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Diagnostic and Therapeutic Options for Prostate Cancer UNI V ER SIT Y HE A LTH SYSTEM is utilizing new diagnostic and thera- peutic techniques and technologies to improve prostate cancer care for its patients. Fusion-guided biopsy has been offered at University Health System since 2016 and offers a more precise method of examining the prostate for biopsy sites. This method merges MRI and ultrasound imaging to create more detailed images of the prostate than either method alone. These images help specialists identify abnormal cells. Biopsies can then be performed in those areas where prostate cancer is more likely to occur. Traditionally, prostate biopsies are performed based on a template model, but the new fusion-guided method allows for the identification of possible cancer in areas that would not normally be located on the template. "The prostate is one of the only organs where biopsies are performed in this way," says Michael Liss, MD, Director of Clinical Research at University Hospital and Assistant Professor of Urology at UT Health San Antonio. "The traditional method is similar to playing Battleship and choosing to biopsy areas where we think cancer may be present. With fusion- guided biopsy, we can better choose our biopsy targets — we can see where the 'ships' are." Recommended patients for fusion-guided biopsy include patients who are undergoing active surveillance for low-grade prostate cancer and those who are suspected of having pros- tate cancer despite a negative result from a traditional biopsy. "We're doing a study with the National Cancer Institute to determine if fusion-guided biopsy is appropriate for a wider range of patients," Dr. Liss says. "We want to be sure we don't increase the number of false positive findings for prostate cancer." University Health System is involved in many other studies as well, including clinical trials that can provide additional therapy options to patients who have exhausted current treatment modalities. University Health System's emphasis on research extends to every aspect of care, and patients are encouraged to participate in whatever way they can. "Patients don't need to be in a randomized clinical trial to help," Dr. Liss explains. "For example, they can donate blood or tissue samples to projects that advance cancer research." Regardless of what procedures or studies patients undergo, specialists from both University Health System and Mays Cancer Center UT Health San Antonio have synergized with MD Anderson Cancer Center to ensure every aspect of a patient's care is vetted from multiple viewpoints. This multidisciplinary approach involves urologists, radiation oncologists, hematolo- gists, radiologists, pathologists, residents and more. "We have tumor boards every two weeks to go over patient cases," Dr. Liss says. "It helps to have multiple eyes examine a case. No single one of us is as smart as all of us combined." Open communication between members of University Health System and UT Health San Antonio ensure patients receive the care they need as soon as possible. Specialists have excellent communication with each other through various means that include the medical health record to a simple phone call, which expedites test orders and access to urgent care. Should patients require surgery for prostate cancer, University Health System surgeons perform a high volume of robotic surgeries using the latest da Vinci Surgical System, the da Vinci Xi. This model allows for greater visualization through the use of HD imaging and tenfold magnification capabilities. "The newest robot allows us better visualization and improved focus on the procedure with less troubleshooting the equipment," Dr. Liss says. "We can operate with minimal incisions, and the patient can go home the next day. Our robotic experience with complex cancer cases is exponen- tially growing." For patients who cannot undergo laparoscopic sur- gery due™to a previous procedure or wound, surgeons at University™Health System are also proficient in traditional open surgery. visiting surgeons¥ca n obser ve a nd be¥tra ined in these new procedures as well." Steps have a lso been t a ken to ensu re t hat patient s in¥the¥area can be easily referred to University Health¥System for laser¥ enucleation, especia lly if they have large pros- tates¥that¥would require open prostatectomy were it not for¥University Health System's ThuLEP capabilities. "It's important for widespread implementation of¥laser¥enu- cleation to be realized," Dr. Mansour says.¥"Until¥then,¥we¥have a dedicated team that can manage¥physician referra ls to make¥the process easier for doctors." B P H i s t h e m o s t p r e v a l e n t p r o s t a t e p r o b l e m f o r ¥ m e n o l d e r t h a n 5 0 , ¥ a f f e c t i n g a l m o s t h a l f o f a l l ¥ m e n ¥ b e t w e e n 5 1 a n d 6 0 y e a r s ¥ o l d . E n l a r g e d p r o s t a t e s ¥ c a n ¥ a p p l y e x c e s s i v e p r e s s u r e t o t h e u r e t h r a ¥ a n d ¥ c a u s e ¥ i s s u e s s u c h a s a c u t e u r i n a r y r e t ent ion ,¥ bl a dder¥ a nd k id ne y d a m a ge ,¥ a nd u r i n a r y tract infections. Fo r m o re info r m atio n abo ut T hu L EP o r oth e r urol- ogy programs at University Health System , please visit u n i v e r s i t y h e a l t h s y s t e m . c o m /s e r v i c e s / u r o l o g y o r call 210 - 450 -9600. ■ Michael Liss, MD, Director of Clinical Research at University Hospital and Assistant Professor of Urology at UT Health San Antonio 0 8