Dr. Scionti
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  • New Fusion System Creates a Smart Prostate Biopsy

    The Scionti Prostate Center now can provide FUSION of real-time 3D ultrasound and advanced 3D MRI prostate images using the latest Artemis System. The result is a true targeted biopsy requiring FEWER BIOPSY NEEDLES.

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  • Scionti Advanced HIFU Protocol

    The Scionti Advanced HIFU Protocol is based on his vast skills and experience in treating over 600 HIFU patients along with the unique techniques he developed to reduce HIFU therapy side effects.

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  • Prostate Focal Therapy

    The goal of prostate focal therapy is long-term cancer control with minimal treatment side effects. For the right patients focal therapy can be an effective middle ground. I offer select patients three focal therapy options: Cryotherapy, HIFU and MRI-Guided Prostate Laser Ablation.

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  • MRI Prostate 3D scanning

    The Scionti Prostate Center offers patients 3D MRI scanning capable of detecting tiny tumors that can be precisely sampled to help improve prostate cancer diagnosis, treatment and follow up.

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  • 3D Prostate Mapping

    The Scionti Prostate Center can provide patients a 3D PROSTATE-MAP showing visual details of the size, location and shape of any prostate tumors, all critical information for targeting a biopsy and/or planning a prostate treatment.

  • Scionti Prostate Center of Boston

    Ablation Experience: 600+ HIFU cases & 1,000+ Cryo cases

  • Scionti Prostate Center of Boston

    Pioneer Results: A pioneer in new techniques and technology for HIFU and Cryo

  • Scionti Prostate Center of Boston

    Training and Proctoring: National teacher/proctor for HIFU and Cryo

  • Scionti Prostate Center of Boston

    Unique Protocol: Unique total care approach (Staging, Treatment and Follow up)

  • Scionti Prostate Center of Boston

    Patient Access: Praised by patients for his compassion and dedication
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Targeted Focal Prostate Cancer Treatment

A Middle Ground For A New Prostate Paradigm

  • Total Gland Treatment

    Most physicians have a long-standing conviction that patients diagnosed with prostate cancer must have their entire gland either surgically removed or radiated. This conviction stems from the belief that all prostate cancer is "multifocal." That means if cancer is found in one location (or only on one side of the prostate) it's likely to spread throughout the entire gland. For most physicians this belief holds true even if only a small amount of cancer is found during a patient's prostate biopsy.

    While this conviction was good medicine before the introduction of the PSA blood test (prostate specific antigen) - it may not be as relevant for all men today. The fact is that PSA screening has changed everything. PSA has created a new paradigm for prostate cancer by changing the point in time that we find prostate cancer. Today, we can diagnose prostate cancer much earlier and often in a single location or only on one side of the prostate. In cases where multiple tumors are found they often turn out to be small, low risk cancers that might not necessarily threaten a patient's life. Although some prostate cancers are still "multifocal" and some tumors are still very dangerous, the question arises whether treating the entire prostate gland is necessary for every man. If we establish, with a high degree of confidence thanks to advanced diagnostic technologies, that a patient is a candidate for a focal treatment, it is possible to develop a treatment tailored to that person's disease.

    In my current practice I specialize in approaching prostate cancer not only as whole gland treatment, but also as a targeted (or focal) treatment. The goal of a targeted treatment is to destroy only a patient's known prostate cancer while sparing the remaining health tissue and avoiding collateral damage to sensitive structures that can affect a man's quality of life.

    The idea of a targeted cancer treatment is not new. Today, breast surgeons have options besides removing the entire breast to treat breast tumors. Instead, for qualified patients a lumpectomy is used to remove only the know tumors. What's ironic is that the idea of a similar "targeted treatment" for prostate cancer has lagged behind the breast lumpectomy by almost 30 years.

  • A Middle Ground for Prostate Cancer Treatment

    When prostate cancer is discovered a man typically hears about two basic treatment options: surgery or radiation. Next he learns that both options carry a risk of humiliating side effects which can be temporary or permanent. He then learns neither option comes with a guarantee for a cure. Finally, he learns that if this whole gland treatment fails there are only few "salvage" options to fall back on.

