Topic: Prostate Cancer

Diet and Prostate Cancer: What We Need to Know to Tell our Patients

Diet and Prostate Cancer: What We Need to Know to Tell our Patients

by | Feb 2025

Stacy Loeb, MD, MSc, PhD (hon), emphasizes integrating dietary and lifestyle modifications into prostate cancer management to improve patient outcomes. In this 21-minute presentation, Dr. Loeb notes that patients with localized disease are more likely to die from cardiovascular causes than prostate cancer itself, highlighting the opportunity to address broader health concerns.

Dr. Loeb introduces the six pillars of lifestyle medicine: whole food, plant-predominant nutrition, physical activity, restorative sleep, avoidance of toxic substances, social connection, and stress management. She emphasizes that plant-based diets, particularly whole foods, and plant-based patterns, reduce the risk of prostate cancer, cardiovascular disease, and erectile dysfunction while promoting environmental sustainability.

Loeb advocates for accessible patient resources, tailored educational materials, and collaboration among healthcare providers to promote these practices. The discussion addresses the importance of patient-centered approaches and the potential role of testosterone management in prostate cancer care.

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Role of Digital Pathology and AI in Improving Diagnostic Accuracy

Role of Digital Pathology and AI in Improving Diagnostic Accuracy

by | Feb 2025

David G. Bostwick, MD, MBA, FCAP, explores the role of artificial intelligence (AI) and digital pathology in advancing diagnostic accuracy in prostate cancer. In this 19-minute presentation, Dr. Bostwick addresses the limitations of using biopsies and radical prostatectomies as the gold standard in prostate cancer diagnosis. Despite its high initial costs and operational challenges, he emphasizes that digital pathology holds transformative potential for standardization and efficiency in pathology practices.

Dr. Bostwick delves into the long-standing application of AI in pathology, highlighting its ability to reduce human workloads. Advances in digital pathology have improved resolution, speed, and data transfer capabilities, enabling better integration of AI tools for detecting and grading cancer.

Dr. Bostwick asserts the future of pathology lies in 3D optical slicing and deep learning algorithms, which allow for precise tumor quantification and three-dimensional reconstructions of tissues. These methods could revolutionize grading systems, offering unparalleled accuracy and data granularity.

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Point Counterpoint: Risk Stratification for Biopsy – Biomarkers

Point Counterpoint: Risk Stratification for Biopsy – Biomarkers

by | Feb 2025

Juan Javier-DesLoges, MD, MS, focuses on contemporary advancements in prostate cancer detection, emphasizing the integration of biomarkers and MRI for biopsy decision-making. In this 5-minute presentation, he references recent guidelines, which advocate biomarkers and MRI as tools for determining the necessity of biopsies. Studies comparing biomarkers such as 4K, PHI, SelectMDx, and XODX illustrate their ability to enhance the specificity and accuracy of cancer detection compared to PSA alone.

Dr. Javier-DesLoges stresses that MRI further refines risk stratification when combined with biomarkers. He underscores the complementary role of these tools, advocating their combined use to optimize diagnostic outcomes for patients with intermediate PSA levels.

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Point Counterpoint: Risk Stratification for Biopsy – MRI

Point Counterpoint: Risk Stratification for Biopsy – MRI

by | Feb 2025

Peter A. Pinto, MD, underscores the evolving role of MRI as a critical biomarker in urologic oncology, particularly for prostate cancer detection, staging, and treatment planning.

In this 12-minute conversation, Dr. Pinto highlights MRI’s unique position as a diagnostic and procedural adjunct, emphasizing its ability to improve biopsy accuracy, reduce over-diagnosis of low-grade cancers, and enhance focal therapy targeting. He shares that MRI provides actionable insights that enhance clinical decision-making by correlating radiologic findings with pathological outcomes. Further, the potential of MRI as a screening tool is explored, with promising advancements in shorter, contrast-free scans. Dr. Pinto also addresses the integration of AI for tumor identification, segmentation, and quality control, presented as a pathway to overcoming these limitations.

