Current Advances of Liquid Biopsies in Prostate Cancer
Edwin M. Posadas, MD, FACP, explores prostate cancer diagnostics and treatment, emphasizing biomarkers and liquid biopsy technologies.
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Biomarkers
Role of CtDNA in Bladder Cancer
Alexandra Drakaki, MD, PhD, explores circulating tumor DNA in bladder cancer, highlighting its potential as a biomarker.
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Point: Bladder Sparing Approach for Muscle Invasive Bladder Cancer
Parminder Singh, MD, examines bladder preservation strategies for muscle-invasive bladder cancer (MIBC).
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Prostate Cancer Detection Biomarkers, MRI
Adam S. Kibel, MD, delves into strategies for prostate cancer detection, emphasizing the role of MRI and biomarkers in diagnostic accuracy.
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Point Counterpoint: Risk Stratification for Biopsy – Biomarkers
Juan Javier-DesLoges, MD, MS, focuses on contemporary advancements in prostate cancer detection, emphasizing the integration of biomarkers and MRI for biopsy decision-making. In this 5-minute presentation, he references recent guidelines, which advocate biomarkers and MRI as tools for determining the necessity of biopsies. Studies comparing biomarkers such as 4K, PHI, SelectMDx, and XODX illustrate their ability to enhance the specificity and accuracy of cancer detection compared to PSA alone.
Dr. Javier-DesLoges stresses that MRI further refines risk stratification when combined with biomarkers. He underscores the complementary role of these tools, advocating their combined use to optimize diagnostic outcomes for patients with intermediate PSA levels.
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Point Counterpoint: Risk Stratification for Biopsy – MRI
Peter A. Pinto, MD, underscores the evolving role of MRI as a critical biomarker in urologic oncology, particularly for prostate cancer detection, staging, and treatment planning.
In this 12-minute conversation, Dr. Pinto highlights MRI’s unique position as a diagnostic and procedural adjunct, emphasizing its ability to improve biopsy accuracy, reduce over-diagnosis of low-grade cancers, and enhance focal therapy targeting. He shares that MRI provides actionable insights that enhance clinical decision-making by correlating radiologic findings with pathological outcomes. Further, the potential of MRI as a screening tool is explored, with promising advancements in shorter, contrast-free scans. Dr. Pinto also addresses the integration of AI for tumor identification, segmentation, and quality control, presented as a pathway to overcoming these limitations.
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Update: Studies Combining Secondary Biomarkers and MRI
Leonard G. Gomella, MD, FACS, presents a comprehensive overview of combining secondary biomarkers with MRI.
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Course Introduction: Description of Terminology and Review of Guidelines
Natalie Reizine, MD, delves into the current understanding, treatment options, and future directions for managing prostate cancer. In this 23-minute presentation, Dr. Reizine discusses disease progression, from localized stages to advanced and metastatic forms, emphasizing the evolving role of imaging technologies like PSMA PET scans in early detection and monitoring.
Dr. Reizine reviews the biology of prostate cancer, particularly its reliance on androgen receptor signaling, which forms the foundation for many therapeutic strategies. She highlights the importance of understanding disease-specific nuances, such as low versus high-volume metastases, to tailor treatment strategies.
Bone health in prostate cancer is emphasized, particularly for patients on long-term ADT. Similarly, dental care and endocrinology referrals are underscored as part of comprehensive management.
Dr. Reizine focuses on emerging therapies and personalized medicine approaches, with attention given to biomarkers like DNA damage repair mutations and new treatment modalities, including PARP inhibitors, radioligand therapies, and T-cell activating constructs. She underscores the need for improved predictive and prognostic biomarkers to effectively refine therapy selection and sequence treatments.
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Overview of Liquid Biomarkers
E. David Crawford, MD, professor of Urology at the University of California, San Diego, discusses advancements in risk stratification and biomarkers for prostate cancer detection. In his 10-minute presentation, he highlights the challenges of inconsistent screening guidelines, criticizing the current fragmented approach to PSA screening and underscoring the need for simplified, standardized messaging for primary care providers.
He advocates using a PSA cutoff of 1.5 ng/mL as a threshold for identifying at-risk individuals. Molecular markers, combined with PSA levels, improve precision in detecting clinically significant cancers and reducing overtreatment. Dr. Crawford outlines the complementary roles of PSA testing, molecular diagnostics, and multiparametric MRI in refining prostate cancer risk assessments.
Dr. Crawford introduces novel liquid biomarkers and their evolving role in guiding treatment decisions, cautioning that they serve as data points rather than definitive answers. Drawing analogies, he illustrates the multifactorial approach required for accurate prostate cancer diagnosis, akin to assessing risk in complex scenarios.
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MRI-Based Prostate Cancer Screening in an Era of MCEDs
Mark Emberton, MD, FRCS, discusses advancements in prostate cancer screening, emphasizing the limitations of current methods and the potential of innovative approaches.
In this 9-minute presentation, Emberton discusses emerging technologies, such as polygenic risk scoring and advanced biomarkers, that hold promise for enriching high-risk populations. Imaging, particularly bi-parametric MRI, is presented as a leading tool.
Emerton introduces TRANSFORM, a prostate cancer screening study funded by Prostate Cancer UK and the NHS. Developed through a collaborative, multidisciplinary approach, the study incorporates randomization to minimize bias and contamination. Adaptive trial design ensures underperforming methods are replaced, and novel tests can be incorporated as they emerge. Emerton expresses optimism that this innovative approach will shape the future of prostate cancer screening, addressing equity, efficiency, and scientific rigor.
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Utilizing ctDNA in Bladder Cancer
Leonard G. Gomella, MD, FACS, explores the potential of circulating tumor DNA (ctDNA) and cell-free DNA (cfDNA) as biomarkers in cancer detection, treatment monitoring, and prognosis.
In this 12-minute presentation, Dr. Gomella reviews recent studies, such as those conducted at the European Association of Urology (EAU), demonstrating ctDNA’s potential for early detection, risk assessment, treatment response evaluation, and post-treatment surveillance in bladder cancer. Trials such as InVigor010 highlight ctDNA’s prognostic utility, where analysis revealed that ctDNA positivity predicted a higher risk of relapse.
Gomella reports that innovations extend to ctDNA detection in urine, offering a non-invasive method to monitor disease burden. These developments and the integration of advanced sequencing technologies mark a new era in cancer management, facilitating earlier interventions and more effective treatment planning.
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Biomarkers for Radiation Therapy
Peter F. Orio III, DO, MS, focuses on the evolving role of biomarkers in radiation oncology, particularly for prostate cancer. He asserts that biomarkers serve as biological indicators that help predict and monitor responses to treatment, thereby optimizing therapeutic outcomes and reducing toxicity.
In this 12-minute presentation, Dr. Orio categorizes radiation biomarkers into diagnostic, predictive, prognostic, and monitoring types, emphasizing their distinct roles in disease prediction, treatment response, and patient prognosis. Orio provides examples and discusses how these tools influence radiation planning and decision-making across various medical disciplines, including radiation oncology, medical oncology, and surgery.
The presentation underscores that while many biomarkers are prognostic, the future lies in their predictive capabilities, which are crucial for truly personalized treatment.
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