What’s being presented at the AUA in May: Part VI


There are five sessions on prostate cancer detection and screening at the annual meeting of the American Urological Association (AUA) this year that include 92 presentations and posters. For each session we have tried to identify at least one of the more interesting posters from the data to be presented.

In the session entitled “Prostate Cancer Detection & Screening I

  • There are a total of 12 oral presentations being, but none of them seem to provide data that would suggest any significant changes to current practice in the detection or screening of prostate cancer.
  • The presentation by Bhindi et al. (abstract no. PD19-07) does indicate a decline in the numbers of patients — even in Canada — being biopsied after the issuance of the USPSTF recommendation about screening for risk of prostate cancer, but (as the authors point out) “Long-term population based studies are needed to assess the repercussions” of this recommendation and whether it will have any significant consequences in terms of things like the incidence and prevalence of advanced and metastatic disease and actual prostate cancer-specific mortality rates.

In the session entitled “Prostate Cancer Detection & Screening II

  • There are numerous posters dealing with the potential of MRI and MRI/TRUS-guided fusion biopsy in the diagnosis of prostate cancer giving a wide variety of different perspectives that range from high potential value (see, for example, Rubin et al., abstract no. MP53-02) to correlated and significant potential risk (see, for example, Le et al., abstract no. MP53-01)

In the session entitled “Prostate Cancer Detection & Screening III

  • A poster by Karnes et al. (abstract no. MP63-03) suggests that as many as 70 to 80 percent of all the biopsies carried out for diagnosis of prostate cancer may be unnecessary if patients and clinicians were encouraged to consider additional PSA testing to gain useful information about PSA trends before a biopsy was actually scheduled. (Notably, this finding correlates closely with one of the five “Golden Rules” proposed not so long ago by Vickers et al.: “Don’t biopsy without a compelling reason.“)
  • The poster by Binette et al. (abstract no. MP36-13) comes to an analogous conclusion!

In the session entitled “Prostate Cancer Detection & Screening IV

  • There are another large group of posters on the roles of multiparametric MRI and MRI/TRUS fusion-guided biopsy in the diagnosis and monitoring of early stage prostate cancer that build on previously reported data in this general area. As just one example, see the poster by Ukimura et al. (abstract no. MP67-07).

In the session entitled “Prostate Cancer Detection & Screening V

  • A poster by Gandaglia et al. (abstract no. MP69-01) explores whether selected patients with limited amounts of Gleason 3 + 4 = 7 disease may be appropriate candidates for management on active surveillance. They conclude that men with limited Gleason 3+ 4 disease on extended biopsy who fulfill all other criteria for active surveillance criteria are not at increased risk of unfavorable disease and biochemical recurrence post-surgery, but they also state that “further studies are needed to test the oncological safety of the inclusion of these patients in active surveillance protocols.”
  • A poster by Tomasini et al. (abstract no. MP69-17) suggests that frequent re-biopsies of men with an initial finding of atypical small acinar proliferation (ASAP) on biopsy may be unnecessary, given the very low likelihood of a finding of Gleason scores of 7 or higher in such patients. Current guidance suggests that all such patients should be re-biopsied within 1 year of the finding of ASAP on an initial biopsy.
  • A poster by Capitanio et al. (abstract no. MP69-18) suggests that it may be possible, based exclusively on the percentage of positive biopsy cores and on Gleason score at diagnosis, to extend the initial application of active surveillance to an additional third of contemporary prostate cancer patients without compromising cancer control in the long term.

 

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