Topic: Biomarkers

Point Counterpoint: Risk Stratification for Biopsy – MRI

by Peter A. Pinto, MD | Feb 2025

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.

PCa Commentary | Volume 197 – January 2025

by Edward Weber, MD | Jan 2025

PCa Commentary | Volume 197 – January 2025 Posted by Edward Weber | January 2025 ...

Update of Changes in the Early Detection of Prostate Cancer NCCN Guidelines 2024

by Preston C. Sprenkle, MD | Dec 2024

Preston C. Sprenkle, MD, Associate Professor of Urology at Yale University, delivers a comprehensive update on the 2024 National Comprehensive Cancer Network (NCCN) guidelines for early detection of prostate cancer.

In this 9-minute presentation, Dr. Sprenkle highlights the importance of early detection in identifying aggressive cancers while avoiding overtreatment of indolent disease, with shared decision-making and individualized risk assessment remaining central to guiding screening and treatment decisions. Refinements include clearer recommendations for younger patients with low PSA levels and adjusted screening intervals for men over 75. Genetic risk assessment and counseling are emphasized.

Sprenkle shares that the guidelines now recognize MRI as the standard of care for pre-biopsy evaluation. High-quality MRI imaging and expert interpretation are underscored to address variability in diagnostic practices. Systematic and MRI-targeted biopsies are preferred for improved accuracy in cancer detection. Dr. Frankel underscores the importance of integrating advanced imaging and equitable access to care to transform prostate cancer outcomes.

Optimal Management of Biochemically Recurrent Nonmetastatic Prostate Cancer

by Aaron Berger, MD | Dec 2024

Aaron Berger, MD, delves into the evolving landscape of non-metastatic castration-sensitive prostate cancer (nmCSPC) and high-risk biochemical recurrence, focusing on diagnostic and therapeutic updates. In this 7-minute presentation, Dr. Berger emphasizes advanced imaging, particularly PSMA PET scans, as the diagnostic standard due to its superior sensitivity over conventional CT and bone scans.

Dr. Berger discusses treatment strategies, including salvage radiation therapy and the use of androgen deprivation therapy (ADT). For radiation-treated patients, focal salvage therapies, including cryoablation, HIFU, and electroporation, are discussed as options. The presentation underscores the shrinking non-metastatic space due to advancements in imaging technology that now frequently identify micrometastases.

Dr. Berger reinforces the importance of genetic testing and surveillance protocols involving regular PSA monitoring and imaging triggered by symptoms or PSA progression. He highlights the dynamic shifts in prostate cancer management, driven by improved diagnostics and the integration of advanced systemic therapies within an increasingly precise treatment paradigm.

Course Introduction: Description of Terminology and Review of Guidelines

by Natalie Reizine, MD | Dec 2024

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.

PCa Commentary | Volume 195 – November 2024

by Edward Weber, MD | Nov 2024

PCa Commentary | Volume 195 – November 2024 Posted by Edward Weber | November 2024 NEW...

Overview of Liquid Biomarkers

by E. David Crawford, MD | Nov 2024

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.

Optimizing MRI Techniques for Prostate Cancer Diagnosis

by Fergus Coakley, MD | Nov 2024

Fergus Coakley, MD, Portland Health and Science University, Portland, Oregon, delivers a 10-minute presentation on optimizing MRI for prostate cancer diagnosis, addressing key shifts in diagnostic paradigms. He explains the transition from systematic biopsies following PSA screening to a targeted approach using multiparametric MRI (mpMRI) and in-bore biopsies. He highlights the superior signal-to-noise ratio of endorectal coils, emphasizing their role in enhancing tumor detection and staging. Through case studies, Dr. Coakley demonstrates the efficacy of high-quality MRI in identifying clinically significant cancers that were missed by traditional methods. Data supporting targeted-only biopsies for positive MRI findings are presented, with discussions on the low yield and increased complications of systematic sampling. Dr. Coakley challenges conventional views on multifocality and secondary foci, showing minimal impact on prognosis. He urges the adoption of advanced MRI-guided techniques while acknowledging the need for further research. This insightful presentation invites viewers to explore evolving strategies in prostate cancer diagnostics and their implications for patient outcomes.

Results from the Norwegian Prostate Cancer Consortium (NPCC)

by Jan Oldenburg, MD, PhD | Nov 2024

Jan Oldenburg, MD, PhD, presents a detailed exploration of findings from the Norwegian Prostate Cancer Consortium, focusing on the predictive value of baseline PSA levels for prostate cancer risk and mortality. In this 10-minute presentation, Dr. Oldenburg analyzes the data from the NPCC study, revealing that PSA levels strongly correlate with long-term outcomes over an 18-year follow-up period.

Dr. Oldenburg calls for tailored screening protocols to balance early detection with minimizing unnecessary interventions. With comprehensive data and practical implications, his talk offers critical insights into PSA screening, making it an essential watch for clinicians focused on advancing prostate cancer management.

Update on PROBASE Trial: Baseline PSA in Young Men (Aged 45 and 50)

by Peter Albers, MD | Nov 2024

Peter Albers, MD, highlights key findings from the ongoing PROBASE screening trial, which began in 2014 to evaluate prostate cancer detection in younger men. The trial focuses on identifying low-risk individuals to minimize harm while more effectively targeting high-risk groups.

In this 12-minute presentation, Dr. Albers shares data from PROBASE showing that identifying a baseline PSA low-risk cutoff PSA value of less than 1.5 ng/mL safely reduces unnecessary testing for five years. The strategy could reduce overtesting by broadening the low-risk group definition while ensuring early detection of clinically significant cancers.

Albers shares that MRI also plays a critical role, especially in refining high-risk group identification. PROBASE findings suggest strict biopsy criteria, such as PIRADS 4 thresholds, enhance specificity and reduce unnecessary procedures.

MRI-Based Prostate Cancer Screening in an Era of MCEDs

by Mark Emberton, MD, FRCS | Nov 2024

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.

Counseling Men with Favorable Intermediate Risk Disease- How to Advise, What Evidence Do You Share?

by Dov Kadmon, MD | Oct 2024

Dov Kadmon, MD, provides a comprehensive overview of managing favorable intermediate-risk prostate cancer, focusing on patient counseling, treatment decisions, and long-term outcomes.

In this 21-minute presentation, Dr. Kadmon begins by defining favorable intermediate-risk prostate cancer as grade group 2 (Gleason 3+4), with PSA levels under 10 and limited tumor burden based on biopsy. Patients are reassured that this type of cancer is common, typically indolent, and confined to the prostate, with a slow doubling time of three to five years, allowing a broad window for therapeutic intervention.

The discussion then shifts to treatment options, emphasizing the choice between active surveillance and curative interventions like radical prostatectomy or radiation therapy. Surgery’s side effects, including urinary incontinence and erectile dysfunction, are acknowledged. Radiation therapy, while sparing immediate surgery, carries risks of chronic toxicity.

Dr. Kadmon shares insights from the UK-based ProtecT trial, comparing active monitoring, surgery, and radiation therapy. The trial shows similar overall survival rates across treatment arms, but highlights increased rates of metastasis and disease progression in the active monitoring group. He underscores that while surveillance may be appropriate for select patients, curative treatment offers a more definitive approach, especially in younger individuals or those with a longer life expectancy.