Radiopharmaceuticals Archives - Grand Rounds in Urology

Metastasis-Directed Therapy: Radiation Oncology Updates and Perspective

by Steven E. Finkelstein, MD, FACRO | Oct 2020

Steven E. Finkelstein, MD, FACRO, a radiation oncologist with Florida Cancer Affiliates in Panama City, Florida, discusses metastasis-directed therapy (MDT) as a potential treatment option for oligometastatic prostate cancer. He reviews typical management of metastatic cancer and describes how MDT can minimize the toxicity of systemic therapy, then addresses future treatment options with stereotactic ablative radiotherapy (SABR). Radiation and other local therapies are used for palliation of metastases but can also alter the course of tumor development. Dr. Finkelstein explains that MDT can be particularly beneficial in oligometastatic prostate cancer if the metastases are at a point where both the primary tumor and metastases can be treated together and likely cured. Lastly, he concludes that MDT via SABR could be employed concurrently with other treatments such as androgen deprivation therapy (ADT), chemotherapies, and radiopharmaceuticals, and that further research is necessary.

Radiation Therapy: What’s New for Localized Disease

by Christina E. Henson, MD | Mar 2020

Christina E. Henson, MD, describes how recent trial-based research has established new standards in prostate cancer radiotherapy. She discusses several modes of therapy, including hypofractionation, metastasis-directed therapy for treating oligometastatic disease, and pelvic nodal irradiation, noting that research has shown them to be effective treatments in a variety of disease states. Ultra-hypofractionation has been proven to have an increased therapeutic ratio compared to other methods, as well as a 5-year failure-free survival of 84% across all trials. Elective nodal radiation up to L4 or higher is now recommended to maximize treatment outcomes. Metastasis-directed therapy has been proven to help patients even with limited disease burden and should be viewed as an option in these cases, though it is not always successful.

M0 CRPC: Treatment Options and Emerging Concepts

by Alicia K. Morgans, MD, MPH | Mar 2020

Alicia K. Morgans, MD, MPH, Associate Professor of Medicine in Hematology and Oncology at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, discusses the use of androgen receptor antagonists in treating patients with non-metastatic (M0) castrate-resistant prostate cancer (CRPC). She goes on to discuss how before these three pivotal trials, treatment for patients with M0 CRPC remained a bit of a mystery. However, the results of these trials demonstrated treating men with these agents who had a PSA doubling time less than ten months significantly improved their metastasis-free survival compared to men in the control arm.

MRI First: The Role of MRI in Biopsy Naïve Patients

by Montu J. Patel, MD | Feb 2020

Monju J. Patel, MD, discusses how variation in mpMRI image quality and radiologist interpretation and experience, as well as technicalities of the PIRADS-2 scoring system, can significantly impact radiologists’ ability to detect lesions suspicious for prostate cancer. He goes on to present several case studies on how to utilize mpMRI’s strong specificity to evaluate extraprostatic extension and anterior transition zone tumors, and how to use mpMRI to evaluate the entire pelvis for possible metastatic disease. Finally, Dr. Patel considers the detection pitfalls of mpMRI, such as differentiating benign anatomy versus a malignancy, abnormalities that exist in the central zone, and how to identify diffuse, infiltrative carcinoma.

Exosomal Liquid Biopsy in Prostate Cancer: Role in Prostate Biopsy Decision-Making

by Judd W. Moul, MD | Feb 2020

Judd Moul, MD, Professor of Surgery and Anesthesiology as well as the James H. Semans, MD, Distinguished Professor of Urologic Surgery at Duke University School of Medicine, discusses the ExoDx Prostate Intelliscore (EPI), a urine-based liquid biopsy test with high negative predictive value (NPV) that may be a useful prostate cancer (PCa) diagnostic tool for primary care providers (PCPs). He emphasizes EPI’s relative ease of use, noting that it is necessary to have simple screening procedures in order to take the burden off of over-stretched urologists.

