Frontiers in Oncologic Prostate Care and Ablative Local Therapy Archives

Role of Whole Gland Ablation in Prostate Cancer

Posted by James S. Wysock, MD, MSc | Apr 2025

James Wysock, MD, MS, delves into the evolving role of whole gland ablation (WGA) in prostate cancer management, particularly in intermediate- to high-risk cases and challenging clinical scenarios.

In this 20-minute presentation, Dr. Wysock highlights specific patient profiles where WGA may be preferable, including those with prior pelvic radiation, contraindications to surgery or radiotherapy, or elderly patients seeking less invasive yet effective treatment. In the salvage setting, WGA offers a compelling alternative for local recurrences, achieving substantial cancer control while avoiding aggressive surgical or radiation options.

Technological advancements like TULSA and HIFU enhance WGA precision. Challenges such as recurrence rates and in-field failures underscore the need for meticulous treatment planning and expanded ablation margins.

Dr. Wysock advocates for trials to validate WGA as a mainstream option, particularly in patients who cannot undergo radical treatments. This approach aligns with evolving guidelines and patient preferences, underscoring WGA’s potential as a transformative option in prostate cancer care.

Diet and Prostate Cancer: What We Need to Know to Tell our Patients

Posted by Stacy Loeb, MD | Feb 2025

Stacy Loeb, MD, MSc, PhD (hon), emphasizes integrating dietary and lifestyle modifications into prostate cancer management to improve patient outcomes. In this 21-minute presentation, Dr. Loeb notes that patients with localized disease are more likely to die from cardiovascular causes than prostate cancer itself, highlighting the opportunity to address broader health concerns.

Dr. Loeb introduces the six pillars of lifestyle medicine: whole food, plant-predominant nutrition, physical activity, restorative sleep, avoidance of toxic substances, social connection, and stress management. She emphasizes that plant-based diets, particularly whole foods, and plant-based patterns, reduce the risk of prostate cancer, cardiovascular disease, and erectile dysfunction while promoting environmental sustainability.

Loeb advocates for accessible patient resources, tailored educational materials, and collaboration among healthcare providers to promote these practices. The discussion addresses the importance of patient-centered approaches and the potential role of testosterone management in prostate cancer care.

Point Counterpoint: Risk Stratification for Biopsy – Biomarkers

Posted by Juan Javier-DesLoges, MD, MS | Feb 2025

Juan Javier-DesLoges, MD, MS, focuses on contemporary advancements in prostate cancer detection, emphasizing the integration of biomarkers and MRI for biopsy decision-making. In this 5-minute presentation, he references recent guidelines, which advocate biomarkers and MRI as tools for determining the necessity of biopsies. Studies comparing biomarkers such as 4K, PHI, SelectMDx, and XODX illustrate their ability to enhance the specificity and accuracy of cancer detection compared to PSA alone.

Dr. Javier-DesLoges stresses that MRI further refines risk stratification when combined with biomarkers. He underscores the complementary role of these tools, advocating their combined use to optimize diagnostic outcomes for patients with intermediate PSA levels.

Point Counterpoint: Risk Stratification for Biopsy – MRI

Posted by Peter A. Pinto, MD | Feb 2025

Peter A. Pinto, MD, underscores the evolving role of MRI as a critical biomarker in urologic oncology, particularly for prostate cancer detection, staging, and treatment planning.

In this 12-minute conversation, Dr. Pinto highlights MRI’s unique position as a diagnostic and procedural adjunct, emphasizing its ability to improve biopsy accuracy, reduce over-diagnosis of low-grade cancers, and enhance focal therapy targeting. He shares that MRI provides actionable insights that enhance clinical decision-making by correlating radiologic findings with pathological outcomes. Further, the potential of MRI as a screening tool is explored, with promising advancements in shorter, contrast-free scans. Dr. Pinto also addresses the integration of AI for tumor identification, segmentation, and quality control, presented as a pathway to overcoming these limitations.

Starting a Transperineal Prostate Biopsy Program Cost Effective Strategy for Implementation

Posted by Richard C. Wu, MD | Feb 2025

Richard C. Wu, MD, discusses his innovative approach to enhancing the feasibility and cost-effectiveness of transperineal prostate biopsies, a method recognized for its reduced infection risk and safety advantages over traditional transrectal biopsies.

In this 9-minute presentation, Dr. Wu draws from his research in Michigan and subsequent experiences in Taiwan to address the financial and equipment-related barriers to adopting transperineal biopsy in resource-limited settings. His strategy employs basic equipment to perform free-hand biopsies effectively. He provides a step-by-step overview of his method, including local anesthesia administration, single puncture techniques, and biopsy site targeting, ensuring optimal access to various prostate zones. His approach eliminates the need for expensive alignment systems while maintaining diagnostic accuracy.

Dr. George concludes that his cost-conscious approach makes transperineal biopsies viable in low-resource settings, improving patient outcomes and satisfaction while reducing complications. His work underscores the value of innovative adaptations in global healthcare.