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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Talks by Behfar Ehdaie, MD, MPH
High Intensity Focused Ultrasound Ablation Outcomes – TR, In Bore
Behfar Ehdaie, MD, MPH, discusses High-Intensity Focused Ultrasound (HIFU) ablation, particularly focusing on its application in treating prostate cancer. The presentation highlights the recent advancements and clinical outcomes associated with both transrectal (TR) and in-bore HIFU procedures.
Dr. Ehdaie emphasizes the precision and minimal invasiveness of HIFU and outlines the selection criteria for patients. He also discusses the integration of real-time imaging with magnetic resonance imaging (MRI) in in-bore HIFU.
Dr. Ehdaie highlights the promising results demonstrated in clinical outcomes of HIFU ablation, making HIFU an attractive option for eligible patients. He also addresses the ongoing challenges and future directions in HIFU research. The potential for combining HIFU with other therapeutic modalities, such as immunotherapy and targeted therapies, is a promising avenue for enhancing treatment efficacy.
Read MoreTransperineal Biopsy & Classification of Risk Using Novel Gleason Pattern Quantification
Behfar Ehdaie, MD, MPH, a urologic surgeon at Memorial Sloan Kettering Cancer Center in New York City, outlines the role of Gleason pattern quantification on prostate cancer outcomes. He explains data indicating biopsy pathology primary Gleason grade (GG) is prognostic of disease recurrence after treatment. Research showed an association between the total length of Gleason pattern 4 across all biopsy scores and worse pathologic outcomes among men with GG2 prostate cancer. Dr. Ehdaie explains the total length of Gleason pattern 4 across all biopsy cores best predicts risk of adverse pathology post radical prostatectomy (RP) compared to overall percentage or maximum percentage pattern 4 in a single core. Dr. Ehdaie then asserts that multi-parametric magnetic resonance imaging (mpMRI) and image-based tracking software has improved detection of higher grade prostate cancer. He displays data that show MR-targeted prostate biopsy improves detection of higher grade disease for men on active surveillance. Dr. Ehdaie explains 22 percent of patients on active surveillance experienced an increase in Prostate Imaging Reporting and Data System (PI-RADS) score on surveillance MRI, emphasizing that patients do experience changes in imaging that can be correlated with outcomes. He then explains the shift to transperineal biopsy and points out it enables systematic cores to be taken in a gridlike fashion that offers opportunity for standardization. He displays data comparing transperineal and transrectal biopsy that indicate transperineal prostate biopsy improves detection of higher-grade prostate cancer for men under active surveillance. Dr. Ehdaie concludes that transperineal biopsy may provide a standardized technique for better sampling and, consequently, better classification of risk, emphasizing that technology capable of transitioning from transrectal to transperineal prostate biopsy is key. Dr. Ehdaie concludes his talk by emphasizing that the incorporation of total biopsy length Gleason pattern 4 improves risk classification for men with GG2 and GG3 prostate cancer. This can help select patients for active surveillance and can develop triggers to recommend subsequent treatment. Additionally, Dr. Ehdaie reiterates that adding systematic biopsy cores to MR-targeted biopsy improves overall detection of higher-grade cancer, and seamless transition from transrectal to transperineal biopsy enables a template-based biopsy technique to standardize sampling for risk stratification.
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Role of MR-Targeted Prostate Biopsy in Active Surveillance
Behfar Ehdaie, MD, MPH, a urologic surgeon at Memorial Sloan Kettering Cancer Center, discusses how MR-targeted prostate biopsy in active surveillance improves detection of higher grade prostate cancer and reduces misclassification of patients with low-risk disease. He summarizes the findings of studies that demonstrate MR-targeted biopsy’s superiority over systematic biopsy in detecting cancer, the particular benefits of MR-ultrasound software fusion prostate biopsy as compared to visually targeted biopsy, and the importance of combining MR-targeted biopsy with systematic biopsy since some tumors are not visible on MRI. Dr. Ehdaie also notes that patients on active surveillance particularly benefit from scheduled MR-targeted biopsies since only using changes in surveillance MRI and clinical stage to trigger biopsy can cause many higher grade cancers to be missed. Dr. Ehdaie concludes by emphasizing the importance of using a transperineal biopsy technique as opposed to a transrectal one in order to reduce complications and improve cancer detection.
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