Scott Eggener, MD

Scott Eggener, MD, Professor of Surgery and Radiology and Vice-Chair of Urology at University of Chicago Medicine, discusses image-guided focal therapy and why, despite the challenges of research and adoption of the treatment, it should be researched and taken seriously as a potential standard of care. He explains that focal therapy can be used to minimize unnecessary biopsies and preserve organs. Dr. Eggener then compares the state of breast cancer focal treatment to that of prostate cancer focal treatment by presenting a randomized trial in breast cancer which suggests that prostate cancer care is 50 years behind breast cancer care in this regard. He then states the pros of focal imaging, noting that there have been multiple high-quality trials, that it lowers patients’ likelihood of needing a biopsy, and that it optimizes detection rates. Dr. Eggener then considers the cons of image-guided focal therapy, stating that not all prostate cancer is MR-visible, that MRI tends to underestimate tumor volume, and that MRI is poor at predicting extraprostatic extension. He then summarizes available data on focal therapy showing that vascular targeted photodynamic therapy has much higher outcomes than standard of care, HIFU hemi-ablation has very low rates of salvage therapy or metastases, and gold nanoparticle thermotherapy can result in metastasis-free survival at 1 year after treatment. Dr. Eggener concludes by stating that image-guided focal therapy is worthy of study and physicians should be attentive to results of ongoing and future studies.