Topic: Prevention and Screening

Bi Parametric Optimized 15 min Prostate MRI Protocol – Are we there yet?

by Mukesh Harisinghani, MD | Jan 2025

Mukesh Harisinghani, MD, Harvard University Medical School, presents a compelling talk on achieving an under-15-minute bi-parametric MRI protocol for prostate cancer imaging.

In this 11-minute presentation, Dr. Harisinghani highlights that multiparametric MRI, the standard for detecting clinically significant cancer, requires lengthy protocols. Transitioning to bi-parametric MRI eliminates the need for contrast enhancement, maintaining diagnostic accuracy while significantly reducing scan time.

Harisinghani emphasizes the role of deep learning algorithms in optimizing image quality without compromising timing. He cites studies, including the PRIME study, demonstrating that bi-parametric MRI detects clinically significant cancers.

Update on the PROFILE and IMPACT Studies

by Jana McHugh, MB Bch BAO (Hons), MRCPI, FFR | Jan 2025

Jana McHugh, MB Bch BAO (Hons), MRCPI, FFR, discusses the IMPACT and PROFILE studies, which focus on prostate cancer risk and detection in genetically predisposed populations.

In this 11-minute presentation, McHugh shows that both studies emphasize early detection in genetically high-risk men, particularly BRCA mutation and Lynch syndrome carriers. Updated methodologies incorporate multi-ancestry PRS and expanded genetic sequencing to refine risk assessment and address disparities. These findings highlight the importance of precision screening in managing prostate cancer in diverse, high-risk populations.

Year in Review: Emerging Data and Advances in Prostate Cancer Screening

by Sigrid V. Carlsson, MD, PhD, MPH | Dec 2024

Sigrid Carlsson, MD, PhD, MPH, reviews groundbreaking advancements in prostate cancer screening and data from the past year. In this 9-minute presentation, Carlsson highlights the Swedish Berg trial, which showed a 30% reduction in prostate cancer mortality with regular PSA screening, while data from the UK CAP trial confirm that even a single PSA test reduces mortality. She stresses the utility of PSA as the strongest prognostic marker for lethal prostate cancer, with guidelines evolving to recommend tailored screening for high-risk groups like Black men.

Carlsson also shares that advances in MRI have proven pivotal. She references recent trials that underscore the efficacy of MRI-targeted biopsy in minimizing overdiagnosis. Innovations in AI for MRI interpretation promise to improve equity and diagnostic accuracy.

Dr. Carlssson shares that active surveillance is the standard for managing low-risk cancers and addressing concerns about overdiagnosis. Together, these developments mark a transformative year in personalized and effective prostate cancer screening.

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.

The BARCODE 1 Study: Enrichment of Prostate Cancer Detection in Those with Higher Polygenic Risk

by Ros Eeles, PhD, FRCP, FRCR | Dec 2024

Ros Eeles, PhD, FRCP, FRCR, introduces the BARCODE 1 study, which explores the enrichment of prostate cancer detection using polygenic risk scores (PRS) and addresses challenges with traditional screening methods.

In this six-minute presentation, Eeles interprets the study’s results, concluding that PRS offers a robust, one-time genetic test to guide targeted screening, detecting more significant cancers without contributing to overdiagnosis.

Point Counterpoint: Risk Stratification for Biopsy – Biomarkers

by Juan Javier-DesLoges, MD, MS | Dec 2024

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.

PSMA PET for Preoperative Planning of Prostate Cancer: Nodes, Nerves and Margins

by James S. Wysock, MD, MSc | Dec 2024

James Wysock, MD, MS, highlights the transformative role of novel imaging techniques, particularly PSMA PET and MRI, in improving prostate cancer diagnosis, staging, and management.

In this 14-minute presentation, Dr. Wysock explains the combination of PSMA PET and MRI significantly improves the detection of extraprostatic extension and seminal vesicle invasion compared to conventional imaging.

Meta-analyses confirm PSMA PET’s superior accuracy, particularly its high negative predictive value. This suggests that some intermediate-risk men with negative scans might safely omit extended lymph node dissection. This evidence raises important discussions about refining surgical planning and patient consent to balance risks and outcomes.

Wysock addresses emerging data supporting direct prostatectomy based on highly suspicious PSMA PET findings, bypassing biopsies. While controversial, this approach underscores the potential for imaging advancements to redefine standard workflows, especially as artificial intelligence enhances interpretation and decision-making.

Dr. Wysock emphasizes that while PSMA PET and MRI improve staging and management, these tools are still primarily validated in high-risk populations, with sensitivity challenges in lower-risk groups. The evolving role of advanced imaging, coupled with ongoing technological progress, promises to reshape prostate cancer treatment pathways.

PET Scanning in Primary Detection of Prostate Cancer

by Steven P. Rowe, MD, PhD | Dec 2024

Steven P. Rowe, MD, PhD, examines the current role of PSMA PET imaging in prostate cancer detection and management, emphasizing its strengths, limitations, and areas requiring further research.

