Poster presentation from the GU ASCO meeting in San Francisco

Hi All

I wanted you to see this poster presentation that we had at the GU ASCO meeting in San Francisco a few weeks ago. We presented on our patients who underwent focal salvage cryotherapy.

Download Poster: Salvage Cryo (PDF, 313KB)

As you can see the results of these 88 patients  are quite promising! We only had a few patients(6.8%)  who progressed and needed hormone therapy. These hemi -ablations in the salvage setting typically take under an hour to do, and are all performed in an outpatient setting. Urinary incontinence is very rare and we did not have any fistulas or major complications. In my experience, focal salvage cryotherapy is an excellent modality for managing men who have had a unilateral cancer recurrence after radiation.

Aaron E. Katz, MD

“Researchers Develop Intelligent Training Tool to Treat Prostate Cancer”

“Researchers Develop Intelligent Training Tool To Treat Prostate Cancer” Researchers at Carnegie Mellon University have developed a new approach to improve training for cryosurgery, a procedure used to treat prostate cancer by freezing and destroying the diseased tissues. The new approach will shorten the learning curve and improve the quality of the minimally invasive treatment by reducing complications, shortening recovery times and lowering health care costs. Yoed Rabin, a professor of mechanical engineering and a board member of the American College of Cryosurgery, has led the development of this first computerized training tool. This intelligent training tool provides feedback to the trainee and offers advice on how to maximize the freezing of cancer tumors while preserving the healthy tissues surrounding the site. Prostate cancer is the second leading cause of cancer death in men according the American Cancer Society, which predicts that one in seven men will be diagnosed with the disease during his lifetime and one in 38 will die from the disease. “As engineers, we can take advantage of recent developments in computer hardware and computation techniques to help doctors develop education methods for minimally invasive thermal surgery,” Rabin said. In a recent article published in Technology in Cancer Research & Treatment, Rabin’s team demonstrated how its intelligent tutoring approach could shorten the learning curve of surgical residents. The computerized system, which runs about 100 times faster than the actual cryosurgery procedure, uses novel algorithms to create 3-D thermal images of tumors in patients in a variety of scenarios. This allows the trainees to see firsthand the effects of the tissue they are freezing. “Cryogenic technology today is far more advanced than the surgical treatment methods used by surgeons,” Rabin explained. “As engineers and surgeons collaborate, we can improve the quality of the applied methods and advance the widespread use of cryotherapy.” Co-authors on the paper are: Kenji Shimada, professor of mechanical engineering; recent Ph.D. graduates Anjali Sehrawat and Robert Keelan; and T. McCormick, director of the General Surgery Program, and Donamarie N Wilfong, director of the Simulation, Teaching and Academic Research (STAR) Center, of the Allegheny Health Network. The tutorial was tested at the STAR Center, a multidisciplinary simulation center where students, practitioners and members of the allied health community can practice and perfect their clinical skills. Contact: Lisa Kulick Carnegie Mellon University 412-268-5444

John G. Baust, PhD elected Journal-in-Chief, Journal Technology in Cancer Research & Treatment

dr-john-g-baust-phd_00F1CE7E-9631-C31A-7C468E8C926631DCHi All! I have some exciting news to share with you. Our friend and colleague, Dr. John G. Baust, immediate past president of ACC, has been named Editor-in-Chief of the Journal Technology in Cancer Research & Treatment(TCRT). John and I had a recent conversation about the American College of Cryosurgery partnering with the Journal and dedicating a SPECIAL ISSUE on “Focal Cryotherapy in Urologic Oncology”.

I would like to set up a review committee which will do a “light” peer-review and not take up too much of your time. So, let me know if you want to be involved. A January 2016 publication date is anticipated. This type of journal could be a great leap for the field. I look forward to your thoughts and interest(don’t be shy…no need to be political correct!) I think this could be a great way for us to work together as an organization and get additional research published on focal cryotherapy.

AUA 2015: Hope For Focal Therapy for Prostate Cancer

Aaron E. Katz, MD

As I am about to take off from New Orleans and leave this year’s meeting behind, I felt it was the perfect time for me to reflect and give you my thoughts and impressions. Each year there seems to be an underlying theme to the meeting within each area of urology, especially urologic oncology. Last year there were many talks and presentations on the new medications for castrate-resistant prostate cancer. The buzz seemed to be on educating physicians on how to sequence these medications for our patients. Although there were many talks and podium sessions dealing with this topic this year, I felt that the tone was focused on early stage, untreated prostate cancer, determining the best way to manage these patients, and selecting men for active surveillance. The use of genomics, MRI and new forms of PSA were addressed in many of the sessions. Many questions were raised as to how radiological imaging fused with needle biopsies can give the urologist the tools needed to feel more comfortable with placing patients on a “watch and see” approach.

