mCRPC: Lu-177 PSMA and Beyond
William K. Oh, MD, discusses prostate cancer diagnosis and treatment, focusing on PSMA diagnostics and LU-177 PSMA therapy.
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PCa Commentary | Volume 197 – January 2025
PCa Commentary | Volume 197 – January 2025 Posted by Edward Weber | January 2025 ...
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Gleason Scoring Has Served Us Well for More than 50 Years, But It Is Time to Start Afresh
Andrew J. Vickers, PhD, discusses the weaknesses of Gleason scoring in diagnosing localized prostate cancer. Dr. Vickers begins by differentiating between Gleason “scoring” and Gleason “grading,” explaining that Gleason grading is robust, while scoring is not as robust. He emphasizes that Gleason Grade Groups 2 through 4 depend on the ratios of tissue with various Gleason scores, which he asserts make little sense.
Dr. Vickers offers clinical examples to support his assertion and explains that, with patients with Gleason Grade Group 2 disease, the total length of biopsied tissue with a Gleason score of 4 is strongly predictive of adverse surgical pathology risk. Dr. Vickers explains that in patients with Gleason Grade Group 2 disease, the amount of tissue with a Gleason score of 3 is not predictive. Dr. Vickers shares data out of France that indicate that the amount of Gleason score 4 or 5 tissue is more predictive of biochemical recurrence (BCR) and metastasis than total Gleason score.
Dr. Vickers asserts that there is a need for urologic oncologists to find a replacement for the Gleason score as the dominant influence on decision-making in localized prostate cancer. Dr. Vickers emphasizes the value of focusing on tumor size and tissue quality in disease assessment, as is done with other cancers.
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PIRADS V2.1 – What a Urologist Needs to Know?
Sadhna Verma, MD, MBA, FSAR, begins this 20-minute presentation by emphasizing the exponential growth of prostate MRI usage and its critical role in prostate cancer detection. Before diving into PI-RADS, the multiparametric MRI approach is explained. T2-weighted sequences are highlighted as the best for anatomical visualization.
PI-RADS scoring, a standardized Likert-like system ranging from 1 to 5, assesses the likelihood of malignancy of a lesion based on size, location, and imaging characteristics. PI-RADS version 2.1 introduces refinements, particularly for transition zone lesions. The updated guidelines also incorporate templates to standardize reporting and emphasize quality assurance. Central zone tumors are recognized for their aggressive nature and specific imaging features.
Dr.Verma shares images to illustrate the scoring refinements of PI-RADS version 2.1. Despite advancements, quality variability in imaging and interpretation remains a concern. Collaborative initiatives led by the American College of Radiology aim to enhance diagnostic accuracy. Dr. Verma emphasizes the need for ongoing quality assurance and training to address current limitations and improve clinical outcomes.
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Emerging Therapies: Autologous Derived Muscle Cells
Christopher E. Wolter, MD, discusses using autologous muscle-derived cells as a promising treatment for stress urinary incontinence.
In this 7-minute talk, Dr. Wolter reviews the steps for the therapy procedure, which involves procuring muscle cells through a minimally invasive biopsy, expanding the cells in culture, and re-injecting them into the patient. He notes that stress urinary incontinence is considered an ideal target for this therapy.
Wolter shares the promising results from Initial studies, including a pilot trial in 2008. Later trials using higher doses of injected cells demonstrated even better outcomes. He also references the MYOCYTE trial, a large multicenter, multi-institutional randomized study, which suggested that patients with previous stress incontinence treatments, such as slings, respond better to the therapy.