Herbert Lepor, MD, presented “Optimal Surveillance Algorithm Following Focal Therapy of Prostate Cancer” during the 2024 Frontiers in Oncologic Prostate Care and Ablative Local Therapy symposium on October 17, 2024, in San Diego, California.
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How to cite: Lepor, Herbert. “Optimal Surveillance Algorithm Following Focal Therapy of Prostate Cancer.” October, 2024. Accessed Jan 2025. https://grandroundsinurology.com/optimal-surveillance-algorithm-following-focal-therapy-of-prostate-cancer/
Optimal Surveillance Algorithm Following Focal Therapy of Prostate Cancer – Summary
In this 13-minute presentation, Herbert Lepor, MD, focuses on the development and implementation of an evidence-based surveillance algorithm following focal therapy for prostate cancer. Dr. Lepor highlights the fundamental role of longitudinal PSA testing, imaging, and biopsy in monitoring patients. Key findings from his cohort of over 500 patients include:
- PSA Trends as Predictors: Longitudinal consecutive PSA rises are the strongest predictors of clinically significant recurrence.
- MRI Utility: Positive MRIs are associated with a 30-40% likelihood of detecting cancer, but the overall frequency of positive MRIs remains low, justifying their use selectively.
- Biopsy Strategies: The cohort’s data indicate that systematically performing biopsies patients with negative MRIs yields low detection rates, and most findings represent low-volume or less concerning disease.
Dr. Lepor concludes that the current algorithm incorporates PSA testing, selective MRI, and biopsy based on imaging or PSA trends, reducing unnecessary procedures while maintaining effective cancer surveillance. However, further data, especially at the five-year mark, are needed to refine this approach further. This pragmatic and evolving strategy balances oncologic safety with patient quality of life.
Frontiers in Oncologic Prostate Care and Ablative Local Therapy (FOCAL) is an outstanding program on prostate imaging, transperineal interventions, and ablative treatments for prostate cancer and benign prostatic hyperplasia. Bringing together community-based, academic, and industry partners, FOCAL offers lectures by world-renowned faculty and hands-on training workshops on in-office transperineal interventions, fusion-guided prostate ablation and state-of-the-art BPH management with novel technologies.
ABOUT THE AUTHOR
Herbert Lepor, M.D. received his undergraduate degree from the University of California Los Angeles in 1975 and his doctor of medicine from The Johns Hopkins University School of Medicine in 1979. Dr. Lepor completed his surgery and urology residency training at The Johns Hopkins Hospital.
In 1993, Dr. Lepor was appointed Professor and Chairman of the Department of Urology, NYU School of Medicine and Professor of Pharmacology at NYU School of Medicine. Dr Lepor is presently Urologist in Chief at NYU Langone Medical Center and the “Martin Spatz Chairman of the Department of Urology” Dr. Lepor’s primary clinical and basic research interests are related to the prostate.
Dr. Lepor has served on the editorial boards for four major urological journals and has authored over 350 peer reviewed articles, 50 book chapters, and 12 books related to prostate cancer, benign prostatic hyperplasia, and the pharmacology of the prostate. He is the co-founder and editor of Reviews in Urology. Dr. Lepor has been a visiting professor at 30 institutions. Some of Dr. Lepor’s landmark scientific contributions have focused on the identification of the autonomic intervention regulating male sexual function, development of the nerve sparing radical prostatectomy, improving outcomes following radical retropubic prostatectomy, characterization of the prostate alpha1adrenoceptor, and the medical and surgical management of benign prostatic hyperplasia.
In 1995, Dr. Lepor was awarded the Gold Cystoscope Award by The American Urological Association. Dr. Lepor is a member of the American Association of Genitourinary Surgeons, Clinical Society of the American Association of Genitourinary Surgeons, the American Surgical Association, and the Johns Hopkins University Society of Scholars.
