Dr. Laurence Klotz reports OPTIMUM trial results showing micro-ultrasound is non-inferior to MRI fusion biopsy for detecting clinically significant prostate cancer.
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Laurence Klotz, MD, explains how MRI-invisible prostate cancers differ from visible cancers in both genomic features and clinical behavior. He highlights radiogenomic evidence and long-term clinical outcomes supporting targeted biopsy strategies and reduced reliance on systematic biopsies in prostate cancer management.
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Laurence Klotz, MD, FRCSC, explores the genomics and natural history of MRI-visible versus invisible prostate cancers and their clinical implications.
In this 12-minute presentation, he highlights that while MRI is transformative in identifying significant prostate cancer, it misses about 15% of “invisible cancers.” Recent research reveals that the invisibility of these tumors correlates with favorable genomic profiles, including fewer genetic aberrations and reduced aggressivity.
Dr. Klotz presents compelling evidence linking visible tumors to adverse molecular features and worse clinical outcomes, whereas invisible cancers are largely indolent. He underscores the potential of radiogenomics in guiding treatment decisions, advocating for management strategies based on imaging rather than solely histology.
Dr. Klotz considers avoiding unnecessary systematic biopsies in favor of targeted MRI approaches can minimize patient anxiety and reduce overdiagnosis of insignificant cancers. However, challenges remain in addressing gray areas, such as PI-RADS 3 lesions and visible but low-grade cancers, which may require more nuanced management.
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Laurence Klotz, MD, FRCSC, introduces the OPTIMUM trial, a landmark international study comparing micro-ultrasound and MRI for prostate cancer detection. In this 9-minute presentation, Dr. Klotz explains that micro-ultrasound, operating at 29 MHz, offers three times greater resolution than conventional ultrasound. Using a PRIMUS scoring system analogous to PI-RADS, micro-ultrasound demonstrates its utility in identifying highly sensitive lesions.
Dr. Klotz details the trial’s three-arm design, which involves MRI with conventional ultrasound, MRI with micro-ultrasound, and micro-ultrasound alone to assess non-inferiority and complementary detection capabilities.
Dr. Klotz emphasizes the trial’s importance for minimizing bias and improving diagnostic practices, particularly given its potential to replace or complement MRI. He highlights the study’s robust design, comprehensive objectives, and international collaboration, anticipating its transformative impact on prostate cancer diagnosis and management.
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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 tha
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