Phillip J. Koo, MD

Phillip J. Koo, MD

Banner MD Anderson Cancer Center

Phoenix, Arizona

Phillip J. Koo, MD, is the Division Chief of Diagnostic Imaging and Northwest Region Oncology Physician Executive 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. Dr. Koo completed his transitional internship at the University of Pennsylvania Medical Center-Presbyterian, his radiology residency at Pennsylvania Hospital of the University of Pennsylvania Health System, and his fellowship at the Harvard Medical School Joint Program in Nuclear Medicine. He is a diplomate of both the American Board of Radiology and the American Board of Nuclear Medicine. Dr. Koo is an active member of multiple societies and has served as the Chair of Nuclear Medicine for the RSNA Scientific Program Committee, Chair of the Quality and Evidence Committee for the Society of Nuclear Medicine and Molecular Imaging (SNMMI), and Chair of the Prostate Cancer Working Group at the SNMMI. Dr. Koo has published on various topics related to radiology and nuclear medicine in multiple journals such as Radiology, Radiographics, the European Journal of Nuclear Medicine and Molecular Imaging, Urology, and the Journal of the American College of Radiology.

Disclosures:

Articles by Phillip J. Koo, MD

Next Generation Imaging for Prostate Cancer

Phillip J. Koo, MD, Division Chief of Diagnostic Imaging and Northwest Region Oncology Physician Executive at the Banner MD Anderson Cancer Center in Phoenix, Arizona, gives an overview of the current state of next generation imaging (NGI) for prostate cancer and how it compares to conventional imaging, i.e., bone scans and CT scans. He begins by noting that while there are strengths to conventional imaging and the NCCN clinical guidelines still recommend its use, it misses a lot of cancer, especially in patients with low PSA or biochemical recurrence (BCR). Dr. Koo suggests that NGI is to conventional imaging as a high-definition television is to a conventional one: both show a picture, but one shows a clearer one. He briefly looks at how NGI for prostate cancer works, explaining that NGI takes advantage of unique biological aspects of prostate cancer carcinogenesis and that increased metabolism and vascular changes in prostate cancer cells can be evaluated with radiolabeled analogs of choline, acetate, glucose, amino acids, and nucleotides. Dr. Koo then goes over the different approved NGI PET/CT options, including 11C-choline, 18F-fluciclovine, 68Ga-PSMA-11, and PyLARIFY PSMA. He particularly focuses on the 2 PSMA ligands, since data indicates that PSMA PET/CT performs better than anything used in the past, detecting more cancer at lower PSA levels than other techniques and in places where prostate cancer has rarely been seen before. Dr. Koo notes that PSMA is not infallible though, highlighting a study showing that while 68Ga-PSMA-11 generally has better detection rates than fluciclovine, fluciclovine has a higher detection rate in the prostate bed, suggesting that each radiopharmaceutical has its own strengths and weaknesses. He concludes with a summary of when and how clinicians should use NGI, emphasizing that NGI is here to stay and the field of urologic oncology should be prepared for rapid change.

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Future Directions in Molecular and Multi-Modality Imaging and Theranostics of Prostate Cancer

Phillip J. Koo, MD, Division Chief of Diagnostic Imaging and Northwest Region Oncology Physician Executive at the Banner MD Anderson Cancer Center in Phoenix, Arizona, discusses the clinical, research, and educational targets that will advance nuclear medicine’s future role in prostate cancer treatment. He proposes that physicians should consider nuclear medicine the fourth pillar of a cancer specialty, not only for its role in diagnostics but also due to the increased use of radiopharmaceuticals. Dr. Koo reviews results from the TheraP and VISION trials that illustrate the efficacy of PSMA PET/CT, the current diagnostic standard in clinical care. Dr. Koo then describes how nuclear medicine clinicians and radiologists can partner with medical oncologists in clinical settings to create patient-friendly, multidisciplinary care models. This model further integrates nuclear medicine clinicians and radiologists into diagnostic and therapeutic discussions, with the aim of determining the appropriate type of therapy faster. Relatedly, he sees an opportunity for nuclear medicine physicians to lead clinical trials as principal investigators. Dr. Koo concludes with a discussion about the role of education, contending that exposing medical students and residents to nuclear medicine is key to developing a future workforce.

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Imaging Strategies for GU Cancers: PSMA PET

In conversation with E. David Crawford, MD, Editor-in-Chief of Grand Rounds in Urology and Professor of Urology at the University of California, San Diego, Phillip J. Koo, MD, Division Chief of Diagnostic Imaging and Northwest Region Oncology Physician Executive at the Banner MD Anderson Cancer Center in Phoenix, Arizona, discusses the recent FDA approval of Gallium (Ga) 68 PSMA-11 PET/CT and its implications for prostate cancer care. Dr. Koo discusses the indications for use approved by the FDA, noting the emphasis on PSMA PET/CT’s role in treating oligometastatic disease. He observes that it is still unclear what impact the availability of PSMA PET will have on patient care and outcomes, but suggests that studies like the ORIOLE trial indicate that better imaging will lead to better outcomes. Dr. Koo then goes over the availability and potential of different PSMA imaging agents, noting that while Ga 68 PSMA-11 is the only approved agent and has the benefit of being a generic product, it is prohibitively difficult to manufacture and its supply may always be limited. Not-yet-approved alternatives like the Ga 68 PSMA kit, F-18 PyL, and F-18 rhPSMA could all potentially be easier to distribute but may be very expensive. Dr. Koo also mentions that coverage might be a concern for PSMA generally, and he argues that physicians must fight to ensure that insurance pays for PSMA imaging. The talk concludes with a Q&A session during which Drs. Crawford and Koo discuss whether PSMA will replace bone scans and how PSMA compares to MRI.

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Timing and Optimization of Radium 223 in CRPC

Phillip J. Koo, MD, briefly reviews several clinical trials examining the use of radium 223, focusing on its use in combination with second generation AR inhibitors. He also reviews the data from the ERA 223 trial that was recently reported at ESMO 2018 and discuss lessons learned, including the optimal use of radium 223 in patients with endocrine resistant prostate cancer.

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