Mukesh Harisinghani, MD, discusses how deep learning can accelerate MRI for prostate cancer detection without compromising scan quality.
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Mark A. Moyad, MD, MPH, the Jenkins/Pokempner Director of Preventive/Complementary and Alternative Medicine (CAM) in the Department of Urology at the University of Michigan Medical Center in Ann Arbor, Michigan, reports on the latest trends in men’s health and related research. Covering topics from blood pressure to vitamin D, Dr. Moyad brings levity to the array with a “hot or not” rating.
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In this 12-minute presentation, Peter F. Orio III, DO, MS, Vice Chair of Network Operations for Dana-Farber/Brigham and Women’s Cancer Center Department of Radiation Oncology and Associate Professor of Radiation Oncology at Harvard Medical School in Boston, Massachusetts, explains prostate brachytherapy is effective, efficient, and convenient, and he says it is “the right thing to do for patients.” He sees a threat to patients posed by radiation oncology without brachytherapy and concludes by encouraging urologists to explore a broad range of treatments to maximize the benefit to patients.
Read MoreAbraham Morgentaler, MD, FACS, Associate Clinical Professor of Urologic Surgery at Harvard University, summarizes results from a recent study on testosterone (T) therapy for patients with biochemical recurrence and metastatic prostate cancer. He provides some background, explaining that physicians have been taught that raising testosterone in a man with prostate cancer is like “pouring gasoline on a fire,” even though approximately 20 years of evidence suggests that T therapy is safe after radical prostatectomy, after radiation therapy, in patients with prostatic intraepithelial neoplasia, and in patients on active surveillance. Dr. Morgentaler notes that his and his colleagues’ research indicates that T therapy is also safe for patients with advanced disease. He then goes over the makeup and design of the observational study, which featured 22 symptomatic men of a median age of 70.5. The median duration of T therapy was 12 months, and all patients reported symptomatic benefit from the treatment. The overall mortality was 13.6% with only one prostate cancer-specific death, and morbidity was fairly low, with no cases of pulmonary embolism, spinal cord compression or pathological fractures, and no observed rapid or precipitous progression of disease. Dr. Morgentaler highlights one 94-year-old patient’s experience, describing how this man wanted to be on testosterone because androgen deprivation made him too tired to do the things he enjoyed. After 6 weeks of T therapy, this patient’s brain was clearer, his appetite had improved, and he was exercising daily, and even though he died at age 95 after 11 months of therapy, Dr. Morgentaler emphasizes the importance of T therapy’s benefit to his quality of life in his final months. He concludes that there are men who prioritize quality of life over duration, that data contradict the idea that T therapy is dangerous for patients with prostate cancer, and that T therapy might in fact be a reasonable option for selected men with metastatic disease who refuse androgen deprivation.
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Clare Tempany, MD, the Ferenc A. Jolesz Professor of Radiology at Harvard Medical School in Boston, Massachusetts, summarizes evidence for multiparametric magnetic resonance imaging’s (mpMRI) utility in prostate cancer diagnosis, and goes over recent developments in its use. She first looks at selection criteria for biopsy and biopsy type, including history, digital rectal examination (DRE), prostate specific antigen (PSA), and imaging, arguing that mpMRI is particularly helpful in allowing patients to avoid unnecessary biopsies. Dr. Tempany then defines state-of-the art mpMRI as featuring diffusion/apparent diffusion coefficient, being T2-weighted, being IV contrast/dynamic contrast enhanced, and as being reported using the PI-RADS v2.1 assessment. She goes over the PI-RADS assessment categories, considers the findings of multiple publications backing up the value of mpMRI as compared to transurethral ultrasound (TRUS), and looks at evidence supporting guidance indicating patients with PI-RADS 3 lesions should get a biopsy. Dr. Tempany follows this up by summarizing a paper from the PI-RADS steering committee on how PI-RADS and mpMRI should be used. Suggestions include performing mpMRI in most men suspected of having clinically-significant disease, providing a safety net of monitoring for patients who decline immediate biopsy after low-likelihood MRI findings, and using a combination of systematic and targeted biopsies in biopsy-naive patients while only using targeted biopsies for patients with prior negative findings on TRUS. Dr. Tempany then notes that the AUA, EAU, and NICE guidelines all now recommend MRI before biopsy, and also observes that MRI is cost-effective if it leads to the avoidance of biopsy. She concludes by listing areas for future development, including multi-omics, molecular pathology, germline mutations, CTC/blood biomarkers, and mass spectrometry.
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