Frontiers in Oncologic Prostate Care and Ablative Local Therapy Archives

High Intensity Focused Ultrasound Ablation Outcomes – TR, In Bore

Posted by Behfar Ehdaie, MD, MPH | Aug 2024

Behfar Ehdaie, MD, MPH, discusses High-Intensity Focused Ultrasound (HIFU) ablation, particularly focusing on its application in treating prostate cancer. The presentation highlights the recent advancements and clinical outcomes associated with both transrectal (TR) and in-bore HIFU procedures.

Dr. Ehdaie emphasizes the precision and minimal invasiveness of HIFU and outlines the selection criteria for patients. He also discusses the integration of real-time imaging with magnetic resonance imaging (MRI) in in-bore HIFU.

Dr. Ehdaie highlights the promising results demonstrated in clinical outcomes of HIFU ablation, making HIFU an attractive option for eligible patients. He also addresses the ongoing challenges and future directions in HIFU research. The potential for combining HIFU with other therapeutic modalities, such as immunotherapy and targeted therapies, is a promising avenue for enhancing treatment efficacy.

Margin Call: Focal vs. Regional Ablation

Posted by Preston C. Sprenkle, MD | Aug 2024

Preston C. Sprenkle, MD, analyzes focal versus regional ablation in prostate cancer treatment, examining the nuances and outcomes associated with each approach. His discussion centers on the effectiveness, risks, and clinical decision-making processes involved in choosing between these two strategies.

Dr. Sprenkle highlights the advantages of focal ablation, including reduced side effects, such as urinary incontinence and erectile dysfunction. Dr. Sprenkle also discusses the potential benefits of regional ablation, particularly in patients with multifocal or higher-risk disease.

Multiparametric MRI (mpMRI) and targeted biopsies play crucial roles in mapping the extent of the disease and guiding the ablation strategy. Dr. Sprenkle underscores the need for a personalized approach, considering factors such as tumor size, location, Gleason score, and patient comorbidities. The discussion also covers the technical aspects and outcomes of both ablation techniques, with data on success rates, complications, and long-term efficacy.

Dr. Sprenkle highlights future directions in prostate cancer ablation, including advancements in imaging, robotic assistance, and the integration of novel therapeutic agents to enhance precision and effectiveness.

Mechanisms and Management of Recurrence

Posted by Samir S. Taneja, MD | Jul 2024

Samir S. Taneja, MD, examines the mechanisms underlying focal therapy failure and best practices in managing prostate cancer recurrence. He begins by defining “failure” in the context of focal therapy, noting that progression-free survival may be a better benchmark for determining the success of focal therapy, rather than recurrence-free survival.

Dr. Taneja then addresses the most common expressions of cancer recurrence post-focal therapy: metastatic recurrence, multifocal recurrence, and recurrence of the treated tumor. He provides real-world examples of treatment failure for each type of recurrence, illustrates the underlying mechanisms, and suggests practical techniques and tools for preventing or managing focal therapy failure.

Dr. Taneja concludes by providing guidance on when focal therapy is no longer appropriate. He advises that re-ablation is not appropriate for high-risk prostate cancer patients or in patients with extraprostatic recurrence.

Complications of Focal Therapy – Risk Factors, Timepoints, Management

Posted by Arvin George, MD | Jun 2024

Arvin K. George, MD, examines common complications from the use of focal therapy to treat prostate cancer and explores management strategies. In this presentation, he discusses the causes and management strategies for possible complications resulting from focal therapy, including:

Continence
Erectile and Sexual Dysfunction
Prostatic Abscesses
Rectourethral Fistulas
Urethral Sloughing
Urethral Strictures
Urinary Retention
Venous Thromboembolisms

Dr. George concludes by comparing the risks and benefits of focal therapy to those of HIFU and Cryoablation. He holds a Q+A session with the audience after his initial presentation.

Rise of the Machines: AI in Prostate MRI

Posted by Baris Turkbey, MD | Jun 2024

Baris Turkbey, MD, explores the capabilities and training gaps of Artificial Intelligence in MRI prostate cancer detection. He begins by establishing the ubiquity of MRI technology in prostate cancer treatment across the globe and highlighting the shortcomings of previous and current guidelines on the use of MRI for disease detection.

Dr. Turkbey highlights the shortcomings of previous and current guidelines on the use of MRI for disease detection, noting that current data is too dependent on the experience of the practitioner. He then introduces the idea of using Artificial Intelligence (AI) to standardize prostate cancer detection.

Dr. Turkbey then presents examples of AI successfully detecting prostate cancer lesions on MRI imaging. However, he cautions that more rigorous training and supervision is still needed for AI imaging, as AI has a high false-positive rate.

Dr. Turkbey concludes by examining the impact of image quality on AI performance, indicating that more training is required before these models can be deployed as a diagnostic aid. He presents data that demonstrates that low-quality images significantly impact the cancer detection rate of AI models.