 5 days a week for 6 to 9 weeks, up to 45 treatments — Lee Ponsky (clinical) [Ep 1 · 1:53](https://qa.library.globalcastmd.com/watch/iquestions-cyberknife-procedure-for-prostate-cancer-13661?t=113)
- CyberKnife treats patients in 5 treatments total — Lee Ponsky (clinical) [Ep 1 · 2:06](https://qa.library.globalcastmd.com/watch/iquestions-cyberknife-procedure-for-prostate-cancer-13661?t=126)
- Each CyberKnife treatment takes about 1 hour, for 5 hours total treatment time — Lee Ponsky (clinical) [Ep 1 · 2:16](https://qa.library.globalcastmd.com/watch/iquestions-cyberknife-procedure-for-prostate-cancer-13661?t=136)
- No prostate cancer treatment has been able to totally remove the possibility of having side effects — Lee Ponsky (clinical) [Ep 1 · 2:29](https://qa.library.globalcastmd.com/watch/iquestions-cyberknife-procedure-for-prostate-cancer-13661?t=149)
- CyberKnife patients experience about 2 to 3 weeks of either no side effects, very mild urinary or rectal side effects, or sometimes bothersome rectal or urinary side effects — Lee Ponsky (clinical) [Ep 1 · 2:46](https://qa.library.globalcastmd.com/watch/iquestions-cyberknife-procedure-for-prostate-cancer-13661?t=166)
- Most CyberKnife side effects have gone away by 3 to 4 weeks — Lee Ponsky (clinical) [Ep 1 · 3:00](https://qa.library.globalcastmd.com/watch/iquestions-cyberknife-procedure-for-prostate-cancer-13661?t=180)
- Urinary incontinence and erectile dysfunction are possible side effects of CyberKnife but have been found to be very minimal in patients at this institution — Lee Ponsky (clinical) [Ep 1 · 3:03](https://qa.library.globalcastmd.com/watch/iquestions-cyberknife-procedure-for-prostate-cancer-13661?t=183)
- CyberKnife is a noninvasive technology for treating prostate cancer. (clinical) [Ep 2 · 0:06](https://qa.library.globalcastmd.com/watch/cuts-like-a-cyberknife-new-surgical-technique-for-prostate-cancer-13662?t=6)
- Treatment planning involves MRI and CT imaging, which are fused into a single image. (clinical) [Ep 2 · 0:12](https://qa.library.globalcastmd.com/watch/cuts-like-a-cyberknife-new-surgical-technique-for-prostate-cancer-13662?t=12)
- The radiation oncologist and surgeon review fused images together and outline the prostate and surrounding structures. (clinical) [Ep 2 · 0:16](https://qa.library.globalcastmd.com/watch/cuts-like-a-cyberknife-new-surgical-technique-for-prostate-cancer-13662?t=16)
- Dose instructions are given to the computer to treat the prostate while protecting the rectum, bladder, and nerves controlling erections. (clinical) [Ep 2 · 0:33](https://qa.library.globalcastmd.com/watch/cuts-like-a-cyberknife-new-surgical-technique-for-prostate-cancer-13662?t=33)
- A robotic arm moves approximately 360 degrees around the patient during treatment. (clinical) [Ep 2 · 0:51](https://qa.library.globalcastmd.com/watch/cuts-like-a-cyberknife-new-surgical-technique-for-prostate-cancer-13662?t=51)
- One dose of radiation is delivered as hundreds of individual beams from different locations. (clinical) [Ep 2 · 0:59](https://qa.library.globalcastmd.com/watch/cuts-like-a-cyberknife-new-surgical-technique-for-prostate-cancer-13662?t=59)
- Each individual beam is a very low dose, causing minimal damage to tissue it passes through. (clinical) [Ep 2 · 1:04](https://qa.library.globalcastmd.com/watch/cuts-like-a-cyberknife-new-surgical-technique-for-prostate-cancer-13662?t=64)
- When hundreds of beams converge at the focal point of the prostate, they destroy the cancer. (clinical) [Ep 2 · 1:11](https://qa.library.globalcastmd.com/watch/cuts-like-a-cyberknife-new-surgical-technique-for-prostate-cancer-13662?t=71)
- Initially, patients were treated with CyberKnife over 5 consecutive days (Monday through Friday). (clinical) [Ep 2 · 1:21](https://qa.library.globalcastmd.com/watch/cuts-like-a-cyberknife-new-surgical-technique-for-prostate-cancer-13662?t=81)
- Initial data suggests treating patients every other day over 5 sessions (Monday, Wednesday, Friday, Monday, Wednesday) may result in slightly fewer side effects. (clinical) [Ep 2 · 1:28](https://qa.library.globalcastmd.com/watch/cuts-like-a-cyberknife-new-surgical-technique-for-prostate-cancer-13662?t=88)
- Patients are monitored with PSA measurements, which have shown a nice drop-off over the years since treatment, indicating cancer cure. (clinical) [Ep 2 · 1:42](https://qa.library.globalcastmd.com/watch/cuts-like-a-cyberknife-new-surgical-technique-for-prostate-cancer-13662?t=102)
