Navigating Focal Therapy for Prostate Cancer: Contemporary Perspectives and Future Trajectories in the Canadian Context.

This article equips Canadian urologists with the latest advancements in focal therapy (FT) principles and outcomes while providing an overview of its current landscape in Canada, including challenges and future directions. We conducted a nonsystematic review of the literature on FT in urology and prostate cancer (PCa), focusing on Canadian-led studies. Articles were identified using PubMed, MEDLINE, and Google Scholar and selected based on relevance and originality.

The Role of Tumor Volume Ratio in Predicting Clinically Significant Prostate Cancer on Transperineal Biopsy.

Multiparametric magnetic resonance imaging (mpMRI) has made dramatic inroads into the management of localized prostate cancer (PCa); however, not all suspicious lesions represent clinically significant (cs) PCa. We aimed to analyze the hypothetical effect of incorporating tumor volume ratio (TVR) into prostate biopsy (PBx) decision-making. Two hundred and fifty-two patients with suspicious lesions at mpMRI undergoing transperineal PBx under local anesthesia between 2019 and 2022 were retrospectively evaluated.

The use of focal therapy for the treatment of prostate cancer in Canada: Where are we, how did we get here, and where are we going?

Introduction: Focal therapy is an emerging treatment for localized prostate cancer. The objectives of this review were to: 1) review how focal therapies are regulated and approved; 2) summarize the scope and quality of the literature regarding safety, efficacy, and side-effects; and 3) outline ongoing clinical trials of focal therapy in Canada.

Methods: Using the PRISMA framework for scoping reviews, we searched PubMed, Embase, and Cochrane from 2021-2024, complementing Hopstaken et al's search up functional and oncologic outcomes.

Partial gland ablation with high intensity focal ultrasound impact on genito-urinary function and quality of life: our initial experience.

Introduction:   Partial gland ablation (PGA) using high intensity focal ultrasound (HIFU) is an alternative to active surveillance for low to intermediate risk localized prostate cancer.  This pilot study assessed quality of life (QoL) outcomes during the implementation of PGA-HIFU at our institution.

Materials And Methods:   We prospectively enrolled 25 men with a diagnosis of localized low/intermediate risk prostate cancer who elected to undergo PGA-HIFU in a pilot study at our institution between 2013 and 2016.

Magnetic Resonance Imaging-Targeted Versus Systematic Prostate Biopsies: 2-year Follow-up of a Prospective Randomized Trial (PRECISE).

Background: The prospective randomized PRECISE trial demonstrated that magnetic resonance imaging (MRI) with only targeted biopsy (TBx) was noninferior to systematic transrectal ultrasound biopsy (SBx) in the detection of International Society of Urological Pathology grade group (GG) ≥2 prostate cancer (PC). An unanswered question is the outcome for patients who avoided a biopsy because of negative MRI findings.

Objective: To explore the rate of PC diagnosis based on 2-yr MRI for PRECISE participants who had no biopsy and for patients who had a negative result or GG 1 on TBx in comparison to those with a negative result or GG 1 on SBx.

[Oncological and functional results of focal treatment of localized prostate cancer with HIFU].

Introduction: In recent years, improved diagnosis of prostate cancer has allowed the development of focal therapy, in order to reduce the morbidity of treatments. Our study assesses the medium-term oncological and functional results of FocalOne® HIFU treatment in localized prostate cancer.

Methods: This is a retrospective, multicentre study including patients with low- or intermediate-risk localized prostate cancer treated with Focal one HIFU between November 2014 and December 2019.

The diagnostic accuracy of micro-ultrasound for prostate cancer diagnosis: a review.

Purpose: Micro-UltraSound (microUS) is a new imaging modality capable of identifying and targeting suspicious areas, which might further increase the diagnostic yield of prostate biopsy (PBx). Aim of this review is to provide insights into the usefulness of microUS for the sub-stratification of prostate cancer (PCa), clinically significant PCa (i.e.

Prophylactic A-Blockers for Radiotherapy-Induced Lower Urinary Tract Symptoms in Men with Prostate Cancer: A Phase III Randomized Trial.

Purpose: The present phase III randomized trial assessed the efficacy of prophylactic versus therapeutic α-blockers at improving RI-LUTSs in prostate cancer patients receiving external beam radiotherapy (EBRT).

