Topic: Prevention and Screening

Prostatectomy: What is the Future?

John F. Ward, MD, FACS discusses patient selection in definitive prostate cancer treatment and avoiding over and undertreatment. He then analyzes the impact of the evolving United States Preventive Services Task Force (USPSTF) recommendations for PSA screening on prostate cancer incidence, over and undertreatment, and amount of biopsies performed in urologic practice.

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Update on Prostatectomy Versus Observation Trials

Gerald L. Andriole, MD, who served on the cause of death ascertainment committee for the Prostate Intervention Versus Observation Trials (PIVOT), discusses PIVOT and criticisms to the trial design. Additionally, he analyzes similar trials testing definitive versus non-definitive treatment in low-risk disease.

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Changing Distribution, Size and Grade of Prostate Cancer: Whole-Mount Prostatectomy Analysis

M. Scott Lucia, MD, summarizes the changes in the clinical management of prostate cancer since 1990, specifically regarding PSA screening, active surveillance, targeted focal therapy, and pathology grading practices. Also, he analyzes whole-mount prostatectomy data from the past 16 years that has shown increasingly higher grade and volume tumors. He then discusses whether or not this is exclusively due to patient selection and over-grading.

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Should MRI Be Used to Monitor for AS? Pro Argument

Peter A. Pinto, MD, argues that MRI can help select prostate cancer patients for active surveillance (AS). While MRI has some limitations, with proper application, it can reduce patient and urologist anxiety, repeat biopsies, and amount of cores taken during AS. Subsequently, this will reduce morbidity, bleeding, erectile dysfunction, and infections related to biopses.

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Should MRI Be Used to Monitor for AS? Con Argument

Nelson N. Stone, MD, argues that MRI’s limitations make it insufficient for evaluating and managing prostate cancer patients under consideration for active surveillance (AS) or targeted focal therapy (TFT). Instead, urologists should consider technology like the under-development 3DBiopsy™ system, with a transperineal needle along with mapping software. This approach can detect the precise location of lesions and create a roadmap for treatment planning.

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3DBiopsy™ Transperineal Mapping Biopsy

Nelson N. Stone, MD, Founder and CEO/President of 3DBiopsy™, discusses how his comprehensive system aides in accurately identifying Gleason scores and guiding focal therapy. He and 3DBiopsy™ co-founders, E. David Crawford, MD, and M. Scott Lucia, MD, perform a demonstration of the system’s needle, actuator, pathology carrier, and 3D mapping software.

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Biomarkers for Prostate Cancer: Whom to Treat

Gerald Andriole, MD, discusses the limitations and successes in the design of the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO) and European Randomized Study of Screening for Prostate Cancer (ERSPC) trials. He also emphasizes the importance of patient selection in PSA screening and utilizing other diagnostic methods.

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