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3D Prostate Mapping Biopsies

3D Prostate Mapping Biopsies. HAS A SIGNIFICANT IMPACT ON PROSTATE CANCER MANAGEMENT GARY ONIK MD MATTHEW MIESSAU DAVID BOSTWICK MD. TRUS BX-Gold Standard Staging of PCa. TRUS Bx highly inaccurate for staging Accurate stage and grade, effects therapeutic decisions Watchful waiting

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3D Prostate Mapping Biopsies

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  1. 3D Prostate Mapping Biopsies HAS A SIGNIFICANT IMPACT ON PROSTATE CANCER MANAGEMENT GARY ONIK MD MATTHEW MIESSAU DAVID BOSTWICK MD

  2. TRUS BX-Gold StandardStaging 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 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 • 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. 2008 Jul 15;71(4):1028-33. • 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 • 74 yr old • PSA=200 ng/ml • Gleason 10 • 12 months, CHT resistant • 4 yrs Post op • PSA undetectable off CHT 3 yrs P/O

  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=120 1-13 year F/U

  13. Focal Therapy Results 100% local control, 8 patients retreated

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

  15. FOCAL THERAPY MORBIDITYN=120 • 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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