Guilherme Godoy, MD, MPH, presented “The Pros and Cons of Imaging for Biopsy Guidance” during the 23rd Annual Innovations in Urologic Practice on September 14, 2018 in Santa Fe, New Mexico.
How to cite: Godoy, Guilherme. “The Pros and Cons of Imaging for Biopsy Guidance” September 14, 2018. Accessed Nov 2024. https://dev.grandroundsinurology.com/the-pros-and-cons-of-imaging-for-biopsy-guidance/
The Pros and Cons of Imaging for Biopsy Guidance – Summary:
Guilherme Godoy, MD, MPH, provides an overview of the evolution of prostate cancer imaging technologies. He then discusses mpMRI targeted biopsy and the ability of this approach to detect significant prostate cancer and mitigate insignificant tumor detection.
Abstract:
This is a partner presentation coupled with John W. Davis’s “The Pros and Cons of Genomic Markers for Biopsy Guidance.” Although there can be a debate constructed between MRI and genomic biomarkers to guide prostate biopsy, clinicians generally integrate these technologies instead of using one over the over. This presentation focuses on the role of MRI in the evolution of prostate biopsy guiding methods.
In the past, crude parameters such as PSA, digital rectal exam (DRE), and sampling biopsy information guided clinical decisions. Sampling biopsies, in particular, have fundamental limitations that often lead to repeat biopsies, increasing cost to the patient and risk of complications and detection of indolent cancers. Improved transrectal ultrasound (TRUS) techniques emerged for the purpose of mitigating these risks. However, these techniques had limitations, and ultimately did not significantly improve accuracy in biopsy guidance.
The advent of multiparametric MRI (mpMRI) brought about the ability to localize, measure, follow, grade, and target lesions. MRI/ultrasound fusion not only allows for diagnostic utility in targeted biopsy, but also focal therapy strategies. When combined with MRI techniques, new genomic markers that integrate blood, urine, and tissue have a role in individualizing prostate cancer risk assessment. Updates and improvements in the Prostate Imaging Reporting and Data System (PI-RADS) also help to standardize the interpretation of MRI.
This discussion covers various MRI magnets and coils, as well as TW2 fast spin echo, diffusion-weighted imaging, apparent diffusion coefficients, dynamic contrast-enhancing, and MR spectroscopy imaging sequences. Additionally, this presentation reviews MRI’s accuracy in guiding prostate biopsy as demonstrated in the PROFUS, PROMIS, and PRECISION trials.
About Innovations in Urologic Practice
Innovations in Urologic Practice (IUP) is an annual CME-accredited conference devoted to updating urologists on the rapidly changing healthcare environment. Topics focus on innovative diagnostic and treatment strategies, controversies, new and currently developing technologies, and challenges in today’s urologic practice. Dr. Godoy presented this lecture during the 23rd IUP in 2018. Please visit this page in order to learn more about future IUP meetings.
ABOUT THE AUTHOR
Dr. Godoy is an Assistant Professor of Urology and Urology Oncology at Baylor College of Medicine, Houston, Texas. He received his MD from Fundacao Universitaria do ABC in Sao Paulo, Brazil, and has received numerous fellowships at several institutions, including Memorial Sloan Kettering Cancer Center in New York City, Irmandade da Santa Casa de Misericordia de Sao Paulo Medical School in Sao Paulo, Brazil, Vancouver General Hospital in Vancouver, British Columbia, New York University School of Medicine in New York City, and Baylor College of Medicine. Dr. Godoy is skilled at managing patients with bladder cancer, kidney cancer, prostate cancer, and testis cancer. He also specializes in bladder issues, erectile dysfunction, kidney stones, and prostatitis. Dr. Godoy is a respected writer, researcher, and presenter as well, and has published numerous articles and papers. He has won a Best Published Clinical Research Paper Award from European Urology and has been recognized on several occasions as a Best Poster of the Section at American Urological Association Annual Meetings and European Association of Urology Annual Congresses. Dr. Godoy is also heavily involved in the medical community, both nationally and internationally. He is a member or candidate member of nine medical societies, including the Pan American Society of Anatomy, the Brazilian Society of Anatomy, the American Association of Cancer Research, and the Southwest Oncology Group.
