Thomas J. Polascik, MD, FACS

Thomas J. Polascik, MD, FACS

Duke University Medical Center

Durham, North Carolina

Thomas J. Polascik, MD, FACS, is Professor of Surgery at Duke University Medical Center and the Director of Surgical Technology at the Duke Prostate and Urological Cancer Center. He is the Founder and Co-Director of the International Symposium on Focal Therapy and Imaging of Prostate and Kidney Cancer, which began at Duke in 2008. Dr. Polascik is the Editor of Imaging and Focal Therapy of Early Prostate Cancer. He is Founder and President of the Focal Therapy Society, as well as Director of Duke’s Society of Urologic Oncology Fellowship Training Program and the Genitourinary Program on Focal Therapy at the Duke Cancer Institute. He is the Medical Director of Duke’s Men’s Health Initiative Screening Event and is a governing member of several medical boards and societies. His clinical and research interests focus on prostate and kidney cancer. He has authored over 350 peer-reviewed manuscripts and book chapters.


Consultant for Angiodynamics

Talks by Thomas J. Polascik, MD, FACS

Utilization of Focal Therapy for Patients Discontinuing Active Surveillance of Prostate Cancer: Recommendations of an International Delphi Consensus

In this 21-minute presentation, Thomas J. Polascik, MD, FACS, Professor of Surgery at Duke University and Director of Surgical Technology at the Duke Prostate and Urological Cancer Center, posits that patients discontinuing active surveillance (AS) for prostate cancer may be good candidates for focal therapy (FT) rather than radical therapy, describing an international Delphi Consensus on the issue. Eighty-seven percent of respondents agreed that there is a role for FT for men coming off AS, citing the fact that FT is less invasive, has a greater likelihood of preserving both urinary continence and erectile function, comes with fewer side effects, and has an earlier recovery post-treatment as part of the rationale for recommending FT over radical therapy for men discontinuing AS with an imageable, biopsy-confirmed, localized cancer.

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Focal Prostate Cryotherapy

Thomas J. Polascik, MD, FACS, Professor of Surgery at Duke University and Director of Surgical Technology at the Duke Prostate and Urological Cancer Center, discusses focal prostate cryotherapy and recent data on the treatment’s outcomes. He begins by describing the ideal patient for focal cryotherapy as someone with a greater than ten-year life expectancy and single or multiple mpMRI-visible, biopsy-proven Gleason Grade 2 prostate cancer (PCa) in locations amenable to ablation. Dr. Polascik outlines the procedure and states that the goals of the treatment are eradication of PCa, avoiding urinary and sexual dysfunction, and being a fast and simple outpatient procedure. He then begins discussing data on focal cryotherapy that shows that vitamin D3 functions as a sensitizer to cryoablation and that it is reasonable to re-treat about 20% of PCa patients with focal therapy. Dr. Polascik reviews the latest cryotherapy outcomes that all show focal cryotherapy to be approaching 100% rates of metastasis-free survival, cancer-specific survival, and urinary continence. He summarizes several studies that also show continence to be at about 95-100%, while potency was shown to be between 40-80%. Dr. Polascik then considers a study of long-term outcomes of focal therapy for low-intermediate risk cancer that found focal cryotherapy capable of increasing the time until radical or systemic therapy. He summarizes another study on anterior gland focal cryoablation showing that it can be effective based on erectile function and International Prostate Symptom Score (IPSS) not changing post-treatment. Dr. Polascik discusses expert consensus on how to surveil focal cryotherapy patients post-op, focusing on how in-field failure is a sign of poor treatment while out-of-field failure signals poor patient selection. He concludes by giving an overview of the Focal Therapy Society and by considering the future of focal cryotherapy.

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Focal Cryosurgery: Outcomes and Observations

Thomas J. Polascik, MD, FACS, Professor of Surgery at Duke University and Director of Surgical Technology at the Duke Prostate and Urological Cancer Center, discusses focal cryosurgery for prostate cancer and its functional outcomes. He introduces, as a typical example of his patients, the case of a 64-year-old mostly healthy man who is concerned with the side effects of radical prostatectomy. Dr. Polascik describes the 21st century prostate cancer patient and discusses how and why doctors’ recommendations are becoming less influential, especially when it comes to active surveillance. He returns to the case of the 64-year-old man and shows how cryo-probes are used in an overlapping manner to create a kill zone, and then outlines the procedure. Dr. Polascik reviews a study on Vitamin D3 as a sensitizer to cryoablation that found that on post-treatment day 9, freezing with Vitamin D3 has near a 98% reduction in cell repopulation compared to just freezing. He discusses functional outcomes such as high rates of continence, failure-free survival rates of about 75% at 5 years, 100% metastasis-free survival, and no infield recurrence of Gleason grade 2 or higher in anterior gland focal cryoablation. Dr. Polascik concludes with a look at the future of focal cryoablation, highlighting its ability to maintain quality of life, serve as durable cancer control, be pain-free, and support rapid recovery.

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Surveillance After Image-Targeted Focal Therapy

Thomas J. Polascik, MD, FACS, Professor of Surgery at Duke University and Director of Surgical Technology at the Duke Prostate and Urological Cancer Center, discusses the process of active surveillance and retreatment after image-targeted focal therapy (FT). He begins by describing cancer control and how it may fail. Dr. Polascik then defines intermediate to long-term treatment success as eradication of all aggressive or clinically significant disease in the treated zone, and treatment failure as a significant volume of .2 cc or greater of GS 3+4 in the treated zone and development of any foci of clinically significant cancer requiring further therapy. He cites several studies as contributing to the conclusion that PSA alone is insufficient in defining oncological success, and that a targeted and systematic biopsy should be done 6 to 12 months post-treatment based on rising PSA or suspicious mpMRI lesions. Dr. Polascik then reviews a study outlining guidelines for post-treatment FT for localized prostate cancer in clinical practice. He outlines FT failure through the categories of ablation, targeting, and selection failure, which respectively consist of leaving a tumor in the ablation area, energy not being correctly applied to the tumor, and a patient being inappropriately selected for FT. Dr. Polascik then discusses repeat FT, stating that it is recommended when the reasons for the initial failure can be identified and corrected. He cites Donaldson et al. as showing that FT retreatment rates below 20% are clinically acceptable, any subsequent whole gland therapy reflects a failure of focal therapy, and that a retreatment rate of below 10% with whole gland therapy is clinically acceptable. He concludes by stating that functional outcomes will be clear at between 12 and 18 months post-treatment and by recommending that a post-ablation targeted biopsy of the ablation zone and any new lesions be done between 6 and 12 months post-treatment and possibly 5 years post-treatment, and that PSA density be used for surveillance.

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Updates in Focal Therapy of Prostate Cancer

Thomas J. Polascik, MD, FACS, Professor of Urology at Duke University Medical Center, discusses the effectiveness of focal therapy for prostate cancer as an alternative to radical therapy. He presents a trial that tested vascular-targeted photodynamic therapy (VTP), which resulted in a higher chance for negative biopsy and lower risk of progression at 24 months when compared with active surveillance. Patients who underwent VTP were also less likely to later require radical treatment. Dr. Polascik then highlights another promising form of localized therapy, gold nanoshell-localized photothermal ablation, in which the tumor site is infused with gold nanoshell localized particles that are then activated by a laser. Lastly, he describes the Focal Therapy Society, an international group whose mission is to advance minimally invasive treatments and image-targeted cancer treatments. In addition to promoting focal therapy, the Society creates training and education opportunities, advocates for changes to clinical guidelines, and authors white papers.

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