Missouri Archives

PET Imaging for Prostate Cancer

Posted by Gerald L. Andriole, Jr., MD | Oct 2020

Gerald L. Andriole, Jr., MD, the Robert K. Royce Distinguished Professor and Chief of Urologic Surgery at Barnes-Jewish Hospital, the Siteman Cancer Center, and Washington University School of Medicine in St. Louis, Missouri, reviews the 2020 NCCN Guidelines, focusing on PET imaging for prostate cancer and related studies. He establishes that PET/CT and PET/MRI for detection of biochemically recurrent disease have been approved, though the majority of the data collected is specifically for the Ga-68 PSMA tracer. F-18 DCFBC, F-18DCFPyl, and F-18 PSMA 1007 are currently being evaluated for possible advantages over Ga-68 PSMA. Dr. Andriole then discusses several studies which demonstrate both the benefits and limitations of PET-directed therapies in the prostate cancer setting.Dr. Andriole concludes by looking at studies which compared PSMA PET to conventional imaging and found PSMA PET to be significantly more effective.

Updates in Screening: Prostate Cancer Guidelines

Posted by Gerald L. Andriole, Jr., MD | Sep 2020

Gerald L. Andriole, Jr., MD, a Robert K. Royce Distinguished Professor and Chief of Urologic Surgery at Barnes-Jewish Hospital, the Siteman Cancer Center, and Washington University School of Medicine in St. Louis, Missouri, reviews guidelines for prostate cancer screening, including the unchanged 2018 AUA guidelines and the 2020 updates to the NCCN and EAU guidelines. Following this, he explains why he disagrees with a 2020 article that suggests physicians use a PSA level of 10 ng/mL as the threshold when referring PCa patients to urology and thus biopsy. Lastly, he outlines five ways physicians can improve the early detection of prostate cancer.

Covert Pathogenesis in the Urinary Tract

Posted by Nicole M. Gilbert, PhD | Jun 2020

In a conversation with A. Lenore Ackerman, MD, PhD, Section Editor of the Next Generation Microbiome and Urologic Infection Learning Center on Grand Rounds in Urology, Nicole M. Gilbert, PhD, an instructor in the Department of Pediatrics at Washington University School of Medicine, discusses her research linking urogenital microbes to recurrent urinary tract infection (rUTI). Although the bladder was long regarded as sterile in the absence of overt infection, recent research suggests that there is a urinary microbiome and that two commonly found bacteria in the bladder are Gardnerella and Lactobacillus, both of which are also common in the vagina. Dr. Gilbert and her colleagues wanted to investigate how those urogenital microbes affect the bladder, and determined that Gardnerella vaginalis causes urothelial exfoliation, a condition that has been associated with rUTI. Because Gardnerella vaginalis appears able to trigger rUTI even when it is cleared out of the bladder within 12 hours, Dr. Gilbert calls it a covert pathogen, and suggests that further research is needed to find stable indicators of repeat exposure to Gardnerella.

What Role Do Markers Play in Establishing Active Surveillance or Definitive Care?

Posted by Gerald L. Andriole, Jr., MD | May 2020

Gerald L. Andriole, Jr., MD, explains that while active surveillance is on the rise, doctors can do a better job of selecting patients for it. He points out that NCCN and ASCO guidelines indicate that routine ordering of molecular biomarker tests is not recommended, and state that doctors should only perform active surveillance on low- and favorable-risk patients. He concludes that clinical criteria are very useful in determining when to use active surveillance, and notes that MRI and gene expression classifiers add some certainty to the decision. There are other markers that may aid in decision making, but the current data is sparse.

Non-Invasive Molecular Imaging – Fluciclovine

Posted by Gerald L. Andriole, Jr., MD | Nov 2019

Gerald L. Andriole, Jr., MD, discusses the unmet need for precise imaging of biochemical recurrent prostate cancer. He reviews data on imaging agents, especially 18F-fluciclovine PET/CT, ¹¹C-choline PET/CT, and 68Ga-PSMA-11, and deliberates on the impact of imaging-guided treatment changes on patient outcomes.