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Phillip Koo: Hi, my name is Phillip Koo, and welcome to UroToday. Today we have with us Dr. Faina Shtern, who's the president of AdMeTech, which is an organization familiar to all of us in the prostate cancer community. First off, I want to congratulate you, Faina, for hosting the 7th annual Global Summit on Precision Diagnosis and Treatment of Prostate Cancer, which is scheduled to go on this year from September 21 to 23. I know this year you have a really amazing lineup of speakers and topics, but can you sort of give us some of the highlights that you feel like are really different this year compared to years past?

Faina Shtern: Absolutely. Phil, thank you so much to you and to the staff of UroToday for the opportunity to appear today on UroToday. We really appreciate that, particularly given the incredible footprint UroToday has in the urologic community. We are pretty proud of our annual Global Summit on Precision Diagnosis and Treatment of Prostate Cancer that was established in 2016. The Summit, as you probably remember, Phil, because you were one of the first people I asked for support of this event, this summit was established because before 2016, we saw such large gaps between the imaging community, so many silos surrounding MRI, molecular imaging, ultrasound, advanced ultrasound, not to mention incredible gaps between imaging and the clinical community that was very actively engaged in therapeutic innovations and in innovation in genomic cancer profiling and a lot of development of biomarkers.


Baseline PSA, we were running the International Prostate MRI Working Group, I remember it was 2015, I came to the meeting of our incredible experts of the International MRI Working Group behind PI-RADS standardization. I was excited about baseline PSA, and it was very clear to me that my excitement and all my messages about baseline PSA had fallen on deaf ears.


Clinicians like Dr. Adam Kibel, head of Urology at Brigham and Dana-Farber, were telling me that he has these people coming to him, imaging people, biomarker people, genetic cancer profiling people, and everyone sounded like they had the solution to prostate cancer care, precision diagnostics, and integration mistreatment. I was listening to all of these discussions, I was hearing all the discussions thinking, "My goodness, prostate cancer is a very complex biologic disease. The future will not be in any single individual diagnostic. The future will be in the integration of diagnostics. Integration of MRI with molecular imaging, integration of imaging with biomarkers and genetic cancer profiling."


To me, it sounded like the key need that we had at that time was to bring key opinion leaders together. And that's exactly what our summit did. And if you look at the evolution of the Summit, the first thing we took on, as you probably remember the discussions time and over again, is radiogenomics. Work that was exemplified by what the University of Miami was doing at that time and a few other key institutions. Integration of MRI versus biomarkers and genetic cancer profiling. And I am excited to share that we've seen such incredible emerging data on correlation and integration of imaging data, histopathologies, genetic cancer profiling, biomarkers, and molecular diagnostics.


And for the first time in Summit 2023, they will have a panel on multiomics. They're beyond radiogenomics right now. They're looking at proteomics, they're looking at any kind of omics you can possibly imagine. So for the first time, they will have a panel on multiomics. And we will be specifically discussing what does it mean when disease is visible on imaging and what does it mean when disease is not visible on imaging? What are the implications of that? Because, so far, emerging data indicates that, let's say, if disease, if prostate cancer is not visible on MRI, the probability is that the genomic cancer profiling, histopathology, and biomarkers will not have a diverse profile. But we'll be discussing this at greater length during the multiomics panel. To my knowledge, it is the first multiomics panel that any meeting in prostate cancer will have. I strongly believe the future of precision diagnostics is in the integration of diagnostics and the utilization of machine learning, deep learning with AI in analyzing data and predictive modeling for treatment planning.

Phillip Koo: Faina, I couldn't agree with you more. This idea of integration and no single tool being the answer, I think, I completely agree, and it's really up to us to make those connections and really harness things and be able to see insights that we can't see with the human mind. And I agree, machine learning and AI is where it's at. I think it's wonderful to see the evolution of your meeting start off with radiogenomics, radiomics, and now we're talking about multiomics which is a hot topic. Let's dive a little bit deeper into this idea of AI and machine learning. How do you see that facilitating this discussion with regards to multiomics in the future?

