Sigrid V. Carlsson, MD, PhD, MPH, and Gerald L. Andriole, Jr., MD, discuss the pros and cons of omitting biopsy in patients with abnormal PSA levels and a negative MRI. While avoiding standard biopsy can mitigate serious complications, the data may not support full confidence in MRI’s detection quality.
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Gary M. Kirsh, MD, discusses the challenges that independent urology practices face from complexities in the constantly-evolving healthcare industry. He then describes the benefits of adopting configurations of independent urology groups in which physicians have equity ownership.
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Sigrid V. Carlsson, MD, PhD, MPH, suggests that, rather than abandoning PSA screening altogether, doctors should focus on patient selection for screening. She provides 5 key considerations for PSA screening, emphasizing risk-stratification and shared decision-making.
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Karim Kader, MD, PhD, explains how controversies have led to the decline of PSA screening, and therefore fewer diagnoses and the presentation of more high-grade disease. He suggests that the use of a prostate genetic score, based on SNPs, can more efficiently guide patient selection.
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R. Jonathan Henderson, MD, argues that the goal of ADT should be to achieve and maintain the lowest levels of T possible in prostate cancer patients. The FDA-recommended target low of 50 ng/dL originates from constraints of outdated technology, and multiple studies indicate that there is a benefit to patients when T-levels fall below 20 ng/dL.
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