Promising Advances from Industry: Diagnostics, Devices, and Therapy

How to cite: Pavlovich CP. Promising Advances from Industry: Diagnostics, Devices, and Therapy. Grand Rounds in Urology. February 2026. Accessed Mar 2026. https://grandroundsinurology.com/promising-advances-from-industry-diagnostics-devices-and-therapy-2/

Summary

Christian P. Pavlovich, MD, Bernard L. Schwartz Distinguished Professor of Urologic Oncology, Director of the Prostate Cancer Active Surveillance Program, Director of Prostate Cancer for the National Capital Region, and Co-Director of the Prostate Cancer Multidisciplinary Clinics, Johns Hopkins, Baltimore, Maryland, reviews emerging industry-driven advances in prostate cancer diagnostics and localized therapy.

Diagnostic innovation builds upon multiparametric magnetic resonance imaging (mpMRI) and transperineal biopsy. Three evolving tools are highlighted: biparametric magnetic resonance imaging (bpMRI), microultrasound, and prostate-specific membrane antigen positron emission tomography (PSMA PET) for intraprostatic targeting.

bpMRI omits gadolinium contrast while maintaining T2-weighted and diffusion-weighted sequences. In multicenter noninferiority trials, including the PRIME study, biparametric imaging demonstrates noninferiority to multiparametric imaging when all prostate imaging reporting and data system (PI-RADS) 3–5 lesions are biopsied. Clinically significant cancer detection rates are comparable, including in active surveillance cohorts.

Microultrasound, guided by the prostate risk identification using micro-ultrasound (PRI-MUS) grading system, has matured following early randomized limitations. The OPTIMUM trial demonstrates that microultrasound-guided biopsy is noninferior to MRI-fusion biopsy for detecting clinically significant cancer. The modality offers real-time imaging and potential access advantages, though training considerations remain.

PSMA PET, established for metastatic staging, shows promise for identifying dominant intraprostatic lesions in selected high-suspicion cases. Cost and reimbursement currently limit broader application.

Therapeutic advances include focal ablation platforms such as transurethral ultrasound ablation, focal laser ablation, and irreversible electroporation. Current National Comprehensive Cancer Network guidance supports focal therapy primarily in salvage settings after radiation recurrence. Five-year recurrence-free survival across salvage modalities approximates 55 percent, with reported genitourinary and gastrointestinal toxicity.

Robotic surgery continues to evolve. Multiport systems remain dominant, while single-port platforms offer advantages in selected patients with prior abdominal surgery.

Dr. Pavlovich concludes by arguing that diagnostic advances are supported by strong trials, whereas therapeutic innovation requires additional randomized evaluation.

The International Prostate Cancer Update (IPCU), is a multi-day, CME-accredited conference focused on new developments in prostate cancer treatment, diagnosis, and prevention. IPCU 36 will feature lectures, interactive discussions, panel roundtables, debates, and case reports. This conference is led by expert physicians and is designed for urologists, medical oncologists, radiation oncologists, and other healthcare professionals involved in the diagnosis and treatment of prostate cancer.

The goal of this educational program is to equip healthcare professionals involved in the diagnosis and treatment of prostate cancer with the up-to-date clinical knowledge and tools they need to best treat their patients. The program will discuss the treatment of prostate cancer from diagnosis to treating advanced and metastatic disease. The conference aims to give physicians exposure to a comprehensive review of treating prostate cancer patients and to give them a chance to discuss the issues with peers and experts.