One of the first podium sessions of this year’s meeting was a debate on focal therapy versus whole gland treatment for early stage prostate cancer. Dr. Emberton (University of London) and I were on the side of “HOPE FOR FOCAL THERAPY” and we debated Dr Klein(Cleveland Clinic) and Dr Gonzalez(Univ of Miami) who were arguing that there is just HYPE. The points of discussion were whether we are currently able, with reasonable certainty, to ablate the area of cancer and not leave unrecognized high- grade cancers untreated on the contralateral side. The discussion centered on multi-parametric MRI, biopsy strategies, and ways of following these men after treatment were all debated. The oncological early outcomes from both focal cryotherapy and focal HIFU were presented and are very encouraging with over 90% of the cancers ablated. In addition, the quality of life outcomes are clearly better than whole gland treatment with over 80% of men having return of sexual function and normal ejaculation. Dr. Emberton and I argued that we have diagnostic tools available in 2015, which include perineal-mapping biopsy, fusion biopsy and genomics that give us the ability to properly select these men. We also argued that that the new tools, when used in combination with the older, simpler tools (PSA density, percent of cancer on biopsy, and PSA), can be predictive of unilateral cancer.

So who won? I am not going to say that there was a clear, definite winner, but I do feel that to have the concept of focal therapy debated at a major podium session at the AUA was in itself a winner. This was a major step in the right direction for those of us that believe that there is a role for focal therapy. A few years ago I would never have thought that the AUA would even consider such a debate. Could the tide be changing? What has changed? Is it a realization that whole gland therapy is associated with an unacceptable rate of side effects despite the widespread use of robotics? Or is it the new advances in imaging, biopsy strategies and genomics that are currently available? Or perhaps, even more remarkable, is it the possibility that this is an approach being driven by patients. Having attended the AUA almost every year for the past 25 years, the fundamental recommendation has always been that for “younger men,” the urologist should perform radical prostatectomy. For those who were older or associated with other co-morbidities, the urologist should refer this man for radiation. But, with greater understanding of the biology of these low level “cancer cells,” we are learning a lot more about the progression rate. For many men, it appears to be slow and the ability to ablate these cancers becomes quite possible, rational, and one that many urologists might be engaged.

The AUA also hosted a joint session with the FDA to address the issue of focal therapy. Dr. Scardino(MSKCC) moderated the session which lasted almost 4 hours. Panel members of international experts included Dr. Pinto(NIH), Dr Emberton(Univ London), Dr Polascik(Duke), Dr Andriole(Washington University), Dr. Epstein(Johns Hopkins), Dr Coleman(MSKCC), and many others. There was discussion again about the different therapeutic modalities for ablation (HIFU, CRYO, Laser, Photo dynamic therapy), patient selection, how to follow patients, and clinical trials that need to be developed for focal therapy.

Overall, I think that this was a great meeting for cryotherapy users and for those that believe in focal therapy. The American College of Cryosurgery had a booth for the first time at the AUA! The College was able to dispense material about the organization and reveal the new website. In addition, I was pleased that we were able to add 35 new members (big thanks to Joanne and DeAnn for all of their efforts!). The new focal trial, “POTENT C,” which recently received its first IRB approval at Winthrop, was discussed in a session that the ACC held at the World War II Museum. The meeting was attended by urologists, PAs, and members from the industry. If you missed the meeting, you also missed the frozen Vodka drinks with lime at the end of the session, which were absolutely delicious! Members of the ACC will now have the ability to gain access to the protocol and put this through their IRB for approval. The trial will accrue 86 men prospectively for 3 years and follow men with subsequent biopsies and MRIs. All men enrolled will be potent at the start of the trial and will receive daily Cialis 5mg for a period of time.

To take from a famous quote, “this meeting was a small step for focal cryo, and a larger leap for cryoablation.”

STM Annual Meeting Orlando

I wanted to take this opportunity to thank ACC for your participation and sponsorship in the 32nd annual meeting of the Society for Thermal Medicine and to Joanne for her help in making it all happen. The afternoon plenary session was very much appreciated by members based on the feedback I’ve received. There is a clear interest to know more both about clinical applications of cryotherapy and to reinforce and expand the representation at the low temperature end of the spectrum of thermal therapies. Please extend our gratitude to the other speakers as well. Eric Cressman, PhD

Thank you for the feedback. I agree that the integration worked well and there is great enthusiasm for thermal ablation for many cancers. I have a recent approval of an IRB study on focal cryotherapy and would like to see if there are members from STM that would be interested in participating.  I will be promoting this at the AUA this year.  Aaron E. Katz, MD

 

Robinson Awards Dinner During The STM Meeting

This year’s Robinson Award was given to Dr. Elizabeth Repasky of the Roswell Park Cancer Institute, Buffalo, NY.

Award details:
“The J. Eugene Robinson Award is presented annually to an investigator who has made outstanding contributions to the field of hyperthermic oncology in one or more of the three main disciplines: Medicine/Clinical, Biology/Physiology, and Physics/Engineering. It is the highest and most prestigious award of the Society for Thermal Medicine. The award is named after J. Eugene Robinson who was a pioneer of hyperthermia research from the 1960’s through the 1980’s and a strong proponent of combined radiation and hyperthermia for cancer therapy.”