Wei-Wen Hsu’s research while affiliated with University of Cincinnati Medical Center and other places

Focal Therapy (FT) is an emerging treatment modality for prostate cancer (PCa). Due to its novelty, the research exploring how patients should be followed-up after treatment is limited. There is currently no established role for non-prostate-specific-antigen (PSA) biomarkers and PSMA PET. However, a combination of PSA testing, multiparametric magnetic resonance imaging (mpMRI), and systematic and targeted biopsies should routinely be used for surveillance after FT. PSA values that rise 1.0 ng/mL over the nadir after twelve months or rise 1.5 ng/mL over nadir after twenty-four to thirty-six months should raise suspicion for recurrence. The standard imaging technique is mpMRI, but it can often be difficult to interpret after FT, so using a scoring system such as prostate imaging after focal ablation (PI-FAB) or the transatlantic recommendations for prostate gland evaluation with magnetic resonance imaging after focal therapy (TARGET) allows for greater consistency between readers. This review seeks to summarize the current literature regarding surveillance after FT as it relates to biomarkers, imaging, biopsies, and consensus statements.

Background: Prostate cancer (PCa) diagnosis remains a complex field of study. Multiparametric magnetic resonance imaging (mpMRI) technology presents opportunities to enhance diagnostic precision. While recent advances in imaging and biopsy techniques show promise, the oncological implications of prebiopsy magnetic resonance imaging (MRI) and combination biopsy (ComBx) are not fully understood. This retrospective study evaluates the potential clinical impact of prebiopsy MRI and ComBx on PCa treatment outcomes. Methods: We conducted a comprehensive review of treatment-naïve patients undergoing prostate biopsy and subsequent radiation therapy (RT) or radical prostatectomy at the University of Cincinnati Health Center (2014–2020). Patients were categorized into two cohorts: those with prebiopsy mpMRI and ComBx versus those with systematic biopsy (SBx) alone. Patients with prostate-specific antigen (PSA) > 20 ng/mL were excluded. Biochemical recurrence (BCR) was defined as PSA ≥ 0.2 ng/mL post-prostatectomy or ≥2 ng/mL above nadir post-RT. Results: This study included 518 patients (189 SBx, 329 ComBx) with a median follow-up of 19.1 months. Median patient ages were 65.9 years (SBx) and 64.6 years (ComBx). The overall BCR rate was 10% with significantly lower rates in the ComBx group compared to SBx (6.4% vs. 16.4%, p < 0.001). Multivariable Cox regression analysis showed patients undergoing prebiopsy mpMRI with ComBx were 63% less likely to experience BCR (HR: 0.37, 95%CI 0.20–0.70, p = 0.002). Conclusions: Prebiopsy MRI followed by ComBx demonstrated lower BCR rates, suggesting improved PCa diagnosis and risk stratification. These findings highlight the potential of advanced imaging and biopsy techniques to benefit the management of PCa. Further longitudinal studies are needed to confirm the long-term clinical benefits of this approach.

Introduction Focal therapy (FT) is emerging as an alternative to radical treatment for prostate cancer (CaP). The purpose of this study is to assess the current perceptions of FT amongst urologists. Methods A 22-item questionnaire was e-mailed to members of the American Urological Association. Multivariate logistic regression analysis was used to identify predictors of FT utilization. Results were compared to a previous survey from 2019. Results Two hundred and sixty-four responses were recorded. Less than half (115/264, 43.6%) of respondents utilize FT; among them, 42% perform FT on more than 10 patients/year. Reasons for avoiding FT included: lack of experience (51.8%), belief that CaP is multifocal (46.0%), and lack of infrastructure (43.1%). The most common modalities for FT were high-intensity focused ultrasound (63.4%) and cryoablation (47.3%). Preferred patients for FT were primarily unilateral/anterior only Gleason Grade Group 2 (95/110, 86.4%). A fellowship training in urologic oncology (odds ratio [OR] = 2.86, P = 0.008) and seeing more than 10 CaP patients per month (OR = 2.46, P = 0.002) were associated with greater utilization of FT. Most respondents (85.4%) cited better imaging methods as a factor that has increased FT utilization. Compared to a previous survey, a higher number of respondents (43% vs. 24%) utilize FT and more respondents believe in the “index lesion theory.” Conclusions Less than half of the respondents utilize FT in their practice. Fellowship training in urologic oncology and a higher volume of CaP patients were correlated with FT utilization. As urologists gain more experience, the trend of further utilization of FT for CaP may continue.