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Adaptive Radiotherapy

Adaptive Radiotherapy

by | Feb 2025

In this 23-minute presentation, Richard D. Stock, MD, explores integrating artificial intelligence in radiation oncology, focusing on adaptive radiation therapy (ART). Three categories of ART—offline, online, and real-time—are detailed, explaining their respective timelines, imaging technologies, and resource requirements. The discussion critically evaluates ART in prostate cancer, where anatomical shifts due to bladder or rectal changes can influence treatment accuracy.

Examples of imaging technologies like MRI and PET scans are discussed for their contributions to ART’s precision and potential to adapt treatment based on tumor shrinkage or biological response. Comparative studies from the Netherlands and other institutions demonstrate ART’s ability to refine target margins, decrease normal tissue exposure, and predict patient outcomes more accurately.

As ART shows promise in improving treatment precision, Dr. Stock emphasizes its potential for advancing radiation oncology, driven by technological innovation and ongoing research.

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Starting a Transperineal Prostate Biopsy Program Cost Effective Strategy for Implementation

Starting a Transperineal Prostate Biopsy Program Cost Effective Strategy for Implementation

by | Feb 2025

Richard C. Wu, MD, discusses his innovative approach to enhancing the feasibility and cost-effectiveness of transperineal prostate biopsies, a method recognized for its reduced infection risk and safety advantages over traditional transrectal biopsies.

In this 9-minute presentation, Dr. Wu draws from his research in Michigan and subsequent experiences in Taiwan to address the financial and equipment-related barriers to adopting transperineal biopsy in resource-limited settings. His strategy employs basic equipment to perform free-hand biopsies effectively. He provides a step-by-step overview of his method, including local anesthesia administration, single puncture techniques, and biopsy site targeting, ensuring optimal access to various prostate zones. His approach eliminates the need for expensive alignment systems while maintaining diagnostic accuracy.

Dr. George concludes that his cost-conscious approach makes transperineal biopsies viable in low-resource settings, improving patient outcomes and satisfaction while reducing complications. His work underscores the value of innovative adaptations in global healthcare.

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Point Counterpoint: Is Focal Therapy Ready for Prime Time (No)

Point Counterpoint: Is Focal Therapy Ready for Prime Time (No)

by | Feb 2025

Michael Rothberg, MD, critically examines whether focal therapy for prostate cancer is ready for widespread clinical adoption, emphasizing the need for rigorous evaluation. The 10-minute discussion highlights prostate cancer’s biological complexity, including its multifocal and heterogeneous nature, which challenges the premise of focal therapy targeting the “index lesion.”

Dr. Rothberg underscores significant limitations in current diagnostic tools, particularly MRI and biopsy techniques. Imaging inconsistencies and operator variability reduce the reliability of identifying clinically significant lesions.

Current guidelines from leading organizations like NCCN and AUA do not endorse focal therapy as a standard treatment due to insufficient high-level evidence. Dr. Rothberg cites the lack of randomized controlled trials comparing focal therapy to whole-gland treatments, which leaves gaps in understanding survival and recurrence rates beyond medium-term follow-ups.

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Point Counterpoint: Is Focal Therapy Ready for Prime Time (Yes)

Point Counterpoint: Is Focal Therapy Ready for Prime Time (Yes)

by | Feb 2025

Ruben Olivares, MD, emphasizes the growing momentum of focal therapy in prostate cancer management, urging clinicians to embrace its evolving philosophy. The 9-minute discussion highlights a shift from whole-gland treatment to strategies aimed at cancer control, progression delay, and preserving quality of life.

Dr. Olivares underscores the importance of tailored approaches, utilizing advanced imaging like MRI to localize aggressive lesions. Enhanced biopsy techniques and energy-based modalities offer new avenues for precise and effective treatments. Emphasizing the balance between oncological control and functional preservation, his talk highlights the need for proficiency and sufficient patient volumes to optimize outcomes. Focal therapy is presented as a safe, feasible, and effective strategy with excellent functional and medium-term oncological outcomes, marking it as a critical component of the evolving prostate cancer treatment paradigm.

