Fernando J. Bianco, MD, presented “MR Fusion Targeted Therapy: Emerging Management for Localized PCa?” during the 33rd International Prostate Cancer Update on January 23, 2023, in Vail, Colorado.
How to cite: Bianco, Fernando J. “MR Fusion Targeted Therapy: Emerging Management for Localized PCa?” January 23, 2023. Accessed Jul 2024. https://grandroundsinurology.com/mr-fusion-targeted-therapy-emerging-management-for-localized-pca/
MR Fusion Targeted Therapy: Emerging Management for Localized PCa? -Summary
Fernando J. Bianco, MD, aims to decrease the uncertainty that shrouds prostate cancer. He recalls the uncertainty within the history of prostate cancer. Ten years ago, active surveillance often led to radical therapy, which can harm instead of benefit. Currently, localized prostate cancer is on the rise, with a 100% increase in men with localized, metastatic disease. He compares the previous use of random biopsies to the definition of insanity. Bianco describes focal therapy as using an ultrasound machine. Personally, Bianco prefers the term “targeted therapy,” which is based on precision in your diagnosis. He describes hemi-ablation as naive, as most cancers are multifocal. He suggests the arsenal for partial gland ablation is growing. Current options include cryoablation or laser, with future options including radiofrequency or artificial intelligence (AI). In particular, AI can identify specific areas of tumors and reduce bias, which can lead to targeted biopsy rather than a random biopsy. Bianco suggests AI could lead to certainty for patients, giving them the ability to know the exact location, quantity, and type of their lesions, and that treatment will only target the cancer and nowhere else. Bianco presents a review of the literature spanning two years, with a total sample population of over 5,000 patients, that compared efficacy and complication rates of using different energy sources for partial gland ablation (PGA). Out of the modalities, focal laser ablation showed particular promise. Bianco then explains his experience in a phase 1 trial evaluating MR fusion laser ablation in an office setting. Each laser application takes about four minutes, which is notable compared to the about twenty-minute cryotherapy application time. The space of PGA is currently saturated with literature and ongoing trials. Bianco highlights some of the most compelling data, including early-medium-term outcomes in a cryotherapy study, an outcomes registry of office-based MRI/ultrasound-guided-prostate-cryotherapy showing a a low rate of conversion to surgery or radiation, and a study following PSA levels after hemigland cryoablation. He ends on the optimistic notes that payers are now recognizing prostate cancer focal therapy procedures, and that he is confident when talking to patients about the eradication of their tumors, their quality of life post-procedure, and options for future therapies staying open to them post-procedure.
About The 33rd Annual International Prostate Cancer Update:
The International Prostate Cancer Update (IPCU), founded in 1990, is a multi-day CME conference focused on prostate cancer treatment updates with expert, international faculty. It is led by expert physicians and is designed for urologists, medical oncologists, radiation oncologists, and other healthcare professionals involved in the diagnosis and treatment of prostate cancer. The 33rd iteration of the meeting occurred January 22-25, 2023 in Vail, Colorado. To view more educational presentations from IPCU 33, visit our collection page.
ABOUT THE AUTHOR
Fernando J. Bianco, MD, is the Investigator-in-Chief for the Urological Research Network in Miami. Upon completion of his medical studies at Memorial Sloan-Kettering Cancer Center in New York City, he moved to Washington, DC, to serve as Chief of Urologic Oncology in the George Washington University Department of Urology. Dr. Bianco relocated to South Florida in 2008, serving as Associate Professor of Urology at Columbia University in New York City and as Founder and Director of the Columbia University Division of Urology, as well as Director of Robotic Surgery at Mt. Sinai Hospital in Miami Beach. In 2011, he co-founded the Robotic Surgery Program at Doctors Hospital in Coral Gables, Florida. He also served as Professor of Urology for Nova Southeastern University.
Dr. Bianco is an innovative urological oncologist and robotic surgeon who has conducted more than 12 randomized clinical trials, and who is committed to the best care options for his patients.
Dr. Bianco serves as principal investigator for the Fuse Image MRI-Guided Prostate Cryotherapy Clinical Trial. He has been a pioneer in urologic robotic procedures for cancer patients and in complex robotic reconstructive procedures, and in 2015 was the lead author of the first Level 1 evidence study that evaluated urinary continence outcomes after robotic prostatectomy.
In addition, Dr. Bianco has served as a lead scientist involved in the PRO-IMPACT trial evaluating the molecular profiles of prostate cancers. This represents an important effort supported by the Society of Urological Oncology Clinical Trials Consortium.
Dr. Bianco’s work has been recognized by the American Urological Association, the Society of Urologic Oncology, and the American Society of Clinical Oncology. He has served on the review panel and editorial board of numerous publications, including the Journal of Urology, Urologic Oncology, the Journal of Clinical Oncology, Urology, Cancer, Lancet Oncology, and European Urology.
