Robert E. Reiter, MD, presented “Can MRI Be Used to Select Patients for Focal Therapy or To Guide Therapy?” during the 29th Annual International Prostate Cancer Update on January 24, 2019 in Beaver Creek, Colorado.

How to cite: Reiter, Robert E. “Can MRI Be Used to Select Patients for Focal Therapy or To Guide Therapy?” January 24, 2019. Accessed Dec 2019. https://grandroundsinurology.com/can-mri-be-used-to-select-patients-for-focal-therapy-or-to-guide-therapy/

Can MRI Be Used to Select Patients for Focal Therapy or To Guide Therapy? – Summary:

Robert E. Reiter, MD, reviews data comparing tumor analysis as seen on MRI and fusion biopsy to whole-mount histology following radical prostatectomy. He discusses whether evidence supports the use of MRI for determining patient eligibility and planning for focal therapy. 

Abstract:

MRI is a well-established technology for prostate cancer detection, biopsy guidance, and informing management. However, there is not yet a consensus as to whether or not MRI or MRI-targeted biopsies are sufficient for guiding focal therapy, patient selection, and treatment planning. 

The generally-established focal therapy eligibility criteria include the presence of clinical stage T2c or less, serum PSA of 20 ng/mL or less, and a PI-RADS region of interest (ROI) Grade 3 or higher visible on MRI.

In an assessment of focal therapy eligibility, out of patients who were eligible according to multiparametric MRI and targeted biopsy findings, a significant number were found to be ineligible based on whole-mount histology after radical prostatectomy. This calls into question the sensitivity and specificity of fusion biopsy for predicting focal therapy eligibility.

The discordance of fusion biopsy and whole-mount tumor analysis could be due to the limited sensitivity and detection rates of MRI. The mean difference in size between ROIs seen on MRI and whole-mount tumors is about 15mm. This shows that MRI significantly under-detects the dimensions of tumors, and is an insufficient tool for planning ablation.

About the International Prostate Cancer Update

The International Prostate Cancer Update (IPCU) is an annual, multi-day CME conference focused on prostate cancer treatment updates. The conference’s faculty consists of international experts, and the event caters to urologists, medical oncologists, radiation oncologists, and other healthcare professionals. Topics encompass prostate cancer management, from diagnosis to treating advanced and metastatic disease. Dr. Reiter presented this lecture during the 29th IPCU in 2019. Please visit this page in order to learn more about future IPCU meetings.