Topic: Prevention and Screening

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.

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.

Optimization of Prostate Biopsy – Micro-Ultrasound versus MRI (OPTIMUM)

by Laurence Klotz, MD, FRCSC | Nov 2024

Laurence Klotz, MD, FRCSC, introduces the OPTIMUM trial, a landmark international study comparing micro-ultrasound and MRI for prostate cancer detection. In this 9-minute presentation, Dr. Klotz explains that micro-ultrasound, operating at 29 MHz, offers three times greater resolution than conventional ultrasound. Using a PRIMUS scoring system analogous to PI-RADS, micro-ultrasound demonstrates its utility in identifying highly sensitive lesions.

Dr. Klotz details the trial’s three-arm design, which involves MRI with conventional ultrasound, MRI with micro-ultrasound, and micro-ultrasound alone to assess non-inferiority and complementary detection capabilities.

Dr. Klotz emphasizes the trial’s importance for minimizing bias and improving diagnostic practices, particularly given its potential to replace or complement MRI. He highlights the study’s robust design, comprehensive objectives, and international collaboration, anticipating its transformative impact on prostate cancer diagnosis and management.

MRI PI-RADS Standardization and Clinical Evaluation

by Clare Tempany, MB, BCh, BAO | Nov 2024

Clare Tempany, MB, BCh, BAO, Harvard Medical School, addresses the standardization and clinical evaluation of PI-RADS, a key tool in prostate cancer imaging. In her 13-minute presentation, Dr. Tempany begins by tracing the history of the RADS program, emphasizing its role in reducing variability and improving communication in radiological reporting. She highlights the utility of prostate MRI, focusing on its capacity to aid in detection, characterization, and targeted biopsies for clinically significant cancers.

Dr. Tempany reviews the PI-RADS v2.1 updates, which refine imaging protocols and stress the inclusion of previously overlooked areas like the anterior fibromuscular stroma. She provides examples to illustrate how these improvements enhance lesion detection and biopsy targeting. While discussing the growing interest in bi-parametric MRI, Dr. Tempany remains cautious, advocating for multiparametric MRI in most cases due to its added value for less experienced readers or in challenging cases.

She highlights the global shift toward recommending MRI before biopsy, citing changes in major guidelines and increased adoption rates. Dr. Tempany underscores the ongoing efforts to enhance MRI quality and interpretation, focusing on integrating AI for future improvements.

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

by Mukesh Harisinghani, MD | Nov 2024

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.

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.

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

by Preston C. Sprenkle, MD | Nov 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.

Connected Care and Latest Developments in Prostate Cancer Management

by Ilya Gipp, MD, PhD | Nov 2024

Ilya Gipp, MD, PhD, delivers a 9-minute presentation on connected care and advancements in prostate cancer management, emphasizing integrating innovative diagnostic and therapeutic approaches. Dr. Gipp discusses the pivotal role of MRI in prostate imaging, showcasing advancements in ultra-fast protocols that enhance efficiency without compromising diagnostic accuracy. He highlights targeted biopsy techniques enabled by data fusion, focal therapies, and the growing impact of theranostics, particularly radioligand therapies like PSMA PET, as transformative tools in treatment and monitoring.

A significant theme in Dr. Gipp’s presentation is integrating actionable data across departments, bridging radiology, urology, and oncology to foster precision care. He emphasizes the role of AI in utilizing these vast datasets for real-time decision-making and patient-specific treatment strategies. By demonstrating the value of connected care and data-driven innovation, his presentation provides essential insights for professionals aiming to advance prostate cancer management.

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

by Sigrid V. Carlsson, MD, PhD, MPH | Nov 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 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.

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

by Ros Eeles, PhD, FRCP, FRCR | Nov 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.

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