0:01

We've already established why we

0:03

want to use MRI for prostate imaging.

0:05

To survey or for surveillance in patients

0:08

who are in low-risk categories, so-called

0:11

Tier 1, which is what this vignette is about.

0:14

For staging, for biopsy localization under

0:17

ultrasound guidance, to detect recurrence,

0:20

especially where partial treatments are used,

0:23

where there's not a radical prostatectomy, and

0:26

in those cases, there's some prostate tissue left.

0:28

You can't use the PSA to determine

0:31

whether there's a recurrence.

0:32

So here, imaging really shines.

0:35

And then finally, with some of these before

0:37

it, it assists you in decision-making

0:40

as to what procedure you're going to do.

0:42

You know, is it surgery?

0:44

Is it focal laser?

0:45

Is it electroporation?

0:47

Is it seeds or radiation?

0:50

Is it hormone therapy?

0:51

Is it cryotherapy?

0:53

Is it photodynamic therapy?

0:55

Or is it High-Frequency Ultrasound Heat Therapy?

0:58

A lot of choices.

0:59

So let's talk about the tiers, which kind

1:02

of comes off the survey line right here.

1:05

So we have a three-tiered system,

1:08

and that's going to include Low Risk,

1:11

Intermediate Risk, and High Risk.

1:15

So what determines those risk factors?

1:18

And this tiering was developed by

1:21

D'Amico and it's used by urologists in

1:24

both Europe and in the United States.

1:28

Well, we've got the PSA level, we've got

1:32

the Gleason score, which we're going to

1:34

explain in its own vignette, which is

1:36

a histologic score of aggression may

1:40

not be quite as simple as you think.

1:42

Then we've got the depth of invasion

1:45

by the primary tumor, which is

1:48

more or less the T stage category.

1:54

So these combine together.

1:56

Are going to give us what will determine

2:00

whether we're in Tier 1, Tier 2, or Tier 3.

2:04

It is the Tier 1 individuals who

2:06

are the best candidates for survey.

2:09

Perhaps some selected ones

2:11

in Tier 2, but not in Tier 3.

2:14

Let's look at the tiers in its own

2:16

dedicated tier-segmented vignette.