Management of Urologic Cancer Focal Therapy and Tissue Preservation

Managing urologic cancer by preserving, as opposed to removing, affected tissue, is rapidly becoming the favoured choice for urologists and oncologists.  Discover all available options and how to achieve the best possible patient management with this expert guide to the area. The editor, Mark Schoenberg, is an internationally-renown expert in this exciting new area and has recruited an outstanding team featuring some of the leading urologists/oncologists in North America and Europe to assist him.

MARK P. SCHOENBERG, MD, University Professor & Chair, Department of Urology, The Montefiore Medical Center and The Albert Einstein College of Medicine, Bronx, NY, USA

KARA L. WATTS, MD, Assistant Professor, Department of Urology, The Montefiore Medical Center and The Albert Einstein College of Medicine, Bronx, NY, USA

List of Contributors xiii

Preface xvii

Cancer Genetics, Cancer Biology, and Tumor Growth and Metastasis: The Interaction of Cancer and Its Host Environment 1
Mark C. Markowski and Kenneth J. Pienta

Renal Cell Carcinoma 1

Bladder Cancer 3

Prostate Cancer 6

References 12

Pathological Basis of Tumor Characterization: Cytopathology, Surgical Pathology,  and How Histo�]Morphology Informs Treatment Decision Making 19
Oleksandr N. Kryvenko and Fadi Brimo

The Kidney 23

The Urothelium 27

The Testis 29

References 30

The Immunobiology of Tumor Ablation 33
Rafi Kabarriti and Chandan Guha

Manipulating the Immune System to Fight Cancer 33

Can We Take Advantage of Ablative Therapies to Activate the Immune System? 34

Immunomodulatory Properties of HIFU 35

Immunomodulatory Properties of Cryotherapy 36

Immunomodulatory Properties of Radiation Therapy 37

References 38

Computed Tomography of Urologic Malignancies: The Role of MDCT in Renal Cell Carcinoma and Transitional Cell Carcinoma 41
Siva P. Raman and Elliot K. Fishman

Introduction 41

MDCT Protocol Design 41

Three�]Dimensional Reconstructions 44

Neoplasms of the Intrarenal Collecting Systems, Ureters, and Bladder 45

Solid Renal Parenchymal Lesions 49

Conclusion 55

References 55

MRI and Metabolic Imaging 59
Louise Dickinson, Francesco Fraioli, Athar Haroon, and Clare Allen

Magnetic Resonance Imaging 59

MRI Sequences 59

Clinical Applications of MRI for Prostate Cancer 61

Clinical Applications of MRI for Renal Cancer 63

Clinical Applications of MRI for Bladder Cancer 64

New Advances in MRI 65

Metabolic Imaging 66

Clinical Applications of PET–CT for Prostate Cancer 69

Active Surveillance for Low�]Risk Prostate Cancer 113
Laurence Klotz

Introduction and Background 113

Rationale 113

Genetic Features of Low�]Grade Prostate Cancer 114

Metastatic Potential 115

Limitations of PSA Kinetics 116

Role of MRI 116

Implications for Patient Management 117

Eligibility for Surveillance 118

Outcome of Surveillance 119

Modeling 119

AS in Practice 121

Conclusions 121

References 122

Tissue�]Preserving Surgical Approaches in Urologic Oncology: The Therapeutic Mechanism for Tumor Ablation 127
Ganesh Kartha and J. Stephen Jones

Introduction 127

Cryoablation: Extreme Cold for Tumor Necrosis 128

Conclusion 130

References 130

Focal Therapy for Prostate Cancer: An Evidence�]Based Approach to Tissue�]Preserving Strategies 133
Kara L. Watts, Yaalini Shanmugabavan, Victoria Chernyak, and Hashim Uddin Ahmed

Introduction 133

Key Concepts in FT for PCa 134

Tissue�]Preserving FTs 135

Cryotherapy 135

HIFU 137

Salvage Focal/Hemiablation HIFU 140

IRE 141

Radiation 142

Additional Therapies 143

Implications for Research 144

Conclusions 144

References 145

The Modern Basis for Nephron�]Sparing Surgery in Patients with Renal Cancer: Biologic Heterogeneity, the Significance of Tumor Biopsy, and the Changing Roles of Partial Nephrectomy and Tumor Ablation 151
Jeffrey J. Tomaszewski, Robert G. Uzzo, and David Y.T. Chen

Introduction 151

Principal Treatment Options for SRMs and the Basis for Nephron Preservation 152

Comparative Effectiveness of Radical versus NSS 153

Rationale for Ablative Therapies 154

Treatment Trends for Stage I RCC 157

The Role of RMB 158

Challenges Posed by Intratumoral Heterogeneity 161

Conclusions 161

References 162

Bladder�]Preserving Strategies in the Treatment of Urothelial Cancer: The Disease Spectrum and the Dawn of Molecular Surgical Guidance 169
Stephan Kruck and Arnulf Stenzl

Augmented Cystoscopy 170

Fiber�]Optic Probe Technology 171

Conclusion 172

References 172

Image�]Guided Thermal Ablation of Adrenal Malignancies 175
Kyungmouk Steve Lee, Bradley B. Pua, and Stephen B. Solomon

Introduction 175

Clinical Results 175

Preprocedural Evaluation 176

Technical Considerations 178

RFA 178

Microwave Ablation 179

Cryoablation 180

Complications 180

Follow�]up 181

Conclusion 182

References 182

Managing Penile Cancer: Integrating Tissue Preservation, Energy�]Based Therapeutics, and Surgical Reconstruction 185
Arthur L. Burnett

Introduction 185

Description 186

Diagnosis and Staging 186

Treatment 189

References 193

Testis Cancer: Testis�]Sparing Cancer Surgery 199
Nilay M. Gandhi and Pravin K. Rao

Introduction 199

Imaging of Testicular Tumors 199

Bilateral Tumors 201

The Advent of Testis�]Sparing Surgery 201

Concerns about TSS 201

Indications for TSS 204

Preoperative Considerations and Surgical Technique 204

Postoperative Care and Follow�]Up 207

Considerations Regarding Surgical Technique 207

Outcomes of TSS 208

Summary 209

References 210

Nanotechnology: An Evolution in Tissue Preservation and Focal�]Targeted Oncologic Therapy 213
Kara L. Watts and Joshua M. Stern

Introduction 213

Introduction to Nanotechnology 214

Types of Nanoparticles 214

Delivery and Use of Nanoparticles 217

Nanotechnology in Prostate Cancer 219

Imaging in Prostate Cancer 219

Therapeutics in Prostate Cancer 221

Nanotechnology in Renal Cancer 223

Nanotechnology in Other Urologic Cancers 224

Limitations of Nanoparticles 224

Future Directions and Conclusions 225

References 226

Trial Design Issues in the Study of Focal Therapy in Prostate and Kidney Cancer 233
John B. Eifler and David F. Penson

Issues around Endpoints in Studies of Focal Therapy 234

Issues around Defining the Study Population and the Control Arms of Comparative Studies in Focal Therapy 237

Issues around Selecting the Optimal Study Design in Focal Therapy 238

Conclusion 238

References 239

Index 000

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