Methods: A total of 148 prostate cancer patients were randomized 1:1 to receive either prophylactic silodosin on day one of EBRT or the occurrence of RI-LUTSs. LUTSs were quantified using the international prostate symptom score (IPSS) at regular intervals during the study.

Neoadjuvant versus Concurrent Androgen Deprivation Therapy in Localized Prostate Cancer Treated with Radiotherapy: A Systematic Review of the Literature.

Background: There is an ongoing debate on the optimal sequencing of androgen deprivation therapy (ADT) and radiotherapy (RT) in patients with localized prostate cancer (PCa). Recent data favors concurrent ADT and RT over the neoadjuvant approach.

Methods: We conducted a systematic review in PubMed, EMBASE, and Cochrane Databases assessing the combination and optimal sequencing of ADT and RT for Intermediate-Risk (IR) and High-Risk (HR) PCa.

Advances in PARP Inhibitors for Prostate Cancer.

Poly-adenosine diphosphate-ribose polymerase plays an essential role in cell function by regulating apoptosis, genomic stability and DNA repair. PARPi is a promising drug class that has gained significant traction in the last decade with good outcomes in different cancers. Several trials have sought to test its effectiveness in metastatic castration resistant prostate cancer (mCRPC).

Performance of clear cell likelihood scores in characterizing solid renal masses at multiparametric MRI: an external validation study.

Purpose: The purpose of this study is to evaluate the accuracy and interobserver agreement of ccLS in diagnosing clear cell renal cell carcinoma (ccRCC).

Methods: This retrospective single-center study evaluated consecutive patients with solid renal masses who underwent mpMRI followed by percutaneous biopsy and/or surgical excision between January 2010 and December 2020. Predominantly (> 75%) cystic masses, masses with macroscopic fat and infiltrative masses were excluded.

Salvage external beam radiotherapy after HIFU failure in localized prostate cancer: A single institution experience.

Purpose/objectives: High-intensity focused ultrasound (HIFU) remains investigational as primary treatment for localized prostate cancer but is sometimes offered to select patients. At HIFU failure, data guiding salvage treatment is limited to small retrospective series with short follow-up. We evaluated our institutional experience using salvage radiation therapy (SRT) after HIFU failure.

'A pain in the buttock': A case report of gluteal compartment syndrome after robotic partial nephrectomy.

Acute compartment syndrome is a surgical emergency that, if unrecognised, leads to tissue and muscle ischaemia, necrosis, multi-organ failure and even death. Gluteal compartment syndrome is a rare type of compartment syndrome that typically occurs as a sequela of trauma, and its presentation may be difficult to recognise. We describe a case of a patient who developed gluteal compartment syndrome following a prolonged renal surgery in lateral decubitus position.

The Triple-Tracer strategy against Metastatic PrOstate cancer (3TMPO) study protocol.

Objective: To determine the prevalence of intra-patient inter-metastatic heterogeneity based on positron emission tomography (PET)/computed tomography (CT) in patients with metastatic castration-resistant prostate cancer (mCRPC) and to determine the prevalence of neuroendocrine disease in these patients and their eligibility for radioligand therapies (RLTs).

Patients And Methods: This multicentre observational prospective clinical study will include 100 patients with mCRPC from five Canadian academic centres. Patients with radiological or biochemical progression and harbouring at least three metastases by conventional imaging will be accrued.

Role of Systematic Control Biopsies following Partial Gland Ablation with High-Intensity Focused Ultrasound for Clinically Significant Prostate Cancer.

Purpose: Partial gland ablation (PGA) using high-intensity focused ultrasound (HIFU) is currently under investigation for clinically significant prostate cancer (Cs-PCa). Our primary objective was to assess the role of systematic control biopsies following HIFU-PGA in a cohort of Cs-PCa patients.

Materials And Methods: We studied a single-center retrospective cohort of 77 men treated with HIFU-PGA between October 2015 and December 2019.

Comparison of Multiparametric Magnetic Resonance Imaging-Targeted Biopsy With Systematic Transrectal Ultrasonography Biopsy for Biopsy-Naive Men at Risk for Prostate Cancer: A Phase 3 Randomized Clinical Trial.

Importance: Magnetic resonance imaging (MRI) with targeted biopsy is an appealing alternative to systematic 12-core transrectal ultrasonography (TRUS) biopsy for prostate cancer diagnosis, but has yet to be widely adopted.

