Prostate Imaging: MRIs & PSMA | Steven Raman, MD & Mark Moyad, MD, MPH | [Video]

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1:21 Prostate cancer in 2024
2:26 Problems with current techniques
2:47 Prostate Specific Antigen (PSA) 1987
4:20 1-2 million men have undergone treatment that probably didn’t need it
4:48 SPCG-4, PIVOT and ProtecT Trial – Sharks and Minnows
6:49 Digital Rectal Exam (DRE)
7:30 TRUS Guided Biopsies
11:13 Prostate cancer is the only major solid organ malignancy not routinely imaged
11:48 Prostate cancer is blind
12:04 Clinically significant prostate cancer
12:27 Magnetic Resonance Imaging (MRI)
15:17 Multi-parametric MRI of the prostate
16:00 PSMA PET vs mpMRI – PCa detection
16:39 MRI shapes and margins: Peripheral/Transition Zone
17:27 Diffusion imaging correlates with Gleason score
18:15 PIRAD score for MRI’s
20:21 MR guided biopsy and treatment
21:13 MRI guided biopsy
22:20 Transperineal US PSMA PET fusion biopsy
23:25 Regional targeted biopsy
24:56 UCLA Integrated Idx biopsy report
25:50 MRI detects up to 90% of csPCa
26:27 Randomized controlled trials
27:24 MRI and PSMA PET CTRI
28:02 Indications for Prostate MRI
28:29 Prostate MRI: Active Surveillance for the minnows
30:15 MRI improves surgical planning for sharks
31:10 MRI DTI can show nerves
31:28 MRI-visibility and outcomes after Prostatectomy
33:05 Radiation planning: MRI + PET
34:22 Artificial Intelligence for Prostate Cancer Diagnoses
35:33 MRI helps improve Genomic tests and MRI visible tumors
36:10 MRI improves performance of Oncotype, Decipher tests
37:33 MRI and 4K tests are additive
37:44 MRI improves urinary PCA 3 prediction of high grade PCa
38:14 Genomics may influence MRI visibility of Pca
38:38 MRI radiogenomics
38:56 Nimbosus: Co-Occuring aggressive features
39:56 MRI visible tumors genetically enriched with unfavorable PCa features
40:30 MRI visible lesions have aggressive protein structures
41:34 PI-RADS score and outcomes after radiation therapy
42:17 MRI is critical for personalized medicine at work
42:55 Summary
44:40 Dr. Mark Moyad Q & A
51:02 What is the best tool we can adopt into prostate?
53:13 Will we get to the point where we can diagnose prostate cancer without a biopsy?
55:30 Interventional radiology
58:20 Open vs closed MRI
1:00:41 Do you need a 3T level MRI or 1.5T?
1:02:24 Can you get an MRI with metal in the body?
1:06:38 What does in bore/fusion biopsy mean?
1:09:19 Should everyone get an in-bore biopsy?
1:14:28 How long do you wait for an MRI if there has been trauma to the prostate?
1:16:10 Does experience reading the MRI make a large difference?
1:19:03 What about second opinions?
1:22:31 Why do MRI’s miss 20%
1:26:03 Combining MRI with PET scan
1:27:17 With an MRI do you use contrast (Gadolinium) or not?
1:34:56 What about diet restrictions with imaging
1:37:24 Is MRI sensitive and accurate in measuring prostate size?
1:41:56 Pros and cons about MRI combined with PET scan
1:45:15 Different types of PET CT scan
1:48:16 SUV & PET/CT scan
1:50:36 PET/CT scan false positives and/or false negatives
1:55:35 Are more cancers caught as a result of increasing velocity?
1:56:46 PSMA predictability
2:01:10 PSA fluctuation – PSMA used for confirmation?
2:03:26 What is better for screening – MRI or PSMA PET?
2:04:02 Better for active surveillance – MRI or PSMA PET?
2:04:57 Better for rising PSA after treatment – MRI or PSMA PET?
2:05:16 Better for no PSA after treatment means no cancer – MRI or PSMA PET?
2:05:37 What is better for rising PSA with ADT – MRI or PSMA PET?
2:05:56 Impact pf PSMA PET on prostate cancer management
2:07:40 What makes you a good candidate using PSMA for radioligand therapy?
2:10:38 What about Halo artifacts on a PSMA PET CT scan?
2:11:59 With a PSA of 0.5 or higher and no evidence of tumor – repeat MRI or PSMA?
2:13:00 Where is the best use of resources for study – MRI or PET scan?

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