Los Angeles Archives

PSMA PET Imaging in Advanced Prostate Cancer

Posted by Jérémie Calais, MD, PhD | Dec 2020

Jeremie Calais, MD, MSc, Assistant Professor and Director of the Clinical Research Program of the Ahmanson Translational Theranostics Division at UCLA, discusses the use of prostate-specific membrane antigen PET imaging, or PSMA PET, in diagnosing advanced prostate cancer. Noting that PSMA PET is currently the most sensitive imaging technique, he reviews well-known studies, STOMP and ORIOLE, and shares patient success stories of PSMA PET guided therapy. PSMA PET is able to detect tumor deposits of 4.5 mm with 90% accuracy and 2.3 mm with 50% accuracy making it more effective in locating disease migration. However, there will still be some micrometastases that are too small to yet be detected by PSMA PET. Because active distant lesions are not successfully identified under all imaging types, Dr. Calais proposes including the modality employed when stating a patient’s disease progression; for example, “mCRPC by PSMA-PET,” thereby expressing the means by which the disease stage was determined. PSMA PET can be used to follow disease mutation and more quickly identify non-metastatic castration-resistant prostate cancer.

PSMA PET Gallium Scan Approved by FDA

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

Updates in Muscle Invasive Bladder Cancer

Posted by Siamak Daneshmand, MD | Sep 2020

Sia Daneshmand, MD, Associate Professor of Urology and Director of Clinical Research at the University of Southern California, describes the current landscape of muscle invasive bladder cancer treatment, highlighting developments in radical cystectomy and chemotherapy. He observes that while radical cystectomy has long been the gold standard, efforts are being made to preserve reproductive organs in female patients who have low-stage disease. Dr. Daneshmand also notes the significant number of neoadjuvant chemotherapy phase II trials currently underway. While studies examining adjuvant chemotherapy have shown promise, the limitations of these trials necessitate further research. Similarly, research comparing super-extended lymph node dissection (LND) with extended LND have yielded insignificant p-values, but absolute numbers demonstrate a positive upward survival trend over 5 years. Dr. Daneshmand concludes that additional clinical trials will reveal the optimal combination and sequencing of treatment options.

Cannabis in the Urologic Practice

Posted by Richard J. Boxer, MD, FACS | Jul 2020

Richard J. Boxer, MD, FACS, Clinical Professor of Urology in the David Geffen School of Medicine at the University of California, Los Angeles, discusses the use of cannabis in the urology practice. Dr. Boxer describes how cannabis works and dispels many of the myths associated with its use. He delineates the safe use of cannabis and its specific urologic applications, emphasizing the role it can play in pain management and nausea from chemotherapy for urology patients, among other debilitating ailments. He also highlights the important role cannabis can play as an alternative to opioid use, which he points out are misused by 11 million Americans. Dr. Boxer concludes that cannabis is safe, is not a gateway drug, and that it may serve an important role in some urologic applications.

Molecular Imaging For Staging and Advanced Disease – Axumin and PSMA

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