Special 30th Annual IPCU Interview Series – Jelle Barentsz, MD, PhD E. David Crawford, MD, Editor-in-Chief of Grand Rounds in Urology, interviewed world-renowned MRI expert Jelle Barentsz, MD, PhD, during a break at the...
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Laurence Klotz, MD, Professor of Surgery at the University of Toronto and Sunnybrook Chair of Prostate Cancer Research, discusses a newly FDA-approved treatment of localized prostate cancer: MRI-guided transurethral ultrasound ablation (TULSA). He explains how using MRI improves ablation technique, offers a technical overview of the procedure, and then reviews clinical trials of TULSA. As Dr. Klotz describes, MRI thermometry allows physicians to see what temperature the tissue is reaching during ablation, and the use of urethral and rectal cooling helps protect the urethra, making TULSA an effective treatment. He then explores a clinical study of MRI-guided TULSA conducted in five countries that showed a significant reduction of the prostate with minimal adverse effects.
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Jelle Barentsz, MD, PhD, Professor of Radiology at the Nijmegen Medical Center of Radboud University in Nijmegen, The Netherlands, discusses the use of MRI to determine targets for focal therapy in prostate cancer patients with E. David Crawford, MD, Professor of Urology at the University of California, San Diego. Dr. Barentsz emphasizes that practitioners require appropriate experience to use MRI in this way, suggesting that a lack of base-level knowledge has prevented many doctors in the United States from making effective use of this technique. He notes, however, that focal therapy has revolutionized breast cancer treatment and has the potential to transform prostate cancer care as well. Dr. Crawford concurs and shares his largely positive experiences with MRI-targeted focal therapy.
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Neal D. Shore, MD, FACS, Medical Director for the Carolina Urologic Research Center and a urologist at the Atlantic Urology Clinics in Myrtle Beach, South Carolina, discusses the use of a 29MHz micro-ultrasound (MUS) in targeting suspicious regions during prostate biopsy. He explains how the MUS can expedite time to diagnosis through improved real-time visualization, notes the short 15-case learning curve of the device, and discusses studies demonstrating improved negative predictive value and sensitivity of MUS compared to MRI.
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Daniel P. Petrylak, MD, Director of Genitourinary Oncology, Professor of Medicine and Urology, Co-Leader of Cancer Signaling Networks, and Co-Director of the Signal Transduction Program at Yale University Cancer Center, gives an overview of the most important, recent anti-androgen trials, as well as those that are currently still underway. He highlights how the trials were conducted, what the researchers found, and what he feels is still missing from the research. Dr. Petrylak compares and contrasts the different studies and draws conclusions about each. He also goes over a couple of trials with novel anti-androgens with unique mechanisms of action, which are currently in phase 1, that are showing promise.
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