PSMA-11 PET: Atypical Paths to FDA Approval and Academic NDAs

by Thomas Hope, MD | Feb 2020

Thomas Hope, MD, Assistant Professor in Residence in Abdominal Imaging and Nuclear Medicine in the Department of Radiology at the University of California, San Francisco, explains how an academic institution successfully submits a new drug application (NDA) to the US Food and Drug Administration (FDA), using the NDA for prostate-specific membrane antigen (PSMA) 11 as an example. He notes the limitations that academia has in this area, and recommends that, going forward, institutions design imaging studies so that they report usable detection rates and have blinded readers.

Current and Emerging Role of Radiogenomics

by John Feller, MD | Feb 2020

John Feller, MD, Founding Partner and Medical Director at Desert Medical Imaging, gives an overview of radiogenomics’ current and possible future role in prostate cancer care. He notes the recent promising results of multiparametric MRI (mpMRI) from trials, which have shown that using mpMRI before transrectal ultrasound-guided (TRUS) biopsy can decrease the number of unnecessary biopsies, limit detection of insignificant cancer, and improve detection of significant cancer. These have influenced the updated 2019 National Comprehensive Cancer Network (NCCN) Guidelines for prostate cancer. Dr. Feller further discusses other biomarkers for risk stratification and promising research on radiogenomics in the setting of focal therapy.

Combining SBRT and Brachytherapy in Higher Risk Prostate Cancer

by Michael J. Zelefsky, MD | Sep 2019

Michael J. Zelefsky, MD, argues that combining stereotactic body radiation therapy (SBRT) with low-dose rate brachytherapy can help to reduce the morbidities of combined-modality radiotherapy. He also emphasizes the need to address the issue of toxicity with careful patient selection, treatment planning, and adherence to tight dose constraints.

Role of Brachytherapy in High-Risk Prostate Cancer

by Nelson N. Stone, MD | Sep 2019

Nelson N. Stone, MD, explains that many studies show benefits from combination external beam radiation therapy (EBRT) and brachytherapy in high-risk prostate cancer patients. He then discusses potential reasons for these benefits and the impact of brachytherapy dosage in patient outcomes.

Role for Rectal Spacer in the Radiotherapeutic Management of Prostate Cancer

by Michael J. Zelefsky, MD | Aug 2019

Michael J. Zelefsky, MD, examines the clinical issue of rectal toxicity in prostate cancer patients treated with prostate radiotherapy. He reviews the current findings on the efficacy of rectal spacers in reducing rectal, gastrointestinal, and genitourinary toxicities in these patients.

External Beam Radiation Therapy for High-Risk/Locally Advanced Prostate Cancer: The Shifting Landscape

by Jason A. Efstathiou, MD, DPhil | Aug 2019

Jason A. Efstathiou, MD, DPhil, emphasizes the need for continued clinical trials to refine therapy options for high-risk and locally advanced prostate cancer patients. He reviews six major considerations regarding the current state of external beam radiation therapy (EBRT) for the treatment of high-risk disease.

Long-Term Erectile Dysfunction and Urinary Morbidity Following Brachytherapy

by Nelson N. Stone, MD | Jun 2019

Nelson N. Stone, MD, identifies high-risk factors for erectile dysfunction and urinary morbidity and discusses management strategies for preventing these complications when treating patients with brachytherapy. He specifically addresses seed implementation techniques in patients with prior prostate surgery and large glands, as well as managing post-implantation symptoms.

Topic: Radiopharmaceuticals

Metastasis-Directed Therapy: Radiation Oncology Updates and Perspective

Radiation Therapy: What’s New for Localized Disease

M0 CRPC: Treatment Options and Emerging Concepts

MRI First: The Role of MRI in Biopsy Naïve Patients

Exosomal Liquid Biopsy in Prostate Cancer: Role in Prostate Biopsy Decision-Making

PSMA-11 PET: Atypical Paths to FDA Approval and Academic NDAs

Current and Emerging Role of Radiogenomics

Combining SBRT and Brachytherapy in Higher Risk Prostate Cancer

Role of Brachytherapy in High-Risk Prostate Cancer

Role for Rectal Spacer in the Radiotherapeutic Management of Prostate Cancer

External Beam Radiation Therapy for High-Risk/Locally Advanced Prostate Cancer: The Shifting Landscape

Long-Term Erectile Dysfunction and Urinary Morbidity Following Brachytherapy

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