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PEER-TO-PEER CLINICAL CONVERSATIONS |
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| Integrating Genomic Testing with MRI Enhances Stratification of Surveillance Patients |
Eric Kim, MD, and Mark Sultan, MD
Mark Sultan and Eric Kim discuss research on predicting prostate cancer progression during active surveillance using Decipher® genomic classifier scores and MRI characteristics. Their study reveals that while both high Decipher® scores and high-risk MRI findings independently predict progression, these markers are weakly correlated, suggesting they capture distinct risk information. |
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| Investigating the Relationship Between MRI Findings, Genomic Markers, and Gleason Score |
Eric Kim, MD
Eric Kim discusses the variation in prostate cancer genomic subtypes related to MRI PI-RADS scores and racial differences. He focuses on the correlations between mpMRI findings and the Decipher genomic classifier in a racially diverse cohort of men. |
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Evaluating a Sequential Screening Approach for Prostate Cancer Using PSA, Kallikrein Panel, and MRI in the ProScreen Trial, Journal Club
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Rashid Sayyid, MD, MSc, and Zachary Klaassen, MD, MSc
Rashid Sayyid and Zach Klaassen explore the findings of the ProScreen trial, a rigorous examination into sequential prostate cancer screening using PSA, a kallikrein panel, and MRI.
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| Integrating Genetic Variants and Clinical Factors for Improved Prostate Cancer Prognostication |
Susan Halabi, PhD
Susan Halabi discusses her presentation on prognostic factors in metastatic castration-resistant prostate cancer (mCRPC) based on the Alliance trial. The phase three trial, which enrolled 1,311 patients, compared the effects of enzalutamide alone to enzalutamide combined with abiraterone and prednisone. |
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| Clinical Progression of Prostate Cancer from Active Surveillance is Predicted by Decipher® Genomic Classifier Score on Index Biopsy Independent from Risk Assessment by MRI Characteristics |
| Mark Sultan, MD |
| Mark Sultan presents a study showing that the Decipher® Genomic Classifier (GC) score on the index biopsy independently predicts clinical progression in prostate cancer patients on active surveillance, regardless of MRI findings. The analysis demonstrated that a Decipher® GC score ≥0.45 was significantly associated with higher rates of treatment progression, while MRI PI-RADS 4-5 lesions were not predictive for patients with elevated Decipher® GC scores. |
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| Prostate Cancer Screening with Biomarkers and MRI–A European Perspective |
| Tobias Nordström, MD |
| Tobias Nordström's SUO 2024 presentation highlighted the integration of biomarkers (e.g., Stockholm3) and MRI in European prostate cancer screening to improve the detection of clinically significant cancers while reducing overdiagnosis and unnecessary biopsies. Trials like STHLM3-MRI and Göteborg-2 demonstrated the cost-effectiveness and efficiency of these approaches, with biomarkers reducing MRI use and enhancing cancer detection. |
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Evaluating 4Kscore's Role in Predicting Progression on Active Surveillance for Prostate Cancer Independently of Clinical Information and PIRADS Score - Beyond the Abstract
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| Jamie Thomas, DO, Helen Hougen, MD, and Sanoj Punnen, MD |
| This study evaluated the 4Kscore, a blood-based biomarker, for predicting prostate cancer progression in men undergoing active surveillance (AS) within an MRI-based protocol. Results showed that a baseline 4Kscore ≥20% strongly predicted grade progression at confirmatory and subsequent biopsies, demonstrating its utility as an independent and objective risk stratification tool. The 4Kscore complements MRI by providing standardized assessments that could reduce biopsy frequency and burden, particularly in settings with limited MRI access or quality concerns. |
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| A Prospective Pilot Study Investigating 18F rhPSMA-7.3 PET/MRI to Detect Recurrent Disease and Guide Radiotherapy Planning in Patients with Biochemically Recurrent Prostate Cancer Post-Prostatectomy |
| Devaki Shilpa Surasi, MD, MBBS |
| A prospective pilot study presented at ASTRO 2024 investigated the utility of F-18 rhPSMA-7.3 PET/MRI in detecting recurrent prostate cancer and guiding radiotherapy (RT) planning in patients with biochemical recurrence post-prostatectomy. The study demonstrated a high positive predictive value (93.75%), even at low PSA levels, and led to significant RT plan changes in 36% of patients, including adjustments to target volumes and the addition of metastasis-directed therapy. |
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Prostate Magnetic Resonance Imaging Utilization and Its Relationship with Advanced Prostate Cancer Detection - Beyond the Abstract
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| Zhiyu Qian, Yu-Jen Chen, Julia Feldman, Edoardo Beatrici et al. |
| A study analyzing SEER-Medicare data from 2004-2015 found no significant link between increased prostate MRI use and the proportion of advanced prostate cancer diagnoses, challenging the idea that rising advanced cases are solely due to improved imaging. Factors such as the 2012 USPSTF recommendation against routine PSA screening likely contributed to delayed diagnoses and more advanced disease at presentation. While MRI utilization was low during the study period, further monitoring is needed as MRI technology advances and becomes more widespread. |
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