Prostate Cancer Risk Assessment: PSA Test

David Alvara, MD: Hello, nice to meet you Uro View™ Video Series “The Role of Liquid Biomarkers for Early Detection of Prostate Cancer”. I’m Dr. David Albala, Ph.D., Chief of Urology at Crouse Hospital in Syracuse, NY, and Physician at Associated Medical Professionals. One of my former partners, a good friend and colleague, Dr. Jud Mole, a urology oncologist at the Duke Cancer Center in Durham, North Carolina, is participating in this discussion. Today’s discussion discusses the need for risk assessment tools and the availability of liquid biomarkers for early detection of prostate cancer. Dr. Mohr, thank you for your participation. I am honored to meet you again. This will be a wonderfully lively debate as we are talking about the role of biomarkers in prostate cancer.

What is the spread of prostate cancer in the United States to get started and lay a little foundation for some audiences? What are your thoughts on what is the standard treatment for prostate cancer risk assessment? Is it not?

Judd W. Mall, MD: thanks so much. I’m really happy and honored to be with you in this program. Before talking about prostate cancer, we worked together at Duke from 2004 to 2011. It was a pre-risk era, as it is associated with prostate cancer. I remember you and me in the operating room. We performed a large amount of radical prostatectomy in many low-risk men. Things have changed since then. Looking at the past 15 to 20 years for prostate cancer today, the incidence in the United States is as high as 330,000 cases per year, and 200,000 per year when the US Preventive Health Commission issues a PSA. It covered the range up to the case. [prostate-specific antigen] D Test the evaluation. It’s up now. More and more primary care physicians are reusing PSA tests and screenings, as is done in Durham, perhaps as seen in Syracuse. But during the pandemic, and talking about it, it’s everywhere on the map and we’re waiting for how the pandemic affects prostate cancer.

David Alvara, MD: Judd, some simple questions. There are many advantages and disadvantages when talking about prostate screening. When you and I trained, the PSA era came in the late 1980s and 1990s, and the incidence of prostate cancer was 1 in 6 and 1 in 7 men, but still 200,000. More than one person was dead. However, the types of patients we were seeing were declining.When i was in VA [Veterans Affairs Medical Center], We will see many metastatic patients coming. The PSA era really changed that. There was a real pendulum switch, and then patients came in. Obviously, we were treating patients with early illnesses, perhaps much more aggressively than they are today with active surveillance. What are the advantages and disadvantages of screening tests?

Judd W. Mall, MD: First, PSA testing is not gone. Obviously it needs to be improved and we are now using secondary tests many times to fine-tune our decisions before doing a biopsy. However, the PSA test was surprising in that it was a very good basic screening test. PSA has been widely criticized, but I’m not sure if the PSA test was bad. It was a way for healthcare professionals to use tests in groups, or to use information. One of the early major benefits was a reduced incidence of metastatic prostate cancer. This is because it works well to detect metastatic disease when PSA is high. When you and I were training, one in five men usually had metastatic disease.You will remember the days we went to ER [emergency department] And look at the guy who is squeezing the code. It’s a terrible situation. In the PSA era, it dropped to 2% or 3%. That is, only 2% to 3% of men with prostate cancer had metastases. Currently, it is gradually increasing in the era of COVID-19. Let’s see what it looks like. But there is no doubt that PSA has done a great job of reducing metastasis rates. What was lacking in the early stages was that they didn’t really realize that they didn’t have to deal with many small amounts of Gleason 6. We have responded to this as urologists. Indeed, active oversight is accepted among colleagues. There is a better risk assessment. However, the PSA test has saved countless lives overall, so I can’t deny the PSA test. We need to tweak and we have learned how to tweak in the last 30 years.

David Alvara, MD: I fully agree. PSA has contributed significantly to our equipment for detecting prostate cancer. Over the years, we’ve looked at the sum of PSA, PSA velocity, and PSA density and used it in a variety of ways. However, this is not a cancer-specific test, and we recognize that it has its limits as a urologist.

I edited the transcript for clarity.