Guilherme Godoy, MD, MPH, presented “Decisional Tools to Determine Need for Biopsy and Re-Biopsy in Men with Elevated PSAs” during the 25th Annual Innovations in Urologic Practice on September 25th, 2021, in Santa Fe, New Mexico.
How to cite: Godoy, Guilherme. “Decisional Tools to Determine Need for Biopsy and Re-Biopsy in Men with Elevated PSAs.” September 25th, 2021. Accessed Mar 2024. https://grandroundsinurology.com/decisional-tools-to-determine-need-for-biopsy-and-re-biopsy-in-men-with-elevated-psas/
Decisional Tools to Determine Need for Biopsy and Re-Biopsy in Men with Elevated PSAs – Summary
Guilherme Godoy, MD, MPH, Assistant Professor of Urology and Urology Oncology at Baylor College of Medicine, in Houston, Texas, discusses how and when to use elevated PSA and other markers to determine whether a biopsy is needed. Dr. Godoy cautions that relying solely on an abnormal level for a sensitive biomarker like PSA can lead to false positives and overtreatment, noting that an elevated PSA is an indicator of the prostate but not necessarily of cancer. He reminds physicians to consider the PSA level related to the size of the prostate before jumping ahead to other steps. Dr. Godoy describes how oft-overlooked PSA derivatives in conjunction with family history and other risk factors can be used to individualize risk and personalize assessments for a patient. He then presents an array of current and emerging molecular, genetic, and imaging-based testing options. The 4Kscore assesses the probability of high-risk cancer (Gleason 7 or higher) in the biopsy and informs risk of metastatic disease in 20 years. This test can also indicate risk stratification for mortality. Urine-based tests such as SelectMDx and EPI ExoDx Prostate Intelliscore similarly provide risk stratification for biopsy-naïve men, while tissue-based tests such as ConfirmMDx are useful when a patient has had a previous negative prostate biopsy. He summarizes with a diagram of the clinical integration of MRI and molecular markers illustrating how these testing options should be used.
About The 25th Annual Innovations in Urologic Practice:
Presented by co-chairs Mohit Khera, MD, MBA, MPH, and Michael Coburn, MD, FACS, the Innovations in Urologic Practice conference provides a detailed review and commentary on multiple genitourinary and urologic diseases. Among the featured oncological topics are bladder cancer and immunotherapies, as well as upper tract cancer management, prostate cancer, including state-of-the-art imaging, focal therapy, and MRI. Experts also discuss new tools and techniques for nephrectomy and treating advanced renal cell carcinoma. In terms of general urological approaches, the conference also includes pelvic reconstruction and trauma, men’s health topics like male infertility and sexual dysfunction, and ways to diagnose and treat infections in the urology patient. Dr. Godoy presented this talk at the 2021 conference.
For further educational activities from this conference, visit our collection page.