E. David Crawford, MD, summarizes talks from the session he moderated on Men’s Prostate Health during the 31st International Prostate Cancer Update in July 2021 in Snowbird, Utah. See below for links to full presentations from the conference as well as related panel discussions.
Read MoreE. 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.
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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.
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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.
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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.
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