Laurence Klotz, MD, presented “Using High Resolution Micro-Ultrasound for Prostate Biopsies for Active Surveillance” during the 29th Annual International Prostate Cancer Update on January 26, 2019 in Beaver Creek, Colorado.
How to cite: Klotz, Laurence “Using High Resolution Micro-Ultrasound for Prostate Biopsies for Active Surveillance” January 26, 2019. Accessed Dec 2024. https://grandroundsinurology.com/using-high-resolution-micro-ultrasound-for-prostate-biopsies-for-active-surveillance/
Using High Resolution Micro-Ultrasound for Prostate Biopsies for Active Surveillance- Summary:
Laurence Klotz, MD, discusses the limitations of multiparametric MRI (mpMRI) targeted prostate biopsy, especially in the active surveillance setting, and how a novel 29 MHz high resolution micro-ultrasound technology could be an improved alternative. Additionally, he describes his experience with this technology at his institution.
Abstract:
While mpMRI targeted biopsy is an improvement from systematic biopsy, this technique still has limitations. Notably, mpMRI does not allow for real-time monitoring, requires an external specialist, and has disadvantages in terms of cost and complexity. Recent data also shows that mpMRI has limitations in the active surveillance setting. In one study, mpMRI demonstrated a 27% false negative rate in patients on active surveillance. Due to the low relative sensitivity of mpMRI for detecting low-volume tumors, there is now a consensus in the urologic community that a negative mpMRI does not preclude the importance of systematic biopsy. The ASIST trial further supports this conclusion.
A novel 29 MHz high resolution micro-ultrasound technology could be the solution to overcoming these limitations. This technology employs a unique system for assigning a risk score to each prostate region, called prostate risk identification using micro-ultrasound (PRI-MUS). A physician can acquire expertise in identifying subtle abnormalities on micro-ultrasound imaging in time by performing a multitude of cases. Clinicians can also use this micro-ultrasound system to biopsy and evaluate patients post-focal therapy or post-partial gland ablation.
During this presentation, Dr. Klotz reviews his experience with and key findings of micro-ultrasound at Sunnybrook Health Sciences Center. He compares these results to other published data on micro-ultrasound, which generally supports that the technology maintains sensitivity in active surveillance populations. Overall, micro-ultrasound could be a welcome disruption in this MRI-targeting era.
About the International Prostate Cancer Update
The International Prostate Cancer Update (IPCU) is an annual, multi-day CME conference focused on prostate cancer treatment updates. The conference’s faculty consists of international experts, and the event caters to urologists, medical oncologists, radiation oncologists, and other healthcare professionals. Topics encompass prostate cancer management, from diagnosis to treating advanced and metastatic disease. Dr. Klotz presented this lecture during the 29th IPCU in 2019. Please visit this page in order to learn more about future IPCU meetings.
ABOUT THE AUTHOR
Laurence Klotz, MD, FRCSC, is a professor of surgery at the University of Toronto and the Sunnybrook Chair of Prostate Cancer Research. Dr. Klotz was the founding editor-in-chief of both the Canadian Journal of Urology and the Canadian Urology Association Journal (CUAJ), and he is now editor emeritus of the CUAJ. Dr. Klotz obtained his medical degree and completed his residency at the University of Toronto. He was also a uro-oncology fellow at Memorial Sloan Kettering Cancer Center in New York.
Dr. Klotz has 550 peer review publications and eight books. He coined the phrase “active surveillance” and successfully championed this approach for men with favorable-risk prostate cancer against substantial resistance. He was the associate editor of the Journal of Urology, responsible for prostate cancer, for eight years. Dr. Klotz received the Queen’s Jubilee Medal for outstanding public service, the University of Toronto's Lister Prize, the Society of Urologic Oncology’s SUO Medal, the American Urological Association’s Richard Williams Award, the University of Toronto's Lifetime Achievement Award, the Canadian Urological Association Lifetime Achievement Award, and the Harold Warwick Award from the Canadian Cancer Society for “outstanding contributions to cancer control.” In 2015 he was inducted as a Member of the Order of Canada, Canada’s highest civilian award.
