Arvin George, MD

Arvin George, MD

Johns Hopkins School of Medicine

Baltimore, Maryland

Arvin George, MD, serves as Director of Prostate Cancer Programs and Associate Professor (PAR) of Urology at Johns Hopkins School of Medicine in Baltimore, Maryland. He is a urologic surgeon who specializes in the diagnosis and management of genitourinary cancers. After obtaining his medical degree from the Royal College of Surgeons in Ireland, he completed his urology residency at the Smith Institute for Urology at the Hofstra North Shore-LIJ School of Medicine. He remained there to complete his endourology fellowship in New York, gaining additional subspecialty expertise in robotic, laparoscopic, and percutaneous surgery. Subsequently, he completed a urologic oncology fellowship at the National Cancer Institute of the National Institutes of Health. Dr. George’s research interests include minimally-invasive and image-guided treatments, functional prostate imaging, and focal therapy for prostate cancer. His research aims to identify appropriate use for imaging in diagnosis, risk stratification, and management of prostate cancer, including active surveillance and selection/treatment of patients with novel focal therapy modalities.

Disclosures:

Talks by Arvin George, MD

Transperineal Biopsy: Rationale, Outcomes, and Techniques

Arvin K. George, MD, discusses the rationale behind performing transperineal biopsies over transrectal biopsies, supporting outcome data, and actionable techniques to combat the perceived shortcomings of the procedure. Dr. George begins by providing data on the fluoroquinolone-resistant infection risks of transrectal biopsies, and that, by avoiding the issue of antibiotic-resistant rectal flora, transperineal biopsies circumvent the rising rate of infections and strengthen antibiotic stewardship during procedures.

Dr. George then addresses the issue of patient pain in transperineal biopsies. He offers techniques on ideal administration of local anesthetic for decreasing patient pain.

Dr. George concludes by providing information on patient set-up, procedure equipment, and transperineal guides, presenting multiple options and encouraging urologists to choose according to their needs. He offers several resources for urologists and their patients from the Michigan Urologic Surgery Improvement Collaborative.

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Focal HIFU

Arvin K. George, MD, discusses the use of Focal High Intensity Focused Ultrasound (HIFU) ablation for prostate cancer treatment. He begins by listing the indicators and guidelines for Focal HIFU, particularly after failed radiation therapy.

Dr. George then walks through the selection process for Focal HIFU. He presents the ideal patient and disease characteristics for HIFU ablation therapy, and contraindications for the treatment, including tumor size.

Turning to complications associated with HIFU ablation therapy, Dr. George discusses the common early-, medium-, and late-stage complications associated with Focal HIFU. The most common complications for Focal HIFU ablation therapy being urinary retention and erectile dysfunction. He discusses strategies for avoiding common complications from HIFU.

Dr. George concludes by reviewing patient outcomes of Focal HIFU ablation compared to other treatments for prostate cancer. He presents studies comparing failure-free survival outcomes between patients treated with Focal HIFU over three, five, and eight years compared to other established prostate cancer treatments.

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Optimizing Biopsy Approach Before Precision Prostatectomy

Arvin K. George, MD, reviews the strengths and limitations of prostate magnetic resonance imaging (MRI), identifies strategies to optimize the detection of clinically significant prostate cancer, and reviews outcomes of precision prostatectomy. Dr. George begins by addressing the weak predictive value of multiparametric MRI (mpMRI,) calling it imperfect. However, data from the PROMIS study supports mpMRI over transrectal ultrasound (TRUS.) 

Dr. George cites data on MRI-targeted, systematic, and combined biopsy for prostate cancer diagnosis, and defines precision prostatectomy as a subtotal prostatectomy that preserves tissue and nerves. Dr. George illustrates two scenarios to support the use of precision prostatectomy in conjunction with a 3D ultrasound to guide treatment—one for biopsy-naive patients and the other for patients with prior biopsy. He then shares data on precision prostatectomy outcomes, in which all patients maintained social continence and 85% of patients maintained potency after one year. 

In regards to remission rates, only 6.6% of post-mpMRI biopsy patients presented with clinically significant prostate cancer at 36 months, with over 90% of patients requiring no secondary treatment. Dr. George reiterates that mpMRI is not perfect, but its preservative effects on patients makes it worth further exploration.

About the 26th Annual Southwest Prostate Cancer Symposium:
This conference educated attendees about advances in the management of localized and advanced prostate cancer, with a focus on imaging, technology, and training in the related devices. It included a scientific session, as well as live demonstrations of surgical techniques. You can learn more about the conference here.

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High Intensity Focused Ultrasound for Prostate Cancer: Guidelines, Complications, and Outcomes

Arvin George, MD, Assistant Professor of Urology at the University of Michigan in Midland, Michigan, reviews high intensity ultrasound (HIFU) for prostate cancer and outlines guidelines, patient selection, complications, and outcomes for the treatment. The NCCN guidelines state that HIFU is included as a salvage option after prior treatment failure, specifically radiation failure, but is not recommended as routine primary therapy due to lack of long-term comparative data. The EAU guidelines say to only offer HIFU within clinical trials or well-designed prospective cohorts. Dr. George describes the ideal HIFU patient as having unifocal, clinically-significant, and MRI-visible disease that has an absence of high-risk features. He then goes over a list of common complications and their rates of occurrence: retention (7-27%), hematoma (0-1.6%), sloughing (3-8%), urinary tract infection (5-18%), orchitis (2-8%), abscess (1-2%), fistula (.3-3%), pain (.5-3%), erectile dysfunction (12-30%), incontinence (0-5%), and stricture (2-4%). Dr. George says that to prevent complications one should not retreat the posterior zone, and should plan above the capsule while avoiding near field heat. He then reviews a study on focal therapy compared to radical prostatectomy for non-metastatic prostate cancer that found mostly HIFU focal therapy to have a failure free survival (FFS) rate comparable to that of radical prostatectomy, never exceeding a difference of 13%. Dr. George also discusses another study of medium-term oncological outcomes in a large cohort of men treated with either focal or hemi-ablation using high-intensity focused ultrasonography for primary localized prostate cancer which showed FFS rates of 86% at 24 months, 64% at 60 months, and 54% at 96 months. He concludes with a final study which consolidated and compared HIFU’s outcomes to those of active monitoring, radiotherapy, and radical prostatectomy, showing that HIFU produces consistently better quality of life outcomes.

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