Instructional Course - Requires Course Pass, Additional Registration Required

Instructional Course

010IC - Multi-Disciplinary, Interactive Tumor Board: MRI-TRUS Fusion-Guided Prostate Biopsy

Friday, May 18
10:00 AM - 12:00 PM
Location: MCC WEST, 2002

Trans-rectal ultrasound guided (TRUS) sextant prostate biopsy has been the gold standard for diagnosing prostate cancer (PCa). In recent years, multi-parametric magnetic resonance imaging (mpMRI)-TRUS image-fusion targeted biopsy has shown greater accuracy in cancer localization & sampling, resulting in more accurate diagnosis of clinically-significant PCa, either primarily or as repeat biopsy after a prior negative TRUS biopsy.
This course will discuss various clinically important facets of MRI-TRUS fusion biopsy in the setting of an interactive multi-disciplinary tumor board, using audience-response system. We will focus on practical issues of daily relevance, backed by current literature (rationale, protocols, outcomes data) and our personal aggregate experience in over 1,000 prostate biopsies. In this radio-patho-genomic course, a multi-disciplinary panel (urologists, MRI radiologist, pathologist, molecular biologist) will discuss 15-20 actual clinical cases, covering the entire disease spectrum from low-to-high risk non-metastatic PCa.

Clinical cases will be carefully selected such that all of the following issues are discussed in step-wise fashion:

a) Clinical PCa case history, including current FDA-approved molecular genomic tests (urine, serum, tissue) and biopsy indications (first-time vs repeat biopsy).

b) mp-MRI: how to read mpMRI (most important), practical tips, significance of each mpMRI parameter [T2-weighted (T2w), diffusion weighted (DWI), diffusion contrast enhancing (DCE), MR spectroscopy]; MRI reporting systems: Prostate Imaging & Reporting Data System Version 2 (PIRADS-v2) & Likert scale; MRI protocol (endo-rectal vs pelvic; 1.5 vs 3 Tesla); MRI limitations & fallacies.

c) TRUS: TRUS is a core component of fusion biopsy. As such, we will discuss: TRUS technique, interpretation of multi-parametric TRUS (gray-scale, color Doppler, elastography, contrast-enhanced, histoscanning), its role in MRI/TRUS fusion biopsy.

d) MRI-TRUS image-fusion: process of image registration (rigid vs elastic), various available platforms for MRI-TRUS fusion biopsy.

e) MRI-TRUS fusion biopsy: indications, technique of biopsy (how-to-do, pearls, tips, tricks), how accurate is fusion-targeting? (corroboration with step-sectioned RP specimens), biopsy types (confirmatory biopsy for Active Surveillance (AS), staging biopsy, repeat biopsy after prior negative biopsy); specific situations (large prostate, anterior tumors, mp-MRI post-primary treatment [HIFU, cryo, EBRT, brachy]).

f) Special issues: exporting MRI-TRUS fusion biopsy data onto focal therapy systems (HIFU platform); role of MRI for AS; 3D mapping of the prostate gland & cancer location for AS and focal therapy (FT), “per-lesion” based AS.

g) Prostate biopsy technique details: TRUS machine set-up, patient preparation, needle “sterilization”, antibiotic prophylaxis/augmentation, minimize/manage complications (infection, bleeding, retention).

h) Trans-perineal vs trans-rectal biopsy: Pros & cons, techniques, outcomes (cancer detection, complications).

i) Pathologic evaluation of biopsy cores: how-to-handle biopsy core samples (containers, inking the core for spatial orientation), how pathologists read the biopsy (cancer core percent/length, continuous vs discontinuous cores), what should comprise a pathology report (perineural invasion, Gleason score/Group, core length/percent positive, number of cores, etc)

j) Future directions: Emerging techniques & technologies of targeted prostate biopsy will be discussed.

Learning Objectives:

