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Judd Moul, MD
JuddMoulMD (Physician - Urology (Verified) )| Communities: Prostate Cancer | Answers: 8 |
| Member Since: Jul. 2012 |
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Professional Statement
Judd W Moul, MD, is the Director of the Duke Prostate Center and a Professor of Surgery at Duke University School of Medicine.
Moul is an international authority on prostate cancer and outcomes/database research. His clinical interests include minimally invasive nerve-sparing radical prostatectomy, multidisciplinary management of prostate cancer, and clinical trials in prostate disease.
Prior to joining Duke, Moul was a professor of surgery at the Uniformed Services University of the Health Sciences in Maryland and an attending urologic oncologist at the Walter Reed Army Medical Center in Washington, D.C. In addition, he was director of the Center for Prostate Disease Research, a Congress-mandated research program of the Department of Defense. He received national acclaim for creating a prostate disease research database that houses information on more than 20,000 prostate cancer patients treated at nine collaborating institutions.
In 2009, he was selected as a recipient of the "National Physician of the Year" award, presented by Castle Connolly, publisher of the America's Top Doctors series.
Moul is an international authority on prostate cancer and outcomes/database research. His clinical interests include minimally invasive nerve-sparing radical prostatectomy, multidisciplinary management of prostate cancer, and clinical trials in prostate disease.
Prior to joining Duke, Moul was a professor of surgery at the Uniformed Services University of the Health Sciences in Maryland and an attending urologic oncologist at the Walter Reed Army Medical Center in Washington, D.C. In addition, he was director of the Center for Prostate Disease Research, a Congress-mandated research program of the Department of Defense. He received national acclaim for creating a prostate disease research database that houses information on more than 20,000 prostate cancer patients treated at nine collaborating institutions.
In 2009, he was selected as a recipient of the "National Physician of the Year" award, presented by Castle Connolly, publisher of the America's Top Doctors series.
Professional Info
Credential: MD
Primary specialty: Urology
Medical school: Jefferson Medical College of Thomas Jefferson University
Residency: Walter Reed Army Medical Center
Fellowship: Duke University Medical Center
Areas of expertise:
Minimally invasive nerve-sparing radical prostatectomy, treatment of PSA-only or biochemical recurrence of prostate cancer, prostate cancer in African Americans, multidisciplinary management of prostate cancer, clinical trials in prostate disease, elevated PSA and screening, prostate cancer and outcomes/database research, elevated PSA and prostate cancer screening issues, active surveillance in early stage prostate cancer.
Hospital affiliation: Duke Medicine
Practice address:
2301 Erwin Road
Durham, NC
27710
Practice phone number: 919-684-5057
JuddMoulMD Activities
This is a good question, but I am a urologic surgeon and not a radiation oncologist so I may not be the best expert to answer this. In general, experienced doctors, whether they are surgeons or radiation oncologists, tend to get higher marks and outcomes in their results of cancer treatments. However, there are excellent caring doctors even at smaller, lesser known centers. For a patient, it is best to try to be an educated consumer- word of mouth, the Internet, and the library are all excellent sources to find well known and recommended radiation oncologists, surgeons and medical oncologists.
New answer by JuddMoulMD (Physician - Urology (Verified))
2
Answers |
9 months ago
Different prostate cancer experts have differing opinions here. For example, I am a urologic surgeon and tend to favor radical prostatectomy (RP) for the healthy man with high risk prostate cancer. Specifically, I prefer to recommend RP first because sometimes a man can avoid use of hormonal therapy when he chooses surgery. Specifically, when a man with high risk prostate cancer chooses primary external beam radiotherapy (EBRT), he is always recommended to receive hormonal therapy (HT), also called androgen deprivation therapy (ADT). However, HT/ADT can have a lot of side effects including hot flashes, loss of libido, weight gain, loss of muscle mass and loss of bone mineral density. Even only 6 months of HT/ADT can result in these side effects for many men. With surgery, if the high risk disease was contained to the prostate or there are only positive margins, the patient may need no additional therapy or only post-operative radiation therapy and no need for any HT/ADT. On the other hand, some men still need ADT/HT even after surgery.
New answer by JuddMoulMD (Physician - Urology (Verified))
1
Answer |
9 months ago
The use of biomarkers in prostate cancer remains a work-in-progress. As noted in a previous answer (http://talkabouthealth.com/what-factors-are-important-in-determining-the-prognosis-for-a-castrate-resistant-prostate-cancer-patient), PSA, Alkaline phosphatase (ALK PHOS), Anemia status by hemoglobin count (HB), and circulating tumor cell count (CTC) are all starting to be used alone and in combination. However, we still need more research in this area to help us predict response to the variety of new treatments we have now. For example, we are currently now certain how to sequence the new agents. Should we give Provenge first? Who is best suited to this novel immunotherapy? Who would be better served with Zytiga or another hormonal agent before the Provenge? We could go on and on with more unknown sequencing questions but you get the picture.
