Gerald L. Andriole, Jr., MD

Gerald L. Andriole, Jr., MD

Barnes-Jewish Hospital and Washington University School of Medicine

St. Louis, Missouri

Gerald L. Andriole, Jr., MD, is the Robert K. Royce Distinguished Professor and Chief of Urologic Surgery at Barnes-Jewish Hospital, the Siteman Cancer Center, and Washington University School of Medicine in St. Louis, Missouri. Dr. Andriole received his medical degree from Jefferson Medical College in Philadelphia, Pennsylvania. He trained in surgery at Strong Memorial Hospital and the University of Rochester and completed his Urology Residency at Brigham and Women’s Hospital and Harvard Medical School. Subsequently, he was a Fellow in Urologic Oncology at the National Cancer Institute in Bethesda, Maryland. Dr. Andriole has over 35 years of consistent contributions in the areas of BPH and prostate cancer screening and prevention research. He has contributed well over 400 peer-reviewed publications and serves on the editorial boards of several prestigious journals. He is Chairman of the Prostate Committee of the National Cancer Institute’s Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial, and PI of the NIDDK Multidisciplinary Approach to Urologic Pelvic Pain (MAPP) and Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN). He was Chairman of the Steering Committee of the REDUCE Prostate Cancer Prevention Trial, as well as PI of both the NIDDK Medical Therapy of Prostatic Symptoms (MTOPS) BPH trial and the NIDDK Complementary and Alternative Medicine for Urinary Symptoms (CAMUS) study. He is a member of the American Urological Association, the American Association for Cancer Research, the American Society of Clinical Oncology, the American Surgical Association, the American Association of Genitourinary Surgeons, and the Clinical Society of Genitourinary Surgeons, among other societies.

Disclosures:

Articles by Gerald L. Andriole, Jr., MD

The OPTIMUM Trial: 29 MHz Micro-Ultrasound vs. MRI in Diagnosis of Prostate Cancer

Gerald L. Andriole, Jr., MD, Robert K. Royce Distinguished Professor and Chief of Urologic Surgery at Barnes-Jewish Hospital, the Siteman Cancer Center, and Washington University School of Medicine in St. Louis, Missouri, introduces the OPTIMUM trial comparing high-resolution 29 MHz micro-ultrasound to MRI in the diagnosis of prostate cancer. After an introduction by E. David Crawford, MD, Professor of Urology at the University of California, San Diego, and Editor-in-Chief of Grand Rounds in Urology, Dr. Andriole explains that micro-ultrasound is a novel ultrasound-based system operating at 29 MHz that results in a 300 percent improvement in resolution compared to conventional ultrasound. He explains that micro-ultrasound can be used for transrectal or transperineal biopsy, with or without MRI. Dr. Andriole also notes that, like MRI with PI-RADS, micro-ultrasound has its own prostate risk identification using micro-ultrasound (PRI-MUS) classification system and works with all the skills urologists already have. He observes that several small studies have found superior or comparable sensitivity and/or clinically-significant prostate cancer detection with micro-ultrasound as compared to MRI, but that level 1 evidence is lacking. Dr. Andriole explains that the OPTIMUM trial, a 3-arm randomized controlled trial, is intended to fill in that gap and provide better evidence regarding micro-ultrasound’s efficacy. He describes the design of the trial, noting that 1200 biopsy-naïve subjects will be randomized to micro-ultrasound-only biopsy, MRI/micro-ultrasound “FusionVu” biopsy, and MRI/ultrasound biopsy with conventional fusion system, and that the trial is set to begin in winter 2021 and finish by spring 2023. The discussion concludes with a question and answer session in which Drs. Crawford and Andriole discuss which fusion platforms will be used, the price of micro-ultrasound, other potential applications for micro-ultrasound, and more.

