Kae Jack Tay, MBBS, MRCS, MMed, MCI, FAMS, presented “Patient Selection for Focal Therapy: What is an Optimal Biopsy Strategy?” for the Grand Rounds in Urology audience in November 2020.
How to cite: Tay, Kae Jack. “Patient Selection for Focal Therapy: What is an Optimal Biopsy Strategy?” November 2020. Accessed Dec 2024. https://grandroundsinurology.com/patient-selection-for-focal-therapy-what-is-an-optimal-biopsy-strategy/
Summary:
Kae Jack Tay, MBBS, MRCS, MMed, MCI, FAMS, Director of Urologic Oncology and Consultant Urologist at the Singapore General Hospital, discusses how and why to combine biopsies when determining patient suitability for focal therapy. He reviews the evidence guiding patient selection and how to achieve success through focal therapy, and argues that both systematic and fusion biopsies are necessary. Successful focal therapy requires accuracy in staging, grading, and intra-prostatic position determination, as well as the ability to ablate the lesion with a low rate of complications while preserving sexual and urinary function and also detecting recurrences. Dr. Tay reviews trials demonstrating the superiority of MRI-fusion biopsy to standard TRUS-biopsy, noting however that MRI has significant false positives. Research indicates that fusion biopsy alone misses 5-10% of clinically significant prostate cancer and that systematic biopsy can help make up this difference. Dr. Tay concludes that while MRI is the imaging modality of choice, confirmation of clinically significant disease through targeted biopsy is critical. Moreover, the number of cores taken will vary based on the patient and further research may determine how many cores are sufficient.
ABOUT THE AUTHOR
Dr. Tay is Director of Urologic Oncology and Consultant Urologist at the Singapore General Hospital. He is also Adjunct Assistant Professor at the Duke-NUS Graduate Medical School. He graduated from urology residency at the Singapore General Hospital in 2014 with the College of Surgeons Gold Medal and obtained a Master of Clinical Investigation at the National University of Singapore that same year with a research thesis on the use of MRI-guidance in robotic biopsy of the prostate. In 2016 Dr. Tay was a Society of Urologic Oncology Fellow at Duke University, North Carolina with a clinical focus on complex resections of genitourinary (GU) cancers and a research focus on the areas of prostate cancer risk stratification, advanced imaging, biopsy, active surveillance, cryotherapy, and focal therapy under the mentorship of Dr. Thomas J. Polascik.
Dr. Tay has written more than 50 publications on the topic of cancer and collaborates on several international multicenter projects including the Cryo On-Line Data (COLD) registry and the Shared Equal Access Regional Cancer Hospital (SEARCH) database. He has participated in several international consensuses including the International Consultation of Urological Diseases (ICUD) consensus on follow-up surveillance after prostate focal therapy (2015) and international consensus on Patient Selection for Prostate Focal Therapy (2016 and 2019). Currently, he is the Principal Investigator of a Phase II trial for focal cryotherapy in localized prostate cancer at the Singapore General Hospital. Dr. Tay aims to develop better risk stratification methods for prostate cancer and a modern approach to prostate cancer active surveillance.
