Management of High Risk Prostate Cancer
Adam S. Kibel, MD, presents on high-risk prostate cancer management.
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Boston
Bi Parametric Optimized 15 min Prostate MRI Protocol – Are we there yet?
Mukesh Harisinghani, MD, Harvard University Medical School, presents a compelling talk on achieving an under-15-minute bi-parametric MRI protocol for prostate cancer imaging.
In this 11-minute presentation, Dr. Harisinghani highlights that multiparametric MRI, the standard for detecting clinically significant cancer, requires lengthy protocols. Transitioning to bi-parametric MRI eliminates the need for contrast enhancement, maintaining diagnostic accuracy while significantly reducing scan time.
Harisinghani emphasizes the role of deep learning algorithms in optimizing image quality without compromising timing. He cites studies, including the PRIME study, demonstrating that bi-parametric MRI detects clinically significant cancers.
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MRI PI-RADS Standardization and Clinical Evaluation
Clare Tempany, MB, BCh, BAO, Harvard Medical School, addresses the standardization and clinical evaluation of PI-RADS, a key tool in prostate cancer imaging. In her 13-minute presentation, Dr. Tempany begins by tracing the history of the RADS program, emphasizing its role in reducing variability and improving communication in radiological reporting. She highlights the utility of prostate MRI, focusing on its capacity to aid in detection, characterization, and targeted biopsies for clinically significant cancers.
Dr. Tempany reviews the PI-RADS v2.1 updates, which refine imaging protocols and stress the inclusion of previously overlooked areas like the anterior fibromuscular stroma. She provides examples to illustrate how these improvements enhance lesion detection and biopsy targeting. While discussing the growing interest in bi-parametric MRI, Dr. Tempany remains cautious, advocating for multiparametric MRI in most cases due to its added value for less experienced readers or in challenging cases.
She highlights the global shift toward recommending MRI before biopsy, citing changes in major guidelines and increased adoption rates. Dr. Tempany underscores the ongoing efforts to enhance MRI quality and interpretation, focusing on integrating AI for future improvements.
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Current State of the Art in Bladder-Preserving Trimodality Therapy for Muscle-Invasive Bladder Cancer
Jason A. Efstathiou, MD, DPhil, FASTRO, FACRO, emphasizes the growing interest in bladder preservation therapies as an alternative to radical cystectomy for muscle-invasive bladder cancer (MIBC). While cystectomy remains an effective treatment, it is not performed in about half of eligible patients. Trimodality therapy (TMT), combining maximal transurethral resection (TUR), chemotherapy, and radiation, offers a promising bladder-sparing approach.
In this 11-minute presentation, Dr. Efstathiou compares outcomes between TMT and cystectomy, showing no significant difference in metastasis-free or cancer-specific survival. A shift toward biomarker-driven management is also highlighted, with specific markers, such as MRE11 and immune signatures, indicating better responses to chemoradiation. Immunotherapy is increasingly integrated into treatment regimens, with promising trials like SWOG 1806 exploring the addition of immune checkpoint inhibitors to chemoradiation.
TMT, now recognized by major guidelines, offers patients a viable option with preserved bladder function, improved quality of life, and less life interference. The presentation stresses the need for improved staging, expanded access to bladder-sparing options, and informed decision-making to optimize outcomes for MIBC patients.
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Advances in Treating the Primary and Sites of Metastases in Oligometastatic Prostate Cancer
Jason A. Efstathiou, MD, DPhil, FASTRO, FACRO, highlights the evolving landscape of prostate cancer management, emphasizing the impact of new data, technologies, and clinical trials. A key focus is on the role of radiation therapy in treating metastatic and oligometastatic prostate cancer, particularly in combination with systemic therapies such as androgen deprivation therapy (ADT) and next-generation agents like abiraterone.
In this 11-minute presentation, Dr. Efstathiou reviews studies like the STAMPEDE and the P1 trials, suggesting that radiation combined with intensified systemic therapy can delay disease progression. The presentation also highlights advancements in imaging, such as trials like STOMP and ORIOLE.
Dr. Efstathiou emphasizes the integration of advanced imaging and genomics into clinical practice, allowing better patient selection and risk stratification. The discussion touches on the importance of multidisciplinary care to ensure optimal treatment strategies, particularly as prostate cancer management becomes increasingly complex.
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