IPCU 32 Archives

Current Status of PSMA PET in the United States

by Phillip J. Koo, MD | Oct 2022

Philip 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 PSMA PET and how it is poised to supplant conventional imaging techniques in the diagnosis of prostate cancer. He begins by observing the shortcomings of conventional imaging techniques such as bone scintigraphy and computed tomography. While these remain the current standard of care, they result in false negative diagnoses in most patients with biochemical recurrence, especially when the lesion is less than 1 cm with a PSA of <20 ng/ML. Dr. Koo then focuses on prostate-specific membrane antigen (PSMA) positron emission tomography (PET) imaging. He cites a study that found PMSA has double the detection rates over fluciclovine, with an exception of lesions in the prostate bed, indicating that different tools may be appropriate depending on lesion location. However, Dr. Koo clarifies that there currently is no data that proves the superiority of a specific PET radiopharmaceutical. Additionally, he cautions that overdiagnosis using next-generation imaging, such as PSMA PET, is likely as physicians continue to learn the benefits and drawbacks. To that end, he notes that there is a spectrum of visible lesions when using PET and a threshold below which it cannot detect disease. Dr. Koo concludes that while conventional imaging is more readily available than next-generation imaging, its limited sensitivity indicates a necessary shift to more advanced tools like PMSA PET. Similarly, since prostate cancer will advance after initial treatment in 30-50% of patients, he sees an opportunity to use PSMA PET to identify patients who require further treatment or who have metastases undetected by conventional imaging.

Genetic Testing for Identifying Who is at Risk of Prostate Cancer and Lethal Cancer

by Jianfeng Xu, MD, DrPH | Oct 2022

Jianfeng Xu, MD, DrPH, Vice President of Translational Research at NorthShore University HealthSystem (NorthShore), the Ellrodt-Schweighauser Family Chair of Cancer Genomic Research, Director of the Program for Personalized Cancer Care (PPCC) at NorthShore, and a Research Professor at the University of Chicago Pritzker School of Medicine, discusses the role of genetic testing in prostate cancer risk identification. Dr. Xu discusses who is at elevated risk for prostate cancer, the relationship among three inherited risk factors (family history [FH], monogenic rare pathogenic mutations [RPMs], and polygenic genetic risk score [GRS]), the idea that monogenic and polygenic may be tested at the same time, key challenges for germline testing, and the improvement of current guidelines for prostate cancer early detection.

Brachytherapy: The Royal Flush of Radiation Treatment for Men with High-Risk Prostate Cancer

by Mira Keyes, MD, FRCPC, FABS | Oct 2022

Mira Keyes, MD, FRCPC, a Clinical Professor at the University of British Columbia (UBC) and a radiation oncologist at the Vancouver Centre of the British Columbia Cancer Agency (BCCA), discusses the benefits of prostate brachytherapy (PB) for men with high- and very high-risk prostate cancer. Dr. Keyes explains PB has excellent long-term outcomes (with the best cure rates of all radiation therapy [RT] treatments), requires less androgen deprivation therapy (ADT), has less downstream toxicity and lower cost than alternatives, calling it a “royal flush” treatment when used as a boost with external beam radiation therapy (EPRT).

Updates in Prostate Cancer Biomarkers

by Matthew R. Cooperberg, MD, MPH | Sep 2022

Matthew R. Cooperberg, MD, MPH, Professor of Urology and Epidemiology & Biostatistics and Helen Diller Family Chair in Urology at the University of California, San Francisco, addresses prostate-specific antigen (PSA) testing and explains that a PSA below the median has a very strong negative predictive value (NPV) in terms of meaningful cancer. He asserts that, when combined with secondary biomarker testing before biopsy, early baseline PSA can be very effective in terms of risk assessment. He also explains that as research on biomarkers evolves, the field will get closer to being able to use genomic information derived from the primary tumor to make initial and follow-on treatment decisions.

How to Integrate PSMA PET Findings Into Treatment Algorithms

by Jérémie Calais, MD, PhD | Sep 2022

Jérémie Calais, MD, MSc, Associate Professor of Nuclear Medicine and Theranostics in the Department of Molecular and Medical Pharmacology at the University of California, Los Angeles (UCLA), Director of the UCLA Theranostics Program, and Director of the Clinical Research Program of the Ahmanson Translational Theranostics Division discusses how to integrate prostate-specific membrane antigen (PSMA) positron emission tomography (PET) findings into treatment algorithms. Dr. Calais explains that PSMA PET results in new staging categories, has predictive value, and has value in response assessment. He emphasizes that inclusion criteria of randomized phase-3 trials must include PSMA PET staging/screening/selection for PSMA PET to be integrated into treatment algorithms.

