Boston Archives

Update on the State of the Art Radiation Treatments for Prostate Cancer

Posted by Peter F. Orio III, DO, MS | Sep 2024

Peter F. Orio III, DO, MS, discusses radiation oncology for localized prostate cancer. He focuses on a range of advanced techniques aimed at delivering high-dose radiation to the tumor while minimizing toxicity to surrounding tissues. Key modalities include Image-Guided Radiation Therapy (IGRT), Intensity-Modulated Radiation Therapy (IMRT), Stereotactic Body Radiation Therapy (SBRT), and adaptive radiation therapy, each providing distinct advantages in precision and dose management.

Dr. Orio discusses emerging technologies like MR-guided linear accelerators (MR-Linacs), and controversial options like proton therapy and prostate brachytherapy. He also addresses evolving advanced radiation techniques, with artificial intelligence growing in treatment planning and execution.

Despite these advances, ongoing research is necessary to validate the clinical benefits of these technologies and ensure they effectively reduce toxicity and improve patient outcomes. The overarching goal remains to provide personalized, precision radiation therapy that maximizes tumor control while minimizing harm to patients.

Rectal Spacing for All Forms of Radiation: Cryotherapy, HIFU, Tesla, and More

Posted by Peter F. Orio III, DO, MS | Sep 2024

Peter F. Orio III, DO, MS, focuses on the management of localized prostate cancer, particularly emphasizing the use of rectal spacers to reduce radiation toxicity. In this 14-minute presentation, Orio discusses rectal spacing as a pivotal advancement in radiation oncology, enhancing the safety and efficacy of treatments by physically distancing the rectum from the prostate to minimize exposure.

Orio explores various rectal spacing techniques, including SpaceOAR, Barrigel, and BioProtect. The presentation stresses the importance of precise placement and the role of imaging, particularly MRI, in enhancing treatment accuracy and reducing complications. The variability in implant symmetry across products highlights the need to carefully select and use these technologies to avoid adverse effects.

The discussion concludes with considerations for extending the application of these technologies to other modalities, such as cryotherapy and focal laser ablation, reinforcing the broader implications of tumor spacing in oncologic treatment.

Biomarkers for Radiation Therapy

Posted by Peter F. Orio III, DO, MS | Sep 2024

Peter F. Orio III, DO, MS, focuses on the evolving role of biomarkers in radiation oncology, particularly for prostate cancer. He asserts that biomarkers serve as biological indicators that help predict and monitor responses to treatment, thereby optimizing therapeutic outcomes and reducing toxicity.

In this 12-minute presentation, Dr. Orio categorizes radiation biomarkers into diagnostic, predictive, prognostic, and monitoring types, emphasizing their distinct roles in disease prediction, treatment response, and patient prognosis. Orio provides examples and discusses how these tools influence radiation planning and decision-making across various medical disciplines, including radiation oncology, medical oncology, and surgery.

The presentation underscores that while many biomarkers are prognostic, the future lies in their predictive capabilities, which are crucial for truly personalized treatment.

How Well Do You Know Doublets and Triplets? – A Pop Quiz

Posted by Marc B. Garnick, MD | Sep 2024

Marc B. Garnick, MD, tests knowledge on doublet and triplet therapies in prostate cancer. In this quiz-themed 13-minute presentation, he poses a series of questions. After each, he discusses the correct response.

Dr. Garnick begins by matching prostate cancer stages—such as non-metastatic castration-resistant, metastatic castration-sensitive, first-line castration-resistant, and castration-resistant post-docetaxel—with corresponding clinical trials. He incorporates key studies, including SPARTAN, PROSPER, ARAMIS, TITAN, and PREVAIL, and therapies like apalutamide, enzalutamide, daralutamide, and abiraterone in his questions. He also quizzes his audience on side effects and NCCN Guidelines for treating metastatic disease.

The presentation provides a unique comprehensive examination of the landscape of doublet and triplet therapies in prostate cancer, emphasizing the critical importance of personalized treatment approaches based on a detailed understanding of clinical trial data and drug-specific side effect profiles.

HoLEP

Posted by Lori B. Lerner, MD | Sep 2024

Lori B. Lerner, MD, delves into the complexities of enucleation techniques for treating benign prostatic hyperplasia (BPH), emphasizing the importance of understanding prostate anatomy. In this 11-minute presentation, she highlights how individual anatomical variations influence surgical decisions and outcomes, particularly in laser enucleation.

Dr. Lerner outlines different approaches to enucleation, involving strategic incisions to address each patient’s specific anatomy. She discusses complex cases, such as patients with a significant portion of their prostate extending into the bladder, nodular prostates, or elevated bladder necks, which necessitate tailored approaches.

Dr. Lerner’s presentation underscores the necessity of careful preoperative imaging, using tools like MRI or CAT scans, to map the prostate’s structure and guide the surgical approach. She advocates against routine excessive testing, emphasizing responsible and targeted use of diagnostic tools to inform clinical decisions without unnecessary expenditure. Lerner also addresses potential complications such as postoperative stress urinary incontinence.