University of Southern California Archives

Highlights of NCCN/AUA Guidelines 2024

Posted by Siamak Daneshmand, MD | Apr 2025

Siamak Daneshmand, MD, covers recent updates in bladder cancer guidelines, focusing on the 2024 NCCN and AUA recommendations.

Energy Selection Ablative Technologies for Focal Therapy

Posted by Andre Abreu, MD | Jan 2025

Andre Abreu, MD, delves into energy modalities for focal therapy in prostate cancer, presented with a comprehensive and practical approach. This 16-minute presentation explores multiple energy options, including cryoablation, high-intensity focused ultrasound (HIFU), irreversible electroporation (IRE), laser ablation, and microwave ablation. Dr. Abreu emphasizes the importance of aligning energy selection with institutional expertise and patient-specific factors.

Patient-specific considerations guide technology selection, including rectal wall thickness and proximity to critical structures. Transition zone lesions benefit from tools like aqua ablation, while anterior lesions present challenges for certain devices. The speaker emphasizes the need for personalized management, integrating oncologic characteristics with procedural capabilities.

Dr. Abreu optimistically frames the future of focal therapy, with ongoing trials like vapor ablation and the potential for low-dose radiation therapy combined with IRE promising advancements. He calls for practical recommendations and an invitation for ongoing exploration in the evolving field of prostate cancer management.

Complications of Focal Therapy – Risk Factors, Timepoints, Management

Posted by Amir Lebastchi, MD | Dec 2024

Amir Lebastchi, MD, explores complications associated with focal therapy for prostate cancer, emphasizing the variability influenced by patient characteristics, disease features, treatment factors, and operator experience.

In this 14-minute keynote presentation, Dr. Lebastchi highlights studies reporting a 13-32% overall complication rate. Bleeding complications, sensory changes like penile numbness, and functional impacts such as erectile dysfunction and transient urinary incontinence are discussed.

To minimize risks, operator expertise and careful patient selection are emphasized. Strategies for prevention and management include tailored ablation templates, urethra-sparing techniques, and post-procedure interventions like alpha-blockers and antibiotics. Advanced techniques such as hydro-dissection and real-time monitoring with temperature probes further mitigate risks.

Dr. Lebastchi stresses the safety profile of focal therapy, noting its significantly lower morbidity compared to radical treatments like prostatectomy or radiation. Close postoperative monitoring is recommended to ensure patient recovery and address complications promptly.

Oral Abstracts – Best Clinical Practices for Transperineal Postate Biopsy

Posted by Lorenzo Ramacciotti, MD | Dec 2024

Lorenzo Ramacciotti, MD, a research fellow at USC Urology, explores a consensus-driven approach to addressing unanswered questions about transperineal prostate biopsy. In this 3-minute presentation, Dr. Ramacciotti shares the results of a consensus panel of urologists and interventional radiologists.

Overall, the study underscores the growing preference for transperineal biopsy. These findings enhance patient safety, diagnostic accuracy, and procedural efficacy in prostate cancer management.

AI and Treatment Planning for Prostate Cancer

Posted by Andre Abreu, MD | Dec 2024

Andre Abreu, MD, explores the role of artificial intelligence in treatment planning for prostate cancer, with a particular emphasis on focal therapy. This presentation, lasting approximately 15 minutes, begins by acknowledging the complexity of selecting candidates for focal therapy, which involves synthesizing clinical data, imaging, and biopsies. The potential for AI to streamline this intricate process is highlighted, particularly in improving MRI quality and prostate cancer detection.

Key insights include evidence that AI performs on par with non-expert radiologists in MRI interpretation and can enhance imaging outcomes, directly impacting prostate cancer detection rates. AI-driven segmentation is emphasized, showing its value in planning biopsies, surgeries, and focal therapies. Using a database of 750 patients at USC, Dr. Abreu provides an AI model with a reported accuracy compatible with leading deep learning systems.

The application of AI extends to histology, where it quantifies cancer presence with greater precision than traditional pathology methods. Combining clinical, imaging, and histological data demonstrates the potential for multimodal risk stratification, improving the selection process for intermediate-risk patients.

AI limitations are also addressed, including small sample sizes, lack of diversity in studies, and the “black box” nature of AI models, which raises concerns about transparency and explainability in healthcare. Dr. Abreu underscores the need for rigor in AI research to ensure its reliable integration into clinical practice.