Early Detection of Prostate Cancer: Navigating the Challenges in 2021

Posted by E. David Crawford, MD | Dec 2021

E. David Crawford, MD, presented “Early Detection of Prostate Cancer: Navigating the Challenges in 2021” during the virtual 5th Global Summit on Precision Diagnosis and Treatment of Prostate Cancer in September 2021.

How to cite: Crawford, E. David. “Early Detection of Prostate Cancer: Navigating the Challenges in 2021.” September 2021. Accessed May 2024. https://grandroundsinurology.com/early-detection-of-prostate-cancer-navigating-the-challenges-in-2021/

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.

The Virtual Global Summit on Precision Diagnosis and Treatment of Prostate Cancer brings together key international opinion leaders of every clinical subspecialty involved in patient care. This event is an integral part of the AdMeTech Foundation’s Annual Summit, which was established in 2016 and became seminal in shaping the state of the art and future vision for precision care. The goal of this event is three-fold: 1) Educating the key stakeholders; 2) Supporting a sustained cross-disciplinary dialogue and consensus on the best emerging clinical practices and research priorities; and 3) Expediting clinical adoption of promising novel diagnostics and therapeutics. For more educational activities from this virtual event, visit our collection page.

About The Author

E. David Crawford, MD

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 and Jack A. Vickers Director of Prostate Research at the University of California, San Diego. 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.

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