Dr. Rowe asserts in this detailed 15-minute talk that PSMA PET excels in identifying metastatic sites and aiding metastasis-directed therapy. He references advanced trials, such as OSPREY and Lighthouse, revealing its utility’s nuances.

Much of the discussion underscores the need for caution in interpreting data on extra-prostatic extension, with Rowe questioning recent claims of PSMA PET’s superiority over MRI. Challenges in standardizing interpretation across different scoring systems, such as PIRADS and Primary Score, are addressed, suggesting the potential oversimplification of tumor categorization. The talk also introduces technological barriers inherent in PET imaging.

Practical insights are provided into PSMA PET’s use in clinical settings. The societal and financial implications of widespread PSMA PET adoption are highlighted, stressing the need for cost-effective implementation strategies.

Can Imaging Replace Prostate Biopsy – Primary Detection, Active Surveillance and Recurrent PCa?

by Veeru Kasivisvanathan, MBBS, BSc, FRCS, PhD, MSc, PGCert | Dec 2024

Veeru Kasivisvanathan, MBBS, BSc, FRCS, PhD, MSc, PGCert, reflects on the significant advancements in prostate imaging over the last decade, emphasizing the transformative role of MRI. A central question in this 15-minute presentation is whether prostate cancer can be diagnosed and managed without a biopsy. While biopsies are the current standard, they carry risks such as sepsis, patient discomfort, and financial burden.

The PROMIS study demonstrated MRI’s ability to detect all Gleason 4+3 cancers, though it also revealed MRI’s high number of false positives. Combining PSMA PET with MRI improves sensitivity to 97%, particularly for detecting clinically significant cancers, but specificity remains a challenge, raising concerns about unnecessary treatment. New scoring systems, like the P score, integrate PET avidity and PI-RADS scores to refine risk assessment and treatment decisions.

Kasivisvanathan discusses the concept of “biopsy-light” pathways, citing cohorts where patients undergo fewer biopsies, with monitoring driven by MRI and PSA changes. This approach shows promising compliance and oncological outcomes comparable to standard active surveillance but with less patient burden. Despite advancements, a fully biopsy-free pathway remains unfeasible due to limitations in MRI standardization, interpretation variability, and a lack of high-volume data.

PIRADS V2.1 – What a Urologist Needs to Know?

by Sadhna Verma, MD, FSAR | Dec 2024

Sadhna Verma, MD, MBA, FSAR, begins this 20-minute presentation by emphasizing the exponential growth of prostate MRI usage and its critical role in prostate cancer detection. Before diving into PI-RADS, the multiparametric MRI approach is explained. T2-weighted sequences are highlighted as the best for anatomical visualization.

PI-RADS scoring, a standardized Likert-like system ranging from 1 to 5, assesses the likelihood of malignancy of a lesion based on size, location, and imaging characteristics. PI-RADS version 2.1 introduces refinements, particularly for transition zone lesions. The updated guidelines also incorporate templates to standardize reporting and emphasize quality assurance. Central zone tumors are recognized for their aggressive nature and specific imaging features.

Dr.Verma shares images to illustrate the scoring refinements of PI-RADS version 2.1. Despite advancements, quality variability in imaging and interpretation remains a concern. Collaborative initiatives led by the American College of Radiology aim to enhance diagnostic accuracy. Dr. Verma emphasizes the need for ongoing quality assurance and training to address current limitations and improve clinical outcomes.

MRI in Localized and Recurrent Prostate Cancer

by Baris Turkbey, MD | Nov 2024

In this 9-minute presentation, Baris Turkbey, MD, discusses the role of MRI in diagnosing localized and recurrent prostate cancer. He begins with a clinical case illustrating how MRI-guided biopsy can identify significant cancers missed by traditional systematic approaches.

Dr. Turkbey highlights the importance of standardized imaging practices, such as PI-RADS guidelines, which improve consistency in image acquisition and interpretation. He emphasizes that effective use of MRI involves coordination among radiologists, urologists, and pathologists, making quality control critical across all stages.

In recurrent prostate cancer, Dr. Turkbey stresses that MRI proves especially valuable in conjunction with PSMA PET imaging, aiding in localizing biochemical recurrence foci and enabling early curative interventions. He discusses updated PI-RR guidelines for interpreting MRI in post-treatment settings, recommending specific imaging sequences to improve detection in challenging scenarios. He demonstrates successful applications of MRI in detecting recurrence after surgery or radiotherapy, underscoring its diagnostic precision.

Update on PRAISE-U Project – European Union Initiative in PC Screening

by Monique Roobol, PhD | Nov 2024

Monique Roobol, PhD, focuses on prostate cancer screening practices in Europe, highlighting recent developments, ongoing initiatives, and future prospects. In 2022, the European Union (EU) updated its cancer screening recommendations, formally including prostate cancer alongside breast, lung, colorectal, and gastric cancers, spurring momentum for organized prostate cancer screening initiatives across Europe.

In this 11-minute presentation, Dr. Roobol shares the PRAISE-U initiative, launched following the EU’s recommendations. This initiative seeks to pilot and evaluate risk-based screening strategies across all EU member countries, including Spain, Ireland, Lithuania, and Poland.

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