Your Education Resource for Urology | Grand Rounds in Urology

E. David Crawford, MD, Editor-in-Chief

LEARNING CENTERS

Next Generation Androgen Deprivation Therapy

Editor: Celestia S. Higano, MD

Next Generation Genomics and Biomarkers

Editor: Leonard G. Gomella, MD

Next Generation Upper Tract Urothelial Carcinoma

Editor: Seth P. Lerner, MD

PSMA-11 PET: Atypical Paths to FDA Approval and Academic NDAs

Thomas Hope, MD, Assistant Professor in Residence in Abdominal Imaging and Nuclear Medicine in the Department of Radiology at the University of California, San Francisco, explains how an academic institution successfully submits a new drug application (NDA) to the US Food and Drug Administration (FDA), using the NDA for prostate-specific membrane antigen (PSMA) 11 as an example. He notes the limitations that academia has in this area, and recommends that, going forward, institutions design imaging studies so that they report usable detection rates and have blinded readers.

Recent Clinical Radionuclide Therapy Advances in mCRPC

Ulka Vaishampayan, MD, Professor of Oncology at Wayne State University and Chief of Solid Tumor Oncology at the Karmanos Cancer Center, discusses the phase 3 randomized controlled trial of 177-Lutetium-PSMA radionuclide therapy. In this brief summary, Dr. Vaishampayan discusses the mechanism of action of this novel therapy, how to identify patients utilizing a PSMA-based PET scan, and the inclusion/exclusion criteria from the phase 3 randomized control trial of this targeted agent.

Overview of Treatment for Advanced Prostate Cancer, including Metastatic Disease – Novel Treatment

Christopher Sweeney, MD, MBBS, gives an overview of the most promising research into novel treatments for metastatic castration-resistant prostate cancer (mCRPC), focusing on phosphatidylinositol 3-kinase (PI3Kinase)/Akt inhibition, Poly ADP-ribose polymerase (PARP) inhibitors, and lutetium-labeled prostate-specific membrane antigen (Lu-PSMA). He emphasizes the importance of careful patient selection for these therapies, and suggests that future studies should focus on combination therapies and avoid duplicative research.

Prostate Cancer Initial Staging and Evaluation of Recurrent Disease with PSMA-Targeted PET

Steven Rowe, MD, PhD, gives an overview of current data on prostate-specific membrane antigen (PSMA)-targeted PET imaging for initial staging of prostate cancer (PCa) and evaluation of recurrent disease. He emphasizes PSMA’s limited sensitivity for initial diagnosis and high sensitivity for recurrent disease, while also noting potential strengths and weaknesses of PSMA that are independent of sensitivity.

Diagnostic Challenges with Upper-Tract Urothelial Carcinoma

Peter Black, MD, FACS, FRCSC, discusses questions, challenges, and methods in diagnosing upper-tract urothelial cancer. He analyzes established criteria for when to conduct a biopsy, discusses various methods and tools used for obtaining sufficient tissue for diagnosis, and how risk stratification impacts the selection of options for management of the disease.

Biochemical Recurrence After Local Therapy: Assessment and Management

Peter R. Carroll, MD, MPH, Taube Family Distinguished Professor in Urology, Department of Urology at the University of California, San Francisco, outlines detection and treatment options for biochemical recurrence following a prostatectomy or radiation therapy. He details how recurrence can be detected with PSMA PET imaging, as the majority of cases have PSMA-avid lesions present. Dr. Carroll further notes typical and atypical regional and local areas of recurrence. He also describes a new disease management algorithm for deciding between further radiation therapy or monitoring & localized treatment.

Current and Emerging Role of Radiogenomics

John Feller, MD, Founding Partner and Medical Director at Desert Medical Imaging, gives an overview of radiogenomics’ current and possible future role in prostate cancer care. He notes the recent promising results of multiparametric MRI (mpMRI) from trials, which have shown that using mpMRI before transrectal ultrasound-guided (TRUS) biopsy can decrease the number of unnecessary biopsies, limit detection of insignificant cancer, and improve detection of significant cancer. These have influenced the updated 2019 National Comprehensive Cancer Network (NCCN) Guidelines for prostate cancer. Dr. Feller further discusses other biomarkers for risk stratification and promising research on radiogenomics in the setting of focal therapy.