    In addition to surgery and radiation, men with early stage, low-risk disease may also be told they are candidates for "Watchful Waiting" or a form of active surveillance. Under watchful waiting the cancer remains untreated. Instead, the patient's disease progression is monitored at intervals by a PSA screening, DRE (digital rectal exam) and repeat biopsies. While watchful waiting may be a good fit for some conditions, it is also a calculated risk. Even more troubling may be the anxiety many men feel about their untreated cancer. The psychological pressure can be daunting.

    My argument is for an option that provides an effective middle ground to prostate cancer treatment. A third option that falls between watchful waiting and total gland destruction. A therapeutic approach that can be victorious over prostate cancer while eliminating or reducing the negative consequences of a total treatment. In short, an option that can destroy the known cancer without destroying a man's quality of life.

    The rational case for targeted prostate treatment is based on two main principals:
    1. The first principal is to treat only the known cancer (including any region of high risk) while sparing the regions that don't need treatment. This logic is based on the long standing edict of "do no harm." In other words, do what's required to treat the identified disease while doing as little as possible to cause side effects.
    2. The second principal is to preserve all possible options to re-treat if any additional cancer is discovered or if new cancers develop down the road. Logically, this provides a "safety net" for patients should it be needed.

  • The Science Behind Targeted Prostate Treatment

    Dr. Scionti The Science Behind Targeted Prostate Treatment unifocal-tumor.pngThis illustration shows a unifocal tumor located in only one location.

    The science that supports targeted treatment is based on pathology studies from prostate glands that were surgically removed then examined to identify the location, volume, and the aggressiveness of any prostate cancer discovered. Multiple published studies clearly show that up to one third of all prostate tumors appear to be "unifocal" rather than "multifocal," meaning they are found only on one side of the gland. As a result up to 70,000 men a year might clinically qualify for a targeted prostate treatment. Likewise, based on the degree of clinical significance, the actual number of potential candidates for targeted treatment may be even higher. Studies suggest that up to 30% of multi-focal tumors may be clinically insignificant, meaning that based on the volume and aggressiveness of the prostate cancer found, some patients might not need immediate or entire gland treatment.

  • The Best Candidates for Focal Treatment

    For me the best focal therapy candidates fall into three categories:
    1.  The first category includes men who are eligible for watchful waiting (including active surveillance). The logic here is simple: if your doctor is willing to forgo treatment then focal therapy would be something above and beyond the recommend level of care.
    2. The second category includes men with apparent unifocal disease (meaning prostate cancer is found only on one side of the prostate gland). Treating just the one side of the gland with cancer while sparing the opposite side of the gland would offer a rational middle ground approach for these men.
    3. The third category includes men with clinically insignificant multifocal disease (meaning patients with very small tumors that are found on both sides of the gland). While this group may present the highest degree of risk I believe that risk can be further filtered with a comprehensive diagnosis and screening process combined with a diligent follow up and management program.

  • Identifying Appropriate Focal Candidates

    The first and most important clinical objective to identifying potential candidates for focal therapy is to confirm the location and clinical significance of prostate cancer. Before moving ahead with a focal treatment I work to find the exact location, volume and aggressiveness (or stage) of the cancer. I want to be sure the cancer is contained within the gland and that a patient's cancer truly meets my low risk criteria.

    To help determine a patient's risk level I have developed a comprehensive detailed diagnostic protocol I call the NavigatorTM. Developed over the past 10 years, the Navigator protocol is an advanced prostate cancer staging and prostate mapping procedure that goes well beyond the standard for most patients. However, it's a vital part of qualifying and planning a targeted treatment that no patient should skip. The goal is to create a precise anatomic map of the prostate that details the location, volume and stage of cancer within the gland. It works by combining four interdependent steps into a single prostate map and treatment blueprint:

