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3D Prostate Mapping Biopsies

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Presentation on theme: "3D Prostate Mapping Biopsies"— Presentation transcript:

1 3D Prostate Mapping Biopsies

2 TRUS BX-Gold Standard Staging of PCa
TRUS Bx highly inaccurate for staging Accurate stage and grade, effects therapeutic decisions Watchful waiting Choice of radiation therapy/brachytherapy alone Addition of CHT to radiation Suitability for RP Appropriateness of focal therapy “lumpectomy”

3 3D Mapping Biopsies/Technique

4 CD-US false negative Bilateral Gleason 8 Normal CD-US 54 yr old
Gleason 6, 1mm, Rt side One year WW Bilateral Gleason 8

5 Increasing Stage 60 yr old PSA 5.3, T1c TRUS bx, 1.3 mm, 1 core, left
Gleason 6 Considering WW 3D PMB 78 cores 14 cores positive bilat I one, cancer into fat T3

6 3D Mapping-Results Bilateral cancer, (55%)
N=180 all previous TRUS bx, ALL positive only one side TRUS BX 3D-PMB shows that: Bilateral cancer, (55%) Increased Gleason score (22%) Over 70% would have management changed Morbidity- hematuria (1.2%), retention (7%)

7 Focal Therapy for Prostate Cancer
The Male Lumpectomy

8 Local Control of PCa Matters!!!!
Accepted Theory-Mets already present LOCAL CONTROL DOES NOT CHANGE SURVIVAL Recent evidence to the contrary Zelefsky MJ et al. “Higher radiation dose levels (better local control) improved biochemical tumor control and decreased risk of distant metastases.” Int J Radiat Oncol Biol Phys Jul 15;71(4): Trock et al. “Salvage radiotherapy (better local control) administered within 2 years of biochemical recurrence was associated with a significant increase in prostate cancer-specific survival.”

9 Focal Therapy and Local Control
Hypothesis: Focal Therapy with Cryo Provides better local control than RP or Rad Superior treatment of ECE Only treatment that can be repeated Treatment rad failures Achieved with significantly lower morbidity.

10 Superiority of Local Control-ECE
3 yrs P/O PSA=200 ng/ml 74 yr old Gleason 10 12 months, CHT resistant 4 yrs Post op PSA undetectable off CHT

11 Superiority of focal Therapy/Retreatment
52 yr old, 6/2002, PSA 6.3, G6 left gland, Re TRUS bx rt side negative, left hemi cryo, PSA stable 6 years then rise, Mapping bx +, retreat, PSA .4 stable

12 Risk level N= year F/U

13 100% local control, 8 patients retreated Focal Therapy Results Total
Risk Level N= ASTRO Pheonix Rad failure 11 2 (81%) Total 120 8 (93%) 7 (94%) 100% local control, 8 patients retreated

14 Male Lumpectomy Results
high RP/45% Lodde M, et al

CONTINENCE 100% POTENCY 85% Reproduced 2 published studies

16 CONCLUSION In the patients who need treatment the most Focal therapy provides better local control of prostate cancer. This will translate into improved survival Focal therapy, promises better cancer results with lower morbidity It is now an obligation of the medical community to produce a randomized trial comparing focal ablation to Robotic RP

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