Interactive Transcript
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We've already established why we
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want to use MRI for prostate imaging.
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To survey or for surveillance in patients
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who are in low-risk categories, so-called
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Tier 1, which is what this vignette is about.
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For staging, for biopsy localization under
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ultrasound guidance, to detect recurrence,
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especially where partial treatments are used,
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where there's not a radical prostatectomy, and
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in those cases, there's some prostate tissue left.
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You can't use the PSA to determine
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whether there's a recurrence.
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So here, imaging really shines.
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And then finally, with some of these before
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it, it assists you in decision-making
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as to what procedure you're going to do.
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You know, is it surgery?
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Is it focal laser?
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Is it electroporation?
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Is it seeds or radiation?
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Is it hormone therapy?
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Is it cryotherapy?
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Is it photodynamic therapy?
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Or is it High-Frequency Ultrasound Heat Therapy?
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A lot of choices.
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So let's talk about the tiers, which kind
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of comes off the survey line right here.
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So we have a three-tiered system,
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and that's going to include Low Risk,
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Intermediate Risk, and High Risk.
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So what determines those risk factors?
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And this tiering was developed by
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D'Amico and it's used by urologists in
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both Europe and in the United States.
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Well, we've got the PSA level, we've got
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the Gleason score, which we're going to
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explain in its own vignette, which is
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a histologic score of aggression may
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not be quite as simple as you think.
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Then we've got the depth of invasion
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by the primary tumor, which is
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more or less the T stage category.
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So these combine together.
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Are going to give us what will determine
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whether we're in Tier 1, Tier 2, or Tier 3.
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It is the Tier 1 individuals who
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are the best candidates for survey.
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Perhaps some selected ones
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in Tier 2, but not in Tier 3.
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Let's look at the tiers in its own
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dedicated tier-segmented vignette.
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