- Monitoring of urinary side effects and erectile dysfunction has found very minimal side effects in the majority of patients. (clinical) [Ep 2 · 1:56](https://qa.library.globalcastmd.com/watch/cuts-like-a-cyberknife-new-surgical-technique-for-prostate-cancer-13662?t=116)
- The overall cost of CyberKnife treatment is slightly less than some other treatments due to the shorter treatment period. (clinical) [Ep 2 · 2:21](https://qa.library.globalcastmd.com/watch/cuts-like-a-cyberknife-new-surgical-technique-for-prostate-cancer-13662?t=141)
- CyberKnife treatment is covered by most insurance companies. (clinical) [Ep 2 · 2:40](https://qa.library.globalcastmd.com/watch/cuts-like-a-cyberknife-new-surgical-technique-for-prostate-cancer-13662?t=160)
- Patients are pre-screened to ensure insurance coverage will not be a problem before CyberKnife is offered. (clinical) [Ep 2 · 2:46](https://qa.library.globalcastmd.com/watch/cuts-like-a-cyberknife-new-surgical-technique-for-prostate-cancer-13662?t=166)
- Patients should ask their physician about experience, number of patients treated, duration of practice, treatment approach, and follow-up plan. (opinion) [Ep 2 · 2:54](https://qa.library.globalcastmd.com/watch/cuts-like-a-cyberknife-new-surgical-technique-for-prostate-cancer-13662?t=174)
- Patients should ask what side effects to expect, when they will occur, and how they will be managed. (opinion) [Ep 2 · 3:11](https://qa.library.globalcastmd.com/watch/cuts-like-a-cyberknife-new-surgical-technique-for-prostate-cancer-13662?t=191)
- A working relationship with the physician is important so the physician can be the patient's advocate during cancer treatment. (opinion) [Ep 2 · 3:15](https://qa.library.globalcastmd.com/watch/cuts-like-a-cyberknife-new-surgical-technique-for-prostate-cancer-13662?t=195)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- Dr. St. Peter's hospital completed a randomized trial of 110 patients comparing epidural and PCA, and epidurals did not show superior results — Todd Ponsky summarizing a resource [Ep 6 · 1:02](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=62)
- After implementing cryoanalgesia, the first patient went home on post-operative day one, leading Dr. St. Peter to discontinue enrollment in the epidural/PCA comparison trial — Cecilia Gigena summarizing a resource [Ep 6 · 1:21](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=81)
- Cryoanalgesia uses cold temperatures to cause a conduction block that interrupts pain impulses to the brain — Todd Ponsky summarizing a resource [Ep 6 · 1:56](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=116)
- The cryoanalgesia technique involves freezing ribs 4 through 7 for two minutes per rib — Todd Ponsky summarizing a resource [Ep 6 · 2:09](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=129)
- Cryoanalgesia should not be performed on rib 8 or below because it can cause abdominal wall paralysis — Todd Ponsky summarizing a resource [Ep 6 · 2:09](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=129)
- With cryoanalgesia, length of stay decreased from four days (baseline) to one day — Cecilia Gigena summarizing a resource [Ep 6 · 2:33](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=153)
- Cryoanalgesia dramatically reduced median morphine equivalents compared to previous pain control methods — Todd Ponsky summarizing a resource [Ep 6 · 2:43](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=163)
- Dr. Garcia expressed concern that there are no long-term studies of cryoanalgesia and potential for chronic neuropathic pain — Cecilia Gigena summarizing a resource [Ep 6 · 2:52](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=172)
- Medical devices and implants are not required to undergo clinical trials before introduction to market, unlike medications which require FDA clinical trials with long-term results — Todd Ponsky summarizing a resource [Ep 6 · 3:14](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=194)
- Dr. Garcia's hospital uses erector spinae catheters placed by the pain team with ultrasound guidance, positioned juxtaposed to but not in the vertebral space — Cecilia Gigena summarizing a resource [Ep 6 · 3:50](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=230)