Brachytherapy: What’s New and Where are We Going?

by Peter J. Rossi, MD | Aug 2022

Peter J. Rossi, MD, a board-certified radiation oncologist affiliated with Calaway Young Cancer Center at Valley View Hospital in Glenwood Springs, Colorado discusses innovations and advances in low-dose-rate (LDR) and high-dose-rate (HDR) prostate brachytherapy as well as American Brachytherapy Society (ABS) initiatives and training opportunities. Dr. Rossi explains that innovations have resulted in brachytherapy treatment that is evidence-based, innovative, efficient, cost effective, flexible, yields highly personalized treatment, and is of high value to multidisciplinary teams and to patients.

Just the Beginning: What’s Next for Radiotheranostics in Prostate Cancer?

by Geoffrey B. Johnson, MD, PhD | Aug 2022

Geoffrey B. Johnson, MD, PhD, Chair of the Division of Nuclear Medicine at the Mayo Clinic in Rochester, MN, discusses 177Lu-PSMA-617 treatment for castration-resistant metastatic prostate cancer (mCRPC) along with other advances in theranostics. He reviews how drug treatments target prostate-specific membrane antigen (PSMA) receptors, then highlights the VISION trial which tested 177Lu-PSMA-617 on patients who had previously undergone chemotherapy and hormone therapy. This trial found that patients with advanced prostate cancer had well-tolerated side effects, leading to studies like PSMAfore with patients who had not started chemotherapy. Dr. Johnson points out several drawbacks of 177LuPSMA-617, namely that it does not cure prostate cancer, there are dosing limitations, it is very expensive, and not all prostate cancer patients can be treated with it. He also notes that not all prostate cancer tumors express PSMA thereby reducing the benefit of 177LuPSMA-617. Dr. Johnson then describes combination therapies using hormonal therapy, chemotherapy, immunotherapy, external radiation, cocktail radionuclide therapy, and external radiation. Finally, he presents new technologies like PSMA post-therapy imaging, strategies to improve efficacy of cell binding, and targeting agents such as fibroblast activation protein (FAP) inhibitors.

Men’s Health & My World from A-to-Z: What is New, Old, Hot, or Cold?

by Mark A. Moyad, MD, MPH | Aug 2022

Mark A. Moyad, MD, MPH, the Jenkins/Pokempner Director of Preventive/Complementary and Alternative Medicine (CAM) in the Department of Urology at the University of Michigan Medical Center in Ann Arbor, Michigan, reports on the latest trends in men’s health and related research. Covering topics from blood pressure to vitamin D, Dr. Moyad brings levity to the array with a “hot or not” rating.

Burning Questions and Controversies in the Management of Advanced Prostate Cancer Patients

by Scott B. Sellinger, MD | Jul 2022

Scott B. Sellinger, MD, President of Advanced Urology Institute and a Partner at Southeastern Urological Center in Tallahassee, Florida, breaks down treatment groups for advanced prostate cancer and details therapeutic options for each, including additional therapeutic options beyond androgen deprivation therapy such as ARIs, APIs, and PARP inhibitors.

The Wild, Wild West of Radiation Oncology: An Update on Radiation Tools, Toys and Trials

by Peter F. Orio III, DO, MS | Jul 2022

In this 12-minute presentation, Peter F. Orio III, DO, MS, Vice Chair of Network Operations for Dana-Farber/Brigham and Women’s Cancer Center Department of Radiation Oncology and Associate Professor of Radiation Oncology at Harvard Medical School in Boston, Massachusetts, explains prostate brachytherapy is effective, efficient, and convenient, and he says it is “the right thing to do for patients.” He sees a threat to patients posed by radiation oncology without brachytherapy and concludes by encouraging urologists to explore a broad range of treatments to maximize the benefit to patients.

The Urinary Microbiome and Prostate Disease

by J. Curtis Nickel, MD, FRCSC | Jul 2022

In this 17-minute presentation, J. Curtis Nickel, MD, FRCSC, the Canada Research Chair in Urologic Pain and Inflammation and Professor of Urology at Queen’s University in Kingston, Ontario, discusses recent research on the relationship between prostate cancer and the male urinary tract microbiome.

Forward Progress in Molecular Markers in Prostate Cancer

by Matthew R. Cooperberg, MD, MPH | Jul 2022

Matthew R. Cooperberg, MD, MPH, Professor of Urology and Epidemiology & Biostatistics and Helen Diller Family Chair in Urology at the University of California, San Francisco, explores a range of biomarkers used for diagnosis, risk stratification, and guiding treatment for prostate he cancer. He first details pre-biopsy diagnosis or prostate cancer, including PSA, 4K, phi, MyProstateScore, ExoDX, SelectMDx, and mpMRI. Dr. Cooperberg discusses how post-diagnosis biomarkers must be shown to improve on an existing, validated, multivariable model reflecting all available clinical information rather than on a single variable or nonlinear risk grouping, and reviews post-diagnosis options for risk stratification and treatment.