    1. The first step is a high definition, multi parametric Magnetic Resonance Imaging (MRI) of the prostate. MRI is imaging that uses a magnetic field and radio waves to produce highly detailed images of the body. The MRI helps me to map the prostate by providing precise images that detail the size and dimensions of the gland. In addition, the multi parametric MRI scan includes several tests performed by a radiologist to identify potential tumors within the prostate gland and then to annotate (or mark) these regions of interest on the MRI scan. The result is incredibly detailed information about the size and location of possible tumors within the prostate gland.
    2. The next step is to correlate the MRI scans with a live Ultrasound. To integrate the MRI and live ultrasound images, I use my own anatomic co-registration technique. Correlating the MRI and Ultrasound images helps to create a map of the prostate based on the actual size, shape and density of the gland. It also helps to further pinpoint potential tumors identified within the prostate from the MRI scan.
    3. Next I use a Power Color Doppler Ultrasound to identify blood flow in and around the prostate. The Doppler allows help me to analyze vascular flow near any suspected tumors. This information helps to zero in on the precise location and volume of any suspected tumors. Armed with this information I then perform a targeted biopsy of suspected prostate tissue located near the annotated regions of interest.
    4. The final step is to use the pathology findings (laboratory analysis of the tissue samples from the biopsy) to help confirm the location, size and aggressiveness of any identified tumors. This would also include molecular markers such as PCA3 levels and new gene sequences to help better understand the aggressivness of the cancer. The end result is a detailed 3D prostate map that provides the best possible tumor information along with a blueprint for targeted treatment. The 3D map also locates precise location of sensitive structures that might be left untreated if no cancer is discovered (e.g. the neurovascular bundles).

    (Note: the Navigator protocol is practiced by Dr. Scionti at (subject to change)the NYU - Joel E. Smilow Comprehensive Prostate Cancer Center in New York City.  If travel to New York is not practical, Dr. Scionti can suggest other centers of excellence closer to your home).
  • Dr. Scionti Targeted Focal Prostate Cancer Treatment multi-parametric-imaging.pngThe latest multi-parametric imaging provides accurate tumor identification and targeting.

    The latest multi-parametric imaging provides accurate tumor identification and targeting.

  • Focal Therapy Treatment Options

    Today there are three target treatment options I use in my practice: HIFU, Cryoablation and MRI Guided Laser Ablation. All three options use thermal energy (heat or cold) to ablate (or destroy) prostate tissue. Likewise, all three techniques can zero in on specific prostate locations while sparing the surrounding healthy prostate tissue; unlike radiation, there is no "scatter effect" so the zone of destruction is precise and immediate. Finally, all three options preserve the ability to re-treat should it be necessary.

    However, each option has advantages and disadvantages and not all of these options are approved for use in the USA or not all options are covered by insurance. Below is a quick summary of each option. 


    Focal HIFU

    I offer focal HIFU outside of the U.S. (specifically, Bermuda, Nassau and Toronto) based on the patient's prostate size, shape, tissue density, tumor volume, tumor location and mapping of sensitive quality of life structures. During a focal HIFU treatment I conform the HIFU energy to the specific region of the prostate. For a focal treatment this can mean energy is sent only to the regions of known confirmed cancer. To ensure appropriate treatment, I modulate the HIFU energy based on prostate tissue characteristics and real time feedback of the treated prostate tissue. This is advanced by using the Tissue Change Monitoring (TCM) feature of the Sonablate 500. During the procedure I work to carefully control the HIFU energy near critical quality-of-life structures to help preserve potency and reduce the risk of a urethral stricture. Similar to other prostate cancer treatments, physician experience is an important factor in treatment success.

    Add Mark Emberton's data here. (Perhaps end the summary of his data with Steve's observation: "This type of result has never been published before with any type of focal treatment.")

  • About HIFU: High Intensity Focused Ultrasound (HIFU) is a state-of-the-art technology that uses ultrasound waves to destroy tissue with pinpoint accuracy. HIFU focuses sound waves in a targeted area, which rapidly increases the temperature in the focal zone causing tissue destruction. In most cases, HIFU is a 1-2 hour, one-time procedure performed on an outpatient basis under general anesthesia. Unlike radiation, HIFU is non-ionizing; this means that HIFU may also be repeated if necessary.

