Laurence Klotz, MD, FRCSC, presented “Alan W. Partin Distinguished Lecture: The Genomics and Natural History of Visible vs. Invisible Cancers” during the 34th International Prostate Cancer Update on February 12, 2024, in Vail, Colorado.
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How to cite: Klotz, Laurence. “Alan W. Partin Distinguished Lecture: The Genomics and Natural History of Visible vs. Invisible Cancers.” February 2024. Accessed Nov 2024. https://grandroundsinurology.com/alan-w-partin-distinguished-lecture-the-genomics-and-natural-history-of-visible-vs-invisible-cancers/
Alan W. Partin Distinguished Lecture: The Genomics and Natural History of Visible vs. Invisible Cancers – Summary
Laurence Klotz, MD, FRCSC, presents the newly-emerging and provocative concept of MRI visibility as a predictor of prostate cancer tumor aggressivity in the Alan W. Partin Distinguished Lecture at IPCU 34. Given that more definitive data on the subject develops, and the urological community accepts it, this could imply significant changes to practice.
Currently, the concern over invisible cancers drives a lot of interventions, such as systemic biopsies in patients who have already undergone targeted biopsies and/or received negative imaging results. Patients on active surveillance derive anxiety from the possibility of having untreated occult cancer.
The clinical implication of imaging-based monitoring has many advantages, such as psychological benefit to the patient, and reduced cost and burden of care from avoiding systematic biopsies. Recent genomic and clinical studies support the idea that tumors invisible on MRI imaging have much more favorable genetics and natural history than those visible on MRI. This implies that in imaging-based management, the occasional missed cancers are not meaningful.
Many exciting genetic studies over the past six years have demonstrated merit to this theory, including a study identifying four genes predicting progression-free survival, metastases-free survival, and MRI visibility; a study correlating cancer aggressiveness and quantitative imaging features; and a correlation analysis of hypoxia-related genes and biparametric MRI visibility. A study from University of California, Los Angeles defined the term Nimbosus—a word derived from nimbus storm clouds—to describe an aggressive pathological, molecular, and microenvironmental phenomenon. This data suggested a confluence of the adverse features that make up nimbosus and MRI visibility.
However, there are still many unmet needs in this area, including an interrogation of uncommon invisible aggressive cancers, existing databases for robust data on invisible versus invisible cancers, and alternative imaging modalities like micro-ultrasound and PSMA-PET. As radiogenomics are still in their infancy, further, more definitive research must occur before adopting this into practice.
About The Alan W. Partin Distinguished Lectureship:
A noted physician-scientist and prostate surgeon, Alan W. Partin, MD, PhD, developed a method to predict the prognosis of prostate cancer. He pursued science with creative vigor, cared for thousands of patients with kind expertise and led the field of urology department through strategic growth, broadening its sphere of influence.
Throughout his 40-year career as a researcher, a clinician and a leader, Dr. Partin was consistently at the heart of discovery and innovation in the field of urology, always keeping a singular focus on improving patient outcomes. Among his many contributions, Dr. Partin was known for developing the Partin Tables, which are used for predicting the prognosis for prostate cancer to this day, and for his work developing several innovative tests to identify and track prostate cancer, including the Prostate Health Index.
Grand Rounds in Urology created the lectureship to honor those who continue Dr. Partin’s spirit of advancement in the fields of urology and oncology.
About The 34th Annual International Prostate Cancer Update:
The International Prostate Cancer Update (IPCU), founded in 1990, is a multi-day CME conference focused on prostate cancer treatment updates with expert, international faculty. It is led by expert physicians and is designed for urologists, medical oncologists, radiation oncologists, and other healthcare professionals involved in the diagnosis and treatment of prostate cancer. The 34th iteration of the meeting occurred February 11-14, 2024 in Vail, Colorado. To view more educational presentations from IPCU 34, visit our collection page.
ABOUT THE AUTHOR
Laurence Klotz, MD, FRCSC, is a professor of surgery at the University of Toronto and the Sunnybrook Chair of Prostate Cancer Research. Dr. Klotz was the founding editor-in-chief of both the Canadian Journal of Urology and the Canadian Urology Association Journal (CUAJ), and he is now editor emeritus of the CUAJ. Dr. Klotz obtained his medical degree and completed his residency at the University of Toronto. He was also a uro-oncology fellow at Memorial Sloan Kettering Cancer Center in New York.
Dr. Klotz has 550 peer review publications and eight books. He coined the phrase “active surveillance” and successfully championed this approach for men with favorable-risk prostate cancer against substantial resistance. He was the associate editor of the Journal of Urology, responsible for prostate cancer, for eight years. Dr. Klotz received the Queen’s Jubilee Medal for outstanding public service, the University of Toronto's Lister Prize, the Society of Urologic Oncology’s SUO Medal, the American Urological Association’s Richard Williams Award, the University of Toronto's Lifetime Achievement Award, the Canadian Urological Association Lifetime Achievement Award, and the Harold Warwick Award from the Canadian Cancer Society for “outstanding contributions to cancer control.” In 2015 he was inducted as a Member of the Order of Canada, Canada’s highest civilian award.
