Can focal therapy truly “thread the needle” between active surveillance and radical prostate cancer treatment? In this episode of BackTable Urology, host Dr. Tiwa Akinsola is joined by Dr. George Schade from the University of Washington to explore focal therapy as a middle ground between active surveillance and radical treatments. Dr. Schade reviews non-radiation energy modalities including HIFU, TULSA/HI-DU, cryotherapy, and irreversible electroporation, highlighting patient selection, institutional experience, technical nuances, and quality-of-life outcomes from recent trials.
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Timestamps00:00 - Introduction02:09 - Overview of Focal Therapy Modalities04:46 - Deciding Between HIFU and IRE06:56 - Evidence and Trials09:40 - Counseling Patients on Outcomes12:09 - Building a Focal Therapy Program16:12 - Navigating Insurance and Appeals21:48 - Managing Large Glands And TURP25:12 - Preop Workup Essentials and OR Workflow32:32 - Overcoming the Learning Curve35:52 - PostOp Recovery and Surveillance39:04 - Options for Managing Recurrence42:44 - Challenges with Repeat Ablation44:56 - Final Takeaways
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More about this episodeThe conversation covers candidate selection and confirmatory biopsy, perioperative technique and recovery, and ongoing surveillance with PSA, MRI, and biopsy. Dr. Schade also discusses challenges with insurance approvals, building a focal therapy practice, and options for managing recurrence, including repeat ablation, surgery, or radiation. The episode examines how to balance cancer control with quality of life and reviews the evolving evidence base supporting focal therapy’s role in prostate cancer treatment.
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Resources
Irreversible Electroporation for Prostate Tissue Ablation in Patients with Intermediate-risk Prostate Cancer: Results from the PRESERVE Trial:https://www.sciencedirect.com/science/article/pii/S030228382500346X
Focal therapy of localized prostate cancerhttps://pubmed.ncbi.nlm.nih.gov/35996758/
Focal Therapy for Prostate Cancer: Available Technologies, Patient Selection, Follow-Up Protocols and Reported Outcomeshttps://pubmed.ncbi.nlm.nih.gov/41339218/
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