Los Angeles Archives

MRI: Can It Be Used to Plan Ablative Therapies?

Posted by Robert E. Reiter, MD, MBA | Dec 2021

Robert E. Reiter, MD, the Bing Professor of Urology and Molecular Biology and Director of the Prostate Cancer Treatment and Research Program at the David Geffen School of Medicine at the University of California, Los Angeles, discusses and evaluates MRI in terms of its ability to select patients for and help plan ablative therapies. He begins with an evaluation of MRI’s capabilities in patient selection. Dr. Reiter cites a study on multiparametric (mp)MRI detection of prostate cancer (PCa) foci that found mpMRI was capable of missing 20-30% of significant tumors. He also discusses a study of systematic and targeted biopsies concordance, finding that there was non-concordance in 36.1% of cases. Dr. Reiter cites a third study that found that 48% of MRI-selected candidates for hemiablation were actually ineligible for prostatectomy. He continues with a discussion of using MRI for targeting PCa adequately for complete ablation. Dr. Reiter reviews a study on mpMRI and predicting pathological tumor size, finding that MRI was less useful for smaller lesions but was quite effective for larger and higher-grade tumors. He suggests that MRI is not particularly useful for predicting tumor distance from the urethra based on one study that suggests that finding tumors near the urethra is important due to about 66% of PCa tumors being within 5 mm of the urethra, and another study finding that MRI fails to detect many tumors near the urethra based on an AUC curve. Dr. Reiter concludes that MRI can aid patient selection and planning but has multiple shortcomings that need to be accounted for.

Fear and Frustration Among Women with Recurrent UTIs

Posted by Ja-Hong H. Kim, MD | Dec 2021

In conversation with A. Lenore Ackerman, MD, PhD, Assistant Professor of Urology and Director of Research in the Division of Female Pelvic Medicine and Reconstructive Surgery at the University of California, Los Angeles, Ja-Hong H. Kim, MD, Associate Professor in the Division of Pelvic Medicine and Reconstructive Surgery at the University of California, Los Angeles, and Victoria C. Scott, MD, Associate Program Director of the FPMRS Fellowship at Cedars-Sinai Medical Center, discuss a recent study of the experience of women with recurrent urinary tract infections (rUTIs). Dr. Scott explains that 29 women were recruited to participate in 1 of 6 focus group discussions to investigate the perspective of women suffering from rUTIs. She then lists some preliminary themes from the discussions with the women, including fear of development of antibiotic resistance, widespread knowledge of the collateral damage from antibiotics, concern about taking unnecessary antibiotics, anger at physicians for “throwing” antibiotics at them, a feeling that the medical profession underestimates the impact of rUTIs, a need for research on nonantibiotic options for prevention and treatment, and resentment towards the medical system for not dedicating more research efforts to providing more timely diagnosis. Dr. Scott synthesizes these themes into two emergent concepts: fear about the overuse of antibiotics and frustration at the medical system for not providing alternative treatments or taking rUTI symptoms seriously. Dr. Kim then notes that this initial study has produced two additional studies on the current management of rUTIs that take expert and personal care provider experiences into account. Dr. Ackerman highlights the importance of data capturing that patients are not seeking antibiotics necessarily in the way doctors assume they are, though Dr. Kim does add the caveat that the women in the study were a relatively homogeneous group of college-educated white women. Dr. Ackerman also muses that the attitudes expressed in this study suggest that this population may be interested in a vaccine for rUTIs. Drs. Ackerman, Scott, and Kim conclude by noting that the study made evident the importance to patients with rUTIs of focusing on their experience rather than merely the clearance of bacteria.

