Early Diagnosis of Prostate Cancer: A Path Forward

Posted by E. David Crawford, MD | Sep 2021

E. David Crawford, MD, presented “Early Diagnosis of Prostate Cancer: A Path Forward” during the 31st International Prostate Cancer Update in July 2021 in Snowbird, Utah.

How to cite: Crawford, E. David. “Early Diagnosis of Prostate Cancer: A Path Forward.” July 2021. Accessed Apr 2024. https://grandroundsinurology.com/early-diagnosis-of-prostate-cancer-a-path-forward/

Early Diagnosis of Prostate Cancer: A Path Forward – Summary

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.

About The 31st Annual International Prostate Cancer Update:

The International Prostate Cancer Update (IPCU), founded in 1990, is a multi-day CME conference focused on prostate cancer treatment updates with expert, international faculty. It is led by expert physicians and is designed for urologists, medical oncologists, radiation oncologists, and other healthcare professionals involved in the diagnosis and treatment of prostate cancer. Dr. Crawford delivered this educational activity during the 31st iteration of the meeting in July 2021 in Snowbird, Utah.

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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