Frontiers in Oncologic Prostate Care and Ablative Local Therapy Archives

Energy Selection Ablative Technologies for Focal Therapy

Posted by Andre Abreu, MD | Jan 2025

Andre Abreu, MD, delves into energy modalities for focal therapy in prostate cancer, presented with a comprehensive and practical approach. This 16-minute presentation explores multiple energy options, including cryoablation, high-intensity focused ultrasound (HIFU), irreversible electroporation (IRE), laser ablation, and microwave ablation. Dr. Abreu emphasizes the importance of aligning energy selection with institutional expertise and patient-specific factors.

Patient-specific considerations guide technology selection, including rectal wall thickness and proximity to critical structures. Transition zone lesions benefit from tools like aqua ablation, while anterior lesions present challenges for certain devices. The speaker emphasizes the need for personalized management, integrating oncologic characteristics with procedural capabilities.

Dr. Abreu optimistically frames the future of focal therapy, with ongoing trials like vapor ablation and the potential for low-dose radiation therapy combined with IRE promising advancements. He calls for practical recommendations and an invitation for ongoing exploration in the evolving field of prostate cancer management.

Results of the PRIME Trial Biparametric Versus Multiparametric MRI for Prostate Cancer Detection – Impli

Posted by Veeru Kasivisvanathan, MBBS, BSc, FRCS, PhD, MSc, PGCert | Dec 2024

Veeru Kasivisvanathan, MBBS, BSc, FRCS, PhD, MSc, PGCert, shares results from the PRIME study, which explores the potential of biparametric MRI (bpMRI) as a non-inferior alternative to multiparametric MRI (mpMRI) for diagnosing clinically significant prostate cancer. In this 14-minute presentation, Dr. Kasivisvanathan shares that the results demonstrate that bpMRI detects clinically significant cancers at rates comparable to mpMRI, with no significant differences in false-positive rates or biopsy recommendations. Quality control analyses confirmed that imaging quality was critical, with optimization efforts ensuring high diagnostic reliability across centers.

The study concludes that bpMRI is a viable, cost-effective alternative for primary prostate cancer diagnosis, offering broader access without compromising clinical outcomes. The adoption of bpMRI as the new standard of care has the potential to streamline diagnostics and expand access to advanced prostate imaging globally.

Complications of Focal Therapy – Risk Factors, Timepoints, Management

Posted by Amir Lebastchi, MD | Dec 2024

Amir Lebastchi, MD, explores complications associated with focal therapy for prostate cancer, emphasizing the variability influenced by patient characteristics, disease features, treatment factors, and operator experience.

In this 14-minute keynote presentation, Dr. Lebastchi highlights studies reporting a 13-32% overall complication rate. Bleeding complications, sensory changes like penile numbness, and functional impacts such as erectile dysfunction and transient urinary incontinence are discussed.

To minimize risks, operator expertise and careful patient selection are emphasized. Strategies for prevention and management include tailored ablation templates, urethra-sparing techniques, and post-procedure interventions like alpha-blockers and antibiotics. Advanced techniques such as hydro-dissection and real-time monitoring with temperature probes further mitigate risks.

Dr. Lebastchi stresses the safety profile of focal therapy, noting its significantly lower morbidity compared to radical treatments like prostatectomy or radiation. Close postoperative monitoring is recommended to ensure patient recovery and address complications promptly.

KEYNOTE LECTURE – Introduction of Disruptive Technologies The Lessons From the Minimally Invasive Surgery

Posted by Ralph V. Clayman, MD | Dec 2024

Ralph V. Clayman, MD, offers an inspiring and pragmatic perspective on fostering innovation and navigating the challenges of medical advancements. He begins this 34-minute keynote presentation by emphasizing the importance of curiosity and intellectual humility.

Dr. Clayman underscores how disruptive technologies have evolved in urology by presenting historical examples. He traces the creative and collaborative processes that turned initial skepticism into groundbreaking techniques, emphasizing the philosophical, practical, and personal factors required to drive innovation. These include having a clear vision, protected time, effective partnerships, and a multidisciplinary team.

Clayman discusses the future intersection of robotics and artificial intelligence, foreseeing advancements like automated anastomoses and enhanced focal therapies. He stresses that meaningful progress will require collaboration, resourcefulness, and a willingness to challenge conventional norms. He offers practical advice for aspiring innovators and recommends building diverse teams with complementary strengths, as innovation is inherently collaborative.

Mechanisms and Management of Recurrences

Posted by Abhinav Sidana, MD, MPH | Dec 2024

Abhinav Sidana, MD, MPH, delves into the mechanisms and management of recurrences in patients undergoing focal therapy. This 17-minute presentation underscores the absence of a consistent surveillance strategy and advocates for a standardized approach, combining PSA tests, MRI, and biopsies to detect clinically significant cancer.

Dr. Sidana identifies factors such as patient selection, multifocal disease, and tumor biology as primary contributors to failures. His talk also addresses the challenges of inadequate margins and the spatial localization of lesions. Management strategies for recurrences focus on returning to foundational clinical assessments, considering patient life expectancy, comorbidities, cancer grade, and preferences. Cases illustrating success and challenges in treatment strategies reinforce the need for individualized patient care.

Dr. Sidana advocates for integrating biopsies and MRIs into surveillance protocols and highlights patient selection as pivotal to reducing therapy failures. This comprehensive analysis aims to refine focal therapy practices and improve patient outcomes.