Maryland Archives

Focal Therapy for Prostate Cancer: Role of Brachytherapy

Posted by Daniel Y. Song, MD | Jun 2024

Dr. Daniel Y. Song examines the critical role of brachytherapy as a focal therapy in the management of prostate cancer, emphasizing its significance within the broader context of precision oncology. Dr. Song discusses the technical aspects and advancements in brachytherapy, including the use of image-guided techniques. He underscores the importance of meticulous planning and execution in achieving optimal therapeutic outcomes.
Dr. Song also addresses the evolving role of brachytherapy in the era of multimodal treatment approaches. He explores its integration with other therapeutic modalities, such as external beam radiation therapy and hormonal therapy, to enhance treatment efficacy and tailor interventions to individual patient profiles. This approach aligns with the principles of personalized medicine, aiming to optimize therapeutic benefits while minimizing treatment-related morbidity.

Industry Perspective: BioProtect Balloon Implant™ System

Posted by Daniel Y. Song, MD | Apr 2024

In this Industry Perspective, supported by BioProtect, Daniel Y. Song, MD, compares the BioProtect Balloon Implant™ System to rectal gel spacers currently on the market. Dr. Song begins by presenting the composition, dimensions, and safety features of the balloon.

Dr. Song then compares the balloon’s features and implantation process to those of the two most readily available rectal gel spacers on the market. He notes that, unlike the gel spacers, the balloon creates predictable, reproducible, symmetrical results.

Dr. Song presents a step-by-step illustration of the implantation process for the BioProtect Balloon Implant™ System. He presents a video demonstration of an implantation via blunt dissection, which reduces the risk of rectal, capsular, and vascular infiltration. He adds that the balloon is simple to degrade, with 98% of the material degraded at the 6-month mark.

Dr. Song concludes by presenting the results of the BioProtect Multinational Pivotal Study. He compares the GI toxicities at 3 and 6 months of patients treated with rectal gel spacers versus those treated with the BioProtect Balloon Implant™ System. He demonstrates that the balloon achieves robust reduction in radiation dose, while being well-tolerated by patients and easy for healthcare professionals to implant and adjust.

Point Counterpoint: Micro Ultrasound

Posted by Gerald L. Andriole, Jr., MD | Mar 2024

Gerald L. Andriole, Jr., MD, presents the benefits of including micro ultrasound (microUS) in prostate imaging. He begins by noting that microUS is a relatively new technology compared to multiparametric magnetic resonance imaging (mpMRI).

Dr. Andriole presents examples of the detailed prostate images produced by microUS. He discusses the Prostate Risk Identification using MicroUltraSound (PRIMUS) classification system, intended as an analog to PRI-RADS, and the training required for practitioners using microsUS. He presents video examples of microUS-guided versus MRI-guided biopsies.

He concludes by comparing the specificity, sensitivity, and NPV of mpMRI and microUS biopsies in identifying clinically significant cancer. He presents recent studies which indicate that microUS alone may be as effective as mpMRI alone in the context of biopsies.

Point Counterpoint: MRI

Posted by Thomas P. Frye, DO | Mar 2024

Thomas P. Frye, DO, argues in favor of multiparametric magnetic resonance imaging (mpMRI) over micro ultrasound (MicroUS) for prostate imaging. He begins by stating the underlying goals of prostate imaging in the context of triaging in urologic oncology.

Dr. Frye then turns to the lack of data in support of microUS over mpMRI. He highlights that prostate imaging from MicroUS lacks the scale and reliable interpretability of mpMRI.

Dr. Frye supports the effectiveness of mpMRI in detecting clinically significant prostate cancer with data from the PROMIS and PRECISION studies. He notes that the use of mpMRI in screening can prevent unnecessary biopsies of insignificant cancers.

He concludes by reviewing weaknesses in recent studies of mircoUS. He presents a clinical analysis of microUS which demonstrated the superiority of conventional imaging (TRUS) and mpMRI over microUS.

PSMA PET for Prostate Cancer: Primary Staging, Recurrent Disease Localization

Posted by Steven P. Rowe, MD, PhD | Mar 2024

Steven P. Rowe, MD, PhD, discusses the strengths of Prostate-Specific Membrane Antigen (PSMA) PET in PCa staging and localization. Dr. Rowe begins with a brief overview of PSMA PET and its correlation with metastases and tumor aggressiveness.

Dr. Rowe focuses on the sensitivity and specificity of PSMA PET for identifying metastases. He establishes that PSMA PET has high specificity, regardless of metastatic tumor size, but that the sensitivity to tumors below 5 millimeters in diameter is low. For treatment of the primary disease in the prostate, Dr. Rowe discusses the role of PSMA PET in tumor segmentation.

Dr. Rowe concludes by addressing the use of PSMA PET in identifying recurrent disease and salvage therapy candidates. He discusses the design and results of the CONDOR trial, and the lesion-level positive predictive value of PSMA PET in recurrent disease.