EAU18 – Innovations in imaging

For audience members who wanted to know more about the imaging options for prostate cancer after Plenary Session 3, Thematic Session 4 followed up with more state-of-the-art lectures, case discussions and abstract presentations.

The case for MRI and further developments in ultrasound were made by Profs. Jelle Barentsz (NL) and Georg Salomon (DE)respectively. Salomon showed much improved experimental results at 29MHz rather than 9MHz. Barentsz, noting that an MRI helps clarify an ultrasound, hypothesised a combined MRI-Ultrasound: two short exams for the patient with a superior end result.

Potential for ultrasound

The merits of (improved) ultrasound, when compared to multiparametric MRI and PET-CT, were of particular interest in a clinical case discussion that was moderated by Prof. Alexander Govorov (RU).

Mr. Derek Rosario (GB) spoke on some of the pitfalls of MRI usage:

“Evidence at the moment does seem to favour multi-parametric MRI. Level 1A, 1B evidence would suggest that MPMRI upfront aids in risk stratification and in the decision of whether or not to biopsy. But it’s not perfect. Having an MRI done doesn’t easily fall into the current workflow of a practicing urologist, because you have to rely on a third party. There is potential for loss in translation from acquisition, reporting, interpretation and then implementation.”

“We can continue working as we do now for a year or two, but there are two other options. We can forget MRI for diagnosis altogether and work on improving ultrasound. MRI can then be used for staging later down the line.”

“A third option is sticking with MRI. And if we do, we shouldn’t try to fit that in our current way of working but develop new methods. If MRI identifies a lesion, we need to be able to immediately biopsy. But that will have huge logistical and cost implications.”

3D Printing

At the same session, Prof. Ukimura (JP) gave a demonstration of some new 3D-printing techniques, including the use of an elastic material that simulates the consistency of prostate (and kidney) tissue.

Although primarily a proof of concept, the imaging-based 3D models with accurate representation of tumours in transparent, elastic organs has led to some careful conclusions. Ukimura: “Understanding the exact location of the cancer is important to achieve negative surgical margins and functional representation. By allowing surgeons to first practice on an exact replica of the patient’s prostate, they gain intraoperative precision and confidence before they go into surgery.”

Article by Loek Keizer