Robert E. Reiter, MD, MBA, Author at Grand Rounds in Urology

PSMA Imaging as a Biomarker for Early Stage Prostate Cancer

Posted by Robert E. Reiter, MD, MBA | Aug 2024

Robert E. Reiter, MD, discusses PSMA imaging’s potential as a biomarker for early-stage prostate cancer. In this 11-minute presentation, Dr. Reiter compares PSMA PET and MRI. PSMA PET imaging, more sensitive than MRI, can detect cancer presence, tumor size, and potential spread beyond MRI’s capability, offering a possible advantage in early and focal disease management.

PSMA’s prognostic value is explored. Data indicate a correlation between high PSMA uptake (SUV) and higher Gleason scores. Low PSMA expression is linked with more aggressive cancer markers.

Additionally, Dr. Reiter asserts that PSMA’s potential as a guide in surgical procedures, such as radio-guided lymph node removal, could enhance surgical precision and reduce the chance of residual disease.

Clinical Impact of PSMA PET Prior to Prostatectomy

Posted by Robert E. Reiter, MD, MBA | May 2024

Robert E. Reiter, MD, MBA, illustrates the diagnostic and predictive value of PSMA PET imaging and the role of PSMA as a biomarker. He begins by examining the sensitivity of PSMA PET against that of MRI and the benefits of using combined PSMA PET/MRI for intermediate-risk tumors.

Dr. Reiter then turns to the functionality of PSMA PET/CT as a predictor of clinical outcome. He presents data comparing pre- and post-prostatectomy PSMA and CAPRA-(S) scores in association with biochemical recurrence, noting that PSMA outperformed CAPRA-(S) scores in some situations.

Dr. Reiter concludes by examining the utility of PSMA as a biomarker for tumor biology and how that can inform treatment. He presents data comparing tumors with high PSMA expression against those with low PSMA expression. He notes that PSMA-high tumors are responsive to primary treatment, while low-PSMA tumors are likely to require secondary treatment.

MRI: Can It Be Used to Plan Ablative Therapies?

Posted by Robert E. Reiter, MD, MBA | Dec 2021

Robert E. Reiter, MD, the Bing Professor of Urology and Molecular Biology and Director of the Prostate Cancer Treatment and Research Program at the David Geffen School of Medicine at the University of California, Los Angeles, discusses and evaluates MRI in terms of its ability to select patients for and help plan ablative therapies. He begins with an evaluation of MRI’s capabilities in patient selection. Dr. Reiter cites a study on multiparametric (mp)MRI detection of prostate cancer (PCa) foci that found mpMRI was capable of missing 20-30% of significant tumors. He also discusses a study of systematic and targeted biopsies concordance, finding that there was non-concordance in 36.1% of cases. Dr. Reiter cites a third study that found that 48% of MRI-selected candidates for hemiablation were actually ineligible for prostatectomy. He continues with a discussion of using MRI for targeting PCa adequately for complete ablation. Dr. Reiter reviews a study on mpMRI and predicting pathological tumor size, finding that MRI was less useful for smaller lesions but was quite effective for larger and higher-grade tumors. He suggests that MRI is not particularly useful for predicting tumor distance from the urethra based on one study that suggests that finding tumors near the urethra is important due to about 66% of PCa tumors being within 5 mm of the urethra, and another study finding that MRI fails to detect many tumors near the urethra based on an AUC curve. Dr. Reiter concludes that MRI can aid patient selection and planning but has multiple shortcomings that need to be accounted for.

Management of Oligometastatic Disease

Posted by Robert E. Reiter, MD, MBA | Jul 2021

Robert E. Reiter, MD, the Bing Professor of Urology and Molecular Biology and Director of the Prostate Cancer Treatment and Research Program at the David Geffen School of Medicine at the University of California, Los Angeles, discusses oligometastatic prostate cancer, explaining how to treat it and the long-term benefits of doing so. He describes oligometastatic prostate cancer (PCa) as an intermediate disease state characterized by limited disease (1-5 lesions). Dr. Reiter then shows evidence of the oligometastatic disease state through data suggesting that if you can identify patients with oligometastases and have a treatment plan for them then you can have a great impact on their OS. He discusses the impact of imaging on defining oligometastases through a study on the distribution of lesions in men with BCR, finding that as PSA increases so does the range of areas that PSMA detects lesions within; a UCLA study comparing PSMA and conventional imaging (CI), finding that 21% of cases showed non-concordance between the two methods for node-positive PCa; and a pathologic assessment of PSMA PET in the detection of nodal disease, showing that PSMA PET still misses small positive lymph nodes in about 20% of patients. Dr. Reiter continues with a review of clinical trials in Oligometastatic disease. He shows data from the SABR-COMET trial suggesting that treating oligometastatic disease in many different cancer types did improve overall survival and progression-free survival in the long term, and the STOMP trial, finding that administration of SABR to patients with oligometastatic disease defined by choline has a beneficial effect on PCa outcomes. Dr. Reiter concludes with the ORIOLE study which suggests that patients in whom all lesions can be found and treated will have significantly better outcomes than others, and a study on curative-intent metastasis-directed therapies for molecularly-defined oligorecurrent PCa using PSMA finding that median time to progression could be extended to 17 months.

Neoadjuvant Trials in High Risk Prostate Cancer: A Must Do for the Field

Posted by Robert E. Reiter, MD, MBA | Apr 2021

Robert E. Reiter, MD, MBA, Bing Professor of Urology and Molecular Biology and Director of the Prostate Cancer Treatment and Research Program at the David Geffen School of Medicine at the University of California, Los Angeles, and Principal Investigator of UCLA’s SPORE (Specialized Program in Research Excellence) program, argues for supporting neoadjuvant trials in high-risk prostate cancer as a key way to improve treatment results. He explains that ⅓ of high-risk patients die from their cancer, citing this as evidence that high-risk prostate cancer management must improve. Dr. Reiter then reviews several trials, beginning with CaLGB 90203, a neoadjuvant chemohormonal therapy study which found that over the course of ten years neoadjuvant patients experienced an 80% survival probability, while patients who were treated with only surgery experienced a 74% survival probability. He analyzes an assortment of phase II trials exploring whether more intensive androgen ablation can improve the short-term results of, for example, pathologic complete responses. These trials found that the complete response rates increased from 4% to 14% over the course of 12 weeks with no biochemical recurrences. Dr. Reiter continues by drawing attention to the current phase 3 PROTEUS trial, which should clarify whether or not pathologic complete response is a valid endpoint. He concludes with a discussion of the beneficial findings of pure translational neoadjuvant studies.

Robert E. Reiter, MD, MBA

Geffen School of Medicine at UCLA

Los Angeles, California

Talks by Robert E. Reiter, MD, MBA

PSMA Imaging as a Biomarker for Early Stage Prostate Cancer

Clinical Impact of PSMA PET Prior to Prostatectomy

MRI: Can It Be Used to Plan Ablative Therapies?

Management of Oligometastatic Disease

Neoadjuvant Trials in High Risk Prostate Cancer: A Must Do for the Field

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