Panel Discussion: Didactic Session 2: Radioprotection
Peter F. Orio III, DO, MS; Leonard S. Marks, MD; Richard G. Stock, MD
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Southwest Prostate Cancer Symposium
Panel Discussion: Didactic Session 1: Prostate Biopsy
James A. Eastham, MD, FACS; Leonard S. Marks, MD; Michael A. Gorin, MD; Nelson N. Stone, MD; Arvin George, MD
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Focal Cryoablation
Michael A. Gorin, MD, discusses the value of focal cryoablation as a treatment option for prostate cancer in modern practice. He begins by providing a brief overview of negative patient outcomes after whole-gland treatment, and the benefits of subtotal gland treatments in the form of focal ablation therapies like cryoablation and High Intensity Focused Ultrasound (HIFU) therapy.
Dr. Gorin notes that HIFU and cryoablation are the two most commonly used and studied modalities for prostate cancer treatment. He discusses the benefits and weaknesses of focal HIFU, with particular focus on the possibility of incomplete cancer treatment, and compares them to those of focal cryoablation.
Dr. Gorin presents the elements of focal cryoablation which reduce the risk of incomplete treatment. He presents current guidelines and devices for performing focal cryoablation which protect the patient against side effects, like urethral sloughing, which had been previously associated with cryotherapy.
Dr. Gorin concludes by demonstrating the long-term success rate for patients treated using focal cryoablation. He compares the QOL outcomes of focal cryoablation to those of HIFU, and presents a recording of a real focal cryoablation procedure.
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Focal HIFU
Arvin K. George, MD, discusses the use of Focal High Intensity Focused Ultrasound (HIFU) ablation for prostate cancer treatment. He begins by listing the indicators and guidelines for Focal HIFU, particularly after failed radiation therapy.
Dr. George then walks through the selection process for Focal HIFU. He presents the ideal patient and disease characteristics for HIFU ablation therapy, and contraindications for the treatment, including tumor size.
Turning to complications associated with HIFU ablation therapy, Dr. George discusses the common early-, medium-, and late-stage complications associated with Focal HIFU. The most common complications for Focal HIFU ablation therapy being urinary retention and erectile dysfunction. He discusses strategies for avoiding common complications from HIFU.
Dr. George concludes by reviewing patient outcomes of Focal HIFU ablation compared to other treatments for prostate cancer. He presents studies comparing failure-free survival outcomes between patients treated with Focal HIFU over three, five, and eight years compared to other established prostate cancer treatments.
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Physics of Intraoperative Dose Planning for Focal Brachytherapy
Ren-Dih Sheu, PhD, DABR, presents an overview of intraoperative dose planning for focal brachytherapy in prostate cancer treatment. He begins by presenting the two most common options for Focal Radiotherapy: Brachytherapy using LDR Seed Implants and EBRT using Stereotactic Radiosurgery (SRS). He compares the reaction dose fall-offs for each treatment, demonstrating Brachytherapy’s faster radiation fall-off compared to EBRT, despite its higher initial radiation dose.
Dr. Sheu then lists the steps for determining the initial dose and other patient-specific factors affecting the implementation of focal brachytherapy. He highlights factors associated with late local failure and increased patient mortality, emphasizing the importance of high Biologically Effective Doses (BEDs) in preventing recurrence.
Dr. Sheu provides the audience with the equations for determining appropriate BED in Brachytherapy and EBRT patients. Finally, he covers techniques for limiting radiation damage to the patient.
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