Radiation Oncology Perspective: Image-Guided Metastasis-Directed Therapy

Posted by Steven E. Finkelstein, MD, FACRO | Sep 2021

Steven E. Finkelstein, MD, FACRO, presented “Radiation Oncology Perspective: Image-Guided Metastasis-Directed Therapy” during the 31st International Prostate Cancer Update in July 2021 in Snowbird, Utah.

How to cite: Finkelstein, Steven E. “Radiation Oncology Perspective: Image-Guided Metastasis-Directed Therapy.” July 2021. Accessed Apr 2024. https://grandroundsinurology.com/radiation-oncology-perspective-image-guided-metastasis-directed-therapy/

Radiation Oncology Perspective: Image-Guided Metastasis-Directed Therapy

Steven E. Finkelstein, MD, FACRO, radiation oncologist with Florida Cancer Affiliates in Panama City, Florida, discusses 3 unique cases of recurrence after robotic-assisted laparoscopic radical prostatectomy and bilateral pelvic lymphadenectomy and their clinical management from a radiation oncology perspective. He introduces the first case of a patient with a PSA of 5.4 ng/mL and a Gleason score of 5+4 at the time of initial diagnosis. Dr. Finkelstein states that the recurrence became apparent once the patient’s PSA rose from .15 to .9 and a negative bone scan led to the initially planned treatment of post-prostatectomy radiotherapy (XRT). He explains that next-generation imaging (NGI) was then ordered and showed increased tracer uptake in an area of the left pelvis, leading the patient to begin a course of intensity-modulated radiation therapy and daily image-guided radiation therapy (IGRT). Dr. Finkelstein then moves on to the second patient, who had a PSA of 4.4 ng/mL and a Gleason score of 4+4 initially and whose recurrence was identified once their post-treatment PSA rose from .25 to 1. He describes how a negative bone scan led to initially planning a post-prostatectomy XRT, but when NGI found a sclerotic lesion in the middle right iliac bone, his treatment changed to stereotactic body radiation therapy (SBRT). Dr. Finkelstein then introduces the final patient, who had a PSA of 4.4 ng/mL and a Gleason score of 4+4 and whose recurrence was identified once their post-treatment PSA of .25 increased to 1. He states that, again, a negative bone scan led to planning post-prostatectomy XRT for the patient. NGI proved that XRT would have been insufficient by identifying a sclerotic lesion in the middle right iliac bone and 5 other bone metastases. Dr. Finkelstein concludes by noting that, due to NGI, the patient also received SBRT.

About The 31st 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. Dr. Finkelstein delivered this educational activity during the 31st iteration of the meeting in July 2021 in Snowbird, Utah.

About The Author

Steven E. Finkelstein, MD, FACRO

Steven E. Finkelstein, MD, FACRO, is a radiation oncologist with Florida Cancer Affiliates in Panama City, Florida. He has served as a Co-Chair on the NRG Immunotherapy Committee, Co-Chair of the 2018-2019 ACRO Scientific Program Committee, and Chair of the SWOG Radiation STG Committee. He currently serves on the Board of Chancellors for ACRO. Dr. Finkelstein has also served as National Director of Translational Research Consortium (TRC), the cutting-edge therapy arm of 21st Century Oncology in Scottsdale, Arizona. Inspired by his grandmother, a cancer patient, he became a dedicated cancer surgeon who found that radiation therapy could sometimes do for his patients what surgery could not. Dr. Finkelstein received his medical degree from the University of Michigan Medical School. He served a residency in General Surgery at Washington University in Saint Louis, Missouri, and was Chief Resident in Radiation Oncology at the Moffitt Cancer Center in Tampa, Florida. Dr. Finkelstein also served fellowships in Biologic Immunotherapy, Clinical Cancer, and Surgical Oncology at the Surgery Branch of the National Cancer Institute in Bethesda, Maryland. He is a member of the American College of Radiation Oncology, the American Medical Association, the American Society of Clinical Oncology, the American Society for Therapeutic Radiology and Oncology, the Radiological Society of North America, and the Radiation Therapy Oncology Group.

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