Debate: Can Focal Therapy Replace Prostatectomy in Men with Localized, Clinically Significant Lesion and a Negative Standard Biopsy
A debate was held on 19 Februay 2021 on the treatment of Focal Therapy vs Radical Prostatectomy. Dr Peter Carroll presented for Radical Prostatectomy while Dr Mark Emberton presented for Focal Therapy. Please watch below for their engaging presentations.
Dr Peter Carroll for Radical Prostatectomy
Dr Mark Emberton for Focal Therapy
Patient Selection for Focal Therapy: What is an Optimal Biopsy Strategy?
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.
Kae Jack Tay, 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.
HIFU: The European Experience
Rafael Sanchez-Salas, MD, attending surgeon at L’Institut Mutualiste Montsouris in Paris, France, and member of the Focal Therapy Society, discusses high-intensity focused ultrasound treatment (HIFU) in the context of the European experience with focal therapy. He gives an overview of the 18 current registered clinical trials in Europe focused on HIFU, highlighting that the large majority involve only minor reported complications. Dr. Sanchez-Salas also looks at the intermediate outcomes, concluding that HIFU shows promise for lowering PSA. He also notes that improved procedural controls have led to some groundbreaking technological development. Overall, Dr. Sanchez-Salas argues that the European experience with HIFU includes some of the most relevant advances in the field of focal therapy.
Rafael Sanchez-Salas, MD, presented “HIFU: The European Experience” for the Grand Rounds in Urology audience in August 2020.
Sanchez-Salas, Rafael. “HIFU: The European Experience” August 2020. Accessed Nov 2020. https://grandroundsinurology.com/hifu-the-european-experience/