Prostate Cancer Focal Therapy: A Novel

Treatment for Select Patients

Behfar Ehdaie, MD, MPH

Department of Surgery,
Urology Service
Department of Epidemiology
and Biostatistics

Memorial Sloan Kettering

Cancer Center
 Disclosures
P.I. Multicenter Clinical Trial (no salary support), InSightec
A

B
This talk will outline the role of focal therapy in
the treatment of prostate cancer

Who? What? How?

Data? Outcomes?

Future studies
Trends in Cancer Incidence and Death Rates
Among Males, United States, 1930 to 2016
Biopsy pathology primary Gleason grade is
prognostic of disease recurrence after treatment

(1) 3+3

(2) 3+4

(3) 4+3

(4) 4+4
(5) ≥4+5

[Epstein , 2016]
Comparative 10-year mortality data across 3
landmark prostate cancer trials

1.0 1.5 1.0

10.0 10.8 10.0

[Hamdy, NEJM 2016]

Among 3,000 men with prostate cancer on active
surveillance at Memorial Sloan Kettering, only 2
men have developed metastases in 15 years
A

B
Approximately 40% of men randomized to active
monitoring underwent radical treatment within 5
years

[Hamdy, 2016]
Men who undergo surgery to remove the prostate
gland or radiation to the prostate cancer experience
significant adverse effects
Therefore, focal therapy or partial gland ablation is
a potentially effective treatment with minimal
morbidity that delays radical treatment for men with
intermediate risk prostate cancer
Energy-based technology for ablation of tissue
vary by thermal or non-thermal therapies
Cryoablation*
HIFU*
Laser*
Radiofrequency*
Magnetic Particle Thermotherapy

Photodynamic therapy
Electroporation*
Tumor localization within prostate glandular
anatomy informs patient and treatment selection

[Ahmed, 2012]
[Arora et al, 2004]
[Arora et al, 2004]
[Fisher et al, 2002]
The sensitivity of MRI to detect prostate cancer is
improved with larger tumor volumes and higher
Gleason scores

[Turkbey, 2012]
MR-targeted biopsy accurately detects the location
and identifies the Gleason score of the index tumor

MR-targeted Radical Prostatectomy

biopsy Gleason 6 Gleason 7 Gleason ≥8
Gleason 6 23 (70%) 10 (30%) 0
Gleason 7 2 (4%) 50 (88%) 5 (8%)
Gleason ≥8 0 6 (30%) 14 (70%)

[Baco, 2015]
Surrogate oncologic outcomes aim to achieve
studies with 3-year duration

Prostate Cancer-specific Survival Overall Survival

[Popiolek, 2013]
Focal therapy to treat a single foci of prostate
cancer leads to a low-rate of urinary/sexual
functional impairment with effective early absence
of cancer

[Ahmed, 2012]
Focal therapy for prostate cancer is safe and has
favorable functional outcomes

• Systematic review: 14 studies

• Potency preservation (%): 76.9% - 100%
• Leak free (%): 90-100%
• Serious adverse events (%): 0% - 4.2%
Identify tumor and set ablation zone with
appropriate margins for treatment
System automatically plans sonication map for
treatment
Real-time monitoring of tissue temperature during
sonication cycles
MRI post treatment with contrast demonstrating
ablation zone
 Focal MR-Guided Focused Ultrasound Treatment of
Localized Prostate Cancer: Multi-center Phase II
Clinical Trial (PI: Ehdaie)

Enrollment Treatment 6 months 24 months

MR-Guided HIFU Focal
MR-Targeted Biopsy

MR-Targeted Biopsy

MR-Targeted Biopsy
Therapy with MR-
Thermography

• Gleason ≤4+3, ≤pT2 Data: Outcomes:

• Unifocal prostate cancer HRQOL 1. Serious Adverse Events
• MRI detected lesion Complications 2. 6- and 24- month pathology
• Prostate ≤60mL MRI
• Continent, Potent PSA
In conclusion, focal therapy of index tumors
provides an alternative treatment for intermediate
risk prostate cancer
Intervention Cohort
• Treatment of the index tumor and
subsequent surveillance of low risk
tumors overcomes challenges in
multifocal cancer
• Building on short term outcomes
and planning appropriate clinical
trials are keys to delivering this
novel treatment to patients

Thank You