1 Introduction

Introduction to the Course

Morning, I'm Jeff Weinreb
and I'm introducing this course to you on prostate
MRI and targeted procedures.
And I wanna just give you a little background
of why we're having the course
and talk about
what we're trying to accomplish here.

The Prostate Gland and Its Challenges

I think everybody knows
that the prostate gland is a little gland.
It's about the size of a walnut,
but it's causing big problems, a lot
of headaches for a lot of people.

History of Prostate MRI

Prostate MRI is not new.
We've been doing it for since the early 1990s.
And it's come
and gone in popularity for a variety of reasons.

Prostate Cancer as a Public Health Issue

Prostate cancer is a big public health problem,
probably from the point of view
of imaging hasn't gotten the same kind
of attention as breast cancer.
But the public health issues with it are
somewhat similar and a lot
of people have been asking about a mangram for a long time.

Multiparametric MRI and Its Role

M-P-M-R-I-A Multiparametric MRI is a kind
of acute name that has gotten everybody's attention
for doing MRI of the prostate using a variety
of different techniques that give us functional
and anatomic information.
And a lot
of people are asking if this is in fact our mammogram.
And this has been leading a lot of people to discuss about
who should be scanned with MRI,
which prostate should be scanned to scan or not to scan.
This has been an interesting debate
that's been going on now in the radiology
and the urology
and in the prostate cancer community in general
for some time.
But it's really seems to have be reaching a peak right now.

Recent Debate in the Journal of Urology

There's an interesting article published in the Journal
of Urology last year, just about RSNA time.
And there was a debate in a sense
between two urologists who took opposing points
of view about prostate MRI and MR
targeted biopsies.
And one of the urologists said that
we're already finding too many things in the prostate
and that unless essentially,
unless we can do better in terms of specificity,
that's really no reason to do prostate
MRI. The opposing point of view
from another urologist was, as he said,
the train has already left the station that prostate
MRI and targeted biopsies using prostate MRI are proving
to be so much of an advance over
what has been previously available that it's taking off.
And rather than trying to stop it, that the best approach
would be to get on board, make it's done right.

Current Status of Prostate MRI and Biopsies

So essentially where we are with this right now is
that up until relatively recently, if somebody
had a suspicion of prostate cancer,
they'd get trans rectal ultrasound guided biopsies,
which we know have limitations.
And you'll hear more about this during the course.
And with MRI, we've raised the bar, and as you'll hear over
and over again during this course,
MRI is not perfect by any stretch of the imagination,
but it's been shown repeatedly to improve
over what has been the standard of care
for many years in the United States.
And as a result,
although prostate MRI has had a history in
this country and around the world where it's been popular,
then disappeared, been popular
and disappeared, what we're seeing now is
that it's really taking off
and you'll hear a lot about that from
various speakers.

Goals of the Course

So in this course, what we're trying to do
is really educate you all about exactly where
prostate MRI is, what the appropriate uses are,
what the benefits are, what the limitations are,
and how to fit it into a comprehensive care
for prostate cancer, including MR targeted biopsies.
And we've managed to pull together really a lot
of the leaders in prostate
MRI from the United States in one place.
So what you'll be hearing is really this truly the state
of the art and the course is divided
into a number of sections.

Course Structure

So the first part, we're gonna talk about prostate cancer
pathology, and then we're gonna talk about PI-RADS
and the latest version of PI-RADS, something that
we've been working on for almost three years.
Then we'll have a session on how to perform
and interpret prostate MR with a lot of examples,
case studies, we'll move on to MR
targeted biopsies because there are a number
of different ways of doing this.
Not just different products,
but different approaches to it.
We're gonna talk about the current clinical applications.
These are the applications that we're already using
prostate MR for in routine clinical use.
And then we're gonna move on to emerging applications.
So applications that are looking promising,
which could tremendously expand the role
of prostate MR in the care of patients with prostate cancer.
And then finally, at the end, tomorrow we're gonna
talk about our experiences with building prostate
MRI practices
because it's a little bit different than building some
of the other MRI practices that we've had
to build in the past.