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Howard Wolinsky's avatar

Martin, I am not sure of the citation. I will ask. Howard

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Martin Gewirtz's avatar

Part I:

1) Re your citation from Dr. Scholz: "Scholz described a recent European study......." could you provide a link to that study, since most recent studies out of Europe and the U.S. conclude that the combined MRI-Targeted and Fusion/Systematic biopsy is more efficacious than an MRI-Target biopsy alone. The overall estimated false negative rate of mpMRI is around 10–20%. I believe that biopsy is the standard of care at Johns Hopkins with a large AS cohort.

2) Dr. Scholz incorrectly refers to the systematic portion of the combination biopsy as "random." It is not.

3) You refer to statistics per the AUA Aqua Database. A recent study, among the authors of which are Cooperberg and Catalona can be found here: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2801916

I cite it because I think patients would benefit from reading the entire study including the section with the header: Limitations. In that section, the authors state "Our definition of AS is intentionally liberal; follow-up with PSA testing alone without subsequent biopsies is not considered adequate AS but has been documented very commonly in community practice," citing a Michigan study.

4) In your article, you refer to the "Oncotype, Polaris and Decipher" tests. In his January 30 webinar, Dr. Scholz advised patients to avoid the Decipher test.

In my opinion, Dr. Scholz's book was groundbreaking and was instrumental in moving the needle on unnecessary over treatment and towards Active Surveillance. There is no doubt about that. However, now, work needs to be done to bridge the divide in the PCa community, as to how to communicate diagnoses of low to favorable-risk cancer to patients. The premise that there are "more prostate snatchers" out there serves to fan the flames of the divide.

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