By Mike Krachon
The treatment of prostate cancer depends on a partnership among multiple specialities, often including urology, radiation oncology, radiology, family medicine, and, at times, a medical oncologist. However, for most patients, the journey to move beyond their cancer starts with their urologist confirming a diagnosis of cancer. Fully understanding the clinical, patient, and, sometimes, economic pathways of this disease are important components of gaining a deeper understanding of the medical community's needs and perceptions. For these reasons, we attend events like International Prostate Cancer Update 2018 (IPCU) so we can listen to and learn directly from physicians.
Less Invasive Screening
Changes in screening patterns are creating a need for better diagnostic processes and tools to efficiently identify prostate cancer. At the IPCU meeting, there was significant discussion about the growing interest in targeted biopsies. The speakers encouraged the incorporation of MRI-guided or other specific biopsies into practice to more accurately identify whether there are significant cancers and, if so, where they are located. They also discussed the increasing value of genetic testing to identify potentially virulent or aggressive disease.
The interest in minimally invasive screening is driven by the goal of identifying less aggressive disease that can be addressed with watchful waiting. This continuing investment in diagnostic tools and techniques appears to be an attempt to counter the ever-increasing cost of care throughout the system. Also, the ability to identify individual foci of disease allows physicians to explore targeted, less invasive treatments.
Using New Data to Drive Treatment
On the treatment side, urologists are eager to understand how to use newly available diagnostic information to arrive at reasonable treatment strategies for the different prostate cancer risk groups—differentiating treatment for primary aggressive disease (Gleason scores of 8 and 9) from treatment for low-risk or recurrent disease. We heard many urologists express interest in new ways to deliver targeted treatment for salvage procedure patients who have failed external radiation, as well as alternatives for patients with aggressive localized disease.
A notable urologist opined that 80% of prostate cancer treatments will be targeted in five years. While I think this might be an optimistic estimate, I believe the community wants to move quickly in this direction and improve the patient experience.
On the industry side, urologists have a complicated relationship with brachytherapy. Twenty years ago, before intensity-modulated radiation therapy and robotic surgery were treatment options, brachytherapy was a solution for many patients. However, the isotopes available at the time had longer-lasting side effects, which both patients and physicians eventually deemed unacceptable. Much has happened in the past two decades, with improvements in the procedure and, especially, the introduction of Cesium-131, a fast-acting isotope that allows patients and urologists to quickly move past the treatment.
This combination of improved treatment tools and a faster isotope provides a new opportunity for urologists and clinicians to consider for their prostate cancer patients. Cesium-131 has a significantly shorter half-life than Palladium-103 or Iodine-125, which have traditionally been used, and it delivers an aggressive dose of radiation in an outpatient setting. The dose is delivered, is concentrated in the tumor, and quickly dissipates. This is particularly exciting for targeted treatments for focal therapy, salvage cases, or use in combination strategies for aggressive disease.— Mike Krachon is vice president of Isoray Medical. Isoray manufactures Cesium-131 brachytherapy seeds.