E. David Crawford, MD, Editor-in-Chief of Grand Rounds in Urology and Professor of Urology at the University of California, San Diego, discusses the challenges of early detection of prostate cancer (PCa), the role of markers in identifying patient risk, and the impact of early detection. He begins by acknowledging the limitations of prostate-specific antigen (PSA) testing alone and notes that the United States Preventive Services Task Force (USPSTF) has raised concerns about PCa early detection, asserting that there is too much overdiagnosis and overtreatment. Because most diagnostic testing is completed by primary care physicians (PCPs) who may not understand the nuances of PSA testing, Dr. Crawford recognizes that PCPs need a simple message from urologists. He states that a PSA of >1.5 ng/ml is a good surrogate for benign prostatic hyperplasia (BPH), prostatitis, and PCa risk, and explains that patients with a PSA of 1.5 ng/ml to 4.0 ng/ml may be in a “danger zone” and require additional testing. Dr. Crawford argues, however, that an abnormal PSA alone should not guide biopsy decisions. Rather, he suggests that prostate cancer markers (PCMs) for patients with elevated PSA can better risk-stratify patients and identify significant cancers, enabling many to avoid biopsy. Dr. Crawford cites the example that using SelectMDx as a risk-stratification tool for biopsy-naive men avoids unnecessary biopsies in 38 percent of patients, minimizes detection of low-grade PCa, and misses only 10 percent of high-grade PCa. Further, using mpMRI in all patients had the highest net benefit, allowing 49% of patients to avoid biopsy and missing only 4.9 percent of high-risk PCa. However, if mpMRI availability is limited or expensive, using mpMRI-only in SelectMDx-positive patients is a good alternative strategy. Dr. Crawford concludes by outlining a diagnostic process whereby doctors may refer a patient to a urologist, repeat PSA testing, and incorporate PCM to better determine the risk of significant cancer as well as the need for biopsy for their patients with an elevated PSA.Read More
E. David Crawford, MD
Grand Rounds in Urology
Professor of Urology
University of California, San Diego
San Diego, California
Researcher-physician E. David Crawford, MD, has devoted his career in medicine to educating the public about men's health issues and finding effective techniques and procedures to address prostate cancer, the most common malignancy affecting men in the United States.
He is currently a Professor of Urology at the University of California, San Diego, and emeritus distinguished endowed Professor of Surgery, Urology, and Radiation Oncology, and Head of the Section of Urologic Oncology at the University of Colorado Anschutz Medical Campus in Aurora, Colorado. Dr. Crawford received his medical degree from the University of Cincinnati and his postgraduate training included an internship and residency in urology at the Good Samaritan Hospital in Cincinnati. He subsequently completed a genitourinary cancer fellowship at the University of California Medical Center in Los Angeles.
Dr. Crawford is an internationally recognized expert in benign prostate hypertrophy, urologic cancers, and in particular, prostate cancer. He has conducted research in the treatment of advanced bladder cancer, metastatic adenocarcinoma of the prostate, hormone-refractory prostate cancer, and other areas of urological infections and malignancies. He has authored or coauthored over 810 scientific articles, has published seven textbooks, authored over 60 book chapters, and provided more than 2,200 educational talks for patients and physicians.
In an effort to raise public awareness about prostate health, Crawford in 1989 founded the Prostate Conditions Education Council (PCEC). The non-profit organization is comprised of a consortium of leading physicians, health educators, scientists, and men's health advocates. PCEC's advocacy for free or low-cost prostate screening has affected the lives of millions of American men. He currently chairs the PCEC.
Crawford is an active member of many national and international organizations, including the American Society of Clinical Oncology, the American Urological Association (AUA), and the American Association for the Advancement of Science. Within the AUA, he has been a member of the Committee to Study Urologic Research Funding and the prostate cancer clinical trials subcommittee. Crawford served on the board of governors, the scientific advisory board of the Southwest Oncology Group, and was chairman of the Genitourinary Cancer Committee for 27 years. This group is the largest clinical trials group in the world.
Crawford's involvement in the national prostate cancer arena has been widely recognized. He has received many honors and awards, including the CAP Cure Annual Award for Scientific Presentation in 1999 In 1997, he was presented with a 'Freddie Award" at the AMA International Health and Medical Film Competition for the program, ITV: The Cutting Edge Medical Report (Prostate Cancer: Understanding, Diagnosing, and Defeating), which Crawford hosted with special guest, retired General Norman Schwarzkopf.
Crawford again won a prestigious 'Freddie Award" 5 years ago... He is a member of Best Doctors of America and was named Healthcare Provider of the Year in the Denver Metro area by the Denver Business Journal.
