Juanita M. Crook, MD, FRCPC

Juanita M. Crook, MD, FRCPC

University of British Columbia

Kelowna, British Columbia, Canada

Juanita M. Crook, MD, FRCPC, completed her medical training at the University of Toronto and her Residency in Radiation Oncology at Princess Margaret Hospital. She is currently a Professor of Radiation Oncology at the University of British Columbia in Kelowna. She is a radiation oncologist at the BC Cancer Agency Sindi Ahluwalia Hawkins Centre for the Southern Interior, also in Kelowna, where she has developed image-guided HDR gynecologic brachytherapy, US-planned HDR prostate brachytherapy, and permanent seed brachytherapy for breast cancer.

Previously a Professor of Radiation Oncology at the University of Toronto/University Health Network and Associate Professor at the University of Ottawa, she has a particular interest in intermittent androgen suppression, post-radiation prostate biopsies, and penile brachytherapy. She has written more than 20 book chapters and over 200 journal articles and is a frequent speaker at international meetings where she presents in English, French, and Spanish. She was Scientific Chair of the 2007 American Brachytherapy Society meeting and frequently teaches at the ABS Prostate Brachytherapy School. She is the Former President of the Board of the American Brachytherapy Society and the recipient of the Thom Shanahan Distinguished Brachytherapy Educator Award.


Talks by Juanita M. Crook, MD, FRCPC

Focal Brachytherapy for Prostate Cancer

Juanita M. Crook, MD, FRCPC, discusses the use of focal brachytherapy for prostate cancer treatment. She highlights the importance of patient selection, technical considerations, efficacy, and post-focal therapy monitoring. Dr. Crook demonstrates the significance of accurate localization through mpMRI and template mapping biopsies for precise treatment planning for patients with favorable-risk disease and a low disease burden.

Dr. Crook discusses the evolution of active surveillance in managing low-risk patients. She also emphasizes the need for careful candidate selection, considering factors like unilateral disease, lower intermediate risk, PSA levels, and life expectancy.

Dr. Crook touches upon various focal therapy scenarios which should be tailored to the patient’s specific case. She discusses options which fall under the umbrella of focal therapy such as low dose rate (LDR) or high dose rate (HDR) brachytherapy, cryotherapy, and HIFU.

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A Biochemical Definition of Cure Following Brachytherapy of Prostate Cancer

As part of a special course on brachytherapy for prostate cancer from the American Brachytherapy Society (ABS) and Grand Rounds in Urology, Juanita M. Crook, MD, FRCPC, Professor of Radiation Oncology at the University of British Columbia in Kelowna, discusses the development of a biochemical definition of cure following low-dose-rate (LDR) prostate brachytherapy. She begins with some background, explaining that the interpretation of post-radiation PSA values has been challenging. She relates that the 1996 ASTRO consensus conference defined biochemical failure as 3 consecutive rises after the nadir with failure backdated to midway between the nadir and the first rise, while the 2005 Phoenix consensus conference defined biochemical failure as 2 ng/ml > nadir, a definition still widely used today. Dr. Crook emphasizes that neither definition was meant to be a trigger for intervention, and neither attempted to define cure. She then discusses research on the importance of PSA nadir in LDR brachytherapy which showed that if PSA at 4 years was less than 0.2 to 0.4 ng/ml, patients tended to do well, but if it was greater than 1.0, the majority were going to fail. Dr. Crook considers another study on long-term PSA stability after LDR brachytherapy which found that 86% of patients had stable PSA at a median followup of 89 months. She also briefly notes that a study of intermediate-risk patients undergoing external beam radiation therapy (EBRT) + high-dose-rate brachytherapy boost found similar results to the studies of LDR brachytherapy regarding the importance of PSA nadir. Dr. Crook then goes into detail about a study she and her colleagues conducted to define a biochemical definition of cure following LDR brachytherapy by identifying a PSA threshold value at an intermediate follow-up time that is associated with long-term (10-15 year) freedom from prostate cancer. She explains that by using prospectively-collected data sets combined from 7 institutions, she and her colleagues were able to determine that patients with a PSA ≤ 0.2 ng/ml by 4-5 years have a 99% probability of being free of clinical failure at 10-15 years. Dr. Crook concludes that PSA ≤ 0.2 ng/ml should be adopted as biochemical definition of cure for comparison with surgical series, but highlights that those patients not achieving this threshold PSA should not be considered as having “failed” but should continue to be monitored with the understanding that they are at higher risk of subsequent clinical failure.

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Long-Term Outcomes of HDR

Juanita M. Crook, MD, FRCPC, reviews the radiobiologic rationale for high-dose-rate brachytherapy (HDR BT), its technical advantages, the evolution of HDR fractionation, and recent toxicity reports for both HDR BT boost and HDR BT monotherapy according to prescribed dose and fractionation.

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Does Radiation Therapy Favor Radical Prostatectomy in Long-Term QOL?

Juanita M. Crook, MD, FRCPC, discusses the challenges of assessing modalities for the management of high-risk prostate cancer in terms of quality of life (QOL) outcomes. She then reviews QOL data from the ProtecT trial, the efficacy and toxicity of presented for ASCENDE-RT trial, and data from two large, mature prospective databases. She also shares her opinion on the “tri-modality” approach.

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Focal Brachytherapy

Juanita M. Crook, MD, FRCPC, argues that focal brachytherapy is one of the most effective and least invasive treatments for prostate cancer. She discusses patient selection for focal therapy, technical limitations, efficacy data, and best practices in post-focal-therapy monitoring.

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