Latest Videos Archives

Oral Abstracts – Spacial Characterization and AI-Driven Prevention of Residual Cancer Following Focal Therapy

Posted by Preston C. Sprenkle, MD | Dec 2024

Substituting for Wayne Brisbane, MD, Preston Sprenkle, MD, highlights the evaluation of AI-driven cancer risk mapping in guiding focal therapy for prostate cancer. This 7-minute presentation shares results related to Unfold AI, a tool cleared by the FDA in December 2022 for generating 3D cancer risk maps.

The primary focus of the presentation is determining whether AI mapping could predict marginal treatment failures. The AI model demonstrated high precision, significantly reducing necessary treatment margins and potentially enhancing patient outcomes while minimizing treatment invasiveness.

Dr. Sprenkle discusses future directions, including the prospective use of AI-defined margins in treatment planning, which could potentially reduce focal therapy failures. This retrospective study underscores the transformative potential of AI in improving prostate cancer treatment precision.

Oral Abstracts – Best Clinical Practices for Transperineal Postate Biopsy

Posted by Lorenzo Ramacciotti, MD | Dec 2024

Lorenzo Ramacciotti, MD, a research fellow at USC Urology, explores a consensus-driven approach to addressing unanswered questions about transperineal prostate biopsy. In this 3-minute presentation, Dr. Ramacciotti shares the results of a consensus panel of urologists and interventional radiologists.

Overall, the study underscores the growing preference for transperineal biopsy. These findings enhance patient safety, diagnostic accuracy, and procedural efficacy in prostate cancer management.

Outcomes of Recent Clinical Trials for Focal Therapy

Posted by Derek Lomas, MD | Dec 2024

Derek Lomas, MD, provides an extensive overview of recent clinical trials and emerging technologies in focal therapy for prostate cancer. In this 13-minute presentation, Dr. Lomas showcases studies which illustrate focal therapy’s potential as safe, effective, and minimally invasive options for prostate cancer management.

The first study highlights nanoparticle-directed photothermal ablation using gold nanoparticles and MRI-ultrasound fusion guidance. Preliminary results show promising safety and efficacy.
The HIFI trial evaluates focal therapy with high-intensity focused ultrasound (HIFU) versus radical prostatectomy. Findings reveal that HIFU achieves non-inferior outcomes regarding salvage therapy-free survival and demonstrates better urinary and erectile function preservation.
Further insights come from randomized trials comparing focal ablation with radical prostatectomy. These studies consistently show non-inferior treatment failure rates and a reduced impact on functional outcomes with focal therapy.
The PRESERVE trial on irreversible electroporation provides preliminary safety data, with final oncologic outcomes pending. Early results indicate significant reductions in PSA and low adverse effect rates.
The FOSTINE1b trial explores targeted microwave ablation, demonstrating complete necrosis in treated areas with no severe adverse effects.
Two-year data from the ExAblate system, utilizing MRI-guided transrectal HIFU, report high cancer-free rates within treatment zones and overall glands while preserving functional outcomes.

Dr. Lomas shares that ongoing research promises to further refine these technologies. This dynamic field continues to offer exciting prospects for individualized prostate cancer treatment.

Interpretation of Post Focal Therapy Imaging Target and Pifab

Posted by Sadhna Verma, MD, FSAR | Dec 2024

Sadhna Verma, MD, MBA, FSAR, explores advancements in imaging and reporting for post-focal therapy in prostate cancer, highlighting the emergence of two scoring systems, TARGET and PI-FAB. This 16-minute presentation provides an overview of expected multiparametric MRI findings at different post-treatment intervals, describing immediate changes like coagulative necrosis and late findings such as fibrosis and scarring.

Dr. Verma introduces TARGET, a consensus-based system focusing on MRI timing, technical parameters, and interpretation. The PI-FAB system, developed from expert opinion, similarly prioritizes dynamic contrast imaging. Comparative examples illustrate their application.

Preliminary studies reveal moderate inter-reader agreement for both systems, though sensitivity and specificity vary, underscoring the importance of experience in interpretation. Despite promising results, the presenter stresses the need for validation through large, multicenter cohorts and integration with molecular imaging to enhance diagnostic accuracy.

Optimal Surveillance Algorithm Following Focal Therapy of Prostate Cancer

Posted by Herbert Lepor, MD | Dec 2024

In this 13-minute presentation, Herbert Lepor, MD, focuses on the development and implementation of an evidence-based surveillance algorithm following focal therapy for prostate cancer. Dr. Lepor highlights the fundamental role of longitudinal PSA testing, imaging, and biopsy in monitoring patients. Key findings from his cohort of over 500 patients include:

PSA Trends as Predictors: Longitudinal consecutive PSA rises are the strongest predictors of clinically significant recurrence.
MRI Utility: Positive MRIs are associated with a 30-40% likelihood of detecting cancer, but the overall frequency of positive MRIs remains low, justifying their use selectively.
Biopsy Strategies: The cohort’s data indicate that systematically performing biopsies on patients with negative MRIs yields low detection rates, and most findings represent low-volume or less concerning disease.

Dr. Lepor concludes that the current algorithm incorporates PSA testing, selective MRI, and biopsy based on imaging or PSA trends, reducing unnecessary procedures while maintaining effective cancer surveillance. However, further data, especially at the five-year mark, are needed to refine this approach further. This pragmatic and evolving strategy balances oncologic safety with patient quality of life.