Case Discussions II-Complications and Recurrences
Abhinav Sidana, MD, MPH; Arvin K. George, MD; Phillip Stricker, MBBS; Taimur T. Shah, MD; Alice Yu, MD; and Thomas Frye, DO;
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Talks by Abhinav Sidana, MD, MPH
Case Discussion 1 – Patient and Treatment Selection
Abhinav Sidana, MD, MPH, Peter K.F. Chiu, MD, PhD, FRCSEd, Behfar Edhaie, MD, Arvin K. George, MD, Preston C. Sprenkle, MD, and Samir S. Taneja, MD
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Combination of Prostate Ablation with Systemic Therapy for Management of Prostate
Abhinav Sidana, MD, MPH, addresses the integration of prostate ablation with systemic therapy for the management of prostate cancer. This strategy aims at improving treatment outcomes through synergistic effects and personalized care.
Prostate ablation techniques, including cryoablation or high-intensity focused ultrasound (HIFU), target localized prostate tumors while preserving surrounding healthy tissue. Dr. Sidana emphasizes that these minimally invasive procedures offer potential advantages over traditional treatments by reducing treatment-related side effects such as urinary incontinence and erectile dysfunction. The integration of systemic therapy, such as hormonal therapy or chemotherapy, complements prostate ablation by addressing systemic disease and enhancing treatment efficacy.
By leveraging both local and systemic treatment modalities, clinicians can tailor treatment strategies to individual patient profiles, ultimately improving long-term survival and quality of life for prostate cancer patients.
The Who and Why of Focal Therapies
Abhinav Sidana, MD, MPH, discusses the selection processes, objectives, and data supporting the use of focal therapy to treat prostate cancer. He begins with an overview of the state of focal therapy, and how it can be used to provide more personalized prostate cancer treatment to patients.
Dr. Sidana then compares the weaknesses of focal therapy to those of radical surgery and surveillance. He notes that while focal therapy has been criticized for its shortcomings in addressing “invisible” and multifocal cancers, radical surgery has permanent negative effects on patient QOL and that many patients on active surveillance drop out after a certain length of time.
Dr. Sidana then addresses recent advances in focal therapy which can partially mitigate some of the shortcomings of focal therapy. He focuses on advancements in MRI accuracy and specificity which makes treating multifocal and previously invisible clinically significant cancers using focal therapy effective.
Dr. Sidana concludes by outlining strategies for patient selection for focal therapy. He presents examples of ideal patient and disease characteristics for focal therapy treatment and lists relevant contraindications.
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Selection and Outcomes of Image-Guided, Minimally-Invasive Treatment
Abhinav Sidana, MD, MPH, aims to identify key selection criteria for image guided minimally invasive treatments, also known as focal therapy, for prostate cancer. Dr. Sidana begins by noting that the use of focal therapy for prostate cancer treatment has become widespread in the past decade.
Dr. Sidana then addresses current EAU and NCCN guidelines for focal therapy. He highlights the lack of guidelines specific to focal therapy, and notes that the medical community has been trying to address this deficiency in recent years.
Dr. Sidana concludes by summarizing current best-practices regarding appropriate imaging modalities for screening, appropriate biopsy strategies, and optimal characteristics for determining focal therapy candidacy. He highlights the importance of the correct selection of energy modality in treating prostate cancer, noting that not every surgeon will have access to all the available energy modalities.
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