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
Read More
Talks by Samir S. Taneja, MD
Mechanisms and Management of Recurrence
Samir S. Taneja, MD, examines the mechanisms underlying focal therapy failure and best practices in managing prostate cancer recurrence. He begins by defining “failure” in the context of focal therapy, noting that progression-free survival may be a better benchmark for determining the success of focal therapy, rather than recurrence-free survival.
Dr. Taneja then addresses the most common expressions of cancer recurrence post-focal therapy: metastatic recurrence, multifocal recurrence, and recurrence of the treated tumor. He provides real-world examples of treatment failure for each type of recurrence, illustrates the underlying mechanisms, and suggests practical techniques and tools for preventing or managing focal therapy failure.
Dr. Taneja concludes by providing guidance on when focal therapy is no longer appropriate. He advises that re-ablation is not appropriate for high-risk prostate cancer patients or in patients with extraprostatic recurrence.
Read More
Selecting the Optimal Energy Source
Samir S. Taneja, MD, compares the merits and limitations of the leading energy sources used in prostate focal ablation. The sources available for use in prostate ablation today include laser, electroporation, radiofrequency, photodynamic therapy, high-intensity focused ultrasound (HIFU), cryosurgery, drugs/toxins, radiations (focal/interstitial), surgery, steam, and gold nanoparticles.
Dr. Taneja outlines the ideal criteria for an energy source based on the individual characteristics of the patient and their disease, as well as real-world considerations like ease of use and insurance coverage. He gives examples of which energy sources are best-suited for certain cases based on disease presentation and other factors.
In a full focal therapy practice, the optimal situation would be one with multiple energy sources available so that physicians can tailor treatments to each individual patient. Since this saturation of options can be daunting to physicians just starting in a focal therapy program, Dr. Taneja advises practitioners to pick one energy source to practice at first, limiting patient selection to those with disease that is best-treated with that specific modality. After becoming proficient with that energy source, more can be added to increase candidate selection.
Read More
Rationale for Focal Therapy
Samir S. Taneja, MD, describes the basis for focal therapy for prostate cancer and how to use it successfully.
Read MoreHow to Utilize MRI for Focal Therapy Planning
Samir S. Taneja, MD, the James M. Neissa and Janet Riha Neissa Professor of Urologic Oncology, Co-Director of the Smilow Comprehensive Prostate Cancer Center, and Vice Chair of the Department of Urology at NYU Grossman School of Medicine, discusses how to use MRI in planning and doing follow-up on focal therapy for prostate cancer. He begins by introducing the critical decisions in focal therapy implementation, including candidate selection, method of disease mapping/identification, choice of energy, and manner of follow-up/verification of efficacy. Dr. Taneja then lists imaging-related factors influencing oncologic efficacy including tumor size/extent, tumor location, focality, energy source, and gland size. He considers biopsy vs. MRI in treatment planning, explaining that systematic biopsy is inadequate for mapping disease, transperineal template biopsy is the gold standard, and MRI/MRI-targeted biopsy is not perfect, but very good. Dr. Taneja notes that MRI misses some clinically significant cancer, but observes that a 9 to 10 millimeter MRI/MRI-targeted biopsy guided focal ablation seems to identify all the index tumors. He also goes over imaging factors such as disease location and volume affect the choice of energy selection for focal therapy. Dr. Taneja then considers the benefits of imaging post partial gland ablation, explaining that very early imaging evaluates the anatomy of ablation but not its efficacy, intermediate interval imaging guides biopsy and identifies need for retreatment, delayed imaging identifies recurrence. He also briefly discusses the use of PET in cases where MRI does not detect recurrence. Dr. Taneja concludes that MRI has the ability to localize the index tumor, that margin considerations should take into account the known limitations of MRI in disease mapping, and that MRI remains the essential mainstay for monitoring following focal ablation.
Read More- 1
- 2