The Hidden Role of Radiologists in Prostate Cancer Treatment, Research, and Support

With over 15 of experience in radiology, and as an internationally-recognized expert in the use of imaging for the detection and treatment of genitourinary diseases such as prostate cancer, Antonio Westphalen, MD considers the role radiologists play in overall patient care significant.

"It's important for patients to realize that there is a group of people involved in their care, and in that group is radiologists," says Dr. Westphalen. "We work in the background — our face is not necessarily seen by patients — but we are there for them. Usually, they interact with a urologist, or radiation oncologist, or clinical oncologist, however there is a larger group [involved in their care]. We are a part of that team and we act at different time points in the care of patients."

In his role as a professor in of Abdominal Imaging and Urology, as well as director of the Prostate MRI Program in the UC San Francisco Department of Radiology & Biomedical Imaging Clinical, Dr. Westphalen understands that the complex process of detecting and treating prostate cancer is continually evolving. Though there are many options available to patients seeking treatment for prostate cancer, there is a typical trajectory: Patients often first undergo ultrasound for diagnosis because of availability, and after, magnetic resonance imaging (MRI), which can be an effective tool because of its ability to produce images that are more accurate in identifying the most suspicious areas in the gland to harbor aggressive disease.

There are also future opportunities to expand the role MRI plays in the treatment of prostate cancer and improvement of patient comfort when used early and for specific populations. "Imagine a patient who is already diagnosed with prostate cancer and is being monitored based on the results of an ultrasound biopsy. Every 12 to 24 months, this patient would likely undergo another biopsy," says Dr, Westphalen. "Performing an MRI prior to that (next) biopsy and identifying the most suspicious sites harboring disease could potentially replace the systematic biopsies with a procedure including just three to five samples of that area."

Along with advancing the techniques of MRI, Dr. Westphalen explains, more ways of identifying prostate cancer are being developed with the potential to improve early detection and patient care, such as the use of prostate specific membrane antigen (PSMA) and 18F-fluciclovine (commercially known as Axumin) agents in positron emission tomography (PET) scans. These agents are used particularly in detection of systemic disease, with the latter approved for patients who may have experienced biochemical failure from previous treatment.

"We have now realized that the paradigm is changing—we had one idea of how disease spreads and that is not necessarily true. Disease can spread at earlier stages and at different sites," says Dr. Westphalen. Yet the specific medical applications of these agents, particularly the yet-to-be FDA-approved PSMA, remain uncertain. "This must be clear to patients. It's a promising tool, but we don't know what will happen in the future."

Learn more about the UCSF Radiology PSMA clinical research trial here.