Panel Discussion: Didactic Session 2: Radioprotection
Peter F. Orio III, DO, MS; Leonard S. Marks, MD; Richard G. Stock, MD
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Talks by Peter F. Orio III, DO, MS
New Spacer Technology for Prostate Cancer Radiation Therapy
Peter F. Orio III, DO, MS, discusses the critical role of rectal spacing in reducing the toxicity associated with radiation therapies in the treatment of prostate cancer. While not yet FDA approved, Dr. Orio reviews several pivotal trials on SpaceOAR and Barrigel which support the use of rectal spacing technology in prostate cancer treatment.
Dr. Orio underscores the role of rectal spacing technology in a patient-centric approach to cancer care. Throughout his presentation, Dr. Orio focuses on the mechanisms behind rectal spacing technology which preserve patient quality of life more effectively than traditional approaches when done correctly.
Dr. Orio then reviews the weaknesses and dangers of rectal spacer technology and analyzes reports in the FDA MAUDE database for SpaceOAR Classic, SpaceOAR Vue, and Barrigel. He cautions physicians and surgeons to know their own skill-level and to always choose the safety of the patient.
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Treatment of Localized Disease
Peter F. Orio III, DO, MS, discusses the treatment of localized prostate cancer, with emphasis on maximizing the value for the patient. Dr. Orio explains Michael Porter’s equation for determining patient value: patient-relevant outcomes, divided by the cost to achieve the outcomes.
Dr. Orio then reviews the benefits and limitations of common treatments for prostate cancer, including:
External Beam Radiation Therapy with and without Androgen Deprivation Therapy
Brachytherapy
Radical Prostatectomy with and without Pelvic Lymph Node Dissection
Focal Therapies
Dr. Orio concludes by emphasizing that the goal of treatment is to cure the patient and avoid reducing QoL as much as possible. As long as the physician keeps that goal top of mind, the journey to remission will be different for every patient
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Identification of Localized Disease
Peter F. Orio III, DO, MS, discusses the process of identifying localized prostate cancer. Dr. Orio emphasizes that prostate cancer is a spectrum of disease, rather than a binary, as prostate cancer is not necessarily confined to the prostate organ alone, and that the ultimate goal of treatment is reduction of harm to the patient’s future self.
Dr. Orio reviews the current screening, imaging, and testing steps to identifying localized prostate cancer, including the best candidates for screening. He notes that mandatory DREs discourages patients from coming in to the urologist, and suggests that screening should eliminate them.
Dr. Orio offers the more sensitive and less invasive PSA tests in combination with MRIs as an alternative first step in screening. He concludes by offering PSA – MRI – Fusion Biopsy – Germline Testing – FHX – FNX Imaging as the new path for screening and identifying localized prostate cancer.
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The Wild, Wild West of Radiation Oncology: An Update on Radiation Tools, Toys and Trials
In this 12-minute presentation, Peter F. Orio III, DO, MS, Vice Chair of Network Operations for Dana-Farber/Brigham and Women’s Cancer Center Department of Radiation Oncology and Associate Professor of Radiation Oncology at Harvard Medical School in Boston, Massachusetts, explains prostate brachytherapy is effective, efficient, and convenient, and he says it is “the right thing to do for patients.” He sees a threat to patients posed by radiation oncology without brachytherapy and concludes by encouraging urologists to explore a broad range of treatments to maximize the benefit to patients.
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