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 Preston C. Sprenkle, MD
Margin Call: Focal vs. Regional Ablation
Preston C. Sprenkle, MD, analyzes focal versus regional ablation in prostate cancer treatment, examining the nuances and outcomes associated with each approach. His discussion centers on the effectiveness, risks, and clinical decision-making processes involved in choosing between these two strategies.
Dr. Sprenkle highlights the advantages of focal ablation, including reduced side effects, such as urinary incontinence and erectile dysfunction. Dr. Sprenkle also discusses the potential benefits of regional ablation, particularly in patients with multifocal or higher-risk disease.
Multiparametric MRI (mpMRI) and targeted biopsies play crucial roles in mapping the extent of the disease and guiding the ablation strategy. Dr. Sprenkle underscores the need for a personalized approach, considering factors such as tumor size, location, Gleason score, and patient comorbidities. The discussion also covers the technical aspects and outcomes of both ablation techniques, with data on success rates, complications, and long-term efficacy.
Dr. Sprenkle highlights future directions in prostate cancer ablation, including advancements in imaging, robotic assistance, and the integration of novel therapeutic agents to enhance precision and effectiveness.
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NCCN Guidelines for Early Detection of Prostate Cancer 2023
Preston C. Sprenkle, MD outlines the 2023 NCCN Guidelines for Early Detection of Prostate Cancer, emphasizing the importance of these guidelines in standardizing prostate cancer screening and improving patient outcomes. These guidelines aim to balance the benefits of early cancer detection with the risks of overdiagnosis and overtreatment.
The guidelines advocate for shared decision-making between physicians and patients, emphasizing the importance of informed discussions about the benefits and harms of prostate-specific antigen (PSA) testing. Dr. Sprenkle also underscores the role of multiparametric MRI (mpMRI), particularly for men with elevated PSA levels or abnormal digital rectal exams. He discusses the incorporation of novel biomarkers, such as the Prostate Health Index (PHI) and the 4Kscore, which provide additional information to guide biopsy decisions.
Dr. Sprenkle explains that identifying high-risk individuals allows for more personalized screening strategies and early intervention. The guidelines provide criteria for selecting patients for active surveillance and outline protocols for monitoring, including periodic PSA testing, mpMRI, and repeat biopsies.
OPTIMUM Trial – Current and Emerging Evidence Supporting 29MHz High- Precision, Real-Time Micro-Ultrasound
Preston C. Sprenkle, MD, discusses the OPTIMUM trial examining micro-ultrasound, MRI fusion, and the combination of these in prostate cancer diagnosis.
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Updates of Changes in the Early Detection of Prostate Cancer NCCN Guidelines 2021
Preston C. Sprenkle, MD, Associate Professor of Urology at Yale University School of Medicine in New Haven, Connecticut, offers an update of changes in the National Comprehensive Cancer Network (NCCN) guidelines for 2021 regarding the early detection of prostate cancer. Dr. Sprenkle first explains the rationale behind the early detection of prostate cancer guidelines, with the NCCN recognizing that prostate cancer is a spectrum of disease, that early detection is for men who opt-in to screening, and that early detection allows for treatment of aggressive cancer, realizing the challenge of not treating indolent disease. Dr. Sprenkle then displays a schematic to outline the format and elements of the NCCN guidelines before highlighting some changes made since 2020. The revised guidelines clarify language regarding race and ancestry as well as germline mutations. The revisions strengthen statements supporting the use of magnetic resonance imaging (MRI), reflecting an understanding that the benefit of MRI fusion prostate biopsy is clear and that data on multi-parametric (mp)MRI are no longer simply “emerging.” Additionally, the new recommendations remove the prostate cancer antigen 3 gene (PCA3) from the list of recommended biomarkers that further define risk. Guidelines now also recommend that high-grade prostatic intraepithelial neoplasia (HGPIN) be treated as benign disease. Dr. Sprenkle emphasizes that while these 2021 guidelines do not introduce major changes, the addition in 2020 of intraductal carcinoma (IDC) as a concerning pathological feature was a major change that merits continued attention.
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