    IMPORTANT HIFU INFORMATION: HIFU is not an approved procedure in the U.S. and the Sonablate® 500 system that is used during the HIFU prostate procedure remains investigational in the U.S. This technology is being studied for the treatment of prostate cancer in clinical trials in the U.S. However, the FDA has made no decision as to the safety or efficacy of the Sonablate®500 for the treatment of prostate cancer at this time.

    HIFU is not covered by Medicare or private insurance. Some patients with private insurance have been able to recover a portion of their costs through their insurance, but as of this writing there is no pre-authorization. HIFU is practiced outside of the U.S. in over 100 HIFU centers worldwide.

  • Cryotherapy

    Prostate cryotherapy is an effective, minimally invasive prostate cancer treatment for men with all forms of localized prostate cancer. To perform the treatment I use ultrasound imaging and very sophisticated computer planning to place small needles directly inside the prostate. Argon gas is then circulated inside the needles creating supercold ice that freezes the targeted prostate tissue and kills the cancer. For safety a warming catheter is used to protect the urethra along with temperature monitoring and ultrasound visualization.  The procedure is covered by Medicare and most private insurance companies.  I perform prostate cryotherapy several times a week at the New York University School of Medicine and Langone Medical Center.

    The procedure only takes 1-2 hours, and most patients are typically treated on an outpatient basis - meaning no long hospital stay. Recovery time is fast. Most patients are typically back on their feet in a few days. The treatment has a low incidence of side effects. In fact, incontinence affects have been less than 5% for my patients - far less than other procedures. And because the procedure is minimally invasive it does not have risks of side effects and complications associated with major prostate surgery. Likewise, prostate cryotherapy does not have any of the dangers of radiation therapy or of radioactive seeds left in the body. Because we use ICE the treatment is natural.

    Focal - Targeted Cryotherapy: Perhaps the biggest advantage to cryotherapy is that the procedure can be tailored for each patient and the freezing can be focused or targeted just in the area where the cancer is identified. A targeted approach allows me to spare the healthy prostate tissue and further reduce the risk of side effects, procedure time and recovery. For many patients I can spare the nerves that control sexual function.

  • Dr. Scionti Targeted Focal Prostate Cancer Treatment focal-freeze.png

  • MRI Guided Laser Ablation

    MRI-guided laser ablation is an advanced, minimally invasive focal procedure which uses an MRI to place a tiny laser fiber to ablate the targeted tumors and tissue in the prostate. Performed in conjunction with a radiologist, the MRI provides accurate visualization of the tumors in real time. The tumor to be treated must be readily visible by MRI imaging. The tiny laser fiber is used to ablate the targeted prostate issue using thermal energy (heat) while preserving normal tissue and adjacent vital organs. Procedural planning creates "safety zones" to protect the bladder, neurovascular bundles and the rectal wall. These protections can help to decrease the risk of erectile dysfunction and the loss of bladder control (commonly known as incontinence). The process can be repeated if necessary and does not preclude any future prostate therapies. MRI Laser ablation is an outpatient procedure performed in specialized MRI centers in about one hour. It requires no surgery, no anesthesia, and no catheter. MRI-guided laser ablation is not covered by Medicare or private insurance.
  • Dr. Scionti Focal Therapy Follow-up lesion-laser-probe.pngThis image is provided courtesy of Dan Sperling, MD.

    Focal Therapy Follow-up

    The final step in all focal prostate therapy is a comprehensive post treatment follow up plan for each patient.  I personally monitor the recovery progress of every patient I treat. This personalized recovery plan includes access to the highly trained specialty team of physicians and health care professionals at NYU. Likewise, I work extensively with a patient's local care provider to help achieve a speedy and effective return to normal life and to establish an appropriate monitoring plan. It's vital that each patient remains diligent, consistently observing a well designed treatment follow up plan. For that reason, I look beyond just the clinical aspects to assess each patient's attitude and commitment to a focal therapy treatment.

    Accurate follow up requires advanced MRI imaging and the use of advanced molecular testing including PCA3

    IMPORTANT INFORMATION: The information provided on this website is for general information purposes only and is not intended to replace sound professional medical advice and care. All treatment options and potential outcomes and complications should be discussed with Dr. Scionti or a qualified healthcare provider.

 

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