Virtual Global Summit on Precision Diagnosis and Treatment of Prostate Cancer Archives

Practical Applications and Clinical Utility of PYLARIFY Injection: Implications for Urology and Radiation Oncology

Posted by Phillip J. Koo, MD | Aug 2022

Phillip J. Koo, MD, Division Chief of Diagnostic Imaging and Northwest Region Oncology Physician Executive at the Banner MD Anderson Cancer Center in Phoenix, Arizona, discusses the expansion of the role and utility of prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) in the management of prostate cancer. He highlights the fact that this next-generation imaging (NGI) technology will lead to changes to diagnostic approach and management, explaining that a landscape change is imminent as NGI is poised to fundamentally change the medical management of prostate cancer.

Highlights from the 5th Global Summit on Precision Diagnosis and Treatment of Prostate Cancer

Posted by Faina Shtern, MD | Jun 2022

Faina Shtern, MD, President and CEO of the AdMeTech Foundation, presents key highlights from the 5th Global Summit on Precision Diagnosis and Treatment of Prostate Cancer, a virtual event organized by the AdMeTech Foundation and held from September 23 through September 25, 2021. After introducing the AdMeTech Foundation, Dr. Shtern goes over the rationale for the annual summit and brain trust, explaining that the goal is for multi-disciplinary key opinion leaders to address fundamental challenges in patient care by: developing accurate diagnostic tools; integrating anatomic, biologic, and histologic diagnostics; and integrating precision diagnosis with precision treatment. She discusses the AdMeTech Foundation’s approach, which includes reaching consensus on the best emerging clinical practices, identifying clinical needs and related research priorities, educating the medical community and general public, and expediting the transfer of promising diagnostics and therapeutics to patients. Dr. Shtern then considers the 5th Global Summit specifically, noting that it focused on integrating precision diagnostics and therapies and addressing fundamental problems in prostate cancer care. She summarizes key points from the four meeting sessions, which focused on: the population of men prior to diagnosis with prostate cancer (Session I); the population of men with newly diagnosed localized disease (Session II); precision oncology of advanced prostate cancer (Session III); and image-targeted, minimally-invasive focal procedures. Dr. Shtern concludes by summarizing the key findings of the 2021 meeting’s Panel on Health Disparities and Panel on Bioinformatics, Machine & Deep Learning, and Artificial Intelligence.

Prostate Imaging Elevated By Deep Learning

Posted by Mukesh Harisinghani, MD | Mar 2022

Mukesh Harisinghani, MD, Director of Abdominal MRI at Massachusetts General Hospital and Professor of Radiology at Harvard Medical School in Boston, Massachusetts, discusses how deep learning algorithms can improve the efficiency and accuracy of prostate cancer imaging. He highlights the importance of widespread prostate cancer screening, observing that every 3 minutes, a man is diagnosed with prostate cancer, and every 17 minutes, a man dies of prostate cancer. Dr. Harisinghani notes that patients want to get a multiparametric (mp)MRI if there is a clinical suspicion of prostate cancer and, if negative, avoid a biopsy in order to prevent unnecessary intervention and avoid cost. Because this is such a widespread need and mpMRIs are relatively time-consuming, he argues there is a need to figure out how to reduce scan time and not lose accuracy. Dr. Harisinghani explains that the two main time sinks in prostate mpMRI are T2-weighted imaging and diffusion-weighted imaging (DWI). He then demonstrates how deep learning reconstruction using software like AIR Recon DL in all 3 planes leads to significant time gain for T2-weighted imaging. Dr. Harisinghani says that many might be hesitant to ‘skimp’ on DWI, since higher b value (which takes a longer time to attain) leads to better image quality. However, he argues that deep learning can reduce scan time without reducing scan quality in DWI, and presents images comparing standard DWI and Air Recon DL to show the improved quality of the latter. Dr. Harisinghani concludes that a scan time of less than 10 minutes is not necessarily just a dream if you can apply Air Recon DL to both T2 and DWI.

Current and Emerging Role of Radiogenomics in Risk Assessment for Focal Therapy

Posted by John Feller, MD | Mar 2022

John F. Feller, MD, Founding Partner of Desert Medical Imaging, Chief Medical Officer for HALO Diagnostics, Assistant Clinical Professor in the Departments of Radiology at Loma Linda University and at Riverside School of Medicine, and Chief of Radiology and Partner of the American Medical Center in China, discusses the emerging role of radiogenomics in prostate cancer in the context of risk stratification for focal therapy. He explains that he and his colleagues at HALO Diagnostics are interested in finding “Whack-a-Mole” patients whose cancer tends to recur in a way that makes them difficult to manage with focal therapy. Dr. Feller asks whether risk stratification for focal therapy can be done using radiogenomics and whether responders to focal therapy for prostate cancer can prospectively be distinguished from non-responders using biomarkers. He defines responders as those with a negative MR guided biopsy of the treatment site(s) 6 months following focal therapy who do not develop in-field or out-of-field clinically significant recurrences over time. Dr. Feller then lists the biomarkers and other criteria used in risk stratification with radiogenomics, including age, initial serum PSA, initial PSA density, mpMRI, index lesion mpMRI volume, index lesion quantitative ADC, systematic biopsy, Gleason score, tissue-based genomics, liquid biopsy, molecular imaging. He goes into depth about results from the tissue-based genomics PTEN and ERG (ProstaVysion), Decipher for biopsy (Decipher Score), and Decipher GRID. He also further explores liquid biopsy options, including urine (ExoDx) and blood (Biocept). Dr. Feller concludes: that mpMRI followed by genomics and other biomarkers show promise for risk stratification for focal therapy of prostate cancer; that a biomarker ensemble approach to prostate cancer helps mitigate the blind spots of individual biomarkers, as well as the heterogeneity of the disease; that research of radiogenomics in the setting of focal therapy for prostate cancer may help develop novel combination therapies such as focal therapy combined with checkpoint inhibitors; and that multiple biomarker complex data sources present an artificial intelligence/machine learning opportunity.

Standard Treatments and Global Perspective

Posted by Marc B. Garnick, MD | Jan 2022

Marc B. Garnick, MD, the Gorman Brothers Professor of Medicine at Harvard Medical School and the Beth Israel Deaconess Medical Center, summarizes recent developments in nomenclature, disease states, and standard treatments for advanced prostate cancer. Using material from a chapter he wrote for ASCO-SEP with David J. Einstein, MD, Assistant Professor of Medicine at Harvard Medical School, Dr. Garnick begins by considering the new language used to describe different states of advanced prostate cancer, including non-metastatic castrate-sensitive prostate cancer (nmCSPC), non-metastatic castrate-resistant prostate cancer (nmCRPC), metastatic castrate-sensitive prostate cancer (mCSPC), and oligometastatic prostate cancer. He then discusses new standards of care for these different states, highlighting recent research indicating the benefits of using darolutamide, enzalutamide, and apalutamide in the nmCRPC setting, and explaining how to appropriately layer and sequence therapies across disease states. He briefly looks at the role of next-generation sequencing in informing the potential benefit of PARP or PD-L1 inhibitors and touches on bone considerations in mCRPC. Dr. Garnick concludes with some comments on the global inequities of prostate cancer treatment, citing data on the significant disparity in mortality-to-incidence rate of prostate cancer in high-income countries compared to low- to middle-income countries.