Maryland Archives

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.

Transperineal vs Transrectal Biopsy Clinical Trials: Mo’ Data Mo’ Problems

Posted by Arvin George, MD | Dec 2024

Arvin K. George, MD, delves into the nuances of prostate cancer biopsy techniques, focusing on the comparison between transperineal and transrectal approaches.

In this 14-minute presentation, Dr. George shares that transperineal and transrectal biopsies demonstrate equivalent cancer detection rates, particularly for clinically significant prostate cancer. However, some retrospective data suggest potential advantages of transperineal biopsy in specific anatomical areas, with notable studies emphasizing the reduced risk of infections with transperineal biopsy. Dr. George also discusses a decreased need for antibiotics and the use of local anesthesia in a transperineal approach.

Further, Dr. George reflects on the implications for clinical practice, antibiotic stewardship, and cost-effectiveness for transperineal and transrectal approaches. His talk provides a comprehensive synthesis of current evidence, encouraging a balanced and thoughtful approach to biopsy method selection.

Emerging Role of Focal Therapy in the Management of Prostate Cancer

Posted by Daniel Y. Song, MD | Dec 2024

Daniel Y. Song, MD, discusses focal brachytherapy for treating prostate cancer.

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.

Renal Ablation Technologies – Impact on the Treatment of Small Renal Masses

Posted by Thomas W. Jarrett, MD | Oct 2024

Thomas W. Jarrett, MD, explores the evolving role of renal ablation technologies in managing small renal masses (SRMs), highlighting their increasing importance as an alternative to traditional surgical approaches. In this 20-minute talk, he provides a detailed overview of the various ablation techniques, including radiofrequency ablation (RFA), cryoablation, and microwave ablation, emphasizing their distinct mechanisms of action and clinical applications.

The presentation delves into the outcomes associated with renal ablation, discussing the advantages and disadvantages of the different ablation options. Dr. Jarrett also addresses the limitations and challenges of renal ablation, including the potential for incomplete tumor destruction and the difficulties in monitoring long-term outcomes.