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Expanding Treatment Options at Ambulatory Surgical Centers: LDR Brachytherapy for Prostate Cancer

Expanding Treatment Options at Ambulatory Surgical Centers: LDR Brachytherapy for Prostate Cancer

by | Feb 2025

H1: LDR Brachytherapy for the Treatment of Prostate Cancer

E. David Crawford, MD, Professor of Urology, University of California, San Diego, California, Mira Keyes, MD, FRCPC, Clinical Professor Radiation Oncology, University of British Columbia, BC Cancer, Vancouver Cancer Centre, Vancouver BC, Canada, and Steven M. Kurtzman, MD, Director of Prostate Brachytherapy, Western Radiation Oncology, Mountain View, California, discuss low-dose rate (LDR) brachytherapy as a treatment for prostate cancer.

H2: Benefits of Brachytherapy for Prostate Cancer

Dr. Crawford explains that brachytherapy gets excellent results in prostate cancer patients across different risk and demographic groups, Gleason scores, and PSA levels. Dr. Keyes then shares the clinical rationale for performing LDR brachytherapy in ambulatory surgical centers (ASC).

H3: Prostate Cancer Treatment Strategies: Benefits of Brachytherapy on Different Risk Groups

Dr. Keyes explains that patients eligible for the low-dose rate brachytherapy, also referred to as seed implants, include all prostate cancer patients. She highlights that hormone treatment duration is significantly shorter when brachytherapy is included in the treatment plan. For example, in high risk prostate cancer patients, randomized controlled trials show that six months of androgen deprivation therapy (ADT) is enough when combined with brachytherapy. Avoiding 12 or 24 months of ADT, which is necessary when external beam radiation is utilized, helps decrease unwanted side effects for patients.

Finally, Dr. Keyes discusses toxicity in brachytherapy treatments and asserts that data cited on this topic often utilize older studies. Dr. Keyes emphasizes considering results from more recent publications.

H4: Expanding Treatment Options at Ambulatory Surgical Centers: LDR Brachytherapy for Prostate Cancer

Next, Dr. Kurtzman discusses how to set up high quality programs in ambulatory surgical centers and his opinion that LDR brachytherapy is an underutilized treatment for prostate cancer. He examines LDR brachytherapy’s high cure rates, low-long term complication rates, convenience for patients, financial benefits, and reasons LDR brachytherapy is not as prevalent.

Additionally, Dr. Kurtzman presents his strategy for bringing prostate brachytherapy programs to communities and reasons to perform it at ASCs, including fostering a genuine collaboration between urologists and radiation oncologists. Overall, he highlights how incorporating LDR brachytherapy into urology practices and ASCs fosters collaboration between urologists and radiation oncologists.

Conclusion

This 20-minute discussion concludes with Dr. Crawford’s comments on the importance of multidisciplinary care for better patient outcomes and strong interdisciplinary collaboration between urologists and radiation oncologists.

Appendix

Dr. Keyes also provided analysis of some recent studies that review:
Results showing 77% of patients in low and intermediate risk groups have PSA equal to or less than 0.2 five years after treatment with 1-2% recurrence, suggesting brachytherapy is very consistent with very low risk of prostate cancer recurrence
The ASCENDE RT trial that compared external beam radiation and LDR brachytherapy boat or dose-escalated external beam boost, and LDR boost in intermediate and high risk patients. Trial results showed a huge difference in PSA outcomes
If hormone treatment is needed for high risk prostate cancer patients who are also treated with external beam radiation with brachytherapy boost
Outcomes of intermediate and high risk patient groups treated with brachytherapy versus radical prostatectomy that showed positive outcomes for patients treated with brachytherapy, particularly in high risk groups
A study evaluating outcomes of patients with very high risk groups with Gleason 9 and 10 treated with prostate brachytherapy boost, external beam radiation, or prostatectomy. The study showed very favorable outcomes for patients treated with brachytherapy

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