Frontiers in Oncologic Prostate Care and Ablative Local Therapy Archives

Point Counterpoint: Is Focal Therapy Ready for Prime Time (No)

Posted by Michael Rothberg, MD | Feb 2025

Michael Rothberg, MD, critically examines whether focal therapy for prostate cancer is ready for widespread clinical adoption, emphasizing the need for rigorous evaluation. The 10-minute discussion highlights prostate cancer’s biological complexity, including its multifocal and heterogeneous nature, which challenges the premise of focal therapy targeting the “index lesion.”

Dr. Rothberg underscores significant limitations in current diagnostic tools, particularly MRI and biopsy techniques. Imaging inconsistencies and operator variability reduce the reliability of identifying clinically significant lesions.

Current guidelines from leading organizations like NCCN and AUA do not endorse focal therapy as a standard treatment due to insufficient high-level evidence. Dr. Rothberg cites the lack of randomized controlled trials comparing focal therapy to whole-gland treatments, which leaves gaps in understanding survival and recurrence rates beyond medium-term follow-ups.

Point Counterpoint: Is Focal Therapy Ready for Prime Time (Yes)

Posted by Ruben Olivares, MD | Feb 2025

Ruben Olivares, MD, emphasizes the growing momentum of focal therapy in prostate cancer management, urging clinicians to embrace its evolving philosophy. The 9-minute discussion highlights a shift from whole-gland treatment to strategies aimed at cancer control, progression delay, and preserving quality of life.

Dr. Olivares underscores the importance of tailored approaches, utilizing advanced imaging like MRI to localize aggressive lesions. Enhanced biopsy techniques and energy-based modalities offer new avenues for precise and effective treatments. Emphasizing the balance between oncological control and functional preservation, his talk highlights the need for proficiency and sufficient patient volumes to optimize outcomes. Focal therapy is presented as a safe, feasible, and effective strategy with excellent functional and medium-term oncological outcomes, marking it as a critical component of the evolving prostate cancer treatment paradigm.

PIRADS V2.1 – What a Urologist Needs to Know?

Posted by Sadhna Verma, MD, FSAR | Jan 2025

Sadhna Verma, MD, MBA, FSAR, begins this 20-minute presentation by emphasizing the exponential growth of prostate MRI usage and its critical role in prostate cancer detection. Before diving into PI-RADS, the multiparametric MRI approach is explained. T2-weighted sequences are highlighted as the best for anatomical visualization.

PI-RADS scoring, a standardized Likert-like system ranging from 1 to 5, assesses the likelihood of malignancy of a lesion based on size, location, and imaging characteristics. PI-RADS version 2.1 introduces refinements, particularly for transition zone lesions. The updated guidelines also incorporate templates to standardize reporting and emphasize quality assurance. Central zone tumors are recognized for their aggressive nature and specific imaging features.

Dr.Verma shares images to illustrate the scoring refinements of PI-RADS version 2.1. Despite advancements, quality variability in imaging and interpretation remains a concern. Collaborative initiatives led by the American College of Radiology aim to enhance diagnostic accuracy. Dr. Verma emphasizes the need for ongoing quality assurance and training to address current limitations and improve clinical outcomes.

Surgical BPH: 2024 Updates and Where Are We Going

Posted by Nicole L. Miller, MD, FACS | Jan 2025

Nicole L. Miller, MD, FACS, delivers an incisive update on the surgical management of benign prostatic hyperplasia (BPH). In this 11-minute presentation, Dr. Miller outlines the current AUA guidelines, highlighting a broad spectrum of treatments tailored to prostate size. Trends in national data reveal that transurethral resection of the prostate (TURP) remains the dominant procedure, while minimally invasive options like UroLift have gained substantial traction.

Dr. Miller discusses emerging technologies, including the OptilumeⓇ BPH System. She also reviews promising data on MRI-guided transurethral ultrasound ablation (TULSA). Advanced laser techniques, particularly holmium pulse modulation, and thulium fiber laser, are explored for their efficacy in enucleation procedures, showing advantages in operative time, hemostasis, and same-day discharge rates. Miller highlights evolving techniques like en bloc enucleation with early apical release. A brief discussion on robotic-assisted simple prostatectomy includes recent shifts toward single-port approaches.

Dr. Miller stresses the importance of aligning treatment with patient preferences and quality-of-life goals, emphasizing shared decision-making as central to optimizing outcomes in this rapidly advancing field.

Oral Abstracts – SV Recurrences After Radiation

Posted by Aaron E. Katz, MD, FACS | Jan 2025

Aaron E. Katz, MD, FACS, examines the clinical management of seminal vesicle (SV) invasion following radiation therapy in prostate cancer patients. In this 18-minute presentation, Dr. Katz highlights its significance in recurrence and treatment, emphasizing the anatomy, detection, prognosis, and ablative techniques for managing SV invasion.

Dr. Katz shares emerging management options, including robotic excision of SVs and cryotherapy. Integrating PSMA PET scans and MRI enhances diagnostic accuracy, aiding surgical planning.

Dr. Katz calls for a multidisciplinary approach, emphasizing careful patient selection and robust imaging protocols. Ablative therapies, while feasible, require expertise and may benefit from combining modalities for optimal outcomes.