Jelle Barentsz, MD, PhD

Jelle Barentsz, MD, PhD

Nijmegen Medical Center

Nijmegen, Netherlands

Jelle Barentsz, MD, PhD, is a Professor of Radiology at the Nijmegen Medical Center of Radboud University in Nijmegen, The Netherlands. He is an internationally recognized researcher known for developing, validating, and implementing new MRI techniques in oncology. He is also the Chair of the Prostate MR-Reference Center, Founding Member and Past-President of the International Cancer Imaging Society, and Past-President of the European Society of Urogenital Radiology (ESUR). In 1980, he earned his MD from Utrecht University. In 1990, he earned his PhD in medical research on MRI of the urinary bladder from Radboud University Nijmegen. Since then, he has contributed to almost 300 peer-reviewed publications. One of his notable contributions involves initiating PI-RADS and, along with ESUR and the American College of Radiology, making the system a world standard, thereby enabling early selective detection of aggressive prostate cancer. Also, he helped revive Combidex-MRI, which can detect 1.5 mm lymph node metastases of any cancer. He has been decorated as a “Knight in the Order of the Dutch Lion.” In addition, he has been awarded the Wertheim Salomonson Medal, the SAR Lifetime Achievement Award, the Dutch Cancer Society’s Queen Wilhelmina Research Award, and the SCBTMR Lauterbur Award.

Disclosures:

Articles by Jelle Barentsz, MD, PhD

Recent Advancements in PI-RADS: mpMRI vs. bpMRI

Jelle Barentsz, MD, PhD, Professor of Radiology at the Nijmegen Medical Center of Radboud University in Nijmegen, The Netherlands, begins his talk on recent advancements in the prostate imaging-reporting and data system (PI-RADS) by asserting the value of local magnetic resonance imaging (MRI) in the diagnosis of prostate cancer. He cites the 2019 European Association of Urology (EAU) guidelines, which recommend performing a prostate MRI before biopsy, and points out that this results in 2,000,000 MRIs annually. He asserts there is a need for fast MRI, citing a PI-RADS committee position on MRI without the use of gadolinium (Gd)-based contrast medium (biparametric MRI, or bpMRI) which suggests that if certain prerequisites are satisfied, bpMRI may offer a fast MRI option for some patients. Dr. Barentsz then cites three studies. The first compared screenings using multi-parametric MRI (mpMRI) with bpMRI and found the prostate cancer detection rate was identical (but it failed to specify which patients had insignificant vs. clinically-significant prostate cancer [csPCa]). The second study compared single-plane (or “fast”) bpMRI vs. mpMRI and concluded mpMRI found nine percent more csPCa; however Dr. Barentsz points out the study was underpowered and used an older technique, a 1.5T endorectal coil (ERC) MRI. Dr. Barentsz explores data from the third study, which found that mpMRI and fast bpMRI demonstrated equal sensitivity in finding csPCa, at 95 percent. He outlines the pros and cons of the fast bpMRI, emphasizing that for less-experienced radiologists, the procedure increases uncertainty. Dr. Barentsz explains that the PI-RADS committee concludes there is a need to have both unenhanced MRI and contrast-enhanced MRI approaches available for prostate-cancer diagnosis. Dr. Barentsz then turns to the issue of costs, showing data comparing the direct cost of mpMRI, bpMRI, and “fast” bpMRI, specifying that mpMRI is more than twice as costly as “fast” bpMRI. Dr. Barentsz asserts that dynamic contrast-enhanced (DCE)-MRI is a better choice for patients with a previous negative bpMRI with persistent clinical suspicion, DWI-artifacts (e.g., hip prosthesis), and for doctors with a lower level of expertise. Dr. Barentsz then explains situations when bpMRI (no DCE) may be an appropriate choice, such as in a low-risk (screening) population or when there is a high chance of having significant prostate cancer. Dr. Barentsz concludes his talk by stating that bpMRI can be effective for very skilled prostate radiologists. He reiterates that DCE helps find small tumors, reduces uncertainty, and increases confidence. He also states that the prerequisites for bpMRI are good quality imaging, and specifies the need for objective quality assessment and control as well as training and certification.

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Usefulness of Adjustable Needle Sizes for Biopsies

E. David Crawford, MD, Professor of Urology at the University of California, San Diego, discusses the usefulness of adjustable needle sizes for prostate biopsies with Jelle Barentsz, MD, PhD, Professor of Radiology at the Nijmegen Medical Center of Radboud University in Nijmegen, The Netherlands. Dr. Barentsz agrees with Dr. Crawford that a needle that can be adjusted from 10 to 60 gauge would be useful in situations such as when the smaller needle sometimes needed to reach an area is unable to pierce through fat to take the needed core sample. Drs. Barentsz and Crawford then address the pros and cons of mapping biopsy of the prostate: Dr. Barentsz contends that the use of 180 needles to obtain only slightly more accurate results than MRI may not be warranted, and Dr. Crawford notes that mapping biopsies are usually reserved for patients with negative MRIs and negative biopsies.

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The Use of MRI to Determine the Target for Focal Therapy

Jelle Barentsz, MD, PhD, Professor of Radiology at the Nijmegen Medical Center of Radboud University in Nijmegen, The Netherlands, discusses the use of MRI to determine targets for focal therapy in prostate cancer patients with E. David Crawford, MD, Professor of Urology at the University of California, San Diego. Dr. Barentsz emphasizes that practitioners require appropriate experience to use MRI in this way, suggesting that a lack of base-level knowledge has prevented many doctors in the United States from making effective use of this technique. He notes, however, that focal therapy has revolutionized breast cancer treatment and has the potential to transform prostate cancer care as well. Dr. Crawford concurs and shares his largely positive experiences with MRI-targeted focal therapy.

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Multiparametric MRI for the Detection of Clinically Significant Prostate Cancer

Jelle Barentsz, MD, PhD, Professor of Radiology at the Nijmegen Medical Center of Radboud University in Nijmegen, The Netherlands, discusses the ins and outs of diagnosing clinically significant prostate cancer (csPC) using mpMRI. He goes on to discuss how to improve the diagnostic accuracy of mpMRI, including optimizing image acquisition, use of training sessions to refine the radiologist’s expertise and interpretation of results, as well as how to reduce systematic and random error associated with MRI-directed biopsy.

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The Capacity of MRI to Predict Extracapsular Disease

Jelle Barentsz, MD, PhD, Professor of Radiology at the Nijmegen Medical Center of Radboud University in Nijmegen, The Netherlands, discusses the capacity of MRIs to predict extracapsular disease. He notes that this is not a perfect technology and it is not possible to predict with one hundred percent accuracy, but he emphasizes how it can be useful for staging. He also discusses when it is necessary to wait and how long to wait after a biopsy for a staging MRI. Lastly, he covers situations where it is not necessary to wait for an MRI.

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