Phillip J. Koo, MD

In this discussion, E. David Crawford, MD, Jack A. Vickers Director of Prostate Research and Professor of Urology at the University of California, San Diego, leads a discussion of the case study of a 63 year old patient with a strong family history of prostate cancer. He presents this case study to a panel of experts comprised of:

Wayne G. Brisbane, MD – Assistant Professor of Urology at the University of California, Los Angeles.
Phillip J. Koo, MD – Division Chief of Diagnostic Imaging and Northwest Region Oncology Physician Executive at the Banner MD Anderson Cancer Center.
Daniel P. Petrylak, MD – Director of Genitourinary Oncology, Professor of Medicine and Urology, Co-Leader of Cancer Signaling Networks, and Co-Director of the Signal Transduction Program at Yale University Cancer Center.

Dr. Crawford informs the panel that the patient, a physician with a history of low-grade prostate cancer, initially presented with a PSA of 4.9 ng/ml, his germline test was negative, and his MRI revealed a 40g prostate with a PI-RADS 3 lesion at the left base. After a negative SelectMDx scan and low-risk OncotypeDX score, along with a course of finasteride which lowered his PSA to 1.43 ng/ml, Dr. Crawford asks the panel to weigh in on further steps.

Dr. Brisbane suggests exploring reclassifying the patient’s risk score, given his family history, in order to qualify them for a PSMA. Dr. Petrylak supports the suggestion, mentioning that it has been common practice to reimage patients after finasteride use.

Dr. Crawford shows the results from the patient’s POSLUMA scan which showed uptake in multiple foci. Dr. Koo digs into the results, noting that there are alternate explanations for the results showing multiple uptakes. Given the patient’s risk profile, the panel suggests a confirmatory biopsy of the prostate in the highest activity areas.

Dr. Crawford reveals that the patient’s confirmatory biopsies showed the presence of Gleason 6 (3+3) prostate cancer in the uptake areas. Given the discordance between the biopsies and the scans, the panel discusses possible next steps, including sending the biopsy samples for Decipher testing, treating the patient with targeted focal therapy, and options for whole-gland therapy. The panel also discusses the dangers of over-reliance on scan results in treatment selection and cautions against over-treatment.

This is the sixth in a series of discussions on PSMA PET supported by Blue Earth Diagnostics. For the first installment, click here. For the second installment, click here. For the third installment, click here. For the fourth installment, click here. For the fifth installment, click here.

In this discussion, E. David Crawford, MD, Jack A. Vickers Director of Prostate Research and Professor of Urology at the University of California, San Diego, leads a discussion of the case study of a healthy 69-year-old male with a history of multiple BPH treatments presenting with Gleason Grade 2 prostate cancer. He presents this case study to a panel of experts comprised of:

Wayne G. Brisbane, MD – Assistant Professor of Urology at the University of California, Los Angeles.
Phillip J. Koo, MD – Division Chief of Diagnostic Imaging and Northwest Region Oncology Physician Executive at the Banner MD Anderson Cancer Center.
Daniel P. Petrylak, MD – Director of Genitourinary Oncology, Professor of Medicine and Urology, Co-Leader of Cancer Signaling Networks, and Co-Director of the Signal Transduction Program at Yale University Cancer Center.

After reviewing the patient’s treatment history, Dr. Crawford informs the panel that the patient initially presented with a PSA of 4.55 ng/ml, his 12 core biopsies were negative after 6 months of treatment, and he was placed on active surveillance post-biopsies. However, the patient returned one year after initial presentation with a PSA of 8.5 ng/ml. Dr. Crawford asks the panel to weigh in on next steps.

Dr. Petrylak recommends pursuing active surveillance based on the patient’s 2.1% Decipher score and the patient’s preference of preserving his quality of life. Dr. Koo suggests using an mpMRI to resolve the discordance between the PSA level and the negative biopsies.

Dr. Crawford shows the results from the patient’s POSLUMA scan which showed focal uptake in the right base of the prostate. Dr. Koo acknowledges that the scan results are promising, but he reminds the panel to be cautious about the sensitivity of PSMA PET before definitive therapy.

Dr. Crawford reveals that the patient had an mpMRI and 12 core biopsies in addition to the POSLUMA scan, all of which confirmed the presence of prostate cancer in the right base. The panel recommends focal therapy as a next step, and discusses the available options for focal therapy.
This is the fifth in a series of discussions on PSMA PET supported by Blue Earth Diagnostics. For the first installment, click here. For the second installment, click here. For the third installment, click here. For the fourth installment, click here.

In this discussion, E. David Crawford, MD, Professor of Urology and Jack A. Vickers Director of Prostate Research at the University of California, San Diego, leads a discussion of the case study of a healthy 80-year-old male with a history of BPH presenting with a rapid rise of PSA from a PSA of 3-4 ng/ml to 9.7 ng/ml and increased urgency and perception of difficulty fully voiding. He presents this case study to a panel of experts comprised of:
Wayne G. Brisbane, MD – Assistant Professor of Urology at the University of California, Los Angeles.
Phillip J. Koo, MD – Division Chief of Diagnostic Imaging and Northwest Region Oncology Physician Executive at the Banner MD Anderson Cancer Center.
Daniel P. Petrylak, MD – Director of Genitourinary Oncology, Professor of Medicine and Urology, Co-Leader of Cancer Signaling Networks, and Co-Director of the Signal Transduction Program at Yale University Cancer Center in New Haven, Connecticut.
After revealing that the patient had a PSA of 7.2 ng/ml after a 4-week course of Cipro, Dr. Crawford tells the panel that his recommendation was for the patient to undergo an mpMRI, with possible biopsies. This revealed that the patient had a 65g prostate with a PI-RADS 5 lesion, and several suspicious pelvic nodes. After 12 core biopsies, each core had a Gleason Score of 4 or 5.
Dr. Crawford then asks the panel to weigh in on the next steps for imaging for the patient. Dr. Petrylak and Dr. Koo both recommend PSMA PET scanning over bone scans as the appropriate next step.
Dr. Crawford presents the results of the patient’s PSMA PET scan, which revealed extensive skeletal disease, to the panel. Dr. Petrylak recommends ADT, and debates the use of doublet or triplet therapy for the patient. Dr. Brisbane points out that the patient’s PSA level does not necessarily reflect the burden of disease, and Dr. Petrylak agrees.
Finally, the panel discusses the possibility of using PSMA PET scan for the primary. The panel is ambivalent, citing the lack of long-term data supporting its use in the primary.
This is the fourth in a series of discussions on PSMA PET supported by Blue Earth Diagnostics. For the first installment, click here. For the second installment, click here. For the third installment, click here.