Fergus Coakley, MD, Author at Grand Rounds in Urology

Fergus Coakley, MD

Portland Health and Science University

Portland, Oregon

Dr. Coakley is the chair of Diagnostic Radiology. He joined OHSU in August 2012 from the University of California, San Francisco (UCSF) where he was a professor in residence in the Department of Radiology and Biomedical Imaging in the UCSF School of Medicine. He was also chief of the Abdominal Imaging Section and vice chair for Clinical Services in the Department of Radiology and Biomedical Imaging.

Dr. Coakley received his medical degree in 1988 from the School of Medicine, University College Cork, Ireland. His postgraduate training includes an internship at Mercy Hospital in Cork, medical residency at Mater and St. Vincent’s Hospitals in Dublin, and radiology residency at Leicester teaching Hospitals in Leicester, England. Dr. Coakley was a fellow in body imaging at Memorial Sloan-Kettering Cancer Center before joining UCSF in 1997. During a year away from UCSF in 2000–2001, he was assistant professor and director, body MRI, at Memorial Sloan-Kettering and Weill Medical College of Cornell University.

Dr. Coakley is an active clinician, teacher and researcher. He is involved in teaching at all levels, from medical students to postgraduate trainees. As Chair, he has worked to build productive teams, conduct successful recruitment, and develop a positive and equitable culture within the department. Since 2016, his research work has centered on developing a system that would allow for integrated endorectal MRI and in-bore targeted biopsy of the prostate, including the establishment of a small medical device company as an OHSU spin-off to attract small business grant funding. This reflects his longstanding interested in prostate cancer imaging and diagnosis. As a teacher, he finds educating the next generation of doctors to be both rewarding and stimulating, and is committed to involving young physicians in research.

Talks by Fergus Coakley, MD

Optimizing MRI Techniques for Prostate Cancer Diagnosis

Posted by Fergus Coakley, MD | Nov 2024

Fergus Coakley, MD, Portland Health and Science University, Portland, Oregon, delivers a 10-minute presentation on optimizing MRI for prostate cancer diagnosis, addressing key shifts in diagnostic paradigms. He explains the transition from systematic biopsies following PSA screening to a targeted approach using multiparametric MRI (mpMRI) and in-bore biopsies. He highlights the superior signal-to-noise ratio of endorectal coils, emphasizing their role in enhancing tumor detection and staging. Through case studies, Dr. Coakley demonstrates the efficacy of high-quality MRI in identifying clinically significant cancers that were missed by traditional methods. Data supporting targeted-only biopsies for positive MRI findings are presented, with discussions on the low yield and increased complications of systematic sampling. Dr. Coakley challenges conventional views on multifocality and secondary foci, showing minimal impact on prognosis. He urges the adoption of advanced MRI-guided techniques while acknowledging the need for further research. This insightful presentation invites viewers to explore evolving strategies in prostate cancer diagnostics and their implications for patient outcomes.

Optimizing MRI Targeted Biopsy – Including Endorectal Imaging for Tumor Localization and In-Bore Biopsy for Tissue Diagnosis

Posted by Fergus Coakley, MD | Jan 2024

Fergus Coakley, MD, discusses the use of MRI targeted biopsy for tumor localization and in-bore biopsy for tissue diagnosis. He begins by noting the changing paradigm of tumor diagnosis, moving away from the traditional systematic TRUS biopsy after an abnormal PSA or DRE, towards a multiparametric MRI and target-only biopsy after abnormal PSA or DRE. He discusses the benefits of multiparametric MRI over TRUS, addressing the issues of multifocality, overdiagnosis, and underdiagnosis in prostate cancer.

Dr. Coakley then discusses the benefits of including endorectal imaging as part of the multiparametric MRI to avoid underdiagnosis in patients. He presents a few examples of patients with known prostate cancer whose tumors were not visible through outside MRI alone.

Dr. Coakley addresses in-bore versus fusion biopsy for tissue diagnosis. He notes that fusion biopsy does not take into account prostate deformation during the procedure. He then presents evidence that in-bore biopsies are roughly as accurate as off-target fusion biopsies, and concludes that technical and interpretive variability is the biggest challenge facing clinicians in tumor diagnosis today.