Phillip J. Koo, MD

Phillip J. Koo, MD

Banner MD Anderson Cancer Center

Phoenix, Arizona

Phillip J. Koo, MD, is the Chief of Diagnostic Imaging at the Banner MD Anderson Cancer Center in Phoenix, Arizona. Prior to this, he was Chief of Nuclear Medicine and Associate Professor of Radiology at the University of Colorado School of Medicine in Aurora, Colorado. Dr. Koo completed his transitional internship at the University of Pennsylvania Medical Center-Presbyterian and his radiology residency at Pennsylvania Hospital of the University of Pennsylvania Health System in Philadelphia, Pennsylvania. He completed his fellowship at the Harvard Medical School Joint Program in Nuclear Medicine in Boston, Massachusetts. Dr. Koo is a diplomate of both the American Board of Radiology (ABR) and American Board of Nuclear Medicine(ABNM). His academic interests have focused on PET imaging in prostate cancer, response to novel therapies using PET, and data-driven motion correction. He has lectured nationally and internationally on topics related to imaging and radiopharmaceutical based therapies in prostate cancer. In 2022, Dr. Koo was the recipient of the Society of Nuclear Medicine and Molecular Imaging (SNMMI) Presidential Distinguished Service Award.

Disclosures:

Dr. Koo has the following disclosures:
Speaker: Bayer
Consultant: Janssen

Talks by Phillip J. Koo, MD

Molecular Targeted Imaging

Phillip J. Koo, MD, gives a high-level overview of the current state of molecular targeted imaging in identifying prostate cancer. Dr. Koo begins by establishing the sensitivity and accuracy of PSMA PET molecular targeted imaging at various PSA levels. He compares the efficacy of the four most commonly used commercially available agents in PSMA PET, noting that there is no data available that indicates one agent is superior to another.

Dr. Koo then delves into the sensitivity of different PSMA PET agents, including Gallium-68-PSMA-11 and Fluorine-18-DCFPyl. He highlights that imaging is not yet a reliable replacement for prostatectomy, using a few case studies as supporting evidence.

Dr. Koo concludes by reviewing the issue of biochemical recurrence and how it impacts disease management. He notes that molecular targeted imaging can detect recurrences in different sites in the body, and how current data may support a more aggressive treatment approach in the future.

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Challenging Case Discussion Panel

Philip J. Koo, MD, discusses the intricate aspects of prostate cancer diagnosis and treatment. Dr. Koo delves into various challenging cases, shedding light on the significance of personalized approaches tailored to individual patients. The presentation focuses on the utilization of PSMA PET, an advanced imaging technique, which showcases promising performance in detecting localized disease. Drawing from the study conducted by Jeremie Calais, the audience learns about the notable comparison between fluciclovine and PSMA, revealing higher detection rates with the latter.

Furthermore, the potential application of PSMA PET in guiding biopsies is explored, demonstrating its potential to enhance diagnostic accuracy. As the presentation progresses, Dr. Koo provides a compelling case study involving a high-risk prostate cancer patient who presents with back pain and neck swelling. Dr. Koo emphasizes the critical role of biopsy in ensuring tissue concordance, thereby enabling accurate treatment decisions. Throughout the presentation, the complexities of low PSA levels become apparent, underlining the need for comprehensive evaluation in prostate cancer cases.

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Point-Counterpoint: Will Conventional Imaging Become Obsolete? – Pro

Philip J. Koo, MD, delves into the ProPSMA Study, shedding light on the remarkable superiority of PSMA PET over conventional imaging in detecting prostate cancer. The study’s findings showcased an impressive treatment impact of 92% for PSMA PET, surpassing the 65% achieved by conventional imaging, while also demonstrating fewer uncertain results.

Dr. Koo emphasizes that PSMA PET is recommended for patients classified as unfavorable, intermediate, high, and very high-risk, while low or intermediate-risk patients do not require conventional imaging. Moreover, the recognition of PSMA PET’s performance in response assessment is steadily growing, signaling its potential as a reliable and accurate tool in evaluating treatment effectiveness.

The increasing utilization of PSMA PET in other countries hints at an imminent shift in the global landscape of prostate cancer imaging. With ongoing advancements and cost reductions, the wider accessibility and affordability of PSMA PET hold the promise of revolutionizing the field and improving patient outcomes on a global scale.

This lecture is part of a Point-Counterpoint debate. Its opposing lecture is “Point-Counterpoint: Will Conventional Imaging Become Obsolete? – Con.”

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Clinical Update on PSMA Diagnostics and Therapies

Philip J. Koo, MD, discusses the current status of PSMA PET and its role in the diagnosis, treatment, and management of prostate cancer. Dr. Koo highlights the uses of PSMA PET in patients with initial diagnosis, biochemical recurrence, and oligometastatic disease, and the variety of radiopharmaceuticals available for theranostic treatment of patients.

Dr. Koo emphasizes the evolving landscape of prostate cancer staging, with PSMA PET only being appropriate to use at certain stages. Dr. Koo concludes that PSMA PET, while not yet ready for “Prime Time,” is a powerful tool in prostate cancer management, poised to shape the future of diagnosis and patient care.

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PSMA PET Imaging: A Primer for the Urologist or Oncologist

Phillip J. Koo, MD, presents a primer for urologists and oncologists on prostate-specific membrane antigen (PSMA)-positron emission tomography (PET) imaging. Dr. Koo asserts that PSMA-PET is rapidly becoming a modern-day practice. He explains that not all hotspots shown on these scans are necessarily prostate cancer; sharing research demonstrating PSMA-PET images, including normal images and other findings, that are not prostate cancer. 

If a practitioner is uncertain, magnetic resonance imaging (MRI) can be performed. Dr. Koo highlights solitary rib lesions, which can present a challenge to clinicians due to a high proportion of false positives on the PSMA-PET scan. He then emphasizes that what is seen on the scan is only half the story, explaining how technicians window, fuse, and send images can affect what a practitioner sees. Dr. Koo recommends that practitioners avoid sole reliance on fused images. Practitioners should reach out to radiologists in order to gain clinical context and the opportunity to educate and learn from those experts. 

He then addresses variability in standard uptake value (SUV) and cites a study on the repeatability of SUV in oncologic 18F-FDG PET, concluding that practitioners should be very careful with SUV numbers and take them in context. Dr. Koo shares a scoring system for various PSMA-PET findings and calls this a clear, standardized way for practitioners to communicate with referring physicians. Finally, Dr. Koo addresses RADAR VI and VII as well as procedure guidelines for PSMA-PET.

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