Mark Emberton, MD, FRCS

Mark Emberton, MD, FRCS

University College London

London, United Kingdom

Mark Emberton, MD, FRCS, is Professor of Interventional Oncology at the University College London. He is an Honorary Consultant Urologist at University College Hospitals NHS Foundation Trust and Founding Pioneer of The Charity Prostate Cancer UK. He was appointed Dean of UCL Faculty of Medical Sciences in 2015.

Professor Emberton’s clinical research is aimed at improving the diagnostic and risk stratification tools and treatment strategies for prostate cancer (PCa). He specializes in the implementation of new imaging techniques, nanotechnologies, bio-engineering materials and non-invasive treatment approaches, such as high intensity focused ultrasound and photo-dynamic therapy.

His research has been published in over 300 peer-reviewed scientific papers in journals including BMJ, Lancet Oncology and European Urology. He has also contributed to the development of guidelines for the management of PCa and lower urinary tract symptoms, published by the International Society of Geriatric Oncology and the European Association of Urology.

Professor Emberton is also involved in teaching within UCL and the London and South East Urological Training scheme. In addition to being a member of various urological and medical organisations (American Association of GenitoUrinary Surgeons, British Association of Urological Surgeons, European Association of Urology). He is a founding partner of London Urology Associates.


Talks by Mark Emberton, MD, FRCS

The Modern (Overlapping) Relationship Between Active Surveillance and Focal Therapy

Mark Emberton, MD, FRCS, discusses the overlap between active surveillance and focal therapy in modern prostate cancer treatment. He begins by arguing that the proliferation of MRIs, which can accurately identify previously non-visible lesions, makes active surveillance unviable as a default treatment, emphasizing the survival rates of patients on active surveillance.

Dr. Emberton then presents an example case of a patient presenting with a lesion and the options physicians have for treatment. He compares the risks and benefits of treating the patient with focal therapy or monitoring the patient with active surveillance.

Dr. Emberton concludes by addressing the role of patient choice in prostate cancer treatment. He notes that informed patients tend to prefer treatment over surveillance, with little to no long-term regret about the decision. Patients opting for active surveillance over focal treatment tend to regret their decision not to treat the lesion earlier.

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MRI-Based Prostate Cancer Screening in an Era of MCEDs

Mark Emberton, MD, FRCS, discusses magnetic resonance imaging (MRI)-based prostate cancer screening in an era of multi-cancer early detection tests (MCEDs). Prof. Emberton explains that, while screening is beneficial, prostate cancer doesn’t lend itself to the MCED approach.

Prof. Emberton addresses high-quality imaging tools available for prostate cancer screening, mpMRI, and bi-parametric MRI. He outlines and illustrates possible approaches before enumerating challenges of previous screening trials, including poor adherence and contamination.

To combat these challenges, Prof. Emberton proposes a Zelen or embedded cohort design, calling it nondisruptive and fair, eliminating contamination, mitigating nonadherence, and permitting adjustments for underrepresented groups. Dr. Emberton summarizes that the demand for accurate prostate cancer screening and early detection is high.

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Cancer Control in 1379 Men Undergoing HIFU: A Multi-institute 15-year Experience

Mark Emberton, MD, FRCS, Professor of Interventional Oncology at University College London, summarizes the design and findings of a 15-year multi-institute study of high-intensity focused ultrasound (HIFU) in patients with nonmetastatic prostate cancer. After an introduction from E. David Crawford, MD, Professor of Urology at the University of California, San Diego, and Editor-in-Chief of Grand Rounds in Urology, Dr. Emberton notes that the results of this 15-year study resulted in a wave of positive press about HIFU in popular outlets, observing that this widespread enthusiasm is due not just to HIFU’s efficacy, but its safety and adverse event profile as well. He then details the design of the study, beginning with the patient profile. Noting that outcomes in prostate cancer treatment are largely dependent on the risk profile of the patient, Dr. Emberton explains that in this study the average patient age was 66, ⅕ of patients had a PSA greater than 10, the average prostate volume was relatively low, the majority of patients were Gleason 3+4, and the majority of patients were T2. He mentions that intervention varied, and that while the majority of patients had quadrant ablation, about ⅓ had hemiablation. Dr. Emberton then considers the outcomes, observing that the “headline” of the study was the 83% 5-year failure-free survival for intermediate-risk disease. He also highlights that only 0.5% of patients experienced greater than 2 adverse events. Dr. Emberton discusses some supplementary data, emphasizing that if a clinician commits to HIFU, they also commit to retreating a subset of patients. He concludes that HIFU is very safe and that the data suggests that the majority of eligible patients with intermediate-risk disease can defer or avoid radical therapy with HIFU.

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Focal Therapy (HIFU): Functional and Oncological Outcomes

Mark Emberton, MD, FRCS, Professor of Interventional Oncology at University College London, discusses what is and is not known as of 2020 about focal therapy—particularly high intensity focused ultrasound, or HIFU—for localized prostate cancer. He observes that since there is more than a decade’s worth of research behind it, HIFU is hardly experimental anymore, and urologists are by now aware of the therapy’s safety profile, patient selection criteria, short-term outcomes, and medium-term outcomes, with only long-term outcomes still unknown. Dr. Emberton then discusses the goals of focal therapy, the technologies that can or could potentially be used to perform focal therapy, and patient eligibility criteria. He addresses the criticism that focal therapy only treats disease that does not need to be treated, explaining that while this may have been somewhat true in focal therapy’s early conservative years, the era of multiparametric MRI and PSMA PET-CT has made focal therapy more effective, and there exists plenty of research showing that focal therapy is a good alternative treatment that allows patients to maintain continence and erectile function while controlling their cancer. Dr. Emberton concludes by discussing the future of focal therapy, noting that focal therapy programs must embrace stringent quality-control measures, have a true partnership with radiology, have excellent risk stratification, and be committed to long-term follow-up through registries.

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