#Plea #clinical #implementation #PSMA #PETCT #stages #prostate #cancer
On February 7, 2024, Dennie Meijer received his PhD from the Vrije Universiteit Amsterdam for his thesis ‘Towards clinical implementation of PSMA PET/CT in prostate cancer’. Prof. Dr. NH Hendrikse and Prof. Dr. AN Vis acted as promoters; co-supervisors were Dr. DE Oprea-Lager and Dr. PJ van Leeuwen. Dennie Meijer currently works as an independent occupational health and safety doctor for various occupational health and safety services in absenteeism guidance.
What was the purpose of your PhD research?
The aim of my PhD research was to investigate the oncological outcomes of patients with prostate cancer in the PSMA era, a new imaging technique that has been increasingly used in the Netherlands since 2016-2017. More and more results emerged that the diagnosis using this scan was better than with conventional imaging, and that the treatment of patients with prostate cancer is increasingly adapted based on the findings of the PSMA PET/CT. We wanted to map out what influence this has had on oncological outcomes, and how the PSMA PET/CT has been/is being implemented in clinical practice.
What do you want the clinical doctor to know about your research?
Those are several things. To begin with, in my opinion there is no longer any doubt about the usability of the PSMA PET/CT in patients with prostate cancer, and that – if available – it should be used in various phases of the disease. We have provided some guidance in our studies by creating multiple nomograms that predict the chance of certain outcomes for patients using this new technique, so that we can take an extra step towards ‘personalized medicine’. In addition, it is important to know that in my research we focused on the applicability of the PSMA PET/CT in patients with newly diagnosed prostate cancer and patients with recurrent prostate cancer, but that more evidence is expected to emerge in the coming years that the PSMA PET/CT can also be of added value in other phases of the disease.
What was the most frustrating part of your research?
Here too I can mention several things, because a PhD trajectory is all about peaks and valleys. If I have to mention one particularly frustrating part, it’s the long road we had to go through to get our first article accepted. We were rejected by several magazines with comments, and after the fourth magazine my heart sank for a moment. Ultimately, the fifth journal did accept this article and the follow-up articles often ended up in the journal of our choice. So perseverance pays off in this case!
What moment/insight brought a breakthrough?
As annoying as the corona period has been, it has provided a breakthrough in my PhD trajectory. I was then in the early stages of my research and during the lockdown I could actually do nothing but collect data and fill databases with patient data from the studies already approved by the METc. In the years that followed, I benefited greatly from the fact that we had so much data complete and in order, and several articles subsequently emerged from this.
What is the follow-up question that arises from your research?
As already indicated in the second question, one of the major challenges lies in the wide dissemination of PSMA PET/CT in multiple phases of the disease, such as for prostate biopsies, for local staging and, for example, for treatment with systemic therapy. The influence of the scan on policy choices and oncological outcomes is a major question that remains unanswered. In addition, there is increasing attention to artificial intelligence and semi-quantitative assessments of the PSMA PET/CT, instead of only visual assessments. These facets are expected to play a role in the assessment of the PSMA PET/CT in the near future, but what influence this will have on policy choices is still unclear. In addition, not discussed in this PhD research, but relevant in the world of PSMA research, is the Lutetium-PSMA as a treatment method, instead of PSMA only as a diagnostic. The role of PSMA treatment will have to be determined in the coming years.
What do you take away from your PhD research? What are your next steps?
An important lesson is that perseverance pays off; that setbacks are part of life and that together we are strong. In my research we have set up many different collaborations, with various departments, with various hospitals and even with various other countries, in order to join forces and look for answers to questions that are struggled with on a daily basis in clinical practice. We could never have done this alone, so investing in contacts with other researchers and research bodies is essential.
I don’t know yet what my next steps are. I am looking for a position in which I can use my analytical and social skills, but in which I also have enough time to enjoy my family. I am looking for a position to continue in scientific research, although I am now also enjoying working in occupational medicine.
