Finding a balance in detecting and overdetecting prostate cancers
Also, don't miss Dr. Geo's upcoming free "prostate cancer summit"
By Howard Wolinsky
In an editorial in the Nov. 4 issue of Nature’s Prostate Cancer and Prostatic Diseases, a Johns Hopkins researcher lays out the challenges of PSA (prostate-specific antigen) screening and overdetection of clinically insignificant prostate cancers leading to overtreatment,
Jun Luo, PhD, Alan W. Partin, M.D., Ph.D. Professor in Urology at Johns Hopkins School of Medicine, noted research highlighting “the high prevalence of low-grade, low-volume prostate cancers (~41%), which are unlikely to result in mortality but are detected through PSA screening. There is a consensus that the PSA screening-biopsy-treatment paradigm leads to unnecessary biopsies and overtreatment of prostate cancers.” (The late Dr. Partin was urologist-in-chief at Hopkins.)
(Jun Luo, PhD)
Luo, whose research focuses on prostate cancer biology, genetics/genomics, detection, and treatment, asks: “How can we find the optimal balance to reduce the number of biopsies while ensuring that GG) ≥ 2 cancers are not missed?” His editorial summarizes a series of five papers by leaders in the field that appeared this year in Nature’s Prostate Cancer and Prostatic Diseases,
Luo summarized a series of articles appearing in Nature’s Prostate Cancer and Prostatic Diseases covering these issues.
He said that a variety of biomarkers, including Prostate Health Index (PHI), 4Kscore, MyProstateScore (MPS), SelectMDx, ExoDx Prostate Intelliscore (EPI), and IsoPSA, were developed in hopes of identification of patients with clinically significant cancers (Grade Group 2 and above) while “minimizing unnecessary biopsies, i.e., biopsies that are negative or biopsies detecting GG1 tumors.”
Luo cites researchers who concluded these tests “are clinically useful and could potentially reduce unnecessary biopsies by up to 50% while maintaining a sensitivity of 90–95% for detecting GG ≥ 2 cancer. However, they acknowledged the lack of prospective studies evaluating the impact of these biomarkers on biopsy decisions, particularly when used in conjunction with mpMRI.
Luo stressed that “new biomarkers and imaging modalities must be developed” and the importance of prebiopsy multiparametric magnetic resonance imaging (mpMRI).”
Citing one of the articles in the Nature series, he said micro-ultrasound, contrast-enhanced ultrasound, elastography, multiparametric ultrasound, and PSMA PET/CT are showing promise but more research is needed before incorporating them into practice.
Luo said PSMA PET/CT—not currently recommended for surveillance patients—“presents a potential one-step approach for accurate diagnosis and staging of prostate cancer.”
He also discusses the role of nomograms or algorithms that can help in deciding which patients should be biopsied.
He concluded: “This series highlights the ongoing efforts to improve prostate cancer detection by finding a balance between minimizing unnecessary biopsies and ensuring the detection of significant cancers. Integrating advanced biomarkers, imaging techniques, and risk calculators is a step forward. Further research, especially in diverse populations, is necessary to refine these tools.”
Dr. Geo hosting the free 'Prostate Cancer Summit,' addressing AS, MJ, herbs, diet, prostate massage, sexual health and more
By Howard Wolinsky
Dr. Geo Espinosa (you may know him as the author and podcaster “Dr. Geo,”), the naturopath specializing in prostate care on faculty at New York University, is hosting a free week-long “Prostate Cancer Summit” you shouldn’t miss.
The free event runs starting at 6 p.m. Eastern November 19 - 25, with an “encore weekend” November 29 - December 1, 2024. Register here: https://drtalks.com/summit/prostate-cancer-summit/?uid=814&oid=83&ref=4266
(Dr. Geo)
Geo interviewed about 40 experts on prostate cancer—plus me. The interviews cover a full range of prostate cancer topics.
Speakers include urologist Dr. Stacy Loeb of NYU, on lifestyle; Dr. Sanoj Punnen of the University of Miami, on the value of MRI and biomarkers in diagnosing prostate cancer; Man Up podcaster Justin Dubin, MD, on regaining sexual health after treatment; Donald Abrams, MD, on marijuana’s role in prostate cancer management; Eric Yarnell, ND, on herbs and PCa; and Darryl Mitteldorf, LCSW, founder of Malecare, on finding reliable information on prostate cancer online.
Geo interviewed me about Active Surveillance.
Register here: https://drtalks.com/summit/prostate-cancer-summit/?uid=814&oid=83&ref=4266
Videos will be available for 24 hours, so you can watch at a time that works for you. DrTalks, the platform on which the summit appears, is selling full access.
The program is offering free downloads of e-books on the topics, including Drinks and Prostate Cancer by Geo Espinosa, ND.