Robert E. Reiter, MD

Robert E. Reiter, MD

Geffen School of Medicine at UCLA

Los Angeles, California

Robert E. Reiter, MD, MBA, is 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. He is currently the Principal Investigator of UCLA’s SPORE (Specialized Program in Research Excellence) program, a $12 million research grant from the National Cancer Institute to develop new diagnostic and treatment options for men with prostate cancer. Dr. Reiter’s clinical interests include robotic surgical management of prostate cancer and the use of both MRI and molecular imaging tools to manage this disease. His research is focused on the development of novel antibodies for both treatment and imaging of prostate cancer, as well as on the role of epithelial to mesenchymal transition in castration and treatment resistance. Dr. Reiter completed his undergraduate studies at Yale University and earned his medical degree at Stanford University Medical School.

Disclosures:

Talks by Robert E. Reiter, MD

MRI: Can It Be Used to Plan Ablative Therapies?

Posted by | 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.

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Management of Oligometastatic Disease

Posted by | 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.

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

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

Posted by | 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.

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PSMA PET Gallium Scan Approved by FDA

PSMA PET Gallium Scan Approved by FDA

Posted by | Dec 2020

E. David Crawford, MD, Editor-in-Chief of Grand Rounds in Urology, interviews Robert E. Reiter, MD, Bing Professor of Urology and Molecular Biology, Director of the Prostate Cancer Program, and Director of Urologic Research at the David Geffen School of Medicine at UCLA, on yesterday’s FDA approval of PSMA PET gallium scans for use in prostate cancer patients at the University of California, Los Angeles, and the University of California, San Francisco. Dr. Reiter, one of the investigators on the study that led to this, discusses how the approval, which was a joint effort between teams at UCLA and UCSF, is the first approval of a PSMA targeting agent in the United States, and will give new, potentially more effective options for urologists to stage prostate cancer for both newly-diagnosed and recurrent disease, leading to earlier detection of both metastatic disease and sites of recurrence, as well as improved overall management of the disease. They also discuss costs and potential insurance coverage at the currently-approved UCLA/UCSF sites and beyond, next steps for broader approval, and the implications of using PSMA PET in a theranostics approach to diagnosis and treatment of mCRPC and oligometastatic prostate cancer, as well as other disease states.

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Molecular Imaging For Staging and Advanced Disease – Axumin and PSMA

Molecular Imaging For Staging and Advanced Disease – Axumin and PSMA

Posted by | Jun 2020

Robert E. Reiter, MD, Bing Professor of Urology and Molecular Biology, Director of the Prostate Cancer Program, and Director of Urologic Research at the David Geffen School of Medicine at the University of California, Los Angeles, discusses the benefits of PSMA imaging in the context of biochemical recurrence. He reviews data from an Australian and an American study which both depict a positive correlation between PSA levels and PSMA prostate cancer detection rates, as well as high sensitivities for detection of recurrence based on pathologic confirmation. He then discusses the results of a study which compared PSMA with Axumin and found PSMA to be more than twice as effective in all areas but the prostate bed, which is most likely due to PSMA being excreted through the bladder. He argues that PSMA imaging can produce between a 29% and 76% change in prostate cancer management and allows for greater precision in treatment, resulting in fewer occurrences of unnecessary radiation therapy and long term systemic therapy.

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