Osher Mini Medical School for the Public

Transcription

1 Osher Mini Medical School for the Public

2

3

4 Education Research Patient care

5 Education Practice Basic science research First human studies Research Patient care Clinical studies

6

7

8

9 Lifetime risk

10 Prostate Cancer (2017) 14% 86% New cases (161,360) Deaths (26,730)

11

12

13 Benefits 5 fewer Pca deaths Harms 130 negative biopsies 120 positive biopsies 35 develop bladder, bowel or sexual side effects 8 complications of biopsy or treatment (i.e. sepsis, wound infection, DVT, MI, etc.) <1 death due to treatment Slide courtesy of Dr. Peter Carroll

14 overdiagnose overtreat

15

16

17

18 UCSF Osher Mini Medical School for the Public Westphalen AC

19 After abnormal PSA Before diagnosis, i.e. biopsy After diagnosis, i.e. biopsy Before treatment After treatment Treatment

20 After abnormal PSA Before diagnosis, i.e. biopsy MRI After diagnosis, i.e. biopsy Before treatment MRI / CT / bone scan / PET We play a role at all stages of patient care! After treatment PET Treatment CT / bone scan / PET

21

22

23 ? CT scan Ultrasound MRI

24

25 09/31/2017

26 UCSF Osher Mini Medical School for the Public Our group has over 200 publications focused on MRI of prostate cancer! Westphalen AC

27 When the MRI is negative it is unlikely the patient has a bad/aggressive prostate cancer, i.e. tumor with Gleason pattern 4

28 When the MRI is negative it is unlikely the patient has a bad/aggressive prostate cancer, i.e. tumor with Gleason pattern 4 Questions: Do men with a negative MRI need a biopsy? Do men with known cancer and negative MRI need immediate treatment?

29 Benefits 5 fewer Pca deaths Harms 130 negative biopsies 120 positive biopsies 35 develop bladder, bowel or sexual side effects 8 complications of biopsy or treatment (i.e. sepsis, wound infection, DVT, MI, etc.) <1 death due to treatment Slide courtesy of Dr. Peter Carroll

30 When the MRI is negative it is unlikely the patient has a bad/aggressive prostate cancer, i.e. tumor with Gleason pattern 4 Problem: Between 5 and 20% of Gleason 4 tumors are invisible Do invisible tumors impact patients lives? Can these tumors be followed until visible?

31 Patient A PSA B D PSA PSA PSA B TRUS guided every 3 6 months TRUS guided, per protocol at 12 to 24 months Patient B PSA PSA PSA B D B? TRUS guided TRUS guided 31

32 Patient B PSA PSA PSA B D B? TRUS guided TRUS guided Cancer is invisible? Cancer is now visible Cancer remains invisible 32

33 Flipside bad tumors are usually very positive! PI RADS scores

34 Flipside bad tumors are usually very positive! PI RADS scores Questions: Can we target these areas on biopsy to diagnose the bad cancer?

35

36 UCSF Osher Mini Medical School for the Public Westphalen AC

37 Flipside bad tumors are usually very positive! PI RADS scores Questions: Can we target only these areas?

38 Flipside bad tumors are usually very positive! PI RADS scores Questions: Can we treat only these areas?

39

40 MRI trifecta

41 Flipside bad tumors are usually very positive! PI RADS scores Problem: UCSF Variation when assigning scores Expected We is leading are planning a study rates of Gleason a study with 20 to institutions and over 2000 patients from 4 continents to determine these 4 investigate rates per score and establish not MRI guided conclusively focal quality benchmarks determined therapy

42 Biopsy Active surveillance Focal therapy We can also help patients and our physician colleagues to decide for definitive therapy (surgery or radiation)!

43

44 Normal cell PCa cell

45 Normal cell PCa cell

46 DWI AC PET ADC map T2 Slide courtesy of Dr. Thomas Hope

47 Post gad T1 Post gad T1 AC PET AC PET Slide courtesy of Dr. Thomas Hope

48 S/P RP Disease site 1: right humerus Disease site 2: left internal iliac node WB anterior MIP Slide courtesy of Dr. Thomas Hope

49 S/P RP Disease site 1: right pelvic side wall node 1 Disease site 2: right pelvic side wall node 2 WB anterior MIP Slide courtesy of Dr. Thomas Hope

50 Negative CT Negative bone scan Positive PSMA Slide courtesy of Dr. Thomas Hope

51

52 Osher Mini Medical School for the Public