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HOW I DO IT


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  • How I Do It -MRI-ultrasound fusion prostate biopsy using the Fusion MR and Fusion Bx systems

    Perlis Nathan, Lawendy Bishoy, Barkin Jack, MD University of Toronto, Department of Surgery, Toronto, Ontario, Canada

    There is increasing evidence to support the use of multiparametric magnetic resonance imaging (MRI) in men at risk for clinically significant prostate cancer to help identify lesions and inform biopsy. Randomized, level 1 evidence demonstrates that men who are managed with MRI and MRI-ultrasound fusion targeted biopsy (MRF-TB) have more clinically significant prostate cancer and less clinically insignificant prostate cancer detected and avoid biopsy altogether more often than men who undergo systematic, whole-gland prostate biopsy (SPB). Furthermore, strategies that incorporate MRF-TB have lower rates of upgrading on radical prostatectomy compared to SPB. However, generalizing this data to wider practice is challenging because there is a learning curve for interpreting MRI and performing MRF-TB, and some of the fusion technologies are better than others. We describe our group's early experience with the Fusion MR and Fusion Bx systems (Focal Healthcare, Toronto, ON, Canada). These products are designed with elastic fusion technology that is user-friendly, intuitive and accurate. The Fusion MR contouring system is straightforward and allows for contouring with several MRI sequences simultaneously. The Fusion Bx biopsy system has a semi-robotic arm that accounts for prostate deformation and patient movement and allows for freehand-like access, which is a seamless transition from SPB for clinicians. There were 68 lesions targeted in the first 51 patients. The overall cancer detection rate was 22%/61%/83% for PI-RADS 3/4/5, respectively. The Gleason grade group 2 prostate cancer or higher rate was 6%/47%/75% for PI-RADS 3/4/5, respectively. There were no major complications in this cohort of patients. Limitations of this study include small number of patients and lack of formal follow up to rule out sepsis. Overall, the Fusion MR and Fusion Bx systems are accurate, straightforward and safe to use for MRF-TB. Early experience does not show any significant learning curve.

    Keywords: prostate cancer, multiparametric magnetic resonance imaging, systematic prostate biopsy, MRI-ultrasound fusion-targeted biopsy, Gleason grade group,

    Apr 2020 (Vol. 27, Issue 2 , Page 10185)
  • How I do it: Apalutamide use in non-metastatic castrate resistant prostate cancer

    Moul W. Judd, MD Division of Urology, Department of Surgery and Duke Cancer Institute, Durham, North Carolina, USA

    Urologists have been using oral nonsteroidal antiandrogens (AA) for 30 years as a component of combined androgen blockade. In February 2018, a new third generation AA, apalutamide, became available for the first time for non-metastatic (M0) castrate resistant prostate cancer (CRPC). Apalutamide was found to delay the presence of metastases (metastases free survival-MFS) by approximately 2 years versus placebo in M0 CRPC. While overall survival benefit has yet to be established, the MFS benefit is clinically meaningful and urology practices should be equipped to manage patients using this new oral agent. Since the majority of patients remain under urologic care when this disease stage develops and because the drug is straightforward to administer, urology practices are ideal to identify and treat. The objective of this brief article is to discuss the typical patient profile for use of apalutamide and to review the pros and cons of use and common side effects and management.

    Keywords: prostate cancer, apalutamide, castrate-resistant, non-metastatic disease, antiandrogen,

    Jun 2019 (Vol. 26, Issue 3 , Page 9782)
  • How I Do It: Hydrogel spacer placement in men scheduled to undergo prostate radiotherapy

    Montoya Juan, Gross Eric, Karsh Lawrence, MD The Urology Center of Colorado, Denver, Colorado, USA

    Hydrogel spacer placement between the prostate and rectum in men scheduled to undergo prostate radiotherapy is an emerging technique well suited for urologists. The hydrogel spacer reduces rectal injury during radiotherapy by displacing the rectum away from the high dose region. Following radiotherapy the hydrogel spacer then liquifies, is absorbed, and then clears via renal filtration in approximately 6 months. Herein we describe the appropriate patients eligible for this procedure, and the application technique we use in our clinic.

    Keywords: prostate cancer, radiotherapy, hydrogel spacer, application, quality of life,

    Apr 2018 (Vol. 25, Issue 2 , Page 9288)
  • How I Do It: Managing bone health in patients with prostate cancer

    Barkin Jack, MD Humber River Hospital, Toronto, Ontario, Canada

    Urologists have two scenarios where they have to address bone loss or increased risk of fractures in men with prostate cancer. In the first setting, a patient who has been started on androgen deprivation therapy may develop cancer-treatment-induced bone loss. In the second setting, a patient’s prostate cancer may have metastasized to the bone. This article describes six steps to manage bone health in patients diagnosed with prostate cancer in a community practice.

    Keywords: prostate cancer, managing bone health,

    Aug 2014 (Vol. 21, Issue 4 , Page 7399)
  • Robot assisted radical prostatectomy: how I do it. Part II: surgical technique

    Valdivieso F. Roger , Hueber Pierre-Alain , Zorn C. Kevin, MD Hopital St. Luc Montreal, Quebec, Canada

    The introduction of the "da Vinci Robotic Surgical System" (Intuitive Surgical, Sunnyvale, CA, USA) has been an important step towards a minimally invasive approach to radical prostatectomy. Technologic peculiarities, such as three-dimensional vision, wristed instrumentation with seven degrees of freedom of motion, lack of tremor, a 10x-magnification and a comfortable seated position for the surgeon has added value to the procedure for the surgeon and the patient. In this article, we describe the 9 step surgical technique for robot assisted radical prostatectomy (RARP) that is currently used in our institution (University of Montreal Hospital Center (CHUM) - Hopital St-Luc). We use the four-arm da Vinci Surgical System. Our experience with RARP is now over 250 cases with the senior surgeon having performed over 1200 RARPs and we have continually refined our technique to improve patient outcomes.

    Keywords: surgical techniques, prostate cancer, robot assisted radical prostatectomy,

    Dec 2013 (Vol. 20, Issue 6 , Page 7073)
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Current Issue

October 2020, Vol.27 No.5
canadian journal of urology