Objective: To determine whether MRI with only targeted biopsy was noninferior to systematic TRUS biopsies in the detection of International Society of Urological Pathology grade group (GG) 2 or greater prostate cancer.

Design, Setting, And Participants: This multicenter, prospective randomized clinical trial was conducted in 5 Canadian academic health sciences centers between January 2017 and November 2019, and data were analyzed between January and March 2020.

Diagnostic performance of F-DCFPyL positron emission tomography/computed tomography for biochemically recurrent prostate cancer and change-of-management analysis.

Introduction: Conventional imaging (CI) performs poorly to identify sites of disease in biochemically recurrent prostate cancer. Ga-PSMA-11 positron emission tomography/computed tomography (PET/CT) is most studied but has a very short half-life. This study reports the diagnostic performance of the novel prostate-specific membrane antigen (PSMA) radiotracer F-DCFPyL using real-life data and tumor board simulation to estimate the impact of F-DCFPyL PET on patient management.

Canadian Update on Surgical Procedures (CUSP) Urology Group consensus for intraoperative hemostasis during minimally invasive partial nephrectomy.

Introduction: Partial nephrectomy remains the gold standard in the management of small renal masses. However, minimally invasive partial nephrectomy (MIPN) is associated with a steep learning curve, and optimal, standardized techniques for time-efficient hemostasis are poorly described. Given the relative lack of evidence, the goal was to describe a set of actionable guiding principles, through an expert working panel, for urologists to approach hemostasis without compromising warm ischemia or oncological outcomes.

Are basic robotic surgical skills transferable from the simulator to the operating room? A randomized, prospective, educational study.

Introduction: We aimed to assess the transferability of basic robotic skills from the simulator to the operating room (OR) while performing robotic-assisted radical prostatectomy (RARP).

Methods: Fourteen urology residents were randomized into two groups: group A was required to practice three sessions (nine tasks each) on the simulator, whereas group B was required to practice (same nine tasks) until they reached competency. Both groups were recorded while practicing on the da Vinci Surgical Skills Simulator.

Postoperative Management of Ectopic Ureter Injury After Robotic-assisted Radical Prostatectomy: A Case Report.

A 66-year-old male, with an undiagnosed duplex system, underwent a Robotic-assisted Radical Prostatectomy that was complicated by an ectopic ureter injury. Given the incidence of less than 0.001%, management of ectopic ureters for patients undergoing a RARP is foreign to most urologists.

Combined Long-Term Androgen Deprivation and Pelvic Radiotherapy in the Post-operative Management of Pathologically Defined High-Risk Prostate Cancer Patients: Results of the Prospective Phase II McGill 0913 Study.

Following radical prostatectomy, prostate bed radiotherapy (PBRT) has been combined with either long-term androgen deprivation therapy (LT-ADT) or short-term ADT with pelvic lymph node radiotherapy (PLNRT) to provide an oncological benefit in randomized trials. McGill 0913 was designed to characterize the efficacy of combining PBRT, PLNRT, and LT-ADT. It is the first study to do so prospectively.

Predicting Gleason Score of Prostate Cancer Patients Using Radiomic Analysis.

Use of quantitative imaging features and encoding the intra-tumoral heterogeneity from multi-parametric magnetic resonance imaging (mpMRI) for the prediction of Gleason score is gaining attention as a non-invasive biomarker for prostate cancer (PCa). This study tested the hypothesis that radiomic features, extracted from mpMRI, could predict the Gleason score pattern of patients with PCa. This analysis included T2-weighted (T2-WI) and apparent diffusion coefficient (ADC, computed from diffusion-weighted imaging) scans of 99 PCa patients from The Cancer Imaging Archive (TCIA).

F-fluorocholine positron emission tomography-computed tomography (F-FCH PET/CT) for staging of high-risk prostate cancer patients.

Introduction: We sought to evaluate the diagnostic performance of F-fluorocholine positron emission tomography-computed tomography (F-FCH PET/CT) for initial staging of patients with high-risk prostate cancer. Secondary objectives were to compare the value of F-FCH PET/CT to conventional imaging modalities and to evaluate its clinical impact.

Methods: We conducted a retrospective study of 76 patients who underwent F-FCH PET/CT for initial staging of high-risk prostate cancer.