He has been recognized as one of the Best Doctors of America for the past two decades and is recognized as one of the top 20 urologists in the country, for men, by Men’s Health Magazine. In 2018 he received the honor of being named the Distinguished Alumnus of the Year from the University of Cincinnati School of Medicine. In May of 2019, he received the Presidential citation from the American Urological Association recognizing for his “tireless role in genitourinary cancer research that has benefited countless urologic cancer patients.” He accepted the position of Editor in Chief of Grand Rounds in Urology in June of 2019. In 2021, he was the recipient of the Merle Stringer, M.D. annual award for excellence in medicine by the Florida State Medical Association.Disclosures:
Lectures by E. David Crawford, MD
Posted by E. David Crawford, MD | Feb 2021
E. David Crawford, MD, Editor-in-Chief of Grand Rounds in Urology and Professor of Urology at the University of California, San Diego, discusses how to use liquid diagnostics in combination with PSA testing to reduce unnecessary prostate biopsies. Dr. Crawford explains that while PSA is a good, inexpensive test of the relative risk of prostate cancer, better guidance is needed for application, especially because 90% of PSA tests are ordered by general practitioners rather than specialists. He suggests that medical practitioners consider a PSA of >1.5 to 4 as the danger zone where further evaluation is indicated. These patients should not be immediately sent for a prostate biopsy, but should instead be evaluated for benign prostatic hyperplasia and then for prostate cancer risk using liquid diagnostics. Dr. Crawford recommends following a diagnostic pathway, like the one at pcmarkers.com, to determine which patients need treatment.Read More
Posted by E. David Crawford, MD | Jan 2021
E. David Crawford, MD, Professor of Urology at UC San Diego and Editor-in-Chief of Grand Rounds in Urology, interviews Alan H. Bryce, MD, Medical Director of the Genomic Oncology Clinic at Mayo Clinic Arizona in Scottsdale, and Neil H. Baum, MD, Professor of Urology at Tulane Medical School, about the COVID-19 vaccine—how it works, its safety, and possible side effects. Currently, Pfizer and Moderna have each created a vaccine for the novel coronavirus, both of which are mRNA vaccines containing code for the protein found within the virus. Dr. Bryce describes how this portion of RNA causes cells to synthesize what is known as a “spike protein,” which then stimulates an immune response. He observes that side effects are typically mild and similar to what one could expect with a standard flu vaccine, notwithstanding rare, severe reactions. Dr. Baum then addresses the psychological manifestations associated with COVID-19, such as anxiety, fear of contracting or spreading the disease, PTSD, depression, and even suicide. It is important to note that these symptoms are also associated with burnout which, within the medical community, impacts urologists to a greater degree. Dr. Baum warns that the stress of being a frontline worker, decreases in income, and the shift from in-person to telehealth appointments and related “Zoom fatigue” may further increase burnout among urologists.Read More
Posted by E. David Crawford, MD | Dec 2020
E. David Crawford, MD, Editor-in-Chief of Grand Rounds in Urology and Professor of Urology at the University of California, San Diego, compares transperineal prostate biopsy to transrectal ultrasound (TRUS)-guided prostate biopsy, listing the pros and cons of each. He establishes that the transperineal approach is superior to the transrectal one in minimizing risk of sepsis and urinary tract infection, although transperineal biopsy is more associated with urinary retention. Dr. Crawford goes on to discuss the comparative cost and convenience of the techniques, observing that TRUS-guided biopsy is typically far less expensive and that more doctors have the requisite experience and equipment to perform such a biopsy as opposed to a transperineal one. Dr. Crawford suggests that the transrectal approach is currently easier than the transperineal one for most urologists and patients, but notes that urologists may want to consider tailoring their technique to an individual patient’s particular needs and risk factors. However, Dr. Crawford concludes by introducing a demonstration of a transperineal 3D mapping biopsy, suggesting that this may be disruptive technology capable of transforming prostate cancer care.Read More
Posted by E. David Crawford, MD | Nov 2020
In the second part of this urologic debate, E. David Crawford, MD, Editor-in-Chief of Grand Rounds in Urology and Professor of Urology at the University of California, San Diego, argues that while MRI has a role in prostate cancer detection, PSA and other molecular marker tests should be used earlier in sequence. He notes that while many healthcare providers are unhappy with the current state of early detection for prostate cancer, this has less to do with PSA’s merits as a test for determining the relative risk of prostate cancer, and more with a lack of good guidance on how to interpret it. Dr. Crawford argues that all men with a PSA greater than 1.5 should receive further evaluation, first for evidence of benign prostatic hyperplasia, and then for prostate cancer. Other molecular markers can help determine increased risk and help doctors decide whether or not to biopsy, and marker tests like ConfirmMDx can also help if a biopsy is inconclusive. Dr. Crawford concludes by noting that MRI is best used after patients have been biopsied.Read More