2024

Sanoj Punnen, MD, MAS, discusses the use and benefits of integrated diagnostics for monitoring prostate cancer during Active Surveillance (AS). He begins by noting that AS is becoming a popular treatment for a wide range of low-risk prostate cancers, thanks to more granular risk-stratification methods and an increasing clinical emphasis on lowering patient burden during treatment.

Dr. Punnen then discusses lowering the frequency of serial biopsies as a means of lowering patient burden during treatment. He explores studies which indicate that MRI and Gleason scoring alone are insufficient for monitoring prostate cancer progression.

Dr. Punnen concludes with an exploration of the ongoing Miami MRI-Guided Active Selection for Treatment of Prostate Cancer (MAST) trial examining the use of MRI, 4Kscore, and Decipher scores during AS. The data thus far indicates that MRI alone is not predictive of progression, and that clinicians should consider integrating other prognostic data into their AS treatment protocols.

Liang Wang, MD, PhD, presents current data on the use of noninvasive approaches with radiomics models to identify prostate cancer in active surveillance (AS) patients. Dr. Wang begins by sharing data on the risk reduction that early detection provides, but notes risks of overdiagnosis and overtreatment. He then addresses the role of magnetic resonance imaging (MRI) in prostate cancer management, noting improved techniques and better image interpretation by the Prostate Imaging Reporting & Data System (PI-RADS). However, Dr. Wang highlights that other biomarkers along with MRI must guide further diagnosis and treatment.

Dr. Wang discusses the rapidly evolving field of radiomics, explaining it enables the digital decoding of images into quantitative features that may uncover disease characteristics unseen by the naked eye. Further, it assesses a broad set of predefined features to define patterns relevant to pathology using statistical methods.

Dr. Wang concludes by cautioning that current data on the use of radiomics were from single-institution retrospectives with small cohort sizes and an absence of independent, external validation. Dr. Wang mentions broader, ongoing research which may lead to a non-invasive, radiomics-based tool that may be used to identify AS candidates with prostate cancer in the future.