Phillip J. Koo, MD

Role of Molecular Targeted Imaging in Oligometastatic Disease

Posted by Phillip J. Koo, MD | May 2024

Phillip J. Koo, MD, explores the current state and evolution of the role of molecular targeted imaging in oligometastatic prostate cancer. He begins by examining oligometastatic disease as a diagnosis, and highlights the importance of shared decision-making in approaching treatment and management.

Dr. Koo then reviews recent trials examining the impact of various treatments on oligometastatic disease, including the EMBARK, STOMP, and ORIOLE trials. He discusses weaknesses in these trials, with particular emphasis on the lack of risk stratification in each trial, and the lack of PSMA-PET in the EMBARK and STOMP trials.

On the topic of progression, Dr. Koo highlights current weaknesses in detecting microscopic disease, which allows micrometastatic disease to progress until it is oligometastatic disease. He discusses the weaknesses of BCR, and the low sensitivity of initial diagnostic imaging.

Dr. Koo concludes by outlining future directions for research. He emphasizes the importance of keeping patient goals top-of-mind when exploring treatments.

Molecular Targeted Imaging

Posted by Phillip J. Koo, MD | May 2024

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.

Challenging Case Discussion Panel

Posted by Phillip J. Koo, MD | Aug 2023

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.

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

Posted by Phillip J. Koo, MD | Aug 2023

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.”

Clinical Update on PSMA Diagnostics and Therapies

Posted by Phillip J. Koo, MD | Jul 2023

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.

Phillip J. Koo, MD

Banner MD Anderson Cancer Center

Phoenix, Arizona

Talks by Phillip J. Koo, MD

Role of Molecular Targeted Imaging in Oligometastatic Disease

Molecular Targeted Imaging

Challenging Case Discussion Panel

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

Clinical Update on PSMA Diagnostics and Therapies

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