Veeru Kasivisvanathan, MBBS, BSc, FRCS, PhD, MSc, PGCert, presented “Can Imaging Replace Prostate Biopsy – Primary Detection, Active Surveillance and Recurrent PCa?” during the 2024 Frontiers in Oncologic Prostate Care and Ablative Local Therapy symposium on October 17, 2024, in San Diego, California.
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How to cite: Kasivisvanathan, Veeru. “Can Imaging Replace Prostate Biopsy – Primary Detection, Active Surveillance and Recurrent PCa?.” October, 2024. Accessed Jan 2025. https://grandroundsinurology.com/can-imaging-replace-prostate-biopsy-primary-detection-active-surveillance-and-recurrent-pca/
Can Imaging Replace Prostate Biopsy – Primary Detection, Active Surveillance and Recurrent PCa? – Summary
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.
Frontiers in Oncologic Prostate Care and Ablative Local Therapy (FOCAL) is an outstanding program on prostate imaging, transperineal interventions, and ablative treatments for prostate cancer and benign prostatic hyperplasia. Bringing together community-based, academic, and industry partners, FOCAL offers lectures by world-renowned faculty and hands-on training workshops on in-office transperineal interventions, fusion-guided prostate ablation and state-of-the-art BPH management with novel technologies.
