Bethesda Archives

Point Counterpoint: Risk Stratification for Biopsy – MRI

Posted by Peter A. Pinto, MD | Feb 2025

Peter A. Pinto, MD, underscores the evolving role of MRI as a critical biomarker in urologic oncology, particularly for prostate cancer detection, staging, and treatment planning.

In this 12-minute conversation, Dr. Pinto highlights MRI’s unique position as a diagnostic and procedural adjunct, emphasizing its ability to improve biopsy accuracy, reduce over-diagnosis of low-grade cancers, and enhance focal therapy targeting. He shares that MRI provides actionable insights that enhance clinical decision-making by correlating radiologic findings with pathological outcomes. Further, the potential of MRI as a screening tool is explored, with promising advancements in shorter, contrast-free scans. Dr. Pinto also addresses the integration of AI for tumor identification, segmentation, and quality control, presented as a pathway to overcoming these limitations.

AI and Prostate Imaging and Biopsy

Posted by Baris Turkbey, MD | Dec 2024

Baris Turkbey, MD, discusses the transformative potential and challenges of artificial intelligence (AI) in prostate imaging and biopsies. He begins this 19-minute presentation detailing the benefits of MRI-guided prostate biopsies for localized cancer diagnosis. However, he highlights significant limitations, including low interobserver agreement among radiologists, undermining MRI’s reliability in broader clinical applications.

Turkbey explains how AI can address challenges by standardizing imaging quality and assisting in lesion detection. He references a large-scale European study (PI-CAI) demonstrating AI’s ability to detect clinically significant cancers. Importantly, he illustrates the critical yet underexplored interaction between AI and radiologists, showing that while AI often detects lesions missed by radiologists, its findings are sometimes disregarded, resulting in missed cancers.

Dr. Turkbey introduces an AI model developed at NCI that demonstrates high performance in lesion detection with low false positives. This model, employed for prospective biopsies, radiation oncology planning, and focal therapy, automates prostate segmentation and lesion identification processes, delivering results within minutes. However, his research reveals that human radiologists outperform AI in estimating tumor burden, particularly for PIRADS 4 lesions.

MRI in Localized and Recurrent Prostate Cancer

Posted by Baris Turkbey, MD | Nov 2024

In this 9-minute presentation, Baris Turkbey, MD, discusses the role of MRI in diagnosing localized and recurrent prostate cancer. He begins with a clinical case illustrating how MRI-guided biopsy can identify significant cancers missed by traditional systematic approaches.

Dr. Turkbey highlights the importance of standardized imaging practices, such as PI-RADS guidelines, which improve consistency in image acquisition and interpretation. He emphasizes that effective use of MRI involves coordination among radiologists, urologists, and pathologists, making quality control critical across all stages.

In recurrent prostate cancer, Dr. Turkbey stresses that MRI proves especially valuable in conjunction with PSMA PET imaging, aiding in localizing biochemical recurrence foci and enabling early curative interventions. He discusses updated PI-RR guidelines for interpreting MRI in post-treatment settings, recommending specific imaging sequences to improve detection in challenging scenarios. He demonstrates successful applications of MRI in detecting recurrence after surgery or radiotherapy, underscoring its diagnostic precision.

Panel Discussion: PROSTATE IMAGING

Posted by Baris Turkbey, MD | Aug 2024

Baris Turkbey, MD, Steven P. Rowe, MD, PhD, and Sandeep Arora, MBBS, FSAR presented “Panel...

Novel Molecular Tracers for Prostate Imaging

Posted by Baris Turkbey, MD | Aug 2024

Ismail Baris Turkbey, MD, Senior Clinician, Molecular Imaging Branch (MIB), National Cancer Institute (NCI), National Institutes for Health (NIH) discusses novel molecular tracers for prostate imaging. Dr. Turkbey begins by listing and describing various molecular tracers used with positron emission tomography (PET) imaging of the prostate, including tracers used historically, explaining what each targets (e.g. glucose, cell membrane synthesis). Dr. Turkbey summarizes past trials of various tracers that fell short of prostate-specific membrane antigen (PSMA) in identifying localized disease.

He calls the last few years “exciting” in terms of developments in molecular imaging and several PET tracers targeting PSMA. Dr. Turkbey outlines 68Ga-PSMA-11, 18F-DCFPYL, and 18F-rhPSMA-7.3 and illustrates their use with patient case examples whereby these PSMA tracers helped identify local disease and guide focal therapies. He lists the various tracers available and explains that each has advantages and disadvantages and it depends on the biology to be profiled. Dr. Turkbey reiterates that the strongest evidence for identifying and staging localized disease is PSMA PET CT scans which are now available.