Gerald L. Andriole, Jr., MD

Gerald L. Andriole, Jr., MD

Prostatype Genomics

St. Louis, Missouri

Gerald L. Andriole, Jr., MD, is Chief Medical Officer of Prostatype
Genomics. He retired in June 2023 from Johns Hopkins University
where he was Professor and Director of Urology in the National Capital
Region. Previously, he had been the Royce Distinguished Professor and
Chief of Urologic Surgery at Washington University in St. Louis for
over 20 years.

Dr. Andriole participated in the 5-year accelerated medical program at
Penn State University and Jefferson Medical College, Philadelphia, PA.
He trained in surgery at Strong Memorial Hospital, University of
Rochester, NY and completed urology residency at Brigham and
Women’s Hospital, Harvard Medical School, Boston, MA. He served a
fellowship in Urologic Oncology at the National Cancer Institute of NIH
in Bethesda, Maryland prior to joining the faculty at Washington
University.

Dr. Andriole has significant expertise in prostate cancer screening and
prevention. He was continuously funded by NIH from 1993 and has
contributed over 450 peer-reviewed publications (H-index of 110). He
chaired the Prostate Committee of NCI’s PLCO Cancer Screening Trial
and led the international REDUCE Prostate Cancer Chemoprevention
Trial. He also chaired the Prostate Committee of the Society of Urologic
Oncology Clinical Trials Consortium.
Dr. Andriole is an elected member of the American Surgical
Association, American Association of Genitourinary Surgeons, and the
Clinical Society of Genitourinary Surgeons. He received the
Outstanding Achievement Award from the Urologic Oncology Branch
of NCI, the Distinguished Clinician Award from Washington University,
the Distinguished Alumni Award from Jefferson Medical College and
the Williams Award for Prostate Cancer Research Excellence from the
American Urologic Association Urology Care Foundation.

Talks by Gerald L. Andriole, Jr., MD

Prostate Microultrasound

Prostate Microultrasound

Posted by | May 2023

Gerald L. Andriole, Jr., MD, Director of Urology in the National Capital Region at the Brady Urologic Institute at Johns Hopkins University, discusses the uses of microultrasound in prostate assessment using the PRIMUS (Prostate Risk Identification using Micro-UltraSound) protocol, which allows most prostate ducts to be visualized and tissue patterns appreciated. He compares the accuracy of PRIMUS to its conventional analog, PRIMAD. Dr. Andriole cites research that suggests novice mircroultrasound practitioners can become adept at interpreting images and identifying lesions after as few as 30-40 scans.

He compares images and biopsy results from conventional ultrasound, microultrasound, and multiparametric magnetic resonance imaging (mpMRI) to illustrate the accuracy of microultrasound. Dr. Andriole also shares data that supports the use of systematic biopsy, micro-ultrasound targeted biopsy, and MRI together to identify the greatest proportion of clinically significant prostate cancer. However, Dr. Andriole concludes that while microultrasound is a promising tool for future identification of prostate risk, current studies like the OPTIMUM trial have yet to determine whether it can fully replace conventional diagnostic MRIs.

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Considerations to Improve Screening for Prostate Cancer

Posted by | Dec 2021

Gerald L. Andriole, Jr., MD, outgoing 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, and incoming Director of Urology in the National Capital Region at the Brady Urologic Institute at Johns Hopkins University, reviews current guidelines for prostate cancer screening and considers how screening can be improved. After an introduction from E. David Crawford, Editor-in-Chief of Grand Rounds in Urology and Professor of Urology at the University of California, San Diego, Dr. Andriole summarizes the AUA, EAU, and NCCN prostate cancer screening guidelines, highlighting the NCCN’s recommendation that men get an early-in-life PSA test to obtain a baseline, and interrogating the validity of the age cut-offs for testing in the AUA and EAU guidelines. He then proposes a series of concepts to improve screening, starting with recommendations on how to better identify which men are at above average risk. Dr. Andriole particularly emphasizes the utility of polygenomic risk scores, which have a high negative predictive value and can focus attention on which patients need to be further screened. He suggests that another key way to improve screening is to reduce confusion about the PSA test among patients and primary care providers by setting a cut-point of 1-1.5 as a threshold for referral to a urologist. Dr. Andriole then considers how to identify patients with clinically-significant prostate cancer earlier, focusing on the need for better biopsies. He also notes the importance of reducing unnecessary repeat and initial biopsies and suggests potentially using biomarkers, MRI, and PSMA-PET to decide whether a biopsy is necessary. After concluding his talk, Dr. Andriole further discusses polygenic risk score, the pros and cons of multiparametric MRI, the benefits of micro-ultrasound, transrectal versus transperineal biopsy, and the future of screening with Dr. Crawford.

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

Posted by | Nov 2021

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

Posted by | Aug 2021

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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