Video Archives

Combination of Prostate Ablation with Systemic Therapy for Management of Prostate

Posted by Abhinav Sidana, MD, MPH | Jun 2024

Abhinav Sidana, MD, MPH, addresses the integration of prostate ablation with systemic therapy for the management of prostate cancer. This strategy aims at improving treatment outcomes through synergistic effects and personalized care.
Prostate ablation techniques, including cryoablation or high-intensity focused ultrasound (HIFU), target localized prostate tumors while preserving surrounding healthy tissue. Dr. Sidana emphasizes that these minimally invasive procedures offer potential advantages over traditional treatments by reducing treatment-related side effects such as urinary incontinence and erectile dysfunction. The integration of systemic therapy, such as hormonal therapy or chemotherapy, complements prostate ablation by addressing systemic disease and enhancing treatment efficacy.
By leveraging both local and systemic treatment modalities, clinicians can tailor treatment strategies to individual patient profiles, ultimately improving long-term survival and quality of life for prostate cancer patients.

Patient Selection for Prostate Cancer Focal Therapy: Urologic Perspective

Posted by Geoffrey Sonn, MD | Jun 2024

Geoffrey Sonn, MD, discusses patient selection criteria for prostate cancer focal therapy from a urologic perspective.
Focal therapy aims to treat only the cancerous lesion while preserving surrounding healthy tissue. Candidates for focal therapy typically have localized prostate cancer confined to a specific area of the gland. Imaging techniques such as multiparametric MRI (mpMRI) play a pivotal role in accurately identifying and characterizing these lesions, guiding treatment planning, and ensuring precise targeting during therapy.
Patient selection also hinges on tumor biology and clinical factors. Dr. Sonn explains that biomarkers and genomic testing help assess the aggressiveness and molecular characteristics of the cancer, aiding in risk stratification and predicting the likelihood of disease progression.
Dr. Sonn underscores the importance of patient-centered care in the era of precision medicine. When considering focal therapy as an option, each patient’s preferences, overall health status, and potential impact of treatment on quality of life must be carefully weighed.

PSMA in Metastatic Prostate Cancer: Imaging as Biomarker

Posted by Louise Emmett, MD | Jun 2024

Louise Emmett, MD, addresses prostate-specific membrane antigen (PSMA) in metastatic prostate cancer, focusing on imaging as a biomarker.

Alan W. Partin Distinguished Lecture: The Genomics and Natural History of Visible vs. Invisible Cancers

Posted by Laurence Klotz, MD, FRCSC | Jun 2024

Laurence Klotz, MD, FRCSC, presents the newly-emerging and provocative concept of MRI visibility as a predictor of prostate cancer tumor aggressivity in the Alan W. Partin Distinguished Lecture at IPCU 34. Given that more definitive data on the subject develops, and the urological community accepts it, this could imply significant changes to practice.

Currently, the concern over invisible cancers drives a lot of interventions, such as systemic biopsies in patients who have already undergone targeted biopsies and/or received negative imaging results.Patients on active surveillance derive anxiety from the possibility of having untreated occult cancer.

The clinical implication of imaging-based monitoring has many advantages, such as psychological benefit to the patient, and reduced cost and burden of care from avoiding systematic biopsies. Recent genomic and clinical studies support the idea that tumors invisible on MRI imaging have much more favorable genetics and natural history than those visible on MRI. This implies that in imaging-based management, the occasional missed cancers are not meaningful.

Many exciting genetic studies over the past six years have demonstrated merit to this theory, including a study identifying four genes predicting progression-free survival, metastases-free survival, and MRI visibility; a study correlating cancer aggressiveness and quantitative imaging features; and a correlation analysis of hypoxia-related genes and biparametric MRI visibility. A study from University of California, Los Angeles defined the term Nimbosus—a word derived from nimbus storm clouds—to describe an aggressive pathological, molecular, and microenvironmental phenomenon. This data suggested a confluence of the adverse features that make up nimbosus and MRI visibility.

However, there are still many unmet needs in this area, including an interrogation of uncommon invisible aggressive cancers, existing databases for robust data on invisible versus invisible cancers, and alternative imaging modalities like micro-ultrasound and PSMA-PET. As radiogenomics are still in their infancy, further, more definitive research must occur before adopting this into practice.

Optilume for BPH – Considerations for Use

Posted by Ryan P. Terlecki, MD, FACS | Jun 2024

Ryan P. Terlecki, MD, FACS, examines the use of Optilume, a novel drug-coated balloon technology, in treating benign prostatic hyperplasia (BPH), focusing on its efficacy, safety, and clinical considerations.

He begins by explaining the mechanism of action of Optilume and reviews clinical trial data demonstrating its effectiveness in improving urinary flow rates and reducing symptom severity in patients with BPH. He highlights key findings, such as significant improvements in International Prostate Symptom Score (IPSS) and quality of life metrics, underscoring the potential of Optilume as an alternative to traditional BPH treatments like pharmacotherapy and surgical interventions.
He discusses patient selection criteria, potential contraindications, and the need for thorough patient evaluation before opting for this treatment. Dr. Terlecki delves into the procedural aspects of Optilume use, including technical considerations for optimal deployment and strategies to minimize complications.
Furthermore, Dr. Terlecki explores the comparative advantages of Optilume over existing BPH treatments and considers the economic implications.