- With erector spinae catheters, hospital stay is two days, catheters remain in place for five days total (three days at home on automated pump), and families remove catheters at home on day five — Cecilia Gigena summarizing a resource [Ep 6 · 4:08](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=248)
- Erector spinae catheters reduced opioid requirements both in hospital and outside the hospital, achieving two-day length of stay compared to four or five days with epidurals — Todd Ponsky summarizing a resource [Ep 6 · 4:30](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=270)
- Dr. Rothenberg initially had concerns about cryoanalgesia including added operative time and risk of neuralgia, but after four cases observed that patients not only went home earlier but felt significantly better at discharge — Cecilia Gigena summarizing a resource [Ep 6 · 4:52](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=292)
- Multimodal pain control components include Tylenol, NSAIDs, precedex for gentle wake-up, dexamethasone for post-anesthetic nausea, ketamine to avoid opioids, and support from child life specialists, mindfulness resources, and physical therapists — Todd Ponsky summarizing a resource [Ep 6 · 5:34](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=334)
- Dr. Ponsky's multimodal regimen includes preoperative counseling, gabapentin pre and postoperatively, methadone, clonidine, bowel regimen medications, and antiemetics — Cecilia Gigena summarizing a resource [Ep 6 · 5:34](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=334)
- At Nebraska where Dr. Rayner practices, length of stay is under two days and patients are off opioids by one week using multimodal pain control — Cecilia Gigena summarizing a resource [Ep 6 · 6:15](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=375)
- Bar flippage typically occurs early and is caused by the bar sitting in an incorrect intercostal space, poor positioning, inadequate wrapping, or insufficient securing — Todd Ponsky summarizing a resource [Ep 6 · 6:26](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=386)
- Bar flippage is a surgical technique issue; the bar must sit in a comfortable position before securing or it will not remain stable — Todd Ponsky summarizing a resource [Ep 6 · 6:26](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=386)
- Computational modeling by physics-minded surgeons showed that shorter flat bars create more pressure on the sternum compared to traditional U-shaped bars, potentially increasing stability — Cecilia Gigena summarizing a resource [Ep 6 · 7:35](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=455)
- Bar length selection is not standardized, though there is a trend toward shorter bars based on computational stress modeling — Todd Ponsky summarizing a resource [Ep 6 · 7:49](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=469)
- Dr. Wolkine uses sternal elevator in about 10% of cases, primarily in younger patients where thoracoscopy provides adequate visualization — Todd Ponsky summarizing a resource [Ep 6 · 8:01](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=481)
- Sternal elevation in deep, stiff pectus cases allows less tissue damage and better repair — Todd Ponsky summarizing a resource [Ep 6 · 8:01](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=481)
- Dr. St. Peter uses sternal elevator in every case because it eliminates guesswork and facilitates entering and exiting at the same intercostal space — Todd Ponsky summarizing a resource [Ep 6 · 8:01](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=481)
- Techniques to avoid cardiac injury during introducer passage include thoracoscopy, sternal elevator, vacuum bell in the operating room, and sub-xiphoid incision — Cecilia Gigena summarizing a resource [Ep 6 · 8:58](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=538)
- Some surgeons pass the bar from left chest to right chest because passing right to left directs the introducer toward the ventricle — Todd Ponsky summarizing a resource [Ep 6 · 9:20](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=560)
- Bar passage direction (left-to-right versus right-to-left) is surgeon preference; as long as the sub-sternal space is well dissected and visualization is clear, direction likely does not make a significant difference — Todd Ponsky summarizing a resource [Ep 6 · 9:20](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=560)

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