What is Your Preferred Treatment for mCSPC?
We’re conducting a short one-question poll to determine treatment preferences for mCSPC. If you’re a physician or APP, please respond below. Thank you!
Read More
Talks by E. David Crawford, MD
Early Detection of Prostate Cancer: Navigating the Challenges in 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 the challenges of early detection of prostate cancer (PCa) and recommends a prostate-specific antigen (PSA) cut-off of 1.5 ng/ml. He begins by briefly summarizing different screening guidelines, noting particularly that the United States Preventive Services Task Force (USPSTF) has raised concerns about PCa early detection, asserting that there is too much overtreatment. Dr. Crawford argues, however, that evidence shows that a reduction in PSA screening resulted in a rise in metastatic prostate cancer across the United States. Because most diagnostic testing is completed by family practice physicians who may not understand the nuances of PSA testing, Dr. Crawford recognizes that they 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), PCa, 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 contends that patients do not need to make an informed decision about getting a PSA test, and that PSA testing should be considered as routine as measuring a patient’s weight or cholesterol, especially since more than 70% of men will have a PSA of less than 1.5 and will not require further screening for another 5 to 10 years. He then explains that an abnormal PSA alone should not guide biopsy decisions, though, and suggests that using tests like 4Kscore and SelectMDx in conjunction with MRI can reduce unnecessary biopsies. Dr. Crawford concludes by reiterating the importance of simple messaging to move forward with effective screening and early detection of PCa.
Read MoreGUIDE – A New Initiative For a National Bio Repository
E. David Crawford, MD, Editor-in-Chief of Grand Rounds in Urology and Professor of Urology at the University of California, San Diego, and Matthew O. Leavitt, MD, Chief Executive Officer at PathNet, Inc., present the GUIDE initiative to disrupt current data and bio-specimen collection and streamline the exchange of clinical data. Dr. Crawford offers a vision for integrated data-sharing and then introduces Dr. Leavitt, who describes the process. In order to create personalized treatment plans, Dr. Leavitt reasons that individual patients’ data must be shared between institutions and contends that our current disconnected health systems present a variety of institutional, economic, and data-based barriers to this goal. He then discusses the DDx Foundation, a public non-profit which builds and supports clinical data exchanges that is governed by physicians and supported by allied industry partners. Their aim is to create a network of clinic and hospital bio-repositories that will lead to standardization of patient-informed consent, specimen handling, and data curation. Instead of owning data or specimens, DDx Foundation contractually handles the specimen-data transactions with third parties, and the value of this data is then passed back to the clinical contributors. Dr. Leavitt then walks through the process from consent to data exchange. He describes how utilizing edge computing to capture and analyze patient data at the clinical site instead of in a centralized cloud server creates a more cost-effective method of testing. Once data is collected, it is distributed to a regional tissue data hub automatically and the information is anonymized for data and specimen marketplace and de-identified for future care of the patient. Finally, through regional bio-repositories, data is then shared in a central trust where it can be accessed by researchers across the country for retrospective analysis or clinical trials. Dr. Leavitt concludes by describing the benefits for researchers, clinics, data contributors, and patients.
Read More
Next Generation Imaging in Prostate Cancer – PYLARIFY
E. David Crawford, MD, Editor-in-Chief of Grand Rounds in Urology and Professor of Urology at the University of California, San Diego, explains how next generation imaging (NGI) can benefit prostate cancer patients and improve care, focusing on PYLARIFY PET/CT. He begins by providing some background, defining biochemical failure, noting that conventional imaging has poor sensitivity, and briefly reviewing RADAR I and III guidelines. Dr. Crawford then gives an in-depth summary of the design, patient entry criteria, and results of the CONDOR study on the clinical utility of PYLARIFY PET/CT in patients with biochemical recurrence of prostate cancer and non-informative standard of care baseline imaging. He explains that CONDOR’s primary endpoint was correct localization rate (CLR) of PYLARIFY PET/CT imaging, meaning the percentage of patients with a 1-to-1 correspondence between lesion level localization of ≥1 lesion on PYLARIFY PET/CT imaging and the composite truth standard, and notes that the results far exceeded the 20% baseline for success, with PYLARIFY imaging detecting ≥1 lesion in 59-66% of patients. Dr. Crawford also looks at the secondary endpoint of percentage of patients with a change in intended treatment management due to PYLARIFY PET/CT, observing that 64% of evaluable patients saw a change in management.
Read MoreEarly Diagnosis of Prostate Cancer: A Path Forward
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