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E1195. Focal Therapy of Prostate Cancer: What the Urologist Needs to Know
Authors
  1. Jesse Hinton; University of Cincinnati
  2. Juliana Tobler; University of Cincinnati
  3. Shaun Wahab; University of Cincinnati
  4. Abhinav Sidana; University of Cincinnati
  5. Sadhna Verma; University of Cincinnati
Background
Focal therapy is emerging as promising treatment option for localized prostate cancer. Compared to prostatectomy, benefits of focal therapy include decreased recovery time and decreased complications such as urinary incontinence and erectile dysfunction. Although focal treatment techniques have been described as early as 2002, the addition of prostate MRI has allowed more precise tumor localization, improved treatment planning, and improved follow up imaging. Imaging prior to focal therapy requires excellent communication between the urologist and radiologist. Reporting and communication differs significantly from studies performed for lesion detection and screening, particularly because the current Prostate Imaging Reporting and Data System (PI-RADS) does not include important descriptors for patient selection and procedure planning.

Educational Goals / Teaching Points
Prostate MRI for focal therapy planning versus lesion detection utilizes the same imaging protocols but interpretation varies substantially. PIRADS does not contain key descriptors for focal therapy, particularly relationship of the lesion to adjacent anatomic structures. Knowledge of the treatment modalities and lesion traits that the Urologist needs to know for therapy planning will aid the radiologist in providing more meaningful interpretation. Focal therapy failure can occur at several levels from initial imaging, patient selection, to biopsy. Understanding pitfalls in imaging quality and interpretation are important to minimize complications and treatment failure.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Findings related to patient selection include Gleason score, number of lesions, laterality/bilaterality, and contraindications. Anatomic relationship of the target lesion to surrounding structures will be reviewed to assess for target suitability. Unique considerations between cryotherapy and High Intensity Focused Ultrasound (HIFU) will be described for treatment modality selection. Correlation of MR imaging and intra-procedural US findings will also be demonstrated.

Conclusion
Radiologists play an important role in patient selection prior to focal therapy for prostate cancer through their interpretation of pre and post-treatment prostate MRIs. Characteristics of a target prostate lesion, not routinely included in PI-RADS/diagnostic imaging reports, are important for the urologist to know prior to focal therapy. Cryotherapy and HIFU have shared and unique considerations when assessing imaging for treatment feasibility. Communication between the radiologist and urologist is critical to successful treatment and avoidance of post-procedural complications or treatment failure.