Point: Bladder Sparing Approach for Muscle Invasive Bladder Cancer
Parminder Singh, MD, examines bladder preservation strategies for muscle-invasive bladder cancer (MIBC).
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Mayo Clinic
Emerging Therapies: Autologous Derived Muscle Cells
Christopher E. Wolter, MD, discusses using autologous muscle-derived cells as a promising treatment for stress urinary incontinence.
In this 7-minute talk, Dr. Wolter reviews the steps for the therapy procedure, which involves procuring muscle cells through a minimally invasive biopsy, expanding the cells in culture, and re-injecting them into the patient. He notes that stress urinary incontinence is considered an ideal target for this therapy.
Wolter shares the promising results from Initial studies, including a pilot trial in 2008. Later trials using higher doses of injected cells demonstrated even better outcomes. He also references the MYOCYTE trial, a large multicenter, multi-institutional randomized study, which suggested that patients with previous stress incontinence treatments, such as slings, respond better to the therapy.
Outcomes of Recent Clinical Trials for Focal Therapy
Derek Lomas, MD, provides an extensive overview of recent clinical trials and emerging technologies in focal therapy for prostate cancer. In this 13-minute presentation, Dr. Lomas showcases studies which illustrate focal therapy’s potential as safe, effective, and minimally invasive options for prostate cancer management.
The first study highlights nanoparticle-directed photothermal ablation using gold nanoparticles and MRI-ultrasound fusion guidance. Preliminary results show promising safety and efficacy.
The HIFI trial evaluates focal therapy with high-intensity focused ultrasound (HIFU) versus radical prostatectomy. Findings reveal that HIFU achieves non-inferior outcomes regarding salvage therapy-free survival and demonstrates better urinary and erectile function preservation.
Further insights come from randomized trials comparing focal ablation with radical prostatectomy. These studies consistently show non-inferior treatment failure rates and a reduced impact on functional outcomes with focal therapy.
The PRESERVE trial on irreversible electroporation provides preliminary safety data, with final oncologic outcomes pending. Early results indicate significant reductions in PSA and low adverse effect rates.
The FOSTINE1b trial explores targeted microwave ablation, demonstrating complete necrosis in treated areas with no severe adverse effects.
Two-year data from the ExAblate system, utilizing MRI-guided transrectal HIFU, report high cancer-free rates within treatment zones and overall glands while preserving functional outcomes.
Dr. Lomas shares that ongoing research promises to further refine these technologies. This dynamic field continues to offer exciting prospects for individualized prostate cancer treatment.
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Patient Selection: How to Pick a Focal Therapy Candidate
Derek Lomas, MD, outlines a comprehensive approach to patient selection for focal therapy in prostate cancer in this 12-minute presentation. The overarching criteria emphasize that focal therapy is suitable for patients with localized, clinically significant disease, distinct from candidates for active surveillance or those unsuitable for surgery or radiation. Two key dimensions, patient and disease characteristics, guide decision-making, balancing individualized patient factors with disease-specific metrics like tumor location and grade.
Patient health status is central, with functional baseline metrics, particularly urinary and sexual function, critical for setting realistic expectations. Patients must be well-informed about focal therapy’s pros, cons, and guideline limitations.
Disease characteristics identify the ideal focal candidate as patients with low- and intermediate-risk cancer. Multiparametric MRI and systematic and targeted biopsies, sometimes repeated, ensure comprehensive mapping.
Dr. Lomas emphasizes the importance of tailoring treatment to available modalities, such as HIFU for posterior lesions or cryoablation for anterior challenges. Critical to the most successful strategy is patient understanding and a willingness to decline unsuitable candidates, reinforcing a commitment to patient-centered care and optimal outcomes.
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Female SUI: Full-length MUS, PVS
Christopher E. Wolter, MD, focuses on advancements in the surgical management of female stress urinary incontinence, emphasizing the evolving role of different sling techniques. In this 11-minute presentation, Wolter highlights midurethral slings (MUS), specifically retropubic slings, widely accepted as the gold standard.
The discussion includes photographic, ultrasound, and drawn images to illustrate correct sling placement. Wolter also discusses patient selection criteria for different sling options. He notes that addressing the stress component first often helps alleviate urgency; however, data suggests that urgency symptoms resolve in 66% of cases when treated with mid-urethral slings. Finally, Wolter acknowledges the importance of patient counseling and education, to assure sling success.
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