When to Opt for Focal vs Radical Interventions in Localized Prostate Cancer

In an interview with CancerNetwork, Mina Fam, MD, medical director of Urologic Oncology at Jersey Shore University Medical Center and of Robotic Surgery at Ocean University Medical Center, as well as a urologic oncologist in the Hackensack Meridian Health system, identified imaging and genomic modalities to help inform his use of high-intensity focused ultrasound vs more radical alternatives, such as surgery or radiation, to treat patients with localized prostate cancer.

Regarding his use of imaging, he explained that a “well-defined” MRI can be used to find visible lesions consistent with biopsy-proven cancer, which allows for confident treatment of index lesions with focal therapies to confer optimal outcomes. Next, he explained that he uses genomic testing as a means of safety, to confirm a patient’s ability to achieve a response with focal therapy. For those who may not be, he expressed that they undergoing counseling for salvage therapy, particularly whole gland surgery or radiation.

Transcript:

In terms of imaging, MRI is the mainstay of how we determine if a patient’s a candidate for focal therapy, or HIFU focal therapy, and what we’re really looking for is a well-defined MRI visible lesion that’s consistent with the area of biopsy-proven cancer. That allows us to treat an area focally with HIFU with confidence that we’ll be able to treat the higher risk or the index lesion, if you will, and to make sure that that therapy is effective and has good oncological outcomes.

In terms of genomic testing, I use it as more of a safety check and to determine whether my patient is a candidate for focal therapy. An example being, [if] you have a patient who you think is candidate for focal therapy, but you get a genomic marker that may say the patient’s higher risk than we believe. That patient may be counseled that they have a higher risk of recurrence or a higher risk that they would need salvage therapy, and they may elect for doing more whole gland therapy, such as surgery or radiation. By the same token if the patient’s on the fence of whether to be on surveillance vs receiving focal therapy or more advanced therapy, the genomic test can help guide us towards surveillance vs one of those therapies.