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Osher Mini Medical School for the Public
Westphalen AC
UCSF Osher Mini Medical School for the Public
Westphalen AC
UCSF Osher Mini Medical School for the Public
Education
Patient careResearch
Westphalen AC
UCSF Osher Mini Medical School for the Public
Education
Patient careResearch
Basic science research
First human studies
Clinical studies
Practice
Westphalen AC
UCSF Osher Mini Medical School for the Public
Westphalen AC
UCSF Osher Mini Medical School for the Public
Lifetime riskWestphalen AC
UCSF Osher Mini Medical School for the Public
86%
14%
Prostate Cancer (2017)
New cases (161,360)
Deaths (26,730)
Westphalen AC
UCSF Osher Mini Medical School for the Public
Westphalen AC
UCSF Osher Mini Medical School for the Public
Westphalen AC
UCSF Osher Mini Medical School for the Public
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.)
overdiagnose
overtreat
Westphalen AC
UCSF Osher Mini Medical School for the Public
Westphalen AC
UCSF Osher Mini Medical School for the Public
Westphalen AC
UCSF Osher Mini Medical School for the Public
Westphalen AC
UCSF Osher Mini Medical School for the Public
Westphalen AC
UCSF Osher Mini Medical School for the Public
After treatment Treatment
After abnormal PSABefore diagnosis, i.e. biopsy
After diagnosis, i.e. biopsyBefore treatment
Westphalen AC
UCSF Osher Mini Medical School for the Public
After treatmentPET
TreatmentCT / bone scan / PET
After abnormal PSABefore diagnosis, i.e. biopsy
MRI
After diagnosis, i.e. biopsyBefore treatment
MRI / CT / bone scan / PET
We play a role at all stages of patient care!
Westphalen AC
UCSF Osher Mini Medical School for the Public
Westphalen AC
UCSF Osher Mini Medical School for the Public
https://youtu.be/OG9SnEluQ6A
Westphalen AC
UCSF Osher Mini Medical School for the Public
?CT scan Ultrasound MRI
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1983 1988 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Westphalen AC
UCSF Osher Mini Medical School for the Public
09/31/2017
Westphalen AC
UCSF Osher Mini Medical School for the Public
Our group has over 200 publications focused on MRI of prostate cancer!
Westphalen AC
UCSF Osher Mini Medical School for the Public
When the MRI is negative it is unlikely the patient has a bad/aggressive prostate cancer, i.e. tumor with Gleason pattern 4
Westphalen AC
UCSF Osher Mini Medical School for the Public
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?
Westphalen AC
UCSF Osher Mini Medical School for the Public
Benefits
5 fewer Pca deaths
Slide courtesy of Dr. Peter Carroll
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.)
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?
Westphalen AC
UCSF Osher Mini Medical School for the Public
31
every 3‐6 months TRUS‐guided, per protocolat 12 to 24 months
D PSA PSA PSA BPSA B
Patient A
D
PSA
PSA
BPSA B
TRUS‐guided
Patient B
?
TRUS‐guided
TRUS‐guided
Westphalen AC
UCSF Osher Mini Medical School for the Public
D
PSA
PSA
BPSA B
TRUS‐guided
Patient B
?
TRUS‐guided
32
Cancer is invisible
Cancer is now visible
Cancer remains invisible
Westphalen AC
UCSF Osher Mini Medical School for the Public
?
Flipside – bad tumors are usually very positive! PI‐RADS scores
Westphalen AC
UCSF Osher Mini Medical School for the Public
Flipside – bad tumors are usually very positive! PI‐RADS scores
Questions:– Can we target these areas on biopsy to diagnose the bad cancer?
Westphalen AC
UCSF Osher Mini Medical School for the Public
Westphalen AC
UCSF Osher Mini Medical School for the Public
Westphalen AC
UCSF Osher Mini Medical School for the Public
Flipside – bad tumors are usually very positive! PI‐RADS scores
Questions:
– Can we target only these areas?
Westphalen AC
UCSF Osher Mini Medical School for the Public
Flipside – bad tumors are usually very positive! PI‐RADS scores
Questions:
– Can we treat only these areas?
Westphalen AC
UCSF Osher Mini Medical School for the Public
Westphalen AC
UCSF Osher Mini Medical School for the Public
MRI trifecta
Westphalen AC
UCSF Osher Mini Medical School for the Public
Flipside – bad tumors are usually very positive! PI‐RADS scores
Problem:–Variation when assigning scores– Expected rates of Gleason ≥ 4 per score not conclusively determined
UCSF is leading a study with 20 institutions and over 2000 patients from 4 continents to determine these rates and establish quality benchmarksWe are planning a study to investigate MRI‐guided focal therapy
Westphalen AC
UCSF Osher Mini Medical School for the Public
BiopsyActive surveillanceFocal therapy
We can also help patients and our physician colleagues to decide for definitive therapy (surgery or radiation)!
Westphalen AC
UCSF Osher Mini Medical School for the Public
Westphalen AC
UCSF Osher Mini Medical School for the Public
Normal cell PCa cell
Westphalen AC
UCSF Osher Mini Medical School for the Public
Normal cell PCa cell
Westphalen AC
UCSF Osher Mini Medical School for the Public
Westphalen AC
AC PET ADC map
DWI
T2
Slide courtesy of Dr. Thomas Hope
UCSF Osher Mini Medical School for the Public
Westphalen AC
AC PET
AC PET
Post‐gad T1
Post‐gad T1
Slide courtesy of Dr. Thomas Hope
UCSF Osher Mini Medical School for the Public
WB anterior MIP
Disease site 2: left internal iliac node
Disease site 1: right humerus
Westphalen AC
S/P RP
Slide courtesy of Dr. Thomas Hope
UCSF Osher Mini Medical School for the Public
WB anterior MIP
Disease site 1: right pelvic side wall node 1
Disease site 2: right pelvic side wall node 2
Westphalen AC
S/P RP
Slide courtesy of Dr. Thomas Hope
UCSF Osher Mini Medical School for the Public
Westphalen AC
Negative CT Negative bone scan Positive PSMA
Slide courtesy of Dr. Thomas Hope
UCSF Osher Mini Medical School for the Public
UCSF Osher Mini Medical School for the Public
Osher Mini Medical School for the Public