Should Screening be Altered Based on Germline and Family History?
Sigrid V. Carlsson, MD, PhD, MPH, explores the role of genetics in risk-stratified prostate cancer screening.
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Memorial Sloan-Kettering Cancer Center
Role of DNA Repair Mutations in Sensitivity to Cisplatin-based Chemotherapy
Gopalkumar Iyer, MD, explores the role of genomic alterations in predicting response to neoadjuvant chemotherapy for muscle-invasive bladder cancer.
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Role of PLND for High Risk Bladder Cancer
Bernard H. Bochner, MD, FACS, examines the extent of lymph node dissection in bladder cancer surgery and its impact on oncologic outcomes.
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Gleason Scoring Has Served Us Well for More than 50 Years, But It Is Time to Start Afresh
Andrew J. Vickers, PhD, discusses the weaknesses of Gleason scoring in diagnosing localized prostate cancer. Dr. Vickers begins by differentiating between Gleason “scoring” and Gleason “grading,” explaining that Gleason grading is robust, while scoring is not as robust. He emphasizes that Gleason Grade Groups 2 through 4 depend on the ratios of tissue with various Gleason scores, which he asserts make little sense.
Dr. Vickers offers clinical examples to support his assertion and explains that, with patients with Gleason Grade Group 2 disease, the total length of biopsied tissue with a Gleason score of 4 is strongly predictive of adverse surgical pathology risk. Dr. Vickers explains that in patients with Gleason Grade Group 2 disease, the amount of tissue with a Gleason score of 3 is not predictive. Dr. Vickers shares data out of France that indicate that the amount of Gleason score 4 or 5 tissue is more predictive of biochemical recurrence (BCR) and metastasis than total Gleason score.
Dr. Vickers asserts that there is a need for urologic oncologists to find a replacement for the Gleason score as the dominant influence on decision-making in localized prostate cancer. Dr. Vickers emphasizes the value of focusing on tumor size and tissue quality in disease assessment, as is done with other cancers.
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Year in Review: Emerging Data and Advances in Prostate Cancer Screening
Sigrid Carlsson, MD, PhD, MPH, reviews groundbreaking advancements in prostate cancer screening and data from the past year. In this 9-minute presentation, Carlsson highlights the Swedish Berg trial, which showed a 30% reduction in prostate cancer mortality with regular PSA screening, while data from the UK CAP trial confirm that even a single PSA test reduces mortality. She stresses the utility of PSA as the strongest prognostic marker for lethal prostate cancer, with guidelines evolving to recommend tailored screening for high-risk groups like Black men.
Carlsson also shares that advances in MRI have proven pivotal. She references recent trials that underscore the efficacy of MRI-targeted biopsy in minimizing overdiagnosis. Innovations in AI for MRI interpretation promise to improve equity and diagnostic accuracy.
Dr. Carlssson shares that active surveillance is the standard for managing low-risk cancers and addressing concerns about overdiagnosis. Together, these developments mark a transformative year in personalized and effective prostate cancer screening.
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