International Prostate Cancer Update Archives

MRI-Invisible Prostate Cancer and Use of Biomarkers to Identify Potential Candidates

Posted by Priya N. Werahera, PhD | Aug 2024

Priya N. Werahera, PhD, discusses the challenges of MRI-invisible prostate cancer and biomarkers in prostate cancer diagnosis and treatment. His discussion highlights the limitations of current imaging techniques and the approaches being developed to overcome these obstacles.
Dr. Werahera begins by addressing the inherent difficulties in detecting prostate cancer lesions that evade MRI visibility. He emphasizes the role of biomarkers, which can reveal the presence of cancerous changes even when imaging results appear normal, as a complementary tool to imaging techniques.
By combining biomarker analysis with existing imaging techniques, clinicians can achieve a higher diagnostic yield and better tailor treatment strategies to individual patients. Dr. Werahera calls for collaborative efforts to validate and standardize biomarker use, ensuring their reliability and accessibility in routine clinical practice.

AI in Healthcare: The Hype, The Reality, and The Promise

Posted by A. Karim Kader, MD, PhD | Aug 2024

A. Karim Kader, MD, PhD, FRCSC, explores the current state and future potential of artificial intelligence (AI) in healthcare. Dr. Kader begins by analyzing AI’s role in transforming current medical practice.
Dr. Kader acknowledges AI’s benefits, including its potential to revolutionize diagnostics, treatment planning, and patient care. When acting as a “scribe,” AI can be invaluable in creating grant proposals, patient education materials, and the writing of operative notes.
Looking ahead, Dr. Kader envisions a future where AI is seamlessly integrated into routine clinical practice, augmenting the capabilities of healthcare professionals and enhancing patient care. He calls for continued investment in AI research, interdisciplinary collaboration, and the development of robust frameworks for AI implementation and governance.

Treatment of Oligometastatic Prostate Cancer in the Era of PSMA PET Imaging

Posted by Andrew W. Hahn, MD | Aug 2024

Andrew W. Hahn, MD, explores the treatment of oligometastatic prostate cancer in the context of advancements in PSMA PET imaging. Dr. Hahn examines the integration of systemic therapies with local treatments, discussing the benefits and challenges of combining androgen deprivation therapy (ADT) with newer agents like androgen receptor inhibitors and chemotherapy. The presentation also delves into the evolving role of PSMA-targeted radioligand therapy, outlining promising results from early-phase studies and ongoing research on this treatment modality.
A significant portion of the presentation is dedicated to the practical considerations and challenges associated with implementing PSMA PET imaging and MDT in clinical practice. Dr. Hahn addresses issues related to accessibility, cost, and the need for multidisciplinary collaboration to ensure the best patient outcomes.

PSMA PET Imaging

Posted by Phillip J. Koo, MD | Aug 2024

Phillip J. Koo, MD, Division Chief of Diagnostic Imaging and Northwest Region Oncology Physician Executive of Oncology at the Banner MD Anderson Cancer Center in Phoenix, Arizona, presents a primer for urologists and oncologists on prostate-specific membrane antigen (PSMA)-positron emission tomography (PET) imaging. Dr. Koo asserts that PSMA-PET is rapidly becoming a modern-day practice. He explains that not all hotspots shown on these scans are necessarily prostate cancer; sharing research demonstrating PSMA-PET images, including normal images and other findings, that are not prostate cancer. If a practitioner is uncertain, magnetic resonance imaging (MRI) can be performed. Dr. Koo highlights solitary rib lesions, which can present a challenge to clinicians due to a high proportion of false positives on the PSMA-PET scan. He then emphasizes that what is seen on the scan is only half the story, explaining that how technicians window, fuse, and send images can affect what a practitioner sees. Dr. Koo recommends that practitioners avoid sole reliance on the fused images. Practitioners should reach out to radiologists in order to gain clinical context and the opportunity to educate and learn from those experts. He then addresses variability in standard uptake value (SUV) and cites a study on the repeatability of SUV in oncologic 18F-FDG PET, concluding that practitioners should be very careful with SUV numbers and take them in context. Dr. Koo shares a scoring system for various PSMA-PET findings and calls this a clear, standardized way for practitioners to communicate with referring physicians. Finally, Dr. Koo addresses RADAR VI and VII as well as procedure guidelines for PSMA-PET.

Assessing and Managing Metabolic Risk in Patients with Prostate Cancer

Posted by Robert H. Eckel, MD, FAHA, FACC, FNLA | Aug 2024

Robert H. Eckel, MD, FAHA, FACC, FNLA, presents a high-level overview of the assessment of metabolic risk in patients with prostate cancer. He begins with a summary of the known metabolic risks associated with Androgen Deprivation Therapy (ADT) in prostate cancer management.

Dr. Eckel then presents data on the changes in patient body composition which result from 12 weeks of ADT. He notes that while weight does not significantly change in patients being treated with ADT, he reviews the impact of changes in insulin resistance, waist circumference, and other factors which contribute to metabolic syndrome.

He concludes by examining racial disparities in those who develop metabolic syndrome after being treated with ADT for prostate cancer. He presents a short questionnaire that urologists can use to assess ongoing risk during ADT.