Immunotherapy in Prostate Cancer
Sandy Srinivas, MD, delves into the potential and challenges of using immunotherapy as a treatment modality for prostate cancer.
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2024
Precision Diagnostics and Emerging Treatment Strategies
David M. Nanus, MD explores the advancements in diagnostic techniques and novel therapies in prostate cancer care.
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Expectations for Mentorship Among APPs: What Urologists Should Know
Mikel L. Gray, PhD, PNP, FNP, CUNP, CCCN, FAANP, FAAN, provides guidance on how Urologists and APPs can get the most out of mentorships. Dr. Gray begins by reviewing the critical importance of APPs in Urology, and highlighting the AUA’s history of explicit support of APPs in urologic practice.
Dr. Gray then outlines the general experiences of APPs regarding training and fellowship in urology practices, and the lack of available structure for advancement. He outlines the various paths for APPs to enter into practice, and the challenges they represent.
Dr. Gray then turns to the role of the Urologist in mentoring urologic APPs. He explicitly highlights the “4 Cs” that the Mentor Urologist must actively facilitate for a successful mentorship: Connection, Conversation, Community, and Culture.
Dr. Gray concludes by providing guidance on what an APP should actively seek out in a mentor. He underscores the importance of finding the right mix of subspecialty and general urology in a practice, and seeking both Urologist and APP mentors.
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Novel Targeted Treatment and Its Integration with Precision Diagnostics
Daniel P. Petrylak, MD, highlights advanced therapeutic approaches and cutting-edge diagnostic techniques in prostate cancer treatment.
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Update on PROBASE Trial: Baseline PSA in Young Men (Aged 45 and 50)
Peter Albers, MD, provides an update on the ongoing PROBASE trial, which examines the relationship between PSA tests and PCa overdiagnosis. He begins with an overview of the state of PCa screening, noting that there is no current standard practice for using PSA as a screening tool in younger patients.
Dr. Albers shares the background and design of the PROBASE trial, in which more than 46,000 participants were randomized into 2 risk-adapted arms, Immediate Screening and Deferred Screening. The Immediate Screening arm is composed of men who had their PSA levels tested at age 45. The Deferred Screening arm delayed PSA testing until age 50.
After testing, participants in each arm of the trial were classified according to their PSA level. Participants with a PSA level of under 1.5 ng/ml were classified as Low-Risk and only required to repeat testing every 5 years, those with PSA levels between 1.5 and 2.99 ng/ml were considered “Intermediate-Risk” and were required to test every 2 years, and those with PSA levels of 3.0 ng/ml and above were considered “High-Risk” and sent for immediate MRI and biopsy.
Dr. Albers notes that 90% of participants were classified as “Low-Risk,” and have yet to be diagnosed with prostate cancer. In the High-Risk group, 40% were diagnosed with prostate cancer to date.
Dr. Albers concludes by noting that future directions for the study may include investigating the value of MRI, genetic risk factors, the occurrence of other blood/urine-based biomarkers, and other “Smart Screening” mechanisms for early prostate cancer detection. Overall, he notes that the current data supports the hypothesis that PSA testing alone for early detection of prostate cancer creates overdiagnosis with minimal benefit and that risk-adapted screening is effective.
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