Commentary
Video
SUO 2023: Dr. Cookson discusses prostate cancer highlights
Author(s):
“What it brought up is the point that where the field seems to be going is incorporating the PET imaging and the MRI imaging, and maybe PET MRI,” says Michael S. Cookson, MD, MMHC, FACS.
In this video, Michael S. Cookson, MD, MMHC, FACS, discusses prostate cancer highlights from the 2023 Society of Urologic Oncology Annual Meeting in Washington, DC. Cookson, a professor and the Donald D. Albers Endowed Chair in Urology at the University of Oklahoma Health Sciences Center in Oklahoma City, Oklahoma, is a co–editor in chief for Urology Times.
Transcription:
AI and Path - Peter A. Humphrey, MD, PhD
He gave a really interesting talk previewing, I think some that's currently available, but the suggestion would be that artificial intelligence can perhaps do a better job at picking out patterns, more standardization of the grading. And I think a little bit of the emphasis was on prostate in this session. But the idea that you wouldn't actually even have to make H&E stains anymore, that there may be some photographic ability to digitalize and then import it in and then get a read that enhances what we currently know about things like Gleason score and stuff like that. So it's a little bit of a thought-provoking and futuristic [talk]. With all these things comes the fear that the machines are going to take over. But I do think that some of the things he said are already available, and just figuring out how to incorporate that not only into a...center, but then like, what if you need a path review? How do you do that? Will that be easy for somebody else to review it and give it a second opinion on the AI part? That part's not really there yet. I think it could improve some things, but it could also create some new challenges as we try to figure out, [for instance, if] somebody comes to your institution and needs treatment for prostate cancer, the standard is to get that reviewed. Why? Well, what if you remove their prostate and there's no cancer? Well, what do you do next; you're going to go back to those slides. If your group didn't agree that those were cancer cells under that microscope, then that's a problem. So path review is an important part of it, and then getting consistency between those reviews is going to be an integral part of that emerging market, if you will.
Advances in Imaging (PSMA/MRI) - Shane Wells, MD
That was a good talk. And really, what it brought up is the point that where the field seems to be going is incorporating the PET imaging and the MRI imaging, and maybe PET MRI...Currently, our gold standard for establishing a diagnosis is really a tissue diagnosis. And some of that imaging could allow for you to perhaps call cancer without making that diagnosis on a biopsy. But showing a lot of the power of the combination of the imaging with PET and MRI was what I found most exciting. And the cost, of course, has to be contended with, because in some places in the world, I think MRIs were done very inexpensively, and for a long time, the US was slow to adopt, partly due to data but also to cost. And now you layer in that PSMA imaging with it, which is powerful, but it's got only really narrow indications right now. PSMA imaging is for things like suspected metastases once you have a diagnosis; it's looking at that biochemically recurrent patient. But it's not before you have a diagnosis. And so the hope would be that someday we'll be able to incorporate that kind of imaging to pinpoint that we may still, for the foreseeable future need to get a tissue diagnosis. But that might help. The other thing that was noted is, what about monitoring after treatment? How does that type of imaging help you understand that? I don't know whether it was that session or another that it was discussed at, but the idea that if you do, say, a focal treatment for prostate cancer or even radiation treatment for prostate cancer, and you have a rising PSA, what is the accuracy of predicting recurrence in the prostate using PET imaging? So we think we know but we don't really know that yet. Those are some questions that were raised; it was a thought-provoking talk.
Genetic Testing - William J. Catalona, MD
Dr. Catalona, of course, has been one of the pioneers in collecting specimens. I remember even when I was interviewing as a resident, they were doing all kinds of data collection, mapping bloodwork with the biopsies on Saturdays at Washington University. Dr. Catalona gave a very insightful talk about the role of germline testing, some of the excitement around it, and...talked a little bit about somatic testing. So despite the knowledge that germline mutations exist, and of course, we're probably still at the tip of the iceberg of understanding because so many of the times, like for early localized disease, the germline testing is negative for metastatic disease, maybe 10%. As you get into castration resistance, if you combine the somatic, maybe you get 25% to 30%. But we're probably missing things and we don't know what we're missing yet. So he talked a little bit about the importance of germline testing, of course the companion possibility of treatment for the more advanced diseases with PARP inhibitors and that sort of thing. But just to continue to forge the work forward with looking into expanding our understanding of what are the mutations that are most impactful, and then how we can treat men differently once we know those.
The Impact of Screening Practices for Black Men - Leanne Woods-Burnham, PhD
She gave a really nice talk. She's a basic scientist, but then she has become more involved with the community outreach for African Americans. And certainly, all of us look to ways to reach the underserviced and the minority who don't come forward with traditional screening. You can recommend they go to their primary care and get a PSA, but they just don't do it. So some of the efforts, like the one she discussed, are really about understanding the community, finding out who those people are in the community that are sort of the gatekeepers. It can be through churches, it can be through organizations, but you have to earn their trust. And if you don't partner with them, and you don't get that trust, then the people won't be willing to come forward and get the testing done. What is the future of testing? Could it be more sophisticated testing; could we do better? Right now, it's blood tests. We want to do that. There's probably some potential for urinary marker tests that can help lead to better screening, but just getting engaged with the community and getting out beyond the walls of your institution, your center, to offer messages as well as to engage them. That was kind of the point of her talk. It was a pretty good talk.
This transcription was edited for clarity.
