Los Angeles Archives

Emergent Applications of Prostate Cancer Mapping with Artificial Intelligence

Posted by Alan Priester, PhD | Jun 2024

Alan Priester, PhD explores the cutting-edge applications of artificial intelligence (AI) in mapping prostate cancer, emphasizing its transformative potential in precision diagnosis and treatment. Dr. Priester illustrates how AI-driven algorithms analyze vast datasets, offering unprecedented insights into prostate cancer’s spatial and molecular characteristics. These advanced mapping techniques enable the identification of cancerous lesions with remarkable precision, facilitating earlier and more accurate diagnoses.

Moreover, Dr. Priester highlights the role of AI in developing predictive models that forecast disease progression and patient outcomes. These models are instrumental in tailoring individualized treatment plans.

Dr. Priester also addresses the challenges and ethical considerations associated with integrating AI into clinical practice, including data privacy and algorithmic transparency. The discussion extends to the future prospects of AI in prostate cancer care.

Cardiovascular Side Effects of ADT

Posted by Robert H. Eckel, MD, FAHA, FACC, FNLA | May 2024

Robert H. Eckel, MD, FAHA, FACC, FNLA, outlines common cardiovascular risks in prostate cancer patients on androgen deprivation therapy (ADT). Dr. Eckel launches his talk by explaining the most common non-prostate cancer cause of death in men with metastatic prostate cancer is cardiovascular disease (CVD).

Dr. Eckel points out the potential molecular connections between CVD and prostate cancer. He illustrates tissue-specific effects in terms of adverse cardiovascular consequences of various ADTs.

Dr. Eckel displays data on adjusted hazard ratios of cardiovascular events in prostate cancer patients with and without ADT exposure and points out ADT increases risk of heart failure in men without preexisting CVD. He points out chemotherapy and immunotherapy are also associated with increased CVD risk and shares a science advisory on ADT and CVD risk, outlining factors to examine such as obesity, serum lipids, insulin sensitivity, blood pressure, waist-hip ratio, and C-reactive protein.

Dr. Eckel explains there is no formalized approach for identification or stratification of cardiovascular risk or tools to reduce risk. He describes a multidisciplinary panel tasked with considering the challenges in managing cardiovascular risk in men with prostate cancer on ADT.

Dr. Eckel summarizes the panel’s recommendation of an assessment tool that identifies CVD risks for men with prostate cancer, which can be exacerbated by treatment. He explains that urologic oncology providers comfortable managing CVD risk factors are empowered to do so and highlights the importance of communication and the “village” of providers (e.g. cardiologists, PCPs, etc.) who may be involved in comprehensive care. He emphasizes these risks are not static and reassessment and follow-up must be ongoing.

Clinical Impact of PSMA PET Prior to Prostatectomy

Posted by Robert E. Reiter, MD, MBA | May 2024

Robert E. Reiter, MD, MBA, illustrates the diagnostic and predictive value of PSMA PET imaging and the role of PSMA as a biomarker. He begins by examining the sensitivity of PSMA PET against that of MRI and the benefits of using combined PSMA PET/MRI for intermediate-risk tumors.

Dr. Reiter then turns to the functionality of PSMA PET/CT as a predictor of clinical outcome. He presents data comparing pre- and post-prostatectomy PSMA and CAPRA-(S) scores in association with biochemical recurrence, noting that PSMA outperformed CAPRA-(S) scores in some situations.

Dr. Reiter concludes by examining the utility of PSMA as a biomarker for tumor biology and how that can inform treatment. He presents data comparing tumors with high PSMA expression against those with low PSMA expression. He notes that PSMA-high tumors are responsive to primary treatment, while low-PSMA tumors are likely to require secondary treatment.

Micro-ultrasound and MRI for Visualization of Prostate Cancer

Posted by Wayne G. Brisbane, MD | May 2024

Wayne Brisbane, MD, explores micro-ultrasound (micro-US) and MRI in visualizing prostate cancer, highlighting their respective strengths and applications in clinical practice.
Micro-ultrasound has emerged as a promising imaging modality for prostate cancer detection due to its high resolution and real-time capabilities. This technology enhances the identification and characterization of suspicious lesions, offering superior spatial resolution. In contrast, MRI, particularly multiparametric MRI (mpMRI), excels in detecting larger and more complex tumors.
Dr. Brisbane emphasizes that while mpMRI remains pivotal in pre-biopsy evaluations and treatment planning, micro-ultrasound complements these efforts by enhancing real-time visualization during targeted biopsies and focal therapies. Combining the strengths of both modalities allows clinicians to leverage the high sensitivity of mpMRI for initial lesion detection and the high resolution and real-time capabilities of micro-ultrasound for precise biopsy guidance and treatment monitoring.

ESMO Updates – EMBARK Study & PSMAfore Trial

Posted by E. David Crawford, MD | Nov 2023

Editor-in-Chief of Grand Rounds in Urology, E. David Crawford, MD, and Stephen J. Freedland, MD, discuss highlights on prostate cancer research from the recent European Society for Medical Oncology (ESMO) meeting in Madrid, Spain. At that meeting, Dr. Freedland presented on the EMBARK trial, a Phase 3, randomized study of enzalutamide or placebo-plus-leuprolide acetate and enzalutamide monotherapy in high-risk, biochemically recurrent prostate cancer. With regard to how these treatments affect quality of life, he explains there is no evidence of a difference in quality of life among them and the major takeaway is that patients do not have to sacrifice quality of life to get cancer benefits.
Dr. Freedland then addresses the PSMAfore clinical trial of patients who had failed when treated with a non-hormonal agent, had a positive prostate-specific membrane antigen (PSMA) scan, and were eligible for PSMA lutetium therapy (Pluvicto). The patients were randomized for Pluvicto or other androgen receptor (AR)-targeted agents. The primary outcome was radiographic progression-free survival.
Dr. Freedland characterizes the study as very positive and clinically relevant with over a 57 percent delay in progression. He explains that afterward, 84 percent of patients who were receiving the other AR-targeted agents ended up crossing over to receive the Pluvicto. Dr. Freedland points out that overall survival between the trial arms showed no difference and asserts that between these results and those shown during the VISION trial, establishing Pluvicto as a tool practitioners should be using for these eligible patients.
Drs. Crawford and Freedland conclude that these are compelling research developments, and Dr. Freedland asserts that these were among the biggest take-home messages from the ESMO meeting.