Inderbir S. Gill

Keck School of Medicine, University of Southern California, Los Angeles

Dr Gill is distinguished professor & chairman, department of urology at the University of Southern California (USC) in Los Angeles. He is also founding executive director, USC Institute of Urology, where he holds the Shirley & Donald Skinner Chair in Urologic Cancer Surgery. He is associate Dean (clinical innovation) at the Keck school of medicine. Prior to this, he was chairman & professor, department of urology at Cleveland Clinic, Cleveland, OH, where he was on faculty for 12 years (1997-2009). He has published over 740 scientific papers with nearly 30,000 citations. Dr Gill’s H-index is 97. He has edited/co-edited 10 text-books and has been on the editorial board of 9 urologic journals. He is principal investigator of a funded R-01 grant from the NCI and co-PI on 3 other NIH grants. Dr Gill has been invited for over 450 visiting professorships, invited lectures and live surgery demonstrations world-wide. He is elected to the prestigious American Association of Genito-Urinary Surgeons (2003) and the Clinical Society of AAGUS (2009). Dr Gill has received many honors - the Dr. B. C. Roy National Award for Eminent Medical Person awarded by the President of India (2005); St. Paul’s Medal by the British Urological Association (2006); honorary Fellow of the Royal College of Surgeons of England; President, 24th World Congress of Endourology & SWL (2006); USC Presidential Medallion (2013); listed in Thomson Reuters “The World’s Most Influential Scientific Minds” (2014); AUA Ramon Guiteras Lecturer (2015); AUA Chair Global Initiatives (2015-2017). Dr. Gill’s primary focus is advanced robotic urologic oncologic surgery, with his team having amongst the world’s largest aggregate robotic/laparoscopic experiences in over 15,000 cases in the United States


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Andre Luis de Castro Abreu

USC Institute of Urology

Andre Luis de Castro Abreu, MD, is an Assistant Professor of Clinical Urology at the Keck School of Medicine of USC. Dr. Abreu has expertise in MRI/TRUS fusion prostate biopsy and focal therapy, including High Intensity Focused Ultrasound (HIFU) and Cryoablation, for prostate cancer. He performs “per-lesion” active surveillance for prostate cancer with a detailed 3D mapping of the prostate and cancer location. Dr. Abreu performs robotic surgery for prostate, kidney and bladder cancers. Dr. Abreu has authored many book chapters and peer-reviewed publications in various prestigious medical journals. He serves as a reviewer for several journals in the field of urology.


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Mahul B. Amin

University of Tennessee Health Science Center

Dr Amin is the Professor and Chair of the Department of Pathology and Laboratory Medicine, Professor of Urology and the Gerwin Endowed Chair for Cancer Research at University of Tennessee Health Sciences Centre. He is a national and international consultant in tumors of the genitourinary tract, including prostate, urinary bladder, kidney, and testis. Dr. Amin is a world-renowned expert and educator in genitourinary pathology having co-authored the 2002 World Health Organization (WHO) classification systems for urothelial tumors and renal neoplasms (authored 7 chapters); and the 2016 WHO classification systems for tumors of the prostate, bladder, kidney, penis and testis (authored 21 chapters). Dr Amin was the co-first author on the new Prostate Cancer Foundation sponsored proposed classification for neuroendocrine tumors of the prostate. Dr Amin was involved in developing the 7th (2010) edition and 8th (2017) edition of the AJCC TNM staging of prostate cancer; he was a co-organizer and co-author of the influential International Society of Urologic Pathologists Consensus Conference papers on Gleason Grading of Prostate cancer (2004 and 2014 meetings). Thus, Dr. Amin has for over two decades helped set the standards of grading and staging of prostate cancer which are vital for appropriate management of prostate cancer patients around the world. Dr. Amin has also co-authored 12 books (two in their second and third editions) including two Armed Forces Institute of Pathology (AFIP) fascicles, two major texts in urologic pathology and a monograph on Gleason grading of prostate cancer. He has authored over 325 publications and 65 book chapters. Dr. Amin is a much sought of as a speaker and has given over 352 pathology grand rounds, lectures and workshops. He has extensively spoken around the world and lectured in 30 countries and 63 cities outside of the US.


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Suzanne L. Palmer

Keck School of Medicine, University of Southern California

A native of Southern California, Dr. Palmer received her BA from Vassar College and her medical degree from Temple University School of Medicine. She completed an Internal Medicine residency at St. Mary Medical Center in Long Beach, California and passed the American Board of Internal Medicine before completing her Radiology residency at the University of California, Irvine.

Dr. Palmer joined the USC Department of Radiology in 1997, where she completed her Body Imaging and Interventional Fellowship. She is currently a professor of Clinical Radiology and Medicine and Chief of the Body Imaging Division. Although she has advanced training in computerized tomography, ultrasound and magnetic resonance imaging, Dr. Palmer’s main area of interest is abdominal MRI with special focus on prostate imaing, transplant imaging, pelvic floor imaging, and enterography. Dr. Palmer is board certified in radiology and is active in local, national and international radiology societies.


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010IC - Multi-Disciplinary, Interactive Tumor Board: MRI-TRUS Fusion-Guided Prostate Biopsy


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