What Comes After MRI?

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Dr. Matthew Cooperberg is an Associate Professor of Urology and the Helen Diller Family Chair in Urology at the University of California, San Francisco. He is keenly interested in risk-stratifying prostate cancer to better match treatments to those most likely to benefit.

Prostatepedia spoke with Dr. Cooperberg recently about the role imaging plays in prostate cancer treatment.

Are there any other imaging techniques on the horizon that may replace the MRI?

Dr. Cooperberg: There is a lot of excitement for what will be the next-generation MR spectroscopy based on hyperpolarized Carbon-13 imaging. This is next-generation MR imaging in which we can essentially watch metabolic pathways unfold in real time at the millimeter level. That’s going to be incredible. This technology was developed by John Kurhanewicz at UCSF and is in late phase testing now. A few of these machines exist so far around the world; this may really be a game changer.

Technologies for next-generation ultrasound may also be able to yield a very high-resolution picture. These technologies have to be studied carefully head-to-head. It may bear out that better ultrasound technology will prove more cost-effective and easier on the patient than MRI, which requires separate visits, separate costs, and multiple physicians. Plus, MR is competing—especially when we talk about active surveillance—with blood, urine, and tissue biomarkers. Should a surveillance candidate who is on the edge get an MRI, a Decipher test, or both?

Would you use multiple tools or just one?

Dr. Cooperberg: Potentially multiple, but if everyone uses multiple tools, the cost increases exponentially. We don’t always know what to do with conflicting information. If you have a reassuring MRI and a concerning Decipher score, what do you do? If you have a high biomarker score and the MRI still doesn’t show anything, what do you do? These are challenging questions.

From a research standpoint, this is what makes it fun. But for the man on the ground, there is a lot of confusion. It’s part of the reason that I’m skeptical about how aggressively a number of these tests are marketed in the prostate cancer community.

You mean how tests like Decipher are marketed in the community?

Dr. Cooperberg: And MRI. It’s all in the same category. When I give a talk on MRI, I consider it to be a novel biomarker. It faces all the same challenges and has to play by all the same rules as Polaris or Decipher. You’ve got to prove that it’s going to give you better information than you can get from the basic clinical assessment. You’ve got to prove it’s going to help you make a better decision. And you’ve got to prove that it gets better outcomes, just like the biomarkers. Just as we’re not quite there with the biomarkers, we’re not quite there with MRI.

Subscribe to read the rest of our conversation with Dr. Cooperberg.


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