Fear and Frustration Among Women with Recurrent UTIs

Posted by A. Lenore Ackerman, MD, PhD | Nov 2021

In conversation with A. Lenore Ackerman, MD, PhD, Assistant Professor of Urology and Director of Research in the Division of Female Pelvic Medicine and Reconstructive Surgery at the University of California, Los Angeles, Ja-Hong H. Kim, MD, Associate Professor in the Division of Pelvic Medicine and Reconstructive Surgery at the University of California, Los Angeles, and Victoria C. Scott, MD, Associate Program Director of the FPMRS Fellowship at Cedars-Sinai Medical Center, discuss a recent study of the experience of women with recurrent urinary tract infections (rUTIs). Dr. Scott explains that 29 women were recruited to participate in 1 of 6 focus group discussions to investigate the perspective of women suffering from rUTIs. She then lists some preliminary themes from the discussions with the women, including fear of development of antibiotic resistance, widespread knowledge of the collateral damage from antibiotics, concern about taking unnecessary antibiotics, anger at physicians for “throwing” antibiotics at them, a feeling that the medical profession underestimates the impact of rUTIs, a need for research on nonantibiotic options for prevention and treatment, and resentment towards the medical system for not dedicating more research efforts to providing more timely diagnosis. Dr. Scott synthesizes these themes into two emergent concepts: fear about the overuse of antibiotics and frustration at the medical system for not providing alternative treatments or taking rUTI symptoms seriously. Dr. Kim then notes that this initial study has produced two additional studies on the current management of rUTIs that take expert and personal care provider experiences into account. Dr. Ackerman highlights the importance of data capturing that patients are not seeking antibiotics necessarily in the way doctors assume they are, though Dr. Kim does add the caveat that the women in the study were a relatively homogeneous group of college-educated white women. Dr. Ackerman also muses that the attitudes expressed in this study suggest that this population may be interested in a vaccine for rUTIs. Drs. Ackerman, Scott, and Kim conclude by noting that the study made evident the importance to patients with rUTIs of focusing on their experience rather than merely the clearance of bacteria.

Current Status of PSMA Diagnostics

Posted by Jérémie Calais, MD, PhD | Aug 2021

Jeremie Calais, MD, MSc, Assistant Professor and Director of the Clinical Research Program in the Ahmanson Translational Theranostics Division of the Department of Molecular and Medical Pharmacology at UCLA, discusses PSMA diagnostics and compares imaging modalities to establish which modality is ideal for prostate cancer staging. He shares the FDA guidelines, stating that Ga 68 PSMA-11 is to be used for patients with prostate cancer (PCa) with suspected metastasis who are candidates for definitive therapy, and with suspected recurrence based on elevated serum prostate-specific antigen (PSA) level. Dr. Calais summarizes two trials used to support FDA approval of the diagnostic agent, including one on biochemical recurrence localization showing an overall detection rate of 75%, and another on primary nodal N1 staging that shows a sensitivity of 40% and a specificity of 95% for Ga 68 PSMA-11. Dr. Calais also notes the weaknesses of PSMA-11, including PET/CT’s inability to detect microscopic cancer cells, the way bone trauma in the ribs can lead to false positives, the challenge of accurately reading faint uptake lymph nodes, and how urine can disrupt analysis of the prostate fossa. Dr. Calais then compares PSMA against fluciclovine, finding that PSMA has a 30% higher detection rate; and against conventional imaging, finding that PSMA has a 27% higher rate of accuracy, as well as higher sensitivity and specificity. He also compares PSMA and local staging with MRI, highlighting a study on intra-prostatic tumor detection that shows a negligible difference in detection rates, as well as two studies on PSMA PET for biopsy guidance that show PSMA PET’s effectiveness in detecting especially challenging cancer. Dr. Calais concludes that PSMA PET/CT should replace other imaging modalities for prostate cancer staging and should be used as a complement to MRI for intra-prostatic tumor detection and staging.

Management of Oligometastatic Disease

Posted by Robert E. Reiter, MD, MBA | Jul 2021

Robert E. Reiter, MD, the Bing Professor of Urology and Molecular Biology and Director of the Prostate Cancer Treatment and Research Program at the David Geffen School of Medicine at the University of California, Los Angeles, discusses oligometastatic prostate cancer, explaining how to treat it and the long-term benefits of doing so. He describes oligometastatic prostate cancer (PCa) as an intermediate disease state characterized by limited disease (1-5 lesions). Dr. Reiter then shows evidence of the oligometastatic disease state through data suggesting that if you can identify patients with oligometastases and have a treatment plan for them then you can have a great impact on their OS. He discusses the impact of imaging on defining oligometastases through a study on the distribution of lesions in men with BCR, finding that as PSA increases so does the range of areas that PSMA detects lesions within; a UCLA study comparing PSMA and conventional imaging (CI), finding that 21% of cases showed non-concordance between the two methods for node-positive PCa; and a pathologic assessment of PSMA PET in the detection of nodal disease, showing that PSMA PET still misses small positive lymph nodes in about 20% of patients. Dr. Reiter continues with a review of clinical trials in Oligometastatic disease. He shows data from the SABR-COMET trial suggesting that treating oligometastatic disease in many different cancer types did improve overall survival and progression-free survival in the long term, and the STOMP trial, finding that administration of SABR to patients with oligometastatic disease defined by choline has a beneficial effect on PCa outcomes. Dr. Reiter concludes with the ORIOLE study which suggests that patients in whom all lesions can be found and treated will have significantly better outcomes than others, and a study on curative-intent metastasis-directed therapies for molecularly-defined oligorecurrent PCa using PSMA finding that median time to progression could be extended to 17 months.