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Prostate Cancer Risk Assessment: Focus on Early PSA and Hereditary Risk

Gerald L. Andriole, Jr., MD, Robert K. Royce Distinguished Professor and Chief of Urologic Surgery at Barnes-Jewish Hospital, the Siteman Cancer Center, and Washington University School of Medicine in St. Louis, Missouri, discusses two areas of prostate cancer risk assessment: age-adapted PSA and hereditary risk. Dr. Andriole begins with an early trial which showed that for men who have a PSA of <1 in their first screening, their 15-year chance of developing metastatic prostate cancer or dying is less than 1%. Their risk level drops down to <0.2% if their PSA value remains at <1 in a second screening. If screenings continue to show low PSA levels as the patient ages, one could conclude that a low-risk score should result in no further screening, but Dr. Andriole cautions against this approach. He then discusses the PROBASE study, a prospective study randomizing PSA testing in men starting at age 45 vs. the standard age of 50. The early arm of the study has 23,301 men and the goal is to look at the detection of Gleason grade group 2 or above cancer by the time a man reaches age 50. Dr. Andriole addresses the role of family history, noting that a positive family history increases the probability of developing prostate cancer, but not necessarily mortality. In contrast, a higher genetic risk score (GRS) is associated with a higher mortality rate. He then discusses using a Prompt score, which is more efficient when compared with a PSA screening alone. Dr. Andriole concludes that physicians should assess PSA early in life and may consider adding in 4K score. Ultimately, a combination of a number of factors, including family history, race and ethnicity, genetic risk score, and PSA, will be needed.

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Non-Metastatic CRPC: Finding Advanced Disease with Next Gen Imaging Matters

Gerald L. Andriole, Jr., MD, the Robert K. Royce Distinguished Professor and Chief of Urologic Surgery at Barnes-Jewish Hospital, the Siteman Cancer Center, and Washington University School of Medicine in St. Louis, Missouri, defines non-metastatic castration-resistant prostate cancer (nmCRPC) as having rising PSA measurements on three consecutive measurements with a PSA of greater than two. He also defines next-generation imaging as PET scans. He discusses FACBC scans and PSMA-based PET scans, as well as the history and treatment of nmCRPC. Dr. Andriole reviews the SABR-COMET study, the STOMP trial, and the ORIOLE study. He concludes that next-generation imaging is necessary for patients with nmCRPC, that metastasis-directed therapy shows benefits, and that larger and longer trials are warranted.

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PET Imaging for Prostate Cancer

Gerald L. Andriole, Jr., MD, the Robert K. Royce Distinguished Professor and Chief of Urologic Surgery at Barnes-Jewish Hospital, the Siteman Cancer Center, and Washington University School of Medicine in St. Louis, Missouri, reviews the 2020 NCCN Guidelines, focusing on PET imaging for prostate cancer and related studies. He establishes that PET/CT and PET/MRI for detection of biochemically recurrent disease have been approved, though the majority of the data collected is specifically for the Ga-68 PSMA tracer. F-18 DCFBC, F-18DCFPyl, and F-18 PSMA 1007 are currently being evaluated for possible advantages over Ga-68 PSMA. Dr. Andriole then discusses several studies which demonstrate both the benefits and limitations of PET-directed therapies in the prostate cancer setting.Dr. Andriole concludes by looking at studies which compared PSMA PET to conventional imaging and found PSMA PET to be significantly more effective.

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Updates in Screening: Prostate Cancer Guidelines

Gerald L. Andriole, Jr., MD, a Robert K. Royce Distinguished Professor and Chief of Urologic Surgery at Barnes-Jewish Hospital, the Siteman Cancer Center, and Washington University School of Medicine in St. Louis, Missouri, reviews guidelines for prostate cancer screening, including the unchanged 2018 AUA guidelines and the 2020 updates to the NCCN and EAU guidelines. Following this, he explains why he disagrees with a 2020 article that suggests physicians use a PSA level of 10 ng/mL as the threshold when referring PCa patients to urology and thus biopsy. Lastly, he outlines five ways physicians can improve the early detection of prostate cancer.

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