Dr Olivares on the Functional Advantages of Focal Therapy in Prostate Cancer

Ruben Olivares, MD, urologic surgeon, associate professor, Urology, Glickman Urological Institute, Cleveland Clinic, discusses the functional advantages of using focal therapy over localized radiation in prostate cancer, as well as the use of failure-free survival (FFS) as a surrogate end point for evaluating survival outcomes with this approach.

The primary distinction between localized radiation and focal therapy for prostate cancer lies in the guidance used to deliver the treatment, Olivares begins. Focal therapy employs advanced fusion imaging capabilities that provide precise anatomical guidance, allowing for the targeted delivery of energy to specific areas of the prostate, he explains. This method enables clinicians to accurately map the area that will be affected by the energy, using probes or needles to delineate the outer layer of energy reach, Olivares adds.

Clinical data suggest that focal therapy has favorable functional outcomes, particularly in terms of minimizing the risk of erectile dysfunction and urinary incontinence, despite the use of high-energy modalities, he continues. These outcomes are especially relevant when considering the treatment’s impact on quality of life. However, to comprehensively evaluate the effectiveness of focal therapy, long-term oncological outcomes such as overall survival (OS) are crucial, Olivares emphasizes.

Prostate cancer is characterized by its slow progression, making it challenging to obtain OS data within a short timeframe, he notes. The disease's indolent nature means that it may take 30 to 40 years of follow-up to gather reliable OS data for patients undergoing focal therapy, Olivares states. As a result, researchers currently rely on alternative end points such as FFS and metastasis-free survival (MFS) to assess the efficacy of focal treatments.

FFS measures the time during which a patient remains free from treatment failure, while MFS tracks the period without the development of metastasis, Olivares clarifies. Both metrics are increasingly accepted as surrogate end points for OS, given their correlation with long-term outcomes. Evidence from other slow-growing tumors suggests that FFS and MFS may be reliable indicators of OS, providing a promising outlook for the continued use of focal therapy in managing prostate cancer, he concludes.

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Ruben Olivares, MD, discusses the functional advantages of using focal therapy over localized radiation in prostate cancer.
 

Dr Olivares on Considerations for Managing Prostate Cancer in the Community Setting

Ruben Olivares, MD, urologic surgeon, associate professor, Urology, Glickman Urological Institute, Cleveland Clinic, discusses considerations for managing prostate cancer in the community setting, particularly regarding early detection and screening.

Community-based oncologists play a vital role in early prostate cancer detection, especially through prostate-specific antigen (PSA) screening, Olivares begins. PSA screening remains crucial in reducing mortality, particularly in high-risk populations, such as African American men, who have a higher incidence and mortality rate from prostate cancer, he explains. African American men are 1.7 times more likely to be diagnosed with, and 2.1 times more likely to die from, prostate cancer than White men.

Early detection of prostate cancer increases the likelihood of offering less invasive treatments that reduce adverse functional outcomes, Olivares reports, adding that prompt referral to a urologist is critical, especially for patients with elevated PSA levels or other concerning symptoms. Once an abnormality is detected through PSA screening, Olivares advises referral to a urologist for further diagnostic evaluation, such as prostate MRI or biopsy. This approach ensures accurate staging and risk stratification of the disease, enabling more tailored treatment strategies.

Olivares goes on to state that, in the community setting, where access to advanced diagnostic tools and multidisciplinary care may be more limited than in academic centers, early referral pathways ensure that patients benefit from comprehensive management. This again emphasizes the importance of early intervention, as it may lead to a higher likelihood of curative treatment and potentially avoid the need for more radical interventions, which are often associated with greater morbidity, he emphasizes.

Providing a continued emphasis on early detection, advocating for the appropriate use of PSA screening, and prompt referrals for further evaluation are crucial for optimizing prostate cancer care in the community setting, Olivares concludes. This approach enhance accurate diagnoses and broaden the selection of treatment modalities that balance oncologic control with the preservation of quality of life.

Ruben Olivares, MD, discusses considerations for managing prostate cancer in the community setting, particularly regarding early detection and screening.

Ruben Olivares, MD, discusses the evolving role for focal radiation therapy in the management of prostate cancer.

Dr Olivares on the Use of Focal Therapy in Localized Prostate Cancer

Ruben Olivares, MD, urologic surgeon, associate professor, Urology, Glickman Urological Institute, Cleveland Clinic, discusses the evolving role of focal radiation therapy in the management of localized prostate cancer, highlighting its optimal use according to risk factors and patient characteristics. 

By precisely targeting and ablating cancerous tissue while preserving surrounding healthy tissue, focal treatment offers a promising approach to reduce metastatic spread and mortality associated with prostate cancer, Olivares begins. One of the key advantages of focal treatment is its ability to utilize various sources of energy, Olivares states. This includes thermal energy and non-thermal methods like irreversible electroporation (IRE), also known as NanoKnife, he expands. These technologies enable targeted destruction of prostate cancer cells, offering patients a less invasive treatment option with potentially fewer toxicities compared with traditional therapies such as radical prostatectomy or irradiation, Olivares explains.

However, patient selection is crucial for the success of focal treatment, Olivares continues. Candidates for this approach must have clear, visible lesions on MRI scans that correspond to biopsy-confirmed areas of cancer, he states. Patients with unilateral cancer and clear, visible lesions on MRI scans corresponding to biopsy-confirmed cancer areas are often preferred candidates for focal treatment, he details.

When understanding the consideration of focal treatment, it is essential to consider the need for more long-term follow-ups, Olivares emphasizes. Although the feasibility of focal treatment has been substantiated with 15 years of follow-up data, it's important to acknowledge that traditional treatments like radical prostatectomy or irradiation have longer-term data spanning up to 34 years, he notes. Therefore, it is important to weigh the potential benefits and risks of focal treatment against established standards of care, considering factors like treatment efficacy, adverse effects, and quality of life, Olivares concludes.

Ruben Olivares, MD,

Articles

Dr Olivares on the Functional Advantages of Focal Therapy in Prostate Cancer

Dr Olivares on Considerations for Managing Prostate Cancer in the Community Setting

Dr Olivares on the Use of Focal Therapy in Localized Prostate Cancer