University of Indiana School of Medicine Archives

University of Indiana School of Medicine

Technical and Diagnostic Limitations to Partial Prostate Ablation for Prostate Cancer

Posted by Michael O. Koch, MD | Apr 2020

Michael O. Koch, MD, provides an overview of High Intensity Focused Ultrasound (HIFU) and Transurethral Ultrasound Ablation (TULSA-PRO), focal prostate ablation therapies that have recently shown promise as treatments for localized prostate cancer. Both treatments only have de novo approval from the FDA and have no specific indication for prostate cancer and there have been some disappointing international studies of the therapies. However, several studies with carefully-selected patients who are not thriving on active surveillance, have unilateral significant disease, and have limited calcifications have had remarkable results, with high rates of failure-free survival and PSA reduction. For approximately 10-15% of prostate cancer patients, prostate ablation may be a very good technique.

Expanding the Role of Surgical Management of High-Risk Prostate Cancer

Posted by Michael O. Koch, MD | Mar 2020

Michael O. Koch, MD, the John Donohue Professor and Chair of Urology at the Indiana University School of Medicine, discusses the advantages and disadvantages of open retropubic radical prostatectomy (RRP) and robotic-assisted radical prostatectomy (RARP) in decreasing disease burden amongst high-risk prostate cancer patients. He goes on to discuss data from the Capsure Database, which placed more high-risk patients on ADT rather than surgery, as well as data from the Pivot Trial, which demonstrated a decrease in prostate cancer mortality among high-risk patients treated with surgery versus the observation (control) group. Finally, Dr. Koch evaluates several studies pertaining to the efficacy of wide surgical resection in reducing positive surgical margins among RRP and RARP cohorts, and how urologists can utilize imaging such as mpMRI and 68Ga PSMA to identify patients who would most likely benefit from wide versus nerve-sparing surgical approaches.