Phillip J. Koo, MD

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.