Prevent and manage complications and recurrence of focal therapy (FT) for prostate cancer.
Discuss concept, rationale, indications, contraindications and limitations of FT.
Classify patient selection and maximizing chances of success.
Classify energy/technique and technology selection.
Explain how to troubleshoot intraoperative issues and how to provide postoperative care
Assess how to follow up focal therapy.
Discuss the role of imaging and PSA on recurrence, recurrence definitions, and functional and oncologic outcomes.
Determine the salvage options and outcomes if focal therapy fails.
Determine the role of focal therapy as salvage treatment after radiation therapy.
Description: To present and discuss the several aspects of focal therapy (FT) for prostate cancer (PCa) focusing on preventing and managing complications and PCa recurrence. Understanding concept, rationale, indications, contraindications, patient selection and limitations of FT. How to avoid complications and troubleshoot intraoperative issues? How to follow up? The role of imaging and prostate specific antigen (PSA) on recurrence, recurrence definitions, functional and oncological outcomes. Predictors for failure, long-term outcomes and comparison to radical treatment will be discussed. Salvage options and outcomes of FT failures and the role of FT as salvage treatment after radiation therapy will be explored.
Index cases and data will be presented such that the following issues will be discussed: a. Concept of FT: rationale and definitions. b. Technologies: understanding the different technologies, mechanism of action (tissue damage) and how they destroy cancer cells. How to match the adequate treatment/technology to cancer characteristics, patient characteristics and surgeon expertise. Different technologies will be presented: high intensity focused ultrasound (HIFU; transrectal magnetic resonance imaging [MRI]-guided), cryoablation, irreversible electroporation (IRE), focal laser ablation (FLA), microwave, vascular targeted photodynamic (VTP)/(photodynamic therapy (PDT). c. Patient selection: indications, contraindications and limitations: prostate size, calcifications, disease burden, rectal/anal stenosis. The role of imaging on patient selection multiparametric (mp)-MRI, MRI/transrectal ultrasound (TRUS) fusion biopsy, mp-TRUS, positron emission tomography (PET)-computerized tomography (CT). d. Preoperative: patient preparation, bowel preparation, antibiotics, need for transurethral resection of the prostate (TURP). e. Ablation techniques: experts who are familiar with several devices available in the market will address differences between the systems and show techniques on how to perform ablation. Machine/device set-up, intraoperative troubleshooting, pearls, and tips and tricks will be addressed. f. Safety margins for ablation: image-guided surgery using imaging fusion systems to FT and ensure oncologic margins for ablation. g. Complications: how to prevent/minimize and manage complications: urinary retention, infection, bladder neck contracture, rectal injury and fistulas. This will be a keystone of the course. h. Follow up: How to follow up, currently available/validated follow up protocols. PSA, MRI, biopsies, when and how often. i. Oncologic outcomes: outcomes of FT: negative biopsy, absence of significant cancer on biopsy, avoidance of radical treatment and its inherent side-effects, metastases-free, survival. j. Local recurrence: the role of imaging on local recurrence. Definition of local recurrence by mp-MRI. The role of PSA and PSA kinetics on follow up, biochemical recurrence definitions: Astro, Phoenix, Stuttgart. k. How to treat local recurrence: redo FT, salvage radical prostatectomy, androgen deprivation therapy (ADT), radiation therapy. This will be a keystone of the course. l. Functional outcomes: validate questionnaires and data on quality of life, continence and potency post FT. m. Special issue: salvage FT after radiation therapy n. Clinical trials: published and current clinical trials on FT in Europe and U.S./North America. o. Future directions: emerging techniques and technologies of FT will be discussed.