New answer by JuddMoulMD (Physician - Urology (Verified))
1
Answer |
9 months ago
There are quite a few things that prostate cancer experts look at to help them determine prognosis for the individual man with CRPC. Among them are PSA level, PSA velocity/doubling-time, anemia status, performance status using certain standard questionnaires, alkaline phosphatase levels, circulating tumor cell counts, and other lab markers. Some experts plug these factors into equations or nomograms to help them determine the best course of action for their individual patients.
New answer by JuddMoulMD (Physician - Urology (Verified))
1
Answer |
9 months ago
After Provenge and Xgeva are given (see previous answer -http://talkabouthealth.com/what-is-the-first-line-of-treatment-for-castrate-resistant-prostate-cancer), the next line of therapy is currently docetaxel-based systemic chemotherapy. However, abiraterone (Zytiga), an oral hormonal therapy, may soon be FDA-approved to be used in CRPC before chemotherapy. Currently, after docetaxel-based chemotherapy stops working, then Zytiga, Jevtana chemotherapy is FDA-approved options. Also, just a few days ago on August 31st, 2012, the FDA approved MDV-3100 (enzalutamide) oral hormonal therapy for use in the post-docetaxel setting. So now we have three new FDA-approved options after docetaxel.
New answer by JuddMoulMD (Physician - Urology (Verified))
1
Answer |
9 months ago
Castrate resistant prostate cancer, or CRPC, is the clinical stage or state where the cancer is starting to progress despite LHRH agents or orchiectomy. It is generally first characterized by a rising PSA level while the man is on traditional hormonal or androgen deprivation therapy. The man should have a low testosterone level of less than 50 ng/ml when he is declared to be CRPC. As far as FDA-approved treatments, the Provenge cellular immunotherapy is best as a first-line therapy. Provenge is best given to the man who has CRPC and documented metastatic disease and has a rising PSA (at least 5 ng/ml but best given before the PSA rises above 25 ng/ml). The man also has to be asymptomatic or minimally symptomatic. This means he should not be taking any narcotic pain medications for cancer-related pain. In addition to Provenge, denosumab (Xgeva) is FDA –approved to be used to prevent skeletal-related events in the early metastatic phase of CRPC.
New answer by JuddMoulMD (Physician - Urology (Verified))
1
Answer |
9 months ago
First, I want to make sure my patients are educated about the pros and cons of early detection using PSA. Second, I want to make sure they have at least a 10 year natural life-expectancy. Usually, men with a less than 10 year life expectancy will not benefit since prostate cancer us usually very slow growing. Third, I want them to know the possible downstream effects. A positive PSA screen may lead to a prostate biopsy and treatment for prostate cancer and that there are pros and cons and possible side effects along the course of events that may follow.
New answer by JuddMoulMD (Physician - Urology (Verified))
1
Answer |
9 months ago
a. The USPSTF gave population-based PSA testing for prostate cancer a “D” rating meaning they feel the harms outweigh the benefits and this government-endorsed committee says we should not conduct PSA screening for any group of men. The Medicare program follows the USPSTF guidelines and now Medicare will not cover the PSA test if it is ordered for the purpose of PSA screening.
b. Other prominent professional organizations including the American Urological Association (AUA) do not agree with the USPSTF and feel their D rating was misguided. The AUA endorses that all men at age 40 be offered a baseline PSA test to be used as a risk-stratification tool for future risk of prostate cancer.
c. There has been a move in the US Congress to ask for a change in the composition of the USPSTF. Currently, this committee is composed solely of public health experts. Congress would like to also see subject experts on the committee. For example, for cancer screening, Congress would like to see cancer experts also be part of the committee for a more balanced view. However, others feel that cancer experts will be biased in favor of early detection of cancer since cancer experts such as oncologists and urologists derive at least part of their income from caring for cancer patients. Stay tuned as this debate is not only about PSA but about mammography for breast cancer early detection.
b. Other prominent professional organizations including the American Urological Association (AUA) do not agree with the USPSTF and feel their D rating was misguided. The AUA endorses that all men at age 40 be offered a baseline PSA test to be used as a risk-stratification tool for future risk of prostate cancer.
c. There has been a move in the US Congress to ask for a change in the composition of the USPSTF. Currently, this committee is composed solely of public health experts. Congress would like to also see subject experts on the committee. For example, for cancer screening, Congress would like to see cancer experts also be part of the committee for a more balanced view. However, others feel that cancer experts will be biased in favor of early detection of cancer since cancer experts such as oncologists and urologists derive at least part of their income from caring for cancer patients. Stay tuned as this debate is not only about PSA but about mammography for breast cancer early detection.
New answer by JuddMoulMD (Physician - Urology (Verified))
1
Answer |
9 months ago
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