Video Archives

Imaging and Biomarkers in Patient Selection for Focal Ablation

Posted by Ezekiel Becher, MD | Aug 2024

Ezequiel Becher, MD, discusses the critical role of imaging and biomarkers in selecting patients for focal ablation in prostate cancer treatment.

He highlights the advancements in imaging technologies that have revolutionized prostate cancer diagnostics, particularly multiparametric MRI (mpMRI). In addition to imaging, Dr. Becher underscores the significance of biomarkers in patient selection. While prostate-specific antigen (PSA) levels are traditionally used, they are complemented by more specific biomarkers such as PCA3, TMPRSS2-ERG, and genomic tests that provide a deeper understanding of tumor biology and aggressiveness.

Dr. Becher also addresses the challenges and limitations of current imaging and biomarker techniques. He advocates for continuous refinement of these technologies and the development of standardized protocols to enhance diagnostic accuracy. Looking forward, he points to the potential of artificial intelligence and machine learning in improving diagnostic precision and patient selection processes.

The When and How of Post-Ablation Surveillance

Posted by Soroush Rais-Bahrami, MD | Aug 2024

Soroush Rais-Bahrami, MD, provides a detailed examination of the timing and methodologies for post-ablation surveillance in prostate cancer care. His discussion emphasizes the critical importance of effective monitoring to ensure the success of ablative therapies and the early detection of any recurrence or progression of the disease.

Dr. Rais-Bahrami outlines the primary goals of post-ablation surveillance, including assessing treatment efficacy, identifying complications, and detecting residual or recurrent disease. He discusses various imaging modalities used in post-ablation surveillance, with multiparametric MRI (mpMRI) playing a central role. Dr. Rais-Bahrami also addresses the utility of PET-CT scans, particularly PSMA PET-CT. In addition to imaging, Dr. Rais-Bahrami highlights serum biomarkers, such as prostate-specific antigen (PSA), in surveillance protocols. He also discusses the timing of surveillance to ensure the detection of any issues and allow for prompt intervention.

Early Continence Recovery After Robotic-Assisted Radical Prostatectomy: The Role of Prostatic Shape

Posted by Pierluigi Bove, MD | Aug 2024

Pierluigi Bove, MD, explores the role of prostatic shape in continence preservation and recovery after robotic-assisted radical prostatectomy (RARP). Dr. Bove begins with a review of the key preoperative anatomical landmarks and how they inform surgical strategy.

Dr. Bove presents data supporting the relationship between preoperative Membranous Urethral Length (MUL,) bladder neck preservation, prostatic shape, and continence recovery post-RARP. He notes that preserving as much of the MUL and bladder neck as possible led to significantly higher rates of continence. Additionally, he notes that prostates with no membranous urethral overlap, or “apple-shaped” prostates, had the best urinary continence recovery.

Dr. Bove concludes by presenting video examples of RARP surgical strategies which preserve/ promote continence recovery. He presents common complications during RARP and examples of how his institution has compensated for them.

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.

Artificial Intelligence for Improving Prostate Cancer Diagnosis and Treatment

Posted by Martin Eklund, PhD | Aug 2024

In this 10-minute video, Martin Eklund, PhD, Professor in the Department of Medical Epidemiology and Biostatistics at the Karolinska Institutet in Stockholm, Sweden, describes the integration of artificial intelligence (AI) into every stage of prostate cancer care.

Traditionally and in the modern era, the process of prostate cancer (PCa) care has followed the path of prostate-specific antigen (PSA) testing leading to biopsy, then pathology, and finally management and treatment. However, every step along this path has opportunities for improvement. PSA testing has poor sensitivity and specificity, and prostate biopsy (especially standard systematic biopsy) often detects indolent cancers, among other insufficient operating characteristics. Pathology assessments have a high operator variability and are burdened with scarce resources. There is a lack of predictive biomarkers to guide treatment decisions, and overall, subjective assessments provide the basis for management and treatment.

To address these shortcomings and better individualize care delivery, there has been a wealth of research focused on developing risk-prediction and artificial intelligence (AI) models. The 2015 Stockholm3 (STHLM3) study introduced a diagnostic model to identify high-risk PCa that performed significantly better than PSA testing alone and suggested it could reduce unnecessary biopsies. Then, a 2021 trial used the STHLM3 test to risk-stratify patients before moving to MRI-targeted biopsy, proving to be an improved prostate screening method over traditional methods.