2021 Archives

Screening and Prevention of Prostate Cancer 2021 (Part 3): Incorporating MRI for Early Detection

Posted by Sigrid V. Carlsson, MD, PhD, MPH | Jun 2021

In the final part of a 3-part series, Sigrid V. Carlsson, MD, PhD, MPH, Assistant Attending Epidemiologist at Memorial Sloan Kettering Cancer Center, considers the current role of MRI in early detection of prostate cancer. She explains that while MRI is a useful screening tool, it is not foolproof, and its accuracy varies widely depending on user expertise. For this reason, using a negative MRI to justify not getting a biopsy is not always strongly advised. However, many studies are underway that may identify combinations of MRI and biomarker tests that will ultimately help patients avoid more unnecessary biopsies.

Application of MRI Fusion Biopsy Results to Focal Therapy

Posted by Leonard S. Marks, MD | Jun 2021

Leonard S. Marks, MD, Professor and inaugural holder of the deKernion Chair in Urology at the David Geffen School of Medicine at the University of California, Los Angeles, discusses focal therapy using MRI fusion biopsy and a novel process to determine tumor margins. He outlines the rationale for focal therapy, addresses previous concerns about the treatment, and discusses focal therapy failure and how to address it.

Industry Perspective: The Role of URO17 ™ in the Diagnosis and Management of Bladder Cancer

Posted by John Cucci | Jun 2021

John Cucci, an executive at Acupath Laboratories, Inc., introduces the URO17TM antibody, a promising adjunct to cytology for bladder cancer diagnosis. Mr. Cucci explains that while cytology is the standard technique used in diagnosing bladder cancer and has a high positive predictive value, its sensitivity is low. URO17TM detects the expression of keratin-17, a protein strongly associated with bladder cancer, and has greater than 95% sensitivity and specificity. Mr. Cucci goes over the promising early results for URO17TM, as discussed in several papers, and notes that it has been given an expedited clinical trial process by the FDA. He also looks at its potential clinical utilization, both as a screening tool for hematuria patients and as a long-term monitoring tool for bladder cancer patients after they complete therapy. He emphasizes that URO17TM can cheaply and effectively provide additional and reliable information for the pathologist and urologist to more appropriately rule in or out additional diagnostic work-up in patients. Mr. Cucci concludes by presenting a graphic of the URO17TM diagnosis categories and risk meter.

The Role of Molecular Imaging to Improve Cancer Control Post-Prostatectomy

Posted by Peter J. Rossi, MD | Jun 2021

Peter J. Rossi, MD, a board-certified radiation oncologist affiliated with Calaway Young Cancer Center at Valley View Hospital in Glenwood Springs, Colorado, considers the evidence for using molecular imaging to improve prostate cancer control post-prostatectomy, focusing on the results of the EMPIRE-1 study comparing 18F-fluciclovine-PET/CT imaging versus conventional imaging alone to guide post-prostatectomy salvage radiotherapy for prostate cancer. Dr. Rossi explains that while doctors may offer postoperative radiotherapy to patients experiencing a PSA rise or biochemical failure, the decision to do so can be complex and failure rates are high. He notes that improving adjuvant therapy is therefore imperative, and investigators have looked to molecular imaging as the means to do so. Dr. Rossi then describes the aims and methods of the EMPIRE-1 trial, noting that the investigators sought to expand the role of 18F-fluciclovine-PET/CT imaging beyond diagnostics and into cancer control by studying how radiotherapy decisions and planning changed based on molecular scans as compared to standard imaging. The results showed that radiotherapy plans were changed in 35.4% of patients based on PET uptake, and that using PET imaging resulted in a significantly improved and significantly more durable failure-free survival rate compared to using standard imaging alone, suggesting that PET is a viable tool for improving adjuvant radiotherapy. Dr. Rossi concludes by looking at future directions for molecular imaging and adjuvant care, highlighting a new study comparing 18F-fluciclovine-PET/CT to PSMA.

Screening and Prevention of Prostate Cancer 2021 (Part 2): Who Needs a Biopsy?

Posted by Sigrid V. Carlsson, MD, PhD, MPH | Jun 2021

In part 2 of a 3-part series, Sigrid V. Carlsson, MD, PhD, MPH, Assistant Attending Epidemiologist at Memorial Sloan Kettering Cancer Center, goes over her 5 Golden Rules for prostate cancer testing, which are intended to minimize overdiagnosis and overtreatment while also making sure that significant disease is not missed. Rule 1 is to get consent and engage in shared decision-making with patients. Dr. Carlsson notes that this can sometimes be difficult since the numerous decision aids available are often difficult to use and understand. The second rule is not to screen men who will not benefit, for instance, older men with multiple comorbidities and short life expectancies. Dr. Carlsson does observe, however, that instituting an age cutoff does not necessarily make sense, and that physiologic assessment of life expectancy may be a more useful metric. In rule 3, Dr. Carlsson advises clinicians not to biopsy patients without a compelling reason, since prostate biopsies may lead to infectious complications and hospitalization. She then lays out the options for risk stratification, such as risk calculators, biomarker tests, and MRI. Rule 4 recommends against treating low-risk disease since, as Dr. Carlsson explains, active surveillance is a safe strategy over longer follow-up for appropriately selected patients with Grade Group 1 prostate cancer when following a well-defined monitoring plan. Finally, rule 5 exhorts clinicians to send patients who require treatment to a high-volume provider. This is key, Dr. Carlsson argues, since evidence shows that there is a large degree of heterogeneity among surgeons regarding functional and oncological outcomes after prostatectomy, and it takes approximately 250 surgeries for a surgeon to really master the procedure.