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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

PSMA Targeted Therapies and the Role of the Urologist

Posted by | May 2022

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 PSMA targeted therapies for prostate cancer and the urologist’s role in using radiotherapy. He begins by looking at the results of the VISION trial of lutetium-177 PSMA-617 for metastatic castration-resistant prostate cancer (mCRPC), explaining that radioligand therapy significantly increased overall survival and radiographic progression-free survival. Dr. Koo then considers the TheraP trial of lutetium-177 PSMA-617 versus cabazitaxel which saw far better PSA response in PSMA arm than in the cabazitaxel one. He notes that the amount of imaging used in patient selection for TheraP would be impractical in a real-world setting. Dr. Koo also looks at the slate of upcoming clinical trials of PSMA, highlighting the number of combination therapy trials in the CRPC setting, as well as the number of trials looking at PSMA’s potential role in earlier phases of the disease. Finally, Dr. Koo discusses the role of the urologist in the new PSMA era, arguing that urologists need to understand and be comfortable with PSMA since it is an increasingly important tool for treating advanced prostate cancer. He recommends that urologists create advanced prostate cancer clinics featuring targeted radiotherapy clinics.

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PSMA: Current State of the Art and Future Vision

Posted by | Feb 2022

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 current and possible future applications for prostate-specific membrane antigen (PSMA) as both a diagnostic and a theranostic radiopharmaceutical for prostate cancer. He begins by considering PSMA in the diagnostic setting and explains that its current state-of-the art use is in the area of detection of metastatic disease. Dr. Koo particularly highlights its role in detecting oligometastatic disease in cases of biochemical recurrence. He also notes that PSMA currently has a role in initial staging, and that this role is likely to expand in the future. He predicts that other future diagnostic applications of PSMA will include restaging/treatment response, primary lesion characterization, and potentially prognosis. Dr. Koo then moves to discussing PSMA in the theranostic setting, mentioning the current role of Lu-177 PSMA on the “thera-” side and looking at PSMA, FDG, and PSMA plus FDG on the “-nostic” patient selection side. He also considers the question of whether imaging is even needed considering the large percentage of patients who are PSMA-positive, though he argues for the benefits of imaging. Dr. Koo lists some potential future therapeutic applications of PSMA, such as in earlier treatment, retreatment, combination therapy, dosimetry, and with alpha particles. He concludes that there are many unanswered questions, that conventional wisdom and anecdotes are not evidence-based, and that there is a need for more clinical trials and more disease site specialization within nuclear medicine.

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Panel Discussion – Focus on PSMA

Panel Discussion – Focus on PSMA

Posted by | Dec 2021

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, leads a panel discussion focused on PSMA PET-CT’s expanding role in prostate cancer screening and diagnosis. The conversation begins with a look at how PSMA ligands are produced and distributed and what this means for access. Jérémie Calais, MD, MSc, Director of the Clinical Research Program of the Ahmanson Translational Theranostics Division of the Department of Molecular and Medical Pharmacology at UCLA, explains the differences between Gallium-68 PSMA-11 and 18F-DCFPyL, noting that the capacity of production and distribution is greater for the latter than the former. He argues, however, that the tracer used does not ultimately matter. E. David Crawford, MD, Professor of Urology at UCSD, observes that there have not actually been any comparative trials of gallium vs. PyL scans, and he suggests that there might be subtle differences in efficacy. Dr. Calais agrees that there is some disparity, but he does not think they are significant enough to affect staging or clinical management decisions. The discussion continues with a brief consideration of PSMA’s potential in theranostics and a look at whether PSMA scans can be trusted without confirmation from biopsy. Dr. Crawford notes that while biopsies are important and should be obtained when possible, as trust grows in the PSMA scans they may become less necessary. Dr. Calais and Dr. Koo then consider the potential for PSMA tests to be reimbursed, observing that they are not yet covered by Medicare but that there is a potential that they will be covered by insurance relatively soon. Dr. Crawford then asks whether the older CT and bone scans will be replaced by scans like PSMA, and the panelists conclude that they inevitably will but that costs will make this shift take some time.

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Next Generation Imaging for Prostate Cancer

Posted by | Aug 2021

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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