Video Archives

Focal HIFU

Posted by Arvin George, MD | Mar 2024

Arvin K. George, MD, discusses the use of Focal High Intensity Focused Ultrasound (HIFU) ablation for prostate cancer treatment. He begins by listing the indicators and guidelines for Focal HIFU, particularly after failed radiation therapy.

Dr. George then walks through the selection process for Focal HIFU. He presents the ideal patient and disease characteristics for HIFU ablation therapy, and contraindications for the treatment, including tumor size.

Turning to complications associated with HIFU ablation therapy, Dr. George discusses the common early-, medium-, and late-stage complications associated with Focal HIFU. The most common complications for Focal HIFU ablation therapy being urinary retention and erectile dysfunction. He discusses strategies for avoiding common complications from HIFU.

Dr. George concludes by reviewing patient outcomes of Focal HIFU ablation compared to other treatments for prostate cancer. He presents studies comparing failure-free survival outcomes between patients treated with Focal HIFU over three, five, and eight years compared to other established prostate cancer treatments.

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.

Learning HoLEP Once Already in Practice: Value, Learning Curve, and Tips/Tricks

Posted by Rebecca C. Gerber, MD | Mar 2024

Rebecca C. Gerber, MD, presents practical guidance on the use of Holmium Laser Enucleation of the Prostate (HoLEP) in clinical practice. Dr. Gerber begins by enumerating the benefits of HoLEP as a treatment, and pre-operative requirements for patients.

Dr. Gerber then provides an overview of perioperative considerations and the steps for the procedure. She presents a video demonstration of the procedure in practice, providing her clinical perspective for each step.

Dr. Gerber concludes by presenting examples of past HoLEP procedures, and providing her perspectives on which cases are better for practitioners with less HoLEP experience. She highlights the benefits of using HoLEP to treat catheter-dependent patients.