Veeru Kasivisvanathan, MBBS, BSc, FRCS, PhD, MSc, PGCert, Author at Grand Rounds in Urology

Talks by Veeru Kasivisvanathan, MBBS, BSc, FRCS, PhD, MSc, PGCert

Results of the PRIME Trial Biparametric Versus Multiparametric MRI for Prostate Cancer Detection – Impli

Posted by Veeru Kasivisvanathan, MBBS, BSc, FRCS, PhD, MSc, PGCert | Dec 2024

Veeru Kasivisvanathan, MBBS, BSc, FRCS, PhD, MSc, PGCert, shares results from the PRIME study, which explores the potential of biparametric MRI (bpMRI) as a non-inferior alternative to multiparametric MRI (mpMRI) for diagnosing clinically significant prostate cancer. In this 14-minute presentation, Dr. Kasivisvanathan shares that the results demonstrate that bpMRI detects clinically significant cancers at rates comparable to mpMRI, with no significant differences in false-positive rates or biopsy recommendations. Quality control analyses confirmed that imaging quality was critical, with optimization efforts ensuring high diagnostic reliability across centers.

The study concludes that bpMRI is a viable, cost-effective alternative for primary prostate cancer diagnosis, offering broader access without compromising clinical outcomes. The adoption of bpMRI as the new standard of care has the potential to streamline diagnostics and expand access to advanced prostate imaging globally.

Can Imaging Replace Prostate Biopsy – Primary Detection, Active Surveillance and Recurrent PCa?

Posted by Veeru Kasivisvanathan, MBBS, BSc, FRCS, PhD, MSc, PGCert | Dec 2024

Veeru Kasivisvanathan, MBBS, BSc, FRCS, PhD, MSc, PGCert, reflects on the significant advancements in prostate imaging over the last decade, emphasizing the transformative role of MRI. A central question in this 15-minute presentation is whether prostate cancer can be diagnosed and managed without a biopsy. While biopsies are the current standard, they carry risks such as sepsis, patient discomfort, and financial burden.

The PROMIS study demonstrated MRI’s ability to detect all Gleason 4+3 cancers, though it also revealed MRI’s high number of false positives. Combining PSMA PET with MRI improves sensitivity to 97%, particularly for detecting clinically significant cancers, but specificity remains a challenge, raising concerns about unnecessary treatment. New scoring systems, like the P score, integrate PET avidity and PI-RADS scores to refine risk assessment and treatment decisions.

Kasivisvanathan discusses the concept of “biopsy-light” pathways, citing cohorts where patients undergo fewer biopsies, with monitoring driven by MRI and PSA changes. This approach shows promising compliance and oncological outcomes comparable to standard active surveillance but with less patient burden. Despite advancements, a fully biopsy-free pathway remains unfeasible due to limitations in MRI standardization, interpretation variability, and a lack of high-volume data.