Intervew with three leading researchers at the NCI


Many readers may be interested in having a look at the text based on a recent interview carried out with four clinicians who specialize in research into the management of prostate cancer at the National Cancer Institute (NCI) and the NCI Clinical Center in Bethesda, Maryland.

In this interview, Drs. Pinto (a surgeon), Choyke (a diagnostic radiologist), and Wood (an interventional radiologist) talk with William Dahut (a medical oncologist) about evolutions in the diagnosis and management of early stage prostate cancer.

Topics covered in this interview include:

  • The role of the rectal examination
  • The role of systematic biopsies
  • Who does and does not need immediate treatment
  • The development of the new UroNav technology in the evolution of MRI/FRUS fusion biopsies
  • Focal laser surgery for carefully selected patients

and other factors.

3 Responses

  1. Wow! Thank you for presenting this most interesting report!

    If this quite credible report is true, the UroNav system should be a game changer for biopsies, both in assessing whether a biopsy is needed, and accurately targeting potential sites of cancer while steering clear of sites that would be unproductive. That has all kinds of implications, including adding confidence in decisions to use active surveillance for a patient.

    Here is the paragraph that most powerfully gripped my attention: “Choyke: The essential innovation here is taking the MRI data, fusing it using software, to ultrasound data, thus enabling the urologist to perform the biopsy under what appears to be real-time MRI. The idea was to transfer high-quality MRI data to the ultrasound suite — which could be a urologist’s office or a procedure room somewhere else in the hospital — and fuse the MRI to the ultrasound, enabling the biopsy to be performed under the ultrasound technique, which takes 10 to 15 minutes.” As the MRI is known to be quite sensitive and specific, but previously impractical in a clinical biopsy setting, fusing it with real-time ultrasound looks like a wonderful innovation. It appears this will open the door to far more effective examination of the anterior prostate, home of much of our troublesome disease.

    Is this as good as it looks?

    On a personal note, I’m missing the prostate cancer conference — had to cancel — to take care of my wife who suffered a small stroke on top of some other problems. She is now getting good care and is clearly improving, though still needing a lot of support.

  2. Dear Jim:

    Like a lot of other technological gizmos, I suspect that the vlaue of the UroNav and similar systems depend on such crucial factors as: the quality of the input (“garbage in, garbage out”) and the skill and experience of the users.

    In theory, yes, a urologist would be able to use this system in an office setting to determine whether biopsy is a good idea and then to actually carry out an MRI/TRUS fusion biopsy … but … if the MRI data aren’t good enough to begin with, and the urologist has little experience at actually being able to accurately interpret what he or sher is looking at ….

    I think it may be a while before most urologists are actually capable of using such technology on a regular basis. Many of them don’t even have the ability to send a patient to get a good quality multiparametric MRI as yet, after all.

  3. This has potential to bring an order of magnitude advance in screening and treatment. If this technology spreads to regional medical facilities, it will be a small step for individual patients to benefit from real-time consultation with international experts.

    An “hour of MRI time” is eye-wateringly expensive. That is likely to be more than offset by pre-screening, economy of scale, avoidance of unnecessary treatment, and reduced cost of treating after-affects.

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