Topic: Localized Disease

Prostatectomy: What is the Future?

John F. Ward, MD, FACS discusses patient selection in definitive prostate cancer treatment and avoiding over and undertreatment. He then analyzes the impact of the evolving United States Preventive Services Task Force (USPSTF) recommendations for PSA screening on prostate cancer incidence, over and undertreatment, and amount of biopsies performed in urologic practice.

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Long-Term Outcomes of HDR

Juanita M. Crook, MD, FRCPC, reviews the radiobiologic rationale for high-dose-rate brachytherapy (HDR BT), its technical advantages, the evolution of HDR fractionation, and recent toxicity reports for both HDR BT boost and HDR BT monotherapy according to prescribed dose and fractionation.

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Minimizing Morbidity and Maximizing Outcomes with ADT

Laurence Klotz, MD, FRCSC, discusses causes of adverse effects of androgen deprivation therapy (ADT) treatment for prostate cancer and approaches to reducing these side effects. Specifically, Dr. Klotz advises physicians about patient counseling, prescribing innocuous drugs like bisphosphonates and metformin, targeting the adrenal pathway, and utilizing intermittent ADT.

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Focal Brachytherapy

Juanita M. Crook, MD, FRCPC, argues that focal brachytherapy is one of the most effective and least invasive treatments for prostate cancer. She discusses patient selection for focal therapy, technical limitations, efficacy data, and best practices in post-focal-therapy monitoring.

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Focal Cryotherapy

John F. Ward, MD, FACS, analyzes the evolution of organ preservation and focal therapy in the past fifteen years, from a random systematic biopsy approach to the introduction of multiparametric MRI (mpMRI) imaging. He then discusses the possibility of using focal cryotherapy as part of a multimodal strategy with immunotherapy.

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Preserving Erectile Function After Radiation and Surgery

Mohit Khera, MD, MBA, MPH, the secretary of the Sexual Medicine Society of North America, explains the importance of implementing penile rehabilitation and erectile preservation programs early following radical prostatectomy (RP). He reviews the literature regarding PDE5 inhibitors, followed by vacuum erection devices (VED), intracavernosal injection therapy, and urethral suppositories. Furthermore, he discusses the possibility of adopting adipose-derived stem cells and shockwave therapy in this setting.  

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Adjuvant or Salvage RT Post-Radical Prostatectomy

Seth R. Blacksburg, MD, MBA, discusses the clinical significance of biochemical failure post-radical prostatectomy (RP). He then reviews the literature comparing the advantages and disadvantages of adjuvant and salvage radiation therapy (RT) for biochemical recurrence. Furthermore, he summarizes consensus guidelines, meta level considerations and debates regarding adjuvant and salvage RT, and prospective trials.

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AUA/ASTRO/SUO Guidelines on Clinically Localized Prostate Cancer

Riccardo Autorino, MD, PhD, FEBU, summarizes the American Urological Association (AUA), the American Society for Radiation Oncology (ASTRO), and the Society of Urologic Oncology (SUO) guidelines on clinically localized prostate cancer. Specifically, he highlights recommendations on shared decision making, risk stratification to dictate the therapy, care options, active surveillance, and directions for future research.

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Management of Post Prostatectomy Vesicourethral Stenosis

Chris Gonzalez, MD, MBA, FACS, discusses incision and dilation options for vesicourethral anastomotic stenosis (VUAS) following radical retropubic prostatectomy (RRP). Specifically, he reviews the efficacy and safety of using cold knife, electrocautery, laser ablation, and mitomycin C in this setting. He cites the 2016 American Urological Association (AUA) urethral strictures guidelines during his analysis.

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Is Focal Ablation of Prostate Cancer Ready for Prime Time?

Herbert Lepor, MD, defines focal ablation and its quality of life, oncological, and cost benefits to patients. He then discusses best practices for the procedure, including optimal patient selection, energy source options, and extent of the ablation zone. Furthermore, he explains the research and improvement needed to make focal ablation of prostate cancer ready for prime time.

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