Steven P. Rowe Archives

PET Scanning in Primary Detection of Prostate Cancer

Posted by Steven P. Rowe, MD, PhD | Dec 2024

Steven P. Rowe, MD, PhD, examines the current role of PSMA PET imaging in prostate cancer detection and management, emphasizing its strengths, limitations, and areas requiring further research.

Dr. Rowe asserts in this detailed 15-minute talk that PSMA PET excels in identifying metastatic sites and aiding metastasis-directed therapy. He references advanced trials, such as OSPREY and Lighthouse, revealing its utility’s nuances.

Much of the discussion underscores the need for caution in interpreting data on extra-prostatic extension, with Rowe questioning recent claims of PSMA PET’s superiority over MRI. Challenges in standardizing interpretation across different scoring systems, such as PIRADS and Primary Score, are addressed, suggesting the potential oversimplification of tumor categorization. The talk also introduces technological barriers inherent in PET imaging.

Practical insights are provided into PSMA PET’s use in clinical settings. The societal and financial implications of widespread PSMA PET adoption are highlighted, stressing the need for cost-effective implementation strategies.

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...

Point Counterpoint: Micro Ultrasound

Posted by Gerald L. Andriole, Jr., MD | Mar 2024

Gerald L. Andriole, Jr., MD, presents the benefits of including micro ultrasound (microUS) in prostate imaging. He begins by noting that microUS is a relatively new technology compared to multiparametric magnetic resonance imaging (mpMRI).

Dr. Andriole presents examples of the detailed prostate images produced by microUS. He discusses the Prostate Risk Identification using MicroUltraSound (PRIMUS) classification system, intended as an analog to PRI-RADS, and the training required for practitioners using microsUS. He presents video examples of microUS-guided versus MRI-guided biopsies.

He concludes by comparing the specificity, sensitivity, and NPV of mpMRI and microUS biopsies in identifying clinically significant cancer. He presents recent studies which indicate that microUS alone may be as effective as mpMRI alone in the context of biopsies.

Point Counterpoint: MRI

Posted by Thomas P. Frye, DO | Mar 2024

Thomas P. Frye, DO, argues in favor of multiparametric magnetic resonance imaging (mpMRI) over micro ultrasound (MicroUS) for prostate imaging. He begins by stating the underlying goals of prostate imaging in the context of triaging in urologic oncology.

Dr. Frye then turns to the lack of data in support of microUS over mpMRI. He highlights that prostate imaging from MicroUS lacks the scale and reliable interpretability of mpMRI.

Dr. Frye supports the effectiveness of mpMRI in detecting clinically significant prostate cancer with data from the PROMIS and PRECISION studies. He notes that the use of mpMRI in screening can prevent unnecessary biopsies of insignificant cancers.

He concludes by reviewing weaknesses in recent studies of mircoUS. He presents a clinical analysis of microUS which demonstrated the superiority of conventional imaging (TRUS) and mpMRI over microUS.

PSMA PET for Prostate Cancer: Primary Staging, Recurrent Disease Localization

Posted by Steven P. Rowe, MD, PhD | Mar 2024

Steven P. Rowe, MD, PhD, discusses the strengths of Prostate-Specific Membrane Antigen (PSMA) PET in PCa staging and localization. Dr. Rowe begins with a brief overview of PSMA PET and its correlation with metastases and tumor aggressiveness.

Dr. Rowe focuses on the sensitivity and specificity of PSMA PET for identifying metastases. He establishes that PSMA PET has high specificity, regardless of metastatic tumor size, but that the sensitivity to tumors below 5 millimeters in diameter is low. For treatment of the primary disease in the prostate, Dr. Rowe discusses the role of PSMA PET in tumor segmentation.

Dr. Rowe concludes by addressing the use of PSMA PET in identifying recurrent disease and salvage therapy candidates. He discusses the design and results of the CONDOR trial, and the lesion-level positive predictive value of PSMA PET in recurrent disease.