A Clearer View of Prostate Cancer
An AI algorithm makes MRI imaging more accurate
Early cancer diagnoses improve outcomes across the board, but they can be a heavy lift. Prostate cancer is particularly challenging, because it can be difficult to differentiate between cancerous lesions and less serious conditions.
“We know screening reduces the chances of dying from prostate cancer,” said Sanoj Punnen, M.D., professor of urologic oncology and vice chair of research at the Desai Sethi Urology Institute, “but there are a lot of risks. A positive PSA (prostate specific antigen) test doesn’t necessarily mean that person has prostate cancer. In the past, we’d go straight to a biopsy, but now, we tend to use an MRI to help decide on the need for a biopsy.”
While MRIs have become increasingly helpful to manage prostate cancer, they have a lot of variability and interpretation issues. In some cases, the results aren’t clear cut, and clinicians must make subjective decisions.
A Clearer View of Prostate Cancer
Dr. Punnen, who is also assistant director of clinical research at Sylvester Comprehensive Cancer Center holds the Sylvester PAP Corps Endowed Chair, and is assistant director of clinical research at Sylvester Comprehensive Cancer Center, is working with physicists, radiation oncologists and others to more precisely assess diagnostic images to detect prostate cancer. Radka Stoyanova, Ph.D., professor of radiation oncology and director of imaging and biomarkers research, has been leading efforts to improve MRI reading to make it more accurate. Dr. Stoyanova developed an AI algorithm that reads the prostate MRI and creates a risk score.
“Looking at radical prostatectomy specimens, we’ve shown that the technology does a good job predicting cancer,” Dr. Punnen said. “We’ve also been evaluating it in patients who are monitoring their prostate cancer.”
Early trials have been promising. In some cases, when the radiologist is not sure how to read the result, the AI has effectively ruled out cancer, which could prevent unnecessary biopsies. However, the technology must meet a high bar and is not quite ready for the clinic.
Dr. Punnen and colleagues are also pursuing other diagnostic avenues, including liquid biopsies, which assess cancer biomarkers in blood or urine. “We’ve done a lot of research with both imaging and liquid biopsies, and they have great value,” he said. “They’re often getting used with imaging to make sure we don’t miss anything when the MRI is negative or indeterminate.”
Liquid biopsy technologies are evolving rapidly. A newer urine test reads exosomes, which conveniently carry DNA, RNA, proteins and other molecules and could provide important information to help clinicians figure out what’s going on in the body.
“If we can capture exosomes that we think are coming from the prostate, we’ll get a much more precise signal and improve the biomarkers for prostate cancer detection,” Dr. Punnen said.
University of Miami Medicine
FALL 2024