Faina Shtern: Absolutely. It's very clear to me. If I were to look in a crystal ball, I would say that this is the future. But right now, if you look at MRI alone, I'm not as familiar with molecular imaging, although I'm extremely excited about the role of molecular imaging, that's biologically unique information to what we can offer with MRI. If you look at MRI alone, an average MRI multiparametric study generates, on average, 1000 2D slides. We are running off cognitive human capacity to process this kind of information. So MRI started using the word 3D imaging because of this multitude of slides.

But if you combine MRI with these other diagnostic tools, we are beyond the cognitive capacity of individual physicians. We have to rely on machine learning. But of course, we also need the appropriate algorithms that will process this information in the right way and will give us predictive modeling so that we will know. And I'm emphasizing predictive as opposed to prognostic, because we want to have actionable information. We need to know, for this individual man, what would be the most optimal treatment based on predictive modeling. And I believe it is the future.


Phillip Koo: Yeah, I agree. I think one of the biggest challenges right now is being able to get the appropriate data sets that combine the clinical data with the MRI, with the imaging, with the genomics, with the histopathology, which is probably one of the biggest stumbling blocks to us sort of taking that next step forward.

So you've identified a lot of gaps and I think it's wonderful that you're incorporating imaging into sort of the larger discussion about diagnosis and treatment of prostate cancer. I think another gap that you've identified is that there is a global disparity with regards to how prostate cancer is diagnosed and treated, not just in America, but across the world. And this year, I know you've sort of added a unique aspect to the meeting, so can you talk a little bit about that?

Faina Shtern: You know what, it's even difficult to talk about a global perspective, Phil. We were actually discussing at the last Summit, absolutely drastic differences in patterns of care in different parts of this country. For example, genomic cancer profiling that is so essential for treatment planning, particularly for large-volume, low-grade disease and low-volume, intermediate-grade disease. It's so essential for treatment selection, right? Active surveillance, focal treatment, whatnot.

And yet, if we look at Florida, if we look at the West Coast, if we look at some areas of the Midwest, it's actually used. You look at the Northeast, you look at the East Coast, you cannot find it. So it's a high quality of MRI. They're not there yet in terms of uniform quality, and therefore, uniform clinical confidence in prostate MRI. Although prostate MRI is more widely implemented than genomic cancer profiling, they are not quite there in image quality and image interpretation and its standardization, PI-RADS made a tremendous difference. So patterns of care are so different in this country.

Then you are also looking at Europe or Australia. Australia and, say, Europe are utilizing MRI much more widely, largely because it's not nearly as expensive as in this country. We are talking about prostate MRI costing thousands here and costing several hundred dollars, for example, in the United Kingdom. In the United Kingdom, MRI is basically a standard tool right now. So, there are so many different patterns of care based on costs of care, based on what physicians are familiar with, based on what they're comfortable with. And this all comes down to the preferences of individual institutions today, even in leading academic institutions.

So the patterns of care really have a way to go in terms of standardization. So we really need to see. We feel lucky that we bring the kind of quality of speakers that we do, and many of them actually are coming from NCCN committee's leadership positions, in the hope that we'll facilitate some sort of consensus on the best emerging practices and research priorities.

Phillip Koo: I agree. I think in the long-term, hopefully we can make decisions based on scientific data as opposed to necessarily the cost of care, but I don't think we're there yet in the US or globally. This year you started an International Organizing Committee, which really broadens the scope of this meeting. Can you talk briefly about that?

Faina Shtern: Absolutely. Thank you. It's a great question. Actually, last year we had a couple of new people participating from the Middle East, from Central and South America, and they got so excited about the quality of presentations and quality of discussions that they observed at the Summit that they offered to create an International Organizing Committee. And I'm pleased to report that if you look at the Summit between, let's say, 2016 up to 2020, we would have 80-90% participants from this country. This year we have over 50% participants from the Middle East, South and Central America, and Africa.

Phillip Koo: I think that's wonderful. Kudos to you for bringing so many different stakeholders to the table to talk about this important topic. Again, congratulations on hosting another wonderful meeting. For those listeners out there, viewers out there, go to admetech.org, register for the meeting. Again, it's September 21 to 23 and it's available virtually for those who are interested. Thank you, Faina.

Faina Shtern: Thank you so much for the opportunity. Have a great day.